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

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.