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.

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

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

New Fixation Network Video

Check out The Fixation Network as we have uploaded a new video sequence on inserting the Extremity Medical IoFix Implant. The video walks you through step by step from start to finish on inserting the implant and points out a few tips and tricks for making your case run more successful. The video focused on performing a calcaneocuboid joint arthrodesis, however, the implant can be used in multiple areas of the foot and ankle. Enjoy.....

New Fixation Network Video

As FootandAnkleFixation strives to keep you up on the latest in foot and ankle implants and medical devices, we have also been in the process of creating The Fixation Network. This section of our website is designed to show you tips and pearls on a variety of implants and particularly in a quick and to the point fashion. The videos shorts are to help show you step by step the sequence for inserting new products, as well as to share tricks that may help facilitate intra-operative decision making.

Our first video is now up and demonstrates how the use of the drill guides can help facilitate the talonavicular fusion portion of the triple arthrodesis when using the Extremity Medical IoFix Implant. The drill guides can help show you where the IoFix Implant will be inserted as well as the placement for the corresponding screw. This is important, as if inserted incorrectly, the talonavicular screw may contact the subtalar joint arthrodesis screw. Watch below.

You can visit The Fixation Network here on the home page of FootandAnkleFixation.com

IoFIX Webinar Tonight

Extremity Medical will be hosting a live webinar tonight with Dr. Brian Donley, MD as he covers the new Extremity Medical IoFix Intraosseous Fusion System. His discussion will cover the various features of the implant and its uses in foot and ankle surgery. The webinar is scheduled for 9:00pm EDT and you can register here.

Dr. Brian Donley, MD is Director of the Center for Foot and Ankle Surgery and is part of the Department of Orthopaedic Surgery and the Orthopaedic and Rheumatologic Institute at the Cleaveland Clinic.

New Extremity Medical Videos Now Online

Extremity Medical has posted another new video on their fixation products. In addition to their previous videos posted on YouTube, they now have a technique video of their IO Fix implant available for viewing. You can see it below as well as on the IO Fix product page.

Extremity Medical Release Additional Technique Guides

Extremity Medical has updated their homepage with two new technique guides for their IO Fix Screw implant. The technique guides focus on using the IO Fix Implant when performing Talonavicular Joint Arthrodesis and Ankle Joint Arthrodesis. The implant can be used in a wide range of foot and ankle procedures from the ankle down to the 1st MPJ. Read more about the Extremity Medical IO FIX here.