Crossed screws versus plating supplemented with an interfragmentary screw in first metatarsophalangeal joint fusion: A systematic review and meta-analysis

First metatarsophalangeal joint (MTPJ) fusion is an effective surgical intervention for conditions such as hallux valgus and hallux rigidus. This systematic review and meta-analysis aims to compare the safety and efficacy of crossed screws versus plating supplemented with an interfragmentary screw. A literature search of the Scopus, Embase, Web of Science, and MEDLINE databases was performed to identify all studies directly comparing the two techniques. Meta-analysis was carried out using RevMan Web. Nine studies with 976 patients (1,035 toes in total, 512 toes in the crossed screws group, and 523 toes in the plate supplemented with screws group) were included. There was no significant difference in union rates (OR=0.75, CI 0.45 – 1.27, p = 0.29), overall complication rates (OR = 1.13, CI = 0.71 – 1.77, p = 0.61), superficial complications, (OR = 0.41, CI = 0.10 – 1.68, p = 0.22), revision surgery (OR = 1.92, CI 0.81 – 4.57, p = 0.14), hardware removal (OR = 1.07, CI = 0.55 – 2.08, p = 0.85), and malunion (OR = 1.63, CI 0.27 – 10.00, p = 0.60). Plate and screws had a significantly shorter time to fusion than crossed screws (MD = 0.51, CI = 0.10 – 0.92, p = 0.02). No significant difference was noted in patient-reported outcome measures or in postoperative hallux valgus, intermetatarsal, and lateral metatarsophalangeal angles. Other potential factors that should influence the decision to use one technique over the other include the indication for MTPJ fusion, the patient's bone quality, and the differing costs of surgery.