We reviewed the use of compression staples made of the memory metal alloy nitinol for fixation in foot surgery. A retrospective study was performed of 31 feet in 27 patients who underwent arthrodesis or an osteotomy fixated using compression staples. OSStaples (BME, San Antonio, Texas) were used in 18 feet, and Memodyn staples (Telos Medical, Fallston, Maryland) were used in 13 feet. A total of 48 compression staples were implanted. The following procedures were performed and fixated using compression staples: 15 Akin osteotomies, 2 first metatarsal base epiphysiodeses, 3 first metatarsal-cuneiform fusions, 2 naviculocuneiform fusions, 3 calcaneocuboid fusions, 4 talonavicular fusions, 3 subtalar joint fusions, and 2 Evans osteotomies. In our clinical experience, compression staples provide an adequate source of internal fixation in foot surgery. Good bone apposition and stabilization and compression of the bone surfaces before staple fixation are important when using staple fixation to promote an optimal environment for bone healing.

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Absorbable fixation has been used since approximately 1971. The bioabsorbable polymeric and composite surgical materials retain tissue-supporting properties for specific periods (from a few days to a year), and they are biologically degraded into tissuecompatible components that are absorbed by living tissue and replaced by human tissue. Various forms of fixation have been developed, along with various materials (synthetic polyesters and high-molecularweight polymers) to fabricate these fixation devices. Poly-L-lactide, polyglycolic acid, and poly-P-dioxanone implants are synthetic devices distinguished by their composite materials. They degrade in aqueous media to monomers, which are metabolized and excreted by the lungs as CO2 and water. Degradation is faster in vivo than in vitro, partly because of cellular enzyme enhancement.Polylactide is a semi-crystalline, bioabsorbable, thermoplastic polymer that is obtainable from re-newable resources. It has a melting point of 174°C. The starting monomeric compound L-lactic acid can be produced in high yields by many fermentation and chemical treatments of inexpensive biomass materials, such as molasses or potato starch. Polylactic implants have been used successfully in orthopedic procedures for more than a decade.To increase the mechanical properties of the bioabsorbable screws, Tormala et al 1 developed a socalled self-reinforcing technique in which the polymer is extruded according to a specific draw ratio under controlled temperature and pressure to produce fibrils of the material. The process fundamentally changes the biomechanical and biocompatible properties of the device. The self-reinforcing technique was first applied in pure polyglycolic acid and poly-L-lactide implants. 2 Advantages and disadvantages are noted with both the self-reinforcing and non-self-reinforcing implants, including the adverse effects of bone resorption, sterile sinus tract formation, osteolytic lesions, and foreign-body reactions. 3-9 Likewise, the structural integrity of each implant was based on the composite material used to fabricate the absorbable implant.