Name: Clinical Value of the NanoScope™ System for Trauma Cases
Uploaded: 2022-02-23T00:00:00Z
Channel: Arthrex
Description: Evan Argintar, MD (Washington, DC), discusses the clinical benefits of the NanoScope™ system for various trauma cases.

<p>Evan Argintar, MD (Washington, DC), discusses the clinical benefits of the NanoScope™ system for various trauma cases.</p>

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VID1-002694-en-US | B | Clinical Value of the NanoScope™ System for Trauma Cases

Evan Argintar

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Clinical Value of the NanoScope™ System for Trauma Cases

Hello, I'm Evan Argenta from Washington DC discussing NanoScope evolution of trauma surgery. We're all familiar with nano arthroscopy. This is a minimally invasive, flexible technology, high resolution. It's rather painless. This is the size of an 18 gauge needle. So it allows us to sneak into places where we never could fit before. Is there a role in trauma surgery? Is it possible to fuze sports medicine and trauma surgery? I think by the end of this talk, we will all agree the answer is yes. We're going to talk about preoperative planning, intraoperative augmentation, actual treatment using NanoScope in trauma applications as well as post-operative assessment. Is it infected. So I will inherit a lot of complicated patients. And this is one of them. This is an HIV positive individual who had a post-operative infection requiring multiple debridement, hardware removal, a free flap and a split thickness skin graft. The stakes are high here. He needs a knee replacement of some sort. But is he still infected? Does he have osteomyelitis? Sometimes the MRI is not quite clear. You can see here I'm using the nano cannula, and I'm now localizing with the spinal needle in preparation for synovial biopsy. And you And you can see here on the next slide I'm using here the nano Grasper. And you can see in that central picture how I'm concurrently using NanoScope in the GraftPro to extract Synovium. In this situation I was able to biopsy and confirm, along with lab values and aspirations, that he was in fact aseptic and in this case he got a knee replacement. What about expectations? We all know that there's a lot of concurrent damage that occurs with trauma, whether that be dislocation or fracture. And is it important I would submit to you, yes. Although there are situations where we find pathology, where there's nothing surgically to do about it. I think it's very useful clinically to be able to predict how people will do in the future if we identify some large articular injury, and in this case, this is an ankle fracture bimalleolar that was fixed with a lateral plate and a medial malleolus screw. And you can see the cartilage surface was normal. Here's a distal radius fracture six weeks out. Difficult fracture pattern. You can see here I'm using arthroscopy both to confirm the articular reduction as well as to make sure that there's no penetration of the screws. We can use this complication avoidance tactic in other areas of the body, specifically the proximal humerus. It's a common question to Tesla residents about the most common complication here. And it is intra-articular perforation of screws. And you can see here, after this plate and screw construct that I'm able to actually look into the shoulder joint, look at real time range of motion, make sure that there's no articular surface injury and confirm that in fact, there's no intra-articular penetration. This is also evidence here with this intramedullary device Intramedullary rod used for the proximal humerus. Similarly, we can see here with this proximal humeral nail that I'm looking into the joint arthroscopically with the NanoScope. And I'm able to confirm that there's no articular injury and no penetration. What about septic arthritis? This is still a surgical emergency, but there could be scenarios where patients are too unhealthy to get to the operating room. Can this be done outside of the operating room? The answer is absolutely yes. You can see with these minimally invasive just percutaneous poke holes we're able to do now urgent debridement and lavage outside of the operating room. Here's an interesting example of using NanoScope for treatment. You can see that this unfortunate guy had a nail gun nailgun injury which pinned his patella to his femur. I actually put the NanoScope through the trajectory hole that the nail created through his patella, and was able to use this to facilitate debridement of the contaminated bone from the dirty nail. What about foreign body removal? You can see here that I'm using the two nano grasper to successfully identify, localize, and extract this metallic ballistic fragment that I found on the anterior aspect of the glenoid. And this can again be done in a very minimally invasive way. The NanoScope is sterile. It lives in the o.R. It's easily accessible, and particularly for the trauma surgeon who encounters a lot of scenarios, perhaps unanticipated. This is a great technology to facilitate open types of procedures. And what about post-operatively? My knee hurts. This is a malunion of the tibia. I use NanoScope frequently, even in the office, to look at the contralateral compartment to see if there's any disease. And in this case, this patient was a great candidate for a partial knee replacement. Here a lateral tibial plateau fracture that's collapsed is the contralateral portion of the joint normal. In this case it is. And I was able to do a hemi tibial allograft plateau with a distal femoral osteotomy. Here's another example of a ballistic distal femoral malunion with medial overload. I scoped her in the office. Lateral joints normal. I was able to do a partial knee replacement with a staged distal femoral osteotomy. This is not an uncommon scenario where I inherited a tibial plateau fracture. There's potentially a lot of reasons to hurt here. There are at least three plates on this proximal tibia. There's some lateral collapse. What is the solution? Is it a full knee replacement? Is it a partial knee replacement. Is it something biologic you can see here when I'm scoping her knee. And again this is the medial compartment. There's more diffuse cartilage injury than originally expected. And you might think about MRI. But when there's this much metal here the metal artifact is going to make that advanced imaging tool pretty useless. So in conclusion the NanoScope is a revolutionizing technology. It's easy. It's direct. It gives us intra-articular access and evaluation that we didn't used to have. And I would submit to you that not only will this help sports surgeons, it will also help trauma surgeons due to its limitless applications.