DynaNite Nitinol Staple, 13 mm x 15/12 mm

DynaNite-Nitinolklammer, 13 mm x 15 mm / 12 mm

Finished Product

AR-8718-131512

Foot and Ankle

Product

The DynaNite Nitinol staple is a low-profile implant that provides exceptional compressive fixation with easy-to-use instrumentation.The Arthrex DynaNite Nitinol staple is intended to be used for fixation procedures such as LisFranc arthrodesis, monocortical or bicortical osteotomies in the forefoot, 1st metatarsophalangeal arthrodesis, Akin osteotomy, midfoot and hindfoot arthrodeses or osteotomies, osteotomies for hallux valgus treatment (scarf and chevron), and arthrodesis of the metatarsocuneiform joint to reposition and stabilize metatarsus primus varus.

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

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Second Tarsometatarsal Arthrodesis Using the DynaNite™ Nitinol Staple

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DynaNite® Staples for Trauma Applications

SuperMX™ Nitinol Talonavicular Fusion

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

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 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® Nitinol Staple

Child (D)

Hand and Wrist

The DynaNite® nitinol and SuperMX™ staples provide low-profile compressive fixation specifically engineered for small-joint osteotomies and fusions. The staples are available in 14 sizes with a combination of bridge widths and leg lengths. They feature easy-to-use instrumentation for quick and accurate insertion. An ergonomically designed DynaNite delivery device allows surgeons to control the opening of the staple legs.

Procedure

The Lapidus procedure is an arthrodesis of the first metatarsocuneiform joint. It is performed most commonly as a method to reduce the intermetatarsal angle (IMA) in the setting of hypermobility or arthritis of the first metatarsocuneiform joint.

The plantar lapidus plate has many proven clinical advantages compared to a dorsal or dorsal/medial-based lapidus plate. Most importantly, an earlier return to weightbearing can be achieved, allowing patients to get back to normal activities much sooner.

Plantar Lapidus Plate Product Demonstration

The Arthrex Plantar Lapidus Plate is anatomically contoured and provides a template for successful bunion correction. The design of the plate spares the anterior tibialis tendon and allows for compression of the 1st TMT joint through the plate.

Plantar Lapidus Surgical Technique

This anatomically contoured plate was designed to provide excellent fixation for a lapidus procedure. The plate is placed plantar on the first TMT joint and is fixed with two locking screws at both the distal and proximal end. The compression mechanism of the plate provides compression over the entire arthrodesis area in order to eliminate an additional dorsal compression screw. An aiming guide allows defined placement of the compression screw in a specified direction without interfering with the proximal locking screws.

Plantar Lapidus Plate Surgical Technique I Plantar Lapidus Plate02 Plantar Lapidus Plate This anatomically contoured plate was designed to provide excellent fixation for a lapidus procedure. The plate is placed plantar on the first TMT joint and fixed with two locking screws at both the distal and proximal ends. The compression feature of the plate provides compression over the entire arthrodesis area. An optional Aiming Guide allows for defined placement of the compression screw in a specified direction without interfering with the proximal locking screws. In general, plantar fixation of the lapidus arthrodesis minimizes soft-tissue irritation and converts the resulting ground forces at the metatarsal head into compression forces in the arthrodesis area, thus avoiding postoperative gapping. Advantages ■ Anatomic Contour Precontoured left and right plates allow secure plantar placement and spare the tibialis anterior tendon ■ Locking Option Two proximal and two distal 3.5 mm locking screws optimize construct strength ■ Compression Option The 4.0 mm compression screw through the plate provides compression over the entire arthrodesis area and eliminates an additional dorsal compression screw ■ Plantar Fixation Avoids gapping of the arthrodesis at early weightbearing ■ Minimized Profile Low-profile plates and screw heads reduce soft-tissue irritation and the need for removal ■ Optional Aiming Guide Allows defined placement of the compression screw in a specified direction without interfering with the proximal locking screws Plantar Lapidus Plate I 03 Initially, remove the cartilage and prepare the 1st TMT joint for fusion. After the appropriate reduction is achieved, provisionally fix the joint with K-wires. You may also use a reduction clamp to hold correction and maintain the desired position and compression. Place the plate plantar on the TMT joint over the tibialis anterior tendon. You may use the Drill Guide as a joystick. Make sure the plate is properly fit to the bone. Note: Do not place the plate too far proximal and be careful to respect the navicular bone. A slight gap between the step of the plate and the proximal metatarsal will be eliminated when tightening the compression screw. Plantar Lapidus Plate Incision A single incision is made over the medial aspect of the 1st TMT joint at the level of the abductor fascia to expose the medial cuneiform and the base of the metatarsal. The insertion area of the tibialis anterior tendon is left intact while the anatomic plate preserves its insertion. This incision can be extended over the medial metatarsal to expose the MTP joint and perform a capsular and soft-tissue release. Alternatively, a second distal incision may be considered. Insert the locking Drill Guide into the plantar distal locking hole and dril with the 2.5 mm drill through both cortices. Correct screw length can be noted from the laser line on the 2.5 mm drill. 3 1 2 I Plantar Lapidus Plate04 Plantar Lapidus Plate Use the screwdriver to insert a 3.5 mm locking screw into the plantar distal locking hole. 4 Repeat steps 3 and 4 and insert the most distal 3.5 mm locking screw. 5 Plantar Lapidus Plate I 05 Plantar Lapidus Plate Drill through the metatarsal and medial cuneiform using a 2.5 mm drill. Aim for the dorsal lateral aspect of the medial cuneiform. Note: You may also choose to drill into the middle cuneiform using the same principles. 6a Optional: Place the Aiming Guide on the plate by inserting the small pin on the lower side of the Aiming Guide into the distal screw head. Thread the Aiming Guide fixation screw into the plantar proximal locking screw hole of the plate. The Aiming Guide provides defined placement of the compression screw at the best angle through the medial cuneiform and prevents interfering with locking screws. Drill with the 2.5 mm drill through the Aiming Guide, metatarsal, and medial cuneiform. 6b I Plantar Lapidus Plate06 Optional: Remove the Aiming Guide. Overdrill the metatarsal with the 4.0 mm drill and then measure the screw length with the depth gauge. Insert a 4.0 mm cancellous screw in the compression hole. Remove the K-wires and BB-Tak anchors before completely tightening the screw to achieve compression. 8 Plantar Lapidus Plate 7 Plantar Lapidus Plate I 07 Plantar Lapidus Plate Ordering Information Plates Product Description Item Number Plantar Lapidus Plate, left AR-8941PL Plantar Lapidus Plate, left, short AR-8941PLS Plantar Lapidus Plate, right AR-8941PR Plantar Lapidus Plate, right, short AR-8941PRS Plantar Lapidus Plate Caddy AR-8950C-36 Instrumentation Product Description Item Number Drill Guide for Compression Hole AR-8949DG Aiming Guide, left, for Plantar Lapidus Plate AR-8941AL Aiming Guide, right, for Plantar Lapidus Plate AR-8941AR Aiming Guide Fixation Screw for Plantar Lapidus Plate AR-8941AS Products may not be available in all markets because product availability is subject to the regulatory approvals and medical practices in individual markets. Please contact Arthrex if you have questions about the availability of products in your area. Insert the locking Drill Guide in the proximal locking holes and drill with the 2.5 mm drill. Note the correct screw lengths from the laser line on the 2.5 mm drill. Insert the remaining proximal locking screws to complete the construct. 9 This description of technique is provided as an educational tool and clinical aid to assist properly licensed medical professionals in the usage of specific Arthrex products. As part of this professional usage, the medical professional must use their professional judgment in making any final determinations in product usage and technique. In doing so, the medical professional should rely on their own training and experience and should conduct a thorough review of pertinent medical literature and the product’s directions for use. Postoperative management is patient-specific and dependent on the treating professional’s assessment. Individual results will vary and not all patients will experience the same postoperative activity level or outcomes. View U.S. patent information at www.arthrex.com/corporate/virtual-patent-marking © 2019 Arthrex, Inc. All rights reserved. | www.arthrex.com | LT1-00013-EN_D

Plantar Lapidus Plate

Ryan B. Rigby, DPM, (Logan, UT) demonstrates a 1st TMT arthrodesis using the Arthrex Plantar Lapidus Plate.

1st TMT Fusion Using the Arthrex Plantar Lapidus Plate

Ryan B. Rigby, DPM, (Logan, UT) presents a case series involving both acute and chronic midfoot injuries. Dr. Rigby addresses this complex pathology with a two-incision technique by first applying a dorsal midfoot fusion plate and then fusing the 1st TMT joint using a plantar lapidus plate.

Plantar Lapidus and Dorsal Midfoot Fusion Plates for Acute/Chronic Midfoot Pathology

Lapidus Hallux Valgus Correction

A Moberg osteotomy is a dorsal closing wedge osteotomy of the proximal phalanx of the great toe. It is used for hallux rigidus, grades 2 and 3, often in conjunction with a cheilectomy or other joint-sparing procedure. The osteotomy can be completed with an open or MIS approach, depending on surgeon preference. In either case, fixation can be achieved with Arthrex Compression FT or PT screws or with DynaNite® Nitinol staples.

Compression and Push-Out Force Comparison of Arthrex to Competitor Compression Screws Arthrex Research and Development Objective Compression Testing – To determine the maximum compression force when screws were inserted flush with the test block surface using two pieces of 20 lb/ft3 (PCF) foam block. Screw Push-Out Testing – To determine the force required to push screws out of 20 PCF foam block with all threads fully engaged. Methods and Materials Compression Testing – A load cell was placed between the two test blocks that had been prepared with the appropriate sized pre-drill according to manufacturer recommendations. Please refer to Figure 1 for the complete test setup. The appropriate driver was selected according to each respective manufacturer and used to insert the screw. For all samples, the compressive force was continuously recorded as the screw was inserted until flush with the top of the test block, then as the screw was inserted further until loss of compression occurred. The maximum compression force during the insertion process was recorded. Screw Push-Out – Foam block samples were prepared with a through hole according to manufacturer recommendations. The screws were inserted into respective test blocks until flush. A dowel pin was then used to push the screw out of the foam block. For each sample, the maximum load was recorded. Figure 1: Compression Test Setup Figure 2: Screw Push-Out Test Setup Figure 3: Compression Force Results 0 5 10 15 P ou nd s (l bf ) Maximum Compressive Force (lbf)* 3.5 M ini x 18 mm 4.0 Standard x 30 mm Acutrak 2 M ini x 18 mm Acutrak 2 Standard x 30 mm 3.0 x 20 mm / 3.1 x 21 mm Arthrex 20 25 30 35 28.3 27 13.7 12.911.9 Acumed Synthes Figure 4: Screw Push-Out Results P ou nd s (l bf ) Maximum Push-Out (lbf)* Arthrex Acumed Synthes 0 20 40 60 80 100 120 140 160 180 117 154 147 69 72 3.5 M ini x 18 mm 4.0 Standard x 30 mm Acutrak 2 M ini x 18 mm Acutrak 2 Standard x 30 mm 3.0 x 20 mm / 3.1 x 21 mm Results The average values and standard deviations for compression and screw push-out testing are shown below in Figure 3, Figure 4, and Table 1. *data on file © 2014, Arthrex Inc. All rights reserved. LA1-0487-EN–A Comparison p-value Statistically Different (Yes/No) 0.01 Arthrex 3.5 Mini x 18 mm vs. Acutrak 2 Mini x 18 mm Arthrex 3.5 Mini x 18 mm vs. Acutrak 2 Mini x 18 mm Arthrex 4.0 Standard x 30 mm vs. Acutrak 2 Standard x 30 mm Arthrex 4.0 Standard x 30 mm vs. Acutrak 2 Standard x 30 mm Arthrex 3.5 Mini x 18 mm vs. Synthes 3.0 x 20 mm / 3.0 x 21 mm Arthrex 3.5 Mini x 18 mm vs. Synthes 3.0 x 20 mm / 3.0 x 21 mm Synthes 3.0 x 20 mm / 3.0 x 21 mm vs. Acutrak 2 Mini x 18 mm Synthes 3.0 x 20 mm / 3.0 x 21 mm vs. Acutrak 2 Mini x 18 mm Yes Yes Yes Yes No No No No 0.002 0.8 0.353 0.005 0.388 0.006 0.454 Table 1: Statistical Comparison of Compressive Forces M ax im um C om pr es si on F or ce M ax im um P us h- O ut F or ce Conclusion Arthrex compression FT screws provide a similar compressive load to competitors (fully threaded-Acutrak 2 and Herbert- Synthes) with statistically greater push-out force that may lead to better long term stability and less likely screw back out.

Compression and Push-Out Force Comparison of Arthrex to Competitor Compression Screws

Moberg Osteotomy

A triple arthrodesis is the fusion of the subtalar, calcaneocuboid, and talonavicular joints. Arthrex has developed 5.0 mm Large and 7.0 mm XL Compression FT Screws and DynaNite® Nitinol staples as options for this procedure. After removing any remaining cartilage and subchondral bone and applying biologic materials to accelerate fusion, apply fixation to compress and stabilize the joint.

DynaNite Nitinol Staple, 13 mm x 15/12 mm

AR-8718-131512

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