GRAND ROUNDS

The Use of the Smart Nail to Fixate the Capital Fragment during Bunion Surgery

 by Brian K. Doerr, DPM
Ft. Myers, FL

*additional information relating to this topic can be found by accessing Dr. Marc Dolce’s lecture on Absorbable Fixation

There are many acceptable ways of fixating the capital fragment during bunion surgery.  These include screws, both cannulated and not, K-wires, circlage wire, or any of the new absorbable materials on the market today.  Because the fixation is only temporary, the use of absorbable materials is a viable alternative to the use of metallic devices.

The Smart Nail is made from polylevolactic acid (PLLA) as opposed to the older and more reactive polyglycolic acid (PGA).  The PLLA implants are made in a temperature controlled, die drawing process which gives them their inherent strength over other absorbable materials on the market today.

We have been using Smart Nail implants for the last year in all but one of our bunion cases.  We have found no cases of tissue rejection or reactions and the patients reported no untoward effects.  We have found the process of inserting the implant to be very quick and easy and have noted good fixation of our osteotomies.  Serial x-rays have not shown any bony resorption of the type that has been noted when using other absorbable materials.

Notice how the implants are held in place by the indentation in the metal cylinder

The osteotomy is being held in place with a 0.045 K-wire
while a second K-wire is used as a drill for the implant

The implant is introduced into the drill hole.  Notice on the sleeve the indentation.  This is to prevent the implant from falling out

Counter-pressure is applied, and the plunger is depressed pushing the implant across the osteotomy

The K-Wire is showing the implant in place.  The system is designed to counter-sink the implant automatically

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Jay Lieberman, DPM
Editor - PRESENT
Director of Podiatric Medical Education
Northwest Medical Center
Margate, Florida