Comparison of 4 different techniques in first metatarsophalangeal joint arthrodesis

  • Farshid Maleki
  • Ashwanth Ramesh
  • Adrian J. Cassar-GheitiEmail author
  • Ciara Fox
  • Paula Kelly
  • Michael M. Stephens
  • Johnny V. McKenna
Original Article



The aim of this study was to evaluate outcomes and fusion rates of 4 different methods of first metatarsophalangeal joint (MTPJ) arthrodesis.


We performed a retrospective analysis of first MTPJ fusion using Bold® and Acutrak® compression screws, universal 1/3 tubular plate and Hallu®-S non-locking plate in 6 hospitals in Dublin over 4 years. A cohort of 300 patients (351 feet) was operated on by 3 feet and ankle fellowship trained orthopaedic surgeons (PK, MMS, JVMcK) over 4 years. Mean age was 62.4 years. There were 261 females and 39 males. One hundred three patients had a fusion of first MTPJ using two Acutrak® screws and 90 with two Bold® screws. Sixty-five were fused with the Hallu-S® plate and 42 with the universal 1/3 tubular plate. Patients were evaluated clinically and radiographically at 6 weeks, 3 months and 12 months.


Functional outcome scores performed using Manchester-Oxford Foot Questionnaire (MOXFQ). Failure rate in those fused with the Hallu®-S plate was 0%, Acutrak® screws 2.4%, Bold® screws 9.5% and universal 1/3 tubular plate 12.5% (p > 0.12). All treatment groups demonstrated significantly reduced MOXFQ scores (p value < 0.05).


In this retrospective study for first MTPJ fusion, a low profile, pre-contoured plate in combination with a screw mode had the best results with no failure rates and improved MOXFQ scores.

Level of clinical evidence: IV, retrospective study.


Fusion Metatarsophalangeal joint Osteoarthritis 


Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This is a retrospective study formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Orthopaedic DepartmentSt. James’s HospitalDublinIreland
  2. 2.Orthopaedic DepartmentTallaght University HospitalDublinIreland
  3. 3.Orthopaedic DepartmentCappagh National Orthopaedic HospitalDublinIreland

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