Double compression technique for first MTP joint fusion: a cadaveric analysis of valgus plate fixation

Introduction: First metatarsophalangeal (MTP) joint arthrodesis is the gold-standard treatment for end-stage arthritis and hallux deformities. Successful fusion is improved by achieving adequate compression across the joint. Traditional plating systems provide single-point compression, whereas the Arthrex MTP valgus plate is designed for double compression, potentially improving stability and union rates. This study aimed to confirm double compression and compare two anchoring methods: K-wire and olive tip guide wire (BB-tack). Methods: Twelve cadaveric feet were randomised to plate fixation using either K-wire or BB-tack anchoring. Compression was measured with Tekscan sensors during three stages: after seating the first compression screw, after seating the second screw, and after reseating the second screw without the stabilising K-wire. Peak force and contact pressure were analysed using ANOVA and t-tests (α = 0.05). Results: Both techniques achieved measurable compression after the first screw, which increased significantly with the second screw (mean pressure: 0.55-0.62 MPa; peak force: 18.3-22.2 N). Removing the stabilising K-wire before reseating reduced peak force but maintained comparable pressure. No significant differences were found between anchoring methods (p > 0.05). Conclusion: The Arthrex MTP valgus plate achieves double compression, enhancing construct rigidity compared to single-compression systems. Further clinical studies are warranted to validate these biomechanical advantages.