Complications of Digit Widget^TM placement are acute or delayed. Acute complications are related to inaccurate placement of the pins leading to iatrogenic middle phalanx fracture or leaving the pins too long causing impingement on the cuff as the contracture improves. Delayed complications are rare but include severe pain or infection and if either does not resolve with treatment may necessitate removal of the Digit Widget^TM prior to complete correction.

Applying the correct amount of torque to the PIP joint is critical to avoid pain, edema, and loss of flexion in the joint. Torque imbalances can also cause MP joint hyperextension due to reduced resting tension in the proximally translocated flexor digitorum superficialis and profundus tendons as well as an increased moment arm due to the dorsal dislocation of the extensor tendon off the metacarpal head. The extension torque on the MP joint caused by PIP joint flexion contractures leads to MP joint hyperextension which reduces the efficiency of the Digit Widget^TM (Agee and Goss 2012). The result is a limitation of proximal excursion of the extensor tendon and its central slip. The net effect is inefficient mechanics required for PIP joint extension. Therefore, critical to achieving long-term active PIP joint extension after reversal of contracture is restoring central slip tension and excursion. If one identifies excessive hyperextension in the MP joint, the MP flexion strap can be used to prevent MP joint hyperextension to facilitate rebalancing of torque forces across the MP joint to allow more efficient PIP joint extension. Edema which causes stiffness of the PIP joint can further undermine device effectiveness.

Patient participation is critical to the success of treatment with the Digit Widget^TM. Full correction of the PIP joint flexion deformity is achievable by 6 weeks after placement. Patients are carefully followed at weekly intervals; range of motion is plotted and rubber bands are adjusted as needed. Progress is plotted as a graph of the change in range of motion as a function of time. Patients are also encouraged to record their progress daily in a “diary.” Rubber bands, which include light, medium, and heavy, are changed daily and added if needed. Once 5 bands of the same gauge are used together, a switch to a larger rubber band is made.