My foot practice at Spire (Little Aston) has been using internal fixators since 2013 for toe deformities. Previously the Smart Toe (Stryker) was used. As we look for consistency in our procedures, the metal design has now been reviewed and a two-piece system Nextra (Osteotec) preferred. This system is more precise to locate into the bone and can be removed or revised more easily if needed. The traditional wire system requires removing usually at six weeks. Wires can loosen and the toe joint has a 15-25% chance of not bonding. I believe internal fixation is the way forward at our hospital, but we constantly review and update methods used. The traditional wire system works very well and is still used with great success. While I still publish the data on the wire system (see table; factsheet 5) we look forward to reviewing our latest method in the future. It may not be possible to use this in all smaller toes, and some patients may find they cannot have this product which is subject to insurer/provider agreement.
Research is always ongoing to find better ways to help our patients.