Elsevier

The Journal of Foot and Ankle Surgery

Volume 51, Issue 6, November–December 2012, Pages 711-713
The Journal of Foot and Ankle Surgery

Original Research
SmartToe® Implant Compared with Kirschner Wire Fixation for Hammer Digit Corrective Surgery: A Review of 28 Patients

https://doi.org/10.1053/j.jfas.2012.06.013Get rights and content

Abstract

For many years, end-to-end arthrodesis of a proximal interphalangeal joint arthrodesis to correct hammer digit deformity has been fixated with a Kirschner wire (K-wire). For this particular hammer digit deformity correction, we attempted to determine the effectiveness of the SmartToe® intramedullary shape memory implant compared with the K-wire. In a retrospective analysis of 28 cases, we evaluated several important parameters at baseline, postoperative days 7, 14, 21, 28, and 56, and 6 months for pain, complications, arthrodesis achieved, and return-to-work status. The SmartToe® outperformed the K-wire in all categories, with no evidence of significant complications, compared with multiple complications for patients in the K-wire arm of the study. This study demonstrates that the SmartToe® is a reasonable choice for fixation of proximal interphalangeal joint arthrodesis in hammer digit correction.

Section snippets

Patients and Methods

This clinical evaluation consisted of 28 patients, analyzed retrospectively after surgical correction of a hammer digit deformity of the PIPJ requiring end-to-end arthrodesis. We assessed 15 patients who received K-wire fixation and compared them with 13 patients who were fixated with the SmartToe®. Each patient was evaluated by the respective surgeon (A.K.A., M.J.B., or D.S.), determined to have a hammer digit deformity with the apex of the deformity at the PIPJ, and determined to be a

Results

The primary outcome measure was pain associated with each fixation technique. At baseline, both arms exhibited very similar VAS levels, with mean ± standard deviation for the K-wire arm of 7 ± 1.60 and 6.83 ± 1.34 for the SmartToe® arm (p > .05). As the successive postoperative visits progressed, the K-wire arm demonstrated consistently higher VAS levels compared with the SmartToe® arm. Fig. 2 demonstrates the progression of pain relief in each arm of the study. After 6 months follow-up, the

Discussion

The data noted earlier lead to an interesting discussion regarding fixation for PIPJ arthrodesis in hammer toe surgery. Schrier et al, in a unique evaluation in The Netherlands, studied methodology and treatment protocols for lesser toe deformities in the Department of Orthopaedic Surgery and Traumatology, Isala Clinics. They concluded that there was absolutely no consensus regarding definitions, treatment protocol, or strategies when addressing lesser toe deformities, which led to a

References (6)

  • E.D. McGlamry et al.

    Lesser ray deformities: deformities of the intermediate digits and metatarsophalangeal joint

  • H.B. Kitaoka et al.

    Realignment of lesser toe deformities

  • J.C. Schrier et al.

    Opinions on lesser toe deformities among Dutch orthopaedic departments

    Foot Ankle Int

    (2007)
There are more references available in the full text version of this article.

Cited by (32)

  • Hammertoe correction with wire fixation of varying length

    2022, Foot and Ankle Surgery
    Citation Excerpt :

    Due to the prevalence of hammertoes, many different surgical techniques and implants have been designed to address them. Multiple studies have repeatedly validated the plethora of surgical approaches to repair hammertoe deformity with excellent patient outcomes and malalignment correction regardless of the technique [9–13]. The surgery is commonly not limited to PIP arthrodesis, but often requires balancing of the MTP joints as well with various soft tissue releases and tendon releases and/or transfers [2,14–16].

  • Bone fixation techniques for managing joint disorders and injuries: A review study

    2022, Journal of the Mechanical Behavior of Biomedical Materials
  • SmartToe, ToeGrip and buried k-wire versus percutaneous k-wire fixation for 2nd PIPJ arthrodesis: A comprehensive review of outcomes

    2020, Foot
    Citation Excerpt :

    The SmartToe implant had the largest implant fracture rate ranging between 0% and 20.7% [13,17]. The hardware fracture rate with k-wire fixation ranged between 0.1% and 7.1% in the percutaneous and buried k-wire techniques respectively [7,14,18,20]. Several authors reported SmartToe migration ranging between 3.8% and 10.8% [12,21].

  • Lesser Digit Implants

    2019, Clinics in Podiatric Medicine and Surgery
    Citation Excerpt :

    In a smaller retrospective study, 28 patients were followed for 6 months after hammertoe correction using a K-wire or memory Nitinol implant. The memory Nitinol implant fixation was reported to outperform the K-wire stabilization.21 A prospective study of 60 digital surgeries using the memory Nitinol implant showed an 85% rate of union with only 1 digital implant failure caused by dislocation of the device.22

  • Digital Arthrodesis of the Lesser Toes

    2017, Clinics in Podiatric Medicine and Surgery
View all citing articles on Scopus

Financial Disclosure: This study was funded with a research grant by MMI-USA, now part of Stryker Foot and Ankle.

Conflict of Interest: None reported.

View full text