Pie y tobillo

Produtos DynaNite® de nitinol

Foot and Ankle

Product

El sistema de reparación digital alberga toda la instrumentación necesaria para las diversas líneas de corrección del dedo en martillo que ofrece Arthrex:
<ul>
 <li>Implante PIP DynaNite®</li>
 <li>Pasadores Trim-it™</li>
 <li>Tornillo de retrofusión</li>
 <li>Tornillos Micro Compression FT™</li>
 <li>Tornillos PT de compresión sin cabeza</li>
 <li>Sistema CPR™&nbsp;</li>
</ul>
Adicionalmente, en este sistema hay nuevas brocas falángicas, ofrecidas en tamaños de 6 mm, 8 mm, 10 mm y 12 mm. Estas brocas crean una forma de copa y cono en el sitio de fusión como las brocas MTP.

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Human

Digital Repair System

Digital Repair System Instrument Set (AR-4158HTS)

Sistema de reparación digital

Nitinol Guidewire, Double Trocar Tip, with Laser Lines, 0.86 mm

Führungsdraht, mit Doppeltrokarspitze, mit Lasermarkierungen, 0.86 mm

Nitinol Guidewire with Double Trocar Tip, .045" x 5.91" (1.1 mm x 150 mm)

Führungsdraht, mit Doppeltrokarspitze, Nitinol, 1.1 mm x 150 mm

Nitinol Guidewire with Trocar Tip, .062" x 5.91" (1.6 mm x 150 mm)

Führungsdraht, mit Trokarspitze, Nitinol, 1.6 mm x 150 mm

Child (D)

El DynaNite FlexWire es un alambre de nitinol de dos zonas que aprovecha las propiedades superelásticas del nitinol para mejorar la fijación del alambre K estándar para la corrección del dedo en martillo. Los alambres rotos y doblados son complicaciones comunes en la fijación con alambre K estándar.1 Las propiedades superelásticas de la zona implantada de este alambre permiten la misma corrección a la que los cirujanos están acostumbrados con los alambres de acero inoxidable, pero con la ventaja de reducir el riesgo de que se doblen permanentemente. La parte flexible que queda fuera de la puntera se puede doblar, cortar y tapar de manera estándar.
El FlexWire se ofrece en diámetros de 0,86 mm, 1,1 mm y 1,6 mm.
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Referencia
1. Catena F, Doty JF, Jastifer J, Coughlin MJ, Stevens F. Prospective study of hammertoe correction with an intramedullary implant. Foot Ankle Int. 2014;35(4):319-325. doi:10.1177/1071100713519780

The DynaNite® FlexWire is an all-nitinol wire that uses superelastic properties to improve on standard K-wire fixation for hammertoe correction.

video

DynaNite® FlexWire

The DynaNite flex wire is a nitinol wire ideal for hammertoe correction. This wire is heat treated in a specific manner to create two different zones with different material properties. These zones are demarcated by a laser line. Two thirds of the wire helps maintain correction by always returning to its manufactured straight position, due to the super elastic properties of nitinol. The remaining one third portion has malleable properties to allow the wire to be bent, cut, and capped in standard wire fashion. After the Pip joint is prepped for hammertoe correction, the superelastic end of the wire is inserted into the central portion of the proximal phalanx and then removed to pre-drill. The wire is then placed on top of the foot, with the laser line just at the tip of the toe. The surgeon then marks the desired end point of the wire. Using wire cutters. The wire is cut at an angle to create a beveled tip to ease implantation. Advance the malleable portion of the wire distally through the middle and distal phalanges. Retract the flex wire into the middle phalanx and align the toe into the corrected position. Ensure the phalanges are in line with the metatarsal for flex wire placement across the MTP joint. The distal malleable portion of the wire left outside of the toe can now be bent, cut, and capped in standard fashion. Postoperatively. As patients begin to move around, the flex wire will retain its memory and return to the corrected straight position. Upon removal of the wire. Surgeons can be confident that the flex wire will be straight. Mitigating the concern of bent or broken K-wires.

Brad Dresher, MD (Colorado Springs, CO), demonstrates hammertoe correction using the 1.6 mm DynaNite® FlexWire.

DynaNite® FlexWire for Hammertoe Correction

Would be a standard hammer toe approach with dissection and preparation. We'll be demonstrating the flex wire on the proximal end of this wire. Nitinol technology allows for bending and returning to original position. The distal portion of the wire is heat treated, allowing for bending for final positioning of the pin with no return to its original position. For the purposes of this demonstration, longitudinal incision will be utilized. Soft tissue release is noted at the MTP joint, allowing for angular correction if needed. In practice, an Eclipse incision is sometimes utilized at the Pip joint, and an EDL lengthening is used for correction of deformity using intraoperative fluoroscopy. Place the laser line at the tip of the digit. Mark the desired endpoint of the implant. At this time, you'll cut the pin at that position. Technique to cut at a bevel to improve placement of the pin. So we'll prepare the pip joint with the Phalangeal reamers. These work much like the MTP reamers, creating a cup and comb position of the bony apposition. The new design of the reamer utilizes a three pronged reamer, allowing for easy position within the joint. We will utilize the concave reamer on the proximal phalanx. Placement of the middle phalanx. Pin in the center center position. The design of the three prong reamer allows for ease of position into the middle phalanx, avoiding the proximal phalanx. For placement of the pin. Place the cut in into the wire driver. This allows for integrating out the toe and then retrograding back into the final position. Now retrograde the pin back into final position. Please evaluate the laser line ending at the tip of the digit. With proper measurement, the second cortex was contacted with the pin. As the laser line gets close to the tip of the digit. If you need to advance the K-wires, please do so to the second cortex. The portion of the flex wire distal to the laser line can be bent, cut, and capped with positioning of the flex wire. The bendable portion of the wire allows for MTP motion with returning to original straight position. The distal portion allows for bending, cutting, and capping in light of flexing and extending at the MTP joint. You can see upon pin removal it is maintained its straight position. This will help avoid the risk of bent or broken pins. Postoperatively.

DynaNite® FlexWire for Hammertoe

DynaNite® FlexWire

Las placas de compresión de nitinol DynaNite aprovechan la propiedad superelástica del nitinol para crear una compresión dinámica en un sitio de fusión. Cada placa está empaquetada con un dispositivo de compresión. Cuando se retira el dispositivo de compresión, se permite que el puente se ensanche a su estado natural. A medida que la placa se ensancha, se acorta para comprimir el sitio de fusión.
Las placas de compresión de nitinol DynaNite se ofrecen en 5 geometrías de placas de diferentes longitudes. Las placas se pueden fijar con tornillos corticales y VAL híbridos de 3,0 mm o 3,0 mm.
Las placas de compresión Arthrex DynaNite están diseñadas para usarse junto con los tornillos Arthrex Compression FT.

Knee

James M. Cottom, DPM (Sarasota, FL), highlights the technique tips and pearls for using Arthrex's DynaNite® compression plating system for various midfoot fusions.

DynaNite® Compression Plates for 2nd TMT and Multizone Fusions

So in this particular video, we're going to demonstrate a second TMT fusion with a two hole compression plate, which is generally the workhorse plate for these particular articulations. Make an incision. So at this point we've dissected out the base of the second metatarsal and intermediate cuneiform. The joint is right in this location. There's some dorsal osteophytes present. And we do recommend resecting those with either a saw or a small osteotomy, which will allow better placement of the compression plate onto the bone. So you can see here two we removed the dorsal osteophytes, which oftentimes with patients with midfoot arthritis we're going to have to do anyways. And that way we are making the bone fit the plate versus having the plate fit the bone. One of the nice things about the set is you also have the adjustable drill guide, which you can utilize to distract the joint during joint prep. Hello. Hey. So as you can see here, we're going to take the sizer and we're going to place the tower right over the joint and measure. And you can see it's one nice and flush on the fusion site. And it looks like a 20 will be adequate for this specimen. So when placing the compression box or device over the fusion site, we want to line up the white line in the in the box with the actual joint line. So we'll make sure we get those lined up appropriately for appropriate placement. In addition, with this, we like to place a nitinol guidewire across the joint prior to plate fixation. So to really enhance compression and stability, we like to place this wire across the fusion site in order to place a 3.5mm compression screw. So at this point we're going to measure for our 3.5mm compression screw. And it's measuring a 30. So we like to start these on power and then finish these screws by hand. We've got a great bite an excellent bite. So at this point we are going to place a screw in the proximal end of the plate. We've got a 30 degree cone that can be placed for variable angulation of the screw. Another nice pearl is to place your thumb on top of the compression box. And so you can go ahead and seat the plate directly down on the bone. At this point, we'll do our standard depth gauge measurement which is a 20. Excellent bite. So in this situation we've done a very good job resecting the bone surfaces. So the plates fitting very nice and flush with the bone. If the plate was lifting at all. So you can utilize a 3.0mm screw to suck the plate down to the bone. 20 and now we will insert our 20 millimeter locking screw. Another great bite. So now that our plate is secured with the screws, we can go ahead and remove the compression box. And we'll be able to assess our pre-operative as well as our post-procedure compression through the plate. So at this time we'll take the three millimeter screwdriver. And we're going to go ahead and remove the compression box. This can take several turns but eventually it will reach an end point. And then it's just very easy to remove. Okay. So here you can see how much the plate that's been implanted widened compared to the pre removal of the compression box plate on the on the right. So at this point, after your fixations in place, it's just routine closure. Deep structures, deep tissues followed by subcu and then skin. So at this point, we've already prepped out for a multi-level fusion. We prepped out the talonavicular articulation as well as the navicular cuneiform articulation. And we've we've plane we've plane the bone down up top here so that our plate will fit nice and flush. So at this point we're going to take the measuring device. I've identified the talonavicular articulation which is right there. And we're going to go ahead and measure with that. With the handle being placed right over the joint it looks like a 20 will be sufficient. So at this point we are measuring the navicular cuneiform articulation. We've got the post right over the joint. And it looks like 20mm will be adequate for this particular location as well. So at this point we'll use a 2020 level plate. We have the locking mechanisms in place. We've got the white lines corresponding to the joints that we're fuzing. So in this situation, we're going to go ahead and run a compression screw from the navicular back into the talus. And then we're going to finish up with a staple through the navicular into the medial cuneiform. So here you can see we have the compression plate in excellent position. We've thrown our guidewire from the navicular into the talus. So at this point we're going to put in a 3.5mm by 46 millimeter comp foot screw. We've got an excellent bite. So now we're going to use the DynaNite reusable drill sleeve to place a DynaNite staple across the navicular cuneiform articulation line. Then we will go ahead and use the tamp to just tamp this down flush with the bone. Initially, we have excellent compression across the talonavicular articulation as well as the navicular cuneiform articulation. And now we'll go ahead and augment this with the DynaNite compression plate. So now we're going to go ahead and drill through the middle hole in the compression plate. And these multi-level midfoot fusions these are great places to have the variable angle screws as an option. We'll go ahead and remove the compression boxes with the three. Millimeter screwdriver. Alternatively, if you're in a tight spot where you're able to utilize this instrument to go ahead and remove it as well, or unscrew it for the sake of the demonstration today. That's how it works. But we'll go back to the screwdriver. So here with our second TMT Arthrodesis. After all the compression, the screws have been placed. This is actually where the joint is. And I can't even get the rear elevator in the joint space due to the excellent compression. And again showing the medial column multi-level fusion. I can't even get the frame into the navicular cuneiform arthrodesis site. So we've got excellent compression through there as well. As we move back to the talo navicular fusion site, we have excellent compression as well. I can't even place the freer through that smaller articulation. In this image you can see the final construct with excellent position, excellent compression across the articulations as well as hardware placement.

Used for several arthrodesis applications, DynaNite® nitinol compression plates take advantage of the superelastic property of nitinol to create dynamic compression across a fusion site. KreuLock™ locking compression screws combine the same proven variable-stepped pitch technology found in the Headless Compression FT screws with a locking head.

2nd TMT Arthrodesis With DynaNite® Compression Plate and KreuLock™ Screws

Arthrex presents the DynaNite Nitinol compression plates, providing continuous compression across an Arthrodesis site as typical during fusion procedures. It is important to adequately prepare the joint initially plane the joint surface to create a flat surface for the DynaNite compression plate. Next, the new and improved Arthrex mini joint extractor can be used to access the joint and remove any remaining articular cartilage. Once the articular cartilage has been removed, Arthrex recommends adding AlloSyncPure to enhance the fusion potential. Allosyncpure is a demineralized bone matrix derived from 100% demineralized cortical bone, with no extrinsic carriers prior to implantation. Allosyncpure may be hydrated with biologic fluids such as bone marrow concentrate following application. The joint extractor is used to compress the joint prior to screw and plate fixation. Next, use the DynaNite plate trial sizer to determine the determine the appropriate length plate to implant. Once reduced, provisionally fixate the plate using tax. Next, insert a 1.1mm guide wire for a 3.5mm compression screw across the joint. Measure, drill and implant the compression screw prior to plate fixation in order to create the strongest construct possible and maximize the dynamic compressive properties of the DynaNite continuous compression plate, Arthrex recommends initially placing a compression screw for all procedures when utilizing a DynaNite compression plate. The compression screw creates strong time, zero compression, and also significantly increases the overall strength of the construct. Following screw insertion, prepare to place the new KreuLock variable angle locking compression screws by drilling and subsequently tapping with the crew lock profile drill. When used for this application, the crew lock locking compression screws will bend the plate down to the bone similar to a cortical screw, before ultimately locking into the plate, thus offering the offering the benefits of both a cortical and locking screw. The variable angle nature of these screws offers a 30 degree cone of variability. Following insertion of the KreuLock screws. The compression box holding the plate at length can be removed on power using a T10 driver in a counterclockwise fashion. As the compression box is removed, the DynaNite compression plate is allowed to shorten, creating continuous compression across the Arthrodesis site during the fusion process. The DynaNite continuous compression plate will continue to attempt to shorten to its originally manufactured state, thus creating dynamic compression and enhancing the potential for fusion. Arthrex presents the DynaNite continuous compression plates. Compression so easy it's automatic.

DynaNite® Compression Plate System

Orthobiologics

Daniel J. Patton, MD (Redlands, CA), demonstrates a talonavicular nonunion revision with a DynaNite® compression plate, augmented with ArthroCell™ viable cellular bone allograft.

Talonavicular Nonunion Revision With a DynaNite® Compression Plate Augmented With ArthroCell™ Viable Cellular Bone Graft

My name is Dan Patton. I'm an orthopedic surgeon. I'm going to be presenting a case of talonavicular nonunion. We did a revision with a nitinol plate. This is a patient, a 34 year old female that had a history of Mueller Weiss syndrome, avascular necrosis of the navicular bone, who presented with arthritis at the tail and navicular joint. Unfortunately, she had a tail navicular attempted fusion that went on to nonunion 16 months prior to presenting to me. She reported no significant relief in her pain from her index surgery due to the nonunion. She had been compliant with post-operative instructions of non-weight bearing. She had no indications of infection. She denied any nicotine use and had no underlying medical issues. Surgical considerations in this case, possible inadequate neutralization of the attempted fusion site. Only isolated talonavicular fusion was attempted, which may have left her with a bit more instability than was needed. Questions of infection, postoperative plan and biologic support in this case, my answers to this. On the right you can see a locking compression DynaNite plate was added, a Subtalar fusion was added in addition to the Talonavicular joint fusion to lock down the acetabulum. Paetus work up for infection. We saw normal labs so no signs of infection. She had been compliant with non-weight bearing and maybe needed some biologic support. So we elected for ArthroCell adjuvant in this case. For this biologic adjuvant, we used an ArthroCell in addition to bone grafting, supplemented with PRP, to make sure that she had all the biologic support needed to go on to union. When selecting a plate, I chose the four hole cross plate with a dynamic DynaNite compression modality to add not only neutralization, but also compression across the attempted fusion site. There are multiple options. The four hole worked best for Talonavicular joint. When thinking about fixation strategy, the operative sequence is important. First, you need to take down the area of nonunion, clean out any scar, then add your biologic adjuvants as you can into that fusion site. I use A20 drill to create multiple perforations through the subchondral bone, and then add the ArthroCell into those perforations. Next is important to get preliminary compression across a well reduced fusion site. I use a clamp, a point to point clamp for that step, and then adding static compression as you would in any fracture or fusion site with a static compression type partially threaded screw. So I use a 4.5mm partially threaded lag screw to obtain that compression Intraoperatively. We want that compression, that dynamic compression to continue Post-operatively. And so adding the DynaNite plate as a final step to continue compressing afterwards allows that compression to continue on in the postoperative period, even after we've left the operating room. Making this plate strategy an advantage over many other plate fixation strategies. Here's an example of how that DynaNite compression plate works. On the static image on the right you can see with it distracted. That's how you implant it. And then after that box is removed, the plate then compresses as far as it can until the bone is compressed together. If there is some reabsorption around the screw holes, or if the patient walks on it, that compression continues even after you've left the operating room. In the video, you can see that on loop as the plate is distracted and compressed. Here are some pictures of the implantation of the plate. Technical considerations here you want to, of course, pick the appropriate position on fluoroscopic images to avoid the nearby joints. Also need to consider the soft tissue surrounding this in releasing the plate, the set screw comes in from the side, which may require a percutaneous incision to access that, making this a fairly minimally invasive approach. Here you can see that set screw being loosened to allow for compression across the tail navicular joint, and the box will then be removed. Here's our final fluoroscopic images intraoperatively of the final construct. In this case, we went on to prepare the subtalar joint and place two partially threaded 6.7mm screws into the calcaneus through the calcaneal tuber. This adds overall stability to the acetabulum to prevent any further motion through that talonavicular joint that initially struggled to go on to union. In summary, consider the talonavicular joint and the subtalar joints to work as a unit. The acetabulum fetus is made up of more than just the talonavicular joint, but also the subtalar joint. Consider multiple biologic options that Arthrex offers, such as ArthroCell with adjuvant of PRP. Dynanite compression plating option is a wonderful tool to have in your armamentarium of fixation options, and it offers a significant advantage in that it allows for dynamic compression even in the post-operative period after you've completed compression in the operating room. This implant continues to compress across the site of union until the patient goes on to full. Union allow you to set the depth, which is an advantage over staples in that you can get bicortical fixation with a fixed angle construct into the DynaNite plate.

Arthrex Presents: Breakthroughs in Foot and Ankle Technology

Placas de compresión de nitinol DynaNite®

Los alambres guía de nitinol de DynaNite aprovechan las propiedades de memoria del nitinol para permitir que los cables se doblen y vuelvan a su forma recta original de fabricación. Ahora disponibles en opciones estériles y no estériles, estos cables ofrecen una forma simple y única de aumentar la eficiencia en el quirófano. Los cables guía de nitinol DynaNite se ofrecen en diámetros de 0,86 mm, 1,1 mm y 1,6 mm con varias longitudes, puntas y marcas láser para adaptarse a las ofertas actuales de acero inoxidable.

Alambres guía de nitinol DynaNite®

La grapa DynaNite Nitinol es un implante de bajo perfil que ofrece una fijación excepcional, por compresión, con instrumentación fácil de usar. La grapa DynaNite Nitinol de Arthrex tiene por objeto su uso en procedimientos de fijación tales como artrodesis de LisFranc, osteotomía monocortical o bicortical en el antepié, artrodesis de la primera articulación metatarsofalángica, osteotomía de Akin, artrodesis u osteotomías del mediopié y del retropié, osteotomías para el tratamiento del hallux valgus (Scarf y Chevron), y artrodesis de la articulación metatarsocuneiforme para reubicar y estabilizar el metatarso primo varo.

Thomas G. Harris, MD, (Pasadena, CA) performs a 2nd TMT arthrodesis using a DynaNite™ Nitinol staple for continuous compression.

Second Tarsometatarsal Arthrodesis Using the DynaNite™ Nitinol Staple

We prepared the joints. You can use temporary fixation if you need to. But we'd also like to see how much the staple compresses together. We want to be centered on both of these bones here. Both the second metatarsal as well as the middle cuneiform. So here's kind of the edge there. Here's our lateral border there. It looks like we're pretty equidistant on both sides there. Bicortical here if need be. And I'll just make a drill hole here in the second metatarsal. Got a retention pin here just so we hold it in place. And then here's our second placement. So here is our staple. And once again comes preloaded out of the disposable kit can be adjusted here and loosened if needed here by turning on here counterclockwise. And then can be tightened and spread apart by moving it clockwise to get the appropriate width of the staple that you want. So I'm going to spread this open just a little bit more. And then here's one hole. Here's the other hole. So that'll be implanted into there. And we can gently impact it too. So it's not going to go all the way because we have that device which will prevent it from doing so. So that's underneath it. So we need to then tamp this into place with the appropriate lid sized tamp which we have here. And we can do a little bit distally. So here we can see the staple in place after it's impacted gently into place. And then we there's a 25 millimeter staple. You just see if we rotate the foot a little bit how flush it is there in the bone. So it really has a nice fit to it, a little bit of contour there in the center. The joint that you could see before is now impossible to see. It's already getting constant compression across that area. And that's what we're doing a generous resection of the joint prior to placement of the staple. So it's low profile but yet very strong. So the staple that we inserted is a little bit more of a wider staple. We also have a staple that has the same length to it, but that staple is just a little bit thinner from in that plane. If for a smaller foot or you were concerned about the width of this staple here, you could also use a smaller, thinner staple that has still the same length to it there. So you've got two options here for TMT joints if needed.

Trauma Lower Extremities

DynaNite® Staples for Trauma Applications

SuperMX™ Nitinol Talonavicular Fusion

The Wynbridge SuperMX staple provides excellent compression and stability for Talonavicular fusions. A linear incision is made dorsally to expose the talonavicular joint. The joint is prepped for fusion per the surgeon's preference. The surgeon has the option of packing the fusion site with biologics such as AlloSyncPure and, if desired, temporarily fixating the bone with an external guidewire at this stage. The SuperMX sizing guide is used to determine the correct SuperMX staple size. Turning the inserter handle clockwise, the SuperMX staple legs are opened from an inward position to a parallel position. The SuperMX drill guide is centered across the fusion site. A 2.6mm SuperMX drill bit is used to drill the first hole in the proximal portion of the fusion site. The drill bit is laser marked to help drill to the correct depth to keep the drill guide alignment. The surgeon can optionally place an alignment pin in the first drilled hole at this stage. A second hole is drilled on the distal portion of the fusion site. The drill guide is held against the cortical surface in order to maintain the location of the drill holes using the staple inserter. Advance the staple legs into the drill holes until the device is seated against the bone. A mallet is often used on the top of the inserter to make sure the staple is down to the bone. The drill guide is then removed once the staple is seated against the bone. The inserter knob is turned counterclockwise to release the tension between the staple and the inserter. The inserter is slid away from the staple. The SuperMX tamp is used to fully seat the staple against the cortical surface. The incision is closed and a compressive dressing is applied.

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.

Thomas G. Harris, MD, (Pasadena, CA) performs an Akin osteotomy on the hallux valgus using a DynaNite® Nitinol staple.

Akin Osteotomy Using the DynaNite® Nitinol Staple

This is the medial aspect of the of the great toe. And we'll be fixing this with a DynaNite staple. So important parts about the Aiken is just want to make sure before you make your cut that you're pretty well centered on the bone. There is some soft tissue here and the plantar aspects that can throw you off a little bit. And dorsally here, a little bit more bone than you sometimes would expect. So there's some bone dorsally there. And then we're going to free this up. One other little tip is just to make sure that your cuts distal enough so that you're not going to make this in any way Intra-articular. Sometimes we'll place a K-wires for our proposed site of osteotomy. So to make sure that we're extra articular, but you definitely want to be distal enough so we can get good fixation in bone that is not too close to the joint. Typically this cut, you want to make it along the long axis of the proximal phalanx there. And I don't remove too much bone. Maybe two 2 or 3mm is all. So I'm just feeling the other cortex but not going through. And then I'll make my other cut diagonally, coming back at that about 2 or 3mm. You can always take more. You can always take more if you need to. And then what I'll do is if you like our overall alignment here, then we'll switch to this K-wires and just perforate that lateral cortex to kind of grain, stick this osteotomy, make a few passes. It definitely weakens the cortex and still allows it to dorsally and bring it together. So it came together okay. There. And then you want to have some sort of temporary fixation however you like to do it across this area. Now we're going to fix this with one of our newer staples. And the nice part about this staple is that it comes pre-fixed. So it's on it's on the application on the Applier as, as it comes out of the bag. The other thing that's nice about this is if it were to fall, it is something that we can reload onto here. So this can tighten or loosen it. So there we can see it spreading the tines apart as we turn this. And then if we need to loosen it a little bit to reapply it or to get it on there, we can do that. This actually fits into it like that. So it's actually you can just make sure that once our holes are drawn and made, then we can just follow it through with our staple. So it really fits in nicely there. So we'll make our drill holes here. There are some pins I'll also show you that we can put in here once the drills are made. So the laser lines you can see on there too. First laser lines used for this smaller staple. So something like that. And then if you want to, you can put a pin in at this point to help hold your position. Not mandatory since we have it held with the wire already. If you just want to make sure it doesn't rotate on you or anything like that, then that pin can be applied there. And then likewise we'll drill this to the first laser line as well. And the pins can be placed or not. And then these are nice pins. You have a nice firm grip to them. You can see it like that. It's not just your standard pin and it's smooth not threaded. And so then we just apply the staple here into the holes that we've made already there and kind of follow it through like that. We can see it in yeah, we can even push it and get it started just a little bit. Or if you don't like it, we can always turn it a little bit, but it's already going in there just fine. And then if you needed to impact it into place a little bit then you can. So perfect. Good. Then we undo this for it to come out, comes out like so, and then we use the rest of the impactor to impact it into place, which comes with the the kit as well. It's nicely threaded there so it fits into the staple. So we line that into the staple like so. And then that could just be impacted into place. Good pretty flush there. We can remove our temporary fixation. And so there is the staple in place there with good fixation if needed. Some of that bone that you took off can be used as crushed up and put on bone graft if needed around this area, but it looks like we have pretty good fixation into. Here as well. And the staple is very low profile. Now this staple that we utilized was nine by seven. Seems to be a nice size for the Aiken. If you had a bigger foot and you wanted to use something that was a little bit offset, you could use this. So in the situation where the staple does come off or it becomes unattached for any reason or just disassembled from the applicator, then it can be easily placed back on it and then hold it there, and then just start spinning this and you can see it's kind of got a good grasp on it there. And then as we keep doing that, it just widens it out into the place that you want it. So now you can see that's maybe even a little too much. So we can back off just a little bit there. And that's completely in its relaxed state where it wants to be. And this is where we have it distracted when you want to apply it. So it has that nice compression to it once the night null is engaged. But it does come out of the package loaded like this. So you're all set to go.

This animation of the DynaNite® staple for Akin osteotomy demonstrates how the low-profile (1.0 mm) DynaNite staple sits flush to the cortical surface of the proximal phalanx. It further highlights the DynaNite drill guide "windows" that allow for easier insertion of the DynaNite staple.

DynaNite® Staple for Akin Osteotomy

Dynanite staple for akin osteotomy, a linear incision is made horizontally over the proximal phalanx of the great toe. A saw is used to create a closing wedge osteotomy. The lateral cortex is preserved to enhance the stability of the osteotomy. The DynaNite sizing guide is used to determine the correct DynaNite staple size. Turning the inserter handle clockwise, the DynaNite staple legs are opened from an inward position to a parallel position. The DynaNite drill guide is centered across the osteotomy site. A 1.6mm DynaNite drill bit is used to drill the first hole in the proximal portion of the osteotomy site. The drill bit is laser marked to help drill to the correct depth if desired. A DynaNite alignment pin is inserted through the drill guide into the first drilled hole. A second hole is drilled on the on the distal portion of the fusion site. If desired, a second alignment pin may be used. The alignment pins are removed from the drilled holes. The drill guide is held against the cortical surface in order to maintain the location of the drill holes, using the windows on the drill guide. The staple legs are inserted into the drilled holes. The drill guide is then removed using the staple inserter. Advance the staple legs into the drill holes until the device is seated against the bone. Once the staple is seated against the bone, the inserter knob is turned counterclockwise to release the tension between the staple and the inserter. The inserter is slid away from the staple. The DynaNite tamp is used to fully seat the staple against the cortical surface. The low profile DynaNite staple is seated flush to the cortical surface. The incision is closed and a compressive dressing is applied. To.

Grapa DynaNite® Nitinol

El implante para dedo en martillo DynaNite PIP ofrece una solución de nitinol roscada y canulada para las deformidades del dedo en martillo. Las lengüetas del implante se extienden mediante la inserción de un alambre de Kirschner y mantienen la fijación debido a las propiedades materiales del nitinol. La canulación permite a los cirujanos cruzar la articulación MTP con el alambre K si lo desea y permite la perforación e inserción precisas del implante. Los implantes se ofrecen en tamaños de 12 mm, 14 mm y 16 mm.

The DynaNite® PIP hammertoe implant is a threaded, cannulated, nitinol solution for hammertoe deformity.

DynaNite® PIP Hammertoe Implant

The DynaNite pip hammertoe implant is a threaded cannulated nitinol solution for hammertoe deformities, offered in three sizes and a bent and straight option. The Cannulation allows for precise placement of the implant when placed over a 1.1mm guidewire. This wire also extends the nitinol prongs to engage into cortical bone to maintain compression and fixation. To begin the procedure, make a transverse incision over the pip joint. Bend the distal end of the toe 90 degrees to access the joint. Insert a 1.1mm K wire into the central portion of the proximal phalanx. Remove the cartilage of the proximal phalanx with the concave reamer. Use the 3.0mm cannulated. Drill over the k wire to drill into the proximal phalanx down to the laser line. Advance the K-wires distally through the middle and distal phalanges. Remove the cartilage in the middle phalanx with the convex reamer. Use the 2.5mm cannulated. Drill over the wire to drill into the middle phalanx down to the laser line. Tap the middle phalanx if necessary. Insert the threaded portion of the implant into the middle phalanx until the inserter is flush to the bone, and the flat notch on the inserter is facing upward. Retract the K-wires slightly into the middle phalanx so no portion is expanding the barbs. Leave the K-wires in the implant. Insert the barbed portion of the implant into the proximal phalanx. If implantation is difficult, use a hemostat to compress the barbs and facilitate insertion. Use the cannulated toe. Tamp over the K-wires to fully seat the implant and impact the joint surfaces. Advance the K-wires into the proximal phalanx to deploy the Talens. The guidewire can be left in place or it can be removed completely at the surgeon's discretion. The surgeon can also cross the MTP joint with the K-wires if desired.

Ryan B. Rigby, DPM (Logan, UT), demonstrates the DynaNite® nitinol PIP implant, a threaded, cannulated solution, to correct a hammertoe deformity.

Hammertoe Correction Using the DynaNite® PIP Hammertoe Implant

Hello. Today we're demonstrating the use of the DynaNite Pip implant for hammertoe correction. This comes in a sterile kit ready to to go in the o.R. Which includes everything from the guide wires, a couple of different sizes of drills, the implant with the inserter, and also a totem. So we'll demonstrate how this is used for you today. Typically, when addressing a second toe at the Pip, I do a longitudinal incision. And I often have to extend that to the MTP level for other pathology. For today we'll keep this isolated to a second toe correction. So I do longitudinal. And we make an incision on the dorsal aspect longitudinally preserving the extensor tendon underlying. We'll close that at the end. And then I usually flex the toe to identify exactly where the joint is. I usually come a little more distal as I incise through the extensor tendon apparatus. And then I'll reflect off the collateral a little bit on each side, and establish a small flap dorsally of the extensor tendon. With this implant, you can resect the joint however you prefer using a saw, a couple of skin hooks to protect the skin. You can use a range or a bone cutter. Up to you, your surgeon preference for joint resection. I'll use a saw today. Next we use a guide wire, which is a 1.1, and we like to make sure this is going right down the proximal phalanx. Usually we'll find its own path. The drill is a 3.0mm drill. Cannulated to go over the guide wire. It does have a laser line to let you know how far you need to drill into the proximal phalanx, and in soft bone, I just go nice and slow and work our way down to the laser line. Remove the wire if it doesn't come out on its own. And now we move to the middle phalanx using the same guide wire. Center this in the middle phalanx, and we are going to extend this out the end of the toe. This is a 2.5mm drill. Again soft bone I usually go nice and slow and bottom it out to the laser line. The implant comes with an inserter the implant you can remove. And if you use the seven degree angled or the bent, there is a specific direction this needs to be inserted for it to go into the bone straight. So there's the the angle. This is a 14. They come in 12, 14 and 16. And that's basically the length. And as they get longer they get a little bit wider. So the inserter comes over the guidewire. And we insert this into the middle phalanx. You can put this down flush to bone. And these threads are very aggressive to help prevent pull off. So we want this to end with the flat spot at the top facing up dorsally, especially when using the the angled implant. And that will assure us that we have the correct amount of of plantar flexion or angulation. So there's the the flat spot. I'm going to bring it back just a little bit more. And then we take this off. As you can see the guidewire is bringing the barbs apart. So we're going to back up the guidewire To allow the barbs to come together for insertion, and then we have the option of advancing it back if, if so desired. At this point, I like to hold the shaft of the proximal phalanx using an instrument, and with the guidewire retracted, the barbs can come together and be inserted, and then you have the option of advancing the guidewire back and springing apart the the barbs within the bone. Now we're going to use the toe tamp, which at this point we want to make sure that the implant is well seated. So we're going to lightly impact here. I'll hold on the the far side of the proximal phalanx. And then the assistant will go ahead and apply some gentle tapping to bring the fusion site together. And then we'll confirm that under fluoro. So at this point the key here is to make sure that the barbs have fully inserted into the proximal phalanx and that they're capturing the bone. If not, you can use the toe tamp to make sure that the fusion has been well seated. You now have a couple of options. You can remove the K-wires, or if you want to bring it further down towards the base of the phalanx for additional stability. That will push the barbs further up further up against the cortical bone inside the phalanx. You'll have a lot of stability. You also can advance it even further across the MTP if you desire for other pathologies. In this particular case, I'm going to remove the wire and the implant holds very nicely. The toe in the corrected straight position with a little slight seven degree angulation. Final floral X-rays confirm the joint has come together. We have good apposition. The implant is well centered with excellent stability. We haven't gone too far. Distally. Breaching the hip joint and overall alignment looks great. So the patient would be very satisfied with this. We'll go ahead and allow immediate weight bearing in a postoperative shoe. And after about 4 to 6 weeks, once I see bone consolidation across the fusion site, we'll go ahead and advance back to regular shoes as tolerated.

James Cottom, DPM (Sarasota, FL), demonstrates a hammertoe correction using the DynaNite® PIP implant in conjunction with the DynaNite FlexWire.

DynaNite® FlexWire and DynaNite PIP Implant for Hammertoe Correction

So today we're going to go ahead and demonstrate the new nitinol DynaNite flex wire. So this is a two zone wire where two thirds of it will bend and always return to its straight or native configuration, and one third can be bent and cut for a standard hammer toe procedure. So with this particular wire, there's a laser mark at the end, which will be at the tip of the toe. So what we can do is check this under Fluoroscopic imaging to identify where we want the wire to end at the most proximal aspect inside the second metatarsal. So at this point we're going to go ahead and cut the wire where we marked it. So this is going to end at the most proximal aspect we marked in the second metatarsal. It's recommended to leave a little bevel on it. So when you cut it kind of cut it at an angle. So at this point standard dissection for a hammertoe repair has been performed. We removed the collateral ligaments and now we're ready for our bone prep. So now we're going to place a wire for our cup and cone reamers right down the central aspect of the head of the proximal phalanx. So now So now we're able to utilize the concave and convex reamers similar to the first metatarsophalangeal joint to prepare the fusion site in the second digit. So another unique feature with this is the end, if you will, is a three prong. So it's a little bit easier to introduce down to the articular surface on the head of the proximal phalanx. So now we're going to use the 3.0 drill bit for the DynaNite hammertoe implant. So at this point we are going to go ahead and retrograde the malleable end of the wire off the distal tip of the digit. So we'll identify the central aspect of the base of the middle phalanx. So now we're going to go ahead and use the convex end of the corresponding reamer to prep the base of the middle phalanx. So So now we're going to go ahead and utilize the 2.5mm drill to prepare the base of the middle phalanx. And we'll drill down to the laser line on the drill. So now we're going to insert the threaded portion of the DynaNite pip implant into the middle phalanx. So with this straight implant you want to make sure that the notch is actually facing upwards or dorsally to make sure that the implant is appropriately aligned. So after inserting the prongs into the proximal phalanx, we can go ahead then and tap distally to compress the joint together. So at this point we are going to advance the wire to expand the barbs in the proximal end of the implant across the second metatarsal phalangeal joint. And you want to insert this until the laser lines at the tip of the digit. Because the end of the wire distal is malleable. It can be bent in a standard fashion. So in addition, what's unique with this particular implant and wire is we can go ahead and we can actually move the MTP joint up and down. And with that flexible end of the wire, it's going to come back to its original position while still maintaining stability at the fusion site at the proximal interphalangeal joint. So when removing the wire in the clinic or we need to do is clamp it like we would normally do and just pull it straight out, and we will be able to see that this wire is straight as opposed to being bent, even though we manipulated the second metatarsophalangeal joint. And this will, of course, minimize the risk of having to remove bent or broken wires, which is a significant advantage in this particular procedure.

Produtos DynaNite® de nitinol

Sistema de reparación digital

DynaNite^® FlexWire

Placas de compresión de nitinol DynaNite^®

Alambres guía de nitinol DynaNite^®

Grapa DynaNite^® Nitinol

Implante para dedo en martillo DynaNite^® PIP

Produtos DynaNite® de nitinol

Sistema de reparación digital

DynaNite® FlexWire

Placas de compresión de nitinol DynaNite®

Alambres guía de nitinol DynaNite®

Grapa DynaNite® Nitinol

Implante para dedo en martillo DynaNite® PIP

DynaNite^® FlexWire

Placas de compresión de nitinol DynaNite^®

Alambres guía de nitinol DynaNite^®

Grapa DynaNite^® Nitinol

Implante para dedo en martillo DynaNite^® PIP