{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:20:25Z","timestamp":1791591625162,"version":"4.3.4"},"reference-count":43,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T00:00:00Z","timestamp":1696464000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Materials"],"abstract":"<jats:p>The first metatarsophalangeal (MTP) joint is a frequently loaded joint, handling loads up to 90% of bodyweight. First MTP arthrodesis is a frequently performed procedure designed to improve pain in patients with degenerative MTP joint disease. There are a wide variety of fixation constructs for this procedure without consensus on the most effective method. The purpose of this study was to compare the biomechanical integrity of various constructs utilized for first MTP arthrodesis. A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, CINAHL, MEDLINE, and Web of Science databases were searched from inception to 18 June 2023. Articles discussing the biomechanics of first MTP arthrodesis constructs were included. A total of 168 articles were retrieved. A total of 20 articles involving 446 cadaveric and synthetic bone constructs were included in the final review. Of the six articles comparing dorsal plating with compression screws to crossed interfragmentary screws, five found that dorsal plating had significantly higher stiffness. All three studies assessing shape-memory staples found them to be significantly less stable than crossed screws or dorsal plates alone. Both studies evaluating fully threaded screws found them to be stronger than crossed cancellous screws. Wedge resections have been shown to be 10 times stronger than standard planar or conical excision. Dorsal plating with compression screws is the gold standard for MTP arthrodesis. However, more research into newer methods such as fully threaded screws and wedge resections with an increased focus on translation to clinical outcomes is needed.<\/jats:p>","DOI":"10.3390\/ma16196562","type":"journal-article","created":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T09:14:22Z","timestamp":1696497262000},"page":"6562","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Evaluating the Biomechanical Integrity of Various Constructs Utilized for First Metatarsophalangeal Joint Arthrodesis: A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Abhinav R.","family":"Balu","sequence":"first","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4175-3135","authenticated-orcid":false,"given":"Anthony N.","family":"Baumann","sequence":"additional","affiliation":[{"name":"College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terence","family":"Tsang","sequence":"additional","affiliation":[{"name":"Campbell University School of Osteopathic Medicine, Lillington, NC 27546, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0018-6410","authenticated-orcid":false,"given":"Grayson M.","family":"Talaski","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA 52242, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5817-3826","authenticated-orcid":false,"given":"Albert T.","family":"Anastasio","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4488-0663","authenticated-orcid":false,"given":"Kempland C.","family":"Walley","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel B.","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University, Durham, NC 27708, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.foot.2017.11.001","article-title":"A locking compression plate versus the gold-standard non-locking plate with lag screw for first metatarsophalangeal fusion: A biomechanical comparison","volume":"34","author":"Mandell","year":"2018","journal-title":"Foot"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1093\/ptj\/79.9.854","article-title":"Anatomy and biomechanics of the first ray","volume":"79","author":"Glasoe","year":"1999","journal-title":"Phys. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"354","DOI":"10.2519\/jospt.1995.21.6.354","article-title":"Complexities of foot architecture as a base of support","volume":"21","author":"Saltzman","year":"1995","journal-title":"J. Orthop. Sport. Phys. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Al-Munajjed, A.A., Bischoff, J.E., Dharia, M.A., Telfer, S., Woodburn, J., and Carbes, S. (2016). Metatarsal Loading During Gait-A Musculoskeletal Analysis. J. Biomech. Eng., 138.","DOI":"10.1115\/1.4032413"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.fcl.2004.11.003","article-title":"The first metatarsal bone under loading conditions: A finite element analysis","volume":"10","author":"Kristen","year":"2005","journal-title":"Foot Ankle Clin."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.fas.2022.09.003","article-title":"First metatarsophalangeal arthrodesis outcomes for hallux rigidus versus hallux valgus","volume":"29","author":"Roth","year":"2023","journal-title":"Foot Ankle Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"485","DOI":"10.5312\/wjo.v12.i7.485","article-title":"Arthrodesis of the first metatarsophalangeal joint: The \u201cwhen and how\u201d","volume":"12","author":"Koutsouradis","year":"2021","journal-title":"World J. Orthop."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1177\/1071100716642286","article-title":"Functional Outcomes Following First Metatarsophalangeal Arthrodesis","volume":"37","author":"DeSandis","year":"2016","journal-title":"Foot Ankle Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.fcl.2008.11.008","article-title":"First metatarsophalangeal arthrodesis","volume":"14","author":"Womack","year":"2009","journal-title":"Foot Ankle Clin."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"34","DOI":"10.5435\/00124635-199501000-00005","article-title":"Disorders of the First Metatarsophalangeal Joint","volume":"3","author":"Mann","year":"1995","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"984","DOI":"10.3113\/FAI.2012.0984","article-title":"Locked versus nonlocked plate fixation for first metatarsophalangeal arthrodesis: A biomechanical investigation","volume":"33","author":"Hunt","year":"2012","journal-title":"Foot Ankle Int."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1016\/j.otsr.2018.08.011","article-title":"Incidence and outcomes of revision surgery after first metatarsophalangeal joint arthrodesis: Multicenter study of 158 cases","volume":"104","author":"Gaudin","year":"2018","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Witkowski, W., Kuik, L., Rucka, M., Daszkiewicz, K., Andrzejewska, A., and Luczkiewicz, P. (2021). Medially positioned plate in first metatarsophalangeal joint arthrodesis. 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Foot Ankle Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"24730114231193424","DOI":"10.1177\/24730114231193424","article-title":"Republication of \u201cFirst Metatarsophalangeal Joint Arthrodesis: Functional Outcomes Using 2 Different Fixation Techniques. Is More Expensive Better?\u201d","volume":"8","author":"Filomeno","year":"2023","journal-title":"Foot Ankle Orthop."},{"key":"ref_18","first-page":"e1786","article-title":"First Metatarsophalangeal Joint Arthrodesis in Hallux Valgus Versus Hallux Rigidus Using Cup and Cone Preparation Compression Screw and Dorsal Plate Fixation","volume":"9","author":"Chien","year":"2017","journal-title":"Cureus"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1053\/j.jfas.2019.01.024","article-title":"Biomechanical Study Concerning the Types of Resection in Arthrodesis of First Metatarsophalangeal Joint","volume":"59","author":"Bartak","year":"2020","journal-title":"J. Foot Ankle Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1177\/1071100713494779","article-title":"Hallux metatarsophalangeal joint arthrodesis with a hybrid locking plate and a plantar neutralization screw: A prospective study","volume":"34","author":"Doty","year":"2013","journal-title":"Foot Ankle Int."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1177\/107110070602701101","article-title":"Hallux metatarsophalangeal joint arthrodesis using dome-shaped reamers and dorsal plate fixation: A prospective study","volume":"27","author":"Goucher","year":"2006","journal-title":"Foot Ankle Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1177\/1071100719837524","article-title":"Biomechanical Comparison of Low-Profile Contoured Locking Plate with Single Compression Screw to Fully Threaded Compression Screws for First MTP Fusion","volume":"40","author":"Fuld","year":"2019","journal-title":"Foot Ankle Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s13018-017-0525-z","article-title":"Weight-bearing recommendations after first metatarsophalangeal joint arthrodesis fixation: A biomechanical comparison","volume":"12","author":"Campbell","year":"2017","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1177\/107110070302400405","article-title":"First metatarsal-phalangeal joint arthrodesis: A biomechanical assessment of stability","volume":"24","author":"Politi","year":"2003","journal-title":"Foot Ankle Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.fas.2014.02.009","article-title":"Biomechanical comparison of first metatarsophalangeal joint arthrodeses using triple-threaded headless screws versus partially threaded lag screws","volume":"20","author":"Lucas","year":"2014","journal-title":"Foot Ankle Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"223","DOI":"10.3113\/JSOA.2012.0223","article-title":"First metatarsophalangeal arthrodesis: A biomechanical comparison of three fixation constructs","volume":"21","author":"Foote","year":"2012","journal-title":"J. Surg. Orthop. Adv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1177\/1938640015583512","article-title":"The Biomechanical Evaluation of Revision First Metatarsophalangeal Arthrodesis: A Cadaveric Study","volume":"8","author":"Aiyer","year":"2015","journal-title":"Foot Ankle Spec."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.fas.2016.07.005","article-title":"Arthrodesis of the first metatarsophalangeal joint-A biomechanical comparison of four fixation techniques","volume":"23","author":"Harris","year":"2017","journal-title":"Foot Ankle Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.fas.2017.03.001","article-title":"Evaluation of different shape-memory staple configurations against crossed screws for first metatarsophalangeal joint arthrodesis: A biomechanical study","volume":"24","author":"Willmott","year":"2018","journal-title":"Foot Ankle Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1177\/10711007221119157","article-title":"Two Orthogonal Nitinol Staples and Combined Nitinol Staple-Screw Constructs for a First Metatarsophalangeal Joint Arthrodesis: A Biomechanical Cadaver Study","volume":"43","author":"Schafer","year":"2022","journal-title":"Foot Ankle Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/S1067-2516(01)80020-X","article-title":"First metatarsophalangeal joint arthrodesis: Quantitative mechanical testing of six-hole dorsal plate versus crossed screw fixation in cadaveric specimens","volume":"40","author":"Buranosky","year":"2001","journal-title":"J. Foot Ankle Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1177\/107110079301400705","article-title":"Arthrodesis of the first metatarsophalangeal joint: A biomechanical study of internal fixation techniques","volume":"14","author":"Curtis","year":"1993","journal-title":"Foot Ankle"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1177\/107110079401500802","article-title":"A biomechanical comparison of four fixation methods of first metatarsophalangeal joint arthrodesis","volume":"15","author":"Rongstad","year":"1994","journal-title":"Foot Ankle Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/107110078600700105","article-title":"A biomechanical study using cadaveric toes to test the stability of fixation techniques employed in arthrodesis of the first metatarsophalangeal joint","volume":"7","author":"Sykes","year":"1986","journal-title":"Foot Ankle"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"89","DOI":"10.3113\/FAI.2007.0016","article-title":"A comparative study of wire fixation and screw fixation in arthrodesis for the correction of hallux rigidus using an in vitro biomechanical model","volume":"28","author":"Faraj","year":"2007","journal-title":"Foot Ankle Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1177\/107110070202300203","article-title":"Arthrodesis of the first metatarsophalangeal joint: A biomechanical study comparing memory compression staples, cannulated screws, and a dorsal plate","volume":"23","author":"Neufeld","year":"2002","journal-title":"Foot Ankle Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1177\/107110070302400212","article-title":"Biomechanical comparison of two fixation methods for first metatarsophalangeal joint arthrodesis","volume":"24","author":"Molloy","year":"2003","journal-title":"Foot Ankle Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"746","DOI":"10.3113\/FAI.2007.0746","article-title":"Technique Tip: Arthrodesis of the First Metatarsophalangeal Joint\u2013Prevention of Excessive Dorsiflexion","volume":"28","author":"DeOrio","year":"2007","journal-title":"Foot Ankle Int."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1053\/j.jfas.2021.06.002","article-title":"Crossed Screw Fixation Versus Dorsal Plating for First Metatarsophalangeal Joint Arthrodesis: A Retrospective Cohort Study","volume":"61","author":"West","year":"2022","journal-title":"J. Foot Ankle Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"245","DOI":"10.30621\/jbachs.1091385","article-title":"Retrospective comparison of two different fixation methods for first metatarsophalangeal joint arthrodesis","volume":"7","author":"Akdemir","year":"2023","journal-title":"J. Basic Clin. Health Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"797","DOI":"10.3113\/FAI.2010.0797","article-title":"First Metatarsophalangeal Arthrodesis using a Dorsal Plate and a Compression Screw","volume":"31","author":"Kumar","year":"2010","journal-title":"Foot Ankle Int."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2401","DOI":"10.1007\/s00264-016-3277-1","article-title":"Long-term outcome of first metatarsophalangeal joint fusion in the treatment of severe hallux rigidus","volume":"40","author":"Chraim","year":"2016","journal-title":"Int. Orthop."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1177\/107110070502600803","article-title":"First Metatarsophalangeal Joint Arthrodesis: An Evaluation of Hardware Failure","volume":"26","author":"Bennett","year":"2005","journal-title":"Foot Ankle Int."}],"container-title":["Materials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1996-1944\/16\/19\/6562\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:01:42Z","timestamp":1760130102000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1996-1944\/16\/19\/6562"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,5]]},"references-count":43,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["ma16196562"],"URL":"https:\/\/doi.org\/10.3390\/ma16196562","relation":{},"ISSN":["1996-1944"],"issn-type":[{"value":"1996-1944","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,5]]}}}