Hammertoe correction with wire fixation of varying length

Area of Science:

• Orthopedic surgery
• Foot and ankle reconstruction

Background:

• Proximal interphalangeal (PIP) joint fusion using Kirschner (K)-wire fixation is a common surgical approach for correcting hammertoes.
• The optimal length of K-wire fixation for hammertoe correction is not well-established, potentially influencing clinical outcomes.

Purpose of the Study:

• To evaluate the impact of Kirschner wire fixation length on clinical outcomes in hammertoe correction.
• To compare outcomes based on whether the K-wire spanned the metatarsophalangeal (MTP) joint.

Main Methods:

• Retrospective review of 157 hammertoe reconstructions performed by a single surgeon.
• Analysis of outcomes including MTP joint congruency, pin complications (breakage), and PIP joint union.
• Categorization of K-wire fixation into two groups: spanning the MTP joint (70 toes) and not spanning the MTP joint (87 toes).

Main Results:

• Wire breaks were significantly more frequent in the group with longer K-wire fixation that spanned the MTP joint (P = .024).
• Metatarsophalangeal incongruency was significantly more common in the MTP-spanning group (P = .014).
• Proximal interphalangeal joint union occurred more frequently with longer K-wire fixation, but this difference was not clinically significant.

Conclusions:

• While longer K-wire fixation may increase PIP joint fusion rates, it is associated with a higher incidence of wire breakage and MTP incongruency.
• Pin breakage was rare and exclusively observed in the MTP-spanning group.
• MTP incongruence, though more common with MTP-spanning wires, may not solely be attributable to surgical technique.