Arthrex bietet eine große Auswahl an perkutanen Fräsen für minimal-invasive Operationstechniken.
Die Fräsen können unter anderem für die folgenden minimal-invasiven Techniken/Osteotomien des Fußes verwendet werden:
• Exostosektomie • Akin-Osteotomie • Chevron-Osteotomie • DMMO • Schneiderballen • MTP-Arthrodese • Mediale Kalkaneusverschiebeosteotomie

Foot and Ankle

Trauma Lower Extremities

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A comprehensive overview of a product team’s portfolio.

Ein umfassender Überblick über das Portfolio eines Produktteams.

Kataloge

Visão geral e abrangente do portfólio de produtos de cada segmento.

Catálogos

Descripción general y completa sobre la cartera de productos de cada segmento. 

Catalogs

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

Imaging and Resection

Charts and graphics providing detailed demo loan set information.

Diagramme und Grafiken, die detaillierte Informationen zu Demo-Leihsets bereitstellen.

Referenztabellen

Tabelas e gráficos fornecendo informações detalhadas sobre conjuntos emprestados para fins de demonstração.

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Gráficos y cuadros que proporcionan información detallada sobre sets de préstamo para demostración.

Tablas de referencia

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Reference Chart MIS Burrs

A document containing information about Arthrex products and product lines.

Ein Dokument mit Informationen über Arthrex Produkte und Produktlinien.

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Documento contendo informações sobre produtos e linhas de produtos da Arthrex.

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Documento que contiene información sobre los productos y líneas de productos de Arthrex.

Folletos

Brochures

Arthrex Power Systems - AR-200 DrillSaw Highspeed Brochure

A step-by-step demonstration of how a product would (or could) be used in a surgical technique.

Eine schrittweise Demonstration, wie ein Produkt in einer Operationsanleitung verwendet werden würde (oder könnte).

Operationsanleitungen

Demonstração passo a passo de como um produto seria utilizado em uma técnica cirúrgica.

Guias de técnicas cirúrgicas

Demostración paso a paso de cómo se utilizaría un producto en una técnica quirúrgica.

Guías de técnicas quirúrgicas

Surgical Technique Guides

Minimally Invasive Surgery - Cheilectomy Surgical Technique

Minimally Invasive Surgery - Medializing Calcaneal Osteotomy Surgical Technique

Minimally Invasive Surgery - Bunion Correction Surgical Technique

James McWilliam, MD, (New York, NY) demonstrates a minimally invasive hammertoe correction with a 2.5 mm Compression FT screw. Dr. McWilliam uses the MIS power unit to prep the PIP joint before placing a percutaneous 2.5 mm Compression FT screw.

video

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Videos - OP-Anleitung

Vídeos — Técnicas cirúrgicas

Videos de técnicas quirúrgicas

Surgical Technique Videos

MIS Hammertoe Correction Using 2.5 mm Compression FT Screws

We're going to be doing a hammertoe repair by Pip arthroplasty using the Arthrex minimally invasive instrumentation. And the 2.5mm compression foot screws. We have a right foot. There's a flexion contracture of the Pip joint. And we're going to address the hammertoe by addressing that flexion contracture using the beaver blade. That's part of the Arthrex mis instrumentation set. We're going to make an incision through the extensor mechanism over the dorsum of the pip joint. Entering the joint as best we can. I'm taking care not to affect the medial and lateral nerve vascular bundles. First we use the two by eight millimeter Shannon Burr. This is going to create a pocket in our joint to accept the larger 2.9mm wedge burr. So I can feel the bird going into the joint. You can do this under Fluoroscopic guidance if you're not familiar with the field. Next, we're taking the 2.9mm wedge burr. The wedge burr is different than the Shannon burr in that instead of cutting bone it's actually designed to remove bone. And we're going to remove bone from both the proximal phalanx by some gentle pressure on the proximal phalanx and a sweeping motion with a little bit of rotation. And we're going to remove burr from the middle phalanx with a little distal pressure, a sweeping motion, and a little bit of rotation. Next we're going to use the 0.86mm guidewire. This is the guidewire that accepts the drill for the 2.5mm compression screw. I'm going to put this guidewire down into the intramedullary canal of the proximal phalanx, because the overall alignment of the toe is going to be contingent upon our drilling and the position of our screw. I'm going to check this under fluoroscopy. So on the AP image we can see good placement of the guidewire down the Intramedullary canal. It's also important to check on the lateral image. And you can see it's right down the shaft. The other thing we see on the AP image is that our joint is unevenly prepared. So we're going to have to remove a little bit more bone from the lateral part of the joint. And that can be done in subsequent steps. So next we're going to use the 2.0mm Cannulated drill that prepares the Intramedullary canal for the 2.5mm compression ft screw. And I'll do this as the positive stop will be my. Proximal cortex or the proximal phalanx. You could drill through. So you do need to use some care in doing this. Next we're going to place in a retrograde fashion the 0.8mm guidewire for the two millimeter drill so that we can prepare the middle phalanx. We're going to send this out, ideally through the tip of the distal phalanx, because once again, our overall alignment is going to be contingent upon our guidewire placement and our drilling. I'm looking at my position here and it looks good, but it's really important to check this under fluoroscopy. So in the AP plane the position is great, particularly with regards to the middle phalanx. On the lateral plane, we can see we're completely lined up appropriately within the middle phalanx. Using the beaver blade, I'm going to cut an incision for exit of the drill bit and insertion of the screw at the tip of the distal phalanx around the exit point for the guidewire. Now we're going to drill antegrade through the middle phalanx and out the distal phalanx using the two millimeter cannulated drill. If you recall, we had a little bit of excessive bone on the lateral side of the proximal phalanx. So we're going to preferentially remove a little bone there. And I can literally I can hear. And I'll be able to feel when the appropriate amount of bone is removed. We can see now that the joint is appropriately prepared. So then by hand, we're going to replace the K-wires antegrade through the middle and distal parts of the toe and then retrograde through the proximal phalanx. But once again I think it's really important to check this fluoroscopic. So here this is going to be the final position of our Toe, which is satisfactory in the AP plane and then in the lateral plane. And you can see it's in the middle and proximal phalanges on the lateral plane as well. I don't typically measure this screw. I almost always use a 26 millimeter 2.5mm compression screw. If it's a really short toe I might go down to a 22. You can see when I insert the screw, there's a tendency for the distal phalanx to rotate. It's important to correct that rotation during insertion of the screw, and I do that manually. I'll check the position on fluoroscopy and then finish this by hand. When you start getting compression across the joint, it's particularly important to hold rotation of the toe because even though clinically it probably doesn't cause much problems, patients are very dissatisfied if their toe is mount rotated. There's your final fluoroscopic image in the AP plane, and here's your image in the lateral plane. Frequently, with the hammer toe deformity, I'll perform a metatarsophalangeal joint release. I'll either palpate the joint or if I can't palpate the joint, then I'll mark the joint using fluoroscopy. I'll take the beaver blade and I'll go almost directly into the joint. Make sure that I cut the long extensor. And then I'll come in. And I'll also cut the short extensor. Putting some gentle plantar flexion pressure on the toe. And you feel a satisfying release once you've been through the tendons. In addition to the tendon release, sometimes you have to release the collateral ligaments off the base of the proximal phalanx, and that can be done through the same incision by gently turning your blade, directing the distal with care taken to prevent injury to the adjacent neurovascular bundle, and continue sequential releases until you have adequate release of the dorsiflexion contracture at the MP joint. For the purposes of this demonstration, we didn't use the irrigator, but every time I'll do the surgery in a live fashion, I will use the irrigator, and you can see the irrigator delivers a constant flow of saline to the field to decrease temperature and decrease the risk of thermal necrosis.

Minimally Invasive Surgery (MIS) OR Setup

Thomas G. Harris, MD, (Pasadena, CA) demonstrates a 5th metatarsal bunionette osteotomy using the Arthrex minimally invasive surgery (MIS) system. Dr. Harris has been using the MIS system to correct painful bunionettes since its launch.

Minimally Invasive Bunionette Surgery Using the Arthrex MIS System

Today we're going to be discussing and going over a fifth metatarsal bunion correction with the miss system. I've gone away from doing open osteotomies for this type of case, and moved on to almost a solely miss approach. I do not use any internal fixation for this type of osteotomy as well. It's a very stable osteotomy that does not require a K-wires. And we're going to go over the details of that case and the technique right now. You can see that we're using the miss system. It's set at an RPM of 6000. And some of the the bur that we'll use initially just to shave down any of the lateral eminence. And then we'll switch that to another burr to make our actual osteotomy. This is a nice tool called a combo elevator that really helps us free off some of the soft tissues around the fifth metatarsal. It's important with all miss cases to make sure you're in the right position. And we do that by utilizing fluoro and making sure our cut is not too far proximal. The air here is to make the cut and the osteotomy a little too proximal, and you ought to be careful about that. And the direction of the cut is important too. And we want to make the cut from a dorsal distal to proximal plantar cut like that. And that sort of cut enables us to have a relative stability to the osteotomy that does not require any supplemental fixation or K-wires. And so the direction of the cut is dorsal distal to proximal plantar and that sort of direction there. And that's probably the most important thing to remember about this case. Here is a fluoroscopic image where we mark that location on the skin. We go in through there, and now we'll come back over, and then we'll use the beaver blade to make a small incision through this area, kind of in the center portion of the metatarsal. You don't want to be too plantar here. You want to be too dorsal here. A nice, important part about this case is you want to maintain the extensor tendon, which helps hold some security and stability to the osteotomy. So you make a small incision through this area, basically just going through the skin here. And then use that small elevator to help free up the area so we know we're in the right spot. And you could use either side here. You can also use the other side if needed to help free up our location. And this is kind of an osteotomy in two separate stages. We do the first stage to remove the prominence. Some patients have bigger prominences than others. And we're going to use the the burr to remove some of that prominence in that area. And here I'm just freeing up tissues around the area just so we can get a good location for our osteotomy on our flora. We're just checking to make sure that we're in the right location to burr down some of this area here, and we're close by. And so now we'll use the miss system to help shave down some of this area. I'm going to take too much here. Just enough. Some patients have bigger prominences than others. Keep in mind you're going to be shifting this part over immediately so you don't have to remove too much bone here. You can see here just from doing that you can generate some nice bone slurry. So you want to remove that from out of there to prevent an exostosis later. And we switched burrs now to use the one that we'll do the osteotomy with. And again we'll check our position fluoroscopic to make sure we like where it's going. But the direction of the osteotomy is going to be something like that. Dorsal distal to proximal plantar. We don't make the osteotomy under fluoroscopy. We just make sure we're in the right starting point. And you'll tactically feel that you've cut through the dorsal cortex, the center portion, and then the plantar cortex, and you'll feel a little palpable. Give as that metatarsal shifts immediately. All right. Now I'm kind of going midline dorsal. And then I'm kind of working my way. Plantar proximal. Kind of can feel it cutting through there. And make sure you're going you want to make sure you're not too far medially and cutting into the fourth at all. But you just kind of feel that cut coming through here, going more and more proximal plantar. So that cut looks pretty good through there. And I think we're through the plantar cortex. I'll just double check and make sure there's no other cortex remaining. Again, making sure you're not too far medially there. The dorsal cortex feels good. So you can see there we got a pretty good shift in that already. Just from that you can see where the the medial cortex of that fifth metatarsal is already significantly shifted. That's an image there. You can see some of that bone medially. So we'll bandage them. We'll close this up with a single monocryl here we'll put a bolster a dressing between the fourth and fifth toes for a few weeks. And then we'll go straight into a post-operative shoe and heel. Wait, bear them for the first 3 to 5 days, and then post, and then weight bearing is tolerated after that. Usually they're into tennis shoes within 2 to 3 weeks. Making sure that the wound has healed up. Okay. But it's actually a very fast recovery. And these heal really nicely.

Jorge I. Acevedo, MD, (Jacksonville, FL) and James McWilliam, MD, (New York, NY) demonstrate their technique for a minimally invasive cheilectomy using the Arthrex® DrillSaw Highspeed 200™ power system. The corresponding sawbones demonstration can be found via this link: <a href="https://www.arthrex.com/link/asset/qL2_GUgf7UyJKAFk1_QVfw">https://www.arthrex.com/link/asset/qL2_GUgf7UyJKAFk1_QVfw</a>

Minimally Invasive Cheilectomy

So my incision is approximately two centimeters proximal to the joint. And keeping in mind trying to avoid the dorsal medial cutaneous nerve. Then I'm going to make an incision. And then we're going to spread with the mosquito. And then we'll use the elevator to elevate the tissues. Basically I'm using my contralateral hand to know how far I've gone as far as the joint is concerned. And again I'm not trying to elevate above over the spur but just right to it. Once you've elevated, you'll bury your burr. You don't want to pull up on the soft tissues with the burr. You don't want to have any chance of entangling the tissue. And so we'll try and demonstrate this. So you can sort of feel it and basically. Kind of go into the wave. And I like to look at this because you can definitely take out too much at times. And so I like to see what I'm doing. I can feel that I've left a little bit of a ridge, but we could actually floor this. And you could see I'm into the wave there, which is exactly what you want. You don't want to go over the wave, and you can basically complete that as a two lane. You can express the bone from the area of surgery just by squeezing. And that will take a lot of the bone out. Sometimes you might want to use a rasp. Now this rasp isn't to necessarily rasp bone spurs out, it's just to help facilitate removal of the already moralized bone from your operative area. The other thing you use is a syringe. This is a needle. We typically use an angiocath, but a 14 gauge angiocath one that's big enough to deliver enough fluid in to make your irrigation worthwhile. So you can sort of irrigate to express a good amount of that bone even before you use the rasp, because otherwise you're rasping forever. That is the typical colectomy. And you can see we've flattened out the the spur. If there's a significant osteophyte from the proximal phalanx, it can be removed through the same maneuver and through the same portal. So just a couple pearls to avoid soft tissue issues is you don't want to elevate the burr up onto the tissues, and you don't want to plantar flex the toe while you're doing this maneuver. Typically, I'll close these with some 400 nylon or prolene suture. Some people would prefer to just put steri strips on, but I prefer a formal wound closure. I typically use A40 prolene suture to close this incision and remove the sutures. At ten days to two weeks, patients are walking on this immediately. Weight bearing is tolerated in a postoperative shoe with a bulky dressing. I'll let them transition to a comfortable shoe after the first dressing change, which they'll perform on their own in 72 hours and maybe put a band aid over the portal. And if they're comfortable in a, in a, you know, accommodative shoe, then I'll encourage them to go into that because I want them to start weight bearing and moving as soon as possible at the latest. Patients come into the office after this at two weeks and they're put into a shoe, then they might be a little bit stiffer and I might really encourage them to do some passive range of motion exercises. But typically physical therapy is not necessary.

Zack Day (Senior Product Manager, Distal Extremities) demonstrates the setup and features of the AR-200 power unit for minimally invasive surgery, the small instrument set, and the single-use disposable burrs.

Animations demonstrating the features and benefits of a specific product.

Animationen, die die Funktionen und Vorteile eines bestimmten Produkts demonstrieren.

Produktdemonstrationen

Animações demonstrando os recursos e benefícios de um produto específico.

Vídeos de demonstração de produtos

Animaciones que demuestran las características y beneficios de un producto específico.

Videos de demostración de productos

Product Demonstrations

Minimally Invasive Surgery

All right. Hi, everybody. This is Zach Day, product manager for this minimally invasive surgery product launch. And real quickly, I just wanted to walk you through how to set up the new R 200 power unit and how to attach the burrs, the pump tubing. And then we'll go over the benefits of the minimally invasive surgery product line. So we're going to attach the R 200 M handpiece. And you see you've got your red dot here. And that plugs into the red dot right there. And now that's plugged in and ready to rock and roll. And the final piece of attachment is the R 300 B burr attachment. And that connects to your handpiece with a simple twist. And then attach. Once you've attached you let go. And now your burr attachment is ready. And it's attached to your R 200 M. So now at this point we're ready to attach our burr. So Arthrex offers various options of burrs specific to the procedures that you'll be you'll be performing for a minimally invasive surgery. So this specific burr you see here is the burr for the calcaneal osteotomy, which is a three millimeter by 20 millimeter working length burr. And these are all single use sterile, packed in a nice white box. And these are just simple peel packs. So I'll pull here and pull it out. And now we're ready to attach the burr. So when we're attaching the burr this has a locking mechanism. On this 300 b you simply turn the locking mechanism counterclockwise to open it up. You slide in the burr attachment and you lock it in clockwise and you feel a very tactile click. So now this burr is locked in. Now say you're doing a case on a patient with a rather large foot. You can always adjust the length of this burr accordingly for that larger patient. So you can see all I did was unlock it. I found the length that I needed to and locked it back in. So one of the key things with minimally invasive surgery and why this power unit is so special, as opposed to the other devices in orthopedics, as this device functions at a high torque but also spins at a low velocity. So what that means is it allows surgeons to make very aggressive cuts on the bone without a causing a drastic increase in the heat used by these burrs. And also, more importantly, is that it will not wrap up any soft tissue structures, tendons, capsular tissue, etc. when they're spinning this burr. And I do think that that's important to highlight as I spin this burr and run it up against my finger, you'll see it doesn't cut my glove. And I'm you can see me pushing into it and creating depression on my glove, but it doesn't cut my glove. And the same is the same can be said about it won't cut tendons and it's also not creating any heat. So my finger is not getting hot. And that is really the nice thing about this system and the fact that it spins at a At a high torque and a low speed. So the other thing that Arthrex offers within this are 200 unit is it also has a built in pump. So this is a single wrapped sterile pump tubing that comes in a box of six. And I'll demonstrate really quickly how to set that up in the box. When you order the R 200 is your IV pole. And so this little pole actually hooks into the top of the R 200 unit. And you can now hook your irrigation to that unit. And then from there you press this button on the R 200. It pops open your pump tubing mechanism. And then I'm just going to simply take this pump tubing. You see this end goes towards the IV pole. And you're just going to simply connect one end to the bottom. There you see how that clicks into the top. And I'm going to do the same thing here. And you want the capture tab in that little window to where it's caught. So now we're caught on both sides. Push it close until you hear it click. So now we're going to take the R 200 SP spray clip and attach it to our R 200 motor. So we can then attach the pump tubing. So this is a simple click on a nice tactile feel. With that you can slide it all the way forward. And the surgeon can adjust where they want this flow to come out accordingly. And then we're simply going to take the other end of our pump tubing with our little inflow. And we're going to attach it to the the distal end of our 200 sp. And now we are ready to move forward and we can start the surgery. So with the R 200 unit the surgeon has the option to toggle through six different presets. And it's two very simple button controls. And they can simply toggle through preset six like you see here. And I can go through one through six very simply. And that's just depending upon if the surgeon wants to. You know, depending on the operation they're performing. If it's only miss. The recommended RPM range is to stay at the 6000 range, but if the surgeon is going to use this for other orthopedic cases, it has a minimum speed of 300 RPMs and a maximum speed of 15,000 RPMs, and those can be easily toggled through. With this simple up and down arrows, they can come to the RPM and they can drop it down to. For this sake, we'll just go down to 4000 and it goes all the way up, like I said, to 15,000. But for the sake of miss, I'm going to keep it on six. This setting allows the surgeon to adjust the torque, assuming that for whatever reason, maybe they didn't want as high torque, they can adjust this accordingly. For miss settings, we'll just keep it at 100%. And then the final setting lets the surgeon adjust the flow rate, and that can be dropped all the way down to zero. So they can have the irrigation tubing set up. And if they don't want the pump to be running, they drop this down to zero or they can also up it to 100. So finally we're going to walk through the functionality of the R 200 foot pedal. It's important to note that this system does come with a bracket that attaches to the back of the foot pedal to allow the surgeon to move this foot pedal seamlessly. In their case, if they want to move it and get it out of the way, it has a very nice tactile feel. And then with their foot, they could simply pick this up and move the foot pedal as they need to. So the left button here on top of the foot pedal controls turning the flow rate on and off. You can't adjust the flow rate, but you can turn it on and off. And you can see when I push the green button that my indicator here shows that flow is on. I push the green button again. Flow is off okay. The orange button cycles through the different presets. So as I push the orange button, the surgeon can toggle through different presets if they so desire. And finally, this yellow button simply toggles the motor function to operate in either the forward or reverse direction. Initially, you will see the M symbol on the display with the arrows pointing clockwise, indicating that the burr is on the forward setting. Now, when I hit the yellow button, it toggles the motor to spin in the reverse direction and you will see the M symbol on the display now with arrows pointing counterclockwise. When the surgeon presses on the foot pedal, there will be an audible beep indicating the reverse function is initiated, followed by a small delay, and then the burr will begin spinning in the reverse direction. So finally I'm going to demonstrate the Mis instrument set. This is a small set that can be very helpful during various Mis procedures. And the first thing that I'm going to demonstrate is the beaver handle. So Arthrex also offers small little beaver blades that are attached very easily. The surgeon simply turns this handle counterclockwise to loosen up the device. They'll take their beaver blade that is sterile, single, packed. So we'll attach the beaver blade and we'll turn the device back clockwise, and they'll feel that lock in place. And now our beaver blade is ready to go. Aside from the beaver blade. We also have a small periosteal elevator that is helpful to remove the periosteum. And you also have a blunt elevator that can be used to help affect your shift for various osteotomies. And then we also have a small and a large rasp slash combo elevator device. So this rasp is not designed to remove bone, but more to remove the bony debris that is created during the Mis procedures to remove that off of the soft tissue. So this is not used to smoothen out any of our osteotomies. That should all be done with the burrs. And then again, you have a small elevator on Elevator on this side. And then the only difference with this other instrument is that it is a larger rasp and a larger elevator. Finally, another instrument that is critical for the calcaneal osteotomy procedure is this Sayer elevator. This is ordered separately as part of the calcaneal osteotomy instruments, but can be very helpful for that procedure in instances where you need to help complete the cut. This is a not a sharp instrument, and it can help break through a cortex or two if you've missed a couple little places. And it's also helpful to affect your shift after you have completed the osteotomy, so definitely highly recommend dropping this into your little accessory tray here. That concludes our demonstration of the Arthrex Minimally Invasive product platform, and be on the lookout for upcoming medical education courses as they are scheduled.

Noman A. Siddiqui, DPM, (Baltimore, MD) demonstrates a minimally invasive bunion correction using the Arthrex minimally invasive surgery (MIS) product platform. Dr. Siddiqui prefers the transverse metatarsal osteotomy to allow him not only to affect a large IM shift but to also bring the sesamoid bones back into proper alignment. Upon fixating the metatarsal osteotomy, Dr. Siddiqui also performs an MIS Akin procedure.

Minimally Invasive Bunion Correction Utilizing the Arthrex MIS Platform

Hi. We're going to be demonstrating the helix valgus correction utilizing a minimally invasive approach. The first step in performing the distal metatarsal osteotomy is to mark off the incision in osteotomy level. And this is done under serum fluoroscopy. A guidewire can be placed on the skin and then an x ray can be obtained. Once the surgeon is satisfied with the level of the osteotomy, a 2 or 3 millimeter incision is drawn and the incision is made. A beaver blade was utilized to perform the incision. Next, blunt dissection is carried straight down the bone to avoid the neurovascular structures. Once the bone is palpated, a periosteal elevator is utilized in the path of the osteotomy. Care is taken to palpate the bone and this is done under fluoroscopy. Once the surgeon is satisfied with the level of the cut, the burr is utilized to perform a perform a through and through osteotomy. When I make this cut, I try to go from medial to lateral with an initial pilot drill hole. And once you're satisfied, the osteotomy can be completed. Once a through and through osteotomy has been performed, the surgeon can confirm by translating the osteotomy. Or de rotating to make sure the osteotomy is through and through. The next step is the critical step in this procedure is placing the temporary fixation for translation reduction as well as Les to maintain the capital fragment laterally once it's been translated. This is a very important step. I like to utilize A20 Steinmann pin or A20 wire in the in the set. The key is to match the declination of the first metatarsal, which is slightly planar, and advance the wire along the base of the proximal phalanx, and it should exit distally. Once the wire has been advanced, it will exit just adjacent to the the nail fold or slightly planar to it, and that is an acceptable place. Now the wire will be pulled back. And once the reduction maneuvers are made, the this wire will be going down the shaft. As you can see that the the capital fragment has been translated laterally. Clearly this patient does not have a valgus deformity. So you're not going to see a lot of translation. But when I try to translate the capital fragment, I aim for 90% translation of the capital fragment. And this step it is also possible to rotate the capital fragment. But once I'm satisfied with the translation, the wire is can be manually advanced along the path of the the hemostat. It's important to check if the wire is in the shaft of the metatarsal. The goal is to keep the the wire in the midpoint. However, if there is a elevated first metatarsal, the the wire can be positioned either dorsally or laterally, and that will impart the opposite translation to the capital fragment. The next step is placing the guide wires for the Definitiv fixation. This is the more challenging aspects of this procedure. Some technical tips. It's important to utilize your thumb and your index finger. The thumb is on the dorsal aspect of the capital fragment. The index finger is on the planar aspect, and this will help the surgeon triangulate placement of the wire. The second wire is placed adjacent to the first wire. This one is a little bit more proximal, and is aiming for the more lateral aspect of the capital fragment in a more valgus type case. This wire may be exiting the lateral cortex, going through some clear space back into the capital fragment, and that is acceptable. Once the incision has been made and blunt dissection has been carried to the bone, the drill holes are made. So once we make our measurement, it measures 42, but we're not on bone. And under CRM, we confirmed that it was 36. Gemini. Chondraldrill. So we're satisfied with our fixation. If we could have made our proximal screw purchase the lateral cortex of the capital fragment, that would be also very helpful. But in many of these cases, with a larger I am, you may find yourself that the smooth portion of the screw would be exiting the lateral cortex, then back into the capital fragment, and that is completely acceptable. The temporary reduction wire is removed, and we can see that we are able to maintain our correction and our translation. If the surgeon felt or needed a additional akin osteotomy, he or she can perform that at this juncture. The lateral view is obtained to confirm excellent alignment and fixation. The same steps that were performed for the initial metatarsal osteotomy are utilized for the osteotomy that is minimally invasive in approach. I mark out the incision at the level of the osteotomy, and there are various levels that the akin can be performed. Surgeons sometimes use a cylindrical akin approach, an oblique akin approach either that is more proximal to distal or distal to proximal. It's up to the surgeon which method they choose. I tend to perform a more distal akin, primarily given the way I fixate the akin itself. Under fluoroscopy, we confirm the placement of our incision, and our incision is made with a beaver blade, which will be followed by our blunt dissection and periosteal elevation. This x ray demonstrate that this burr is different to the metatarsal osteotomy burr. It's a two millimeter by 12 millimeter burr, which helps maintain the lateral cortex and will make it easier to maintain a hinge for the correction. You can say a small oblique osteotomy and wedge resection has been performed. However, it's important to try to maintain the lateral hinge and I will gradually reduce. The osteotomy without breaking the hinge by manual manipulation. Once I'm satisfied with the reduction, I will place my guidewire for my screw and start the guidewire off at the distal aspect of the phalanx. Aiming for the proximal medial aspect. A beaver blade was utilized to make a small incision in the inner space. Blunt dissection was carried to carried to bone and then the screw was measured. Once the appropriate depth has been measured, a screw is inserted. Once compression has been achieved of the oblique wedge osteotomy, the incisions are closed in a standard manner. This is a 2.5 screw. We can alternatively use A30. In this case. Example, we've used for small skin incisions to correct our valgus deformity. These can be closed per the surgeon's preference. Postoperatively. The patient is placed in a weight bearing surgical shoe. Dressings are removed at one week for incision check, and they're typically allowed to shower at that point. I like to transition my patients into a sneaker at about four weeks.

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Arthrex Power Systems AR-200

Jorge I. Acevedo, MD, (Jacksonville, FL) uses a sawbones model to demonstrate a minimally invasive cheilectomy.

We're going to demonstrate the colectomy. The colectomy can be done in a standard colectomy for the halex. This is also very useful with people with midfoot, arthritis or arthritis and other joints where you can do this minimally invasive and basically shave off the dorsal bossing that some people get sometimes. The burr we're using is a little bit different Burr. It's a wedge burr, and it's designed for basically shaving the bone. The incision for the colectomy is usually made about two centimeters proximal to the joint. You make a four millimeter, five millimeter incision in line with the metatarsal. The next step is to elevate the soft tissues up and around the bone. You don't really necessarily want to elevate past your osteophyte, but right to the osteophyte. And you can elevate all around the metatarsal head. Your contralateral hand is often beneficial to give you an idea of how far you're going to go with your colectomy. So when you're putting in your bur, you can put it in like this and you'll know the extent of your colectomy. Using your contralateral hand. And you want to basically go into the wave, so to speak. You don't want to go over the wave. Okay. So you're coming in. You can also switch to the farmers grip and basically kind of peel the the the onion if you will. And finish that off smooth your cut. And obviously always keep in mind your incision when you're doing this. Like so. If you have a spur in the proximal phalanx you can also take care of that in the same in the same fashion.

Jorge I. Acevedo, MD, (Jacksonville, FL) demonstrates his technique for a minimally invasive bunionette procedure using the DrillSaw Highspeed 200™ power system. The corresponding sawbones video can be found via this link: <a href="https://www.arthrex.com/resources/video/aX-j1F7fu0ikSwFk1_DoJQ/minimally-invasive-chevron-osteotomy">https:/www.arthrex.com/link/asset/aX-j1F7fu0ikSwFk1_DoJQ</a>

Minimally Invasive Bunionette

We could mark this under fluoro make sure because the fifth is a little bit more proximal. You could come right at the metaphyseal flair. So in a similar fashion you're going to make your incision just lateral to the extensor okay. Use your elevator once again. And if there was if I was doing a bunion at I would definitely make my cut a little bit more angled sort of 45 degrees. In Europe they tend to make a just a straight DMO. I kind of like more of the abutment of the 45 degree cut. So that's what we'll do here. Our bur and again you're using you're both translating and pivoting off your incision. And let's see. Yep. So that's that's more of a 45 degree cut as you can see. And basically that is allowed to translate. And we can translate it over like so you could pin it if you wanted to. Post-op protocol for a bunion act would be toe strapping and wayfarers tolerated in a postoperative shoe or boot walker. I usually put 140 prolene suture. In Europe, they do a stereo strip.

Jorge I. Acevedo, MD, (Jacksonville, FL) demonstrates a minimally invasive chevron and Akin osteotomy to correct a bunion deformity. The corresponding full length sawbones video can be found via this link: <a href="https://www.arthrex.com/link/asset/QH0Wuk5dekmuFwFk1-5g6w">https://www.arthrex.com/link/asset/QH0Wuk5dekmuFwFk1-5g6w</a>

Minimally Invasive Chevron and Akin Osteotomy

So here we are. We're going to demonstrate the minimally invasive chevron osteotomy. And what I've marked here is a central shaft of the first metatarsal and the metaphyseal flair. So we're aiming slightly distally so as to make up for the two millimeter trough that the burr makes so that we don't get any shortening. In fact, we can aim at slightly more angulated if we want to make up some length as well. And then this trajectory is going to be also slightly planar. So we're going to make our incision in the metaphyseal flair with the beaver blade being mindful of the of the dorsal medial cutaneous nerve. And I like to elevate up and around the metatarsal both dorsally And planoly. And then we're ready to start our osteotomy. You can hold it with a clip if need be, but you really want to be in that top third. Here's inferior. Superior metatarsal. So you want to be kind of in the top third of that. And angle it slightly distally. And that looks like right about the correct angle. So we can then start our burr. And again just with the wrist motion make our dorsal cut. We're using our incision as a pivoting spot. And I'm doing basically pivoting and translation using my other hands to sort of feel when I've gone through the cortex. So we can look at that. Yep. Okay. So now we're going to make our planar cut. Once again. It's just the wrist motion. And we're going to use our incision as our pivot point. And I'm going to bring the BR dorsally so that we get a little bit of a longer planar limb. [00:02:18] Okay. I'm not sure how this is going. I feel like I'm almost through. I'm just going to check the far cortex. So that's that's what it should look like. So we're putting the K-wires. So you want to start this almost at the tarsometatarsal joint in the proximal base of the metatarsal. And I'm starting maybe slightly dorsal. Here as I drew earlier the the mid axis of the metatarsal. And I'm sort of aiming down my line so that I don't place this wire's trajectory to dorsal or planter. So that's kind of where you want your wire to be in that axis. We're going to make a little half centimeter incision with our beaver blade in order to shift it. You could either use a wire like I'm using here Or there's a reduction tool. So you could also put your your elevator on the other side of that metatarsal if you wanted to effect a bigger shift. Okay. So we're looking at it under fluoro. And while we're holding this in the appropriate shift, we're going to drive in, go ahead and drive in the K-wires. All right. Good. Let's just check the lateral. That looks pretty good. Okay. So we've accomplished getting our first wire in. And then our second wire will go parallel to that one. So we'll measure. So it's measuring 58. So I think we could go with a 54. Probably pretty close there. Take a AP. Yep. So let's go ahead and put a second screw in now. So we're going to make a little incision where we scored it with the guide with the parallel guide. Okay. Let's just see how that sits. All right. So we're using our parallel guide here. Okay. So let's go get a lateral real quick. All right. So we'll go. How about a 44 I think would be good. So I drove my wire all the way through the bottom so I can now snap it and not lose my position. So next we will drill. Yeah. Good. Okay. Okay. So this is our final position of our screws. That's a lateral. And that looks pretty good on the lateral. We haven't plantar flexed it excessively. We haven't lost very much length on the on our shift. But that that looks good too. So we could go to our akin at this point we mark our starting point, which is usually a little bit more distal in order to oblique our akin osteotomy, which will be directed in this trajectory. So instead of the traditional transverse akin osteotomy, I like to do an oblique osteotomy like so in order to give me a little bit more room to put the screw. So we'll mark that, make a little incision with the beaver blade. I'm elevating periosteum. For the akin osteotomy we use the 12 by two millimeter bur I usually like to start my osteotomy. Just penetrate and then make sure that I am in the right level. I look at it by Floro. Okay. And then I can judge my angle a little better. So once I got my right trajectory, I can complete my cut. You don't want to go all the way across. You want to cut your superior cortex like so. And then your inferior cortex using your incision site as a pivot once again. And that looks pretty good. We close down our osteotomy. We got to get our pin in very close to the articular surface. So we make a little incision over the guidewire. Then we can measure our two five headless screw size. So we'll take a 28. Okay. So we pass the wire and clip it as we have done before in order to not lose the wire. And then we can over drill it. So we drilled all the way through. Now we'll use the profile drill. [00:07:48] That looks good. That's perfect. Postoperatively on the MCA. That's the chevron akin osteotomy. I let them wait. Bears tolerated. In a postoperative shoe on the heel and lateral aspect of their foot. Immediately, I will let them start weight bearing as tolerated at about four weeks. On the actual osteotomy, still protected in a stiff soled shoe. Once the swelling dissipates, they can move to a regular stiff soled shoe.

James McWilliam, MD, (New York, NY) and Jorge I. Acevedo, MD, (Jacksonville, FL) use a sawbones model to demonstrate a minimally invasive chevron osteotomy to correct a bunion deformity.

Minimally Invasive Chevron Osteotomy

So this is a sawbones that does not have a bunion deformity. But it's fine for us to demonstrate the maneuver that you're going to do with the burr for the chevron. So we're using a two by 20 millimeter burr that's going to remove two millimeters of bone. So already we're shortening the metatarsal. It's important to note that the starting point for the burr is actually at the junction of the top third and inferior two thirds of the metatarsal. It's also important from an axial perspective, to note that this cut is not going to go straight across or parallel to the weight bearing surface of the foot. It's going to be directed a little bit early, 10 to 20 degrees in that plane. I'm going to direct it a little bit distally to make up for our bone loss. And the first maneuver is going to go straight across. You can do this under fluoroscopy if you want, but we're going to see the burr exit out the lateral cortex of the metatarsal head. You can see it see it right there. The next maneuver is going to be straight up and down. Now once again, we're going to use our fulcrum as the we're going to use our incision as the fulcrum. We're not going to directly translate our bur up. We're going to rotate our hand down. And in doing so we're going to bring up the distal part of the bur and affect the cut in the distal portion of the metatarsal. So we're going to rotate our hand like this and perform our cut like that. Okay. So then the planar limb is going to be more horizontal. It's going to be more parallel to the weight bearing surface of the foot. It's not going to be completely parallel, but it's going to be it's going to be basically sort of a shallow chevron in this direction in order to affect that cut. We're going to actually put the bur back in all the way across. And you can use fluoroscopy. Or we're looking at it directly in the sawbones. And once again, instead of translating the bur this way pushing the bur this way, we're actually going to rotate our hand in such a manner as when we're done. Our our bird's almost parallel with the big Tow and depending on which foot you're using, depending on which hand you're using, you might want to use a firmer grip or a pencil grip. In this case, I'm going to use a pencil grip. It doesn't deliver as much force, but it allows you to have more control. In addition, I'm going to have my long finger on the toe on the medial border of the foot to give me more stability. So I'm rotating. I'm doing a little bit of sawing, a little bit of rotating, and you can see what my hand is doing there. And there's our cut. You can see it's a shallow chevron cut just like we planned. It's important to note that as you're rotating, this hand almost ends up superior to your phalanx as you're coming up and over to complete the cut. Yeah. If you come to horizontal or to parallel with the phalanx, then you'll make a very long planter limb of your chevron, and that's going to be much harder to displace because we're not doing any soft tissue stripping here.

Jorge I. Acevedo, MD, (Jacksonville, FL) uses a sawbones model to demonstrate a minimally invasive Akin osteotomy.

Minimally Invasive Akin Osteotomy

We're going to demonstrate the akin osteotomy, and we're using a two by 12 millimeter bur for the akin osteotomy. I like to oblique the osteotomy when I do it that way. It gives you a little bit more landscape for putting in the screw this way. Okay. So basically with the akin you're going to start a little bit more distal and you're going to come in and you want to leave sort of a a little bit of a sleeve to greenstick it on the lateral side of the phalanx. And then you're going to pivot dorsally first, and then you can pivot planoly. You could maybe cut a little bit more. In order to facilitate closing the wedge. Sometimes that's necessary. In real life you can basically correct your osteotomy. You can close the wedge, like so. If you feel like you need a little bit more correction, you can take a little bit more off of that wedge. As you close it down you'll you get a guidewire for your compression screw, and sort of your starting point for the compression screw is going to be right at the base after you've made a tiny little incision and you're basically going to shoot straight across there like so. Okay. At this point you could measure and you could measure 24. So you're measuring at 24. So you could maybe go a little bit shorter to a 22 maybe. Okay. There we go. Bring it out the other end. And then we could go ahead and drill it. And then you can basically drill it. You use the profile drill you like. And then while you're putting it in you could hold your reduction. You can see how that compresses down nicely. It's nicely compressed our our osteotomy and it's through the far cortex.

Jorge I. Acevedo, MD, (Jacksonville, FL) demonstrates a minimally invasive calcaneal osteotomy using Arthrex® MIS instrumentation.

Minimally Invasive Calcaneal Osteotomy

The first thing we're going to demonstrate is the calcaneal osteotomy. We're going to demonstrate it on the sawbone initially. So the first step is you're going to make your incision with the beaver blade. And you're going to make a small incision sort of in the top two thirds of the calcaneus. So you make maybe A56 millimeter incision. Then you're going to spread with a mosquito, and then you're going to take your calcaneal burr, which again is three by 20 millimeter burr. And usually I like to look at my position under fluoro at this point. But obviously this is a sawbone. So we don't need to do that. And as far as the safe zone here, what I've drawn out here, there's a safe zone approximately 11mm distal to the A line drawn here from the posterior superior to the posterior inferior tuberosity of the calcaneus. So you want to be not further than 11mm because then you'll impale the serial nerve when starting. What you want to do is you want to start doing your superior cut, and we divide it into quadrants. And what I've drawn here, the near superior. And then once you've accomplished that, the, the, the burr can go further in and you do the far superior. So the shaft of the burr will be guided by the track that you had just done in the near side of the calcaneus, and then you'll complete that far superior. You can then go to the near inferior quadrant. So basically you want to make sure that at your fulcrum of of the burr, which is right there, you're not translating the burr, you're pivoting the burr while you do that, because if you translate you're going to extend your incision. So that's we were at the near inferior cut. And then similar to what we did in the superior cut, you'll extend the BR and do your far inferior cut. So now we'll we'll actually demonstrate on the saw bone what we'll be doing on the cadaver. And what you want to do is you want to start it. And sometimes I will have my br go in all the way and penetrate both cortex and then back up if you need to. Yeah. And sometimes you can put your non-working hand on the medial side of the calcaneus, and you can actually feel right when you get penetration and it's safe on the medial side because the nerve vascular bundles typically anterior to this osteotomy. So we'll do the near superior. And you want to basically use there's basically two ways of doing it. You can use your, your wrist motion and you supinate your wrist while you're doing this. If it's tough, you can also change your grip to sort of a farmer's grip. And once again, you could use this motion. Okay, so we've completed the near superior. And now we're going to basically go back in our original track and go where we went all the way. And now we'll complete the far superior. We're trying to stay within the same track when we do that. And now we can come and do the near inferior cut. And again, this this time you're going to direct your, your bur almost parallel to your Achilles when you do this. So notice how once again this is a rotational maneuver around the fulcrum being the lateral cortex of the calcaneus, as opposed to a to a purely translational maneuver. And that will allow you to do this through a small incision and spare the soft tissues. And that's it. You can basically shift it either laterally or medially depending on what you're trying to accomplish. And then you can fixate it with two of the compression screws. I usually use the seven compression screws that Arthrex has. And those provide excellent compression for your shift if you have a cavus foot. And you could lateralize it. And even you can even cut a little bit more on the near side. And, and basically diarize it in order to bring it over out of its varus alignment.

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Videos - OP-Anleitung (10)

MIS Hammertoe Correction Using 2.5 mm Compression FT Screws

Minimally Invasive Bunionette Surgery Using the Arthrex MIS System

Minimally Invasive Cheilectomy

Minimally Invasive Bunion Correction Utilizing the Arthrex MIS Platform

Minimally Invasive Cheilectomy

Minimally Invasive Bunionette

Minimally Invasive Chevron and Akin Osteotomy

Minimally Invasive Chevron Osteotomy

Minimally Invasive Akin Osteotomy

Minimally Invasive Calcaneal Osteotomy

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

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Minimally Invasive Surgery - Cheilectomy Surgical Technique

Minimally Invasive Surgery - Medializing Calcaneal Osteotomy Surgical Technique

Minimally Invasive Surgery - Bunion Correction Surgical Technique

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Minimally Invasive Surgery

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Arthrex Power Systems AR-200

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Reference Chart MIS Burrs

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