Technical tip Precise technique for simple and accurate pip arthrodesis using a blunt KW technique Zeev Feldbrin a,b, *, Alexander Lipkin a,b , David Hendel a,b , Dror Lakstein a,b a Department of Orthopedics, Wolfson Medical Center, Holon, Israel b Sackler Faculty of Medicine, Tel Aviv University, Israel Proximal interphalangeal joint (PIP) arthrodesis is a large part of everyday practice for the foot and ankle surgeon and is commonly employed in forefoot reconstructive surgery to correct lesser toe deformities. The standard technique recommended by Myerson and Klammer is to use a Kirschner wire (KW) with double sharp ends [1,2]. K-wire fixation for lesser toe deformities remains the commonest method of fixation in the world despite numerous alternatives appearing in recent years [3]. As described by Klammer [1], the technique involves the introduction of the KW in an ante grade fashion from the base of the middle phalanx through the distal phalanx, exiting underneath the nail bed and then driven retrograde, transfixing the PIP through the proximal phalanx into the metatarsal bone. Klammer [1] used an image intensifier to verify correct placement of the KW. If the KW is penetrating into the metatarsophalangeal joint (MTPJ), there can be pain during walking; and if it is transfixing the MTPJ, the possible complication, such as breaking the KW, can occur. A very efficacious technique of arthrodesis is to use a simple KW with one blunt end and being performed in such a way that it will be done without the need of fluoroscopy and without penetration of the MTPJ; plus, it will have a very precise result. The technique of exposing the PIP is a standard one. Using a 1.8– 1.6 mm KW, which is sharp on one side and blunt on the other side, a hole is prepared with the sharp side in the middle of the proximal phalange by introducing the KW retrogradely (Fig. 1). Then the KW is introduced antegradely into the middle phalange until it penetrates the pulp under the nail, as is usually done, avoiding injury to the nail bed (Fig. 2). Under direct vision, the blunt side of the KW is pushed into the prepared hole in the proximal phalange; then, the KW is pushed gently retrogradely, using a power drill, until a slight resistant is felt (Fig. 3). The end of the KW will be in the subchondral bone precisely where it is required to be without penetrating the MTPJ joint (Figs. 4 and 5). For further verification that the joint was not penetrated, flexion and extension movement of the MTPJ is performed in order to feel for a smooth full range without interruption. Usually, a post-operative shoe is used for six weeks more, until there is stabilization of the arthrodesis. The pin is removed six weeks postoperatively. Hammer toes are among the most common deformity, which are addressed by foot surgeons, and require surgery. The common performance of proximal interphalangeal joint excisional arthro- plasty is often an option [5], but most surgeons prefer to perform solid arthrodesis of the PIP joint to ensure a more reliable result. Currently, a few designated devices are commercially available that can be used to perform the arthrodesis with the benefit that there is no implant perforating the skin with potentially decreased risk of infection but still the use of the simple KW is the standard Foot and Ankle Surgery 19 (2013) 62–64 A R T I C L E I N F O Article history: Received 14 October 2012 Received in revised form 11 November 2012 Accepted 13 November 2012 Keywords: Hammer toe Arthrodesis Kirschner wire Interphalangeal joint A B S T R A C T Proximal interphalangeal joint (PIP) arthrodesis is a very common procedure in the practice of foot and ankle surgeons. The standard technique recommends using a Kirschner wire (KW) with double sharp ends. Using this technique there are some complication that can be eliminated by small modification. The technique of proximal interphalangeal joint arthrodesis using a simple blunt KW on one side with an accurate placement and avoidance of metatarsophalangeal joint (MTPJ) penetration without the need for fluoroscopy is described. This technique is simple, reproducible, very economical and avoiding most of the complications attributed to the KW. ß 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved. * Corresponding author at: Orthopedic Department, Wolfson Medical Center, Holon 58100, Israel. Tel.: +972 3 502 8383; fax: +972 3 502 8774; mobile: +972 50 629 6915. E-mail address: feldbrin@netvision.net.il (Z. Feldbrin). Contents lists available at SciVerse ScienceDirect Foot and Ankle Surgery jou r nal h o mep age: w ww.els evier .co m/lo c ate/fas 1268-7731/$ – see front matter ß 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.fas.2012.11.001