Abstract
Individual optimized positioning of arthrodesis of the first metatarsophalangeal joint (fusion of MTP1 joint) as well as presumable shortage of the first ray using precalculated osteotomies often unpredictable. Preparation of accurately fitting broad contact surfaces for MTP1 joint fusion with maximum flexibility of intraoperative decision-making for an optimized position. ADVANTAGES OF THE INSTRUMENTS: Semi-open or open systems of motor powered Cup & Cone reamers allow removal of remaining cartilage intended for MTP1 joint fusion with checkable shortage of the first ray, creation of exactly congruent concave-convex surfaces for an optimized position of MTP1 joint fusion. Medial longitudinal incision for exposure of MTP1 joint. Removal of osteoarthrophytes, cartilage, and sclerotic bone from the first metatarsal head and the base of proximal phalanx, using a motorized Cup & Cone reamer set over axially directed guide wires to cancellous bone. Provisional positioning of the fragments in an optimized position. Clinical and fluoroscopic control. Definite internal fixation using a plantar lag screw and superelastic bone staples or a locking-plate system. Allows the surgeon to prepare congruent and broad metatarsal and phalangeal cancellous bone surfaces for an optimized position of MTP1 joint fusion. Reamer-induced thermal damage and osteonecrosis were not encountered.
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