K-Wire Fixation vs Implant Device Fixation for Hammertoe Deformity: A Systematic Review and Meta-Analysis

Abstract

Category: Lesser Toes; Other Introduction/Purpose: The purpose of this systematic review was to compare the clinical and radiological outcomes between K- Wire fixation and implant device fixation for the management of hammertoe deformity. Methods: During November 2022, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following either K-Wire fixation and implant device fixation for the treatment of hammertoe deformity at a minimum of 1-year follow-up. Data regarding surgical characteristics, subjective clinical outcomes, radiological outcomes, complications and failure rates were extracted and analysed. 19 studies were included for quantitative analysis, of which 4 studies were included for qualitative analysis. Results: In total, 1343 patients (3468 feet) underwent K-Wire fixation and 456 patients (664 feet) underwent implant device fixation for the management of hammertoe deformity.The osseous union rate in the K-wire cohort was 71.3% versus 74.8% in the implant device cohort. The complication rate in the K-wire cohort was 9.7% versus 29.3% in the implant device cohort. The failure rate in the K-wire cohort was 8.6% versus 6.5% in the implant cohort. The secondary surgical procedure rate in the K-wire cohort was 8.3% versus 3.6% in the device cohort. Qualitative analysis found no difference in osseous union rates (RR=0.5832; 0.0830-4.0985; p=0.3562), complication rates (RR=1.12; 0.11-11.34; p=0.8571), failure rates (RR=0.87; 0.04-21.86; p=0.8746) nor secondary surgical procedure rates (RR=1.05; 0.06-18.32; p=0.9487) between the K-wire cohort and device cohort. Conclusion: This systematic review and meta-analysis demonstrated improvement in clinical and radiographic outcomes following both K-wire fixation and implant device fixation for hammertoe deformity. Qualitative analysis found no significant difference in osseous union rates, complication rates, failure rates nor secondary surgical procedure rates between the 2 cohorts. However, the marked heterogeneity between the included studies and few high level comparative studies limits the generation of any robust conclusions. Further research is warranted to determine the optimal role of both K-wire fixation and implant device fixation in the management of hammertoe deformity.