A New Approach For Correcting Hammertoe Deformities

Author(s): 
By Gerald W. Paul, DPM

Final Thoughts
Using the StayFuse implant gives you several advantages in comparison to other procedures. The three-step technique for implantation is very simple to perform, with minimal instrumentation. A range of diameters and lengths are available, depending on bone size. There is no disruption of the joints, proximal or distal, to the PIPJ. Employing the device enables you to provide a more stable union with added rotational stability. This improved fixation enhances the healing process.
There is no post-op implant exposure, which eliminates pin tract infections. Without an external wire and when you compare it to traditional K-wire fixation, the implant improves patient comfort as well as patient perception and can reduce the prolonged need of a post-op shoe. If the situation arises, you do have the option of removing the device later via a “windowing” technique through the middle phalanx. The only real disadvantage I see with the device is the inability to concurrently stabilize across the metatarsophalangeal joint with pinning, if this was so desired for mechanical or structural reasons.
In comparison to the other digital arthrodesis procedures performed, I have found the StayFuse implant to be an excellent device. It is coupled to a relatively simple implantation procedure and has had reproducible results. I have addressed digits two through four using the implant. (The fifth toe usually is best addressed with a simple arthroplasty at the PIPJ.)
It is up to your discretion whether adjunctive soft tissue procedures (i.e. tenotomy, capsulotomy, etc.) are needed along with the StayFuse. I believe that using the implant leads to fewer complications, such as nonunions, pseudoarthroses, pin tract infections, pain and need for revisional surgeries. In particular, the appearance of a somewhat “bulbous” fused PIPJ — which you’ll often see with the “offset” arthrodesis of the peg-in-hole procedure — is well addressed with the StayFuse implant.

Dr. Paul is in an orthopedic group practice, McLean County Orthopedics, Inc., and is in an orthopedic sports medicine practice, Sports Enhancement Center, Inc., in Bloomington, Ill. He is an Associate of the American College of Foot And Ankle Surgeons and is a team podiatrist for Illinois State University Athletics.
Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons. He is board-certified in foot surgery. Dr. Burks practices in Little Rock, Arkansas.

Editor’s Note: For a related article, see “The Top Eleven Pearls For Hammertoe Surgery” in the April 2002 issue at www.podiatrytoday.com.




References:

References

1. Zimmer, Inc. Warsaw, IN.
2. Pioneer Surgical Technology, Inc. Marquette, MI.
3. Bauer GR, et. al. Lesser Proximal Interphalangeal Joint Arthrodesis. JAPMA Volume 91, No. 7, July-August 2001, pp.331-5.
4. Dockery G., Hall J. Ten Emerging Innovations in Podiatric Care. Podiatry Today August 2001, pp.28-32.
5. McGlamry ED. Interphalangeal Arthrodesis, in Comprehensive Textbook of Foot Surgery, 2nd edition, pp.346-8.
6. Soule RE: Operation for the Cure of Hammertoe. NY Med J 91: 649, 1910.
7. Taylor RG, Sheffield FRCS: An Operative Procedure for the Treatment of Hammer-toe and Claw-toe. J Bone Joint Surg 22: 608, 1940.
8. Selig S: Hammer-toe: a New Procedure For its Correction. Surg Gynecol Obstet 72: 101, 1941.
9. Higgs SL: Hammer-toe. Medical Press 131: 473, 1931.
10. Young CS: An Operation for the Correction of Hammer-toe and Claw-toe. J Bone Joint Surg Am 20: 715, 1938.
11. Schlefman BS, Fenton CS III, McGlamry ED: Peg in Hole Arthrodesis. JAPA 73: 187, 1983.
12. Reese HW: Reese Arthrodesis Screw: Osteosynthesis of the Interphalangeal Joints. JAPMA 77: 490, 1987.
13. Alvine FG, Garvin KL: Peg and Dowel Fusion of the Proximal Interphalangeal Joint. Foot Ankle 1: 90, 1980.
14. Payton GW, Shaffer MW, Kostakos DP: Absorbable Pin: a New Method of Fixation for Digital Arthrodesis. J Foot Surg 29: 122, 1990.
15. Ohm OWII, McDonell M, Vetter WA: Digital Arthrodesis: an Alternative Method for Correction of Hammertoe Deformity. J Foot Surg 29: 207, 1990.
16. Martin WJ, Mandracchia VJ, Beckett DE: The Incidence of Postoperative Infection in Outpatient Podiatric Surgery. JAPA 74: 89, 1984.

Add new comment