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A Novel Technique of Hallux Metatarsophalangeal Arthrodesis Using Intramedullary Fixation

Maloof, Paul MD*; Lin, Sheldon MD*; Berberian, Wayne MD*; Donley, Brian G. MD

Techniques in Foot & Ankle Surgery: June 2011 - Volume 10 - Issue 2 - p 87–91
doi: 10.1097/BTF.0b013e31821a2b1e

Arthrosis of the hallux metatarsophalangeal (MTP) joint and its various treatment strategies has been well described in the literature. Numerous options exist for both nonoperative and surgical management. Arthrodesis of the first MTP joint is a reliable, validated procedure that when performed correctly can produce excellent results with high patient satisfaction. Patients tolerate greater weight bearing on the hallux after MTP fusion and do not show observable differences in gait. Indications for fusion include hallux rigidus, severe hallux valgus, failed hallux valgus correction surgery, failed silicon implantation, previous septic arthritis, osteoarthritis, rheumatoid arthritis, and neuromuscular disorders. Various techniques have been described earlier for arthrodesis of the first MTP joint. These techniques include percutaneous pinning, screw fixation using a crossed construct, plate fixation, external fixation, Herbert screw fixation, parallel screws, and combinations thereof. Joint surface preparation has been described using flat cuts, a notch-and-tongue configuration, and most recently spherical ball and cup-type cuts using reamers to create surfaces which allow the surgeon to “dial in” the correct position of arthrodesis. Arthrodesis using internal fixation has become the gold standard for surgical treatment of end-stage MTP arthritis with the reported rates of fusion of greater than 95% common. Fortunately, nonunions are often fibrous and result in a painless outcome. Until now, all types of described fixation used for hallux MTP arthrodesis have been a variation of percutaneous or open screw fixation with or without the use of a dorsally applied plate. Recently, a new method of intramedullary fixation using the HalluX system (Extremity Medical, Parsippany, NJ) has been developed. On the basis of the widely accepted mechanical and biological advantages of intramedullary fixation, this technique provides significant advantages over traditional fixation options.

*UMDNJ-New Jersery Medical School, Department of Orthopaedic Surgery, North Jersey Orthopaedic Institute, Newark, NJ

Center for Foot and Ankle, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH

Brian Donley is a paid consultant for Extremity Medical and receives royalties and has equity with the company.

Address correspondence and reprint requests to: Brian G. Donley, MD, Center for Foot and Ankle, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH 4419. e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.