Early Complications and Recurrence Rates After Kirschner Wire Transfixion in Lesser Toe Surgery: A Prospective Randomized Study

Abstract

Background: Prolonged percutaneous Kirschner wire transfixion after correction of lesser toe deformities has been associated with an increased rate of complications such as infection, wire breakage or loosening. Currently, the duration of wire transfixion is based on the surgeons' opinion rather than on evidence. We hypothesized that a transfixion time of 3 weeks when compared to 6 weeks would decrease complication rates without an increase in the rate of recurrent deformity. Methods: We prospectively randomized 52 lesser toes corrected for a moderate hammer- or claw toe deformity by means of resectional arthroplasty of the proximal interphalangeal joint into two groups with 3 and 6 weeks of Kirschner wire transfixion, respectively. Kirschner wire-associated complication rates and incidence of early recurrence of malalignment in a short term followup of three months were assessed. Forty-six toes, 23 in each group, were available for final followup. Results: No statistically significant differences were found in pre- and postoperative total AOFAS scores between the groups. No Kirschner wire associated complications occurred. Recurrent malalignment was more often documented in the group with 3 weeks of transfixion (11 of 23 toes, 47.8%) when compared to 6 weeks (two of 23 toes, 8.7%) at 3 months followup. Interphalangeal joint motion was significantly reduced with prolonged Kirschner wire transfixion, indicating a more stable fibrous union ( p = 0.038). Conclusion: At short-term followup, Kirschner wire transfixion of 6 weeks as opposed to 3 weeks showed a lower rate of recurrent malalignment without an increase in Kirschner wire associated complications. Level of Evidence: II, Prospective Comparative Study

Material and Biofilm Load of K Wires in Toe Surgery: Titanium versus Stainless Steel

“…Percutaneous K wire transfixation is the most common method of temporary toe immobilization after surgical correction of lesser toe deformities [9]. However, recurrent deformity may occur in up to 47% of the patients [9].…”

“…However, recurrent deformity may occur in up to 47% of the patients [9]. The risk for recurrence has been linked to primary malalignment owing to insufficient correction, insufficient stability of the resected joint, and too aggressive postoperative mobilization [5,9].…”

“…Various operative procedures include temporary fixation by percutaneous K wires. Recurrence rates of as much as 47% have been reported for toe deformities, with recurrences being mostly related to scar contractures [5,6,9]. Patients also frequently experience residual pain and swelling in the surgically treated toe [5,6].…”

Dual-Component Intramedullary Implant Versus Kirschner Wire for Proximal Interphalangeal Joint Fusion: A Randomized Controlled Clinical Trial

“…The use of K-wires, however, has distinct advantages. For example, an axial, intramedullary percutaneous K-wire that exits the tip of the toe and is maintained in place for 6 weeks has been associated with a lower incidence of recurrent misalignment (with no increase in K-wire-related complications) (24). However, many patients find that living with K-wires protruding from the tips of their toes for 6 weeks is not only inconvenient (e.g., no showering, no regular shoe gear) and sometimes painful, but is also anxiety-triggering owing to the prolonged disruption of body image (25).…”

Correction of Hammer Toe Deformity of Lateral Toes With Subtraction Osteotomy of the Proximal Phalanx Neck

“…Late complications have included nonunion, recurrence of the deformity, malalignment of the toe in the frontal plane at the level of PIPJ (surface not perpendicular to the axis of the phalanges), and rotational defects of the distal part of the toe on the frontal plane (5,(10)(11)(12). Thus, we decided to perform subtraction osteotomy of the proximal phalanx neck to obtain stable and lasting correction of the deformity, preservation of the joint motion of the PIPJ, and bony union with the characteristics of minimal invasiveness.…”