First metatarsophalangeal joint arthrodesis, - Plate or screw fixation - systematic review and meta analysis

Introduction and aim: One common therapy for end-stage hallux rigidus symptoms is arthrodesis of the first metatarsophalangeal joint (MTP). Surgery is usually advised for symptomatic patients with arthritis when conservative measures like activity changes, over-the-counter drugs, intra-articular corticosteroid injections, accommodative footwear, special orthotics, and other symptomatic measures have failed. First MTP joint arthrodesis should also be considered as the preferable treatment option for other severe disorders that affect the Hallux, such as gout, post-traumatic arthritis, and rheumatoid arthritis (RA).This systematic review's objective is to provide an overview and comparison of current fixation techniques for First MPJ arthrodesis, contrasting plate fixation with screw fixation. Methodology: In accordance with PRISMA recommendations, a comprehensive literature search was carried out on PubMed, Google Scholar, Cochrane, Medline, and Embase. Research that compared fixing methods using screws and plates revealed both short-term and long-term problems in addition to union and functional results. The ROBINS-1 tool was used to assess quality assessment and bias risk. Weighted mean differences were used to pool continuous variables, and odds ratios with 95 % CIs were used to compare binary outcomes. Results: Eight studies totalling 642 feet with a first MTP joint fusion were included in our meta-analysis; however, The union rate for patients fastened with screws was 93.4 %, whereas the union rate for those fixed with a plate was 92.5 %. Complication rates for screws and plates were 11.4 % and 10.8 %, respectively. According to our research, screws fixation had a lower incidence malunion than those who underwent plate fixation (OR 1.02; CI 95 % 0.53–1.97; p = 0.49; I2 = 0 %). According to our research, patients with plate fixation had a shorter mean Union team than those with screw fixation (OR 5.48; Cl 95 % 1.64–9.31; p = 0.88; I2 = 0). According to our research, individuals who had plate fixation experienced less complications than those who underwent screw fixation (OR 1.53; Cl 95 % 0.91–2.57; p = 0.93; I2 = 0). Conclusion: According to our research, plate fixation had fewer issues than screws, yet plating and screws had comparable union rates. Howveer there were no randomised control studies which made our studies high risk and our results were not statistically significance, indicating a need for further randomised control studies.