Introduction. Lesser toe proximal interphalangeal joint arthrodesis is a common forefoot procedure for correction of claw toe deformities. The most common method of fixation is with k-wires. Although this is a very cost-effective method of fixation, well-known disadvantages include pin site infection, non union, wire migration and the inconvenience to the patients of percutaneous wires for up to six weeks. For these reasons, intramedullary devices for joint fixation without crossing the distal IP joint have been developed. Many different designs are currently available. The Smart Toe prosthesis which has appeared as a type I and II, is one such implant. In two recent studies using type I, the use of this implant is advocated. We wish to present our experience with the use of the Smart Toe II. Methods. In this retrospective study we present a radiological review of 46 consecutive cases in 25 patients who underwent lesser toe interphalangeal arthrodeses using the Smart Toe II implant between July 2010 and November 2014 by the senior author. There were 7 (28%) male and 18 (72%) female patients. Post operative radiographs, taken at a mean follow up of 6 months, were reviewed for non-union, migration and implant failure. Results. There were 9 (20%) implant fractures, 10 (22%) radiological non- unions and 5 (11%) implant migrations. 4 toes (9%) were sufficiently symptomatic to require revision. Conclusion. In contrast to two previous studies, our series showed a high rate of implant fracture and non-union, sometimes leading to the need for revision surgery. We recommend caution in use of the Smart Toe II and welcome further reports of results. If our experience is replicated, we suggest the device's use is withheld pending appropriate studies to identify and address the reasons for implant failure, especially if more of the radiological failures come to require revision

Osteoarthritis (OA) is a disease of the joints stemming from a variety of factors, including joint injuries and abnormally high mechanical loading. Although the traditional treatment alternatives for end-stage OA are arthroplasty in the case of the hip and knee, and arthroplasty or arthrodesis in the case of the ankle, these options are not ideal for younger, more active patients. For these patients, joint prostheses would be expected to fail relatively quickly, and ankle fusion is not amenable to maintaining their active lifestyles. In these cases, joint distraction has attracted investigative attention as a conservative OA treatment for younger patients. 9-14. . Based on the principle that decreasing the mechanical load on cartilage stimulates its regeneration. 15. , distraction treatment calls for reduced loading of the joint during a period of typically 3 months, during which time the load customarily passing through the joint is taken up by an external fixator spanning the joint . By mounting the fixator components to the bone on each side of the joint, and then lengthening the rods connecting the proximal and distal portions of the fixator, the joint is distracted. Assuming the fixation is appropriately stiff, any load passes through the fixator instead of the joint, and the two articular surfaces will not be allowed to contact each other under physiologic loading. The exact mechanisms leading to cartilage regeneration during distraction are not yet understood. A possible negative consequence of joint fixation is cartilage degeneration due to immobilization during the treatment. It has been shown by Haapala et al. and others that long-term immobilization can be detrimental to articular cartilage. 16-18. . Conversely, joint motion during fixation (even passive motion) is thought to stimulate or encourage cartilage regeneration. 19-22. Toward this end, considerable effort has been invested in the application of hinges to external fixation for joints Joint motion has also been suggested as a potentially beneficial factor in distraction treatment, as well. 10. This is borne out by data from an RCT comparing the use of a rigid vs motion external fixator. Change in joint biology due to resorption of cysts may be responsible for reversal of symptoms

Aims

Fractures of the navicular can occur in isolation but, owing to the intimate anatomical and biomechanical relationships, are often associated with other injuries to the neighbouring bones and joints in the foot. As a result, they can lead to long-term morbidity and poor function. Our aim in this study was to identify patterns of injury in a new classification system of traumatic fractures of the navicular, with consideration being given to the commonly associated injuries to the midfoot.