title: Correction of Hammertoe Deformity With Novel Intramedullary PIP Fusion Device Versus K-Wire Fixation.
abstract: BACKGROUND
  K-wire fixation has been the most common method of fixation for hammertoe deformity. However intramedullary devices are gaining ground in both number of available choices and in procedures performed. This study aimed to compare the outcomes of hammertoe correction performed with K-wire fixation versus a novel intramedullary fusion device (CannuLink).
  
  
  METHODS
  A retrospective review of hammertoe correction by a single surgeon was performed from June 2011 to December 2013. Sixty patients (95 toes) underwent K-wire fixation and 39 patients (54 toes) underwent fusion with the CannuLink implant. Average age was 61.7 years and 61.4 years, respectively. Average length of follow-up was 12.9 and 12.3 months, respectively. Patients were evaluated for medical comorbidities, smoking status, inflammatory arthritis, peripheral vascular disease, peripheral neuropathy, pre- and postoperative visual analog pain scale, bony union percentage, revision rate, complications (hardware and surgery-related), and persistent symptoms at last follow-up. There was no significant difference in demographics or comorbidities between the 2 groups ( P > .05).
  
  
  RESULTS
  In the K-wire group, 16 patients (18 toes) remained symptomatic at last follow-up (27%). Nine toes (9.5%) had recurrent deformity, 3 toes (3%) developed a late infection because of the recurrent deformity, and 1 toe (1%) developed partial numbness. One patient suffered a calf deep vein thrombosis (DVT) and peroneal nerve neuritis, 1 patient developed foot drop, and 3 patients continued to complain of pain. Five toes required revision surgery (5.3%). In the intramedullary group, 3 (7.7%) patients remained symptomatic and all were associated with a complication. One patient developed chronic regional pain syndrome in the foot, a calf DVT, and a nonfatal pulmonary embolus. A second patient developed a painless recurrent deformity. A third patient had wound dehiscence. Nobody had hardware failure or required a second operation.
  
  
  CONCLUSIONS
  The CannuLink intramedullary device for hammertoe correction resulted in fewer complications, only 1 recurrent deformity, and no reoperations compared with K-wire fixation.
  
  
  METHODS
  Level III, retrospective comparative study.
authors.affiliation: 1 Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Seth H
authors.initials: SH
authors.lastname: Richman
authors.affiliation: 1 Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Marcelo Bogliolo Piancastelli
authors.initials: MB
authors.lastname: Siqueira
authors.affiliation: 2 Orthopaedic Surgery, University of Missouri-Kansas City, Leawood, KS, USA.
authors.forename: Kirk A
authors.initials: KA
authors.lastname: McCullough
authors.affiliation: 1 Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Berkowitz
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000295:instrumentation; D001864:Bone Wires; D005500:Follow-Up Studies; D037801:Hammer Toe Syndrome / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies
keywords: CannuLink; K wire; PIP fusion; hammertoe; intramedullary device; lesser toe deformity; toe implant