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The efficacy of an intramedullary nitinol implant in the correction of claw toe or hammertoe deformities

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

A multitude of procedures has been described in the literature for the treatment of lesser toe deformities and there is currently no general consensus on the optimal method of fixation. The aim of this study is to assess the clinical and radiological outcomes of an intramedullary nitinol implant for the correction of lesser toe deformities, and to determine if the distal interphalangeal (DIP) joint and metatarsophalangeal (MTP) joint are modified during patient follow-up after correction of the PIP joint.

Materials and methods

A prospective analysis of 36 patients with claw toe or hammertoe who were treated with an intramedullary nitinol implant. Clinical manifestations and angulation of the metatarsophalangeal, proximal and distal interphalangeal (MTP, PIP, DIP) joints were evaluated in radiographic studies preoperatively, at first medical revision post-surgery, and after a minimum of 1 year of follow-up. Complications such as non-union rate, implant rupture, and implant infection were also evaluated during follow-up.

Results

All patients were women with an average age of 65.5 (range 47–82) years. The average follow-up time was 2.4 (range 1–5.7) years. Fifty intramedullary nitinol implants were used. The MTP joint extension and PIP joint flexion decreased by 15.9° (95% CI – 19.11 to – 12.63) and 49.4° (95% CI – 55.29 to – 43.52), respectively, at the end of follow-up. Moreover, the DIP joint flexion increased progressively during follow-up (13.7° pre-surgery versus 35.6 in last medical check-up, 95% CI 13.24–30.57). There were four (8%) asymptomatic implant ruptures. The rate of fusion was 98%.

Conclusion

The reduction of the PIP joint using an intramedullary nitinol implant is a good option in lesser toe deformities, with few complications and a high rate of arthrodesis. Moreover, the PIP joint reduction affects both the MTP and DIP joints.

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Acknowledgements

We express our gratitude to Ruth Breeze for the language editing of the manuscript.

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Authors and Affiliations

  1. Orthopaedic Surgery and Traumatology Department, Clínica Universidad de Navarra, Av. Pio XII 36, 31008, Pamplona, Spain

    Jesús Payo-Ollero, Rafael Llombart-Blanco, Carlos Villas & Matías Alfonso

  2. Faculty of Medicine, Universidad de Navarra, Av. Pio XII 36, 31008, Pamplona, Spain

    Ahinoa Casajús-Ortega

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  1. Jesús Payo-Ollero
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Correspondence to Jesús Payo-Ollero.

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Payo-Ollero, J., Casajús-Ortega, A., Llombart-Blanco, R. et al. The efficacy of an intramedullary nitinol implant in the correction of claw toe or hammertoe deformities. Arch Orthop Trauma Surg 139, 1681–1690 (2019). https://doi.org/10.1007/s00402-019-03203-w

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