Name: Arthrex Beaming System: Cadaveric Surgical Demonstration
Uploaded: 2026-08-21T14:56:00Z
Channel: Arthrex

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Noman A. Siddiqui, DPM (Baltimore, MD), presents a cadaveric demonstration of the Arthrex Beaming System for midfoot reconstruction. This video provides a step-bystep walkthrough of guidewire placement, implant selection, and beam insertion to restore a stable, plantigrade foot. Throughout the demonstration, Dr. Siddiqui shares procedural pearls, implant positioning strategies, and fluoroscopic guidance to help optimize fixation and attain reproducible outcomes.

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VID1-010323-en-US | A | Arthrex Beaming System: Cadaveric Surgical Demonstration

Noman A. Siddiqui, DPM

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

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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Arthrex Beaming System: Cadaveric Surgical Demonstration

Speaker  With the minimally invasive joint preparation complete, it is important to obtain your position for fixation. I first incorporate axial load on the first MTP joint that imparts stability along the medial column. Mis provides the soft tissue stability, and at this point, provisional fixation can easily maintain the correction for your definitive fixation. The key is to place these wires out of the path of the screws, and this can be done by adjusting the position of the wires in the intended path of the medial column. I like to plantarflex the first ray and adduct the medial column to make sure that the first ray lines up with the talus. At this stage, I'm going to take an AP view of the foot to ensure that this provisional fixation is not going to be in the path of my intended screw. As you can see, our temporary fixation might get in the path of the medial column beam. So I'll just still maintain that axial pressure and oscillate this wire out. I will redirect for this fixation to be slightly lateral. Once I'm satisfied with my position, I can tell on this radiograph that my AP is lined up nicely. The midfoot and hindfoot position are appropriate. Now I'm ready for my guide wires for screw fixation. At this stage, I want to identify the trajectory of my guide wire. I want to be on the medial side of the talus and through the cuneiform and near the mid-shaft of the first metatarsal. I do that by outlining my path on my guide wire, and this is a good landmark at this stage. Speaker  I will be entering the first metatarsal. As you can see, I'm in the mid shaft of the metatarsal, nearly bisecting the cuneiform crossing, the navicular, and on the medial third of that talar body and neck. Now, the placement of this wire can be done through a dorsal incision or a plantar incision. I prefer the planter. When I make this incision, I don't start directly at the level of the joint. I start at the level of the base of the proximal phalanx. That's usually the distal pole of my incision. And I'm identifying midline on the helix. Once the incision has been made, I dissect proximally to this level of the sesamoids. Here I'll bluntly with nick and spread technique, get down. Pass the flexor to the level of the articular surface. The most technically demanding portion of the procedure is accurate k-wire placement. Once you've entered the articular surface, you can adjust the trajectory of that guide wire by oscillating. Once you feel the wire fall into the shaft of the metatarsal, do not advance it any further and get an AP view to make sure you're heading down the bisection line of the metatarsal. At this step of the procedure, it is important to make sure your metatarsal wire is heading correctly into the cuneiform, the navicular, and into the talus. So in my mind's eye, I'll make sure that I adjust the wire at this step to make sure I'm going to engage the appropriate bones. I can see that I'm directed slightly medial, and this is where I can make these minor adjustments by oscillating. Speaker  Any small deviation at this point will have a significant impact at the final wire placement. Though the wires are designed to redirect, you can minimize the direction that they will deviate by just tapping the wire in the metatarsal. Once the metatarsal reached the base, take an X-ray and now you can be confident you're going to be bisecting the cuneiform into the navicular and then redirect into the talus. At this stage, I will transition to the lateral view. At this stage you can see we have entered the cuneiform near midline and we can be pretty confident. Now a technical tip. You want to be on the plantar medial side of the talus on a good healthy talus. So by any means necessary this is going to enter the body of the talus medially. I like to oscillate. Once I'm satisfied with the trajectory, I will deliver it completely. It is important to recognize that the tip of the wire is where the tip of the beam is going to end up. On the medial column, you want to engage as much of the body as you can, but leave yourself enough room to allow for your subtalar joint fixation. At this stage, I will be placing my subtalar joint wire and then followed by lateral column wire across the C-C joint. The sequence of wires is done this way. It allows you to stabilize the medial column, and then the calcaneus or the subtalar joint fusion with respect to the talus. Then finally, the lateral column is fixated to a stable medial column and a stable subtalar joint position. Speaker  I like to place all my wires first prior to placing my fixation. This allows me to respect the limited real estate available in the Talar body. The sequence of fixation follows the medial column, followed by the Subtalar joint, followed by the lateral column. The most important thing to remember is to rotate the midfoot prior to fixation. You cannot leave the first ray elevated. A transverse or a vertical incision can be made at the posterior one third of the tuber, and at this point I'm aiming for the posterior facet trying to be near perpendicular to the posterior facet with my wire placement. I place it initially. And here. Now I can adjust with my trajectory. Once I've bisected my posterior facet, I can use this position to place my lateral column wire. From a visual perspective, I utilize the center of the body of the calcaneus for my wire placement. And then as I advance it into the Talar body, I try to be in the middle one third for final fixation. At this stage, after you've confirmed the accurate position within the body of the talus, take a second to take an axial heel X-ray to make sure you like your position in the center of the calcaneus. This final lateral column fixation is placed through an incision somewhere between the third and fourth digit. I try to come a little distally and make it about a centimeter long, and then I place my wire through this incision. After bluntly dissecting down in between the interval of the metatarsal. Speaker  And to do this, you have to do this in the AP view, but you can start off in the lateral view with your wire placement. So the wire is carefully guided down to that inner space and an X-ray is obtained. So at this point you can advance that wire across the C-C joint. This wire is purposely placed in the interval between the bases of the metatarsals. It serves as a wedge and additional stability to this construct. At this stage, we can remove the provisional fixation prior to placing definitive fixation. At this stage, if you're satisfied with your wires, any provisional fixation can be removed, and the final step of adding biologics to this construct can be performed. The depth gauge is inserted over the k-wire and seated firmly against bone contact can be confirmed fluoroscopically, and then the length is read at the silver to gold transition on the depth gauge. Do not read the length from the back of the K-wires. As with legacy systems, and here it measures somewhere between 155 and 150. Because I'm going to seat this a little further into the head of the metatarsal. I'm going to ask for a 145 millimeter screw. The next step will be to drill. An important step in this aspect of the case is to make sure you drill into the body of the talus. It is not uncommon for the initial guide wire to come out after this step. At this step, the profile drill can be utilized to create a place for the head to be buried in the bone and soft bone. Speaker  The profile drill may be omitted, but in hard bone it should not be omitted to allow proper seating and reduce fracture risk. Okay. The beam is inserted under power. Therefore, you have to stabilize the foot as significant torque can be generated during advancement of this screw. Now this can be done with the first MTP joint. Dorsiflexed. While an assistant is stabilizing the midfoot. After the initial placement of the fixation, you should visualize compression across each joint. The dovetails at the tip of the screw allows for easy compression without a lot of stress for the surgeon, and the final compression can be achieved with the T-handle device. The screw is the subtalar joint screw. Again, you work it all the way down to the body. I look at the transition between the gold and the silver, and it measures approximately 95, because I'm going to be burying the head a little bit. I'm going to choose a 90 millimeter screw. A seven millimeter screw is going to be placed across the subtalar joint. The appropriate size drill and drill sleeve are being utilized. Final fixation is done with a T handle to get the accurate position. Lateral column screw. It's the surgeon's choice to profile drill this. I typically don't because I like it wedged between the metatarsals. You're going to start in the lateral view and then you're going to finish final positioning of this lateral screw in the AP view. This concludes the cadaveric demonstration of miss beam placement using the Arthrex beaming system.

Arthrex Beaming System

Arthrex Beaming System: Cadaveric Surgical Demonstration

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