Name: DynaNite® Nitinol Staples for Navicular Nonunion Augmented With ArthoCell™ Cellular Bone Graft
Uploaded: 2019-10-24T00:00:00Z
Channel: Arthrex
Description: Eric W. Tan, MD, (Los Angeles, CA) gives a case presentation for treatment of a navicular nonunion using DynaNite ® Nitinol staples, a Compression FT screw, and concentrated iliac crest bone marrow aspirate plus an ArthroCell™ allograft.

<p>Eric W. Tan, MD, (Los Angeles, CA) gives a case presentation for treatment of a navicular nonunion using DynaNite<sup>®</sup> Nitinol staples, a Compression FT screw, and concentrated iliac crest bone marrow aspirate plus an ArthroCell™ allograft.</p>

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VID1-000607-en-US | A | DynaNite® Nitinol Staples for Navicular Nonunion Augmented With ArthoCell™ Cellular Bone Graft

Eric W. Tan

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DynaNite® Nitinol Staples for Navicular Nonunion Augmented With ArthoCell™ Cellular Bone Graft

Hello, my name is Eric Tan. I'm a assistant professor at the University of Southern California. Today I'm going to present a case series of patients using the Arthrex DynaNite nitinol staples for traumatic nonunions. So first we have to figure out one. What are non-unions and why do they occur? A nonunion is where a bone doesn't heal. So in a situation where you have a fracture or in a situation where you've done surgery and you've cut the bone, when these bones don't heal, usually in a time frame of 3 to 6 months, we call that a nonunion. And we have to understand how do these occur. Well, fracture healing depends on a complex interplay of two factors. One is mechanical stability and two is biological potential. So when you have an issue with one or both of these factors, this is what leads to non healing or non uniting of the fracture. And this subsequently causes pain and dysfunction to patients. In this case we're going to present the use of the Arthrex DynaNite nitinol staples. There are certain factors and properties of these staples that make them unique and helpful for this complex situation. One they have continuous compression. So in this situation where you want increased stability, the continuous compression of the staple provides that. In addition it has a low profile. So if you want to supplement this with an additional plate additional screws you have more real estate to do. So. In addition there's also multiple sizes. So these range from small sizes such as nine by seven millimeters all the way to 25 by 25 or 25 by 20mm. Finally, they're easy to apply. They're easy to deploy. And also if you need to take them out or revise them, you can reload them and reuse them. And all of these are very helpful in these situations where you may have limited real estate in order to create this healing potential. And this is a case of a navicular nonunion. This is a 28 year old female with right foot pain. She was a military personnel. She had a traumatic foot pain. She was increasing her activity. She was running a CT scan, demonstrated a right navicular stress fracture. We can see from this imaging, you can see some of the changes on the center of the navicular with the non-healing fracture line. There. She was treated initially by her providers with cam boot immobilization and subsequently a bone stimulator without improvements of her pain. Seven months later, she had continued pain and discomfort and presented to our clinic. We can see from the CT scan, we can see the continued fracture line at that navicular and the presence of that nonunion site. So again, for her, from a surgical perspective, we went ahead. We identified and exposed the area of the nonunion. We cleaned out the fibrous tissue, prepared the surfaces with the K-wires as well as osteotomy. And then we again focused on the two major points focusing on mechanical stability in addition to biological healing from mechanical stability standpoint, we compressed across the fracture site. We placed two dorsal Arthrex nitinol staples across the fracture site. The beauty in this situation was that this provided good compression at different sites, but it didn't compromise the real estate. So we added an additional headless compression screw across the navicular bone as well. And from a biological perspective, we did two things. We added the concentrated iliac crest bone marrow aspirate, as well as ArthroCell allograft to again provide supplemental factors to promote healing. These are immediate postoperative radiographs. We can see good placement of the hardware. We can see less visualization of that fracture line of that nonunion site that was present previously. She was kept non-weight bearing for two months. And then she was advanced in her weight bearing. And by three months she was out of a boot. We can see from the CT scan there's good healing across the navicular bone, and the hardware is demonstrating good compression across that site promoting this healing. So in conclusion, nonunion surgery requires addressing both of the major factors mechanical stability as well as biological potential. We need both of these in order to have a successful result and a successful fusion. In addition, in this presentation, we're demonstrating the use of the DynaNite Nitinol staples, which provide a low profile continuous compression which are ideal for situations like these with potentially limited bone and healing. Thank you.

DynaNite® Nitinol Staples for Navicular Nonunion Augmented With ArthoCell™ Cellular Bone Graft

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