Foot & Ankle Fixation Podcast

The Journal of Bone and Joint Surgery (JBJS) has a database of monthly podcasts in which they feature specific content from their corresponding monthly journal articles. They have a database spanning back to 2007. But don't worry, FootandAnkleFixation.com has done the leg work for you (no pun intended) and organized the relevant foot and ankle fixation podcasts. Take a look below and we will continue to bring attention to helpful tools for your daily surgical foot and ankle practice.

JBJS October 2011: Changes in Gait Following the Scandinavian Total Ankle Replacement

JBJS May 2011: A Randomized Trial in Open Tibial Fractures Treated with Reamed Nail Fixation; recorded commentary by Dr. Bhattacharyya

JBJS May 2011: Treatment of Displaced Intra-Articular Calcaneal Fractures with Closed Reduction and Percutaneous Screw Fixation

JBJS April 2010: Maintenance of Hardware After Early Postoperative Infection Following Fracture Internal Fixation

JBJS February 2010: Cartilage Lesions and the Development of Osteoarthritis After Internal Fixation of Ankle Fractures - A Prospective Study

New Company: Internal Fixation Systems

FootandAnkleFixation.com has added another medical device company to their authoritative database: Internal Fixation Systems.

Internal Fixation Systems (IFS) is a new manufacturer of orthopedic and podiatric implants who seek to provide superior products at a lower cost (40-60% lower in some cases). Speaking with Ken West, one of the original founders of IFS and current VP of Sales & Marketing, IFS offers foot and ankle implants that are equipped to manage any type of fracture including basic fragment and cannulated sets. Additionally, they are in the process of developing a complete line of foot and ankle plates & implants for non-traumatic procedures. In fact, Internal Fixation Systems recently announced their 510(K) FDA clearance for a new Subtalar Joint Implant /Arthroereisis. Stay tuned as we will have more information about their upcoming products in the near future, including specific product images and descriptions.

Brachymet: The Wright Medical Way

Brachymetatarsia typically presents multiple challenges to the surgeon. These may include the overall lack of width to the metatarsal, a shorted proximal phalanx in addition to the short metatarsal and, in some cases, multiple short metatarsals. Once it is decided to proceed with callus distraction, there are many options to from which to choose (see all current options).

Above is the Wright Medical Coretrak Tube Fixator in action. This mini external fixator is a little more bulky than some of the other fixators on the market and can be a little overwhelming to the patient at the first post-operative dressing change (then again, most external fixators have that affect on patients). The robust nature to this construct, however, offers stability and patient friendly manipulations. There are no small parts that require assembly and the guide holes within the fixator aids the surgeon for insertion of the fixator post. If you haven't yet given this mini fixator a try, consider it on your next brachymetatarsia case.

The IoFix Experiment: Follow Up

Just a quick follow up from our previous blog on the Extremity Medical IoFix Implant and our first opportunity using the new implant. A few weeks ago, we wrote about our experience with the implant, The IoFix Experiment, and how satisfied we were with the bone purchase of the post and screws. In our patient with significant osteopenia, a 4-hole locking plate failed to stabilize the bone on her opposite foot. We chose to try this implant because of its inherent stability and the need for only two holes created in the bone rather than 4 with the plate. The idea of compressing the screw heads against the intramedullary post instead of applying it directly against the cortex of the bone is a no brainer.

4 weeks post-op, (at right) the patient is well consolidated with no pain on palpation or manipulation. The radiographs demonstrate good alignment of the arthrodesis site, no fixation failure or changes and signs of trabeculation across the fusion site.

We will slowly begin to progress to weightbearing over the next few weeks, (erring on the side of caution) although it appears clinically that she is now ready to start partial weightbearing. Using the IoFix implant was a nice change of pace from the standard fixes and in this case, has proven a good option to have in your bag of tricks. Inserting the implant does require a few extra steps than the standard screw, particularly involving the post insertion. Prepare for your Iofix case by watching (and perfecting) the insertion sequence here in The Fixation Network. Stay tuned for long term follow up.

Foot & Ankle Estimates at $176.9 million

A recent article by BioMedGPS projects that the US market for foot and ankle fixation products will reach an estimated $176.9 million in 2012. They also expect the market to grow at a rate of 9% over the next few years, with estimations as high as $251 million by 2016.

“The market for foot and ankle implants is expanding as acceptance of surgical solutions for treating pain and deformity in this area of the body increases,”

- Lisa Mahan, Senior Analyst SmartTRAK Extremities and Total Joints modules at BioMedGPS.

These estimations reinforce the notion that foot and ankle surgery has drawn the focus of medical device manufacturers as we continued to see both new products and companies enter the market in 2011. As the foot and ankle market continues to grow, FootandAnkleFixation.com will be right there bringing surgeons the information they need to stay informed. Unbiased & Authoritative.

Year in Review: Fixation 2011

2011 was a year of mergers & acquisitions ultimately making the most headlines in the world of foot and ankle fixation news. This all started with the monster mega merger between Depuy Orthopedics and Synthes back in April. Before the dust even had a chance to settle, the acquisition of MMI by Stryker and then Ascension Orthopedics by Integra LifeSciences made headlines. Zimmer made a splash by acquiring the external fixation line ExtraOrtho and finally Wright Medical also joined in the fun by agreeing to carry ArthroCare's Opus Knotless suture fixation technology. The acquisition of these new technologies and expansion of the product lines certainly has influenced the playing field among the "Big" companies who are vying for the majority of the Foot & Ankle market share. Only time will tell who the winners and losers are by how the market responds to these changes and particularly where surgeon loyalty falls.

In light of last years chess match between some of the largest medical device companies, out of the ashes came a handful of new companies and product lines…

For starters, Arrowhead Medical Device Technologies brought forth the Arrow-Lok hammertoe implant. This implant eliminates the need for external k-wire fixation nor does it need any form of temperature control prior to or after insertion of the implant. The company is currently in the process of developing their next foot and ankle implant. Other companies new to the foot and ankle market include Solana Surgical, whose focus in currently on 1st MPJ implants; Nextremity Solutions, who is in the process of bringing forth the Nextra Hammertoe Correction System, and Paragon 28, who will be offering a complete line of forefoot, midfoot and hindfoot plates.

Some of the new products to hit the market this past year introduced traditional concepts with a new twist. The Stryker (formerly MMI) Anchorage CP Plate was the first plate of it's kind, allowing surgeons

the ability to introduce an interfragmental compression screw actually through a dedicated screw hole. The new plates were specifically designed for a 1st MPJ Arthrodesis and Lapidus Arthrodesis. The Arrow-Lok implant previously mentioned takes the traditional buried k-wire fixation concept and augments it with the added benefit of greater pullout strength from the double-ended arrow tips. Other new products to highlight the year include the Pro-Toe VO

& Inbone II Total Ankle Replacement by Wright Medical, the BME Speed, the Integra U-Shaped Plate, and the Arthrosurface HemiCap Talar Resurfacing Implant (which at this time is still not yet available for use in the U.S.) As new products hit the open market, there was a trend in that Ankle Implants and Hammertoe Implants were definitely the hottest fixation of 2011

Probably the most exciting news though of 2011 for foot and ankle surgeons was the inaugural year of FootandAnkleFixation.com! No longer will surgeons have no place to look for updated and relevant foot and ankle surgery information for your daily practice and patients. Too many other orthopedic websites focus on the corporate aspect of medical device information, where our information is dedicated to the driving force behind it all, the actual fixation devices and how it relates to the surgeon's practice. By surgeons, for surgeons.

So what's on the horizon for 2012? Stay tuned to FootandAnkleFixation.com to keep up with the latest unbiased foot and ankle fixation news.

New Product: Wright Medical QUICKDRAW

Wright Medical announced the release of their latest foot and ankle product, the QUICKDRAW, as the announcement was posted on the Wright Medical home page. This news comes in addition to the full release of their new Ortholoc 3Di Ankle Fracture System.

“The launch of the QUICKDRAW™ Knotless Soft Tissue Fixation System through our distribution agreement with ArthroCare^® Corporation will establish a strong foundation for Wright Medical in the growing soft tissue fixation market.”

- Robert Palmisano, President and Chief Executive Officer

The QUICKDRAW Knotless Soft Tissue Anchor utilizes similar technology to that of the ArthoCare Opus Anchor and is specific for soft tissue reattachment procedures of the foot and ankle. The system is composed of the BELAY™ and MINI-BELAY™ Knotless Suture Anchors, and RAPPEL-LINE™ Surgical Suture. FootandAnkleFixation.com has logged this new product under the following foot and ankle procedures: Achilles Tendon Rupture, Kidner Procedure, Lateral Ankle Stabilization, and Retro-Calcaneal Spur Resection.

New Product: Wright Medical Ortholoc 3Di Ankle Fracture System

In addition to the release of the soft tissue reattacthment anchor, the QUICKDRAW, Wright Medical announced the full release of their comprehensive single-tray ankle fracture plates, the ORTHOLOC 3Di Ankle Fracture System.

“We are very pleased to launch the ORTHOLOC^™ 3Di Ankle Fracture System, which further expands our foot and ankle product portfolio and provides surgeons with an innovative solution to treat a wide range of ankle fractures,”

- Robert Palmisano, President and Chief Executive Officer

The ORTHOLOC™ 3Di Ankle Fracture System offers foot and ankle surgeons multiple plating (9) options and utilizes their ORTHOLOC™ 3Di polyaxial locking technology. The various plating options can be seen at FootandAnkleFixation.com under the following categories: Wright Medical, Ankle Fracture, Fibular Fracture, Medial Malleolar Fracture, and Pilon Fracture.

New Company: Paragon 28

FootandAnkleFixation.com has added another company to it's comprehensive Foot and Ankle database. Paragon 28 is an up and coming implant company dedicated specifically to the foot and ankle market featuring over 119 total screws (2 - 7.5mm) in headed, tapered, and headless screw designs. Their product catalog includes 32 styles of the Normed plating system with over 136 different options. Their line of plates is procedure specific to 30 forefoot, midfoot, and hindfoot arthrodesis procedures. Additionally, they carry a line of interference screws and a line of staples. Stay tuned, as FootandAnkleFixation will bring you the latest information on the release of these new products.

Smith and Nephew + Essex Woodlands = Bioventus

Smith & Nephew has agreed to create a joint venture with Essex Woodlands, a specialist health care growth equity and venture capital firm, to create a new biologics company called Bioventus. Smith & Nephew's EXOGEN Ultrasound Bone Healing System will now be marketed through Bioventus.

Although our focus at FootandAnkleFixation.com is not on biologics, the EXOGEN bone stimulator is routinely used in conjuction with foot and ankle surgery. The available foot and ankle fixation products by Smith & Nephew can be viewed here.

New Video: Acumed Mini Calcaneal Plate

Acumed has posted on their website a new video on the application and sequence for the mini Calcaneal plate for ORIF of Calcaneal fractures. The animation (if only ORIF surgery was always this smooth) is clean and demonstrates step by step how to insert the plate. The nature of this implant is designed to be minimally invasive and utilizes a lazy S incision in contrast to the longer flap or extensile incision technique.

Read up more about this and other Calcaneal plating options here on the FootandAnkleFixation.com Calcaneal Fracture procedure page.

New Product: Gramedica osteo-Wedge

The latest medical device to be added to the FootandAnkleFixation.com database is the Gramedica osteo-Wedge plate. There has been very little information released up to this point regarding the new plate other than that it is used in correcting met primus varus, particularly in Hallux Abducto Valgus: Opening Base Wedge procedures. Initial press releases on the implant were made public back in July of 2011 and within the last few months, two amusing you tube videos have been released promoting the new product. It’s in the second video titled “osteo-Wedge part Deux” where we get a first glimpse of the new plate. The plate is oblong in nature with 4 proximal screws and 3 distal.

With the new implant portrayed as the ultimate solution for bunion correction in these promotional videos, it will be interesting to see if it offers any new technology or advancements in regards to correcting severe bunion deformities. We will eagerly await the release of more information on the plate and will bring you our unbiased review once we get a chance to try it ourselves. For now though, you can visit the osteo-Wedge product page on FootandAnkleFixation.com to see the video premiers of the plate.