Symptomatic Hammertoes Treatment Comparison: Peg-in-Hole Arthrodesis Versus End-to-End Screw Fixation.

Proximal interphalangeal (PIP) arthrodesis technique utilizing the peg-in-hole arthrodesis was founded to avoid the use of retained internal fixation implants and thereby potentially decrease the concern of hardware complication. The specific aim of this study was to report the complication rates of the modified peg-in-hole arthrodesis technique and the end-to-end arthrodesis with single screw fixation technique for correcting symptomatic hammertoe deformities in lesser digits. This retrospective chart review included patients who underwent surgical hammertoe correction of lesser digits between the dates of January 2012 and December 2019. Patient demographic data and charts were reviewed to evaluate need for revision including screw/pin removal and complications related to corrective surgery. Five hundred ninety-three symptomatic hammertoe deformity cases (443 female, 150 male) were identified, with 113 cases (88 female, 25 male) treated with peg-in-hole arthrodesis technique and 480 cases (355 female, 125 male) treated with end-to-end arthrodesis with a single screw technique. The deformity recurrence rate was not significantly different between the two techniques (peg-in-hole: 10%, end-to-end: 13%, p = .428). There were 97 cases with postoperative complications that required re-operation (peg-in-hole: 7 cases, end-to-end: 90 cases) with the majority detected at <6 months. There was no statistically significant difference in reoperation rate between the peg-in-hole technique and the end-to-end arthrodesis technique reoperated with reasons excluding simple screw removal (p = .068). This study tended to show these two arthrodesis techniques have equivalent risks and similar success in bone healing; however, the peg-in-hole arthrodesis technique offers an advantage that does not result in retained hardware.

Complex fluids based on methacrylated hyaluronic acid.

We present the preparation and characterization of viscoelastic formulations of hyaluronic acid functionalized with polymerizable methacrylate groups. We explored three different processing strategies for controlling microstructure and interchain interactions: lightly cross-linked near-gels, emulsion-cross-linked microspheres, and an elastic microgel formed through centrifuging the microspheres. The component structure and rheological properties of these formulations were compared to those of high molecular weight hyaluronic acid solutions, which displayed classical behavior of high molecular weight polymer solutions reported by other investigators. We demonstrate that these processing strategies allow the tuning of solution properties from strongly viscoelastic behavior, observed in lightly cross-linked near-gels and concentrated microsphere solutions to elastic behavior in elastic microgels, behaving like pseudoplastic liquids having a well-defined yield stress above which viscous behavior was observed. In the centrifuged microspheres, the hyaluronic acid degree of methacrylation was inversely proportional to the gel elasticity, and a mechanism based on failure due to microsphere brittleness is proposed to explain this behavior. These results suggest that processing methacrylated hyaluronic acid can lead to a diversity of solution properties, providing methods for delivering this biologically active polymer in a broad range of applications.