From the Guidelines
Yes, an MTF fusion surgery can potentially disrupt a nonunion at the midfoot. When performing fusion at the MTF joint, the surgical manipulation, hardware placement, and altered biomechanics can affect adjacent structures, including a pre-existing nonunion in the midfoot region. This disruption occurs because the MTF fusion changes weight-bearing patterns and force distribution across the foot. The altered mechanics may place additional stress on the nonunion site, potentially worsening the condition or preventing healing. Additionally, the surgical approach for MTF fusion might require manipulation near the midfoot, which could directly affect the nonunion. Before proceeding with MTF fusion in patients with midfoot nonunion, surgeons should carefully evaluate both conditions and consider addressing the nonunion simultaneously or prior to the MTF fusion. Treatment planning should account for the biomechanical relationship between these areas to optimize outcomes and prevent complications. Patients should be counseled about the potential interaction between these conditions and the possible need for staged or combined surgical approaches, as suggested by recent guidelines on offloading foot ulcers in persons with diabetes 1. Key considerations include the potential for surgical offloading interventions to provide a more permanent solution for areas of elevated mechanical tissue stress, but also the increased risk of complications, such as new rearfoot ulcers, falls, and infections 1. Given the complexity of these conditions and the potential for significant morbidity, surgeons should prioritize a careful and individualized approach to treatment, taking into account the latest evidence and guidelines. In the context of MTF fusion and midfoot nonunion, this may involve a multidisciplinary team approach, careful preoperative planning, and consideration of the potential need for staged or combined surgical procedures to optimize outcomes and minimize complications. Ultimately, the goal of treatment should be to prioritize the patient's quality of life, minimize morbidity, and prevent mortality, while also addressing the complex biomechanical and surgical considerations involved in these conditions.
From the Research
MTF Fusion Surgery and Nonunion at Midfoot
- MTF fusion surgery can potentially disrupt a nonunion at midfoot, but the available evidence does not directly address this specific question.
- A study on the treatment of nonunion in the foot using a totally implanted direct current stimulator found that this method can be effective in promoting bone healing 2.
- Another study on the treatment of nonunion after hallux metatarsophalangeal joint fusion found that removal of hardware and debridement alone can be a reasonable option, but may not always be successful 3.
- A review of the principles of nonunion management highlights the importance of assessing and treating multiple factors that contribute to nonunion, including infection, impaired biology, and mechanical factors 4.
- A study on the effect of fixation type and bone graft on tarsometatarsal fusion found that the use of bone graft can significantly lower the rate of nonunion, and that isolated plate fixation, smoking, and postoperative nonanatomic alignment can increase the risk of nonunion 5.
- A study on the indications for external fixation in nonunion cases found that external fixation can be an effective tool in managing fracture nonunions, particularly in cases where infection is present or where percutaneous correction of alignment is required 6.