Evolution of the Locking Plate

As locking plates emerged over the past decade, new advances and technologies have continued to evolve. Looking back, it’s hard to forget the classic AO video demonstrating pullout strengths between locking and non-locking 3.5mm cortex screws while applying a cloverleaf plate to an apple. As if the video wasn’t convincing enough, numerous studies and publications further backed the increased stability achieved with the locking constructs. Needless to say, interest in locking plates steadily grew as they became sought after particularly in cases of unstable trauma, revisional surgery and osteopenic bone.

With major companies like Synthes leading the way with newer locking technology, along came the locking drill guide. This added precise accuracy when pre-drilling. Now the drill hole would maintain a centralized position aligning and locking the screw properly with the plate threads. Simple enough right? Not exactly. Problems can still arise

· Alteration of the locking construct following bending of the plate

o Likely the most common cause of problems

o Inherently alters the integrity of the plate threads disrupting the screw from seating properly within the plate.

· Not inserting the screw directly 90 degrees to the plate

o The screw head will not seat properly within the plate

o Can cause the metal to strip or peel off the head

o If enough force is applied, the head of the screw can actually break off

These downfalls can lead to failure with the locking construct and/or neutralize their locking effect, essentially making them no stronger than a non-locking plate. Fast forward to today. New advances in locking plate technology have evolved such that it gives the surgeon additional room for error when applying a locking plate.

Examples:

· The Depuy plating systems

o Pre-loaded locking guides on the plates

- Eliminates the sometimes frustrating step of trying to get the drill guide to properly load into the plate

- Enables the surgeon the ability to bend the plate without disrupting the plate threads

· Smith & Nephew plates

o Variable angle capabilities.

o Now the screw does not need to be directed in precisely at 90 degrees

Some plates have eliminated the need for threads within the plate holes altogether:

· Extremity Medical IoFix Implant

o Although not a plate per say, the IoFix implant utilizes the locking plate idea. Based on the conical shape of the screw head, the screw essentially locks into the post as it is inserted.

· Integra Hallu-Lock Plate

o Utilizes a SurFix system

- There are no threads on the head of the screw

- Instead, a separate threaded washer, applied on top of the screw head, after the screw is inserted

Can traditional non-locking plates get the job done? Probably in most cases, yes. Do locking plates offer multiple advantages over standard plating options? Most definitely. Ultimately, the choice to use these new plating options rests in the hands of the surgeon. Regardless, advances in plating technology have and will continue to evolve, making it not only easier for the surgeon but also superior for the patient.

- www.FootandAnkleFixation.com

Social Fixation

FootandAnkleFixation.com embraced the world of social media this week with Twitter @SurgFix, Facebook, Google+ and LinkedIn.

Of course you can follow our blogs directly and we welcome you to our Community. Please join us as we ease your navigation into the world of surgical implants of the foot and ankle!

New Product: HemiCAP® Talar Resurfacing Implant

With all of the hype surrounding Ankle Joint Implants / TAR, a new implant has surfaced on the market (no pun intended) from Arthrosurface. The Hemicap Talar Resurfacing Implant is different in the sense that it is not a Total Ankle Replacement, but is designed for more specific or focal talar dome defects. Arthrosurface has taken the technology from their Hemicap DF System for 1st MPJ resurfacing and applied the same concept to the new talar implant. The device has a cobalt chrome articular surface with the undersurface coated in Titanium.

As stated on the Arthrosurface website, "The HemiCAP system is intended to provide an effective interim means for managing pain and disability in the middle-aged patient until a total joint replacement treatment option becomes more necessary, and is part of a clinical treatment strategy to help avoid early-age-revision scenarios. The prosthetic may also provide a treatment option for the older patient who may not tolerate the morbidity of a total joint replacement procedure."

This implant is not yet available for use in the United Sates or Canada. However, it is cleared in Europe and Arthrosurface has a program set up through which pateints can connect with physicains overseas. FootandAnkleFixation.com offers many informative services to foot and ankle surgeons, and we strive to provide up-to-date product news and information that we feel is pertinent to your practice. Unfortunatly, we do not include non FDA cleared products in our comprehenisve database. We will bring attention to those that are either on the verge of being cleared or that we feel are potentially industry changing. This is an exciting new option for reconstructive ankle surgery and we look forward to the opportunity when we can explore this implant further

The IoFix Experiment

Yesterday I finally had an opportunity to give the Extremity Medial IoFix implant a try. The patient had a history of osteoporotic bone (as noted in her previous hallux abducto valgus correction) therefore, I sought out a new implant that could help manage the frailness of the bone. And as expected, I was not disappointed.

As with most new implants and instrumentation, putting the first post and screw in took a few extra minutes. However, with this device, the learning curve was quick and the second construct was inserted in a noticeably faster application. One caveat that I can pass along is that I accidentally overdrilled past the laser-etched mark (on the drill) prior to inserting the second post. The over drill is very sharp and in this case when combined with soft bone caused the post to fit loosely within the bone. Although this error on my part was negated with the final screw purchase, pre-drilling for the post prior to screw insertion should not be overlooked.

Overall, the construct was very solid and I was impressed by the way it essentially neutralized the porosity of the patient's poor bone quality. A few of the tips that are demonstrated in this technique video were utilized during the case and really helped me with screw placement. This prevented contact between the two interfragmental screws. The next time that you are preparing for an arthrodesis procedure, consider looking into the Extremity Medical IoFix Implant. If you are concerned about wall breakout or osteoporotic bone, using this implant is a no-brainer.

All Extremity Medical products are viewable here at www.FootandAnkleFixation.com

The Unbiased Authority: There are no conflicts of interest or financial association/assistance between FootandAnkleFixation.com and Extremity Medical

Trends in Hammertoe Surgery

Traditional fixation methods for Hammertoe Correction include cerclage wire and external k-wire fixation for the past 40 years. As of recently though, these traditional methods have been challenged by new fixation options such as screws (BioPro Digital Compression Screw, Vilex Digital Fusion Toe Implant), staples (SBI StaFix Staples), and suture anchors (Core Essence ReNOVO). Additionally, a new breed of hammertoe implants has become increasingly popular including Nitinol shape memory implants, (BME Hammerlock, Stryker (MMI) Smart Toe), peg and hole implants (Wright Medical Pro-Toe VO, Tornier StayFuse), and now Arrow Tipped Implants (Arrowhead ARROW-LOK).

But does it all make a difference? Do these new techniques have an advantage over the standard k-wire? In most cases, the external k-wire is fast, technically straightforward, and inexpensive. Unfortunately with this technique, patients have the added morbidity of a pin protruding out the end of their toe(s), the possibility of a pin tract infection and the anxiety and discomfort involved with removing the pins. There’s a saying that you can’t teach an old dog new tricks, but this may be one worth trying, as newer fixation methods for hammertoe correction can offer some patients a better option.

Specifically in regards to hammertoe implants, three different types have evolved and are now available on the market. First, the memory shape metal implants have taken off in recent years and have become popularized as one of the go to standards in internal options. The BME Hammerlock and the MMI Smart Toe are two Nitinol implants available that have received the most attention and have really opened the door for similar implants to follow. The drawback to these implants is the specific temperature requirement needed to store the implant prior to insertion along with the time sensitive nature of the implant once it is removed from its cryo-preserved state. If the implant is not inserted in a timely manner, the arms of the device can open, hindering the implant’s insertion. Additionally, the implant does have the ability to break over time if stressed above and beyond its modulus of elasticity. In most instances, this does not lead to problematic symptoms and can be monitored over time. Take a look at the new BME Speed as it has eliminated the need for temperature regulation while still utilizing the benefits of the nitinol.

Next up are the peg and hole type implants such as the Tornier StayFuse implant and the Wright Medical Pro-Toe VO. Rather than inserting a time sensitive implant whose legs expand with body temperature, these implants are directly inserted into both ends of the fusion site. From there, the two independent pieces are joined together, creating a stable construct. Lastly and the most recent implant to come to the table is the Arrow-LOK implant. A variation from a buried k-wire, this implant is the most straightforward and simple implant on the market. Even so, initially it is technically demanding and takes a few reps before it becomes second nature (which it does). The 3-dimensional arrow tipped implant is available in both straight and angled options.

So in the end there are a variety of options that surgeons can choose from when correcting hammertoes. The gold standard has been the external k-wire, however, newer implants (at a cost) have demonstrated predictable results with added patient benefits. These new generation implants offer patients the option of internal fixation and potentially less morbidity.

New Company: Nextremity Solutions

Although there are thousands of medical device companies within the orthopedic industry, companies specifically focusing on foot and ankle surgery is somewhat limited. And so it is with great pleasure that FootandAnkleFixation.com is pleased to announce the addition of our 51st foot and ankle medical device company: Nextremity Solutions.

This up and coming orthopedic implant company announced the acquisition of its CE Mark for the Nextra™ Hammertoe Correction System in late November. Next up on their to do list will be the official launch in the U.S.. Specific information and images of the new implant have not been officially released, however, in speaking with a source close to the product's development, the new implant focuses on enhancing the fusion site by way of newly developed technology incorporated into the overall implant design. Check back often with us as we will highlight any information that is released regarding this new technology for Hammertoe Correction.

New Product: Vilex Digital Fusion Toe Implant

One of the hot topics recently in foot and ankle surgery are the continual evolution of fixation options for Hammertoe Correction. We have seen a variety of implants hit the market within the last few years that have offered different advantages over the competition. In keeping tract of all of the available internal and external fixation options for foot and ankle surgery, FootandAnkleFixation.com is proud to announce the newest implant added into the database; the Vilex Digital Fusion Toe Implant. The hammertoe implant is now live online and available for use in the U.S.

Currently there is no surgical brochure on the screw to download, however, the cannulated screw appears to involve a simple insertion following joint preparation. Screw sizes include 2.0mm, 2.5mm, and 3.0mm and is available in sizes ranging from 24-50mm.

New Product: Vilex Opening Wedge Plate

Looking for a plating option for correcting a Hallux Valgus deformity with an Opening Base Wedge Osteotomy, well look no further. Check out the Hallux Abducto Valgus: Opening Base Wedge page on FootandAnkleFixation.com

Recently added to the online fixation database was the Vilex Opening Base Wedge Plate. The product is now live on the Vilex website along with a PowerPoint slide presentation from start to finish on how to apply the plate for Hallux Abducto Valgus correction. There is no pdf brochure on the plate to download, however, the step wise procedure and information is now viewable. To read up more on this new plate for bunion correction, visit the Vilex Opening Base Wedge Plate product page here.

Interested in what else Vilex has to offer, you can see all of their available foot and ankle products by visiting the Vilex product pages here.

Arthrosurface: New Website

Here at FootandAnkleFixation.com, we try not to get bogged down in the corporate side of medicine that you'll find in most orthopedic online websites. Our goal is to present only fixation product updates that will make a difference in your daily practice. With that said, every now and then there are changes within the industry, that we feel are important enough to bring attention to. Arthrosurface, makers of joint resurfacing systems, have upgraded their website and product pages to a more surgeon friendly site where all of their product information is very accessible. It is very easy navigate through their site and find product literature, videos, and general media content.

As Arthrosurface has helped to make it easier for you as a surgeon, unfortunately, most other device companies have not. Thus the idea behind creating SurgicalFixation.com. Our goal is to create an online resource where you can go for all of your Fixation needs without the need to waste time searching for implant information. Like Arthrosurface, we have created a user friendly platform for where you can find product information by procedure including product brochures, product literature, and quick tip videos. Give it a try, start by looking at the Arthrosurface products here.

Fixation Network: Solana Surgical

A new video on the Solana Surgical Metatarsal Decompression Implant has been added to the Fixation Network. The video highlights this new 1st MPJ implant and demonstrates the insertion sequence. Check out the newly added video in The Fixation Network. You can read more about Solana Surgical as well as the Metatarsal Decompression Implant here at FootandAnkleFixation.com.

The Orthopaedic Implant Company (OIC)

FootandAnkleFixation.com is happy to announce the addition of The Orthopaedic Implant Company (OIC) to our Fixation Community. OIC is a Nevada based company currently offering 7.3mm cannulated screws. The screw features a low-profile head, reverse cutting flutes, and is self-drilling & self-tapping.

We will continue to bring you more information and product highlights from the OIC as they are brought to market.