Hammertoe Correction With K-Wire Fixation Compared With Percutaneous Correction

Foot Ankle Spec. 2017 Oct;10(5):421-427. doi: 10.1177/1938640016681069. Epub 2016 Dec 4.

Abstract

Background: Kirschner wire (K-wire) fixation for correction of hammertoe deformity is the gold standard for hammertoe surgery fixation, the current study compares it to percutaneous surgery with 3M Coban dressings.

Methods: All hammertoe corrections performed were retrospectively reviewed. For the K-wire fixation group: resection arthroplasty of the proximal interphalangeal joint was performed and fixed with a K-wire. The percutaneous technique used involved percutaneous diaphyseal osteotomy of the middle and proximal phalanges combined with tendon release. The toes are then wrapped in 3M Coban dressing for 3 weeks. Follow-up duration, preoperative diagnosis, pin duration, concomitant procedures, visual analogue scale (VAS) pain, recurrence rates, and complications were reviewed and analyzed. A total of 352 patients (87 percutaneous/265 open), in whom 675 hammertoes (221 percutaneous/454 open) were corrected. There were 55.9% females, with an average age of 52.8 years, followed for 6 months. The percutaneous group had more diabetics and multiple toes surgery.

Results: Complications of the open surgery group included 5.5% pin migrations, 4.5% infections, and 8 (3%) had impaired wound healing. There were 6.2% recurrent deformities and 2.6% toes were revised. Malalignment was noted in 3.3% toes. Vascular compromise occurred in 0.5%, with 0.25% amputated. Complications of the percutaneous surgery group included 18.4% cases of impaired healing and 2.3% infection. Deep tissue dehiscence occurred in 4.5% of open surgery patients. VAS score decreased in both groups with a more pronounced decline in the percutanteous group (2 ± 2.1 vs 0.5 ± 1.6). The per toe infection rate of patients undergoing open hammertoe correction was 5.3% was significantly higher than with the percutaneous correction group, which was 2.2%.

Conclusions: K-wire fixation and percutaneous surgery have similar abnormal healing rates, alignment and patient satisfaction but the latter technique has fewer infections.

Levels of evidence: Level III: Prospective case series with noncontamporenous cohorts.

Keywords: Coban dressing; claw toe; hammertoe; lesser toe deformity; percutaneous osteotomy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Bandages*
  • Bone Wires*
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hammer Toe Syndrome / diagnosis
  • Hammer Toe Syndrome / surgery*
  • Humans
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / methods
  • Monensin / pharmacology
  • Orthopedic Procedures / instrumentation*
  • Orthopedic Procedures / methods
  • Osteotomy / methods*
  • Recovery of Function
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Monensin