title: Arthrodesis of proximal inter-phalangeal joint for hammertoe: intramedullary device options.
abstract: BACKGROUND
  Proximal inter-phalangeal (PIP) joint arthrodesis today represents the standard treatment for structured hammertoes; however, recently, a lot of new intramedullary devices for the fixation of this arthrodesis have been introduced. The purpose of this work is to look at the currently available devices and to perform a review of the present literature.
  
  
  METHODS
  A literature search of PubMed/Medline and Google Scholar databases, considering works published up until September 2014 and using the keywords: hammertoe, arthrodesis, PIP joint, fusion, intramedullary devices, and K-wire, was performed. The published papers were included in the present study only if they met the following inclusion criteria: English articles, arthrodesis of PIP joints for hammertoes with new generation intramedullary devices, series with n > 10. Studies using absorbable pins or screws that are considered as another kind of fixation that involved more than one articulation, as well as comments, letters to the editor, or newsletters were excluded.
  
  
  RESULTS
  Nine publications were included. Of the patients' reports, 93-100 % were good or excellent concerning satisfaction. Radiological arthrodesis was achieved in 60.5-100 % of cases. Three of the publications compared the new devices with the K-wire. Of these three articles, two employed the traditional technique and one the buried technique. The AOFAS score, evaluated in three publications, showed a delta of 19, 45 and 58 points. Major complications, which required a secondary surgical revision, were between 0 and 8.6 %. The complications of the K-wire and the new devices were similar; also the reoperation rate was close to equal (maximal difference 2 %). On the other hand, these kinds of devices definitely have a higher price, compared to the K-wire.
  
  
  CONCLUSIONS
  The use of these new devices provides good results; however, their high price is currently a problem. For this reason, cost-benefit studies seem to be necessary to justify their use as standard treatment.
authors.affiliation: Orthopaedic and Traumatology Division, G. d'Annunzio University, Via dei Vestini 35, 66013, Chieti, Italy. matteogue@hotmail.com.|, Via Caprera 7/3, 16146, Genoa, Italy. matteogue@hotmail.com.
authors.forename: Matteo
authors.initials: M
authors.lastname: Guelfi
authors.affiliation: Orthopaedic and Traumatology Division, G. d'Annunzio University, Via dei Vestini 35, 66013, Chieti, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pantalone
authors.affiliation: Department of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Augenbruggerplatz 29, 8036, Graz, Austria.
authors.forename: Janos
authors.initials: J
authors.lastname: Cambiaso Daniel
authors.affiliation: Orthopaedic and Traumatology Division, G. d'Annunzio University, Via dei Vestini 35, 66013, Chieti, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Vanni
authors.affiliation: Orthopaedic Division, Clinica Montallegro, Via M.Te Zovetto 27, 16145, Genoa, Italy.
authors.forename: Marco G B
authors.initials: MG
authors.lastname: Guelfi
authors.affiliation: Orthopaedic and Traumatology Division, G. d'Annunzio University, Via dei Vestini 35, 66013, Chieti, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Salini
mesh_terms: D001174:Arthrodesis / Q000379:methods*; D037801:Hammer Toe Syndrome / Q000601:surgery*; D006801:Humans; D050277:Toe Phalanges / Q000601:surgery*
keywords: Arthrodesis; Fusion; Hammertoe; Intramedullary devices; K-wire; PIP joint; Review