Dual-Component Intramedullary Implant Versus Kirschner Wire for Proximal Interphalangeal Joint Fusion: A Randomized...

Area of Science:

• Orthopedic Surgery
• Podiatric Surgery
• Biomedical Engineering

Background:

• Lesser digital hammertoe deformities are common and can cause pain and functional limitations.
• Surgical fixation of the proximal interphalangeal joint is a standard treatment approach.
• Various fixation methods exist, including Kirschner wires and intramedullary implants, each with potential benefits and drawbacks.

Purpose of the Study:

• To compare the outcomes of Kirschner wire fixation versus a 2-piece intramedullary implant for surgical correction of lesser digital hammertoe.
• To evaluate differences in arthrodesis (fusion) rates, complication incidence, and patient-reported foot function.

Main Methods:

• A multicenter, randomized controlled trial was conducted with 91 participants undergoing hammertoe repair.
• Participants were randomized to fixation with either a Kirschner wire (n=46) or a 2-piece intramedullary implant (n=45).
• Outcomes assessed included radiographic fusion, complication rates, Bristol Foot Score, and Foot Function Index.

Main Results:

• No statistically significant differences in complication rates were observed between the two groups.
• The intramedullary implant group demonstrated a higher mean Bristol Foot Score and Foot Function Index score, indicating better subjective outcomes.
• A greater incidence of radiographic fusion was noted in the intramedullary implant group compared to the Kirschner wire group.

Conclusions:

• The 2-piece intramedullary implant appears to offer superior patient satisfaction and a higher fusion rate for lesser digital hammertoe repair compared to Kirschner wire fixation.
• Both fixation methods showed similar complication rates, suggesting that implant choice may primarily influence functional outcomes and fusion success.