10/14/2013    Todd R Stewart, DPM

Fractured Digital Implant

Having an implant fracture is not that rare an
occurrence. We have all seen screws, plates, K-
wires, and in this case, nitinol implants
fracture. These can fracture for various reasons:
defective implant, early unguarded weight-bearing,
trauma, or surgeon error in inserting the implant.

In this case, both arms of the second toe implant
and also a fractured arm of the third toe implant
is noted. If there is mal-alignment or pain, the
implants should be removed. The technique employed
should be standard dissection down to bone, dis-
articulation at joint level (since there is
gaping, this should be quite easy). Grab the
distal part of implant with forceps and pull out,
grab the proximal portion with a hemostat and
twist gently until loose and pull out. If the
fractured arms are not easily seen, leave them in
the bone. Resecting a small amount of bone to help
remove any part of the implant is fine, but can
destabilize the toe. After removal of the implant,
re-align digit and refuse with a K-wire. If the
toe is shortened, bone grafting is also an option.

It is not standard of care to have patient do Yoga
at 4 weeks post-op. Six weeks in a surgical
guarded weight-bearing with serial x-rays to
assess healing of fusion site is preferred.
Normally, when we see breakage at the same spot on
multiple implants and multiple legs, it is
indicative of a severe load, not a random event
In this case, it appears the implants could not be
expected to withstand those type of forces (Yoga)
before bony fusion had occurred. Dealing with
complications are always difficult, but in this
case, due to pain and mal-alignment, surgical
correction is your best option. The manufacturer
of this implant has a detailed protocol on removal
of these implants for further review.

Todd R Stewart, DPM, West Nyack, NY
centerockfeet@optonline.net

There are no more messages in this thread.