Hammertoes, K-Wires, Nonunions, Pin Migration, and Pin Removal
Hammertoes
Hammertoes are the most common lesser toe deformity. They make up nearly 50% of all forefoot surgeries.
K-Wires (Pins)
Kirschner wire (a/k/a K-wire or pin) fixation of hammertoes are the most commonly used devices to correct hammertoes. Complications are not uncommon and include superficial wound infection, pin migration, and recurrent deformities. Pins are usually removed at 3-6 weeks
Nonunions
Nonunions of the interphalangeal joint are quite common, occurring in up to 50% of cases of hammertoe corrective surgery. These nonunions can be symptomatic or asymptomatic. Symptomatic nonunion can be treated with orthotics, by removal of hardware (if present), or revision surgery.
Pin Migration
Though more worrisome, proximal pin migration is less common than distal pin migration. When there is distal pin migration, the pin should not be re-advanced into the bone due to the risk of a pin-associated infection. In the case of distal pin migration, pin removal and a 10-14-day course of antibiotics is usually sufficient.
Pin Removal
Pin removal following hammertoe surgery is a low complexity procedure; in complexity, it is akin to changing a dressing. Even removal of sutures and injections are of a higher complexity than pin removal. These are common procedures for nurses in clinical practice. Nurses, mid-level providers, and even certified medical assistants with proper training and experience, can easily perform these procedures with physician oversight. In short, pin removal is much less complex than many of the other procedures that nurses regularly perform. Pins are usually removed at approximately 3-6 weeks post op.
Hammertoes, K-Wires, Nonunions, Pin Migration, and Pin Removal medical expert witness specialties include podiatry and orthopaedic surgery.