Calcaneal Plating System Brochure & Surgical Technique

Calcaneal Plating SystemAcumed® is a global leader of innovativeorthopaedic and medical solutions.We are dedicated to pioneering products, servicemethods and approaches that improve patientcare.A New Standard of Treatment for CalcanealFractures.Calcaneal fractures are the most common tarsalbone fractures and they are challenging to treat.The extensile lateral incision, which is today’s mostcommon approach, often results in nearly 30% ofpatients developing wound complications. 1With the expertise of Greg A. Horton, MD andSteven A. Herbst, MD, Acumed® has developed afamily of calcaneal plates specifically designed fora minimally invasive approach using a sinus tarsiincision, a technique with less chance of woundcomplications when compared to extensile lateralsurgeries. 1 While this kind of incision is not new, itsuse for calcaneal fractures in conjunction with theAcumed® MINI-Calc Plates is a revolutionary stepforward in the treatment of calcaneal fractures.The Acumed® Calcaneal Plating System is comprised of severalMINI-Calc and lateral wall plates to meet a variety of proceduralneeds. To minimize soft tissue irritation while still providing adurable construct, the Calcaneal Plates were specifically designedto be low-profile and target the best quality bone in the calcaneus.Surgeons now have more options for this complex surgery.ContentsIntroducing the System 2System Features 3Anterior Process Calcaneal Plate Technique 4Posterior Tuberosity Calcaneal Plate Technique 6Combo Calcaneal Plate Technique 8Lateral Wall Calcaneal Plate Technique 10Instrumentation and Screws 11Ordering Information 122

Surgical Technique By Steven A. Herbst, MD5PLATE INSERTION AND INITIAL FIXATION• Insert plate through incision and confirm position underfluoroscopy.• Use K-wires or plate tacks to provisionally fix the plate tothe bone.6SCREW INSERTION• Thread locking drill guide (80-0384 or 80-0385) intothe plate.• Drill and measure for screws buttressing the posterior facet.• Use yellow-banded drill (80-0386) for 2.7 mm screws andgreen-banded drill (80-0387) for 3.5 mm screws.7ANTERIOR PROCESS SCREW INSERTION• Drill, measure, and insert screws on the anterior process.Caution: Anterior screws may collide at lengths longerthan 10 mm.8WOUND CLOSURE AND POSTOPERATIVE PROTOCOL• Verify reduction and screw placement under fluoroscopy.• Close wound in layers.When X-rays indicate adequate healing, full weight-bearing isallowed, based on surgeon judgment.B5

Combo Calcaneal Plate Technique1PATIENT POSITIONING• Obtain lateral and axial views of calcaneus, as well asCT views of the sagittal and coronal planes; compare toopposite extremity.• Place patient in a lateral position with the operativeextremity facing up.2EXPOSURE AND APPROACH• Make a slightly S-shaped incision from base of the lateralmalleolus to the calcaneocuboid joint. Carry dissection downto the subtalar joint.• Retract peroneal tendons plantarly.• To improve exposure, sharply take the calcaneofibularligament.Caution: Avoid peroneal tendon and sural nerve duringdissection.3REDUCTION OF ARTICULAR SURFACE• Use K-wires and Freer elevator to reduce posterior facetfragment to the sustentaculum tali.• Ensure the Angle of Gissane is approximately 100° or equalto the opposite side.4REDUCTION OF POSTERIOR TUBEROSITY• Place Steinmann Pin lateral-to-medial in the approximatelocation shown.• Pull tuberosity out of varus and back to length using theSteinmann Pin.• Ensure Bohler’s Angle is between 25°-40°.• Verify reduction under fluoroscopy.8