Kleinzehendeformitäten

Bioabsorbable Fixation Screw for Proximal Interphalangeal Arthrodesis of Lesser Toe Deformities

BACKGROUND

Although standard fixation of proximal interphalangeal (PIP) arthrodesis by K-wire is relatively inexpensive and well established, it does have some drawbacks, making newer fixation devices interesting. The aim of this study was to clinically and radiologically assess the operative correction of the lesser toe deformation in the form of a PIP arthrodesis using a bioabsorbable 2.7-mm fixation screw.

METHODS

From January 2011 until October 2013, 34 patients underwent a PIP arthrodesis using the TRIM-IT (Arthrex) 2.7-mm fixation screw and were contacted for this retrospective cohort study. At an average of 3.3 years after the operation, 24 patients and 26 toes were evaluated clinically, radiologically, through pedobarography, and a patient-satisfaction survey.

RESULTS

Using the PLLA screw for fixation, 84.6% showed bony union of the arthrodesis, and 84.6% were satisfied. Mean AOFAS score was 82.7 points and thus regarded as good. The mean VAS score was 1.3/10. Overall, 73.1% of the toes showed good alignment, and 7.7% had a painless recurrence of deformity and were still satisfied with the intervention. In addition, 34.6% had floating toes, but only 4.2% without Weil osteotomy or encroachment. Further, 3.8% were advised to undergo a revision because of severe misalignment.

CONCLUSION

The 2.7-mm bioabsorbable fixation screw yielded results that were comparable to other fixation devices for PIP fusion fixation regarding success rate, revisions, and patient acceptance.

LEVEL OF EVIDENCE

Level IV, retrospective case series.

Prospective study of hammertoe correction with an intramedullary implant

BACKGROUND

Operative correction of a hammertoe deformity is often accomplished by excision of the articular surface of the proximal interphalangeal joint (PIP) and fixation across the joint. This study aimed to prospectively evaluate clinical and radiographic outcomes of hammertoe operative correction utilizing an internal implant and assess its ability to maintain postoperative alignment.

METHODS

Twenty-nine patients (53 toes) with a painful rigid hammertoe deformity were prospectively enrolled and operatively treated with resection arthroplasty of the PIP joint and fixation with an implant. Five patients were lost to follow-up, and 24 patients (42 toes) returned at an average of 12 months for final clinical and radiographic evaluation. All patients were evaluated pre- and postoperatively by AOFAS and Visual Analog Pain Scale (VAS) scores. On physical exam, the location and magnitude of the deformity, callosities, and digit circumference were recorded. Radiological parameters evaluated were digital alignment, successful union, implant position, and bone reaction.

RESULTS

All patients reported satisfaction at final follow-up, with an average improvement of AOFAS score from 52 (range, 24-87 points) to 71 (range, 42-95 points) points. The mean VAS pain score improved from 5 points (range, 2 to 10) preoperatively to 1 point (range, 0 to 5) postoperatively. Of patients, 87% reported an ability to return to their preoperative activities without limitations. Regarding digital alignment, there were no recurrent deformities or transverse plane deformities; 1 toe presented with a minor digital rotational deformity at final follow-up. Postoperative radiographs indicated 100% of proximal interphalangeal (PIP) joints with good alignment, and 81% demonstrated bony union.

CONCLUSION

Our results suggest that utilization of an internal implant for hammertoe correction was safe and provided acceptable alignment, pain reduction, and improved function at final follow-up.

LEVEL OF EVIDENCE

Level IV, case series.

Meta-analysis of flexor tendon transfer for the correction of lesser toe deformities

BACKGROUND

Transfer of the flexor digitorum longus tendon is one of the surgical techniques described to treat lesser toe deformities. A global analysis of the benefits of this procedure has not been presented in the literature to date. The aim of this meta-analysis was to evaluate the clinical benefit of transfer of the flexor digitorum longus tendon regarding patient satisfaction.

METHODS

A reviewer formally trained in meta-analysis abstraction techniques searched several databases to identify relevant published studies. Initially, 203 citations were identified and evaluated for relevance. Abstract screening produced 112 articles to be read in their entirety, of which 17 articles studying 515 procedures with a mean ± SD follow-up of 54.21 ± 20.64 months met all of the inclusion criteria necessary for analysis.

RESULTS

Overall crude patient satisfaction after flexor digitorum longus tendon transfer was 86.7% (95% confidence interval, 81.7%-90.5%). A low grade of heterogeneity across studies (Q = 24.458, I(2) =34.583, P = .080) and no influence of the individual studies on overall estimation were found. When adjusting for higher-quality prospective studies, overall patient satisfaction increased to 91.8%, although it did not reach statistical significance. Additional a priori sources of heterogeneity (age, sex, studies with <3 years of follow-up, percentage of patients lost to follow-up, and year of publication) were evaluated by subgroup analysis and meta-regression, but no statistical significance was found. This adjustment also significantly decreased heterogeneity across studies (crude Q = 24.458, high-quality studies Q = 1.504).

CONCLUSIONS

Regarding patient satisfaction, this comprehensive analysis provides supportive evidence of the clinical benefit of flexor digitorum longus tendon transfer.