Incidence of nonunion of first metatarsophalangeal joint arthrodesis for severe hallux valgus using crossed, flexible titanium intramedullary nails and a dorsal static staple with immediate weightbearing in female patients.

Myriad forms of fixation have been proposed for arthrodesis of the first metatarsophalangeal joint (MTPJ). Regardless of fixation type, nonunion of the arthrodesis site has been purported as a common complication. The authors performed a retrospective analysis of all patients undergoing arthrodesis of the first MTPJ for severe hallux valgus with 2 crossed, flexible titanium intramedullary nails and a dorsal static 10-mm titanium staple followed by immediate protected weightbearing. Patients were included if they had: surgery for severe hallux valgus of the first MTPJ; undergone the exact internal fixation technique described; not undergone bilateral surgery in the same setting; weightbearing preoperative radiographs; at least 6-week postoperative weightbearing radiographs; initiated weightbearing on the operative foot immediately postoperative in a protective shoe; been followed up clinically for at least 6 months' time postoperatively; and documentation of any complications. One hundred fifty-six female patients (195 feet) with a mean age of 67 ± 9.3 years met the inclusion criteria. Complications due to technical error during insertion of the crossed, flexibe titanium intramedullary nails occurred in 22 (11.3%) feet, but none led to revision surgery. There were 5 (2.6%) asymptomatic nonunions and 1 (0.5%) delayed union, but this ultimately united. The incidence of nonunion after arthrodesis of the first MTPJ using the specific internal fixation construct presented here for severe hallux valgus is lower than the historic mean for most other fixation techniques. However, there is still a need for methodologically sound prospective cohort studies that compare the technique presented here with other modern osteosynthesis techniques.