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The Best Thing Since
Sliced Bread
Zimmer® Stayfuse
Inter-digital Fusion System
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by Jay
Lieberman, DPM
Editor and Curriculum Developer
PRESENT
For many years, the peg and hole procedure with K Wire fixation has been the
procedure of choice for fusion of the IP joints of the lesser digits.
To the thoroughly initiated surgeon, the procedure has many
drawbacks…
(1) Creating the “peg” often means shortening the toe a bit more than the surgeon
would like. This could create a cosmetic concern post operatively
(2) K Wires are unpleasant, uncomfortable, and unsightly. They can also
inadvertently come out if caught on bed linen
(3) As the toe swells post-operatively, the bone segments distract on the
smooth K Wire. This decreases the likelihood of satisfactory fusion.
K Wires are typically used for three weeks. Many surgeons would
prefer to keep them in place longer. However, the risk of pin
track infection is real.
The Stayfuse system offers an easy to use and reliable method of achieving
inter-digital fusion. It is a two component (male/female) threaded system
made of titanium. The distal component has an elongated fluted stem that
connects to the proximal portion. Once the components have been fitted
together, the “Hex-Lock” snugly snaps the proximal and middle phalanx into
position.
The Stayfuse design prevents rotation and sagittal and transverse plane
displacement. The results have been impressive.
Case Presentation
This is a 48 year old gentleman who has been treated for a flexible forefoot
equinus. Previous surgical procedures included a Jones Tenosuspension and
fusion of the IP Joint of the hallux to address a hallux malleus and chronic
pain underlying the 1st metatarsal head. The patient did not experience any
post operative complications or sequelae.
Within the last year, the patient underwent arthroplasties of the 3, 4
digits of the right foot with attempted “peg and hole” fusion of the 2nd
toe.
Although the preoperative symptomatology abated, satisfactory fusion did not
occur and the toe deviated medially. The patient was then brought back to
the operating room for a revision fusion using Stayfuse.
Preoperatively, templates were used to determine the correct size of the
implant components.
1) Two parallel bone
cuts are made perpendicular to the central canal of the associated bones.
2) Pilot
drill holes are then made 90-degrees to the resected surfaces using
the hand driver and appropriate sized drill.
3) The hand driver is then fitted with an appropriate sized hex driver….
and the Stayfuse screw is inserted flush with the ends of individual bones.
Close up
Insert the proximal end first. This facilitates the procedure.
The implants are then engaged and rotated slightly until the hexagonal
components snap into place. Good bone to bone opposition is immediately
apparent.
Fellow foot and ankle surgeons, this is what we have been waiting for.
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