# Nitinol Compression Staple Fixation Failure in Hand Surgery: A Report of Two Cases

## TL;DR

Two cases show nitinol staples failed in hand surgery due to improper force distribution, requiring revision.

## Contribution

Reports two cases of nitinol staple failure and identifies asymmetrical force distribution as a novel cause.

## Key findings

- Fixation failure occurred in two hand surgeries using nitinol staples.
- Failure was due to asymmetrical force from monocortical and bicortical staple legs.
- Proper preoperative planning and staple placement are critical to avoid failure.

## Abstract

Nitinol compression staples are increasingly used in hand surgery due to their shape memory effect and simplified surgical technique. While they have demonstrated favorable outcomes, reports on complications and failure mechanisms remain limited. We report two cases of fixation failure: one in a vascularized proximal interphalangeal joint transfer and another in thumb carpometacarpal joint arthrodesis. Both cases required revision surgery with plate fixation. These cases suggest that failure resulted from asymmetrical force distribution. This was caused by one staple leg achieving only monocortical purchase while the other was bicortical, combined with a short working length. These cases highlight the critical importance of preoperative planning and precise staple placement, particularly when bone dimensions are unequal or the working length is limited.