Temporary Kirschner Wire Transfixation Versus Strapping Dressing After Second MTP Joint Realignment Surgery

Abstract

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. 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. 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. 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 III, therapeutic study.