Ideal implant choice for proximal interphalangeal joint arthrodesis in hammer toe/claw toe deformity correction: A systematic review

Abstract

Intramedullary devices have been developed to reduce the problems associated with Kirschner (K)-wire fixation in proximal interphalangeal joint (PIPJ) arthrodesis. The purpose of this systematic review is to compare the surgical outcomes of K-wires versus novel internal fixation devices in PIPJ arthrodesis in claw/hammer toe surgery. The databases searched were PubMed, Scopus, Cochrane, and Embase with keywords “claw toe OR hammer toe” AND “proximal interphalangeal OR PIP” AND “fusion OR arthrodesis.” Clinical trials published in English with evidence levels I, II, and III were included. Five studies, including one randomized controlled trial and four case-controlled studies, were identified to meet the inclusion criteria. Overall, the studies showed promising results in union rates using the novel internal devices compared to K-wires. However, the novel internal devices seem not to present advantages in clinical parameters such as pain levels, patient satisfaction, foot-related function, or surgical complication rates.

The use of an Intra-medullary fusion system in hammer toe surgery; mid-term follow-up

“…Non-union, malunion, pin area infection, implant failure, and similar complications are frequently observed in patients treated with K-wire [12][13][14] . When performing an arthrodesis with Kwire, the fusion site cannot be compressed, and only the bone ends in the fusion field may be in contact 2 . The arthrodesis operation can be done on its own, but can also be paired with hallux valgus surgery.…”

“…Other common problems are pin migration and pin bending, which may lead to malalignment and deformity. In one case series, the rate of revision surgery was 33% due to the burrowing of the Kwire under the skin in the later post-operative period 2,5,11 . Baig et al applied the K-wire at the PIP joint during arthrodesis surgery on 19 patients.…”

“…More complex hammer toe deformity accompanies PIP flexion and MTP hyperextension at the distal interphalangeal (DIP) joint, which is in a neutral or sometimes hyperextended position. This serious deformity is as severe as any other of the many other deformities of the foot, but hammer toe may also present in more moderate forms, and may have a flexible or rigid type 1,2,3 . The size and severity of the deformity may be a factor in the success of the treatment modality used.…”

“…Hammer toe is among the common deformities of the forefoot and greatly impairs quality of life, while hallux valgus is commonest forefoot deformity, and both the deformities can be seen together It generally affects people between the 4th and 7th decade of life. There are many techniques for small toe arthrodesis 1,2 . Approximately 30% of hammer toe patients have a deformity of a single toe, and the incidence of hammer toe involving more than three toes is approximately 40% 2,3 .…”

“…There are many techniques for small toe arthrodesis 1,2 . Approximately 30% of hammer toe patients have a deformity of a single toe, and the incidence of hammer toe involving more than three toes is approximately 40% 2,3 . The aetiology of the deformity is multifactorial.…”