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Clinical Solutions In Practice

Fixation Device Allows For Improved Hammertoe Repair

For patients suffering from hammertoe deformity, an emerging modality with an optimized design for superior bone purchase might offer relief and repair.    The Nextra Hammertoe Correction System offers podiatrists a stable, secure implant with 10 degrees of angulation to allow for a natural position of the toe after implantation, notes the manufacturer Nextremity Solutions.    The company also explains that the two-piece implant provides intermediate locking before final closure and a progressive tightening mechanism that allows for retained compression.    Rory Panepinto, DPM, has been using the Nextra Hammertoe Correction System since its FDA approval in 2011. He attests to the system’s superior two-piece design and its accuracy when fixing a hammertoe deformity.    “The Nextra Hammertoe Correction System provides advances for the podiatric surgeon, allowing for greater implantation accuracy, a two-piece device connection and a RevLock adjustable locking mechanism,” explains Dr. Panepinto. “Other two-piece implant systems are not easily reversible or adjustable during and following implantation.”    Michael Tarbox, DPM, FACFAS, concurs that the Nextra implant “supersedes the implant market,” and is able to control and maintain length with its unique cone and cup reamer system, making better bone-on-bone contact for successful fusion. A two-component system will provide the surgeon with better surface contact and compression, adds Dr. Tarbox, who is board certified in forefoot surgery and reconstructive rearfoot and ankle surgery by the American Board of Podiatric Surgery.    Yolanda Ragland, DPM, has been using the Nextra system weekly for approximately two years. She notes that in addition to Nextra’s reliability during hammertoe repair, the system is easy to use and store as it does not require subzero refrigeration. Her confidence in the Nextra system is reinforced by its consistent results and lack of complications. Most complications during hammertoe surgery occur because of implant failure, explains Dr. Ragland, who is in practice in New York City.    “When I have used other metal products that had a higher rate of failure, I would try taping the toes down but that did not always prevent failure,” notes Dr. Ragland. “The way I currently minimize or eliminate this type of complication is by using the Nextra implant.”    To minimize complications during hammertoe implant surgery, Dr. Panepinto suggests having a knowledge of the digital implant designs and sizes available on the market and choosing the implant that the phalanx will best accommodate, notes Dr. Panepinto, who is in practice in New Orleans.    “In the case of the Nextra Hammertoe Correction System, the surgeon should use power instrumentation to remove all or part of the head of the proximal phalanx and only remove the cartilage from the middle phalanx to prevent digital shortening,” points out Dr. Panepinto.    Dr. Panepinto adds that the surgeon must “visualize bone-to-bone purchase and desired alignment prior to implantation of the Nextra implant.”    Dr. Tarbox has been using the Nextra implant for approximately two years. He says the most common complications with hammertoe implants are failed union, loosening and dislocation of the implant.    “I find complications can be avoided if the implant is secure and compressed via stressing the interphalangeal joint once (you have implanted the device),” adds Dr. Tarbox. “Also, resecting more bone on the proximal phalanx side versus the middle phalanx will allow better bone purchase of the distal component.”    Ms. Chicano is a freelance writer who lives in Philadelphia.
Clinical Solutions In Practice
Danielle Chicano, Contributing Editor
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