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Concept: Kirschner wire

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Kirschner wire (K-wire) fixation across the metatarsophalangeal joint (MTPJ) is commonly used in hammertoe repair surgery. The purpose of the present study was twofold: (1) to determine where the K-wire penetrates the metatarsal articular surface to achieve a rectus digit; and (2) to quantify the percentage of cartilage disruption to better understand the consequences of K-wire transfixation of the MTPJ. Arthrodesis was conducted on the second, third, and fourth proximal interphalangeal joints of 10 below-the-knee cadaver specimens, using a 1.6-mm K-wire. Digital alignment was confirmed with simulated weightbearing intraoperatively and radiographically. The K-wire was removed, and the MTPJ was dissected until the metatarsal head was fully exposed. The penetration point was plotted on a quadrant system with deviation noted from the epicenter. Center was defined as the point equidistant from the medial-to-lateral and superior-to-inferior edges on the distal surface of the metatarsal head, excluding the plantar condyles. Statistically significantly deviations were found in the K-wire placement from the center (35.9% ± 17.5%, p < .001), medial-to-lateral width (22.2% ± 19.2%, p < .001), and dorsal-to-plantar height (15.8% ± 25.0%, p = .002). Relative to the center, the K-wire was superior in 22 (79%), inferior in 6 (21%), medial in 22 (79%), and lateral in 6 (21%) of the cadaveric MTPJs. The mean percentage of disruption of the articular cartilage was 1.8% ± .4% and was similar for the second, third, and fourth MTPJs (p = .13) and for the left and right feet (p = .75). This information could be used to guide surgeons when they transfixate the MTPJ during hammertoe correction and might contribute to preservation of the articular cartilage.

Concepts: Bone, Skeletal system, Osteoarthritis, Knee, Joint, Joints, Length, Kirschner wire

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The surgical correction of hammer digits offers a variety of surgical treatments ranging from arthroplasty to arthrodesis, with many options for fixation. In the present study, we compared 2 buried implants for arthrodesis of lesser digit deformities: a Smart Toe(®) implant and a buried Kirschner wire. Both implants were placed in a prepared interphalangeal joint, did not violate other digital or metatarsal joints, and were not exposed percutaneously. A retrospective comparative study was performed of 117 digits with either a Smart Toe(®) implant or a buried Kirschner wire, performed from January 1, 2007 to December 31, 2010. Of the 117 digits, 31 were excluded because of a lack of 90-day radiographic follow-up. The average follow-up was 94 to 1130 days. The average patient age was 61.47 (range 43 to 84) years. Of the 86 included digits, 48 were left digits and 38 were right. Of the digits corrected, 54 were second digits, 24 were third digits and 8 were fourth digits. Fifty-eight Smart Toe(®) implants were found (15 with 19-mm straight; 2 with 19-mm angulated; 34 with 16-mm straight; and 7 with 16-mm angulated). Twenty-eight buried Kirschner wires were evaluated. No statistically significant difference was found between the Smart Toe(®) implants and the buried Kirschner wires, including the rate of malunion, nonunion, fracture of internal fixation, and the need for revision surgery. Of the 86 implants, 87.9% of the Smart Toe(®) implants and 85.7% of the buried Kirschner wires were in good position (0° to 10° of transverse angulation on radiographs). Osseous union was achieved in 68.9% of Smart Toe(®) implants and 82.1% of buried Kirschner wires. Fracture of internal fixation occurred in 12 of the Smart Toe(®) implants (20.7%) and 2 of the buried Kirschner wires (7.1%). Most of the fractured internal fixation and malunions or nonunions were asymptomatic, leading to revision surgery in only 8.6% of the Smart Toe(®) implants and 10.7% of the buried Kirschner wires. Both the Smart Toe(®) implant and the buried Kirschner wire offer a viable choice for internal fixation of an arthrodesis of the digit compared with other studies using other techniques.

Concepts: Bone, Fracture, Surgery, Statistical significance, Implants, Orthopedic surgery, Joints, Kirschner wire

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Hammertoe digital deformity correction is a very controversial topic among foot and ankle surgeons. Hammertoes are characterized by an extension deformity at the metatarsophalangeal joint (MTPJ) and flexion deformity at the proximal interphalangeal joint (PIPJ). Current treatment options are often guided by the patient’s discomfort as well as the reducibility of the affected digit. Kirschner wires (K-wires) have long been considered the gold standard for hammertoe digital repair. Although K-wires are simplistic to use as fixation, they carry inherit risks such as pin tract infections, migration, and breakage. This has lead to multiple intramedullary hammertoe devices including the PROTOE intramedullary device. This paper will discuss the usage and benefits the PROTOE has to offer over the conventional K - wire. Level of Evidence: IV.

Concepts: Foot, Device, Knee, Joints, Wire, Kirschner wire, Hammer toe

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Isolated traumatic carpometacarpal (CMC) dislocation of the thumb is a rare injury. There are many different ways to manage a thumb CMC joint dislocation which ranges from closed reduction with or without Kirschner wires and casting to ligament reconstruction. However, it is still up for debate on the best management for this injury. We describe a case of isolated traumatic carpometacarpal dislocation of the first CMC joint in a 22-year-old student and reviewed the evidence on management. Our patient was managed with manipulation under anaesthesia (MUA). She returned to preinjury activities with no difficulties within 2 months. Good outcomes can be achieved with MUA to manage dislocation of the first CMC joint; however, those with high activity of the hand may also benefit from ligament reconstruction.

Concepts: Activity, Joints, Hand, Carpometacarpal joint, Kirschner wire

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SUMMARY:: Although Kirschner wires (K-wires) are useful implants in many situations, migration of the wire and irritation of the surrounding soft tissues are common complications. Seven steps are described herein which result in a K-wire that is bent 180°, providing a smooth anchor into bone. Use of this technique produces implants that provide stable fixation with few soft tissue complications.

Concepts: Soft tissue sarcoma, Tissues, Implants, Orthopedic surgery, Soft tissue, Wire, Ilizarov apparatus, Kirschner wire

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BACKGROUND: Instability of the second metatarsophalageal (MTP) joint is a common disorder of the forefoot and can be addressed operatively. The objective of this study was to compare a temporary K-wire fixation (tKW) to a postoperative strapping dressing (SD) after realignment surgery of second MTP instability in combination with correction of claw toe deformity. METHODS: Fifty-four consecutive patients with metatarsal index plus or neutral and a collective total of 62 operative interventions were examined at 10 years postoperatively. The operative intervention included dorsal capsulotomy, incision of the extensor hood, and lengthening of the extensor tendon. All operations were carried out at a single institution by orthopedic surgeons experienced in foot surgery. One team preferred fixation with tKW, whereas the other team used only noninvasive SD for postoperative management. The assessment included the American Orthopaedic Foot & Ankle Society (AOFAS) metatarsophalangeal-interphalangeal score as well as the visual analogue scale (VAS) for pain. Kaplan Meier analysis with recurrence of subluxation as the end point was performed, and plain radiographs of the forefoot were investigated. RESULTS: Survival without recurrence of second MTP subluxation was significantly higher in the tKW group (93%) compared with the SD group (88%) (P < .001). There was no statistical significant difference in pre- to postoperative AOFAS and VAS pain between the 2 groups. CONCLUSION: Temporary K-wire fixation had a significantly lower recurrence rate of second MTP subluxation compared with postoperative SD for postoperative alignment management in second MTP instability. LEVEL OF EVIDENCE: Level III, therapeutic study.

Concepts: Bone fracture, Surgery, Foot, Orthopedic surgery, Distraction osteogenesis, Arthroscopy, Ilizarov apparatus, Kirschner wire

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INTRODUCTION: Mallet finger, well-known also as drop finger or baseball finger, is a frequent deformity after extensor tendons injury in the fingers. Although numerous nonoperative or operative techniques have been used in managing this deformity, the treatment still remains a debated subject. PATIENTS AND METHODS: Starting from 1996, 121 fingers in 118 patients with neglected deformity or unsuccessful splinting older than 10 days underwent surgical treatment. In 101 patients a tendinous mallet finger was present, and in 20 patients a bony mallet finger. After immobilising the distal interphalangeal (DIP) joint at 0° extension with a Kirschner wire, the extensor tendon was repaired by using a dorsal deepithelialised skin flap reinserted transosseous. The DIP joint was immobilised for 6 weeks in a thermoplastic splint, and after that it was gradually weaned from the immobilisation. An overnight splint was used for 4-6 weeks after starting the mobilisation. RESULTS: The mean follow-up period was 10 months (range: 3-120 months). An excellent result in 89 fingers and a good result in 32 fingers were obtained, according to Crawford’s evaluation criteria. CONCLUSION: This method seems to be a new reliable alternative in the treatment of chronic mallet finger.

Concepts: Knee, Orthopedic surgery, Extension, Ligament, Tendon, Finger, Kirschner wire, Splint

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There is little consensus on whether Kirschner wire (K-wire) burial is preferable in the management of paediatric lateral humeral condyle fractures. We identified 124 patients from May 2008 to August 2014. Sixty received buried K-wires and 64 received unburied wires. We found no significant difference in the infection rates between groups, but a high rate of skin erosion (23%) in the buried group, with a subsequent high rate of infection in this subgroup (40%). We found a strong association of wire erosion following early surgery. There is a considerable cost saving associated with using unburied wires. We therefore recommend the routine use of unburied wires.

Concepts: Medicine, Ilizarov apparatus, Kirschner wire

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Historically, management of displaced midshaft clavicle fractures has consisted of nonsurgical treatment. However, recent literature has supported surgical repair of displaced and shortened clavicle fractures. Multiple options exist for surgical fixation, including plate and intramedullary (IM) fixation. IM fixation has the potential advantages of a smaller incision and decreased dissection and soft-tissue exposure. For the last two decades, the use of Rockwood and Hagie pins represented the most popular form of IM fixation, but concerns exist regarding stability and complications. The use of alternative IM implants, such as Kirschner wires, titanium elastic nails, and cannulated screws, also has been described in limited case series. However, concerns persist regarding the complications associated with the use of these implants, including implant failure, migration, skin complications, and construct stability. Second-generation IM implants have been developed to reduce the limitations of earlier IM devices. Although anatomic and clinical studies have supported IM fixation of midshaft clavicle fractures, further research is necessary to determine the optimal fixation method.

Concepts: Medicine, Clinical trial, Implants, Anatomy, Human anatomy, Dental implant, Clavicle fracture, Kirschner wire

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