Hand & Handgelenk

FiberLock™-Suspensionsplastik

Bei dem FiberLock-Suspensionssystem handelt es sich um eine Suspensionsplastik mit nur einer Inzision unter Verwendung der neuesten Anker- und Fadentechnologie. Ein FiberTak-All-Suture-Anker ermöglicht die kortikale Fixierung an der fernen Kortikalis des Metakarpale II. Das Metakarpale I wird mit dem SutureTape des FiberTak-Ankers am Metakarpale II aufgehängt und dieses wird dann mit einem knotenlosen DX SwiveLock® SL-Anker am Metakarpale I befestigt.
Ein spezielles Instrumentarium ermöglicht das präzise Bohren und Einsetzen des FiberTak-Ankers durch dieselbe Standardinzision, die für die Resektion des Os trapezium durchgeführt wurde. Alle Bestandteile sind in einem praktischen Systemkit zum Einmalgebrauch verpackt.

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

Damon C. Adamany, MD (Phoenix, AZ), performs a carpometacarpal suspensionplasty with the FiberLock™ Suspension Implant Kit.

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CMC Suspensionplasty With the FiberLock™ Suspension System

So this is our CMC FiberLock kit. We have a 3.5mm DX SwiveLock anchor and then two drill bits, which is the 2.7 and A30 drill bit. We anticipate most patients will require the three drill bit on the right side here. This is for the index metacarpal side. The index side we'll be using a FiberTak anchor. We also have a guidewire with laser lines. Above that is the drill bit with laser lines that match up as well. And then we have our drill guide which goes over the top of that. And that is screwed into the base of the index metacarpal to help keep your trajectory. And also for depth of insertion, guiding this smaller version of the 3.5 SwiveLock anchor that was specially designed for this kit is on the bottom here. It's the same anchor that you're familiar with with regards to the original 3.5 SwiveLock anchor, it's just a much smaller size and makes it much easier for insertion. So as you can see now we've got our K-wires starting at the base of the index finger. I'm right on the facet just distal to the to the trapezoid. And we're going to drill about a 45 degree angle across. We're just trying to go just through to the other cortex. There's one cortex. There's two. The goal here is to place our guidewire bicortical across at about a 45 degree angle, maybe a little bit less than that. So again, it's important to make sure that you are staying as transverse as possible on the index metacarpal. You really don't want to be any further down the index metacarpal than with this x ray. Shows you want to make sure that on the lateral x ray that you're comfortable with where you're exiting so that you're not too volar and not too dorsal. We're inserting our drill guide with the cutting flutes at the end into the base of the second, and we just push firmly and screw it in. This not only helps with the alignment of the anchor, but also helps with our depth of insertion with regards to deploying the anchor. So it's important when you place the green handled guide into the index metacarpal base that you want to bring it in at least halfway through, if not three quarters of the way into the canal, to make sure that there is no movement in the guide itself. If you have poor bone that you're dealing with, I would recommend you take the guide almost all the way up to the far side cortex. But it's important not to violate the far side cortex when you're doing this. Although we have the advantage of using the laser lines on the back of the pin and the drill, it's important to use fluoroscopy to confirm placement of not only the pin and the drill, but also with the anchor, and to make sure that you're placing the anchor exactly where you think it's going. There is the first laser line here, the second laser line here, and there's a third laser line right here. And we were just barely past that as far as depth, to make sure that we know that we've deployed our anchor. Of course, when we remove this guidewire, we want to make sure that the drill guide is left undisturbed and its correct orientation. That drill guide is not only there to help with our drill, but also insertion of the FiberTak anchor, and we don't want to disturb that trajectory. At the base of the drill guide. We have multiple laser lines. It'll start from the back. So we want to basically go to make sure that we have the three and a little bit of past the third line to make sure that we've drilled bicortical. Again, confirmation with fluoroscopy is helpful in this stage to make sure that your drill bit is bicortical. And as you can see, here it is. It's important to note that if you lose the stability on the guide to stop the procedure, remove the guide. Place your guide. Pin back through the index metacarpal and confirm it on fluoroscopy. After you do this, you can rethread your guide into the index metacarpal base, seating it deeper this time to make sure you have good stable fixation. The path for the FiberTak anchor has been drilled, and now we are inserting the FiberTak anchor into the drill guide again, making sure that the guide is undisturbed while we insert it. So when we insert the FiberTak anchor, we want to make sure we're doing this very gently with light taps so that you don't skive with the anchor. Once you've come up to the far side cortex, you want to take great care not to tap too hard with the mallet to make sure you don't skive off your exit side of the second cortex. As you can see, the FiberTak anchor has been inserted through the far side of the cortex with just slightly over the 12 millimeter amount of required depth to allow the anchor to deploy. So the FiberTak anchor now is ready to be deployed. We have this little rubber end cap here that we pull off. And we can unwind the suture. And then we just gently pull back on the inserter. Alternatively you can utilize the inserter and pull back on it without removing the black rubber cap to make sure that the anchor is seated on the far side of the ulnar cortex of the index metacarpal. You can unscrew the drill guide at this point. And you can gently put tension on the ends of this to make sure that it engages the far side cortex. And you can see that we're pulling pretty hard here. And it's definitely engaged the far side cortex. Now we're going to go and place our guide wire for the thumb. Generally speaking we're going to go off to the edge of the corner here on the radial side of the thumb at the base halfway between volar and dorsal and coming in at about a 45 degree angle. Again, you can see the laser line for marking the depth of insertion. Okay. And now we're going to drill our path for the thumb metacarpal. Again this has a stop on it so that we don't drill past our ten millimeters that we need to go. We're now going to put our SutureTape into the eyelet of the SwiveLock anchor. And you can see it comes right across the saddle of the base of the thumb there. I'm just going to put the anchor body up to the bone. And before I insert this in there we really want to make sure your tension properly. You don't want to over adduct it. You want to just make sure it's right up to the base of the index metacarpal. Additionally, it's important to make sure that the thumb is not over distracted. If you place the anchors into position while the thumb is over distracted, your overall construct will be loose at the end of the procedure. And to insert, we basically hold the flat part of the anchor and turn the pear shape part of the top of the anchor, while making sure we have pressure on the anchor the whole time. Our final construct is done goes right across the base of the thumb metacarpal there, right in the saddle you can see with axial loading really no give at all. And the thumb is still fully able to adduct and abduct.

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This animation demonstrates a carpometacarpal (CMC) suspensionplasty using the FiberLock™ suspension system. The FiberLock suspension system uses an all-suture FiberTak® anchor that is placed on the far cortex of the 2nd metacarpal using instrumentation developed specifically for this procedure. SutureTape from the FiberTak anchor is then brought underneath the thumb metacarpal and secured into the base of the 1st metacarpal with a 3.5 mm DX SwiveLock® suture anchor.

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CMC Suspensionplasty Using the FiberLock™ Suspension System

The trapezium is removed. A mcglamry elevator can be used to facilitate removal. Place a guidewire from midline on the radial base of the second metacarpal through the far cortex, stopping just after the far cortex has been breached. Care is taken to place the guidewire in an oblique fashion, exiting distal to the second and third metacarpal interspace. This allows the FiberTak to deploy. Confirm placement of wire with fluoroscopic guidance. Once the guidewire breaches the far cortex. Place the drill guide over the guidewire and screw in the threads up to the laser line on the guide. The guide should be firmly in bone without any play. Note which laser line you measure to on the back end of the guide. This will correspond to the drill and the FiberTak inserter to ensure proper depth is reached. Remove the guide wire and drill with the fluted drill to the same laser mark as used with the preliminary guide wire. Care is taken to not disengage or move the guide. Remove the drill. Place the FiberTak anchor through the guide and advance through the far cortex. A slight tap with a mallet may be necessary to fully pass the inserter past the cortex and to the corresponding laser line. Placement should be confirmed both by the laser line on the inserter and by fluoroscopy. Set the FiberTak anchor by pulling back with slow, steady force on the sutures. The inserter is pulled straight out of the guide, and the guide is unscrewed from the second metacarpal. Using the guide wire for the SwiveLock anchor, insert the guide wire to the laser mark on the radial side of the first metacarpal base. Confirm with fluoroscopy. The blue drill guide and the appropriate drill are then used over the guide wire to prepare the hole for SwiveLock insertion, while capturing both strands of the SutureTape. Insert the 3.5 SwiveLock SL anchor into bone. Cut remaining sutures flush to create the knotless construct.

FiberLock™-Suspensionsplastik

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CMC Suspensionplasty Using the FiberLock™ Suspension System

CMC Suspensionplasty With the FiberLock™ Suspension System

CMC Suspensionplasty With the FiberLock™ Suspension System

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

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CMC Suspensionplasty With the FiberLock™ Suspension System

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CMC Suspensionplasty Using the FiberLock™ Suspension System

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CMC Suspensionplasty With the FiberLock™ Suspension System

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AR-8988-CP