Muhammed KAZEZ, Ömer Cihan BATUR, Gökhan ÖNCE, Hüseyin KÜRÜM, Oğuz KAYA, Mustafa YALIN
Acta Orthopaedica et Traumatologica Turcica - 2026;60(2):1-8
Objective: This study aimed to compare clinical outcomes and total treatment costs of 3 fixation strategies-isolated dorsal plating, dorsal plating with a single lag screw, and dorsal plating with dual lag screws-in patients undergoing first metatarsophalangeal (MTP) joint arthrodesis for advanced hallux rigidus. Methods: This retrospective study included 99 patients who underwent primary first MTP joint arthrodesis between 2019 and 2024. Patients were categorized into Group 1 (dorsal plate only; n = 27), Group 2 (plate + 1 lag screw; n = 42), and Group 3 (plate + 2 lag screws; n = 30). Demographic variables, radiographic union, revision rates, functional outcomes (American Orthopaedic Foot and Ankle Society [AOFAS], Visual Analog Scale [VAS], Foot Function Index [FFI]), and total 12-month treatment costs were evaluated. The primary outcome measures were union rate, time to union, revision surgery, functional scores, and cumulative cost. Results: Group 1 demonstrated significantly lower union rates compared with Groups 2 and 3 (88.9% vs. 100% for both; P = .027) and a longer mean time to union (75 days vs. 65.8 and 62 days, respectively; P = .001). Revision surgery was required only in Group 1 (11.1%). The AOFAS scores were significantly higher in the screw-augmented groups ( P = .013), while VAS and FFI scores showed no between-group differences. Cost analysis identified Group 2 as the most cost-effective strategy (9500 +/- 1100 TL ? $310 +/- 36), compared with Group 1 (11 200 +/- 1400 TL ? $365 +/- 46, P = .021) and Group 3 (11 600 +/- 1300 TL ? $378 +/- 42, P = .038). Conclusion: Single lag-screw augmentation of dorsal plate fixation provides superior union, fewer revisions, improved functional scores, and the lowest overall 12-month cost. These findings support dorsal plating with a single lag screw as a practical, value-based fixation strategy for advanced hallux rigidus, offering optimal clinical and economic outcomes.
