Hammertoe correction with k-wire fixation.

BACKGROUND: Kirschner wire (K-wire) fixation for correction of hammertoe deformity is a common, low-cost method for fixation of hammertoes after proximal interphalangeal (PIP) arthroplasty or fusion. Complications of this procedure include pin-tract infection, pin migration, pin bending or breakage, and recurrence of deformity. The investigators reviewed a large experience using K-wire stabilization for hammertoe correction.

METHODS: All hammertoe corrections performed by a single surgeon from 1999 to 2013 were retrospectively reviewed. A resection arthroplasty of the PIP joint or PIP fusion was performed and fixed with a K-wire. Follow-up duration, preoperative diagnosis, pin duration, concomitant procedures, recurrence rates, and complications were reviewed and analyzed. A total of 1,115 operations were performed on 876 patients, with correction of 2,698 hammertoes. There were 709 female and 167 male patients, with an average age of 57.5 years (range, 14-88 years), followed for an average of 20.8 months (range, 27 days to 12.7 years).

RESULTS: Complications included 94 pin migrations (3.5%), 9 pin-tract infections (0.3%), and 2 pin breakages (0.1%). There were 150 recurrent deformities (5.6%) and 94 toes (3.5%) required revision hammertoe surgery. Malalignment was noted in 55 toes (2.1%). Vascular compromise occurred in 16 toes (0.6%), with 10 (0.4%) requiring amputation. Ninety-four toes (3.5%) required revision surgery because of symptomatic recurrence of deformity. The expected rates and rate ratios (RRs) of patients requiring revision hammertoe correction, compared with the study population as a whole, were statistically significantly higher in patients who underwent an metatarsophalangeal joint capsulotomy (3.10 vs 0.97; RR, 3.20) and those who experienced K-wire-related complications (5.10 vs 1.80, RR, 2.84).

CONCLUSIONS: K-wire fixation for the treatment of hammertoe deformities led to good maintenance of correction with a relatively low complication rate, and we believe that it remains an effective, low-cost method of fixation for hammertoe correction.

LEVEL OF EVIDENCE: Level IV, retrospective case series.