Our fixation with fixation: Are screws clinically superior to external wires in distal first metatarsal osteotomies?

The purpose of this study was to evaluate the immediate postoperative morbidity, the structural correction attained, and the long-term range of motion following fixation with a single external Kirschner wire and an internal cortical screw. We abstracted records for 69 patients undergoing distal unicorrectional chevron osteotomies. Thirty-three patients received percutaneous 0.062-inch K-wire fixation, and 36 patients received single 2.7- min. cortical screw fixation. Among these age- and sex-matched subjects, there was not a significant difference between any of the correctional or morbid outcomes measured in this study on the basis of type of fixation employed. Patients with rigid internal screw fixation did not return to shoe gear sooner, develop fewer postoperative infections, or have increased long- term range of motion than the group receiving external fixation with a single K-wire. Surgical time was significantly longer for those patients undergoing rigid internal fixation with a screw (42.5 ± 9.5 vs. 35.1 ± 6.6 minutes, p < 0.001). We conclude that there is no significant difference in postoperative infection, dehiscence, long-term structural correction attained, or range of motion achieved between rigid internal screws and external K-wires used to fixate distal metatarsal osteotomies.