Hendrick Scott E, Kannegieter Ewan
Podiatric Surgery Departments; Braintree Community Hospital, Essex CM7 2AL, United Kingdom; Mexborough Montagu Hospital, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, S64 0AZ, United Kingdom; Ilkeston Hospital, Derbyshire Community Health Service, NHS Foundation Trust, Heanor Road, DE7 8LN, United Kingdom.
Podiatric Surgery Departments; Braintree Community Hospital, Essex CM7 2AL, United Kingdom.
Foot (Edinb). 2020 Dec;45:101692. doi: 10.1016/j.foot.2020.101692. Epub 2020 May 21.
Proximal interphalangeal joint arthrodesis is a reliable and repeatable method of surgical correction for the semi-rigid and rigid hammer toe deformity. In recent years the authors have noted a significant increase in the use of novel intramedullary devices in place of the traditional percutaneous Kirschner wires (k-wire). This paper set out to critically review three methods of internal fixation; ToeGrip implant, SmartToe implant and buried k-wire technique in comparison to the traditional method of percutaneous k-wire fixation during arthrodesis of the proximal interphalangeal joints (PIPJ) of the toes. The objectives were to review osseous fusion rates, infection, hardware complications, patient satisfaction, and the comparative cost of each modality.
In total 3878 outcomes were reviewed consisting of 3255 percutaneous k-wires, 347 SmartToe implants, 218 ToeGrip implants, and 58 buried k-wires. Overall Infection rates where low; SmartToe infection rates ranged between 1.2% and 5%, percutaneous k-wire fixation 0.3%-7% buried k-wire 3.3%. The SmartToe Implant had the highest hardware failure rate up to 20.7%, the lowest hardware failure occurred in percutaneous k-wire studies at 0.1%-4.3%, no evidence of hardware failure was associated in both ToeGrip and buried k-wire techniques. Percutaneous k-wire migration ranged between 4.4%-5.5% and 3.8%-10% for the SmartToe implant, all significantly lower than buried k-wire migration of 33%. The SmartToe implant demonstrated the highest mean osseous union rate 87.2%, 83% in ToeGrip studies, similar results between the buried k-wire and percutaneous k-wire studies 72% and 73% respectively. Individual unit costs for k-wires £0.37, ToeGrip implant £236.94 and SmartToe implants £331, demonstrating a 640 and 894 fold increase in cost when using implants in comparison to k-wires. Patient satisfaction was poorly reported.
Percutaneous k-wire fixation remains a reliable and cost effective method of stabilisation during hammertoe correction in comparison to newer more costly implantable devices.
IV - critical literature review.
近端指间关节融合术是一种可靠且可重复的手术矫正方法，用于治疗半僵硬和僵硬的槌状趾畸形。近年来，作者注意到新型髓内装置的使用显著增加，取代了传统的经皮克氏针（k针）。本文旨在严格审查三种内固定方法；与传统的经皮克氏针固定方法相比，ToeGrip植入物、SmartToe植入物和埋入式k针技术在脚趾近端指间关节（PIPJ）融合术中的应用。目的是审查骨融合率、感染、硬件并发症、患者满意度以及每种方式的相对成本。
总共审查了3878例结果，包括3255根经皮k针、347个SmartToe植入物、218个ToeGrip植入物和58根埋入式k针。总体感染率较低；SmartToe感染率在1.2%至5%之间，经皮k针固定为0.3%-7%，埋入式k针为3.3%。SmartToe植入物的硬件故障率最高，可达20.7%，经皮k针研究中的硬件故障率最低，为0.1%-4.3%，ToeGrip和埋入式k针技术均未发现硬件故障的证据。SmartToe植入物的经皮k针迁移率在4.4%-5.5%之间，而SmartToe植入物的迁移率在3.8%-10%之间，均显著低于埋入式k针的迁移率33%。SmartToe植入物的平均骨愈合率最高，为87.2%，ToeGrip研究中为83%，埋入式k针和经皮k针研究的结果相似，分别为72%和73%。k针的单个单位成本为0.37英镑，ToeGrip植入物为236.94英镑，SmartToe植入物为331英镑，与k针相比，使用植入物时成本增加了640倍和894倍。患者满意度报告不佳。
与更新的、更昂贵的可植入装置相比，经皮k针固定在槌状趾矫正过程中仍然是一种可靠且具有成本效益的稳定方法。
IV - 批判性文献综述。
