Arthrodesis of the Second and Third Tarsometatarsal Joints: Comparison of Radiological and Clinical Results Using Combined or Individual Plating Techniques

Several techniques for arthrodesis of tarsometatarsal joints have been described.These include percutaneous wires, staples, screws in isolation, plates in isolation, and so-called "hybrid" constructs with a separate lag screw and plate construct.10 We are not aware of any publications of outcomes focussing specifically on the combined fusion of the second and TMTJ.At our center, two techniques have been used for arthrodesis of adjacent tarsometatarsal joints.Either a single "H-shaped" plate (Stryker Anchorage Lisfranc plate) where both second and third TMTJs are fused using a single plate covering both joints (combined plating) or dual plates are used (Stryker Utility or Orthosolutions general Level of evidence: Level III-a retrospective cohort study. BackgroundOsteoarthritis is a common chronic degenerative disease of joints.It affects approximately 10% of men and 18% of women over 60 years of age. 1 The prevalence of osteoarthritis affecting the foot is under-reported compared to joints such as the knee and the hand. 2 Recent estimates put the prevalence of symptomatic and radiographic midfoot osteoarthritis at 16.7%, with often more than one joint affected.The prevalence of osteoarthritis at the second tarsometatarsal joint (TMTJ) specifically is between 5.7 and 7.8%.3 Osteoarthritis of the tarsometatarsal joints causes pain (P), aching, and stiffness of the feet.These symptoms result in reduced physical and social function for patients.4,5 There are socioeconomic implications of foot osteoarthritis owing to increased primary care consultations and a reduction in employment.3,6 Nonsurgical management of TMTJ osteoarthritis includes analgesia, steroid injections, and orthotics.Surgical management usually involves arthrodesis of the affected joints.Surgery is effective at reducing pain and improving function for patients, with patient satisfaction rates of up to 90%.7,8 Reported complications of arthrodesis include infection, wound breakdown, nonunion, malunion, metalwork irritation, complex regional pain syndrome, and metatarsalgia.The rate of nonunion following TMTJ arthrodesis is reported to be approximately 11%.