Debbie Y Dang 1Wesley W Flint 2Craig T Haytmanek 3Katherine J Ackerman 4Michael J Coughlin 5Christopher B Hirose 6


  • 1Fellow, Saint Alphonsus Regional Medical Center Coughlin Clinic, Boise, ID.
  • 2Surgeon, Saint Alphonsus Regional Medical Center Coughlin Clinic, Boise, ID.
  • 3Surgeon, The Steadman Clinic, Vail, CO.
  • 4Premedical Student, Grinnell College, Grinnell, IA.
  • 5Director, Saint Alphonsus Foot and Ankle Clinic, Boise, ID; Clinical Professor, Department of Orthopaedic Surgery University of California San Francisco, San Francisco, CA.
  • 6Clinical Instructor, University of Washington School of Medicine, Seattle, WA; Director, Idaho Foot and Ankle Fellowship, Saint Alphonsus Regional Medical Center Coughlin Clinic, Boise, ID. Electronic address:

PMID: 32863117 DOI: 10.1053/j.jfas.2019.09.044


Midfoot arthrodesis is the accepted surgical treatment for symptomatic midfoot arthritis. The published literature has focused on joint-spanning static fixation. Several companies have developed diamond-shaped locked dorsal compression plates, which allow for longitudinal joint compression. After dorsal plate insertion, a spreader device opens the arms of the plate mediolaterally, which allows the plate to compress longitudinally. This work describes outcomes of such locked dorsal compression plates for midfoot arthritis at a single institution. We reviewed 62 patients who underwent midfoot arthrodesis for symptomatic midfoot arthritis using locked dorsal compression plates over a 7-year period. A total of 173 joints were spanned for fusion. The primary outcome measure was radiographic union and visual analog scale pain scores. Characteristics of patients who experienced nonunion versus those who had union were evaluated. Of the 173 joints, there was a 81.5% fusion rate (141/173 joints) and 14 patients experienced nonunion. There was a statistically significant difference in the average number of joints spanned in patients with nonunion (3.6) and patients with union (2.5) (p = .02). Locked dorsal compression plate arthrodesis is a viable technique for achieving midfoot fusion. This mechanical method of compression does not, however, lend itself to improved fusion rates compared with prior reports. A greater number of arthrodesis sites is associated with a higher nonunion rate. Emerging technology using newer materials and improved biomechanical designs may show improved results.

Keywords: ORIF; arthrodesis; fusion; internal fixation; tarsometatarsal.

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