«Técnica simple para posicionar la primera articulación metatarsofalange durante la artrodesis.
Thomas S. Roukis DPM1, , , FACFAS
Proper alignment of the first metatarsophalangeal joint during arthrodesis, regardless of what form of fixation is used, is essential to avoid complications. Excessive extension of the hallux will result in a hallux malleus contracture; excessive flexion will result in extension at the hallux interphalangeal joint (1, 2, 3, 4, 5 and 6). Excessive valgus alignment of the hallux will result in abutment with the second toe and the potential for interdigital clavi or development of the crossover second toe deformity (1, 2, 3, 4, 5 and 6). Excessive varus alignment will result in shoe gearrelated irritation and the potential for incurvation deformity of the tibial border of the hallux toenail (1, 2, 3, 4, 5 and 6). Although there are a number of different techniques used to allow for accurate positioning of the hallux at the time of arthrodesis (1, 2, 3, 4, 5, 6, 7, 8, 9 and 10) the author has found that placing a once-folded 4- × 4-in gauze sponge between the hallux and second toes allows for accurate transverse plane alignment. Similarly, after the foot has been placed against a sterile instrument tray cover, placing a twice-folded 4- × 4-in gauze sponge underneath the hallux at the level of the hallux interphalangeal joint allows for accurate sagittal plane alignment. There should be no frontal plane rotation, which is easily checked by comparing the dorsal aspect of the hallux toenail with the remaining toes to assure that they are all parallel. With the hallux held in reduced fashion as described above, a smooth longitudinal Kirschner wire is driven from the tip of the hallux into the first metatarsal to provide provisional fixation but allow for linear compression across the first metatarsophalangeal joint. Once the above has been confirmed, a compression screw is then placed from the base of the proximal phalanx into the first metatarsal head followed by application of a well-contoured dorsal plate (11 and 12) or according to the surgeons preference. This technique is rapid and simple to perform; accurate because it respects the patients own foot morphology; and cost-effective because it requires no specialized equipment.
The Journal of Foot and Ankle Surgery. Volume 45, Issue 1 , January-February 2006, Pages 56-57.