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Less OR time, costs found with crossed screw vs locking plate fixation for foot arthrodesis

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CHICAGO — Cost and operative time were significantly reduced in patients who underwent hallux rigidus or valgus fixation with crossed screws rather than locking plates, according to data presented here.

“Although locking plate fixation may be biomechanically superior to crossed screw fixation, fusion rates do not reflect this,” Michael G. Sarson, BS, said during his presentation at the American Orthopedic Foot & Ankle Society Annual Meeting.

Sarson and colleagues performed a retrospective review of 40 patients who underwent hallux metatarsophalangeal (MTP) arthrodesis for severe hallux rigidus or valgus using either crossed screw or locking plate fixation. The investigators defined successful fusion as a non-tender, clinically stable joint that demonstrated bridging trabeculae on multiple radiographs. Average follow-up time was 29 months.

An odds ratio analysis was used to compare union rates and time to fusion between the cohorts. AOFAS hallux MTP values were used to evaluate clinical outcomes. The researchers also conducted an implant retail price-based cost analysis.

No statistically significant differences were observed between patient cohorts in union rate, time to fusion or average AOFAS hallux MTP values. “Union occurred in 85% of patients in the crossed screw group, and in 80% of patients in the locking plate group. Time to fusion in the crossed screw group averaged 48 days compared to 52 days in the locking plate group,” the investigators wrote in their study. The average AOFAS hallux MTP scores for the crossed screw and locking plat groups were 81 in and 79, respectively.

However, significant differences were observed in operative costs ($950 vs. $3,043) and operative time (1.23 hours vs. 1.73 hours) in the crossed screw and locking plate groups, respectively, according to Sarson.

“Additional studies may be needed to clarify which specific patient populations most benefit from the crossed screw fixation,” Sarson said. — by Christian Ingram

Reference:

Sarson MG. Paper #1.3. Presented at: the American Orthopedic Foot & Ankle Society Annual Meeting; Sept. 21-23, 2014; Chicago.

Disclosure: Sarson has no relevant financial disclosures.