Clinical Outcomes of Dorsal Bridge Plating Without Lag Screw Fixation and Immediate Weight Bearing Following First MTP Arthrodesis

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: First metatarsophalangeal (MTP) arthrodesis is commonly performed for hallux rigidus, with varying surgeon-specific fixation techniques and postoperative protocols. Biomechanical studies suggest lag screw fixation plus dorsal bridge plating with short-term non-weightbearing optimizes strength and bony integration, but the safety and efficacy of dorsal bridge plating alone with immediate weightbearing remain uncertain. This study evaluates postoperative radiographic and clinical outcomes of first MTP arthrodesis using dorsal bridge plating only, without lag screw fixation, and with immediate weightbearing. We hypothesize that immediate weightbearing is non-inferior in safety and clinical outcomes compared to alternative constructs and protocols. Additionally, we hypothesize that adding a lag screw does not significantly affect outcomes. Methods: Following IRB approval, a retrospective review identified patients who underwent first MTP fusion (CPT 28750) at our institution with one of three surgeons from 2010-2022. Exclusion criteria included patients under 18, prior ipsilateral first MTP procedures (e.g., cheilectomy, capsulotomy), and neuropathic conditions. A total of 170 patients were included, with preliminary data available from n=98. Patients were categorized into four groups: those who had undergone MTP arthrodesis with (1) immediate weightbearing with plate fixation only, (2) immediate weightbearing with plate and lag screw, (3) non-weightbearing with plate fixation only, and (4) non-weightbearing with plate and lag screw fixation. Demographics collected included age, gender, BMI, smoking status, and comorbidities. Clinical outcomes were assessed via chart review, and radiographic outcomes were evaluated for osseous union. Results: Preliminary analysis of 98 patients showed no statistically significant difference between treatment groups regarding postoperative hardware failure (p=1.0), need for postoperative CT scan (p=0.7886), or rates of revision surgery (p=0.3189). Subgroup analysis revealed that weightbearing versus non-weightbearing protocols did not significantly impact these outcomes (p=0.3191 for CT scan, p=0.0604 for need for revision surgery). Additionally, surgical construct type (plate only vs. plate with lag screw fixation) did not demonstrate statistical significant differences in outcomes (p=0.6783 for need for revision surgery, p=1.0 for CT scan). Conclusion: This study aims to provide clinical evidence on the safety and efficacy of immediate postoperative weight bearing following first MTP fusion using dorsal bridge plating alone. Preliminary data suggest that weight-bearing status and fixation construct do not significantly influence rates of hardware failure, need for CT evaluation, or revision surgery. Findings will contribute to optimizing postoperative protocols and surgical decision-making in hallux rigidus management.