Smooth Kirschner (K) wire fixation of distal metaphyseal osteotomy bunionectomies: a 10-year retrospective survey.

The authors reviewed 500 distal metaphyseal osteotomy bunionectomies with smooth Kirschner (K)-wire fixation performed over a 10-year period. Postoperatively, the patients were allowed to ambulate with a forefoot compression bandage and a semirigid surgical shoe. The cases were evaluated radiographically for malunion, delayed union, nonunion, aseptic necrosis, bone callus formation, and final alignment. Soft tissue and bone infection, as well as pin irritation, were also evaluated. Computation of results demonstrated eight malunions, one delayed union, no nonunions, and two cases of aseptic necrosis. There were 52 cases (10.4%) that led to bone callus formation; 54 patients (10.8%) experienced pin irritation. A total of seven infections occurred (1.4%) that could possibly be attributed to the pin, of which four (0.8%) required incision and drainage. It was observed that certain procedures, such as the Laird osteotomy, decreased the effectiveness of the K-wire, while others, such as the Chevron osteotomy, resulted in the fewest complications. Bunionectomies performed bilaterally or with adjunct procedures, in contrast to isolated bunionectomies, were also found to decrease the effectiveness of the K-wire. Due to the minimal number of complications that were encountered and the high success rate that was attained, the authors conclude that utilization of smooth K-wire fixation for distal metaphyseal osteotomy bunionectomies remains a viable and effective treatment alternative.