An Innovative Application of a Computer Aided Design and Manufacture Implant for First Metatarsal Phalangeal Joint Arthrodesis: A Case Report.

The definitive treatment to correct the deformity of hallux abducto valgus involves surgical fixation. This pathological condition focuses on combined abnormalities of the first metatarsal phalangeal joint (MPJ), medial progression of the first metatarsal, and lateral deviation of the hallux. In most known literature described to date, a computer aided design/manufacture implant has not yet been reported as a viable salvage tool used as an inter-positional structural implant for a first MPJ arthrodesis. The fundamentals of this salvage procedure are to restore anatomical length of the first ray, furnish continuity to the forefoot parabola, administer a robust inter-positional implant (Additive Orthopaedics, Little Silver, NJ) of optimal strength, and provide biomechanical reclamation of the tripod foot. This case study describes a procedural technique that required a 2-stage surgical approach consisting of primary external fixation with a SideKickCoreTrack (Wright Medical, Memphis, TN) tube fixator monorail to expand soft tissues for approximately 1 month.  Followed by a secondary procedure utilizing BioCUE® (Biomet Orthopaedics, Warsaw, Indiana) Bone Marrow Aspiration Concentration system, Augment® Injectable (Wright Medical, Memphis, TN), and custom GAME PLAN (Additive Orthopaedics, Little Silver, NJ) Technology with computer assisted design/manufacture first MPJ inter-positional caged implant arthrodesis.  We present the case of a 46-y-old active female who suffered avascular necrosis of her left foot first metatarsal head from a previous Austin bunionectomy correctional procedure.