Why Patients May Prefer Arthrodesis With A New Screw

Author(s): 
By Brian McCurdy, Associate Editor

Although performing digital arthrodesis on the lesser metatarsals with the traditional K-wire is reliable, patients may not be pleased with the prospect of a pin sticking out of their feet for several weeks after the procedure. A new screw offers compression, stability and perhaps an improved likelihood of patients enjoying the convenience of internal fixation.
The Digital Compression Screw offers patients an alternative which they may find more cosmetically acceptable. William Hineser, DPM, has been using the screw for several months and says it is easy to install and has a short learning curve. He says there is also good patience acceptance when it comes to the screw.

“The patients like the idea,” says Dr. Hineser, the Chief of Podiatry at Lutheran Medical Center in Wheat Ridge, Col. “The acceptance has been very good.”
Biopro, the manufacturer of the Digital Compression Screw, cites the “psychological advantage” of patients not having exposed wires following surgery. Dr. Hineser concurs. While some patients may be put off by the idea of having a second surgery to remove the screw, Dr. Hineser says many prefer the Digital Compression Screw rather than having a wire stick out of their feet for five to six weeks following an arthrodesis.
Dr. Hineser says the fusions he performs with the Digital Compression Screw take as well as those he has performed with K-wires. As Biopro notes, one can use the screw to fuse either proximal interphalangeal joints or distal interphalangeal joints.

How The Digital Compression Screw Can Be Beneficial
For The Patient
The 1.5-mm stainless steel screw is available in lengths from 30 mm to 55 mm while a second screw measures 1.8 mm with lengths from 30 mm to 55 mm. A screwdriver is also available, according to Biopro.
Biopro says pin tract infections are not an issue since no external fixation device is needed. When one uses the Digital Compression Screw, patients can bathe their feet after suture removal, according to the company. The company also notes one can remove the screws after six to eight weeks in the office under local anesthesia.

Other Pertinent Points
Using the Digital Compression Screw will lead to minimal reduction in toe shortening, according to Biopro. The company also touts the screw’s cost effectiveness and ease of use.
Dr. Hineser, who is certified in foot and ankle surgery, says it is possible the screw may bend if patients bend their toes but he has not encountered this with his own patients.
He does emphasize that patients need a lot of instruction regarding the arthrodesis procedure. Dr. Hineser also advises the use of post-op surgical shoes for patients who undergo this procedure.

Editor’s note: For further reading on digital arthrodesis procedures, see “Exploring New Advances In Digital Arthrodesis” in the September 2003 issue of Podiatry Today or the archives of www.podiatrytoday.com.

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