Fixation of Hammertoes with a Permanent Intramedullary K-Wire: A Low-Cost Alternative for a Common Procedure

CATEGORY: Lesser Toes; Midfoot/Forefoot INTRODUCTION/PURPOSE: Traditional K-Wire fixation of the proximal interphalangeal joint during correction of hammertoes is associated with various complications including loss of fixation, recurrence of deformity, pin tract infection and patient dissatisfaction due to the pin. At least 20 devices designed expressly for the purpose of fusing the interphalangeal joint of the lesser toes exist. Cost of the implants can range from $450 to $2000 per implant (when disposable instruments are included in the cost.) We hypothesized that a permanent intraosseous K-Wire bridging the proximal and middle phalanx would perform in an equivalent manner to many commercially available implants with a large potential for cost savings. METHODS: A modified DuVries hammertoe correction procedure through a dorsal approach including resection of both joint surfaces. A 2mm or 1.6mm K-wire is then cut and placed into the intramedullary canals of the phalanges bridging the PIP joint (IP). A snug extensor mechanism repair affords compression and rotational control. External pins (EP) were used if the diaphyseal canal was less than 1.6mm. A retrospective review of medical records and radiographs of all patients undergoing hammertoe correction over three years by a single surgeon. 50 patients (28 Women, 12 Men) and 53 feet (2 bilateral) with mean age 66 (range 34 – 84) who had a minimum 6-month follow-up were available for study. 112 toes were corrected. Osseous union or stable fibrous union were the desired results with non-union, deformity recurrence and/or the need for revision being noted as failure. Average follow-up was 21.7 months (6 – 54). RESULTS: Results: Of the 93 IP fixations, there were 68 fusions, 22 stable fibrous unions, and 3 non-unions. Of the 19 External pins there were, 11 fusions, 3 stable fibrous unions and 5 non-unions. 5 Patients required revision which was done by bone grafting and compression with an intramedullary screw. Success was noted in 96% of IP fixation and 74% of external pin fixations. CONCLUSION: Permanent internal K-Wire fixation for hammertoe correction is a viable option for fixation of hammertoe deformity outperforming traditional temporary K-wire fixation and resulting in good clinical results comparable to other commercially available implants. Given the negligible cost of this implant, the potential cost savings to the medical system is great. K-Wires are readily available worldwide and this technique may useful in countries where resources do not allow use of expensive implants.