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NanoNeedle™ Scope 2.0
Gains National Spotlight Through

Star MLB
Pitcher's Recovery

This video provides an overview of relevant peripheral nerve anatomy, as it pertains to peripheral nerve injuries.

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Anatomy of Peripheral Nerve Injuries

OrthoPedia: Anatomy of Peripheral Nerve Injuries

The PARS system is designed for a minimally invasive surgical repair of an Achilles tendon rupture. It features an anatomic contoured jig designed to fit within the paratenon. The PARS kit contains collagen-coated 1.3 mm SutureTape with new differentiating colors and PARS needles that are used to create strong percutaneous locking sutures on the distal and proximal ends of the Achilles tendon.

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PARS Achilles Jig System

When using the percutaneous Achilles repair system, a small 1.5 to 2 centimeter incision is made in a transverse manner just proximal to the palpable rupture. Alternatively, a small longitudinal incision can be utilized. The tendon is grasped and the jig is inserted with the inner arms inside the peritoneum of the Achilles tendon. The first pass needle is placed in the number one hole in the jig to stabilize the construct, while passing the other needles and sutures in sequential order. Lastly, the white SutureTape is then passed through hole number one. The jig can then be removed, which pulls the sutures out of the incision. Separate out each of the five sutures, the white, blue, and black suture tapes, as well as the two green and white FiberLink sutures. Each suture should be tested by pulling light tension through ten cycles to confirm appropriate hold in the tissue. On both sides. Pass the blue SutureTape under and around both green and white. Fiberlink sutures twice and back through the loop, then advance each loop back through the tendon using the free end of the green and white FiberLink sutures. This creates the locking stitch. The proximal suture tapes are moved away from the rupture site, and the jig is then inserted distally and the SutureTape passing steps are repeated. Once the jig is removed, three suture tapes remain on each side, both proximal and distal, ready for re approximation of the tendon to complete the repair. The foot is placed in maximal plantar flexion, and the black suture tapes are tied first on both sides. 3 to 4 surgeon's knots are recommended. Next, the blue locked suture tapes are tied, followed by the white suture tapes completing the repair. The incision is closed. Jumpstart antimicrobial dressing can be utilized and the result is a secure repair of the Achilles tendon rupture.

PARS Achilles Jig System

This animation highlights the unique features and benefits of the Arthrex Tibial Nail System and its comprehensive instrumentation. Engineered for a streamlined para- or suprapatellar technique, the Arthrex tibial nail’s innovative design enables treatment of extremely distal tibial fracture patterns.&nbsp;

Arthrex Tibial Nail System: Features and Benefits

Arthrex Tibial Nail System: Features and Benefits

The ACP Max™ system provides efficient concentration of platelets and growth factors from platelet-rich plasma (PRP) for use at the patient’s point of care. Expanding on the previous generation of PRP devices, the ACP Max system allows for a larger blood draw and provides increased platelet concentration using a unique double-syringe, double-spin design.&nbsp;

ACP Max™ Platelet-Rich Plasma System

ACP Max™ Platelet-Rich Plasma System

The Univers Apex OptiFit™ system represents the evolution of our stemmed anatomic systems.

Univers Apex OptiFit™ Surgical Technique

The humeral osteotomy is performed by either a freehand cut or with an intramedullary or extramedullary guide provided in the instrument set, taking care to maintain the patient's native articular inclination inversion. The Universe Apex OptiFit instrument set contains reamers and broaches designed to prepare the Intramedullary canal to match the stem's smaller footprint to minimize bone removal. The initial broach has an attachable version guide and version rods for proper broach orientation relative to the osteotomy broach until rotational stability is achieved and the appropriate laser marking is flush with the cut surface. Following canal preparation, a proximal humerus Protector is placed and attention is turned to glenoid preparation. There are three glenoid implants available. The universal glenoid convertible base plate. The keeled glenoid. And the VaultLock glenoid, which provides immediate press fit fixation on the central peg. The VaultLock is demonstrated here. A pin is placed in the center of the glenoid by using the pin guide. The appropriately sized VaultLock reamer is positioned over the pin, and the glenoid surface is then contoured to support the polyethylene component. The central hole is drilled with a six millimeter cannulated drill, stopping once the collar comes in contact with the glenoid surface. The glenoid drill guide is positioned by placing the central peg into the previously drilled hole. A short six millimeter drill bit is used to drill the superior peg hole. It's left in place to stabilize the guide for inferior drilling. The inferior 4.5mm drill bit is then used to prepare for the inferior keel. The glenoid brooch finalizes inferior keel. Preparation. Alternatively, the glenoid punch can be used with attention to impact just so the shoulder is flush with the reamed surface. Translucent glenoid trials are available. These provide visualization for the reamed surface while evaluating the proper orientation and fit prior to cementing the polyethylene component. The glenoid vault is cleansed and dried, followed by cement injection in the superior and inferior peg holes. A pressurizing tool is available for displacing cement throughout the vault. Bone graft can be used on the central peg. Autograft can be obtained from the native humeral head by creating a slurry with the bone graft reamer. The slurry is then placed into the graft compression tool, which is clamped around the central peg. Carefully spinning. The glenoid component on the grafting tool compresses the bone graft into the flutes of the central peg. Alternatively, a demineralized bone matrix product can be used for grafting the central peg. The VaultLock glenoid is then impacted into place. Attention is turned back to the humerus for stem implantation. The OptiFit stem has suture holes in the proximal body for soft tissue repair and subscapularis closure. The apex subscapularis repair technique takes advantage of these holes. Two holes are drilled vertically in the biceps groove for passage of the lateral suture. Limbs two. Number two FiberWire. Sutures are passed through the lateral holes, yielding four suture limbs labeled A through D from superior to inferior. A blue suture is used superiorly and TigerWire inferiorly for number two. Fiberwire sutures are passed through the medial holes, yielding eight suture limbs, labeled one through eight from superior to inferior. Blue and TigerWire. Sutures are alternated from lateral to medial limbs. C and d are passed through the inferior hole from the intramedullary canal out. Similarly, limbs A and B are passed through the superior hole from the Intramedullary canal out. All strands are held out to length on tension as the stem is impacted. Using the pointed stem impactor, followed by the angled Morse taper stem impactor, placing the trunnion flush to the osteotomy surface. The inclination inferior and version superior screws are then tightened with the torque driver. Trailheads are available to verify proper head size, head offset, shoulder motion, and stability prior to impacting the Definitiv head component. Suture limbs one through eight are evenly placed through the medial aspect of the subscapularis tendon. From superior to inferior. Your proper spacing is key to the final repair. The sutures are then tied in the following sequence one to A, eight to D, four to C. Five to B, 2 to 3 and 6 to 7. The suture color pattern is such that the first four knots are tied between similar colors, and the last two knots are tied between different colors. In addition, the last two knots are tensioned and create dynamic compression of the subscapularis tendon over the lesser tuberosity. The repair is then evaluated by externally rotating the arm with the arm abducted. The degree of external rotation achieved without stressing the repair is noted for postoperative therapy limitations. The wound is irrigated and superficial closure is performed according to the surgeon's protocol.

Univers Apex OptiFit™ Surgical Technique

This animation highlights the features and clinical applications of the ApolloRF® H50 probe, anatomically engineered for precision in the hip, with efficient tissue ablation and coagulation.

ApolloRF® H50 Probe

ApolloRF® H50 Probe

Katherine J. Coyner, MD (Farmington, CT), demonstrates how to use the SurgeonVault® surgeon-patient communication tool to effectively manage cases, annotate images, and send patient reports.

SurgeonVault® System Demonstration

Speaker  Hi, I'm Doctor Kathy Coyne, a professor from UConn health. I want to show you today how I use the Arthrex surgeon vault in combination with the Synergy Vision Imaging system to communicate with my patients after surgery. From a practical standpoint, what works really well for me is how streamlined this process is. I can export the case media wirelessly from the O.R. tower directly to my iPad, and often have the patients post op report created before I even leave the operating room. That report includes intraoperative images and video, as well as a brief video explanation of the case from me. The rehab protocol specific to that patient all combined into one secure digital report. The first thing I'll do is I'll find the QR code. I'll then link that to my iPad. It'll then ask me to join the network. I'll join that. It's now pairing from the tower to the iPad. Once it's paired, I will then hit export on the tower screen. I will go to my iPad and you can see that they're now being sent over. I then disconnect and then I'll be able to access the case media. Once I'm ready to create the patient report, I log into the Surgeon Vault app and pull up the case. Speaker  I then pull up the template that I want to use for this particular case. This was a meniscus root repair. This automatically organizes all the images and video in the way I like to present them. Here is a little personalized message to the patient. Exactly what was performed. I can also create what's called a surgeon video. I just want to let you know that surgery went great. I'm getting ready to go talk to your family, but I wanted you to know that we were able to repair your meniscal root. There's a procedure overview about the specific parts of the case. If it was something unique that you also want to add, just go to the library where you can easily add procedures or aspects of a case, and that will add it into your own template. I can link specific PT protocols, and this is where I find it to be really helpful for them to be able to share this with their physical therapist. So we're all working off the same information. So then if I go back up to the case media here, there's a lot of options from this screen where I get to the annotation part of this. Speaker  And on the left hand side you can see all the different annotations. But most easily I can just draw an arrow and you have these pre-populated labels where I can then choose what to annotate. I can flip between images and videos extremely easily. I can see what my initial meniscus tear looked like, and be able to explain that to the patient very easily. And then ultimately, when I feel that everything is annotated appropriately and I'm comfortable with how everything looks, I come back to this screen and I'm ready to send this report and everything will get embedded into a secured email for me. Surgeon vault is far more practical and secure than sending patients home with paper printouts that are often misplaced or never reviewed. I can tell when the patient actually has already opened their report. It really has unlimited cloud based storage, and for me, it creates this powerful, organized library that I can use for teaching files, as well as really high quality presentations. Overall, integrating Surgeon Vault with the Synergy Vision system has really made my postoperative workflow much more efficient and really has improved how I communicate with patients. Thanks for watching this video.

SurgeonVault® System Demonstration

At the Sports Medicine Fellows Forum, Wesley P. Phipatanakul, MD (Loma Linda, CA), demonstrates key exposure techniques for shoulder arthroplasty, emphasizing soft-tissue releases, glenoid visualization, and reproducible surgical steps to optimize implant positioning.

Exposure Pearls in Shoulder Arthroplasty Surgery

OrthoPedia: Exposure Pearls in Shoulder Arthroplasty Surgery

The Arthrex ElbowLOC® positioner is a modular, upper extremity positioner that gives the surgeon the choice of supine, lateral, or supine-suspended positioning for elbow surgery, as well as a wrist traction device for wrist and hand arthroscopy. The ElbowLOC positioner is easy to use and set up, and housed in a space-saving single autoclavable tray.

The Arthrex ElbowLOC® Elbow and Wrist Positioner

The Arthrex ElbowLOC® Elbow and Wrist Positioner

Gautam Yagnik, MD (Miami, FL), demonstrates an arthroscopic Bankart repair using the Knotless 1.8 FiberTak® system, highlighting advanced instrumentation including the pivot guide, flexible fluted drill, and PassPort Button™ cannula with auxiliary lumen. He outlines key steps for labral and capsular release, precise anchor placement along the glenoid rim, and efficient suture management to achieve a reproducible, anatomic repair. The technique emphasizes controlled capsular shift and restoration of the anterior bumper to enhance joint stability using knotless fixation technology.

Arthroscopic Bankart Repair Using the Knotless 1.8 FiberTak® System With Pivot Guide

Speaker  My name is Gautham Yagnik and I'm here from Miami, Florida today to demonstrate an arthroscopic bankart repair using our Knotless fiber tack system. Today we're going to highlight some unique instrumentation that's going to help us with this procedure. First is the Pivot Guide, which is a guide that blends both a straight and curved guide into one guide. The advantage to this guide, it has a nice straight shaft that allows you to get down even a small, low profile five millimeter cannula, but it's got a curve at the end, a seven degree curve that allows you to access even the most difficult aspects of the glenoid. The second item is our flexible fluted drill, and the third item is our passport with the auxiliary lumen. So we have a left shoulder in the lateral decubitus position. And we're viewing from the posterior portal. We've established our single portal just above the subscap with our passport cannula with the auxiliary lumen. We have liberated the labrum here, both anteriorly and anterior inferiorly. Initially, I use a traditional bank card elevator, but at this stage I like to bring in the I 90. It's perfectly shaped for this part of the procedure, and it'll allow me here to continue to release not only the labrum, but the capsular tissue that's adhered to the glenoid neck. The other area where I'll use the Apollo is right here along the rim, just to help me better visualize exactly where the rim of the glenoid is. And this will help for anchor placement. And this is our final prep. We've prepped our glenoid. We've prepped our Capsulolabral complex. Speaker  We're going to introduce the pivot guide into the shoulder. You can see it has this little lip at the end, which allows us to place the guide right on the edge of the glenoid, and it has a 1.5mm offset. So it allows a very reproducible placement of the anchor on the glenoid face. So I'll go ahead and put this down at the 530 position and I'll hook the lip on the edge of the glenoid, and then we'll bring our flexible fluted drill and place our first anchor. The advantage of the flexible fluted drill is that it clears some of the bone debris, and it makes anchor placement even easier. Place our first anchor. Remove the inserter and then I'll bring my guide out. So we have a very nice placement just on the face of the glenoid. We're now going to use our nano retriever through our auxiliary lumen. And we're going to go and we're going to retrieve our shuttle sutures. So we've brought our shuttle sutures out through the auxiliary lumen for suture management. We're going to bring our repair suture that has been loaded on our labrum scorpion down through our passport cannula. Now we're going to be able to get a really nice bite of tissue using this device Not just through the labrum, but through the capsule itself. So you can go ahead and pull that through the capsule label complex here. And you see, we have a nice, real healthy bite of tissue right at that inferior aspect of the answer band of the glenohumeral ligament. So at this point in the procedure, we're going to go ahead now and retrieve the loop out of our main cannula here. Speaker  We're going to go ahead and convert our anchor in a standard fashion. So right when we get down to this part I'll bring in a grasper or kingfisher. In this case we're using a pointed grasper. And the other advantage of this knotless tangible device is I'm able to go ahead and reduce the tissue exactly where I want it on the glenoid. We can sometimes even shift the head slightly posteriorly, and then we can go ahead and finish tensioning our anchor. And that allows us to not only repair the labrum, but to shift the capsule and really reduce the whole complex to the glenoid. And you can see how we get a really nice repair at this point. We have our repair suture out our auxiliary lumen. So it's not getting in the way. And I like to leave this here. So that way I can go back and retension this. After we place our next anchor, we're bringing in our pivot guide again. You can see the lip here. Once again, I'm going to kind of grab the rim of the glenoid with that lip. I'm going to angle the shaft. And the nice thing about this guide is it's stouter than a traditional guide. So it allows me to leverage just a little bit up on the head so I can really get up on the glenoid face there. So go ahead and give it a little tap on the back of the guide to seat it down. Bring our flexible fluted drill. Speaker  The guide has a nice slot here to allow us to see our anchor coming down through the guide and being placed into the bone. It's also vented on the side which helps clear the bone. So now we're going to just repeat the same steps that we did before. So at this point we're going to go down again and use our grasper to help reduce our tissue. So it's not just our anchor doing the work. We're actually going to be able to reduce and push our tissue exactly where we want it on the glenoid. And then we're going to go ahead and tension our second anchors getting a nice shift here. So we tension our anchor. Nice. Really nice. And then we can go back and tension our first anchor. And we can go ahead and get that last little bit of creep out of there. So that's perfect. So we've placed our final anchor here and we're about to do our final tensioning. So once again I'll I'll help to reduce my tissue. Take some tension here off the anchor and we'll go ahead to our final tensioning. And we're really able to kind of reduce that labrum and that whole capsule and shift everything to, to really get a nice anatomic repair of our glenoid and a really nice capsular shift. Here's our final tensioning here. We can kind of get a little bit more by putting our cutter down. You can see we get a really, really nice repair with a really robust capsular shift. I think it's really important, particularly for a patient that's very unstable.

Arthroscopic Bankart Repair Using the Knotless 1.8 FiberTak® System With Pivot Guide

The Mini Fragment System is designed to aid in the reduction and fixation of small- and long-bone trauma injuries. The modular tray offers screw and plate options in 2.0 mm, 2.4 mm, and 2.7 mm variants. With a wide array of plates to fit a multitude of trauma needs, the Mini Fragment System is a keystone addition to the Arthrex Trauma portfolio.

Mini Fragment System Animation

Mini Fragment System Animation

The consolidated trays for the Univers Revers™ total shoulder system are designed to provide a cost-saving solution that preserves patient-specific optimization and enhanced operative workflow.

Univers Revers™ Total Shoulder System: Maintaining Global Patient Parameters With Fewer Trays

Speaker  Shoulder arthroplasty is evolving and so are we at Arthrex. We're giving surgeons a streamlined path to surgical excellence. Fewer trays with the same versatility you've come to expect. All to help you treat your patients better. The result? A dramatic reduction in O.R. waste and significant cost savings without compromising implant modularity or patient optimization. Our new consolidated system lets you perform a standard reverse case with just two trays and an augmented glenoid with only three trays, saving you space and streamlining your workflow, all while continuing to use the implants you're familiar with. Backed by over a decade of clinical data. Fewer trays. Same implant options. More efficiency.

Univers Revers™ Total Shoulder System: Maintaining Global Patient Parameters With Fewer Trays

Jonathan A. Godin, MD (Vail, CO), performs a segmental meniscal allograft transplantation (MAT) using the segmental meniscus procedure pack to treat a midbody meniscal defect. Dr. Godin also shares key tips and technical pearls for using the meniscus template included in the procedure pack to ensure optimal graft matching.

Segmental Meniscal Allograft Transplantation Using the Segmental Meniscus Procedure Pack

Speaker  This is John Golden from the Stomach Clinic in Vail, Colorado. We're going to go over the components that comprise the segmental M.a.t. procedure pack. There are many suture tape links with or without needles, with four distinct colors for the corresponding four quadrants of the graft. And then there are also associated mini suture tape links without needles that will go into the graft. In addition, there is a free needle with a nitinol loop, and one of the most unique aspects of this is the meniscus template for the meniscus template. This is made of the same material as that used for the passport, and you can see distinct radii of curvature throughout the graft template. Four different quadrants showing different radii of curvature that would fit most appropriately in the segmental meniscus defect. Another key feature is that you can trim this to size for the height of the meniscus. Lastly, you can pass a suture through this so that you have complete control of the template within the knee joint for easy placement and extraction. We're starting the prep on a segmental M80. This is a right knee, and we're working on a mid body segmental defect here. We've begun some of the prep with biters and the torpedo shaver. And just doing the finishing touches on that right now with the shaver first. And you can use a combination of different biters to finish your prep work. Speaker  Key here is going to be coming from your control departmental portal to finish to have the best angle to work around the tibial spines. So you can kind of see we're finishing getting an appropriate. You want to leave at least a millimeter of rim if you can. And then another key here is keeping the edges, the anterior and posterior edges as sharp as you can to maximize some of the surface area. And then you'll want to mimic the pattern on your allograft on the back table. As is commonplace, we have fenestrated the proximal MCL to help with our exposure for this procedure helps with a valgus force applied for your visualization. So I'm going to do is switch portals view from our lateral portal to see and measure our defect. Now with the SCR ruler. So we're getting our anterior to posterior dimension here which on this is about a 19 or so nice clean edges nice rim there to repair and have healing to that. You notice the cartilage in the specimen is quite good. The other thing that I'll point out is that we've got our approach for our inside out, a typical inside out. I tend to use a probe to mark the joint line, and I make a third of the incision above that, two thirds below. Speaker  Once we get through the subcutaneous tissue, we're identifying the Sartorius fascia here. And I've kind of come in line with that to retract the hamstrings. And then below that, we're going to have our layer of the capsule and the postero medial gastrocnemius. So there are obviously different dimensions here. The most important is going to be your anterior to posterior. In my opinion, you don't want to short that and have too much strain across the radial repair sites anteriorly and posteriorly. And so getting that is the most vital. You're going to have a size matched graft. And so but sometimes the width is going to be variable. And it doesn't matter as much if there's nothing you can do. If this is a little bit inset after you place the graft in. If it's a little if there's a little excess, if you want just for appearance, it can be trimmed. And then the last is going to be the height. And so that's where we'll use the template. And we can size that more appropriately, which then allows us to size the allograft on the back table before we put it in. Once you have your segmental defect prepped arthroscopically, you can go to the back table. What we've done here is removed a right medial meniscus allograft from the corresponding bone. And then we have the template. Speaker  And so you'll want to use the template to identify the corresponding radius of curvature that best fits the area that you'll be transplanting. And so you can see the shorter radius of curvature here all the way to the longest. And if we put this on the corresponding area that we would be transplanting for this patient. Zone two has the best fit whereas three. And certainly this fourth zone here don't match the radius of curvature as well. And then we have the sizing. And so we can again use that ruler that we used arthroscopically. And within that zone we'll be able to measure to the same length. In this case it measured a 19. So I'll go about a 20 to size the template. And then we can mark the template with a stay stitch and put it into the joint to make sure that the fit is perfect. One thing I would note here, I tried to get pretty right angles on my defect. If you have more of a lower angle than. I would cut that appropriately to try to match when it fits in the joint. And so now we have a 20 millimeter portion on the outer rim for our template here. And I'm going to put a tag stitch in this. Personally, I think the anterosuperior quadrant is the easiest to place. So what we've done is made a small about a millimeter trim in the anterior to posterior position. Speaker  And then we've cut the template at the top of our fourth marking. And the nice thing with this material is the durability and the ease with which you can go in and out. And then I pass this, this link again in it. And you can see that the, the material stands up to that quite easily. So here I'm going to check the anterior posterior position, which looks quite good front to back. And then this view here I'll be checking the height. If this were placed in like that. So in standard fashion, we've placed our mini tape links into the four quadrants Anterosuperior, Anteroinferior, Posterosuperior, and Posteroinferior. And you can see those there. In this case, we used a divider in the passport to help organize those. And then we will refer to those corresponding colors when we pass these links to help shuttle the graph to keep everything sorted out later in the case. Now we'll go to the back table to prep our allograft. So now we're on the back table. We have our template. And if you think of the three dimensions looking at it, the height was appropriate to this template. So that's what we're going to aim for on the allograft as was. Now that we've fine tuned it our A to p length, the width is something I'm keeping in mind. Speaker  And so anatomically This zone is where the segmental defect is. I'm going to come just a little bit anterior because it's a little thinner there, and I think more appropriately matches the size of our template in that zone. Now that we've got the appropriate size in all three dimensions, we'll pass all four of our links in corresponding fashion to the colors that we place them in our defect. So here's the final prepared allograft on the back table with our blue Anterosuperior black Anteroinferior white and blue Posterosuperior and white and black Posteroinferior links passed in luggage tag fashion. We'll now pass these of the corresponding colors in the knee. So now we're going to pass first our two posterior shuttle stitches to feed the posterior mini tape links that are in the graph that have been passed. And this will help pull the graft in. And I'm also going to push with a king fisher. So now what I'm going to do after we have it provisionally placed is Thai order in my opinion doesn't matter. I'm going to for this case do posterior first. So as you can see I'm tying the blue and black striped links together first. And then next we'll tie the anterior solid blue to solid black. So now we have our stability of the graft to the rim. Speaker  And then you can augment with all inside fiber stitch or inside out sutures and side to side fashion to stabilize the graft to the anterior native meniscus and the posterior. So now we're placing a 24 degree fiber stitch in the posterior aspect at the junction of the graft to native meniscus. So here is kind of the final product. You can see that we've added side to side anteriorly in this case with an all inside fiber stitch. This can also be done with an inside out, and this will nicely reduce the allograft to the anterior aspect of the native meniscus. We've done the same posteriorly to reduce the posterior aspect of the native meniscus to the allograft, and then we can cycle the knee gently there to check it. Post-operatively. What I'm currently doing is six weeks non-weight bearing on these. Similar to a meniscal allograft transplantation with a brace start PT immediately post op day one swelling minimization range of motion. Usually do 0 to 90 for two weeks, then advance as tolerated. Usually it's about a 1 to 2 week progression from non-weight bearing at week six. Goal would be about checking strength at three months, six months, then nine months if need be, with a 10% or less differential between the sides before return to sport.

Segmental Meniscal Allograft Transplantation Using the Segmental Meniscus Procedure Pack

At the Hand and Wrist Fellowship Forum, Daniel Koehler, MD (Dallas, TX), reviews indications, anatomy, portal placement, and technical pearls for carpometacarpal (CMC) and metacarpophalangeal (MCP) joint arthroscopy, supported by case-based illustrations.

NanoNeedle™ Arthroscopy for Carpometacarpal (CMC) and Metacarpophalangeal (MCP) Joint Pathologies

OrthoPedia: NanoNeedle™ Arthroscopy for Carpometacarpal (CMC) and Metacarpophalangeal (MCP) Joint Pathologies

Donald Hohmann, MD (Dallas, TX), demonstrates the surgical technique for using an Arthrex bone void filler to augment the bone surrounding the lag screw within the Arthrex Trochanteric Nail System.

Technique Demonstration of the Arthrex Trochanteric Nail Biologic Augmentation System

Hello. My name is Doctor Donald Hohman from Dallas, Texas. And today I'm here to perform a surgical technique demonstration for Arthrex Trochanteric Nail Augmentation System. This system allows for a streamlined approach to deliver biologics to the femoral head in patients with poor bone quality during trochanteric nail implantation. The system is offered as a single use sterile kit and includes a 3.2mm delivery cannula, guide pin and three one cc syringes, and a female to female luer. The delivery cannula features a custom tip design of four slots, spaced equally to deliver biologics to the surrounding bone that the lag screw threads will contact. The cannula also features laser lines that correspond to all lag screw lengths for precise delivery of biologics. The kit also includes a 3.2mm guide pin that is longer than the current lag screw guide pin offerings to simplify the removal of the guide pin prior to inserting the delivery cannula. Finally, the three one cc syringes and female to female luer can be used to transfer the graft into a smaller size syringe and reduce the back pressure that can sometimes occur when dealing with larger syringe sizes with respect to biologic offerings. The system is designed to be compatible with any injectable graft material, but for the purpose of this demonstration, we will be using Quick-set calcium phosphate cement. Now let's walk through the steps to deliver biologics through the lag screw into the femoral head. Prior to beginning lag screw placement, it's important to use the 3.2mm pin offered in the augmentation kit to ensure you can grab and remove the pin once it comes time to replace it with the delivery cannula. If a shorter 3.2mm pin is used initially, it will need to be replaced with the longer pin. Following the initial ream at this junction, you can verify both your reaming depth with a simple measurement and both your lag screw length. I'm going to begin to ream. It is important to note during this step, if you perforate the femoral head, augmentation with cement should not be conducted due to the possibility for material migration into the joint space. You can also verify the femoral head has not been perforated by injecting a radiopaque dye through the delivery cannula prior to cement delivery. Now you can see we've created our pilot hole, and based on our measurements, we're going to use a 95mm lag screw. At this point we're going to begin placement of the lag screw. Now before fully setting the lag screw, it's important to note when planning to augment, you will want to stop advancing the lag screw about ten millimeters from your final placement or just past the metaphysis if you prefer going off an anatomic landmark. This will allow us to inject the biologic into the surrounding bone of the lag screw threads. So now we're about ten millimeters from our final location. You can see this longer guide pin protrudes from the handle, which allows us now to replace it with the delivery cannula. From this step, because we are using a 95mm lag screw, we're going to insert the delivery cannula until we reach the 95mm laser line on the cannula. This measurement tells you the appropriate injection depth with respect to the lag screw On our back table. We've already mixed the quickset and we're going to transfer the cement into the one CC syringes. Again, the purpose of this step is to minimize pressure associated with larger syringes. At this point you can also verify on fluoro the cannula is in the right location for delivery of the cement. By verifying all of the injection ports are past the tip of the lag screw. At this point, you can also adjust the depth of the delivery cannula if a different location is desired. Now that the cannula has been filled with the cement, we can use the inner trocar to deliver all of the cement. A couple fluoro images should be obtained as you are delivering the cement to verify the final location. If significant back pressure is felt when inserting the cement with the trocar, at that point no more cement is needed. Now that all of the cement has been delivered, we are going to advance our lag screw and the technique is complete.

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