SmartToe® Implant Compared with Kirschner Wire Fixation for Hammer Digit Corrective Surgery: A Review of 28 Patients
Private Practice, Podiatric Trauma and Reconstructive Surgery, Southwest Orthopaedic Group, Austin, TX. Electronic address: .The Journal of foot and ankle surgery: official publication of the American College of Foot and Ankle Surgeons (Impact Factor: 0.85). 08/2012; 51(6):711-3. DOI: 10.1053/j.jfas.2012.06.013
For many years, end-to-end arthrodesis of a proximal interphalangeal joint arthrodesis to correct hammer digit deformity has been fixated with a Kirschner wire (K-wire). For this particular hammer digit deformity correction, we attempted to determine the effectiveness of the SmartToe(®) intramedullary shape memory implant compared with the K-wire. In a retrospective analysis of 28 cases, we evaluated several important parameters at baseline, postoperative days 7, 14, 21, 28, and 56, and 6 months for pain, complications, arthrodesis achieved, and return-to-work status. The SmartToe(®) outperformed the K-wire in all categories, with no evidence of significant complications, compared with multiple complications for patients in the K-wire arm of the study. This study demonstrates that the SmartToe(®) is a reasonable choice for fixation of proximal interphalangeal joint arthrodesis in hammer digit correction.
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ABSTRACT: Unlabelled: Digital contractures are a very common deformity of the foot and ankle that require surgical correction. It has been shown that arthrodesis provides a better long-term result than arthroplasty of the interphalangeal joints. Arthroplasties usually require K-wire fixation that presents potential complications, such as pin tract infection. This study presents a new cadaveric bone matrix allograft to be used as rigid internal fixation for proximal interphalangeal joint arthrodesis. The purpose of using the allograft as a fixation device is to achieve solid bone fusion and avoid the potential complications of external pin fixation. Arthrodesis of the proximal interphalangeal joint was performed on 63 toes in 32 patients using TenFUSE (Solana Surgical, Memphis, TN), a sterile bone matrix allograft. The authors found 97% fusion rate with no complications reported to this date. It was concluded that this bone matrix allograft provides excellent results and is a suitable alternative fixation device for correction of hammer toe deformity. Level of evidence: Level V.
Article: Digital Arthrodesis[Show abstract] [Hide abstract]
ABSTRACT: For lesser toe deformities, fusion of the proximal interphalangeal joint offers good long-term correction and predictability. Digital arthrodesis has been described for longer than 100 years in the literature, and current techniques closely resemble those described in early accounts. However, many implants currently being used take advantage of the latest metallurgic and polymeric innovations, with implants being composed of nitinol, polylactic or polyglycolic acids, and polydioxanone. Newer implants offer easy insertion and good stability, with no percutaneous wires. Pin-tract infection rates from exposed Kirschner wires may be as high as 18%, and newer implants help to mitigate this problem.
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ABSTRACT: Unlabelled: A 1-piece memory Nitinol intramedullary fixation device (Smart Toe; Stryker Corporation, Kalamazoo, MI) was used for proximal interphalangeal joint arthrodesis for correction of painful hammertoes in digits 2, 3, and 4. Sixty-five implants were placed in 35 patients. The mean age of our patients was 62.2 years (range = 27-82; standard deviation = 12.5). Mean follow-up time was 27 months (range = 12-40 months; standard deviation = 7). Overall, a 93.8% fusion rate was noted. Complications were noted in 4 patients (6.1%): 1 asymptomatic nonunion (1.5%), 2 hardware failures (3%), and 1 implant displacement (1.5%). To date, no patients required revisional surgery or hardware removal. Level of evidence: V.
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