Fuß & Sprunggelenk

Plattfuß (Rückfuß)

Der Erfolg der medialisierenden Kalkaneusosteotomie zur Korrektur von Plattfußdeformitäten beruht auf der Verlagerung der Achillessehnenzugkräfte auf den Rückfuß. Zur Behandlung dieser Pathologie bietet Arthrex zwei Optionen: 1) Kalkaneusstufenplatte StepPlate 2) kanülierte Schrauben (6,7 mm)

Foot and Ankle

Procedure

Arthrex bietet dem Operateur eine Reihe von Fixierungsoptionen für die Cotton-Osteotomie an. Die porösen BioSync-Titankeile ermöglichen ein stabiles Konstrukt ohne Implantantprominenz, das die Anatomie des Os cuneiforme exakt nachahmt. Für Operateure, die Allograft-Keile vorziehen, bietet Arthrex auch vorgeformte allogene AlloSync-Keile in den gleichen anatomischen Formen und Größen wie die BioSync-Produktreihe an.

Cotton-Osteotomie

Human

Child (D)

Die Sehne des M. flexor digitorum longus wird in den inferomedialen Quadranten des Os naviculare verlagert und mit einer Tenodesis-Schraube fixiert.

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English  - en

video

Flatfoot Repair With the InternalBrace™ Ligament Augmentation Procedure

The Arthrex internal brace. Spring Ligament Augmentation Repair is a surgery for people who have flat foot due to weakness or rupture of the spring ligament or posterior tibial tendon. Spring ligament is the connecting tissue located under the foot that connects the calcaneus and navicular bone. This ligament is often repaired in people that have a condition called flat foot. It is when the arch of the foot collapses coming into contact with the ground. The repair begins with the surgeon making a cut on the side of the ankle, where the calcaneus, navicular bone, and medial cuneiform are located. Next, the surgeon will create a bone tunnel by drilling into the sustentaculum tally of the calcaneus using a guidewire and drill guide. The bone tunnel is made in the calcaneus to prepare for a SwiveLock suture anchor loaded with FiberTape. The SwiveLock anchor is screwed into place. Next, the FTL tendon, also known as flexor digitorum longus, located on the medial side of the leg, is identified, cut, and then tagged with a FiberLoop stitching technique. A bone tunnel is made in the navicular to prepare for an additional SwiveLock anchor. The ankle structures are tensioned and fixed into place by taking one part of the FiberTape and passing it from top to bottom with a suture passing wire. Then take the other part of the FiberTape with the sutures from the FTL tendon, and passing it from bottom to top. The surgeon then holds it in place by inserting the SwiveLock from bottom to top. The remaining sutures are cut. The supporting structures of the arch of the foot are now repaired and held together, with the internal brace, causing the arch of the foot to be restored.

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Flexor Digitorum Longus Tendon Transfer With DX Button and Tension-Slide Technique

The FDL Implant System comes in two size offerings of 4.75 mm × 15 mm and 5.5 mm × 15 mm with everything included for an FDL tendon transfer in association with the tension-slide technique. The addition of the Spring Ligament InternalBrace™ procedure completes this simple and reproducible method of fixation that reliably seats the tendon against the cortex of the bone socket, maximizing the surface area for tendon-to-bone healing as well as augmenting the repair of the superior and inferior band of the spring ligament complex.
The InternalBrace surgical technique is intended only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The InternalBrace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.

FDL Tendon Transfer Using Tension-Slide Technique and InternalBrace™ Spring Ligament Augmentation

Flexor digitorum longus tendon transfer using the DH button and tension slide technique with spring ligament. Internalbrace ligament augmentation. Make a 5cm to 6cm incision from the posterior aspect of the medial malleolus to just below the palpable navicular tuberosity. Use a combination of blunt and sharp dissection to identify the posterior tibial tendon sheath just distal to the medial malleolus. Open the sheath. Expose and debride, or excise the posterior tibial tendon. Insert the 1.35mm K-wires in the sustentaculum tali at 15 degrees palatally and slightly posterior, avoiding the subtalar joint. Shaverdrill with a 2.7mm cannulated drill. Then use the 3.5mm. Tap down to the laser line. Insert a 3.5mm SwiveLock anchor loaded with collagen coated FiberTape suture. Hold the paddle and turn the paddle clockwise until the black line is slightly countersunk. Then move the FiberTape SutureTak to the side. Identify the FDL tendon and open the sheath and dissect into the plantar medial foot. Making sure there is enough length for insertion into the navicular. Then cut the FDL tendon at that point. Place a traction stitch through the tendon using a number two FiberWire or number two. Fiberloop suture. Size the tendon through the tenodesis graft sizer based on the tendon diameter. Open either the 4.75mm or 5.5mm FDL implant system. At the most plantar point of insertion of the posterior tibial tendon on the plantar medial navicular tuberosity. Drill the 3.2mm spade tip pin bicortical across the body of the navicular from plantar to dorsal. Note it is recommended to use fluoroscopy to confirm spade tip pin is centered and just breaches the dorsal cortex with the foot in maximum plantar flexion and inversion. Pull the traction stitch so the FDL is tensioned appropriately at the interface of the bone and drill pen. Use a marking pen and mark the entry point of the tendon. Then make a second mark 15mm distal to the entry point. Use an Allis clamp to secure the end of the tendon. Speedwhip stitch with the FiberLoop SutureTape and lock the construct by making the final pass proximal to the previous pass and having the needle exit through distal tip of tendon. Remove the traction stitch and any excess tendon past the second mark. Use the reamer in the implant system based on the size of the tendon. Drill 20mm or just up to the dorsal cortex, but do not breach the cortex. Remove the spade. Tip. Drill pin. Irrigate to remove bone debris. It is important for surgeons to do a primary repair or imbrication of the spring ligament before the spring ligament. Internalbrace ligament augmentation is Is completed at this point. Take one lib of the FiberTape from the SwiveLock and pass it dorsal to planter using the nitinol wire. Passer and repeat with the other FiberTape limb planter to dorsal confirm concentric reduction of the talonavicular joint. Thread one suture limb from the tendon. Whip stitch through one side of the eight millimeter DX button and back through the opposite side with a straight needle. Thread the other suture limb in the same manner, starting on the opposite side. Make sure the suture limbs are not tangled, pulling each limb to ensure the button slides freely. Hold tension on the suture limbs and insert the tip of the button inserter into the button. Now hold tension on the sutures and insert the button through the navicular under fluoroscopy, ensuring it is deployed through both cortices. Pull lever back on the inserter handle to release the button. Note leave the button inserter in the hole when pulling tension back on button. Pull on the free ends to seat the button against the against the dorsal navicular cortex. Confirm with fluoroscopy that the button is in appropriate position resting against cortical bone. Remove the button. Inserter. Grasp each suture limb and slowly apply axial tension on each suture limb to dock the tendon into the bone tunnel. Once the tendon is fully seated, use the free needle and pass one suture limb through the tendon and tie 3 to 4 knots to complete the construct. Hold one limb of the FiberTape under tension from dorsal to planter, and the second limb under tension from planter to dorsal. Then insert the tenodesis screw next to the tendon and FiberTape sutures, securing it so it is flush with the cortex. Cut the excess suture and fixation is complete.

FDL-Sehnentransfer

Arthrex bietet 6,7-mm-LPS-Schrauben, die speziell zur Fixierung für das Fuß- und Sprunggelenk im Rahmen einer medialisierenden Kalkaneusosteotomie (MCO) entwickelt wurden. Der Operateur kann eine Technik mit einer oder zwei Schrauben anwenden.

Kalkaneusosteotomie bei Plattfußdeformität

Das subtalare ProStop Arthrorise-Implantat dient zur Korrektur des hyperpronierten Fußes durch Stabilisierung des Subtalargelenks. Es soll eine übermäßige Eversion des Rückfußes durch Blockierung der Talusverschiebung verhindern. Die Konusform der ProStop-Schraube entspricht der Anatomie des Tarsalkanals, sodass die Schraube gut sitzt und sich nicht lockert. Das stumpfe Gewindedesign unterstützt dabei den Implantat-Knochen-Kontakt.

Lew Schon, MD, (Baltimore, MD) describes his rationale for incorporating the ProStop® subtalar arthroereisis implant into his practice. The ProStop implant was designed to treat patients with Stage II flexible flatfoot deformities. In this video, Dr. Schon shares his surgical experience of flatfoot cases where he uses the ProStop implant to correct the deformity.

ProStop® Subtalar Arthroereisis Implant

I'm Liu Xiao, an orthopedic surgeon at MedStar Union Memorial in Baltimore, Maryland. Here to talk about the ProStop. The ProStop is an arthrodesis implant, an implant that is used between the talus and calcaneus to help position the talus on top of the calcaneus and correct proper alignment between the talus and navicular. The ProStop can be used as a standalone procedure, or as an adjuvant procedure in both pediatric feet and adult feet. I have found that ProStop a very useful adjuvant in my treatment of these patients. The Arthrosis concept was to splint the bones in proper position and allow correction of the soft tissues through natural healing processes. This probably doesn't occur unless we have a pediatric case with over two years of growth remaining. In the cases where we would use it in adult population. We're typically doing it in conjunction with soft tissue or bony procedures. I have done it in 24 cases of adult flat feet, where we had a severe flat foot next to a more moderate flat foot. In these situations, I had to do major bony and soft tissue reconstructions on the more severely affected foot. And on the other foot I just inserted the ProStop. I did so because the patient was already in a brace, having trouble functioning, and I was concerned that during the reconstruction recovery, on the more affected side that the other foot would fail. We are augmenting the strength of our reconstruction by using the ProStop and effectively blocking excessive eversion of the foot, leaving physiologic valgus, and making sure that we don't supinate the foot inadvertently by overstuffing the sinus tarsi. It's important to note that there is no weight limit to use of the ProStop implant. The biggest consideration with a heavier patient is the degree of the deformity, not their weight. There was a study recently published in the Journal of Pediatric Orthopedic Surgery, July 2015. Chung et al. Presented a prospective comparison of subtalar arthrosis with lateral column lengthening for the painful flat foot, and they found in this pediatric population that the both procedures were effective. In my opinion, this article provided a strong argument in favor of use of the subtalar arthrosis. Given the potential for complications with the lateral column lengthening that would include nonunion malunion impingement Need for hardware removal or worry about extrusion of the graft. The Arthrex is a simple, easy, safe, and effective procedure versus the lateral column lengthening. Although the lateral column lengthening can be performed and is performed very frequently by skilled providers, the recovery time after a lateral column lengthening is also much greater than the recovery from a subtalar implant. The subtalar implant patient can walk on the foot right away, and after two weeks the stitches are removed. They progress with activity as tolerated, even though they may be sore and still have some aches and pains, and feel unusual about walking on their foot, which has been flat for the last many years. They can still get around, unlike with the lateral column lengthening. The patient has to be off their foot for six weeks and between 6 and 12 weeks progressively weight bearing. Not to overdo it for fear that the osteotomy will collapse. And also, it does take longer for these cases to heal, because typically they're done in conjunction with soft tissue procedures. Thus, if we're looking at similar efficacy based on the Chung study between the subtalar arthrosis and lateral column lengthening, I feel this is a strong push for the subtalar arthrosis because of the quicker recovery time and the lower risk of complications. This is a really interesting case. This was a nine year old boy who was the son of an orthopedic surgeon. He was very bright and very agile and was excellent in athletics. He developed a bilateral painful flat foot deformity left greater than right. He wore braces, performed exercises to strengthen the foot. He was doing some Achilles stretching, but had continued pain and deformity as he had been active with athletics. He became more and more weak, more fatigued, and his parents became concerned about the pain, dysfunction and deformity. They wanted to avoid a major reconstruction in the future and became interested in the ProStop arthrosis. They brought him to me from another city to have an evaluation and potentially have bilateral ProStop inserted in one. Anesthesia. On physical exam, the foot and ankle were supple with relatively weak posterior tib tendon function, the foot inverted with four out of five strength with pain along the posterior tib tendon. The arch was low, particularly more on the left than the right. He had a lack of varus positioning when he rose up on his toes. More on the left than the right. He walked with an a propulsive gait without activation of the posterior tib tendon. Tenon. There was some mild Achilles contracture and some forefoot varus. His pulse is. Neurologic status were normal. Here's his X-rays. You see here on the lateral view of the foot weight bearing. The shoulder of the talus sits deep in the ankle. The medial column is below the lateral column. This is a severely flat foot. You do see the growth centers open. And so this is a nine year old foot. And we anticipate maybe four years or more of growth, maybe six years of growth. On the right side, you see also that cassian's angle is obscured by the shoulder of the talus. The medial column is at the same level as the lateral column. So on the AP view you see that on the left foot we had almost 50% coverage of the talus by the nvic. And on the right side about 40 to 45% on average. So this was a very flat foot. But he was nine and I was open to considering the Arthrex as the sole procedure. You see on these oblique views that there were no coalitions. Here's his hind foot view again showing no coalitions. When you when you see him standing here, you see the severe valgus. It's about 25 degrees on the left, maybe 23 degrees on the right. When he rides up on his toes, his left heel stays in neutral. The right side goes into Varus. He had weakness with inversion against resistance. And he walked with an a propulsive gait. Here's his foot again, showing the toe rise and the weakness. The collapsed arch with the midfoot sitting on the ground. So we did bilateral ProStop implants in one setting. Here you see the guidewire going across the sinus tarsi out over the sustentaculum talus. Then we inserted the the sizer and you could see the lateral edge of the sizer was just medial to the lateral side of the talus and did not cross the midline. Then I removed the implant screwdriver. And you see that the screw is still in the proper position. And then I remove the guidewire and you see again that the implant has stayed in position about 50% across the neck, with the lateral aspect of the implant just medial to the lateral shoulder of the talus. And here's the lateral view showing the implant properly positioned in the sinus tarsi. Here he is pre-op on the left side. Here he is post-op. And you can see the talus is now sitting up relative to where it was before. And the medial column is now sitting about a centimeter higher than the lateral calm on the right side. Here's the pre-op. Notice the obliterated gains angle and the low arch. Now look at the post-op. You see, the talus is lifted up. The shoulder of the talus sits back, no longer in the ankle, and the medial column is now about a centimeter and a half above the lateral column. So a very excellent correction. Now let's look at the AP. Here's pre where we had about 50% coverage on the left side 45 or so percent on coverage on the right side. And now look at the coverage. Maybe he has 10 or 15 degrees on coverage on the right and on the left, maybe 20% on coverage. So pre again and post. Now this kid this is how he looked pre. This is how he looks post nicely corrected. Notice I left him with physiologic valgus. Here he is back at sports. And he went back to Back to sports about three months post-op and progressively did well. He's able to play at a higher level than he was pre-operatively. He's able to run fully. No limitations, no fatigue. His parents are delighted. He's delighted. He's not needed. The implants removed and it's now nearly four years and we have a huge success. A very gratifying success because we did this in one procedure, both sides with one anesthetic exposure and a very short recovery time. I do think if you follow the technique and do the proper procedures as indicated, you will have excellent outcomes with a ProStop device. Thank you very much.

ProStop®-Arthrorise

Es handelt sich hierbei um eine Arthrodese des Subtalargelenks. Das Gelenk wird debridiert. Dies kann offen oder arthroskopisch erfolgen. Dann wird durch Fixierung mit kanülierten 6,7 -mm-Schrauben von Arthrex eine Fusion des Kalkaneus und Talus durchgeführt.

Karl M. Schweitzer Jr, MD, (Raleigh, NC) demonstrates a triple arthrodesis using DynaNite® staples and Compression FT screws.

Triple Arthrodesis Using DynaNite® Staples and Compression FT Screws

Today we're going to be highlighting a triple hind foot arthrodesis featuring the Arthrex ft compression screws and DynaNite compression staples. So after our typical soft tissue releases, which might include an Achilles lengthening or further up a gastroc recession, we'll start laterally at the hind foot and we'll mark our mark out our landmarks at the distal fibula. We'll mark out the CC joint and the base of the fourth metatarsal. Here's our standard incision that we're going to use for exposure of the subtalar and the CC joints. So we have our incision drawn out here. We're going to go ahead and make incision from the distal fibula to the base of the fourth metatarsal. So we have our exposure here. We have our self-retaining retractor in place retracting our peroneal tendons here. And posteriorly you can see your CFL ligament. In general we just try to try to keep that intact and expose distally. Here we reflected the EDB muscle belly to expose our CC joint. Here you can see right into there. And so we have our exposure. And so now we'll work on our joint preparation for Arthrodesis. So here we're set up. We have placed 22. four millimeter pins for our new Arthrex distractor device. These are the set screws. And that will keep the device from migrating proximally off the bone and hold it nicely in place. And then here we'll set it to distract. And this will allow us some increased exposure to in order to prepare the whole joint including the posterior middle facets. A nice distraction scene there. And now we'll begin work on the subtalar joint. So we're starting our preparation for the Subtalar joint. We're using a thin osteotomy on the Arthrex set to remove layers of cartilage, both off the calcaneal side here, along with the Taylor side. So this is our completed joint prep of the Subtalar. Joint joint preparation is critical part of the procedure in order to achieve good healing rates. So we have our first wire in for our Subtalar Arthrodesis construct, typically trying to get 2 to 3 screws across the subtalar joint, typically 1 or 2 that are across the posterior facet. And I like those to be diverging in all planes if possible. And for that I'm typically using A70 fully threaded or compression screw from Arthrex. So here we're going to go ahead and work towards placing our second wire for compression across the posterior set. So here we have our second wire across our posterior facet. We're seeing a little bit of divergence here on the lateral view. And we can also check a heel view to make sure our screws are all nicely contained within the bone which they are. So here we're getting ready to place our third screw for our Subtalar arthrodesis, which is a wire for A50 ft compression screw. Here I'm placing it more anteriorly, which is just within the anterior process portion of the calcaneus. And we're going to run that up into the Taylor Neck head region. This will provide additional derotation support and additional compression across the anterior portion of the joint. So here we have our third wire placed for our Subtalar arthrodesis. We're checking on the lateral view. And then we'll also check an AP foot view to make sure we're nicely within the talus. And that has good purchase there. So here we have our depth gauge. We're going to start with screw placement. So we're going to measure our first wire for the screw which is measuring just over an 80. So this being the first screw will most likely get the most compression. So we'll just take a 80 length screw. So here we have our Arthrex profile drill for our headless screw. And we'll go ahead and run that in on the first one. So here we have our 5.2mm drill that we're going to over drill the wire with. And so obviously there's two options here a 5.2 and a 5.0 depending on bone quality. Typically we're going to run the drill in. I'll typically check it under fluoro to check our progression. Also, depending on bone quality, we'll determine how much you drill up into the calcaneus and talus. You can also verify directly on the drill bit as they're marked in integral five millimeter portions. And you can see you can see that directly. So here we've completed our drilling. We're going to remove the drill bit maintain the wire in position and then we're ready for our screw. So this is a seven millimeter by 80 length Arthrex ft compression screw. We're going to start it off on power and then finish on it by hand. Take the hand driver here to complete our compression. You can hear that tapping sound. That's a good sign of good bone purchase and then ultimately compression. These are, of course, headless screws, but we want to make sure that we don't leave them proud at the heel. So here we're measuring for the second screw going across the posterior facet. Measuring just over an eighth. So we're going to take an 80 length screw. So again we're taking our profile drill. And then again our 5.2mm cannulated drill. So we're taking our second screw here and place it over the wire entering it under power and again finishing it off by hand. All right. So we have our second screw in. We've got nice compression across the subtalar joint already. And so we're going to go ahead and remove our wires there. We're going to look for placement of the five zero foot screws. So we're going to make a small skin nick over the wire. And then depth gauge down to bone to measure. And so that's measuring just over a 50. We'll take a 50 length screw. We're going to take our profile drill again. Now we're taking our 3.2mm drill into the calcaneus and talus for this anterior screw. So we're ready for our screw. We're taking A50 foot compression screw length 50. And then we're just finishing off the compression here by hand. So here we have our final screw in place for the subtalar joint. So now that we have our subtalar Arthrodesis completed we're going to move dorsally on the hind foot here. We have our incisions drawn out for our T and Arthrodesis here I've marked out the joint under fluoroscopy. And then here we have a rough incision for where we're going to approach the joint landmarks. Once we get through the skin, we're going to go through an interval between the anterior Tib and L and extensor tendons. We're going to look and make sure that we protect the superficial peroneal nerve. And then as we go deeper to protect the deep nerve vascular bundle. So here we're making incision on our talonavicular arthrodesis. And just confirming here this is our anterior tibialis tendon coming across the field. We're going to incise just lateral to that. So here we have our exposure to our talonavicular joint. We've done our capsulotomy medially and laterally. We've exposed down dorsally. Here you can see a nice exposure as opposed to a more medial approach, where typically you can only see across the medial 50% or so of the joint. Here you can see nicely all the way medially, centrally, and all the way over laterally. As we prepare that more, you can obviously see it's nice and ideal placement for dorsal compression that gets perpendicular to the joint. And so a staple here compression staple is ideal for this type of joint. So we have a small joint distractor in place here from Arthrex medially. And that's going to allow us to prepare both sides of the joint including the Taylor head cartilage surface as well as the proximal portion of the navicular. So we have our joint preparation completed. You can see nicely in the talonavicular joint all the cartilage has been removed. So at this point we would typically drill and use some osteotomies to create fenestrations for healing. And then we would typically add our biologics of choice. Once that's complete, we'll typically check under fluoroscopy to make sure we have we have good correction, but we can also check that clinically to make sure that we have a plantigrade foot. Okay. So we just have a preliminary wire in place just to hold our reduction. So we'll go ahead and work towards getting our dorsal fixation here. Our goal here is to get 2 to 3 compression staples across this construct. So typically we'll use a Arthrex SuperMX compression staple with a wide bridge. This this one here is 25 by 20mm. But you can also consider use of a 20 by 20 or an 18 by 18, depending on the patient's size and anatomy. So typically we'll take a drill guide and we'll get it into position. Be nice to be center center on each portion of the bone so that distally you're not entering the NC joint, and proximally you're not engaging any of that fixation from the subtalar joint. And we'll go ahead and drill. And we'll place a preliminary peg just to hold our position. That way we know when we're drilling our second leg that our distance is correct. So still holding the drill guide here. We're going to remove our peg. We have our staple ready to go. Our assistant has already set the distance accordingly based on the drill guide you can see placement of these is quite simple. There are slots shown here on the drill guide that allow you to slide the staple easily into place. You're going to then bring it in orthogonal and just a couple of taps to get it down loosens easily here. And then we have our impactor for the SuperMX. We're going to line that up nicely there and tamp it into place. You can already see with one staple in place, the nice compression you're seeing across the joint here. So here we're set up for placement of our second staple. We're going to use a DynaNite staple here. And we have a 15 by 15 set out. You can see even here with just two staple placements, that that medial joint is now completely compressed. And even if you check rotational stability, that joint is not going anywhere. And to finish the construct, we're going to now place our third compression staple. And here we're going laterally at the ten joint. That's good. So here you can see our final construct on fluoroscopy of the AP foot. We have our three staples across and we have nice uniform compression. You can also check the lateral view. Here you see the staples are nicely distributed across the joint and spaced evenly. So now we're set up laterally here at the CC joint. We've selected an 18 by 18 staple here based on size and anatomy. We're going to go ahead and drill for that. Typically I'm going to get 2 to 3 staples across this lateral side for uniform compression. And of course this Taxation is ideal here because the legs of the staple are going to allow you to get compression orthogonal to your joint, and that is much more ideal than an oblique screw placed across or other constructs that you may consider. So we'll go ahead and drill. And place our peg just to hold our position. And gently tamp it in. And finish it off here. So here we're set up for our second staple. We're going to place this one more plantar. And here we've selected a 20 by 20. Dynanite staple. You can see how simple hardware placement is here. You can easily imagine on cases where you would normally be applying locking plates and other forms of constructs that you can save a lot of time here with placement of these staples. And that can equate to save tourniquet time for the patient and reduced exposure in the operating room. And of course with these staples, you just don't need as much real estate. So your exposures can be smaller, which will allow for potentially allow for quicker healing for the patient. So here we're looking at a final lateral hind foot fluoroscopic view. You can see our hardware placement across all three joints. And you can of course you're going to want to check other views including an AP oblique Harris heel and an AP ankle view as well to confirm your hardware placement and alignment.

Subtalare Arthrodese (Plattfuß)

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

Hand and Wrist

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.

5.0 mm and 7.0 mm Compression FT Screws

FT-Kompressionsschrauben mit Vollgewinde

Arthrex bietet für Eingriffe zur Verlängerung der lateralen Säule die porösen BioSync®-Titankeile oder die AlloSync™-Allograftkeile an. Beide Produkte sind in verschiedenen Formen und Größen erhältlich und lassen dem/der Operateur:in die Wahl zwischen einem strukturellen Dauerimplantat und einem Allograft-Implantat.

Verlängerung der lateralen Säule (Evans-Osteotomie)

AlloSync Cotton Wedge, 16 mm x 4.5 mm

AlloSync Cotton Wedge, 16 mm x 5.5 mm

AlloSync Cotton Wedge, 16 mm x 6.5 mm

AlloSync Cotton Wedge, 16 mm x 7.5 mm

AlloSync Cotton Wedge, 20 mm x 4.5 mm

AlloSync Cotton Wedge, 20 mm x 5.5 mm

AlloSync Cotton Wedge, 20 mm x 6.5 mm

AlloSync Cotton Wedge, 20 mm x 7.5 mm

AlloSync Evans Wedge, 18 mm x 18 mm x 6.5 mm

AlloSync Evans Wedge, 18 mm x 18 mm x 8 mm

AlloSync Evans Wedge, 18 mm x 18 mm x 10 mm

AlloSync Evans Wedge, 18 mm x 18 mm x 12 mm

AlloSync Evans Wedge, 20 mm x 20 mm x 6.5 mm

AlloSync Evans Wedge, 20 mm x 20 mm x 8 mm

AlloSync Evans Wedge, 20 mm x 20 mm x 10 mm

AlloSync Evans Wedge, 20 mm x 20 mm x 12 mm

AlloSync Evans Wedge, 22 mm x 22 mm x 6.5 mm

AlloSync Evans Wedge, 22 mm x 22 mm x 8 mm

AlloSync Evans Wedge, 22 mm x 22 mm x 10 mm

AlloSync Evans Wedge, 22 mm x 22 mm x 12 mm