![Page 1: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/1.jpg)
Hallux Rigidus:1st MTP Fusion Technique
What is the best construct ?
![Page 2: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/2.jpg)
Disclosure• Consultant for:
• Extremity Medical
• Osteomed
• Crossroad
• Exactech
• BESPA Global
• Reviewer for :
• JBJS American
• JAAOS
• Foot Ankle International
Disclosure
![Page 3: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/3.jpg)
The Problem
![Page 4: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/4.jpg)
The Solution
![Page 5: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/5.jpg)
The Approach
![Page 6: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/6.jpg)
Approach
• Release all capsular attachments to metatarsal
• Collateral ligaments
• Sesamoid ligaments
• Plantar plate
• Allow surgeon freedom to place toe where desired
![Page 7: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/7.jpg)
Joint Preparation: powered
• Avoid soft tissue
• Must use guide wire
• Guide wire must be centered
![Page 8: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/8.jpg)
Joint Preparation: Manual
• Manual debridement
• Rongeur head to cancellous bone
• Shape to desired configuration
• Remove cartilage & osteoophytesfrom phalanx
![Page 9: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/9.jpg)
Joint Preparation: Manual
• Wash out debris
• Fenestrate subchondral bone phalanx with 2.0 drill
• Lateral only to protect lag screw purchase
• Leave reaming as graft filler
![Page 10: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/10.jpg)
Joint Positioning• Fusion position unique to
individual
• Set so that phalangeal head off ground when standing
• Leave in slight valgus to maintain toe alignment
• Provisional fix with K wire
• The bone is deformed from normal anatomy.
• An anatomic plate will not pick correct position
![Page 11: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/11.jpg)
1st MTP Fixation
• Screws Screws and Plate
![Page 12: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/12.jpg)
Issues with Bony Fixation• Driven by anatomy and forces acting on the anatomy
• Implant choice impacts healing stability and post op course
• Cost of implant also plays role
![Page 13: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/13.jpg)
Cross Screw Fixation: 4-6 weeks NWB
![Page 14: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/14.jpg)
Plate and screws: immediate WBRecommend added plantar lag screw to reinforce plate
![Page 15: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/15.jpg)
Technique tip• Be careful of compression holes in plate
• Leave position wire in place if you can
![Page 16: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/16.jpg)
Technique tip: plate
• For best fit contour dorsal bone surface to fit chosen plate
• Nearly all plates will need bending to get anatomy correct
• Prebent plates are for normal anatomy and will rarely be correct
![Page 17: Hallux Rigidus: 1st MTP Fusion Technique 1st mpj... · Microsoft PowerPoint - FAAST 1st mpj fusion talk 1500_1 Author: cbilling Created Date: 7/24/2020 4:28:17 PM](https://reader035.vdocuments.site/reader035/viewer/2022070913/5fb4b59732546432782a91ad/html5/thumbnails/17.jpg)
Post op Protocol
• Place in weight bearing cast
• Ankle dorsiflexed
• Cast beyond toes to prevent weight bearing past metatarsal heads
• Short removeable boot at two weeks
• Shoe wear as comfort allows