title: Early complications and recurrence rates after Kirschner wire transfixion in lesser toe surgery: a prospective randomized study.
abstract: BACKGROUND
  Prolonged percutaneous Kirschner wire transfixion after correction of lesser toe deformities has been associated with an increased rate of complications such as infection, wire breakage or loosening. Currently, the duration of wire transfixion is based on the surgeons' opinion rather than on evidence. We hypothesized that a transfixion time of 3 weeks when compared to 6 weeks would decrease complication rates without an increase in the rate of recurrent deformity.
  
  
  METHODS
  We prospectively randomized 52 lesser toes corrected for a moderate hammer- or claw toe deformity by means of resectional arthroplasty of the proximal interphalangeal joint into two groups with 3 and 6 weeks of Kirschner wire transfixion, respectively. Kirschner wire-associated complication rates and incidence of early recurrence of malalignment in a short term followup of three months were assessed. Forty-six toes, 23 in each group, were available for final followup.
  
  
  RESULTS
  No statistically significant differences were found in pre- and postoperative total AOFAS scores between the groups. No Kirschner wire associated complications occurred. Recurrent malalignment was more often documented in the group with 3 weeks of transfixion (11 of 23 toes, 47.8%) when compared to 6 weeks (two of 23 toes, 8.7%) at 3 months followup. Interphalangeal joint motion was significantly reduced with prolonged Kirschner wire transfixion, indicating a more stable fibrous union (p = 0.038).
  
  
  CONCLUSIONS
  At short-term followup, Kirschner wire transfixion of 6 weeks as opposed to 3 weeks showed a lower rate of recurrent malalignment without an increase in Kirschner wire associated complications.
authors.affiliation: University of Zurich, Balgrist Orthopaedics, Zürich, Switzerland.
authors.forename: Georg
authors.initials: G
authors.lastname: Klammer
authors.forename: Gregor
authors.initials: G
authors.lastname: Baumann
authors.forename: Beat Kaspar
authors.initials: BK
authors.lastname: Moor
authors.forename: Mazda
authors.initials: M
authors.lastname: Farshad
authors.forename: Norman
authors.initials: N
authors.lastname: Espinosa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods; D001864:Bone Wires; D005260:Female; D005530:Foot Deformities / Q000601:surgery*; D037801:Hammer Toe Syndrome / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D018709:Statistics, Nonparametric; D013997:Time Factors; D014033:Toe Joint / Q000601:surgery*