Richman Seth H, Siqueira Marcelo Bogliolo Piancastelli, McCullough Kirk A, Berkowitz Mark J
1 Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
2 Orthopaedic Surgery, University of Missouri-Kansas City, Leawood, KS, USA.
Foot Ankle Int. 2017 Feb;38(2):174-180. doi: 10.1177/1071100716671883. Epub 2016 Oct 22.
K-wire fixation has been the most common method of fixation for hammertoe deformity. However intramedullary devices are gaining ground in both number of available choices and in procedures performed. This study aimed to compare the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device (CannuLink).
A retrospective review of hammertoe correction by a single surgeon was performed from June 2011 to December 2013. Sixty patients (95 toes) underwent K-wire fixation and 39 patients (54 toes) underwent fusion with the CannuLink implant. Average age was 61.7 years and 61.4 years, respectively. Average length of follow-up was 12.9 and 12.3 months, respectively. Patients were evaluated for medical comorbidities, smoking status, inflammatory arthritis, peripheral vascular disease, peripheral neuropathy, pre- and postoperative visual analog pain scale, bony union percentage, revision rate, complications (hardware and surgery-related), and persistent symptoms at last follow-up. There was no significant difference in demographics or comorbidities between the 2 groups ( P > .05).
In the K-wire group, 16 patients (18 toes) remained symptomatic at last follow-up (27%). Nine toes (9.5%) had recurrent deformity, 3 toes (3%) developed a late infection because of the recurrent deformity, and 1 toe (1%) developed partial numbness. One patient suffered a calf deep vein thrombosis (DVT) and peroneal nerve neuritis, 1 patient developed foot drop, and 3 patients continued to complain of pain. Five toes required revision surgery (5.3%). In the intramedullary group, 3 (7.7%) patients remained symptomatic and all were associated with a complication. One patient developed chronic regional pain syndrome in the foot, a calf DVT, and a nonfatal pulmonary embolus. A second patient developed a painless recurrent deformity. A third patient had wound dehiscence. Nobody had hardware failure or required a second operation.
The CannuLink intramedullary device for hammertoe correction resulted in fewer complications, only 1 recurrent deformity, and no reoperations compared with K-wire fixation.
Level III, retrospective comparative study.
克氏针固定一直是锤状趾畸形最常用的固定方法。然而，髓内固定装置在可选择的数量和实施的手术数量方面都在逐渐增加。本研究旨在比较克氏针固定与一种新型髓内融合装置（CannuLink）矫正锤状趾的效果。
对一位外科医生在2011年6月至2013年12月期间进行的锤状趾矫正手术进行回顾性研究。60例患者（95趾）接受了克氏针固定，39例患者（54趾）接受了CannuLink植入物融合术。平均年龄分别为61.7岁和61.4岁。平均随访时间分别为12.9个月和12.3个月。对患者的医疗合并症、吸烟状况、炎性关节炎、外周血管疾病、外周神经病变、术前和术后视觉模拟疼痛量表、骨愈合百分比、翻修率、并发症（内固定物及手术相关）以及末次随访时的持续症状进行评估。两组在人口统计学或合并症方面无显著差异（P>.05）。
在克氏针组，16例患者（18趾）在末次随访时仍有症状（27%）。9趾（9.5%）出现复发性畸形，3趾（3%）因复发性畸形发生晚期感染，1趾（1%）出现部分麻木。1例患者发生小腿深静脉血栓形成（DVT）和腓总神经神经炎，1例患者出现足下垂，3例患者仍有疼痛主诉。5趾需要翻修手术（5.3%）。在髓内固定组，3例（7.7%）患者仍有症状，且均与并发症有关。1例患者足部出现慢性区域疼痛综合征、小腿DVT和非致命性肺栓塞。第2例患者出现无痛性复发性畸形。第3例患者伤口裂开。无人出现内固定物失败或需要二次手术。
与克氏针固定相比，用于矫正锤状趾的CannuLink髓内装置并发症更少，仅1例复发性畸形，且无需再次手术。
III级，回顾性比较研究。
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