Abstract
Category:
Lesser Toes
Introduction/Purpose:
K-wire fixation is the most common operative procedure for hammertoe deformity today. However, intramedullary implants are gaining ground in both number of available choices and in procedures performed. This study aimed to compare the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device.
Methods:
A retrospective review of hammertoe correction by a single surgeon was performed from June 2011 to December 2013. Sixty patients (95 toes) underwent K-wire fixation and 39 patients (54 toes) underwent fusion with the intramedullary implant. Average age was 61.7 years and 61.4 years, respectively. Average length of follow up was 12.9 and 12.3 months, respectively. Patients were evaluated for medical comorbidities, smoking status, inflammatory arthritis, peripheral vascular disease, peripheral neuropathy, pre and postoperative visual analogue pain scale, bony union percentage, revision rate, complications (hardware and surgery-related), and persistent symptoms at last follow up.
Results:
There was no significant difference in demographics or comorbidities between the two groups (p>0.05). In the K-wire group, sixteen patients (18 toes) remained symptomatic (27%). Nine toes (9.5%) had recurrent deformity, three toes (3%) developed a late infection due to the recurrent deformity and one toe (1%) developed partial numbness. One patient suffered a calf DVT and peroneal nerve neuritis, one patient developed a foot drop, and three patients continued to complain of pain. Five toes required revision surgery (5.3%). In the intramedullary group three (7.7%) patients remained symptomatic. One patient developed CRPS in the foot, calf DVT, and a non-fatal PE. A second patient developed a painless recurrent deformity. A third patient had wound dehiscence. Nobody suffered hardware failure or required a second operation.
Conclusion:
The intramedullary device for hammertoe correction resulted in less complications, recurrent deformity, and reoperations than K-wire fixation.