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J Foot Ankle Surg. 2016 May-Jun;55(3):480-7. doi: 10.1053/j.jfas.2016.01.027. Epub 2016 Feb 12.

Two-Pin Fixation of Proximal Interphalangeal Joint Fusion for Hammertoe Correction.

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Director, Foot and Ankle Surgical Residency Program, Regions Hospital/HealthPartners Institute for Education and Research, St. Paul, MN. Electronic address:
Foot and Ankle Surgeon, Orthopedic Center, Mayo Clinic Health System, Eau Claire, WI.
Foot and Ankle Surgeon, Essentia Health, Brainerd, MN.


Single-pin external Kirschner wire (K-wire) fixation has traditionally been a mainstay in proximal interphalangeal joint fusion for central hammertoe repair. Concerns over cosmesis, inconvenience, pin tract infection, hardware failure, nonunion, and early hardware removal have led to the development of implantable internal fixation devices. Although numerous implantable devices are now available and represent viable options for hammertoe repair, they are costly and often pose a challenge in the event removal becomes necessary. An alternative fixation option not typically used is a 2-pin K-wire fixation technique. The perceived advantage of obtaining 2 points of fixation compared with 1 across the fusion site is improved stability against the rotational and bending forces, thus decreasing the potential for pin-related complications. A retrospective assessment of 91 consecutive hammertoe repairs consisting of proximal interphalangeal joint fusion with 2-pin fixation in 60 patients was performed. The K-wires were removed at 6 weeks postoperatively, and the overall postoperative follow-up duration was 28.56 (range 1.40 to 86.83) months. Of the 91 digits, 89 (98%) did not encounter a complication postoperatively and 2 (2.20%) had sustained loosened or broken hardware. No postoperative infection was encountered. The low incidence of complications observed supports the 2-pin K-wire fixation technique as a low-cost and viable construct for proximal interphalangeal joint fusion hammertoe repair.


Kirschner wire; claw toe; digital contracture; proximal phalanx; toe

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