Cross Screw Fixation for First Metatarsophalangeal Joint Arthrodesis: A Technical Guide

Background: First metatarsophalangeal joint (MPJ) arthritis, treatments, and fixation methods have been well described in the literature. Indications for the fusion of the first MPJ include hallux rigidus, severe hallux valgus, failed bunionectomy, failed joint arthroplasty, rheumatoid arthritis, and neuromuscular disorders. Crossing screw fixation has been found to be a stable construct that provides reliable outcomes with high patient satisfaction, specifically for those patients with hallux rigidus and minimal hallux valgus deformity. Crossing screw fixation has also been found to be reliable and more cost-effective than other fixation techniques. However, this method may pose some challenges to novice surgeons and those at academic training institutions. Objective: The objective of this technical guide is to propose a reproducible technique to first MPJ fusion with 2 crossing, cannulated screws. This technique is designed to increase the reliability and speed of the crossing screw technique. Conclusion: Overall, using this technique with cross screw fixation, we have found decreased operative times, better reproducibility of results, efficiency with use in training with resident learners, and reduced hardware costs. Levels of Evidence: Level V, expert opinion