Can A New Implant Lead To More Efficient Hammertoe Fixation?

An emerging implant features a number of effective components to facilitate easier hammertoe fixation.    

The Two-Step Hammer Toe Implant System consists of a cannulated titanium alloy and serves as an interphalangeal joint arthrodesis implant, according to the manufacturer Trilliant Surgical. The company notes the self-drilling, self-tapping threaded section helps rapidly place the implant down the central axis of the phalanx.    

The implant also has a tri-spade stem for multiplane stabilization of the joint with optional spade placement orientation in the proximal or distal phalanx, which Jonathan Blum, DPM, FACFAS, cites as advantageous.    

Dr. Blum has been using the Two-Step Hammer Toe Implant System for approximately two years. “I have found truly excellent clinical results to date with increased healing rates and decreased healing times,” he says.    

Andy Pankratz, DPM, FACFAS, has used the Two-Step Hammer Toe Implant System in about 35 procedures, using it in conjunction with Trilliant’s HTR Hammer Toe Reaming Implant System. He also cites the efficacy of the device’s proximal spade and the fact that the implant is one piece.    

“The technology is still developing but I still think it’s a pretty decent device,” says Dr. Pankratz, who is in private practice in Eau Claire, Wis.    Dr. Blum cites the cannulated design, the first of its kind, as an important advantage of the system. He notes the cannulation allows for stabilization of the metatarsophalangeal joint (MPJ), which is necessary in a digital arthrodesis due to the releases around the MPJ. Dr. Pankratz does caution that since the device is cannulated, one cannot have an angled implant, although the surgeon can still get 10-15 degrees of flexion in the joint by reaming the proximal phalangeal side slightly plantar to dorsal.    

Trilliant notes surgeons can use temporary K-wire fixation through the MPJ if necessary. Dr. Pankratz says one drills the 0.045 inch K-wire retrograde from the middle phalangeal base out the distal tip of the digit and leaves the K-wire 4-5 mm proud from the middle phalangeal base in order to accommodate the the cannulated “screw” portion of the implant. As he notes, the ability to cross the MPJ with a K-wire aids in decreasing the occurrence of a floating toe. He will leave the K-wire in three weeks postoperatively while patients wear a Darco Wedge Shoe.    

Other advantages of the implant are the simple design and insertion, and the fact that one can store the implant at room temperature, according to Dr. Blum. He also cites the short and long thread lengths that can fuse the proximal interphalangeal and distal interphalangeal joints. Trilliant notes the Two-Step comes in a 3.0 mm threaded section with 3.4 mm and 4.5 mm diameter spaded portions. Dr. Blum says the implant length is available from 6 mm up to 30 mm.    

“The (Two-Step Hammer Toe Implant System) is a simple and reproducible device no matter the patient’s bone quality and is for use by all surgeons,” says Dr. Blum, who is in private practice in Kissimmee, Fla.