Abstract
BackgroundHallux valgus disease is a common deformity of the forefoot. There are currently more than 100 surgical approaches for operative treatment. Because hypermobility of the first tarsometatarsal joint is considered to be causal for hallux valgus disease, fusion of the tarsometatarsal joint is an upcoming surgical procedure. Despite the development of new and increasingly stable fixation devices like different locking plates, malunion rates have been reported in 5 to 15% of cases.MethodsBiomechanical comparison of three commonly used fixation devices (a dorsal locking plate, a plantar locking plate, and an intramedullary fixation device) was performed by weight-bearing simulation tests on synthetic bones. Initial compression force and stiffness during simulation of postoperative weight-bearing were analysed.ResultsFixation of the first tarsometatarsal joint with the plantar plate combination demonstrated a higher stiffness compared to fixation with the intramedullary implant or the medial locking plate. The intramedullary device provided the highest initial compression force. Failure was detected in the following ranking: (1) the angle-stable intramedullary fixation device, (2) the medial located plate, and (3) the plantar locking plate.ConclusionThe intramedullary device demonstrated the highest initial compression force of the three tested implants. The plantar locking plate showed the best overall stability during weight-bearing simulation. Further clinical research is necessary to analyse if the intramedullary fixation device needs a longer period of non-weight-bearing to reach a better non-union rate compared to the plantar locking plate.
Highlights
Hallux valgus disease is a common deformity of the forefoot
Hypermobility of the first tarsometatarsal joint is considered to be causal for hallux valgus disease [1]
Compression forces between the different synthetic bones were measured after the osteosynthesis was performed
Summary
Hallux valgus disease is a common deformity of the forefoot. There are currently more than 100 surgical approaches for operative treatment. Because hypermobility of the first tarsometatarsal joint is considered to be causal for hallux valgus disease, fusion of the tarsometatarsal joint is an upcoming surgical procedure. Hallux valgus disease is a very common deformity of the forefoot and was first described by Carl Hueter in 1870 [1, 2]. It is defined by a lateral deviation of the great toe and a medial deviation of the first metatarsal bone [1]. Fusion of the first tarsometatarsal joint is an upcoming surgical procedure in the treatment of hallux valgus deformity [5]. The so-called Lapidus procedure, as a combined fusion of the first tarsometatarsal joint and the medial and intermediate cuneiform bones, often performed as a classical fixation with two crossed screws, has been described as a standard
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