The Daily Fix

Content Transition

2012-03-15T08:15:00.000-07:00

At SurgicalFixation, there has been a lull in the action via the Daily Fix blog, the Article of the Week, Calendar Events, and new product updates. We assure that this is no indicator of future performance.

In fact, we are soon rolling out our new platform. Complete with new features that will enhance the user experience, FootandAnkleFixation.com will continue to function as the procedure based home of medical implants for foot and ankle surgery.

Tornier's Resorbable Fixation System

2012-02-18T06:53:00.001-08:00

At last weeks AAOS meeting in San Fransisco, CA, Tornier announced the launch of a new Resorbable Fixation System; The RFS Cannulated Screw System. Here is the expert from their press release:

The RFS™ Cannulated Screw System, in limited release in the U.S., is a new delivery system for the Company's RFS (Resorbable Fixation System) line for the repair of fractures and other bone disorders of the foot. The new cannulated version provides surgeons an option to deploy the RFS screw using a guide wire for improved precision and simplified delivery. The RFS material technology features auto-compression that causes the screw to contract in length while expanding in diameter in hydrolytic conditions, providing sustained compression during bone healing.

As more information is released on these new screws, FootandAnkleFixation.com will be there to bring you the latest

New Lapidus Plate

2012-02-16T06:48:00.000-08:00

And here's the newest edition to the Hallux Abducto Valgus: Lapidus Arthrodesis section of FootandAnkleFixation.com: The Orthofix Contours Lapidus Plating System (LPS). Orthofix announced the release of this long awaited Lapidus plate last week during the AAOS meeting. New information about the plate will be updated on our site as soon as it's available. Here are comments about the release of the Contours Lapidus Plate and the Centronail Ankle Compression Nailing System by the CEO of Orthofix:

Orthofix's President and Chief Executive Officer Robert Vaters stated, "The introduction of these two novel technologies highlights the Company's commitment to the attractive U.S. foot and ankle market. While Orthofix has a strong presence in external fixation, the bolstering of its internal fixation offering along with its regenerative solutions creates an attractive and differentiated value proposition for both orthopedic surgeons and podiatrists."

Not sure what to use for your next bunion procedure, check out the following links:

HALLUX ABDUCTO VALGUS: DISTAL OSTEOTOMY

HALLUX ABDUCTO VALGUS: LAPIDUS ARTHRODESIS

HALLUX ABDUCTO VALGUS: OPENING BASE WEDGE

HALLUX ABDUCTO VALGUS: PROXIMAL OSTEOTOMY

Orthofix Announces Centronail Ankle Compression Nail

2012-02-15T08:03:00.000-08:00

Orthofix has announced the full US launch of it's new Centronail Ankle Compression Nailing System for the distal tibia. The intramedullary nail is logged in the FootandAnkleFixation.com database for rearfoot fusions including a Pantalar / Tibiotalocalcaneal Arthrodesis. This new system offers a two-piece targeting assembly for screw placement flexibility as well as dynamization along the tibiotalar and subtalar joint surfaces.

Interested in finding out more about what Orthofix has to offer, click here.

Experience with Hammertoe Fixation

2012-02-09T22:00:00.000-08:00

Christopher Hyer DPM, FACFAS of Ohio recently published his insight on Hammertoe Correction and the evolving technology that is now available for fixating hammertoes as an alternative to k-wire fixation. He comments on hammertoe correction and his experience with the Wright Medical Pro-Toe VO, the MMI (Stryker) Smart Toe, and the Tornier StayFuse Implant. Dr. Hyer concluded the importance of being comfortable with multiple devices and techniques, as one must tailor implant selection to patients individually.

FootandAnkleFixation.com recently blogged about the evolution of the hammertoe implant and the overall Trends in Hammertoe Surgery. If you are looking for a new option for fixating hammertoes, check out the Hammertoe Correction page to see all of you current options.

PROPHECY® INBONE® Alignment Guides

2012-02-08T10:36:00.000-08:00

Wright Medical announced the 510(k) clearance and limited U.S. launch for their PROPHECY® INBONE® Pre-Operative Navigation Alignment Guide for use in Total Ankle Replacement / TAR. The guide uses CT scans to create patient-specific ankle alignment guides to facilitate insertion of the Wright Medical INBONE Total Ankle Replacement.

FootandAnkleFixation.com has information on all of the available Total Ankle Replacement / TAR options.

Trilliant Headless Tiger Screws

2012-02-07T15:10:00.000-08:00

FootandAnkleFixation.com now has the Trilliant Headless Cannulated Tiger Screws online. These screw are availble in a 2.0, 2.4, and 3.0mm diameters. If you thought the previous Trilliant Surgical screws had the bite of a tiger, you've got to check these out! The countersink for the screws is significantly more aggressive than standard countersinks as you have to make way for the overall diameter of the proximal screw. With this in mind, make sure you have adequete bone for the screw to sit in (example - proximal arm on a dorsal long arm hallux abducto valgus procedure) otherwise the screw will be too aggressive for the bone.

Check out these news screws as well as other foot and ankle screws at FootandAnkleFixation.com

New Product: Disco Subtalar Implant

2012-02-07T14:52:00.000-08:00

Trilliant Surgical has updated their website with information about their latest foot and ankle product, The Disco Subatalar Implant. FootandAnkleFixation.com has added the new device to the Subtalar Joint Impant / Arthroeriesis page which outlines all of the current available Subtalar Joint implants.

This new titanium implant allows for decreased lateral pressure points with the spherical shape as well as it is designed to integrate quicker into the surrounding tissue by way of the (up to) 75 micro channels embedded into the implant. Trilliant Surgical now has 5 different foot and ankle products available for use in the United States. Take a look at their other products here on the Trilliant Surgical Product Page.

Stay informed. FootandAnkleFixation.com

Foot & Ankle Fixation Podcast

2012-01-27T20:58:00.001-08:00

The Journal of Bone and Joint Surgery (JBJS) has a database of monthly podcasts in which they feature specific content from their corresponding monthly journal articles. They have a database spanning back to 2007. But don't worry, FootandAnkleFixation.com has done the leg work for you (no pun intended) and organized the relevant foot and ankle fixation podcasts. Take a look below and we will continue to bring attention to helpful tools for your daily surgical foot and ankle practice.

JBJS October 2011: Changes in Gait Following the Scandinavian Total Ankle Replacement

JBJS May 2011: A Randomized Trial in Open Tibial Fractures Treated with Reamed Nail Fixation; recorded commentary by Dr. Bhattacharyya

JBJS May 2011: Treatment of Displaced Intra-Articular Calcaneal Fractures with Closed Reduction and Percutaneous Screw Fixation

JBJS April 2010: Maintenance of Hardware After Early Postoperative Infection Following Fracture Internal Fixation

JBJS February 2010: Cartilage Lesions and the Development of Osteoarthritis After Internal Fixation of Ankle Fractures - A Prospective Study

New Company: Internal Fixation Systems

2012-01-26T07:29:00.000-08:00

FootandAnkleFixation.com has added another medical device company to their authoritative database: Internal Fixation Systems.

Internal Fixation Systems (IFS) is a new manufacturer of orthopedic and podiatric implants who seek to provide superior products at a lower cost (40-60% lower in some cases). Speaking with Ken West, one of the original founders of IFS and current VP of Sales & Marketing, IFS offers foot and ankle implants that are equipped to manage any type of fracture including basic fragment and cannulated sets. Additionally, they are in the process of developing a complete line of foot and ankle plates & implants for non-traumatic procedures. In fact, Internal Fixation Systems recently announced their 510(K) FDA clearance for a new Subtalar Joint Implant /Arthroereisis. Stay tuned as we will have more information about their upcoming products in the near future, including specific product images and descriptions.

Brachymet: The Wright Medical Way

2012-01-25T10:00:00.000-08:00

Brachymetatarsia typically presents multiple challenges to the surgeon. These may include the overall lack of width to the metatarsal, a shorted proximal phalanx in addition to the short metatarsal and, in some cases, multiple short metatarsals. Once it is decided to proceed with callus distraction, there are many options to from which to choose (see all current options).

Above is the Wright Medical Coretrak Tube Fixator in action. This mini external fixator is a little more bulky than some of the other fixators on the market and can be a little overwhelming to the patient at the first post-operative dressing change (then again, most external fixators have that affect on patients). The robust nature to this construct, however, offers stability and patient friendly manipulations. There are no small parts that require assembly and the guide holes within the fixator aids the surgeon for insertion of the fixator post. If you haven't yet given this mini fixator a try, consider it on your next brachymetatarsia case.

The IoFix Experiment: Follow Up

2012-01-23T20:16:00.000-08:00

Just a quick follow up from our previous blog on the Extremity Medical IoFix Implant and our first opportunity using the new implant. A few weeks ago, we wrote about our experience with the implant, The IoFix Experiment, and how satisfied we were with the bone purchase of the post and screws. In our patient with significant osteopenia, a 4-hole locking plate failed to stabilize the bone on her opposite foot. We chose to try this implant because of its inherent stability and the need for only two holes created in the bone rather than 4 with the plate. The idea of compressing the screw heads against the intramedullary post instead of applying it directly against the cortex of the bone is a no brainer.

4 weeks post-op, (at right) the patient is well consolidated with no pain on palpation or manipulation. The radiographs demonstrate good alignment of the arthrodesis site, no fixation failure or changes and signs of trabeculation across the fusion site.

We will slowly begin to progress to weightbearing over the next few weeks, (erring on the side of caution) although it appears clinically that she is now ready to start partial weightbearing. Using the IoFix implant was a nice change of pace from the standard fixes and in this case, has proven a good option to have in your bag of tricks. Inserting the implant does require a few extra steps than the standard screw, particularly involving the post insertion. Prepare for your Iofix case by watching (and perfecting) the insertion sequence here in The Fixation Network. Stay tuned for long term follow up.

Foot & Ankle Estimates at $176.9 million

2012-01-13T11:09:00.000-08:00

A recent article by BioMedGPS projects that the US market for foot and ankle fixation products will reach an estimated $176.9 million in 2012. They also expect the market to grow at a rate of 9% over the next few years, with estimations as high as $251 million by 2016.

“The market for foot and ankle implants is expanding as acceptance of surgical solutions for treating pain and deformity in this area of the body increases,”

- Lisa Mahan, Senior Analyst SmartTRAK Extremities and Total Joints modules at BioMedGPS.

These estimations reinforce the notion that foot and ankle surgery has drawn the focus of medical device manufacturers as we continued to see both new products and companies enter the market in 2011. As the foot and ankle market continues to grow, FootandAnkleFixation.com will be right there bringing surgeons the information they need to stay informed. Unbiased & Authoritative.

Year in Review: Fixation 2011

2012-01-10T07:08:00.000-08:00

2011 was a year of mergers & acquisitions ultimately making the most headlines in the world of foot and ankle fixation news. This all started with the monster mega merger between Depuy Orthopedics and Synthes back in April. Before the dust even had a chance to settle, the acquisition of MMI by Stryker and then Ascension Orthopedics by Integra LifeSciences made headlines. Zimmer made a splash by acquiring the external fixation line ExtraOrtho and finally Wright Medical also joined in the fun by agreeing to carry ArthroCare's Opus Knotless suture fixation technology. The acquisition of these new technologies and expansion of the product lines certainly has influenced the playing field among the "Big" companies who are vying for the majority of the Foot & Ankle market share. Only time will tell who the winners and losers are by how the market responds to these changes and particularly where surgeon loyalty falls.

In light of last years chess match between some of the largest medical device companies, out of the ashes came a handful of new companies and product lines…

For starters, Arrowhead Medical Device Technologies brought forth the Arrow-Lok hammertoe implant. This implant eliminates the need for external k-wire fixation nor does it need any form of temperature control prior to or after insertion of the implant. The company is currently in the process of developing their next foot and ankle implant. Other companies new to the foot and ankle market include Solana Surgical, whose focus in currently on 1st MPJ implants; Nextremity Solutions, who is in the process of bringing forth the Nextra Hammertoe Correction System, and Paragon 28, who will be offering a complete line of forefoot, midfoot and hindfoot plates.

Some of the new products to hit the market this past year introduced traditional concepts with a new twist. The Stryker (formerly MMI) Anchorage CP Plate was the first plate of it's kind, allowing surgeons

the ability to introduce an interfragmental compression screw actually through a dedicated screw hole. The new plates were specifically designed for a 1st MPJ Arthrodesis and Lapidus Arthrodesis. The Arrow-Lok implant previously mentioned takes the traditional buried k-wire fixation concept and augments it with the added benefit of greater pullout strength from the double-ended arrow tips. Other new products to highlight the year include the Pro-Toe VO

& Inbone II Total Ankle Replacement by Wright Medical, the BME Speed, the Integra U-Shaped Plate, and the Arthrosurface HemiCap Talar Resurfacing Implant (which at this time is still not yet available for use in the U.S.) As new products hit the open market, there was a trend in that Ankle Implants and Hammertoe Implants were definitely the hottest fixation of 2011

Probably the most exciting news though of 2011 for foot and ankle surgeons was the inaugural year of FootandAnkleFixation.com! No longer will surgeons have no place to look for updated and relevant foot and ankle surgery information for your daily practice and patients. Too many other orthopedic websites focus on the corporate aspect of medical device information, where our information is dedicated to the driving force behind it all, the actual fixation devices and how it relates to the surgeon's practice. By surgeons, for surgeons.

So what's on the horizon for 2012? Stay tuned to FootandAnkleFixation.com to keep up with the latest unbiased foot and ankle fixation news.

New Product: Wright Medical QUICKDRAW

2012-01-07T05:00:00.001-08:00

Wright Medical announced the release of their latest foot and ankle product, the QUICKDRAW, as the announcement was posted on the Wright Medical home page. This news comes in addition to the full release of their new Ortholoc 3Di Ankle Fracture System.

“The launch of the QUICKDRAW™ Knotless Soft Tissue Fixation System through our distribution agreement with ArthroCare^® Corporation will establish a strong foundation for Wright Medical in the growing soft tissue fixation market.”

- Robert Palmisano, President and Chief Executive Officer

The QUICKDRAW Knotless Soft Tissue Anchor utilizes similar technology to that of the ArthoCare Opus Anchor and is specific for soft tissue reattachment procedures of the foot and ankle. The system is composed of the BELAY™ and MINI-BELAY™ Knotless Suture Anchors, and RAPPEL-LINE™ Surgical Suture. FootandAnkleFixation.com has logged this new product under the following foot and ankle procedures: Achilles Tendon Rupture, Kidner Procedure, Lateral Ankle Stabilization, and Retro-Calcaneal Spur Resection.

New Product: Wright Medical Ortholoc 3Di Ankle Fracture System

2012-01-07T05:00:00.000-08:00

In addition to the release of the soft tissue reattacthment anchor, the QUICKDRAW, Wright Medical announced the full release of their comprehensive single-tray ankle fracture plates, the ORTHOLOC 3Di Ankle Fracture System.

“We are very pleased to launch the ORTHOLOC^™ 3Di Ankle Fracture System, which further expands our foot and ankle product portfolio and provides surgeons with an innovative solution to treat a wide range of ankle fractures,”

- Robert Palmisano, President and Chief Executive Officer

The ORTHOLOC™ 3Di Ankle Fracture System offers foot and ankle surgeons multiple plating (9) options and utilizes their ORTHOLOC™ 3Di polyaxial locking technology. The various plating options can be seen at FootandAnkleFixation.com under the following categories: Wright Medical, Ankle Fracture, Fibular Fracture, Medial Malleolar Fracture, and Pilon Fracture.

New Company: Paragon 28

2012-01-06T08:52:00.000-08:00

FootandAnkleFixation.com has added another company to it's comprehensive Foot and Ankle database. Paragon 28 is an up and coming implant company dedicated specifically to the foot and ankle market featuring over 119 total screws (2 - 7.5mm) in headed, tapered, and headless screw designs. Their product catalog includes 32 styles of the Normed plating system with over 136 different options. Their line of plates is procedure specific to 30 forefoot, midfoot, and hindfoot arthrodesis procedures. Additionally, they carry a line of interference screws and a line of staples. Stay tuned, as FootandAnkleFixation will bring you the latest information on the release of these new products.

Smith and Nephew + Essex Woodlands = Bioventus

2012-01-06T05:30:00.000-08:00

Smith & Nephew has agreed to create a joint venture with Essex Woodlands, a specialist health care growth equity and venture capital firm, to create a new biologics company called Bioventus. Smith & Nephew's EXOGEN Ultrasound Bone Healing System will now be marketed through Bioventus.

Although our focus at FootandAnkleFixation.com is not on biologics, the EXOGEN bone stimulator is routinely used in conjuction with foot and ankle surgery. The available foot and ankle fixation products by Smith & Nephew can be viewed here.

New Video: Acumed Mini Calcaneal Plate

2012-01-05T08:55:00.000-08:00

Acumed has posted on their website a new video on the application and sequence for the mini Calcaneal plate for ORIF of Calcaneal fractures. The animation (if only ORIF surgery was always this smooth) is clean and demonstrates step by step how to insert the plate. The nature of this implant is designed to be minimally invasive and utilizes a lazy S incision in contrast to the longer flap or extensile incision technique.

Read up more about this and other Calcaneal plating options here on the FootandAnkleFixation.com Calcaneal Fracture procedure page.

New Product: Gramedica osteo-Wedge

2012-01-04T08:50:00.000-08:00

The latest medical device to be added to the FootandAnkleFixation.com database is the Gramedica osteo-Wedge plate. There has been very little information released up to this point regarding the new plate other than that it is used in correcting met primus varus, particularly in Hallux Abducto Valgus: Opening Base Wedge procedures. Initial press releases on the implant were made public back in July of 2011 and within the last few months, two amusing you tube videos have been released promoting the new product. It’s in the second video titled “osteo-Wedge part Deux” where we get a first glimpse of the new plate. The plate is oblong in nature with 4 proximal screws and 3 distal.

With the new implant portrayed as the ultimate solution for bunion correction in these promotional videos, it will be interesting to see if it offers any new technology or advancements in regards to correcting severe bunion deformities. We will eagerly await the release of more information on the plate and will bring you our unbiased review once we get a chance to try it ourselves. For now though, you can visit the osteo-Wedge product page on FootandAnkleFixation.com to see the video premiers of the plate.

Evolution of the Locking Plate

2011-12-28T05:19:00.000-08:00

As locking plates emerged over the past decade, new advances and technologies have continued to evolve. Looking back, it’s hard to forget the classic AO video demonstrating pullout strengths between locking and non-locking 3.5mm cortex screws while applying a cloverleaf plate to an apple. As if the video wasn’t convincing enough, numerous studies and publications further backed the increased stability achieved with the locking constructs. Needless to say, interest in locking plates steadily grew as they became sought after particularly in cases of unstable trauma, revisional surgery and osteopenic bone.

With major companies like Synthes leading the way with newer locking technology, along came the locking drill guide. This added precise accuracy when pre-drilling. Now the drill hole would maintain a centralized position aligning and locking the screw properly with the plate threads. Simple enough right? Not exactly. Problems can still arise

· Alteration of the locking construct following bending of the plate

o Likely the most common cause of problems

o Inherently alters the integrity of the plate threads disrupting the screw from seating properly within the plate.

· Not inserting the screw directly 90 degrees to the plate

o The screw head will not seat properly within the plate

o Can cause the metal to strip or peel off the head

o If enough force is applied, the head of the screw can actually break off

These downfalls can lead to failure with the locking construct and/or neutralize their locking effect, essentially making them no stronger than a non-locking plate. Fast forward to today. New advances in locking plate technology have evolved such that it gives the surgeon additional room for error when applying a locking plate.

Examples:

· The Depuy plating systems

o Pre-loaded locking guides on the plates

- Eliminates the sometimes frustrating step of trying to get the drill guide to properly load into the plate

- Enables the surgeon the ability to bend the plate without disrupting the plate threads

· Smith & Nephew plates

o Variable angle capabilities.

o Now the screw does not need to be directed in precisely at 90 degrees

Some plates have eliminated the need for threads within the plate holes altogether:

· Extremity Medical IoFix Implant

o Although not a plate per say, the IoFix implant utilizes the locking plate idea. Based on the conical shape of the screw head, the screw essentially locks into the post as it is inserted.

· Integra Hallu-Lock Plate

o Utilizes a SurFix system

- There are no threads on the head of the screw

- Instead, a separate threaded washer, applied on top of the screw head, after the screw is inserted

Can traditional non-locking plates get the job done? Probably in most cases, yes. Do locking plates offer multiple advantages over standard plating options? Most definitely. Ultimately, the choice to use these new plating options rests in the hands of the surgeon. Regardless, advances in plating technology have and will continue to evolve, making it not only easier for the surgeon but also superior for the patient.

- www.FootandAnkleFixation.com

Social Fixation

2011-12-19T07:25:00.000-08:00

FootandAnkleFixation.com embraced the world of social media this week with Twitter @SurgFix, Facebook, Google+ and LinkedIn.

Of course you can follow our blogs directly and we welcome you to our Community. Please join us as we ease your navigation into the world of surgical implants of the foot and ankle!

New Product: HemiCAP® Talar Resurfacing Implant

2011-12-16T01:42:00.000-08:00

With all of the hype surrounding Ankle Joint Implants / TAR, a new implant has surfaced on the market (no pun intended) from Arthrosurface. The Hemicap Talar Resurfacing Implant is different in the sense that it is not a Total Ankle Replacement, but is designed for more specific or focal talar dome defects. Arthrosurface has taken the technology from their Hemicap DF System for 1st MPJ resurfacing and applied the same concept to the new talar implant. The device has a cobalt chrome articular surface with the undersurface coated in Titanium.

As stated on the Arthrosurface website, "The HemiCAP system is intended to provide an effective interim means for managing pain and disability in the middle-aged patient until a total joint replacement treatment option becomes more necessary, and is part of a clinical treatment strategy to help avoid early-age-revision scenarios. The prosthetic may also provide a treatment option for the older patient who may not tolerate the morbidity of a total joint replacement procedure."

This implant is not yet available for use in the United Sates or Canada. However, it is cleared in Europe and Arthrosurface has a program set up through which pateints can connect with physicains overseas. FootandAnkleFixation.com offers many informative services to foot and ankle surgeons, and we strive to provide up-to-date product news and information that we feel is pertinent to your practice. Unfortunatly, we do not include non FDA cleared products in our comprehenisve database. We will bring attention to those that are either on the verge of being cleared or that we feel are potentially industry changing. This is an exciting new option for reconstructive ankle surgery and we look forward to the opportunity when we can explore this implant further

The IoFix Experiment

2011-12-13T11:47:00.000-08:00

Yesterday I finally had an opportunity to give the Extremity Medial IoFix implant a try. The patient had a history of osteoporotic bone (as noted in her previous hallux abducto valgus correction) therefore, I sought out a new implant that could help manage the frailness of the bone. And as expected, I was not disappointed.

As with most new implants and instrumentation, putting the first post and screw in took a few extra minutes. However, with this device, the learning curve was quick and the second construct was inserted in a noticeably faster application. One caveat that I can pass along is that I accidentally overdrilled past the laser-etched mark (on the drill) prior to inserting the second post. The over drill is very sharp and in this case when combined with soft bone caused the post to fit loosely within the bone. Although this error on my part was negated with the final screw purchase, pre-drilling for the post prior to screw insertion should not be overlooked.

Overall, the construct was very solid and I was impressed by the way it essentially neutralized the porosity of the patient's poor bone quality. A few of the tips that are demonstrated in this technique video were utilized during the case and really helped me with screw placement. This prevented contact between the two interfragmental screws. The next time that you are preparing for an arthrodesis procedure, consider looking into the Extremity Medical IoFix Implant. If you are concerned about wall breakout or osteoporotic bone, using this implant is a no-brainer.

All Extremity Medical products are viewable here at www.FootandAnkleFixation.com

The Unbiased Authority: There are no conflicts of interest or financial association/assistance between FootandAnkleFixation.com and Extremity Medical

Trends in Hammertoe Surgery

2011-12-09T20:16:00.000-08:00

Traditional fixation methods for Hammertoe Correction include cerclage wire and external k-wire fixation for the past 40 years. As of recently though, these traditional methods have been challenged by new fixation options such as screws (BioPro Digital Compression Screw, Vilex Digital Fusion Toe Implant), staples (SBI StaFix Staples), and suture anchors (Core Essence ReNOVO). Additionally, a new breed of hammertoe implants has become increasingly popular including Nitinol shape memory implants, (BME Hammerlock, Stryker (MMI) Smart Toe), peg and hole implants (Wright Medical Pro-Toe VO, Tornier StayFuse), and now Arrow Tipped Implants (Arrowhead ARROW-LOK).

But does it all make a difference? Do these new techniques have an advantage over the standard k-wire? In most cases, the external k-wire is fast, technically straightforward, and inexpensive. Unfortunately with this technique, patients have the added morbidity of a pin protruding out the end of their toe(s), the possibility of a pin tract infection and the anxiety and discomfort involved with removing the pins. There’s a saying that you can’t teach an old dog new tricks, but this may be one worth trying, as newer fixation methods for hammertoe correction can offer some patients a better option.

Specifically in regards to hammertoe implants, three different types have evolved and are now available on the market. First, the memory shape metal implants have taken off in recent years and have become popularized as one of the go to standards in internal options. The BME Hammerlock and the MMI Smart Toe are two Nitinol implants available that have received the most attention and have really opened the door for similar implants to follow. The drawback to these implants is the specific temperature requirement needed to store the implant prior to insertion along with the time sensitive nature of the implant once it is removed from its cryo-preserved state. If the implant is not inserted in a timely manner, the arms of the device can open, hindering the implant’s insertion. Additionally, the implant does have the ability to break over time if stressed above and beyond its modulus of elasticity. In most instances, this does not lead to problematic symptoms and can be monitored over time. Take a look at the new BME Speed as it has eliminated the need for temperature regulation while still utilizing the benefits of the nitinol.

Next up are the peg and hole type implants such as the Tornier StayFuse implant and the Wright Medical Pro-Toe VO. Rather than inserting a time sensitive implant whose legs expand with body temperature, these implants are directly inserted into both ends of the fusion site. From there, the two independent pieces are joined together, creating a stable construct. Lastly and the most recent implant to come to the table is the Arrow-LOK implant. A variation from a buried k-wire, this implant is the most straightforward and simple implant on the market. Even so, initially it is technically demanding and takes a few reps before it becomes second nature (which it does). The 3-dimensional arrow tipped implant is available in both straight and angled options.

So in the end there are a variety of options that surgeons can choose from when correcting hammertoes. The gold standard has been the external k-wire, however, newer implants (at a cost) have demonstrated predictable results with added patient benefits. These new generation implants offer patients the option of internal fixation and potentially less morbidity.