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Mateen S, Raja S, Casciato DJ, Siddiqui NA. Minimally Invasive Versus Open Hammertoe Correction: A Retrospective Comparative Study. J Foot Ankle Surg 2024; 63:156-160. [PMID: 37806485 DOI: 10.1053/j.jfas.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/18/2023] [Accepted: 09/30/2023] [Indexed: 10/10/2023]
Abstract
Hammertoe deformity is a common forefoot pathology, characterized by a progressive deformity with dorsiflexion of the proximal phalanx on the metatarsal head at the metatarsal phalangeal joint (MTPJ) and plantarflexion of the intermediate phalanx on the proximal phalanx at the proximal interphalangeal joint (PIPJ). While there is literature available discussing open techniques for hammertoe correction, there is a lack of publications discussing minimally invasive techniques, therefore the objective of this retrospective comparative study is to evaluate minimally invasive versus open hammertoe surgery in terms of time to osseous union, complications, recurrence, and return to full activity. Sixty eight feet among 41 patients met the inclusion criteria and were surveyed. Among the 68 feet, 54 feet (124 toes) underwent minimally invasive hammertoe correction and 14 feet (22 toes) underwent open hammertoe correction. Time to osseous union (weeks) in the MIS group was 8.76 ± 2.31 weeks with similar outcomes to the open group with union at 8.42 ± 2.31 (p = .65). Return to activity (weeks) was 10.47 ± 3.45 in the MIS group and 9.92 ± 3.03 in the open group with no statistical significance (p = .62). There was 4 recurrent hammertoe deformities in the MIS group (3.23%) with no recurrent hammertoes in the open group (0%). In the MIS group 5 hammertoes had unplanned hardware removal (4.03%) compared to 0 in the open group. There was no statistical significance for both recurrence and unplanned hardware removal (p = 1). Overall, we concluded that both techniques are equivocal with no detectable statistical difference.
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Affiliation(s)
- Sara Mateen
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD
| | - Shehryar Raja
- Resident, Rubin Institute for Advanced Orthopedics/VA Maryland Health Care System Podiatric Residency Program, Baltimore, MD
| | - Dominick J Casciato
- Fellow, Limb Preservation and Deformity Correction Fellowship, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Noman A Siddiqui
- International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD; Fellow, Limb Preservation and Deformity Correction Fellowship, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; Director, Podiatric Surgery, International Center for Limb Lengthening, Baltimore, MD; Director, Foot and Ankle Deformity Correction and Orthoplastics Fellowship, Baltimore, MD; Chief of Podiatry, Sinai and Northwest Hospitals, Baltimore, MD.
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Ehredt DJ, Kawalec JS, Zulauf EE, Wetzel B, Kim HM. Relative Strengths of Intramedullary K-Wire Techniques for Digital Deformities. J Foot Ankle Surg 2021; 60:990-993. [PMID: 33985874 DOI: 10.1053/j.jfas.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/08/2021] [Indexed: 02/03/2023]
Abstract
Hammertoe deformity correction surgery is one of the most common procedures performed by foot and ankle surgeons. Recent foot and ankle medical literature presents conflicting opinions regarding the optimal intramedullary fixation device and techniques for use in digital deformity correction. There are a number of varying fixation constructs of intramedullary Kirschner wire fixation reported for proximal interphalangeal joint arthrodesis; however, there are no reports of relative loading strength of the fixations. In this study, 90 sawbone models were divided equally into 3 groups of different intramedullary Kirschner wire fixation techniques: Group A- single straight, Group B- single bent, Group C- double bent. Each fixation construct underwent controlled axial loading and failure points were observed. Results showed no significant difference in load failure from all 3 groups with mean maximum force of Group A = 20N, Group B = 19.1N, and Group C =17.5N. We conclude that all Kirschner wire fixation options for digital deformity correction, will provide similar resistance to sagittal plane axial loads.
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Affiliation(s)
- Duane J Ehredt
- Associate Professor, Division of Foot and Ankle Surgery, Kent State University College of Podiatric Medicine, Independence, OH.
| | - Jill S Kawalec
- Professor and Division Head, Division of Pre-Clinical Sciences, Director of Research, Kent State University College of Podiatric Medicine, Independence, OH
| | - Emily E Zulauf
- PGY-3, Grant Medical Center Foot & Ankle Surgery Residency Program, Columbus, OH
| | - Britain Wetzel
- PGY-2, East Liverpool City Hospital Residency Program, East Liverpool, OH
| | - Heong-Min Kim
- PGY-3, Podiatric Medicine and Surgery Resident, Saint Vincent Charity Medical Center, Cleveland, OH
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Albright RH, Hassan M, Randich J, O'Keefe R, Klein EE, Weil L, Weil L, Fleischer AE. Risk Factors for Failure in Hammertoe Surgery. Foot Ankle Int 2020; 41:562-571. [PMID: 32026702 DOI: 10.1177/1071100720904931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hammertoe correction is perhaps the most common elective surgery performed in the foot, yet rates of symptomatic recurrence and revision surgery can be high. In this study, we aimed to identify patient and provider risk factors associated with failure after hammertoe surgery. METHODS Consecutive patients with a minimum of 6 months' follow-up undergoing hammertoe surgery within a single, urban foot and ankle practice between January 1, 2011, and December 31, 2013, served as the basis of this retrospective cohort study. Cox regression analysis was used to identify important predictor variables obtained through chart and radiographic review. One hundred fifty-two patients (311 toes) with a mean age of 60.8 ± 11.2 years and mean follow-up of 29.5 ± 21.2 months were included. RESULTS Statistically significant predictors of failure were having a larger preoperative transverse plane deviation of the digit (hazard ratio [HR], 1.03 for each degree; P < .001; 95% CI, 1.02, 1.04), operating on the second toe (vs third or fourth) (HR, 2.23; P = .003; 95% CI, 1.31, 3.81), use of a phalangeal osteotomy to reduce the proximal interphalangeal (PIP) joint (HR, 2.77; P = .005; 95% CI, 1.36, 5.64), and using less common/conventional operative techniques to reduce the PIP joint (HR, 2.62; P = .03; 95% CI, 1.09, 6.26). Concomitant performance of first ray surgery reduced hammertoe recurrence by 50% (HR, 0.51; P = .01; 95% CI, 0.30, 0.87). CONCLUSION We identified risk factors that may provide guidance for surgeons during preoperative hammertoe surgery consultations. This information may better equip patients with appropriate postoperative expectations when contemplating surgery. LEVEL OF EVIDENCE Level III, retrospective case series.
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Affiliation(s)
- Rachel H Albright
- Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
- Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Moiz Hassan
- Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Jacob Randich
- Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | | | - Erin E Klein
- Weil Foot and Ankle Institute, Des Plaines, IL, USA
| | - Lowell Weil
- Weil Foot and Ankle Institute, Des Plaines, IL, USA
| | - Lowell Weil
- Weil Foot and Ankle Institute, Des Plaines, IL, USA
| | - Adam E Fleischer
- Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
- Weil Foot and Ankle Institute, Des Plaines, IL, USA
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Nieto-García E, Ferrer-Torregrosa J, Ramírez-Andrés L, Nieto-González E, Martinez-Nova A, Barrios C. The impact of associated tenotomies on the outcome of incomplete phalangeal osteotomies for lesser toe deformities. J Orthop Surg Res 2019; 14:308. [PMID: 31511051 PMCID: PMC6739948 DOI: 10.1186/s13018-019-1353-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/29/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Partial or incomplete osteotomy (IO) of the phalanx is recently described in the literature. However, the clinical outcome and the rate of complications when applied to lesser toe deformities (LTD) have been never addressed. This study aims to find out if the association of tenotomies to incomplete or partial phalanx osteotomies has a significant impact on the clinical outcomes, the occurrence of complications, and the recovery time after surgery. METHODS A retrospective review of two cohorts of cases operated in our institution for hallux abductus valgus (HAV) and associated LTD from 2008 to 2014 was carried out. The surgical correction of both HAV and the associated LTD was always performed by minimally invasive techniques. The study included a total of 223 patients (723 IO in 556 toes). In 129 cases, the IO for LTD correction was performed without tenotomies, and in 94, the procedure was combined with flexor and/or extensor tenotomies. Patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire before surgery and at 6- and 12-month follow-up. RESULTS The mean preoperative AOFAS score before surgery was similar in both cohorts. At 12-month follow-up, the cohort without tenotomies showed better recovery (95.7 ± 2.8 versus 92.5 ± 6.8; p < 0.01). AOFAS scores decreased as the number of associated LTD increased (r = - 0.814; p < 0.001). Cases operated on by PO + tenotomy showed a high rate of complications such as delayed union of the osteotomy (p < 0.01), hypertrophic callus (p < 0.01), phalangeal fracture at the osteotomy site (p < 0.01), and lack of correction (p < 0.05). The overall occurrence of adverse events was 38.6% in cases operated by PO + tenotomy and 13.9% in cases receiving PO alone (p < 0.0001). Cases operated on without tenotomy showed a shorter time to complete recovery for daily life activities (37.4 ± 2.3 versus 43.0 ± 1.7 days; p < 0.01). CONCLUSION The performance of associated tenotomies to incomplete phalanx osteotomies provides worse clinical outcomes, higher complication rates, and longer recovery time as compared to similar forefoot surgeries without tenotomies. TRIAL REGISTRATION The study was based on retrospectively registered data starting on May 24, 2008.
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Affiliation(s)
- Eduardo Nieto-García
- Doctorate School, Valencia Catholic University San Vicente Martir, Valencia, Spain
| | - Javier Ferrer-Torregrosa
- School of Physiotherapy and Podiatry, Valencia Catholic University, Ramiro Maeztu 14, 46900 Torrent, Valencia, Spain
| | - Leonor Ramírez-Andrés
- School of Physiotherapy and Podiatry, Valencia Catholic University, Ramiro Maeztu 14, 46900 Torrent, Valencia, Spain
| | - Elena Nieto-González
- School of Physiotherapy and Podiatry, Valencia Catholic University, Ramiro Maeztu 14, 46900 Torrent, Valencia, Spain
| | | | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, Valencia, Spain
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Ceccarini P, Rinonapoli G, Sebastiani E, Bisaccia M, Ceccarini A, Caraffa A. Clinical Comparison Between Shortening Osteotomy of the Proximal Phalanx Neck and Arthrodesis in Hammer Toe Surgery at Mid-TermFollow-Up. J Foot Ankle Surg 2019; 58:221-225. [PMID: 30553747 DOI: 10.1053/j.jfas.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Indexed: 02/03/2023]
Abstract
The treatment of hammer toe has been advocated for years, and many procedures have been proposed with skeletal and soft tissue intervention. The purpose of the present study was to compare arthrodesis of the proximal interphalangeal joint with shortening osteotomy of the proximal phalanx neck. In most cases, both procedures have been associated with elongation of the extensor apparatus, capsulotomy of the metatarsophalangeal joint, and stabilization with a Kirschner wire. To experiment with a technique that respects the anatomy and joint function, we used a distal subtraction osteotomy of the proximal phalanx neck. We compared a series of 78 patients, divided in to 2 groups: 38 (48.7%) treated with arthrodesis and 40 (51.3%) with shortening osteotomy. Patients were aged 22 to 78 years, with a mean final follow-up period of 56.6 (range 24 to 96) months. For clinical evaluation, we used the American Orthopaedic Foot and Ankle Society score, Foot and Ankle Outcome Score, and a subjective rating scale. The results were comparable between the 2 techniques; however, we report faster functional recovery in the group treated with shortening osteotomy (p < .0001), with an adjunctive advantage of preserving the integrity of the proximal interphalangeal joint. Thus, according to our results, this technique is comparable to arthrodesis.
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Affiliation(s)
- Paolo Ceccarini
- Orthopaedic Surgeon, Department of Orthopaedics & Traumatology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
| | - Giuseppe Rinonapoli
- Orthopaedic Surgeon, Department of Orthopaedics & Traumatology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Enrico Sebastiani
- Orthopaedic Surgeon, Department of Orthopaedics & Traumatology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Michele Bisaccia
- Orthopaedic Surgeon, Department of Orthopaedics & Traumatology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Alfredo Ceccarini
- Orthopaedic Surgeon, Department of Orthopaedics & Traumatology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Auro Caraffa
- Professor, Department of Orthopaedics & Traumatology, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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Albright RH, Waverly BJ, Klein E, Weil L, Weil LS, Fleischer AE. Percutaneous Kirschner Wire Versus Commercial Implant for Hammertoe Repair: A Cost-Effectiveness Analysis. J Foot Ankle Surg 2018; 57:332-338. [PMID: 29478480 DOI: 10.1053/j.jfas.2017.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Indexed: 02/03/2023]
Abstract
Hammertoe deformities are one of the most common foot deformities, affecting up to one third of the general population. Fusion of the joint can be achieved with various devices, with the current focus on percutaneous Kirschner (K)-wire fixation or commercial intramedullary implant devices. The purpose of the present study was to determine whether surgical intervention with percutaneous K-wire fixation versus commercial intramedullary implant is more cost effective for proximal interphalangeal joint arthrodesis in hammertoe surgery. A formal cost-effectiveness analysis using a decision analytic tree model was conducted to investigate the healthcare costs and outcomes associated with either K-wire or commercial intramedullary implant fixation. The outcomes assessed included long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. Costs were evaluated from the healthcare system perspective and are expressed in U.S. dollars at a 2017 price base. Our results found that commercial implants were minimally more effective than K-wires but carried significantly higher costs. The total cost for treatment with percutaneous K-wire fixation was $5041 with an effectiveness of 0.82 QALY compared with a commercial implant cost of $6059 with an effectiveness of 0.83 QALY. The incremental cost-effectiveness ratio of commercial implants was $146,667. With an incremental cost-effectiveness ratio of >$50,000, commercial implants failed to justify their proposed benefits to outweigh their cost compared to percutaneous K-wire fixation. In conclusion, percutaneous K-wire fixation would be preferred for arthrodesis of the proximal interphalangeal joint for hammertoes from a healthcare system perspective.
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Affiliation(s)
- Rachel H Albright
- Podiatric Medicine & Surgery PGY-3 Resident, Advocate Illinois Masonic Medical Center, Advocate Illinois Masonic Medical Center/Wm. M Scholl College of Podiatric Medicine, Chicago, IL.
| | - Brett J Waverly
- Fellowship Trained Foot and Ankle Surgeon, Orthopedic Specialty Clinic, Fredericksburg, VA
| | - Erin Klein
- Associate Director of Research, Weil Foot & Ankle Institute, Des Plaines, IL; Clinical Instructor, Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Lowell Weil
- President, Weil Foot & Ankle Institute, Des Plaines, IL
| | - Lowell S Weil
- Director, Weil Foot & Ankle Institute, Des Plaines, IL
| | - Adam E Fleischer
- Director of Research, Weil Foot & Ankle Institute, Des Plaines, IL; Associate Professor, Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL
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Mueller CM, Boden SA, Boden AL, Maidman SD, Cutler A, Mignemi D, Bariteau J. Complication Rates and Short-Term Outcomes After Operative Hammertoe Correction in Older Patients. Foot Ankle Int 2018; 39:681-688. [PMID: 29444584 DOI: 10.1177/1071100718755472] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hammertoe deformities are the most common lesser toe deformity. To date, no studies have looked at outcomes of operative management in the geriatric population, which may be at greater risk for complications or functional compromise because of comorbidities. METHODS Data on 58 patients undergoing operative correction of hammertoe deformities were prospectively collected. Clinical outcomes were assessed using preoperative and postoperative visual analogue scale (VAS) and Short Form Health Survey (SF-36) scores with a minimum of 6-month follow-up. Patients were divided into 2 groups on the basis of age at the time of surgery: younger than 65 and 65 and older. Complication rates and mean VAS and SF-36 improvement were compared. Forty-seven patients met inclusion criteria (7 men, 40 women), with 26 patients (37 toes) in the younger cohort and 21 patients (39 toes) in the older cohort. RESULTS Overall, patients demonstrated significant improvement from baseline to 6 and 12 months postoperatively in VAS ( P < .001 and P < .001) and SF-36 ( P < .001 and P < .001) scores. Mean improvement in VAS and SF-36 scores was not significantly different between the groups at 6 and 12 months postoperatively. Complications occurred in 13.5% and 10.3% of patients in the younger and older cohorts, respectively. CONCLUSIONS Outcomes of operative correction of hammertoe deformities in older patients were similar to outcomes in younger patients after greater than 6 months of follow-up. Overall improvement in VAS and SF-36 was statistically significant for both cohorts. There was no associated increase in complications for older patients. LEVEL OF EVIDENCE Level, III comparative series.
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Affiliation(s)
| | | | | | | | - Anya Cutler
- 2 Rollins School of Public Health, Atlanta, GA, USA
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Basile A, Albo F, Via AG. Intramedullary Fixation System for the Treatment of Hammertoe Deformity. J Foot Ankle Surg 2015; 54:910-6. [PMID: 26028601 DOI: 10.1053/j.jfas.2015.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Indexed: 02/03/2023]
Abstract
Hammertoe is one of the most common foot deformities. Arthrodesis or arthroplasty of the proximal interphalangeal joint using temporary Kirschner wire fixation is the most widespread method of surgical stabilization. However, this type of fixation is associated with some potential complications that can be obviated if percutaneous fixation is avoided. The purpose of the present study was to prospectively collect clinical and radiographic outcomes of operative correction of hammertoe deformity using a permanently implanted 1-piece intramedullary device. A total of 29 patients with 60 painful, rigid hammertoes were prospectively enrolled, clinically and radiographically examined, operatively treated, then followed and re-examined. The outcomes were measured in terms of the American Orthopaedic Foot and Ankle Society lesser toe and visual analog pain scores. After ≥18 months of follow-up, the incidence of fusion with satisfactory radiographic alignment was 85% (51 of 60 toes). One toe (1.67%) developed early postoperative implant failure because of dislocation of the device, there were no cases of infection, and the mean American Orthopaedic Foot and Ankle Society lesser toe score was 87.4 ± 1.3 and the mean visual analog scale pain score was 1.78 ± 0.94. Twenty-five patients (86.21%) stated that they had no symptoms in the involved toes after surgery, and 4 (13.8%) experienced occasional pain, 2 (6.9%) of whom reported limitations of recreational activities and 2 (6.9%) reported persistent swelling without activity limitations. All the patients stated that they would undergo the surgery again if they had the same preoperative condition.
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Affiliation(s)
- Attilio Basile
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
| | - Francesco Albo
- Departmento of Orthopaedics and Traumatology, Ospedale Padre Pio, Bracciano, Italy
| | - Alessio Giai Via
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata," Rome, Italy
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