Is The InterPhlex A Viable Option In Hammertoe Surgery?

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After making and deepening an incision, visualize the extensor tendon and incise it from proximal to distal, thus exposing the head of the proximal phalanx as one can see here.
Using a micro sagittal saw, excise the head of the proximal phalanx at the level of the anatomical neck. Resect approximately 6 mm to 8 mm of bone.
Use a 2.2-mm drill to ream out the proximal and middle phalanges. Place the longer stem of the implant into the proximal phalanx and the shorter stem into the middle phalanx.
As seen here, remove the sizer and irrigate the operative site with copious amounts of antibiotic irrigation to remove osseous debris that might be present.
By Kerry Zang, DPM

      Podiatric surgeons should obtain intraoperative X-rays or fluoroscopic views prior to applying the final dressings. Doing so helps ensure that the implant is well seated in both the proximal and middle phalanges, and the toe is in good alignment.

      Postoperative care depends on the preference of the podiatric surgeon. Splinting the toe for several weeks is helpful. One should remove sutures in approximately 14 days and the patient can return to shoes in three to six weeks as tolerated.

What Are The Key Advantages Of The Implant?

      There are many potential benefits by using the InterPhlex interdigital implant. The device reestablishes the alignment of the digit as the rod portion of the implant places the intermediate and distal phalanges in line with the proximal phalanx. The device also maintains toe stability. The InterPhlex also maintains some flexibility as the fibrous sheath that forms is dense but not rigid. There is usually less postoperative edema when compared to a straight arthroplasty procedure as the circular spacer portion of the implant presses against the remaining portion of the osteotomized proximal phalanx. This helps to reduce intracapsular hematoma formation.

      Another advantage is that the implant also functions as a tissue expander. If the unlikely situation arises whereby the surgeon needs to remove the implant, the fibrous tissue is dense enough to maintain flexibility, stability and length. This helps to prevent the occurrence of a flail and floppy digit.

      Also significant is the fact that by reducing the tension on both the extensors and flexors by approximately 2 mm to 3 mm, the implant functionally lengthens the supporting soft tissue structures. This often negates the need for tendon lengthening procedures. This is important in maintaining and restoring function.

      The use of this device is contraindicated in patients with advanced peripheral vascular disease, open and non-healing wounds, infection, in medically compromised patients and in those patients with unrealistic expectations.

Final Notes

      Repair of hammertoe deformities via arthroplasty of the head of the proximal phalanx with the use of a flexible stabilizing rod and joint spacer offers the surgeon an excellent alternative to straight arthroplasty or arthrodesis.

      Dr. Zang is a Diplomate of the American Board of Podiatric Surgery, and a Fellow of the American College of Foot and Ankle Surgeons. He practices in Mesa, Ariz.

      Dr. Burks is a Fellow of the American College of Foot and Ankle Surgeons and is board certified in foot and ankle surgery. Dr. Burks practices in Little Rock, Ark.

      Editor’s note: For related articles, see “Point-Counterpoint: Is Fusion The Best Option For Crossover Toe Deformity?” in the October 2005 issue.

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