SLR - March 2022 - Miranda Göransson
Reference: Jung HG, Lee JS, Lee DO, Kim SW, Coruña JA 4th. Comparison between Pin Fixation and Combined Screw Fixation in Proximal Chevron Metatarsal Osteotomy for Hallux Valgus Deformity Correction. Clin Orthop Surg. 2021;13(1):110-116.Level of Evidence: Level III
Scientific Literature Review
Reviewed By: Miranda Göransson, DPM
Residency Program: Westside Regional Medical Center – Plantation, FL
Podiatric Relevance: One of the most common conditions seen and treated by foot and ankle surgeons is hallux abductovalgus (HAV). Throughout history, there have been over 100 procedures proposed to correct the deformity with the main goal being pain relief and restoring the function of the first metatarsophalangeal joint. Kirschner-wire (K-wire) fixation has been widely used, although when used alone has been associated with fixation instability or pin loosening that may lead to skin irritation or loss of correction. Screws and plates provide a stronger construct for fixation, but due to poor contour or non-anatomic placement it may lead to loss of correction. The authors therefore proposed the idea to evaluate the combination of K-wire and screw fixation while performing a proximal metatarsal osteotomy (PCMO) to attempt to decrease complications for HAV repair. This study compares the clinical and radiographic outcomes of 138 patients with HAV correction using either K-wire fixation (KW) alone or a combined K-wire and screw fixation (KWS) technique.
Methods: Level III retrospective study was performed for patients who underwent PCMO for correction of HAV deformity. A total of 138 consecutive patients (173 feet) who received PCMO and Akin osteotomy were divided into two groups with KW fixation alone using two or three K-wires (117 feet in 98 patients), and KWS fixation using two K-wires and a headless cannulated screw (56 feet in 40 patients) were identified with at least one year of follow-up. Evaluation of the prospective outcomes were then achieved by using the visual analog scale (VAS) for pain, American Orthopaedic Foot & Ankle Society (AOFAS) and patient satisfaction score were evaluated. Secondary outcomes were measured including radiographically, hallux valgus angle (HVA) and intermetatarsal angle (IMA).
Results: The KW and KWS groups both had significant improvement in AOFAS and VAS scores. Ninety-three percent in the KWS group, and 85 percent in the KW group, were more than satisfied with their surgical outcome. There was no significant difference in clinical outcome between the groups. There was a statistically significant difference observed for the measured IMA, with the KW group showing a significant increase in IM at three months postoperatively. Recurrence of the hallux valgus deformity occurred in 6 percecnt (7/117) of cases in the KW group and in 3.6 percent (2/56) of cases in the KWS group, with no statistically significant difference between the two groups.
Conclusions: There were no statistically significant differences found in several outcome measures, including: pain, function, HAV clinical differences and the patients’ satisfaction with surgery. There were a few limitations to the study, including, but not limited to, the two techniques not being performed during the same time period, the preoperative HAV, IMA, AOFAS and pain VAS scores of the two groups showed a statistically significant difference. Both KW and KWS groups shows satisfactory outcomes clinically as well as radiographically. Nevertheless, the KWS group showed slightly lower recurrence rates, with insignificant increase in the IMA. Therefore, the authors recommend KWS fixation for increased stability and to prevent loss of fixation following HAV correction.