Bei der Rekonstruktion von Kahnbeinfrakturen, Lisfranc-Frakturen und anderer Mittelfußfrakturen handelt es sich um gängige Operationsverfahren zur effektiven Behandlung der meisten Frakturtypen im Bereich des Mittelfußes. Mit dem System zur Behandlung von Sprunggelenkfrakturen bietet Arthrex eine Komplettlösung zur Behandlung von Mittelfußfrakturen. Das System umfasst verbesserte Kleinfragment-Basisimplantate und -instrumente, anatomische Platten und die Verriegelungsschraubentechnologie. Weitere Informationen zu Operationsverfahren und -techniken am Mittelfuß finden Sie unter „Informationsmaterialien“.

Foot and Ankle

Procedure

Das umfassende Arthrex Mini-Fixierungssystem (Mini CFS) ist eine Komplettlösung für die Fixierung und Fusion von Minifragmenten. Die verschiedenen Module dieses Systems bestehen aus 2 mm Platten/Schrauben und 2.4 mm Platten/Schrauben sowie den dazugehörigen Instrumenten.
Jedes Modul bietet eine Reihe von Plattenoptionen und -größen mit variablen winkelstabilen Fixierungen für jede Familie von Platten bis hinunter zur kleinsten Plattengröße von 1.4 mm. Ein Hexalobe-Schraubendreherschaft garantiert in jedem Platten-/Schraubenmodul eine hervorragende Kraftübertragung und eine umfassende Kontrolle der Schrauben.

Thomas G. Harris, MD (Pasadena, CA), uses the Mini Comprehensive Fixation with the 2.0 mm cage plate to repair a navicular fracture. The 2.0 mm cage plate comes with 2 rows of 5 screwhole options with variable-angle locking technology.

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video

Human

Navicular Fracture Repair With the Mini Comprehensive Fixation System 2.0 mm Cage Plate

We're going to show you guys today a navicular or half of what would be a comminuted type fracture. This 2.0mm cage plate will work nicely. Sometimes it needs to be contoured to place it dorsally based on the dorsal curve of the navicular. Right now when it comes out of the module, it's pretty straight. And you're going to want to curve it like this. Make it a little bit more concave like that. So I'm going to move my hands apart like that and just bend this a little bit to help contour it a little. And we want to just kind of bend it a little bit more like that kind of fit dorsally. So we got a better bend on it at the corners there. And we'll see how it fits in there nicely. You just want to get some compression across this area so that that that widening, that dorsal widening combination can be squeezed together with that clamp. Right. And then, depending on the combination, we can see which holes we want to fill. I just want to make sure we stay out of the joint. And bigger foot. You could probably use a 2.4mm plate. We chose a 2.0mm plate there just for the contour of the navicular, and making sure we get two rows of screws across here. Now some of these are going to be locking just depending on where the comminution is and so forth. Here's our guide our variable angle guide. We can use make sure we stay out of the navicular cuneiform joint. About a 15 degree cone here in terms of our angle that we can use. So we got the locking guide in there. So if you ever need to do any inside tube bending with the plate Played off bone a little bit. You just get one in there or two and then start bending that down nicely. So it sits on there bone nicely like that. So you can actually get it kind of contoured like that. And then that should help contour it a little bit there. So we here you can see the medial side of the navicular there, sitting there nicely on bone. And then we put a first few we put in, there were non-locking. And again here's our talo navicular joint right there. And then here. Down here is our navicular cuneiform joints here. So we're free of any screws in the joint. But you can see we got a really narrow area to work with there for two rows of screws. The, the screws were initially drilled to be non-locking screws. And then after that we put in a few locking screws as well just to contour nicely there. That one's down all the way down with a locking screw. So we did a combination of locking. And again we have 15 degrees of off axis ability to still put in a locking screw there. And we've retracted the medially neurovascular bundle laterally. It's a longitudinal incision. Some people have described a transverse incision. We usually use a longitudinal incision to get to these, and that clamp can be a nice technique and tip to use to compress the navicular medial to lateral. But with this sort of fracture and comminution, you're just spanning those pieces and holding everything together, while the while the fracture heals, as you go more and more medially, you have to angle things more proximally as the navicular curves around. But again, that's a little bit more plantar too. So if you're really trying to bridge dorsal comminution, this plate would be ideal. And you can see we've extended all the way from the lateral articular facet of the cuneiform all the way medially. So it's nice just to bridge the area with that.

Eric W. Tan, MD (Los Angeles, CA), uses the Mini Comprehensive Fixation System Y-plate to stabilize a medial malleolus fracture. The Y-design allows the plate to be contoured to the medial malleolus and features variable-angle locking technology with oblong holes for compression.

Medial Malleolus Fracture Repair Using the Mini Comprehensive Fixation System

So we're going to first see how this plate fits onto the bone. And we can see where we'd like to put it. It's obviously going to be too long. So it's probably going to be about we'd like to have at least three holes proximal to the fracture site. So we're going to cut the plate right where the oblong hole is right here. So once you've cut the plate to the desired length you can take the file here located on the side. And you can actually file the side of the plate so that you don't have any of those rough and sharp edges prior to placing it onto the bone. So now that we have our plate cut to the length, we can then apply it to the bone. And so we'll go ahead and apply it here. And we want to make sure we have three cortices above the fracture site here. We'll hold this in place using one of our tacks. And then we can confirm the placement of the plate onto the bone visually as well as fluoroscopic. With our plate in the appropriate position. We can then start placing the screws. The first screw we like to place is the screw just proximal to the fracture site. And we'll go ahead and we can place our cone here. And again this allows for 15 degrees in all directions for the placement of the screw. And this will traditionally bring just straight across the tibia here. Take our measuring device so we can see on the measuring device. It's actually a matted black so it doesn't reflect as much. And we can see the measurement here more readily at 30mm. Once we have the measurement and chosen the appropriate screw, we do have a holding sleeve for the screw. That helps to prevent any wiggle of the screw or loss of the screw as you take it out and try to apply it. So as we get close to the screw getting into the plate, we can then pull back our holding sleeve. We can take a look at the screw and guide it down to the bone. And then we'll place two additional screws proximally in similar fashion. Again, you can put the screws at a 15 degree arc just depending on where you where you want to put it, using the appropriate sleeve here. And each of these holes do accept both locking and non-locking screws. Perfect. Thank you. So we'll remove this K-wires so we have better access anteriorly to the plate. And then we've taken our measurement and we'll go ahead and take this screw on power. We can see how that helps to bend the plate down to the contour of the medial malleolus. We've got good compression and it fits without being prominent. So we'll place our variable angle guide here. And again we'll want to make sure that we avoid the joint. And again these screws sit well within the plate so you don't have any prominence associated with them as well. So we typically like to create a symmetric construct. We'll have six cortices above. We like to have six cortices below. Certainly you have different holes in these plates. Whether you want to put a screw in the oblong hole or these other locking holes, you can use a locking or non locking screw. So for a locking screw it's the exact same procedure. What we'll do is go ahead and take this variable angle cone wheel plate and place it into the slot. We can then drill just like we did for the non locking screws. And then it uses the exact same holding sleeve. We'll go ahead and place the screw. And again it'll sit well within the plate. It sits flush. There's no prominence of the screw which also prevent irritation as well. Here are all the screws are out of the joint. The plate sits well on the bone. The fracture is well reduced. All the screws are of the appropriate length. And then on the lateral view again we can see that it fits well with on well on the bone and reduces the fracture.

Eric Tan, MD (Los Angeles, CA), uses the Mini Comprehensive Fixation System (CFS) 2.4 mm triangular plate to stabilize a posterior malleolus fracture. The Mini CFS triangular plate features multiple points of fixation with variable-angle locking technology and oblong holes for compression.

Posterior Malleolus Fracture Repair Using the Mini Comprehensive Fixation System 2.4 mm

So here we've created a posterior malleolus fracture. We've gone ahead and reduced the fracture and provisionally pinned it in place. We're going to be demonstrating and using our mini comprehensive fixation system. It again comes in a variety of sizes. We've chosen this plate here which we can see is a 2.4mm plate. We can see again it comes in a standard length, but the plate can be easily trimmed to the length that we need. There are two different compression slots as well. As well as each of these holes have a variable angle of 15 degrees in all directions. So with our fracture exposed we're going to template for our plate. We'll go ahead and put that in here. And we can see we probably are good with the proximal three holes here. And then we'll want to cut the plate just above this hole. So this is our plate cutter. We can see there's three different places to cut depending on the size of the plate that you're using. And this is for the for the 2.4mm plate. So we'll go ahead and take our plate. We're going to place the hole that we want to keep. So that's going to be this hole here. That's going to be the one that we're protecting in the hole. And we're going to cut just the length after that. So we've protected the hole that we want to. We'll hold the other side and then we'll go ahead and cut the plate. So we can see here it cuts with a curved edge. And you can go ahead and take the file on the side of the cutter in order to help remove any sharp edges as well. So with our plate cut to length we're then going to apply it and template it on the back of the tibia here. So we're going to template the position of the plate and hold it secure using one of our tacks. And we'll check the positioning of the plate radiographically. We're then going to put our screws within the plate. The first screw we'll put is just proximal to the fracture site, so that we can bring down the plate and help use the plate in an anti glide fashion. So again we'll take our variable angle guide here. And it fits right into the slot. And again we have 15 degrees to Place the drill bit in order to put the screw. The unique thing about the measuring guide, it's also matted black so that it's easier to read the numbers from the glare. So we'll take slightly shorter than our measurement in order, because there will be some compression of the plate down to the bone. And we can see there's a nice contour of the plate to the bone. We'll take our variable angle guide. And proxy. In the holding sleeve is a locking screw. And again it uses same exact materials to put it in as you would the non locking screw. So distally within the construct we have a multiple array of holes that we can use. So this allows for variability depending on if there's comminution or different fragments that you want to capture. You can place any screw in these holes and get the adequate fixation that you So again, you can point the screw in a 15 degree arc here so that you avoid the joint. You'll get the fixation that you need and engage the bone that you want. And even with putting it in an angle, it does still sit flush within the plate. So it's not something that's prominent and it should irritate. It should be less irritating to the surrounding tissues in the back. So also within the set are different kinds of drill guides. So this is another type of drill guide that we have on here. You can actually directly measure off of the drill guide. So you'll see there's a laser line marked out on the drill bit itself so that as you get to the depth, you can read the exact size without having to go back and remeasure. So again, the beauty of the plate is that you can cut it to variable lengths, and you can see that there's multiple options distally, so that if you need to capture a specific part of the fragment, you should be able to do so with locking or non-locking screws.

Hand and Wrist

application/pdf

Mini Comprehensive Fixation System

The Mini Comprehensive Fixation System consists of 1.4 mm, 1.6 mm, 2.0 mm, and 2.4 mm titanium, variable-angle locking, low-profile plates designed for osteotomies, fusions, and fractures of small bones. There are 56 plating options including straight, T, V, Y, bridge, cage, and triangular plates.

Mini CFS Mini Comprehensive Fixation System

Mini CFS - Mini Comprehensive Fixation System

Fixierung von Minifragmentplatten

Child (D)

Navicularefrakturen (Kahnbeinbrüche) können mit 3,0-mm-BioCompression- oder kanülierten 3,0-mm-Schrauben versorgt werden.

Rekonstruktion von Navicularefrakturen

Product

Die neuen Snap-Off Compression FT Pins bieten Lösungen für die oberen und unteren Extremitäten sowie für den Traumabereich. Die einfache Handhabung der Pins, die variable Gewindesteigung und die Vielzahl an Größen mit Durchmessern von 1.9 und 2.4&nbsp;mm stellen eine innovative neue Technologie zur Behandlung von Pathologien wie Gelenkarthrodesen, Hammerzehen, intra- und extraartikulären Frakturen und Pseudarthrosen dar. Die Pins können zusammen mit anderen Produkten von Arthrex zur Kompression von Knochenfragmenten verwendet werden.

Snap-Off Compression FT Pins

Die FT-Kompressionsschrauben aus Titan (Vollgewinde) sind in den Größen Micro (2.5 mm), Mini (3.5 mm), Standard (4 mm), Large (5 mm) und XL (7 mm) erhältlich. Das variabel abgestufte Gewinde und das kopflose Design tragen zur Verringerung des Risikos von Komplikationen durch prominente Schraubenköpfe bei, bieten Kompression und ermöglichen ein vereinfachtes Einbringen. Die Operateure können so nun ohne Implantatprominenz eine stabile Fixierung erreichen. Die FT-Kompressionsschraubenfamilie eignet sich mit ihren 5 Durchmessern und 91 Schraubenlängen für zahlreiche orthopädische Anwendungen im gesamten Körper.

5.0 mm Large and 7.0 mm x-Large Compression FT Screw System

Imaging and Resection

Minimally Invasive Surgery - Medializing Calcaneal Osteotomy Surgical Technique

The Arthrex MIS platform allows surgeons to perform minimally invasive bunion surgery with equivalent results to traditional open procedures.1
Reference
1. Brogan K, Lindisfarne E, Akehurst H, Farook U, Shrier W, Palmer S. Minimally invasive and open distal chevron osteotomy for mild to moderate hallux valgus. Foot Ankle Int. 2016;37(11):1197-1204. doi:10.1177/1071100716656440

MIS Surgery Bunion Correction

Arthrex presents a minimally invasive bunion correction to correct mild to moderate bunion deformities. First, palpate or outline the dorsal and planter aspects of the first metatarsal and halex. It can also be helpful to mark out the bisection of the shaft on the metatarsal neck, using fluoroscopy as a guide. A five millimeters incision is made with the beaver blade at the midline of the metatarsal, and just proximal to the sesamoid complex. Blunt dissection is carried down to bone, and a curved periosteal elevator is used to dissect subperiosteal in the intended path of the burr. It is important to make sure the extensor tendon and soft tissue structures remain dorsal to the periosteal elevator. The two millimeter by 19mm burr is introduced proximally to the sesamoid complex midline at the metatarsal in advance to puncture both the medial and lateral cortex of the metatarsal. It is important to note the initial trajectory of the miss Burr to ensure the surgeon accounts for maintaining, lengthening or shortening the metatarsal based on Based on the angle of the burr. At this point, the dorsal and plantar aspects of the transverse cut are completed with the burr. By rotating the handle first plantar, then dorsal to complete the osteotomy. Upon completion of the osteotomy, the helix is rotated under fluoroscopy via supination and pronation to confirm the osteotomy is complete. Next, a two millimeter double tipped guidewire is placed antegrade through the incision towards the distal aspect of the toe in an extra periosteal fashion. The pinch should exit the skin midline and medial to the distal phalanx. A curved hemostat is placed through the incision and into the proximal metatarsal shaft to assist in lateral translation of the capital fragment. When the surgeon is satisfied with the translation and rotation of the sesamoid complex while holding simultaneous abduction of the helix, the guidewire is advanced midline through the medullary canal until it is abutting the proximal aspect of the metatarsal near the TMT joint. This will help maintain the lateral and rotational translation of the capital fragment. At this stage, the hemostat can be removed if desired. The capital fragment can be supinated manually via the helix to correct the sesamoid position further. Finally, in preparation for final fixation, two parallel 1.1 guidewires are placed midline from the base of the metatarsal shaft. It is critical to ensure the most proximal wire is inserted in a bicortical fashion prior to entering the capital fragment. This enhances the overall construct stability. The second guidewire is placed in a similar trajectory, one centimeter distal to the initial wire. This wire is critical to provide anti-rotation strength to the overall construct. During early weight bearing, skin, incisions are made and the cannulated depth gauge is inserted over both guide wires to determine the necessary screw lengths. A general rule of thumb is to remove four millimeters from the measured length of the screw. Next, the cannulated drill is drill is inserted over the proximal guidewire, ensuring that the drill is advanced along the entire length of the wire and into the capital fragment, leaving the wire in place. The appropriate length 4.0 compression screw is inserted over the wire. Finally, the process of drilling and implanting the second screw is repeated to complete fixation of the metatarsal osteotomy to ensure appropriate alignment of the helix, and osteotomy is also recommended for this procedure. Initially, a five millimeter incision is made midline on the helix in line with the intended starting point of the osteotomy. After blunt dissection is carried down to the bone, the periosteal elevator is utilized to create a dorsal implanter working space for the burr. The two millimeter by 13 millimeter burr is introduced midline, aiming for distal medial to proximal lateral in order to create a medial wedge osteotomy. Rotate the burr handle plantar and then dorsal to create a transverse cut in the bone while maintaining the lateral cortex to act as a hinge. Gentle manipulation is applied to reduce and compress the osteotomy. Next, place a 0.86mm guidewire across the osteotomy from distal lateral to proximal medial. An incision is made with the beaver blade and the wire is measured. Drill over the wire with the cannulated drill and finally insert the 2.5 compression foot screw to complete the construct. Finally, if necessary, the redundant bone shelf can be removed utilizing a 2.9mm wedge burr. The incisions are closed. A compressive bandage can be applied and the construct is complete.

Mittelfußfrakturen

Fixierung von Minifragmentplatten

Rekonstruktion von Navicularefrakturen

Snap-Off Compression FT Pins

FT-Kompressionsschrauben mit Vollgewinde