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

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.