Novel Extramedullary Fixation Device for Hammertoe Correction: A Retrospective Review of 100 patients

Abstract

Classically, one of the more common treatment options for rigid hammertoe correction consists of end-to-end arthrodesis stabilized by temporary Kirschner wire (K-wire) fixation maintained until osseous consolidation or complication necessitating premature removal. However, single K-wire fixation allows for axial rotation which results in loss of compression at the arthrodesis site. To counteract this, intramedullary implants were designed to provide fusion site stability in all planes negating extra-skeletal extension of the wire. Nevertheless, manual pressfit implants arguably offer less reliable positioning of the fusion site in a true end to end orientation due to variation in intramedullary stem placement compared to direct visualization with dorsal plating. Larger diameter implants create an osseous void at the bony interface reducing the potential of true bony union. Hammertoe implant failure poses a unique and challenging salvage scenario which can ultimately end in amputation. Extramedullary fixation is uniquely designed to merge both benefits of K-wires and intramedullary implants while eliminating inadequacies of each. A total of 100 patients who underwent 150 rigid hammertoe corrections with an extramedullary implant were retrospectively reviewed. The mean postoperative follow-up was 12.6 months (range 12-18 months). Overall, 94 of 100 patients (94%) achieved radiographic union, defined by 2 or more bridged cortices at the arthrodesis site without signs of hardware breakage or signs of lucency across one or more fusion sites at a mean 8.8 weeks (range 7-10 weeks). This study demonstrated excellent results in regards to postoperative arthrodesis when utilizing an extramedullary implant for hammertoe deformity correction. This device minimizes osseous deficit by extramedullary application, all while augmenting intramedullary K-wire fixation.