Mark Campbell, MD - Double Compression Plates
Post-traumatic arthritis following a Lisfranc complex injury is a common occurrence. Although the injury itself predisposes to this complication, popular fixation modes using transarticular screw stabilization result in iatrogenic damage to the joint and results in another possible mechanism of post-traumatic DJD. This complication often results in the need for tarsal metatarsal joint fusion as the definitive treatment.
This case involved a 32-year-old male status post motocross injury. Three years earlier he was treated with an ORIF of his Lisfranc injury using transarticular screws. Patient has continued to have pain. Radiographs suggested, and CT scan confirmed post traumatic degenerative changes.
Treatment consisted of hardware removal and fusion of the 1st, 2nd, and 3rd TMT articulations. Fusion preparation consisted of meticulous joint preparation along with the addition of StimuBlast® DBM mixed with bone marrow concentrate with the Arthrex Angel® system. Fixation was obtained using three Arthrex® Double Compression Plates with the addition of an LPS 4.0 partially threaded Cannulated screw.
The Arthrex® Double Compression Plate system is a revolutionary fixation construct that allows maximal surgical compression across fusion sites. The hallmark of this design is the improved compression achieved using the double compression mechanism. Initial compression is achieved using standard compression hole principles. Additional secondary compression is achieved through the bridge “arms” of the plate construct. This double compression mechanism allows the surgeon maximal compression potential with direct visual and tactile controlled feedback.
The low profile design allows decreased risk of irritation in areas with little soft tissue coverage such as the dorsum of the foot. Once the locking screw is placed flush to the bone, the nonlocking screw will provide not only initial compression, but will mold the plate flush over the osseous bed.
The fixation system’s simplicity, ease-of-use and multiple plate configurations allow these plates to be used for talonavicular, calcaneocuboid, transverse tarsometatarsal, forefoot, and hindfoot arthrodesis sites.
The improved overall compression achieved with the double compression mechanism allows for the maximal potential for bone-to-bone opposition, which is known to be the most critical factor in overall construct stability. Clinically, this can translate to improved fusion rates for simple and complex arthrodesis throughout the foot and ankle.
The views expressed in this post reflect the experience and opinions of the presenting surgeon and do not necessarily reflect those of Arthrex Inc.
