Wright Medical Technology Ortholoc 3Di Foot Reconstruction System: First Metatarsalphalangeal Joint (MTPJ) Arthrodesis Plates

Jeffrey E McAlister, DPM
Christopher F Hyer, DPM, MS, FACFAS

Medical Device

Wright Medical Technology (WMT) has introduced a new Titanium locking plate set with redesigned plates and screw technology for a multitude of applications.  Here we highlight the first metatarsophalangeal joint arthrodesis plating system.

Wright Medical Ortholoc 3Di Foot Reconstruction System: 1st MPJ Arthrodesis Plates
Wright Medical Ortholoc 3Di Foot Reconstruction System: 1st MPJ Arthrodesis Plates

First things first – what are the main differences between the Darco plating system and these new Ortholoc 3Di plates and screws?

WMT MTPJ plate Hyer
Figure 1. The figure above highlights one of many cases where a revision long first MTPJ plate was utilized for a nonunion utilizing calcaneal bone graft and bone marrow aspirate.
  1. Polyaxial Screws.  The screw holes allow for multidirectional locking capabilities up to 30 degrees in any direction.  In addition, each hole accepts either a 2.7 or 3.5-mm locking or non-locking screw, which significantly adds to their versatility.
  2. Anatomic Design.  The plates are anatomic specific with the procedure in mind.  In this case, for a 1st MTP fusion, there is Right and Left-sided primary plates in various sizes and levels of dorsiflexion. In addition, there are specially designed revision plates, which really affords the surgeon options particularly in challenging cases of fusion after failed implant or Keller arthroplasty.
  3. Additional points of fixation distally are also an improvement over the original Darco first MTPJ plates, which only had two locking screws distally.  The Ortholoc 3Di system allows for one more point of fixation in the proximal phalanx.
  4. The compression slot in the plate to achieve eccentrically loaded compression. This slot is proximally located in the diaphysis of the first metatarsal and not in the head of the metatarsal.  This allows for a stronger bi-cortical screw purchase and better ability to compress “through” the plate.

For these reasons, the newly designed WMT Ortholoc 3Di First MTPJ Arthrodesis system is highly useful in the foot and ankle surgeon’s armamentarium.

Technique Tips: 

Figure 2. This figure highlights the use of an compression 4.0-mm screw and the MTPJ Fusion plate in a neutralization manner.
Figure 2. This figure highlights the use of an compression 4.0-mm screw and the MTPJ Fusion plate in a neutralization manner.

1. Insert interfragmentary compression lag screw first if desired. Typically we use a 3.5 or 4.0-mm cannulated partially threaded cancellous screw. Surgeon choice on whether to insert the screw from proximal to distal or distal to proximal. If using a cannulated screw, leave the guide wire in place to visualize where the screw is located during plate application.

2. For primary cases, try to place the distal aspect of the plate slightly lateral on the proximal phalanx to prevent shoegear irritation medially. In most cases, we use a 0 degree plate or flat plate for a neutral to slight dorsiflexed position of the 1st MTP. There are already pre-set dorsiflexed plates in the set if desired.

3. If compression through the plate is desired, first lock the distal screws in the proximal phalanx so the toe is secured to the plate.  Drill bi-cortically in the most proximal side of the slotted compression screw hole. Be sure to use a non-locked screw that crosses the distal cortex by several threads for maximal compression.

4. If one chooses to use the plate tacks or olive wires to temporarily hold the plate in place, be sure to remove these before the compression screw through the plate contacts the screw hole to prevent inadvertent diastasis from the pin.

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Jeffrey E. McAlister, DPM is a current fellow at the Orthopedic Foot and Ankle Center Fellowship and is involved with residency programs at OhioHealth Doctors Hospital and The Ohio State University Medical Center.

Christopher F. Hyer completed his medical training at the Ohio College of Podiatric Medicine, and he completed his surgical internship and residency at The Ohio State University Medical Center. He received additional advanced fellowship training at OFAC. Dr. Hyer is a fellow of the American College of Foot and Ankle Surgeons and a member of the American Podiatric Medical Association. He is board certified in reconstructive rearfoot/ankle surgery and foot surgery with the American Board of Podiatric Surgery.

orthopedic-foot-and-ankle-center

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The Unbiased Authority: There are no conflicts of interest or financial association / assistance between SurgicalFixation and Wright Medical Technology. 

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