What question did this study set out to answer?

The aim is to compare clinical outcomes and costs related to different fixation strategies in metatarsophalangeal joint arthrodesis.

April 12, 2026Open Access

Single lag-screw–augmented dorsal plating yields superior union and lower costs in first metatarsophalangeal arthrodesis

Key Points

The aim is to compare clinical outcomes and costs related to different fixation strategies in metatarsophalangeal joint arthrodesis.
Retrospective analysis of 99 patients undergoing first MTP joint arthrodesis.
Patients categorized into three groups based on fixation strategy: dorsal plate only, plate with 1 lag screw, and plate with 2 lag screws.
Evaluated outcomes included union rates, revision rates, functional scores, and treatment costs.
Group 1 had lower union rates (88.9%) compared to Groups 2 and 3 (100% each).
Mean time to union was significantly longer in Group 1 (75 days) versus Groups 2 and 3 (approximately 65.8 and 62 days, respectively).
Revision surgery occurred only in Group 1 (11.1%).
Functional scores (AOFAS) were higher in screw-augmented groups.
Group 2 was identified as the most cost-effective option.

Abstract

Objective: This study aimed to compare clinical outcomes and total treatment costs of 3 fixation strategies—isolated dorsal plating, dorsal plating with a single lag screw, and dorsal plating with dual lag screws—in patients undergoing first metatarsophalangeal (MTP) joint arthrodesis for advanced hallux rigidus. Methods: This retrospective study included 99 patients who underwent primary first MTP joint arthrodesis between 2019 and 2024. Patients were categorized into Group 1 (dorsal plate only; n = 27), Group 2 (plate + 1 lag screw; n = 42), and Group 3 (plate + 2 lag screws; n = 30). Demographic variables, radiographic union, revision rates, functional outcomes (American Orthopaedic Foot and Ankle Society AOFAS, Visual Analog Scale VAS, Foot Function Index FFI), and total 12-month treatment costs were evaluated. The primary outcome measures were union rate, time to union, revision surgery, functional scores, and cumulative cost. Results: Group 1 demonstrated significantly lower union rates compared with Groups 2 and 3 (88. 9% vs. 100% for both; P =. 027) and a longer mean time to union (75 days vs. 65. 8 and 62 days, respectively; P =. 001). Revision surgery was required only in Group 1 (11. 1%). The AOFAS scores were significantly higher in the screw-augmented groups (P =. 013), while VAS and FFI scores showed no between-group differences. Cost analysis identified Group 2 as the most cost-effective strategy (9500 ± 1100 TL ≈ 310 ± 36), compared with Group 1 (11 200 ± 1400 TL ≈ 365 ± 46, P =. 021) and Group 3 (11 600 ± 1300 TL ≈ 378 ± 42, P =. 038). Conclusion: Single lag-screw augmentation of dorsal plate fixation provides superior union, fewer revisions, improved functional scores, and the lowest overall 12-month cost. These findings support dorsal plating with a single lag screw as a practical, value-based fixation strategy for advanced hallux rigidus, offering optimal clinical and economic outcomes. Cite this article as: Kazez M, Batur ÖC, Önce G, Kürüm H, Kaya O, Yalın M. Single lag-screw–augmented dorsal plating yields superior union and lower costs in first metatarsophalangeal arthrodesis. Acta Orthop Traumatol Turc. , 2026; 60 (2), 0417, doi: 10. 5152/j. aott. 2025. 25417.

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Cite This Study

Kazez et al. (Wed,) studied this question.

synapsesocial.com/papers/69db361c4fe01fead37c452b https://doi.org/https://doi.org/10.5152/j.aott.2026.25417

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