SLR - October 2011 - Jared M. Maker
Reference: Hunt KJ, Ellington JK, Anderson RB, Cohen BE, Davis WH, Jones CP. (2011). Locked Versus Nonlocked Plate Fixation For Hallux MTP Arthrodesis. Foot and Ankle International, 32(7), 704-709.
Scientific Literature Review
Reviewed by: Jared M. Maker, DPM
Residency Program: The Western Pennsylvania Hospital, Pittsburgh, PA
Podiatric Relevance:
Plate fixation for first metatarsophalangeal joint (MTP) arthrodesis procedures is used commonly. Plates provide increased strength and rigidity across the arthrodesis site, allowing early weightbearing with the potential for higher union rates. This article compares radiographic and clinical outcomes of patients that underwent a first MTP arthrodesis with a compression screw and titanium locking plate vs. a compression screw and stainless steel nonlocking plate.
Methods:
Retrospective evaluation was performed of consecutive patients undergoing a first MTP arthrodesis with either a locking titanium plate (Group 1) or a nonlocking stainless steel plate (Group 2). Patients had undergone the procedure for a variety of diagnoses. Analysis included radiographs, visual analog pain scale, American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and a patient satisfaction survey.
Results:
A total of 73 feet were evaluated with the locking titanium plate (Group 1) and 107 feet with the nonlocking stainless steel plate (Group 2). A higher nonunion rate was seen in Group 1 (22.8%) as compared to Group 2 (11.4%). When patients with rheumatoid arthritis (RA) were removed from analysis Group 2 had a much higher union rate (93.1%) when compared to Group 1 (78.8%). Non-union rate was also much lower in group 2 (6.9%) compared to group 1 (21.2%) in non-RA patients. Complication rates, AOFAS scores, number of patients reporting improved physical activity, and patient satisfaction was equivalent between the two groups. VAS score improved by 48.8 pts in group 1 and 53.7 pts in Group 2.
Conclusions:
This retrospective study found an increased nonunion rate in patients receiving a first MTP arthrodesis with a titanium locking plate vs. a traditional stainless steel plate. A possible explanation by the authors for the lower union rate in Group 1 was a decreased ability to obtain adequate interfragmentary compression with the locked plate design, which is crucial to achieve arthrodesis. Another explanation is the possibility of inferior rigidity of the titanium plate in comparison to the stainless steel plate. Limitations include unknown difference in the plate rigidity between stainless steel and titanium. The authors also allowed early heel weightbearing as compared to previously reported fixation methods of crossed screws where there is prolonged nonweightbearing.