Dr. Rubenstein consulted his "foot guy" who said Plantar plating is done. Biomechanically it is superior because it is on the tension side of the construct. However, I never do it. It requires more dissection and hardware which can cause issues. A well done dorsal approach has just as good of fusion rates without the other issues.
On Fri, May 9, 2025 at 12:56 PM hilary wrote:
Dr. Rubenstein shared thishttps://www.arthrex.com/resources/VID1-000010-en-US/1st-tmt-fusion-using-the-arthrex-plantar-lapidus-plate
I have never seen it, but it is clearly a thing
It is possible that I misconstrued the request.
Maybe the referrer plans removal of hardware but wanted to be sure that the fusion was solid.
Maybe.On Fri, May 9, 2025 at 6:00 AM hilary wrote:
The patient has experienced chronic pain ever since the TMT fusion 8 months after arthrodesis.The referring physician ordered the CT to evaluate suspected non-union.
The sagittal image on the left and long axis image on the right show complete, solid fusion across the 1st TMT joint.
The central image show a screw plantar to the undersurface of the 1st metatarsal base, along with the protruding edge of the fixation plate.I did offer the option of ultrasound to demonstrate hardware impingement on plantar structures….because it would be nice to illustrate in a lecture…..but she is solidly fused and I suspect removal of hardware will cure her pain.
I’m sharing this because I was surprised to see plantar plate and screw fixation.
I have only ever seen dorsal +/- medial fixation.
This approach seems doomed to cause irritation to the flexor muscles and tendons and branches of the medial plantar nerve, don’t you think?
Am I wrong about that? Have you ever seen this?Hilary
