An underutilized technique: Box joint arthrodesis of the PIPJ for correction of hammertoe deformity without use of K-wires or commercial implants

Abstract

Two fundamental techniques exist for digital arthrodesis: end-to-end and peg-in-hole. Both methods require either k-wire fixation or commercially available implants which have been found to not be cost effective. For this reason, we will provide a detailed description of the box joint technique for correction of hammertoe deformity utilizing a single 2.0 headless screw with standard AO technique for PIPJ arthrodesis using box joint technique. This procedure was found to be a highly effective and stable technique for PIPJ joint arthrodesis with low rate of symptomatic nonunion (2.3%), hardware removal (2.3%) and revision (4.65%).Overall digital deformity correction continues to be a large part of every foot and ankle surgeon's practice. There are currently numerous, albeit expensive commercial implants on the market which allow for flexibility in fixation beyond traditional k-wire use. The box joint technique allows for a stable osteotomy with rigid internal fixation. Rates of complication in all hammertoe correction regardless of technique can be high with incidence in the literature of 7-27%. This technique offers an alternative option which respects both standard AO technique and cost with a low incidence of complications.