Name: Calcaneal Fracture ORIF with Arthrex Calcaneal Fracture Plate™ Utilizing Arthrex Quickset™ and FlexiGRAFT®
Uploaded: 2014-03-11T00:00:00Z
Channel: Arthrex
Description: Mark D. Campbell, MD, (Phoenix, AZ) demonstrates his technique of calcaneal fractures using the new Arthrex Calcaneal Fracture Plate System. The technique also demonstrates how the fracture site can be augmented with bone void fillers such as the FlexiGRAFT Demineralized Bone Matrix and the Arthrex Quickset Resorbable Calcium Phosphate Cement.

<p>Mark D. Campbell, MD, (Phoenix, AZ) demonstrates his technique of calcaneal fractures using the new Arthrex Calcaneal Fracture Plate System. The technique also demonstrates how the fracture site can be augmented with bone void fillers such as the FlexiGRAFT Demineralized Bone Matrix and the Arthrex Quickset Resorbable Calcium Phosphate Cement.</p>

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VID1-00114-EN | A | Calcaneal Fracture ORIF with Arthrex Calcaneal Fracture Plate™ Utilizing Arthrex Quickset™ and FlexiGRAFT®

Mark Campbell

Human

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.

Operationstechnikvideos

Surgical Technique Videos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Calcaneal Fracture ORIF with Arthrex Calcaneal Fracture Plate™ Utilizing Arthrex Quickset™ and FlexiGRAFT®

There's different ways to expose for a calcaneal fracture. Probably the most common is a hockey stick type shaped incision that pretty much parallels the Achilles insertion, and then is a plantar horizontal incision that tends to base up towards approximately the base of the fourth metatarsal. The things you need to worry about more distally, of course, is the nerve and the perineal tendons that will come into view. We're going to make this a fairly extensile view so that you can see in this demo. So we'll make that through. And again it's very important that full thickness flaps are carried out in this approach. Of course healing is an issue with these fractures back around the turn. You want to go full thickness right down to the bone and really lift this right up off the goals to have the nerve and the peroneal tendons in that soft tissue flap of full thickness, you can put a couple K-wires in as a kind of self retractors. It goes right up into the into the talus. You can actually use those and bend them up. And I'll use the driver. Take that out for a second. And if you bend them up it'll start holding your flap up. So there's one right there I'll put another one up. So combination of this and some hand retractors and we'll be able to see pretty well. We'll go ahead and make a calcaneal fracture. And oftentimes with the bone we'll have bone deficits. Now one trick I often use is that in order to get some control and actually to lever this down and get better visualization of the joint and surface, put a chance pin in the posterior body now, and you can always take it off if you need to. But this gives a really nice joystick to pull this down, and in this case it will open up my fracture site and it will actually help lever down to see the subtalar joint, which I can see. Very nice. If you have a deficit from the cancellous bone being compressed from the injury, you can fill that gap with the cement such as Quickset will give you very good sub articular support, and that's something that can easily be done. And we'll show you that in a second. Another trick you can use is using a FlexiGRAFT sponge that is not hydrated. It's got a fairly firm consistency to it. And it will actually you can wedge that in and hold your sub articular support in place while you put in your Definitiv fixation. Once that's in place, you have a few minutes to put on your Definitiv fixation before that will become hydrated and softer. So once you put it in, I just use an example. If I were to set this in, you can see that wedge is in that completely holds that area over. So if I have that in a subarctic area, it would hold my my subarctic color deficit reduced. I could place my calcaneal plate over that. I do not have any K-wires or other fixation getting in the way of my Definitiv plate fixation. Now the clock is running. I probably have 4 or 5 minutes that that will hold its support before it starts getting hydrated and getting softer. Now what happens to that? Well, once you have placed on your plate, it just becomes bone graft. It has osteoinductive and osteoinductive properties, so it's a perfect thing to have in that area to help with the bone healing. Now see still this sponge is still hard. So that would have done a very nice job of doing that. Quickset will set up. It will give you good support and sub articular support of your fragment as well. And then you can place on Definitiv fixation. So we're going to transfer the solution over and mix the Quickset. So I'm going to put the FlexiGRAFT sponge back in and again again. Now that gives excellent support of my fracture and kind of levers up and hinges up that articular fragment where I want it now. Now I've still got that that deficit in there. And I'd like to fill around that with something. And that's where I'll bring the Quickset in. Now the Quickset is now set, and we'll put the needle on the syringe and it'll be in a very workable form. And it stays in this form for approximately eight minutes. And you'll see as we move it in, it fills nicely into these gaps. And I can fill it right around this FlexiGRAFT sponge. When this hardens, this will give very nice support. And again, this is not meant for Definitiv support. This is meant at this point to fill the gaps and at later time will will fill those gaps and be replaced with bone. So once it's filled around there, I can smooth it off with a little freer elevator. Definitiv fixation I'll use a calcaneal plate here. Now I'll often get a size that I think fits, and oftentimes I'll take this and set an x ray over it to see how it's fitting on there. I like to start with a couple of non-locking screws that will bring my plate down to the bone. Once it's down to the bone. Locking screws give excellent support, but locking screws will not allow you to compress the plate against the bone. It will leave the plate wherever it's sitting and I want it down on the bone so it's not prominent. So. We'll drill right through. And again something you can notice is my the plate. This plate is designed in the the angle of it is right underneath to support the subarctic region of the Subtalar joint. This gives a very nice fixation of those common fragments we see. So I've drilled one and I'll start with one in the back side and I'll measure that. And that's going to measure a 32. I'll then follow the hand driver. So now the plate is down flush against the bone here. Now I'll generally move up and do another one at this time. Now what I'll often do here is I will get an x ray, because you can still rotate around this screw and make sure that I'm sitting in a nice position up on the calcaneus. More more distal. And once I get this, I can still move it very nicely. Once I get it to where I want, I'll set it in. I'll put another non-locking screw up more approximately. And the second one will now. Bring the plate right up against the against calcaneus at that location. And now it's all the way down, all the way across it. And that there measures a 34. So once I've got a couple non-locking screws on I can go to locking screws to give extra stability. Now, there's a couple of different ways you can drill for your variable angle locking screws. There's a couple of different guides that will work. One is this kind of domed guide. And you can put that. And what that will do is it'll allow you just by setting it in to go within 15 degrees. Anywhere throughout this dome is 15 degrees. So as you can see, this rotation will put you at different areas of 15 degrees. So it will keep you true within that. Another option if you like a little more stability, is that dome also comes in one that screws into the plate. So that's screwed in the plate right there. And so I'll nicely be able to come down put it. And I want to aim it up right about there. That's going to keep me within that 15 degree range, and I'll drill. And once it starts engaging, I will take the hand driver and actually thread it right into the plate. Okay. That's giving me very nice fixed angles support right there on the plate. Another option is a placing a screw where that's got the measuring guide on the guide itself. And so I'll pound against the second Vortex right there I see about where we are. And that measures about 30. And I'll stop. And now drop it through 32. It stopped at. So I don't have to measure that. I know from the guide that it measured 32. I would use a combination again of locking and unlocking depending on where I'm putting them. Again, the initial one should be non locking, and once you have the plate down against the calcaneus you can go to locking. Once you've put locking screws in the lock, the non locking screws have less utility and that they will no longer compress the plate against the side of the bone. But I would continue here with a few more locking plates. You do not need to fill every hole, but you want to get enough. You get good support. And again, while we've done this, now we've got the Quickset that's hardening. We've got that FlexiGRAFT that did a great job of holding our reduction and now we don't need it anymore. It's going to now turn into great bone graft with both Osteoinductive and Osteoinductive properties. While the Quickset is going to give us some additional space filling that will again get replaced by bone in the healing process. If you look at these radiographs here, what you're looking for is the subtalar joint is reduced, bohler's angle has been restored and the plate fits anatomically over the lateral border of the calcaneus. We have very nice sub articular support of the middle facet of the subtalar joint.

Calcaneal Fracture ORIF with Arthrex Calcaneal Fracture Plate™ Utilizing Arthrex Quickset™ and FlexiGRAFT®

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