Biomechanics of common fixation devices for first tarsometatarsal joint fusion—a comparative study with synthetic bones

• Main Authors: Rene Burchard, Robin Massa, Christian Soost, Wolfgang Richter, Gerhard Dietrich, Arne Ohrndorf, Hans-Jürgen Christ, Claus-Peter Fritzen, Jan Adriaan Graw, Jan Schmitt
• Format: Article
• Language: English
• Published: BMC 2018-07-01
• Series: Journal of Orthopaedic Surgery and Research
• Subjects: Lapidus fusion; Angle stable; Locking plate; Intramedullary fixation device; Hallux valgus
• Online Access: http://link.springer.com/article/10.1186/s13018-018-0876-0

Abstract Background 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. 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. Methods Biomechanical 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. Results Fixation 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. Conclusion The 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.