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

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0042
Author(s):  
V. James Sammarco ◽  
Josika A. Sammarco ◽  
Allegra L. Delman
Keyword(s):  
Low Cost ◽  
Cost Savings ◽  
Clinical Results ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Potential Cost ◽  
Common Procedure ◽  
Non Union ◽  
Wire Fixation

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.

The Treatment of Dorsal Fracture-Dislocation of the Proximal Interphalangeal Joint by Closed Reduction and Kirschner Wire Fixation: A 16-Year Follow Up

2001 ◽  
Vol 26 (6) ◽  
pp. 537-540 ◽  
Author(s):  
D. P. NEWINGTON ◽  
T. R. C. DAVIS ◽  
N. J. BARTON
Keyword(s):  
Closed Reduction ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Long Term Results ◽  
Kirschner Wire Fixation ◽  
Wire Fixation

Ten patients who had sustained 11 unstable dorsal fracture-dislocations of finger proximal interphalangeal joints were reviewed at a mean follow-up of 16 years. All had been treated acutely by closed reduction and transarticular Kirschner wire fixation of the proximal interphalangeal joint, without any attempt at reduction of the fracture of the base of the middle phalanx, which probably involved 30–60% of the articular surface. Seven of the ten patients complained of no finger pain or stiffness, and none complained of severe pain. There was a mean fixed flexion deformity of 81 at the proximal interphalangeal joint, which had a mean arc of movement of 851. Although subchondral sclerosis and mild joint space narrowing were observed in some instances, there were no severe degenerative changes. These results confirm that this technique is a reliable treatment method for these injuries, and produces satisfactory long-term results.

Problematic Bone Fixation with Pyrocarbon Implants in Proximal Interphalangeal Joint Replacement: Short-Term Results

2006 ◽  
Vol 31 (6) ◽  
pp. 643-651 ◽  
Author(s):  
D. B. HERREN ◽  
S. SCHINDELE ◽  
J. GOLDHAHN ◽  
B. R. SIMMEN
Keyword(s):  
Pain Relief ◽  
Joint Replacement ◽  
Clinical Results ◽  
Pain Scale ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Short Term ◽  
Functional Rehabilitation ◽  
Bone Fixation

Seventeen pyrocarbon PIP prostheses were implanted into 14 patients, followed prospectively and reviewed clinically. The patients were assessed after a mean follow-up of 20.5 months subjectively by a VAS pain scale and radiographically. Significant pain relief was noted in all patients from a mean of 7.6 pre-operatively to 1.3 at final follow-up. Migration of one, or both, components was observed radiographically in eight joints and radiolucent lines were evident in three more cases. The clinical results of the implants which had migrated were less favourable for range of motion and grip strength than the stable joints of this series, although, statistically, the results were not significant. The number of possibly unstable prostheses in this series raises the question as to whether pyrocarbon is suitable for uncemented pressfit fixation in combination with early functional rehabilitation.

HEMI-HAMATE ARTHROPLASTY VERSUS TRANSARTICULAR KIRSCHNER WIRE FIXATION FOR UNSTABLE DORSAL FRACTURE-DISLOCATION OF THE PROXIMAL INTERPHALANGEAL JOINT IN THE HAND

Hand Surgery ◽  
2015 ◽  
Vol 20 (01) ◽  
pp. 115-119 ◽  
Author(s):  
R. C. Barksfield ◽  
B. Bowden ◽  
A. J. Chojnowski
Keyword(s):  
Bone Grafting ◽  
Kirschner Wire ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Kirschner Wire Fixation ◽  
Wire Fixation ◽  
Fracture Dislocations ◽  
Fixed Flexion Deformity

Following the introduction of the hemi-hamate arthroplasty (HHA) technique to our unit, we sought to evaluate the early clinical outcomes achieved with this method of fixation and compare these with simple trans-articular Kirschner wire (K-wire) fixation for dorsal fracture dislocations (DFD) of the proximal interphalangeal joint (PIPJ). Ninteen patients underwent fixation of these injuries with either K-wire fixation (12/19) or hemi-hamate bone grafting (7/19) between 2005 and 2011. At a mean follow-up of 14 weeks median arc of movement at the PIPJ was 65° (range 31° to 108°) following HHA and 56° (range 9° to 85°) (p = 0.82) following temporary transarticular K-wire fixation. Median fixed flexion deformity (FFD) was 20° and 15° for hemi-hamate bone grafting and K-wire fixation respectively. Based upon our findings, transarticular K-wire fixation produced equivalent outcomes to HHA for unstable DFD of the PIPJ in the hand.

Ten year follow-up of pyrocarbon implants for proximal interphalangeal joint replacement

2014 ◽  
Vol 39 (6) ◽  
pp. 582-586 ◽  
Author(s):  
L. Reissner ◽  
S. Schindele ◽  
S. Hensler ◽  
M. Marks ◽  
D. B. Herren
Keyword(s):  
Visual Analogue Scale ◽  
Migration Rate ◽  
Analogue Scale ◽  
Clinical Results ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
High Migration Rate ◽  
The Mean ◽  
High Migration

Results of anatomical resurfacing of the proximal interphalangeal joint using pyrocarbon implants showed reasonable clinical results with a high radiographic migration rate. The aim was to investigate the subjective, clinical, and radiographic results 10 years following surgery, and to compare them with our 2-year follow-up data. We re-evaluated 12 patients with 15 proximal interphalangeal implants on average 9.7 years after surgery. Pain significantly improved from 7.6 on a visual analogue scale pre-operatively to 1.4 at 2 years, and to 0.7 at the final follow-up. The mean total range of motion in all replaced joints was 36° pre-operatively and 39° at the 2-year follow-up, but had decreased significantly to 29° at 10 years. We saw one implant migration in addition to the eight migrated implants we already found 2 years after surgery. The moderate clinical results, combined with the high migration rate, mean that we no longer use this kind of implant.

Surgery of the Hand in Severe Systemic Sclerosis

2004 ◽  
Vol 29 (6) ◽  
pp. 599-603 ◽  
Author(s):  
M. K. GILBART ◽  
B. M. JOLLES ◽  
P. LEE ◽  
E. R. BOGOCH
Keyword(s):  
Systemic Sclerosis ◽  
High Speed ◽  
Hand Surgery ◽  
Metacarpophalangeal Joint ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Non Union ◽  
Joint Fusion ◽  
Lost To Follow Up

Ten patients with scleroderma and severe hand problems required surgery, and seven were available for follow-up (two died from scleroderma-related complications and one was lost to follow-up). The mean duration of follow-up was 4 (range 1.5–9) years. Thirty-three procedures were carried out, including five metacarpophalangeal joint exisional arthroplasties, 13 proximal interphalangeal joint fusions, ten distal interphalangeal joint fusions, and one thumb interphalangeal joint fusion. The metacarpophalangeal joint excision arthroplasties and proximal interphalangeal joint fusions were performed for the correction of severe fixed “finger-in-palm” deformities. Lesions of cutaneous calcinosis were removed in four patients. Fixation was satisfactory in all cases of interphalangeal joint fusion, with no cases of non-union. Wound healing was satisfactory in six of seven patients. A second surgical procedure was required in three patients for the removal of tension band wires following interphalangeal fusion. Calcinosis was effectively removed using a high-speed dental burr. The results of hand surgery for systemic sclerosis are reliable, but goals must be limited and patient expectations should be modest.

Results of Vascularized Joint Transfers from the Foot

1997 ◽  
Vol 22 (4) ◽  
pp. 492-498 ◽  
Author(s):  
G. DAUTEL ◽  
M. MERLE
Keyword(s):  
Joint Space ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Indications For Surgery ◽  
Pip Joint ◽  
Prosthetic Implant ◽  
Metatarsophalangeal Joints ◽  
Second Toe ◽  
The Average Range

We report our results in ten cases of vascularized joint transfer to reconstruct the proximal interphalangeal joint (five cases) or metacarpophalangeal joints (five cases). Donor sites were the proximal interphalangeal or the metatarsophalangeal joints of the second toe. Indications for surgery were the need to reconstruct both the growth plate and joint space in children or the impossibility of a conventional prosthetic implant. The average range of motion was 44° for the PIP joint and 53° for the MP joint at a mean follow-up of 22.7 months.

Results of Treatment of Chronic Dorsal Fracture-Dislocations of the Proximal Interphalangeal Joints of the Fingers

1998 ◽  
Vol 23 (6) ◽  
pp. 798-801 ◽  
Author(s):  
O. ISHIDA ◽  
Y. IKUTA
Keyword(s):  
Articular Cartilage ◽  
Internal Fixation ◽  
Open Reduction ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Fracture Dislocation ◽  
Results Of Treatment ◽  
Palmar Plate ◽  
Fracture Dislocations

We reviewed 20 cases of chronic dorsal fracture-dislocation of the proximal interphalangeal joint, with a mean follow-up period of 74 months. In patients without comminuted palmar fragments, open reduction and internal fixation or osteotomy of the malunited fragment provided good results. In treating patients with damaged articular cartilage or with comminuted palmar fragments by palmar plate arthroplasty, poor results were obtained because of secondary osteoarthritic changes.

Volar plating versus external fixation for unstable dorsal fracture-dislocations of the proximal interphalangeal joint

2021 ◽  
pp. 175319342110593
Author(s):  
Atsuhiko Murayama ◽  
Kentaro Watanabe ◽  
Hideyuki Ota ◽  
Shigeru Kurimoto ◽  
Hitoshi Hirata
Keyword(s):  
External Fixation ◽  
Proximal Interphalangeal Joint ◽  
Interphalangeal Joint ◽  
Volar Plating ◽  
Distal Interphalangeal Joint ◽  
Active Flexion ◽  
Plate Group ◽  
Fracture Dislocations ◽  
Distal Interphalangeal

We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of –6° and –9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and –5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating. Level of evidence: IV

scholarly journals Complications after Displaced Talar Neck Fracture: Results from a Case Series and a Critical Review of Literature

2018 ◽  
Vol 12 (1) ◽  
pp. 567-575
Author(s):  
D. Leonetti ◽  
B. Di Matteo ◽  
P. Barca ◽  
S. Cialdella ◽  
F. Traina ◽  
...  
Keyword(s):  
Functional Performance ◽  
Case Series ◽  
Clinical Results ◽  
Fracture Dislocation ◽  
Review Of Literature ◽  
Non Union ◽  
Fracture Dislocations ◽  
Neck Fracture ◽  
Talar Fractures

Introduction: Talar fractures are uncommon injuries, whose outcome is often characterized by the onset of serious complications. The aims of the present study are: 1) to review the available evidence concerning the outcome and complications of talar neck fractures; 2) to describe the clinical results and the rate of post-op complications in a series of patients treated surgically after talar fracture-dislocations. Materials and methods: The review of the literature was performed on the Pubmed, Embase and Web of Science databases and aimed at identifying clinical trials with at least 10 patients and dealing with surgical management of talar fracture-dislocation (Hawkins grade II to IV). All the papers were analyzed to extract data concerning common complications such as non-union, mal-union, infection, osteonecrosis and osteoarthtritis. The clinical arm of this paper included 26 patients (19 men and 7 women), who underwent fixation of displaced talar fracture by cannulated screws and were retrospectively evaluated, both clinically and radiographically, at a mean 51.2 ± 23.4 months of follow-up. Results: The evaluation through the AOFAS score revelead a loss of functional performance with respect to the pre-injury status. Four patients were re-operated within final follow up, whereas the remaining 22 presented excellent results in 2 cases, good results in 4 cases, fair results in 11 cases and poor results in 5 cases. Osteoarthritis and osteonecrosis incidence were 51.9% and 25.9% respectively. Sixteen studies were included in the review and it was confirmed that the most frequent complication was post-traumatic OA, followed by osteonecrosis and mal-union. A variable range in percentage of complications described should be ascribed to the low quality of trials currently available. Conclusion: Displaced talar fracture are challenging to treat and the outcomes at middle-term are often modest. Looking at complications, the present case series and the review of literature revealed that the most common one is peritalar OA. Osteonecrosis, traditionally regarded as the most fearsome adverse event, is relevant but less frequent than OA.

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