Fuß & Sprunggelenk

Kalkaneusfraktur

Kalkaneusfrakturen entstehen meist durch eine hochgradige Gewalteinwirkung, z. B. durch einen Sturz aus großer Höhe oder einen Autounfall. Arthrex bietet zahlreiche Lösungen für diese Verletzungen an, u. a.:
<ul>
 <li>System für das Frakturmanagement am Kalkaneus (u.&nbsp;a. Perimeterplatten und perkutane Platten)</li>
 <li>Compression FT-Schrauben, 5&nbsp;mm/&nbsp;7&nbsp;mm</li>
 <li>Kanülierte 4.5&nbsp;mm&nbsp;/&nbsp;6.7&nbsp;mm LPS-Schrauben</li>
 <li>Trim-It-Pins − Resorbierbare PLLA-Pins</li>
</ul>

Trauma Lower Extremities

Foot and Ankle

Procedure

Kalkaneusfrakturen entstehen meist durch eine hochgradige Gewalteinwirkung, z. B. durch einen Sturz aus großer Höhe oder einen Autounfall. Arthrex bietet zahlreiche Lösungen für diese Verletzungen an, u. a.:
<ul>
 <li>System für das Frakturmanagement am Kalkaneus (u.&nbsp;a. Perimeterplatten und perkutane Platten)</li>
 <li>Compression FT-Schrauben, 5&nbsp;mm/&nbsp;7&nbsp;mm</li>
 <li>Kanülierte 4.5&nbsp;mm&nbsp;/&nbsp;6.7&nbsp;mm LPS-Schrauben</li>
</ul>

Anand Vora, MD, (Chicago, IL) presents the Calcaneal Fracture Percutaneous Plate Animation. The Calcaneal Fracture Percutaneous Plates feature unique attachable percutaneous guides. There are five different low profile variable angle locking plate designs with tapered end to aid in insertion.

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Human

Calcaneal Fracture Percutaneous Plate

A sinus tarsi approach is used for the incision. Insert the five millimeters Shantz pin into the calcaneal tuberosity. This may be placed posterior. Lateral. Reduce the fracture using the Shands pin and the calcaneal specific elevators. Select and insert the appropriate percutaneous calcaneal fracture plate. Attach a BTec or use a 2.5mm. Drill and drill through the oblong hole in the plate to secure the plate to the calcaneus. Measure and insert a 3.5mm non-locking screw. Insert the corresponding percutaneous guide. Connect the guide to the plate with the attachment screw. Mark the skin and make a stab incision. Insert the percutaneous locking drill. Guide and drill. Measure the depth of the laser line. Insert the 3.5mm locking or non locking screw. The plate may be contoured inside to using the bending guides or locking drill guides. Remove the Shands pin and fill the appropriate holes. Insert Quickset to fill the void. Fixation complete.

Anand Vora, MD, (Chicago, IL) presents the Calcaneal Fracture Perimeter Plate animation. The Calcaneal Fracture Perimeter Plates are low profile, titanium and variable angle locking. There are four sizes available with left and right specific perimeter plates designed to treat any calcaneal fracture classification.

Calcaneal Fracture Perimeter Plate

An extensile L-shaped incision is utilized for exposure. Insert the 5.0mm shank pin into the calcaneal tuberosity. This may be placed posterior or lateral. Reduce the fracture using the Schanz pin and the calcaneal specific elevators. Select and insert the appropriate perimeter calcaneal fracture plate. Attach a BB-Tak or use the 2.5mm. Drill and drill through the oblong hole in the plate to secure the plate to the calcaneus. Measure and insert a 3.5mm non-locking screw. The plate may be contoured inside to using the bending guides or the locking drill guides. Insert the 3.5mm locking drill guide. I'd drill and measure off the laser line on the drill and insert appropriate locking or non-locking 3.5mm screw. Variable angle locking can be achieved by inserting the val guide into the appropriate pilot hole, using a 2.5mm drill bit. The Val guide will allow up to 15 degrees of angulation. Measure the depth with the device and insert the appropriate 3.5mm locking screw. Remove the Shands pin and fill the appropriate holes. Insert Quickset to fill the remaining bone void. The fixation is complete.

The Calcaneal Fracture System is an all-inclusive system of plates, screws and instrumentation designed to treat all classifications of calcaneal fractures. The calcaneal fracture system is comprised of seventeen different low-profile titanium plates with locking and nonlocking options. This all-inclusive system allows for anatomically specific fracture fixation ability.

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Calcaneal Fracture System

Calcaneal Fracture Reduction Using KreuLock™ Locking Compression Screws

Jorge I. Acevedo, MD, (Royal Palm Beach, FL) demonstrates an open reduction internal fixation of a calcaneal fracture using the sinus tarsi approach with the Arthrex® Percutaneous Calcaneal Fracture System. The Percutaneous Calcaneal Fracture Plates feature nine plate options and include percutaneous guides to aid in the insertion.

Calcaneal Fracture ORIF with Percutaneous Calcaneal Fracture Plate

Here we are shown the mini approach for the calcaneus fracture mini plate. What I like to do is I like to draw out the distal tip of the fibula, and then we draw more or less towards the fourth metatarsal. Okay. So we've made our mini sinus tarsi incision. Usually this incision ranges from 3 to 5cm. You can see I've dissected already the peroneal tendons, which usually are going to be somewhat subluxed in the way of your wounds. So you've got to be very careful. You can then dissect underneath the perineal in order to make room for the plate posteriorly as well as anteriorly. Okay. And you can see here we got very good visualization of the joint. And we know that our primary fracture line is going to go from anterolateral to posteromedial. Once you can visualize the fracture you can put in your pin like we've done. And and this is a really nice feature where you got a T handle where you can actually do your initial reduction, which involves restoring the length, bringing it out of varus, and then sliding it over medially. And at this point, once you've reduced it, you can put in our 62K wire to pin the tuberosity to the constant fragment. Now that we have it reduced, we can release our t handle. In addition, I like to check an axial view to make sure that the posterior tuberosity fragment is well reduced to the constant or sustentacular fragment. Next, we can actually provisionally place the plate about ten millimeters or so underneath the posterior facet, and the plate will slide pretty easily as shown. Okay. And we have that oblong hole there Air, which is uniquely designed so that you can basically target the sustentaculum easier. So at this point we could use a BB-Tak. And in order to hold the plate in that position. And we can reduce our articular fragment with A62 K-wires. So the nice thing about this oblong hole. As you can see you got quite a bit of flexibility. And I like to put my finger underneath the sustentaculum and fire right towards the sustentaculum, which is about 20 degree convergence. Once you've placed this K-wires into the sustentaculum and reduced your posterior facet articular fragments that I like to check a broden's view to make sure that that pin is not within the subtalar joint. And at this point you can put the guide over the wire and the plate. Okay, this secures the the guide. And now we can put our first fixation screw. You can actually mark it through the perk guide. And then I'd like to make a little incision. Now that we know exactly where the screw hole is through the skin and then spread down to the actual plate, avoiding the Searle nerve, you can put the guide in and secure the guide, and then you can drill through the drill guide and basically read straight off the drill guide, and you feel the far cortex. I'm feeling the far cortex there. And then we can take the drill guide off, put the appropriate size screw. I would recommend putting a non-locking screw initially so that you still have mobility or fine adjustment of the plate, if you will. Okay. Excellent. So now we've provisionally fixed the plate and we still have some flexibility. And what I'm going to do is I'm going to take my tack out. You want approximately two screws in each of the major fragments. At this point it's beneficial to take an x ray and make sure that you like your positioning, even though you can really see the angle of sin right there, and you can actually rotate that just a tad to make sure that you're in good placement. Now you can secure the anterior process. And again using the guide you can drill and measure. And this can certainly be a locking screw at this point. So you can see that you have very good control of the plate throughout the procedure. Okay. And if I had any concern about the plate laying down, I would put a non-locking screw in that situation. At this point, we can just drill our posterior fragment through here. Here's a new depth device that Arthrex has made. Then you slide it in, engage it, and you can read right off of the device there. Now I'll use a locking screw because we feel that the plate is down to the bone. Okay. Very good. Now at this point, I think we can take our alignment guide out and it will give us more room to actually shoot our system screw. Then you can measure. And here we're measuring approximately a 42. You could actually drill with this cannulation and then actually put in a solid screw. Or you can alternatively put in a partially threaded screw. So here I'm over drilling the near side in case you want to use a solid screw. We're going to put in a partially threaded Zero millimeter cannulated screw. This would normally compress the posterior facet lateral fragment quite nicely, as well as seat the plate even better. You can see how this is hugging the bone here. Normally you may want to lower the plate a little bit, although we are below the articular surface. You may want to be a little bit lower with that plate to prevent impingement. We'll take the wire out. Another advantage of the Arthrex plate is that it's very thin. And they have these nice large bending irons so that you can actually contour the plate like so, and make it so that it hugs the bone even more. And then at this point you can then drill your second anterior process screw. And since we're pretty snug on the bone here I'll use a locking screw. And this locks into the plate very nicely. And so we have one screw reducing our articular fragments. And you have the alternative of placing a second screw within the posterior facet. You can even remove your pin if you want. So it's not in our way. Since we've already reduced our our major fragments. Excellent. And we got to take our final wire out. We got a very nicely reduced calcaneus through a relatively mini incision. And the advantages of this are that decrease morbidity, decrease wound complications, and potentially relatively quicker procedure.

Hand and Wrist

Orthobiologics

J. Chris Coetzee, MD, (Edina, MN) demonstrates his technique for repairing a comminuted calcaneal fracture. Dr. Coetzee describes the pertinent anatomy, reduction and surgical fixation utilizing Arthrex® Calcaneal Fracture System and FlexiGRAFT® demineralized cancellous sponge &amp; cortical fibers. The Arthrex Calcaneal Fracture System contains 17 different plating options and calcaneal fracture specific instrumentation.
FlexiGRAFT® is owned by LifeNet Health.

Calcaneal Fracture Surgical Repair with Calcaneal Fracture Plating System

I'm Chris Goodson. I'm a orthopedic surgeon from Minneapolis, Minnesota. I will be highlighting a surgical video of a calcaneal fracture open reduction internal fixation featuring the Arthrex Calcaneal fracture system. I still use for complicated fractures like this one and Extensile lateral approach. The most important thing is with arm along the Achilles tendon, to be as far posterior as possible to prevent injury to your nerve. And what I'm doing at the moment is to elevate the perennial tendons out of the way. As you can see, I use sharp dissection to minimize soft tissue injury. Just cut into the subtalar joint and you can see there's lots of fluid in the joint. Always clean a little bit of scar tissue and hematoma out of the joint, and then use a few K-wires to keep the flap elevated. You can also use soft tissue retractors if you don't want to use the K-wires to elevate the flap. There's usually a pin in the navicular and the talus, and one in the fibula to keep the flap out of the way. I then use one of the shin splints in the tray to help with distraction and lengthening of the Achilles tendon. This is a severely comminuted fracture, and you can see the posterior facet is flexed down about 90 degrees. I'm using one of the elevators in the set to elevate the posterior facet back in position. Different ways to do it. You can either restore the medial column first. In this case, I prefer to restore the posterior facet first. Because everything was so comminuted, it was very hard to restore the medial column anatomically. Once I have the posterior facet anatomically reduced, then will immobilize it with a few K-wires at this point, then use a sham spin to reduce the medial column as close to anatomic as possible, and then immobilize mobilize the medial column with the K-wires from plantar heel, usually right through into the talus. At this point, I'm reducing the anterior process of the calcaneus, and also the immobilize that to the talus to have everything well aligned. And then after sizing the plates, we'll use the 1.35mm perimeter plate and oppose it to the bone. The first screw goes through the fractured portion of the posterior facet. Use A35 drill bit first, and then overdraw the far side into the system. Tackle him with a 2.5mm drill. The first screw, it will be a 3.5mm non-locking screw to compress and reduce the posterior facet, and also then automatically narrow the width of the calcaneus. I loosen the screw a little bit just to rotate the plate exactly where I want it. And one can then tighten it again. This can obviously be checked under fluoroscopy. Second screw then is again in the posterior facet. This can be locking or non-locking screw. At this point I was happy with the reduction in compression across the fracture. So he used a locking screw and then start to reduce the tuberosity of the calcaneus to the posterior facet. Once the posterior side is done, then we'll immobilize the anterior process of the calcaneus. I very much like the configuration of the plate. We have more than two points of fixation in the anterior facet to avoid or prevent rotational deformity. This point can reduce the ankle and see and the fluoroscopy. If everything looks fine on the lateral, one could see that the posterior facet looked perfect due to the severe comminution of the medial column. That's not perfectly reduced, but the only way to get the fragment on the medial side, perfectly reduced, would be to do a medial opening as well, which I prefer not to do. Once you're fairly happy with the reduction, it's basically a derlin four. Oftentimes with compression across, the screws will be too long because you narrow the width of the calcaneus, and I will check that and replace the screws that are too long. I very seldom use bone graft. In this case, there was very significant comminution in the large defect in the center of the talus. Now use FlexiGRAFT Dyneema bone cubes to fill the void. At that point. The wound is then closed in layers. I use a micro subcutaneous and either nylon or staples. This is a comprehensive system that includes a total of 17 perimeter and percutaneous plating options, along with calcaneal fracture specific instrumentation such as Shands pins. Thank you.