Fuß & Sprunggelenk

Mini-Rail-Fixierungssystem

Mini-Rail ist ein unilateraler Fixateur, der Komprimierung, Distraktion und multiplanare Fixierungsmöglichkeiten bietet. Mini-Rail stellt eine stabile Lösung für Frakturen, Deformitäten und für die Verlängerung von Knochen in Fuß, Sprunggelenk und den oberen Extremitäten dar.
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Hand, Wrist, and Elbow - Next Generation in Repair and Reconstruction

Stephen Frania, DPM (Cleveland, OH), demonstrates the Mini-Rail Fixation System on a first-ray limb salvage case.

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Mini-Rail Fixation System Demonstration

Hi, I'm Doctor Stephen Frania from Cleveland, Ohio. I'm a foot and ankle surgeon. I'm here to go over mini rail fixation for a salvage of a failed fusion or a first limb salvage. Prior to any of these cases, I like to mark out any particular landmarks that are important with this case. I usually look for the tibialis anterior tendon and I always mark this out. It crosses over the Cartiform bone. And that first TMT joint, which is right here. That's a landmark. You don't you just don't want to drive a pin through one of these. And it's right about here. The other one is the extensor hallucis longus tendon, which sits right up about here. You just take your here's e.h.l. Here's tibialis anterior tendon. Next what I like to do is do x ray landmarks. So under live c-arm, I'm going to try to find out where the joint is distally. Really? That's first TMT joint is right there. There's a mark right there. So we make a nice nice distinct mark. And then we're going to come up for MTP joint. It's a little bit distal. Should be right there. And he'll make a mark right there for me as well. And then the other thing, if I'm going to do an osteotomy of the base of the first metatarsal, maybe to lengthen, I want to mark that out so I can find where my pin placement is and my, my clamps where they'll go. And I'll take a shot there and try to be in the met Diaphyseal junction, which is right about there. And he'll mark that one as well, right along my my freer elevator. Once I have all that done, then we can kind of move on and make our incision resect out this osteomyelitis joint, and then we can do the fusion here at the MTP joint. And then we'll fixate it back here approximately, and then possibly do an osteotomy at the junction of the base of the first metatarsal. That's to maintain the length of the fusion. Okay. Now that we have our joint resected right here, this is your potential area of osteomyelitis, or whether you're going back after having antibiotics in here to fixate this and fuze this, what we're first going to do is map out what we're going to do, what kind of rail we're going to put on. I like to temporarily pin this, and I'm going to do that right now with just a regular wire out of the set. This is a 1.6 wire that I'm using, and that just prevents this whole end piece from flopping around and keeping it nice and stable, so you can fixate it nicely without worrying about positioning. The next thing I like to do is kind of see what size rail we're going to use. This is a 75 millimeter rail. I think it's going to be a little too short for us. You can see the markings on it right there. So we're going to pull 100, which I think is probably pretty good for this. We're also going to add a end clamp to this, which adds probably another 20mm to the very end of this clamp. So we'll be right where we want to be approximately at the first Cartiform this is the rail construct. You can see these little black clutches right here. This allows your clamp to move up and down this rail. As you can see right here you have the option of putting them on either side of the rail if you'd like. And if you lift up this black clutch, it allows you to take this off. And I can actually flip this all the way around and put it on the other side. If I lift up the clutch and then set it back down, it'll lock into position and I can put it on either side. It also allows some motion up and down, so you can angulate these pins a little bit as well. You can also angulate them this way as well. In the other plane, that allows you a little bit of divergence or convergence of your pins. That helps with this whole stability of this construct as well. Okay. At this point, we're going to put one of our half pins in approximately. I always like to start proximally just to kind of build everything off. These come in 6080 and 100 millimeter 3.0 half pins. And this is one right here. This is a 80 millimeter 3.0 half pin. I like to use these proximally. We like to make them bicortical. We'd like to have this long enough where you have clearance for the skin. So in case you have swelling around this area, or if you have a wound like this that you might need to go back and do something with the wound, you don't want to be boxed yourself out with the fixator being too close at this point, we're going to put our first pin in. This is going to go into the cuneiform. We'd like to get this pretty much perpendicular to the foot. This is our first guide to kind of buy the rest of the hole. Mini fixation and set our positioning. So here's our first proximal pin. That's what we're going to build our mini rail off of. Our pre-built mini rail can slide right off of this, and you can actually shoot the next wire right off of the clamp. However, there is a parallel guide if you prefer to use a parallel guide that is available in the set to use as well. Okay, now that you have the proximal pin set and you like your alignment under fluoroscopy, which is set, I like to drop a pin freehand and just kind of see where it lines up under fluoroscopy and have someone hold it for you and drill your distal pin. That's going to set your whole entire alignment. The rest of this case is easy after that. Hold on, hold on. Once you confirmed under fluoro the Floro, the position of the screw, you can actually go ahead and drive the screw in and fixate everything distally. You still have mobility of these clamps. If you lift up the black clutch, you can slide them to where you want to hit whatever bone you need to. Okay, now that we have all the pins in place, we have an area right here. If you want to do a lengthening or an osteotomy, you can do that right in between here. So your osteotomy could be here. You could lengthen from here and compress from from here. Between these two you want to tighten all these bolts down. At this point there's two wrenches in the set that allow you to snug everything down. Once you have all the pins set, the last thing you need to do is tighten down all the black clutches. So this is the blocking screwdriver for the black clamp. This is left to tight right to loosen. It's two finger tightness only. And again it's marked on here. You can see the arrow where it tells you which way to turn it. It's left to tighten. So that locks this black clutch on the clamp to the rail where these threads are, so it can travel up and down. There are two clamp drivers in the set, the red and the blue. They're each a little bit different. The red one is used to drive one single clamp to another clamp down the rail. The blue one is basically to drive two clamps or multiple clamps in one direction or the other. We're going to compress our fusion site. We're going to use the red clamp driver to drive the distal clamp towards this proximal clamp and compress our fusion site. It slides right into this channel right within the mini rail right here. You can see it will grab distally and then you can clockwise. Turn it until you get closure. You can check under fluoro to see where you are and how and how much compression you're going to get. You can use these graduated numbers to make sure you're driving in the right direction, and make sure that you're closing this osteotomy or compression site. So we're going to continue to compress. You can see the compression on the wound side here. And it's closing nicely. Okay. Now that you've compressed the joint and you're satisfied with the alignment on this, your next decision is to decide if you'd like to do a lengthening. That's fine. You have the clamps set up for it already if you'd like to do that, that works. Otherwise, you can do the wound management and then decide on your post-op protocol whether you'd like them to walk or not. I usually do non-weight bearing for the least, at least the first four weeks, and then you can progressively weight bear them in a boot with a cutout for the fixator.

Cory Shultz (Arthrex Product Manager) provides an overview of the Arthrex Mini-Rail Fixation System, including set components, assembly, and application.

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Mini-Rail Assembly and Application

My name is Cory Schultz. I'm a product manager on the extremity and trauma team. We're going to go over some of the rail basics, including some of the system components that will be most commonly used with the rail, as well as how to assemble a mini rail on the left. We have all of our clamp options. There are five different types of clamps. On the left side you have all of our standard clamps, the traveling standard, as well as the inline end clamp and the 90 degree end clamp. And then on the right we have the more commonly used, more popular universal clamps, both the universal traveling clamp as well as the universal end clamp. We have four different lengths of rail. We have 50 millimeter, 75 millimeter, 100 millimeter, and 150 millimeter. For fixation options that can be found in the set, we have a one, six and two O wires, as well as three bone screws in 60mm, 80mm, and 100mm, all with varying lengths of threads. I'd like to walk you through some of the defining characteristics of the traveling clamps, so that we know what we're referring to in a surgical setting. At the top of the clamp, you have the lock nut, which secures the clamp and the fixation through the clamp. You have your clamp top here. Your fixation holes. The black paddle is what we call the clutch or the clutch mechanism. Within that clutch mechanism is a small set screw that locks the position of the clamp on the rail. Underneath is the drive screw, which sets into the threads of the rails and actually drives the clamp along the rail. And then lastly what we call the guide pin, which will correspond to the orientation slot on the rail. The clearest distinction between both the universal and standard clamps is the universal clamps ability to place fixation elements in multi-planar and variable angle fashion. You can see that the clamp top is able to articulate in two different planes to accommodate your fixation options. Furthermore, the clamp top can be rotated 90 degrees to allow for fixation with the smaller threaded wires in both a convergent or divergent fashion. The N clamp, you'll notice, is able to articulate 180 degrees around the end of the rail, as well as allows for the same variable angle placement of those fixation options. I'm going to walk you through some of the steps, the crucial steps in assembling a rail and putting the clamps onto the rail. We're going to start with the universal clamp. Articulate the clamp 90 degrees. That's going to open up space for your three millimeter hex driver. Three millimeter hex drivers going to go into the end of the clamp. You'll kind of want to pinch that and hold that on, and then slowly start screwing your rail in a clockwise fashion so that the orientation slot on the rail aligns with the guide pin on the clamp. Once that's the case, you can perform final tightening with the three millimeter hex attachment. When assembling your inline or your traveling clamps, in this case, a universal traveling clamp. You want to make sure that the clutch mechanism is open. Your position on the rail will often be dictated by where your fixation is. On the bony anatomy of the patient. With the clutching mechanism open, you're able to slide the clamp onto the rail. Always make sure that the threads of the rail are facing away from the patient, and also that the clutch mechanism on the clamp is also facing away from the patient. Once you have your clamp in a desired location on the rail, it's time to tighten the set screw using the blocking screw driver. Before doing so, you'll want to make sure that the clutch mechanism is fully seated and that the threads of the drive screw are sitting nicely and engaging with the threads on the rail. Insert the blocking screw driver and you'll actually turn counterclockwise to tighten that set screw. It's important to not over tighten this as to not damage both the driver or the set screw. It's just an easy two finger tightness. One of the benefits of this set is the ability to really construct the rail according to the deformity or the anatomy of the patient. Oftentimes, several points of fixation will be placed either freehand or using the pin insertion guides by the surgeon. With the fixation placed, we can now take the assembled rail and slide it over the fixation points. One pearl is to not tighten the set screws on the fixation clamps, to make way for any minor adjustments that may be necessary to fit the clamps over the fixation. We can slide that clamps over those fixation points. We can then use the remaining holes in the clamps as our drill guide for our final fixation points. Once the final fixation elements are in and the rail is positioned sufficiently off the skin of the patient, we'll use the blocking screwdriver to fixate the set screws in the clutch mechanism and fixate the clamps along the rail. Again, this is going to be counterclockwise Wise fashion to fixate the clamps. In their final position, we'll use the eight millimeter socket wrench and the Anti-torque tool to tighten the lock nuts on top of each of the clamps. At this point, we're ready to compress the joint. We're going to be manipulating the distal clamp on the rail. We'll insert the driver into the hole located near the threaded portion of the rail. If we're wanting to compress, we will rotate the driver in a clockwise fashion. If we were wanting to distract, we would rotate the driver in a counterclockwise fashion. With the driver inserted into the first clamp, we're going to rotate in a clockwise fashion and start to see that joint compress. Once the construct is complete, bone screws or threaded wires can be cut and capped, and the appropriate patient driver kit and surgeon removal kit can be left with the facility.

Stephen Frania, DPM (Mentor, OH), demonstrates the new Mini-Rail Fixation System on a metatarsal fracture.

Mini-Rail Fixation System for Metatarsal Fractures

Hi, I'm Doctor Stephen Frania from Cleveland, Ohio. I'm here to show you how to use mini rail fixation for a metatarsal fracture. First thing I like to do is mark out my landmarks. The Metatarsophalangeal joint is right here. I think our second metatarsal is right along this space. This is proximal. Our fracture is already here, and we can confirm that under fluoro to kind of line up our pins and do this whole case percutaneously or through a little mini incision. If you need to do a little reduction, you can do that. Okay. On our fluoro image we we can see the fracture. It's a mid-shaft fracture with a little bit of comminution and some displacement. Our goal is to get two pins distally and two pins proximally with this mini rail to put it back in place and hold it in distraction or alignment, and then potentially compress it if you need to get healing. At this point, we're going to fixate the distal fragment. I'm using a 2.0 threaded wire. At this point, I'm going to line it up at my distal segment. You need to confirm that the pin is in the bone centrally, so you can put your other pins in and capture everything. So I'm using wires instead of half pins. In this case we are using two threaded wires. I'm using a 75 millimeter rail on this and two clamps just to capture my fracture. I can use wires or half pins depending on which way you turn the clamp. And you can use them wires on one side, half pins on the other. Whatever you'd like, you can mix and match. You also have these black clutches right here. If you lift up, you can slide the clamp back and forth and kind of get your alignment nicely. So I use fluoroscopy on this case to kind of line up my clamps and my holes once you get one aligned. Make sure your your clamp is on the bone so your other pin will will sit on the bone. I like to find the spacing off of the skin here, just to make sure you can allow for some swelling. You can have your assistant tighten it once you like, where the clamp is and the tightness of that. Would lock down that pin a little bit and kind of hold our alignment for us. It doesn't have to be totally snug, just a little snug. At this point, we still have adjustment back and forth. We also have side to side as well. Once you line this up on fluoro and have it where you want it, this end clamp or the proximal clamp, you can drop your pin in and you can tow it in or tow it out whatever you'd like. You also have the capability of going in and out as well, to kind of change your position as you need to. Find the proximal end of this fracture. Okay. Now that I have my proximal pin set, I set that under fluoro to make sure it's in the bone. And it is. You want to look at look at the fracture? Take your fluoro. Make sure your alignment is still nicely aligned, which I think it looks pretty nice right there. We just have to fill in the other two holes, one proximally and one distally. And then I think we can take our final pictures and make sure we like it. Okay. Now that you have both of your proximal pins in at this point, we're going to come back and put our other distal pin in. He's going to have to loosen this end nut here for me to do that. We want someone to your assistant to hold the alignment, just to give you enough clearance for the skin and swelling. Okay. Okay. For our a final tightening, we want to use this black fork device. This is the counter torque. So you're not going to pull your wires or your screws out. Once your assistant is tightening this with you. So these kind of go hand in hand. That just kind of holds everything in alignment. Okay. And distal. You want to check on Flora once more. Make sure everything looks good. Okay. So there's a set screw right here. This locks the black clutch down the blocking screwdriver. This little tiny silver screwdriver left is tight. This is two finger tightness only. And that just locks the the clamp down to the bar. Now that you have all your pins in, you want to check your final Floro. Make sure your fracture is in good alignment. You can either distract or compress if compress if you'd like. These clamps will move towards each other or away from each other. With the use of this clamp driver, there's a red one and a blue one that both drive these clamps. It goes right down the rail here in this little groove, and you can turn it clockwise to compress or counterclockwise to distract. Now that we have fluoro, we're taking our final shots. If you're satisfied with the alignment and everything looks good, you can cut your pins short to whatever length you need them to be out of the way. You can put a small dressing on this, although this is a percutaneous procedure, so no dressing is necessary. I typically walk these patients in a cam boot with the aid of crutches or a walker for at least six weeks. Once healing across the fracture site is seen on x ray. Then you can make plans to remove the fixator.

Product Manager Cory Shultz provides an overview of the Arthrex Mini-Rail Fixation System.

Overview of the Mini-Rail Fixation System

Hi, my name is Cory Schultz. I'm a product manager on the extremities and trauma team. I'm here to walk you through the new Arthrex mini rail fixation system. This is a unilateral fixator that will be used for fractures, bone lengthening, as well as deformity corrections in both the upper and lower extremities. You can see here in the two layer set on the top layer you'll find five different clamp options. Your traveling clamps both in universal and standard, as well as your end clamps, two standard options in both an inline and 90 degree, as well as a universal in clamp option. Most commonly used here are the universal traveling clamps and the universal end clamps. Typically, what we see is a rail with 2 to 3 clamps making up a construct. You'll also find on the top layer your common instruments, both your clamp driver tools, your blocking screwdrivers, triple tools, sockets, and all of your hex drivers. You'll also find your drill guides and drill bit if needed. On the bottom layer, you have all of your fixation options from 1.6 and 1.8mm threaded guide wires to three bone screws and 60 millimeter, 80 millimeter, and 100 millimeter in different thread lengths. There's four different lengths of rails 50mm, 75 millimeter, 100 millimeter, and 150 millimeter. Most commonly used would be the 75 and 100 millimeter. Unless you're spanning something longer, either medial or lateral column or something in the upper extremities.

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510K for Arrowhead Mini-Rail Fixator

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Arthrex Presents: Breakthroughs in Foot and Ankle Technology - ACFAS 2025

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Hand, Wrist, and Elbow - Next Generation in Repair and Reconstruction

Foot and Ankle: Next Generation in Foot and Ankle Technology 2023

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Mini-Rail Assembly and Application

Overview of the Mini-Rail Fixation System

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Mini-Rail Fixation System Demonstration

Mini-Rail Fixation System for Metatarsal Fractures