Biomechanical Comparison of a Novel Method of Tricortical Kirschner Wire Fixation of Distal Chevron Osteotomies of the First Metatarsal Versus Traditional Kirschner Wire and Versus Screw Fixation

Introduction: Traditional Kirschner wire (K-wire) stabilization of first metatarsal distal chevron osteotomy involves 1 cortex of fixation; however, unicortical fixation is associated with a high complication rate, including pin migration. A method of K-wire fixation utilizing 3 cortices may be biomechanically superior and potentially equivalent to single-screw fixation. Methods: Cadaveric specimens fixed with tricortical K-wires were tested in both the physiologic and cantilever conditions against specimens fixed with unicortical K-wires (N = 8) and single screws (N = 9) utilizing matched-pair comparison groups. Differences in physiologic and cantilever fixed/intact stiffness ratio and cantilever failure load were determined. Results: The tricortical fixation specimens had a significantly higher stiffness ratio in cantilever loading than the unicortical fixation specimens (60.50% tricortical, 34.17% unicortical, P =.02) but not in physiologic load (15.34% tricortical, 25.75% unicortical, P =.23). In cantilever failure loading, the tricortical fixation specimens had a significantly higher load to failure than the unicortical fixation specimens (132.81 N tricortical, 58.58 N unicortical, P <.01). Stiffness ratio under physiologic load, cantilever load, and ultimate load to failure were not significantly different between tricortical K-wire and screw-fixation groups. Conclusion: Tricortical K-wire fixation for distal chevron osteotomies is biomechanically superior to traditional unicortical K-wire fixation, and equivalent to single-screw fixation. Levels of Evidence: Level V: Cadaver study.