First Metatarsophalangeal Joint Fusion With Use of Crossed Kirschner Wires and Intramedullary Steinmann Pin

Primary arthrodesis is a thoroughly studied treatment option for end-stage pathologic entities of the first metatarsophalangeal joint. It is a commonly accepted treatment of many pathologic conditions, including hallux rigidus, severe hallux valgus, hallux varus, and other conditions pertaining to the first ray. Numerous fixation techniques are available for this procedure. Fixation constructs range from simple crossing Kirschner wires to plate and screw fixation or, even, external fixation. We propose a simple and cost-effective fixation technique using an intramedullary Steinmann pin with crossing Kirschner wires. Similar fixation techniques have been described; however, minimal data are available regarding this type of fixation. We present a series of 64 first metatarsophalangeal joint fusion procedures performed on 60 patients using our technique. A retrospective review with attention to several clinical and radiographic parameters was performed. The mean follow-up time was 27 (range 6 to 56) months. This technique resulted in a fusion rate of 90.6% (58 of 64 procedures). Despite the use of a large intramedullary Steinmann pin across the interphalangeal joint (IPJ), only 6 of the 64 procedures (9%) resulted in hallux IPJ degeneration. Of these, only 3 (4.6%) were symptomatic and required therapeutic measures. This suggests that violation of the IPJ with this form of fixation contributes minimally to postoperative pathologic features and is a viable alternative to traditional Association for Osteosynthesis/Association for the Study of Internal Fixation techniques.