From almost the beginnings of podiatric surgery the K-wire has been used for all types of fixation including osteotomies, fusions, fracture repair, etc. It is still used frequently in podiatric surgery but not without inherent problems, specifically when performing digital arthrodesis with MTP stabilization. There is no true compression, end wires are exposed, and the possibility of wire breakage from the non-compliant patient. That being said, K-wires do have their place in podiatric surgery but after reviewing many of the new products developed over the years to correct these deformities, it behooves one to choose the best products affording the least amount of complications and increased surgical success.

This is a case where a podiatric surgeon performed a Lapidus procedure (screw fixation) and PIPJ arthrodesis of the second toe (K-Wire fixation) on 7/3/07 for painful hallux valgus and hammertoe deformity. During the postoperative period the K-wire broke and six weeks after surgery, the wire was removed leaving the proximal end in the second metatarsal close to the MTP. The third toe was also contracted with no surgical intervention. Figure 1.

The patient elected not to return to the primary surgeon (who by the way performed all the surgery (correctly) and was subsequently referred to my office. I saw the patient on 8/29/07 for pain on the plantar aspect of the surgical foot along with a painful third toe. X-rays were taken showing the broken K-wire, but at that time no significant joint pathology was observed. The ancillary problem was corrected.

Prior to her discharge, the patient was informed of the rare possibility of pin migration and if any problems developed to call the office. She returned seven months later complaining of pain involving the second and third toes.  X-rays illustrated movement of the K-Wire causing second metatarsal head and joint destruction. (Figures 2 & 3).

The patient was scheduled for hemi joint replacement surgery using the BIOPRO Lesser Hemi Toe for the second MTP, remodeling of the head with bone putty, and arthrodesis of the PIPJ third toe using the BIOPRO Digital Compression Screw. (Figure 4)

This is an unusual case of K-wire migration with joint destruction. The BIOPRO Lesser Hemi is an extremely easy implantable device with an excellent track record. Implantation is very straight forward and simple. Minimal bone is removed from the base and once implanted provides pain free range of motion. The patient appreciated the correction of the contracted third toe using the BIOPRO Digital Compression Screw. A successful arthrodesis was performed without any exposed wires. Psychologically the patient felt better knowing a pin was not exiting her toe and she was allowed to bathe after the sutures were removed. At the time this article was written, the patient was still healing uneventfully and will be scheduled for Digital Compression Screw removal in the office under local anesthesia.

Residents and new practitioners are eager to keep up with new and more advanced products and that’s the way it should be. Veteran podiatric surgeons at times stay in their “comfort zone” and are reluctant to try better engineered implants or fixative devices. My response to students, residents and every practitioner is never allow yourself to get into the “nothing new for me” mentality. Ultimately we want to provide the best for our patients with successful surgery and if it means learning new techniques and new materials, so be it! These advances keep the excitement in surgery.

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