Single lag-screw-augmented dorsal plating yields superior union and lower costs in first metatarsophalangeal arthrodesis.

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.    Cite this article as: Kazez M, Batur ÖC, Önce G, Kürüm H, Kaya O, Yalın M. Single lag-screw-augmented dorsal plating yields superior union and lower costs in first metatarsophalangeal arthrodesis. Acta Orthop Traumatol Turc., 2026; 60(2), 0417, doi: 10.5152/j.aott.2025.25417.