A 1-Piece Shape-Metal Nitinol Intramedullary Internal Fixation Device for Arthrodesis of the Proximal Interphalangeal Joint in Neuropathic Patients With Diabetes

Abstract

A common complication associated with diabetes is the development of a rigid structural lesser toe contracture, which, when combined with peripheral sensory neuropathy, can lead to ulceration, infection, and amputation. Surgical correction of lesser toe contractures in persons with diabetes has been advocated to decrease the potential for ulceration and amputation. Lesser toe proximal interphalangeal joint arthrodesis employing myriad joint preparation and fixation methods is commonly performed to correct a rigid structural toe contracture. The author performed a retrospective, observational, cohort study involving 10 patients (30 toes) with diabetes, dense peripheral neuropathy, and rigid structural toe contracture treated with a 1-piece shape-memory Nitinol intramedullary internal fixation device for arthrodesis of the proximal interphalangeal joint. Successful fusion was achieved in 28 of 30 toes (93%), with a stable nonunion achieved in the remainder. Complications that arose occurred early in the author's experience with this implant and consisted of secondary contracture of the distal interphalangeal joint (23%), displaced fixation (13%), and malunion (7%). No patient developed ulceration, and no additional surgery has been required to date. When properly performed, the use of this implant for arthrodesis of the proximal interphalangeal joint in neuropathic patients with diabetes appears safe and reliable.