Arthrodesis of proximal inter-phalangeal joint for hammertoe: intramedullary device options

Abstract

BackgroundProximal inter-phalangeal (PIP) joint arthrodesis today represents the standard treatment for structured hammertoes; however, recently, a lot of new intramedullary devices for the fixation of this arthrodesis have been introduced. The purpose of this work is to look at the currently available devices and to perform a review of the present literature. Materials and methodsA literature search of PubMed/Medline and Google Scholar databases, considering works published up until September 2014 and using the keywords: hammertoe, arthrodesis, PIP joint, fusion, intramedullary devices, and K-wire, was performed. The published papers were included in the present study only if they met the following inclusion criteria: English articles, arthrodesis of PIP joints for hammertoes with new generation intramedullary devices, series with n > 10. Studies using absorbable pins or screws that are considered as another kind of fixation that involved more than one articulation, as well as comments, letters to the editor, or newsletters were excluded. ResultsNine publications were included. Of the patients’ reports, 93–100 % were good or excellent concerning satisfaction. Radiological arthrodesis was achieved in 60.5–100 % of cases. Three of the publications compared the new devices with the K-wire. Of these three articles, two employed the traditional technique and one the buried technique. The AOFAS score, evaluated in three publications, showed a delta of 19, 45 and 58 points. Major complications, which required a secondary surgical revision, were between 0 and 8.6 %. The complications of the K-wire and the new devices were similar; also the reoperation rate was close to equal (maximal difference 2 %). On the other hand, these kinds of devices definitely have a higher price, compared to the K-wire.ConclusionThe use of these new devices provides good results; however, their high price is currently a problem. For this reason, cost-benefit studies seem to be necessary to justify their use as standard treatment.Level of evidenceLevel III systematic review.

Prospective, Multicenter, Clinical and Radiographic Evaluation of a Biointegrative, Fiber-Reinforced Implant for Proximal Interphalangeal Joint Arthrodesis

“…Furthermore, the lack of rotational stability with K-wire fixation with only 1 wire can lead to malalignment, relapse of deformity, and a need for revision surgery. 21,24 The pain VAS mean score of 0.4 at the 26-week follow-up also compares well with studies of other implants. 2,39 In a retrospective comparative study of PIP joint fusion for correction of hammertoe deformity, Richman et al 39 reported mean pain VAS scores of 1.7 and 1.8 at the 12-month follow-up for 1-piece implant (n¼54) and K-wire (n¼95) fixation, respectively.…”

“…14 Kirschner wire (K-wire) fixation is considered the standard treatment for correction of hammertoe deformity. 21,28,44 Although inexpensive and easy to insert, percutaneous K-wires protrude from the toe during the initial 6-week recovery period and require removal. 24 Complications include wire site infection, wire migration, wire breakage, and nonunion or malunion.…”

“…25,31,34 Most of these implants have not demonstrated improved complication and revision rates when compared to K-wire fixation. 14,19,21,33,34,44,45 A novel class of biointegrative fixation implants has been developed to provide strong, secure fixation while gradually integrating into native tissue. These implants are engineered from continuous reinforcing mineral fibers bound together by a bioabsorbable polymer [poly(L-lactide-co-D,L-lactide), PLDLA] matrix.…”

Ideal implant choice for proximal interphalangeal joint arthrodesis in hammer toe/claw toe deformity correction: A systematic review

“…1,10,11 Complications of using axial K-wires in joint fixation may develop, including inconvenience, pin-tract infection, wire migration, and hardware failure especially since there is no compression or rotational stabilization in axial K-wires. 11 Several alternative options have appeared in recent years, 12 such as the Smart Toe (Stryker Corporation), [13][14][15] TenFuse (Wright Medical Group), 16 StayFuse (Tornier), 17 Hat-trick (Smith and Nephew), and HammerFix (Extremity Medical). These internal fixation methods aim to reduce K-wire complications and aim to achieve a higher level of patient satisfaction, pain control, and union rates.…”

“…14,15,[17][18][19] However, the high cost of these novel internal devices is one of the major reasons hindering more universal utilization. 12 The purpose of this study is to compare the surgical outcomes of K-wire fixation versus novel internal fixation devices in PIPJ arthrodesis in hammer toe surgery.…”