Hammertoe Correction With K-Wire Fixation compared to Percutaneous Correction

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 PIP 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, 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 six 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 versus 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.