title: Material and biofilm load of K wires in toe surgery: titanium versus stainless steel.
abstract: BACKGROUND
  Recurrence rates for toe deformity correction are high and primarily are attributable to scar contractures. These contractures may result from subclinical infection.
  
  
  OBJECTIVE
  We hypothesized that (1) recurrence of toe deformities and residual pain are related to low-grade infections from biofilm formation on percutaneous K wires, (2) biofilm formation is lower on titanium (Ti) K wires compared with stainless steel (SS) K wires, and (3) clinical outcome is superior with the use of Ti K wires compared with SS K wires.
  
  
  METHODS
  In this prospective nonrandomized, comparative study, we investigated 135 lesser toe deformities (61 patients; 49 women; mean ± SD age, 60 ± 15 years) temporarily fixed with K wires between August 2010 and March 2011 (81 SS, 54 Ti). K wires were removed after 6 weeks. The presence of biofilm-related infections was analyzed by sonication.
  
  
  RESULTS
  High bacterial loads (> 500 colony-forming units [CFU]/mL) were detected on all six toes requiring revision before 6 months. Increased bacterial load was associated with pain and swelling but not recurrence of the deformity. More SS K wires had greater than 100 CFU/mL bacteria than Ti K wires. For K wires with a bacterial count greater than 100 CFU/mL, toes with Ti K wires had a lower recurrence rate, less pain, and less swelling than toes with SS K wires.
  
  
  CONCLUSIONS
  Ti K wires showed superior clinical outcomes to SS K wires. This appears to be attributable to reduced infection rates. Although additional study is needed, we currently recommend the use of Ti K wires for the transfixation of toe deformities.
  
  
  METHODS
  Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Clinic for Orthopaedic and Trauma Surgery, Kantonsspital Baselland, Liestal, Switzerland. martin.clauss@ksli.ch
authors.forename: Martin
authors.initials: M
authors.lastname: Clauss
authors.forename: Susanne
authors.initials: S
authors.lastname: Graf
authors.forename: Silke
authors.initials: S
authors.lastname: Gersbach
authors.forename: Beat
authors.initials: B
authors.lastname: Hintermann
authors.forename: Thomas
authors.initials: T
authors.lastname: Ilchmann
authors.forename: Markus
authors.initials: M
authors.lastname: Knupp
mesh_terms: D000368:Aged; D058491:Bacterial Load; D018441:Biofilms; D001864:Bone Wires / Q000009:adverse effects* / Q000382:microbiology; D003114:Colony-Forming Units Assay; D005260:Female; D005530:Foot Deformities / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation*; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000517:prevention & control*; D012008:Recurrence; D013193:Stainless Steel; D013997:Time Factors; D014025:Titanium; D050277:Toe Phalanges / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D013193:Stainless Steel; D014025:Titanium