DynaClip Forte® Procedure Spotlight - Naviculocuneiform Joint Arthrodesis | Oliver Schipper, MD

DYNACLIP FORTE® PROCEDURE SPOTLIGHT:

Naviculocuneiform Joint Arthrodesis Presented by Oliver Schipper, MD

INTRODUCTION • The naviculocuneiform (NC) joint is a challenging joint to achieve a successful arthrodesis with reported nonunion rates as high as 25%.1 • NiTiNOL staples provide continuous dynamic compression as bone resorbs at the fusion site during the native bone healing response while also potentially allowing for earlier weight-bearing.

• The DynaClip® Bone Fixation System in both 2-leg and 4-leg configurations offers superior compression and strength 2,3 as well as ease of use compared with other NiTiNOL staples, making it ideal for NC arthrodesis.

• Here, the surgical technique and a clinical example for an NC joint arthrodesis using the DynaClip staples are presented.

INDICATIONS Primary arthrodesis of the NC joint in the absence of infection, fracture, or nickel allergy.

PROCEDURAL INFORMATION The patient was positioned supine with the foot just off the end of the operating table. A dorsal, longitudinal midfoot incision was made centered between the medial and middle facets of the NC joint. The tibialis anterior tendon and dorsal foot neurovascular bundle were identified and protected with retractors. The medial, middle, and lateral facets of the NC joint were prepped using osteotomes, rongeur, and curved curettes. Both sides of the joint were fenestrated using a .062" k-wire.

Calcaneal bone autograft was obtained from the lateral calcaneus and placed within the NC joint to promote fusion. One 5.0 mm headless, cannulated, partiallythreaded screw was then inserted across the plantar medial NC joint in order to obtain initial static compression and prevent any plantar gapping.

A 26x20 mm DynaClip Forte® 4-leg inline staple was then placed dorsally across the medial facet of the NC joint.

Finally, an 18x18 mm DynaClip 2-leg staple was placed dorsally across the middle facet of the NC joint for additional stabilization (Figure 2).

PATIENT HISTORY A 71-year-old male presented with midfoot pain that had worsened over the past year after conservative management had failed including arch supports, achilles stretching, and ultrasound-guided corticosteroid/local anesthetic injections.

Figure 1. Pre-operative AP and lateral radiographs

Figure 2. Final intra-operative AP and lateral radiographs

DYNACLIP FORTEÂŽ PROCEDURE SPOTLIGHT:

Naviculocuneiform Joint Arthrodesis Presented by Oliver Schipper, MD

POST-OPERATIVE PROTOCOL

The patient was placed in a non-weightbearing short leg splint at the end of the procedure. At 2 weeks post-surgery, the patient was transitioned to a tall CAM walker boot and non-weightbearing was continued for another 4 weeks.

At 6 weeks post-surgery, bony bridging was noted across the NC joint on radiographs (Figure 3). The patient denied pain so weight-bearing as tolerated was initiated in the CAM walker boot.

Figure 3. 6 week post-operative AP and lateral foot radiographs showing bony bridging observed across the NC joint

The patient was weaned from the CAM boot at 8 weeks post-surgery and allowed to begin low impact exercise activity. The patient was fully fused by his 3 month follow-up appointment, as shown on radiographs (Figure 4), and subsequently released to full regular activity. At 6 months post-surgery, the patient commented that he was able to walk and exercise without pain for the first time in a year.

Figure 4. 3 month post-operative AP and lateral foot radiographs

References 1. Schipper ON, Ford S, Moody P, Ellington JK. New Generation Nitinol Compression Staples for Hindfoot and Midfoot Arthrodeses. Foot Ankle Int., 2018 Feb. 39(2): 172-179.

2. MedShape Research & Development. In Vivo Compression Performance of MedShape DynaClip Forte Bone Fixation System [White Paper], 2020.

3. Data on File. MedShape, Inc., 2019.

Oliver Schipper, MD is a board-certified fellowship-trained orthopaedic surgeon who practices at the Anderson Orthopedic Clinic in Arlington, VA. He completed his medical education at the Georgetown University School of Medicine and attended the University of Chicago for orthopaedic surgery residency. He then completed an orthopaedic foot and ankle surgery fellowship at the OrthoCarolina Foot & Ankle Institute. Dr. Schipper is a member of the American Orthopaedic Foot and Ankle Society (AOFAS) and an elected member of the Young Physicians Committee.

For further product information or to arrange a product demonstration, please contact your local MedShape representative or call Customer Service at 877-343-7016. You can also visit www.medshape.com.

1575 Northside Drive NW Suite 440 Atlanta, GA 30318 T: 877-343-7016 F: 877-343-7017

CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician. ŠMedShape, Inc., 2021. All rights reserved. Printed in the USA. Pat: http://www.medshape.com/patents.html Other U.S. and International Patents Pending. MK-10200 Rev 00. Issued 1/2021. DynaClip and DynaClip Forte are registered trademarks of MedShape, Inc. All other trademarks are trademarks of their respective owners or holders.