Appropriate Distraction Strength of Metatarsopahlangeal Joint Arthroscopy

CATEGORY: Arthroscopy; Bunion; Lesser Toes INTRODUCTION/PURPOSE: Appropriate distraction for metatarsophalangeal joint arthroscopy is paramount to increase in visualization and to decrease iatrogenic complications. However, there are few studies on how much adequate distraction is. The purpose of this study was to investigate the appropriate degree of distraction and the associated factors. METHODS: 40 patients who underwent toe arthroscopy from April 2015 to June 2018 were enrolled. Under general or spinal anesthesia, the anterio-posterior foot plain radiograph were taken using mini-fluoroscan; no traction, manual traction, 5, 10 and 15 pound traction and were used to measure the metatasophalangeal joint (MTP) distance. Age, gender, body mass index were compared as associated factors. The minimum joint distance of toe arthroscopy defined as 2.8mm which was sheath size of 1.9mm 30° high definition arthroscopy. Appropriate distraction is defined as an over 70% possible rate. RESULTS: 10lb traction was appropriate distraction on first and fourth MTP joint arthroscopy. 5lb traction was appropriate on second, third, fifth MTP. In first MTP with 5lb traction, there was significant difference according to gender; 9 of 23 male, none of 17 female. (p=0.005). With 10lb traction, 16 of 27 patients under 60 and 3 of 13 patients over 60 years old were could arthroscopy (p=0.046). In third MTP with 5lb traction, 18 of 28 patients over 30 were could arthroscopy, but only 4 of 13 under 30 years old were could(p=0.038). In fourth MTP with 5lb traction, there was significant difference according to gender, male (12 of 23 patients) was had arthroscopy, but only 2 of 17 female patients. (p=0.017). CONCLUSION: In the MTP joint arthroscopy, 10lb was needed in first and fourth MTP joint, and 5lb was needed in second, third, fifth MTP joint. Manual traction is generally not appropriate for distraction. Female and under 60 years old patients needed more distraction in first toe arthroscopy. Under 30 years old patients in third toe and female patients in fourth toe arthroscopy needed more distraction than 5lb.