Locked Dorsal Compression Plate Arthrodesis for Degenerative Arthritis

of the Midfoot

Christopher B. Hirose M.D. Wesley F. Flint MD

Michael J. Coughlin MD

Boise, Idaho

Disclosure

Locked Dorsal Compression Plate Arthrodesis for Degenerative Arthritis of the Midfoot

Dr. Hirose is a consultant for Arthrex

Dr. Flint: No conflicts to disclose Dr. Coughlin is a consultant for Arthrex, Stryker, Integra

We received no financial assistance for this study

The Lack of Popularity of Midfoot Arthritis Surgical

Treatment

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!•  Midfoot  arthrodesis  remains  a  technical  challenge  

•  The  relative  small  number  of  publications  re7lect  its  unpopularity  

•  Multiple  techniques  have  been  reported,  re7lecting  the  dif7iculty  of  achieving  a  good  result  

Midfoot Arthrodesis Current Status

•  No consensus on preferred approach …

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•  No consensus on methods of fixation…

•  No consensus on bone grafting…

Midfoot Arthrodesis With A Locked Dorsal Compression Plate

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!The  purpose  of  this  study  is  to  describe  the  results  of  a  dorsal  7ixed-­‐angle  locking  compression  plate  in  the  setting  of  multiple-­‐joint  midfoot  arthrodeses      

Methods

• Retrospective  study    

• 62  consecutive  patients  who  underwent  midfoot  arthrodeses  from  June  2009  to  May  2016  

• A  total  of  184  joints  were  spanned  by  dorsal  7ixed  angle  locking  compression  plates  

• Patients  were  followed  for  one  year    6

Methods

• Locked  plates  – Either  unilaterally  or  bilaterally  

• Static  dorsal  compression  

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Angular locking

Extended Statically Compressed

Methods

• Radiographs  were  read  by  two  fellowship-­‐trained  surgeons  to  determine  the  time  to  fusion  

• If  union  was  indeterminate,  a  computed  tomography  scan  was  obtained,  with  the  presence  of  50%  or  greater  bridging  bone  as  the  de7inition  of  fusion  

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Results    

• 156/184  fused  (83%)  

• Average  time  to  fusion  was  19.6  weeks  

• Complications  included  persistent  numbness  (10),  wound  infection  (2),  and  deep  venous  thrombus  (1)  

• Average  VAS  score  diminished  from  5.9  to  1.7    

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Conclusion  

 • Dorsal fixed angle locking compression plate

• Fusion rates not any better, and comparable with the existing literature

•  The results indicate room for improvement

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Conclusion: Methods for Improved Results

 

 

• Design of advanced plating systems

• Uniform joint compression • Biologic augmentation

• Increased joint surface area

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References

Baxter JR, Mani SB, Chan JY, Vulcano E, Ellis SJ. Crossed-screws provide greater tarsometatarsal fusion stability compared to compression plates. Foot Ankle Spec 2015 Apr;8(2):95-100.

Cottom JM, Rigby RB. Biomechanical comparison of a locking plate with intraplate compression screw versus locking plate with plantar interfragmentary screw for Lapidus arthrodesis: a cadaveric study. J Foot Ankle Surg. 2013 May-Jun;52(3):339-42.

Cottom JM, Vora AM. Fixation of lapidus arthrodesis with a plantar interfragmentary screw and medial locking plate: a report of 88 cases. J Foot Ankle Surg. 2013 Jul-Aug;52(4):465-9.

Filippi J, Myerson MS,, Scioli MW, Den Hartog BD, Kay DB, Bennett GL, Stephenson KA. Midfoot arthrodesis following multi-joint stabilization with a novel hybrid plating system. Foot Ankle Int 2012 Mar;33(3):220-5

Johnson JE, Johnson KA. Dowel arthrodesis for degenerative arthritis of the tarsometatarsal (Lisfranc) joints. Foot Ankle 1986 Apr;6(5):243-53.

Klein SE, Putnam RM, McCormick JJ, Johnson JE. The slot graft technique for foot and ankle arthrodesis in a high-risk patient group. Foot Ankle Int 2011 Jul;32(7):686-92.

Mann RA, Prieskorn D, Sobel M. Midtarsal and tarsometatarsal arthrodesis for primary degenerative osteoarthrosis or osteoarthrosis after trauma. J Bone Joint Surg Am 1996 Sep;78(9):1376-85.

Withey CJ, Murphy AL, Horner R. Tarsometatarsal joint arthrodesis with trephine joint resection and dowel calcaneal bone graft J Foot Ankle Surg. 2014 Mar-Apr;53(2):243-7.

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