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Wout Füssenich, Gesine H Seeber, Julian R Zwoferink, Matthijs P Somford, and Martin Stevens


  • A systematic review to determine the effect of different types of joint preparation, joint fixation, and postoperative weight-bearing protocols on non-union frequency in first metatarsophalangeal joint (MTPJ) arthrodesis in patients with moderate-to-severe hallux valgus.

Material and methods

  • A systematic literature search (PubMed and EMBASE), adhering to PRISMA guidelines. Data on MTPJ preparation, fixation, weight-bearing, and non-union in patients with moderate-to-severe hallux valgus were collected. Quality assessment was performed using the Coleman Methodology Score.


  • Sixteen studies (934 feet) were included, generally of medium quality. Overall non-union rate was 7.7%. At 6.3%, convex/concave joint preparation had the lowest non-union rate vs 12.2% for hand instruments and 22.2% for planar cuts. Non-union of 2.8% was found for joint fixation with a plate combined with a lag screw vs 6.5% for plate fixation, 11.1% for crossed screw fixation, and 12.5% for a plate with a cross plate compression screw. A 5.1% non-union frequency was found following postoperative full weight-bearing on a flat shoe vs 9.3% for full weight-bearing on a heel weight-bearing shoe and 0% for a partial weight-bearing regimen.


  • Based on medium-quality papers, joint preparation with convex/concave reamers and joint fixation with a plate using a lag screw show the lowest non-union rate. Full postoperative weight-bearing in a stiff-soled postoperative shoe is safe and not associated with non-union vs a more protective load-bearing regimen. Further research should focus on larger sample sizes, longer follow-ups, and stronger study designs.

Xavier Crevoisier, Mathieu Assal, and Katarina Stanekova

. 3 ). In some cases (rheumatoid arthritis, osteo-arthritic MTP1, elderly patient, etc.), a MTP1 fusion may be the best choice. The juvenile hallux valgus, which includes a congruent first MTP and a pathological DMAA ( Fig. 4 ), requires not only the

Hans-Jörg Trnka

cases. Second generation MIS Bösch et al 17 presented their preliminary results with the SCOT (Subcapital Metatarsal First Osteotomy) technique. The average follow-up was 16 months (range 8–32 months). Range of motion of the MTP-1 joint

Lorenz Pisecky, Matthias Luger, Antonio Klasan, Tobias Gotterbarm, Matthias C. Klotz, and Rainer Hochgatterer

in a 48-year-old male five years after MTP-1 (first metatarsal-phalangeal) arthrodesis with a titanium screw (a, left). Solution with two cortical screws three months after revision surgery (b, right). Conclusion Bioresorbable and

Halah Kutaish, Antoine Acker, Lisca Drittenbass, Richard Stern, and Mathieu Assal

construct ( Fig. 5 f ). An additional K-wire is inserted through the first metatarsophalangeal joint (MTP1), in order to force the joint into plantar flexion. This relieves the soft tissue tension at the level of the plantar entry point of the bolt. K

Xue Ling Chong, Lisca Drittenbass, Victor Dubois-Ferriere, and Mathieu Assal

of the shaft or the diaphysis. Salvage procedure with the use of a Lapidus procedure has been shown to be a sound option as it confers a predictable outcome as published by Coetzee et al. ( 38 ). MTP1J fusion is also an option if there are signs