Experience with Hammertoe Fixation

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.

Trends in Hammertoe Surgery

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.

New Company: Nextremity Solutions

Although there are thousands of medical device companies within the orthopedic industry, companies specifically focusing on foot and ankle surgery is somewhat limited. And so it is with great pleasure that FootandAnkleFixation.com is pleased to announce the addition of our 51st foot and ankle medical device company: Nextremity Solutions.

This up and coming orthopedic implant company announced the acquisition of its CE Mark for the Nextra™ Hammertoe Correction System in late November. Next up on their to do list will be the official launch in the U.S.. Specific information and images of the new implant have not been officially released, however, in speaking with a source close to the product's development, the new implant focuses on enhancing the fusion site by way of newly developed technology incorporated into the overall implant design. Check back often with us as we will highlight any information that is released regarding this new technology for Hammertoe Correction.

New Product: Vilex Digital Fusion Toe Implant

One of the hot topics recently in foot and ankle surgery are the continual evolution of fixation options for Hammertoe Correction. We have seen a variety of implants hit the market within the last few years that have offered different advantages over the competition. In keeping tract of all of the available internal and external fixation options for foot and ankle surgery, FootandAnkleFixation.com is proud to announce the newest implant added into the database; the Vilex Digital Fusion Toe Implant. The hammertoe implant is now live online and available for use in the U.S.

Currently there is no surgical brochure on the screw to download, however, the cannulated screw appears to involve a simple insertion following joint preparation. Screw sizes include 2.0mm, 2.5mm, and 3.0mm and is available in sizes ranging from 24-50mm.

Arrowhead Website Now Live

Information about the new hammertoe implant Arrow-Lok Digitial Fusion System, manufactured by Arrowhead Medical Devices Technologies, can now be accessed online as their website has officially launched. The new website is user friendly and visitors to the site have the ability to navigating through topics such as Surgical Tips & Tricks, Instrumentation, Instructions For Use, and Performance Testing Results.

Arrowhead Medical Devices Technologies, founded in August of 2010, specializes in developing medical devices for the treatment of musculoskeletal conditions. The Arrow-Lok Digital Fusion System is the first product for the company.