Evaluation of different shape-memory staple configurations against crossed screws for first metatarsophalangeal joint arthrodesis: A biomechanical study. Issue 3 (June 2018) - Willmott, H.
Highlights: This is the first study to describe the use of staples in an oblique configuration for first MTPJ arthrodesis. We have demonstrated that arthrodeses fixed in this manner are stiffer and stronger than those fixed with staples in the traditional configuration. 45–135° staples have less inter-specimen variation and are more reproducible than crossed screws in first MTPJ arthrodesis. Abstract: Background: The first metatarsophalangeal joint may be fused in order to treat arthritis or instability. The use of shape-memory staples for fixation is well recognised, but little work has been done into the optimal configuration of staples. Methods: The structural behaviour of first metatarsophalangeal joint (MTPJ) arthrodeses using shape-memory staples or crossed screws was studied using cadaveric porcine joints. Five fixation configurations were tested: single vertical or horizontal staple, paired staples in dorsal‐medial configuration (0–90° to the sagittal plane), paired staples in oblique orthogonal configuration (45–135°); or two crossed screws. Specimens were loaded in cyclical dorsiflexion for 1000 cycles. Plantar gapping and shearing were measured. Specimens were then loaded to failure. Results: Cyclic testing caused more shear in the 45–135° staples than the crossed screws (1.0 mm ± 0.5 mm compared to 0.14 mm ± 0.4 mm, p < 0.01). No significant difference was found in plantar gap formation. Single vertical and horizontal single staples failed at 15N and 19. Conclusions: N, respectively. Paired 0–90° staples failed at 43 N ± 9 N, significantly lower than the 45–135° staples (141 N ± 25 N; p < 0.001) and crossed screws (180 N ± 67 N; p < 0.001). There was no significant difference between the 45–135° staples and crossed screws. Screws failed by sudden cortical fracture; staples displayed gradual pull‐out and shearing. First MTPJ arthrodeses fixed with single staples are not recommended. Arthrodeses fixed with staples at 0–90° to the sagittal plane were significantly less strong than two crossed screws. However, positioning oblique staples at 45–135° significantly improved stability, creating a construct as strong as, crossed screws. None of the constructs was strong enough for immediate weight bearing.