Creative cutting to contour and correct Hallux bone graft for three planes of correction

Abstract

Revision surgery for failed hallux rigidus or valgus is fraught because of bone loss at the first metatarsophalangeal (MTP) joint. This may be related to infection or rheumatoid arthritis-related destruction, however in most cases this is iatrogenic, as a direct result of previous hallux valgus or hallux rigidus surgery. A first MTP joint arthrodesis is often the method of choice to salvage this situation and improve a patient’s symptoms. If there is minimal bone loss a standard first MTP joint fusion can be undertaken, as slight shortening creates only minimal cosmetic concerns and functional loss. Significant bone loss and shortening however, will lead to a cosmetic deformity and also defunction the first ray. Interpositional bone grafts are used to fill the defect and maintain length. The use of single conical reaming of structural allografts has been shown to permit more degrees of freedom for toe positioning, it is reproducible, with high rates of fusion [1–3]. Interpositional tricortical iliac crest grafts have also been shown to effective in subtalar arthrodesis for the management of late pain and deformity after calcaneal fractures [4]. We outline a novel and simple method of double conical reaming of bone autograft to allow for greater flexibility in positioning of the toe which provides an increased surface area, leading to better apposition compared with previously described methods.