Foot and Ankle Implants Rationalization

Posterior Plate

  • Post-op results are generally good.
  • Some surgeons find the plates too stout (thick).
  • Thinner plates are preferable, but strength must be maintained.

Competition

  • Discussion of competitor products is restricted.
  • Paragon plates are considered more malleable and contour better.
  • Improvement in malleability and shape could address fitment issues.

Lengths

  • Requests for longer posterolateral plates exist.
  • Rationale: desire for a single, adequate plate when the fracture extends proximally.
  • Concerns: longer plates may disrupt the distal design and not match the fibula's anatomy.
  • Preference for lateral plates in proximal fibula fractures.
  • Posterolateral plates mainly used for posterior malleolus fixation.
  • The current longest plate is considered sufficient by some.

Medial Antiglide Plate

  • The current plate is well-received but may not be suitable for all fracture types.
  • Problem: Only one size available; one size does not fit all.
  • Suggestion: Add one or two more holes to the plate.
  • Different positioning may improve outcomes for medial malleolar or distal tibial fractures.

Hook Plate

  • Issues: Hooks are not long enough and considered "wimpy."
  • Use case: small fractures at the distal fibula tip.
  • Concern: if the fracture is very small, why make the plate longer?
  • Easier to use the alternative plate for achieving compression.
  • Targeting guide is not used by some surgeons.
  • The locking peg hook plate may potentially replace the current hook plate.
  • Critique: Too thick and too big for small fragments.
  • Standard ankle three hook plate to be retained, others potentially removed.
  • Small bone fragments often involve ligaments, capsule, and soft tissues.
  • Alternative plate preferred due to ease of use and consistent compression.

One-Third Tubular Plate

  • Overwhelmingly negative feedback due to lack of locking ability and variable angle.
  • Recommendation: Replace with a locking version.

Two Seven Fragment Plates

  • No clear indication for use in the ankle.
  • Potential use in calcaneal bone.
  • Suggestion: Add holes to the current plate to create a T-shape for posterior malleolus fixation.
  • The current plate effectively reduces the fragment without extensive dissection.

Small Frag System

  • Desire for a blue ratcheting handle.

Screws

  • Generally considered adequate.
  • Issue: Surgeons unaware of separate variable angle (VA) screws.
  • Locking and nonlocking screws exist, with cobalt chrome screws offering variable angle.

Trim a Lock Ankle

  • Generally well-received.
  • Concern: Similarity to existing tibial Plafond plates.
  • If used in the distal tibia, primarily for anterior placement.
  • Longer plates are preferred.
  • Lack of variable angle is a drawback.
  • The plate includes a strut for added strength.
  • Anterolateral placement is appropriate.
  • No anteromedial option available; using the opposite side is possible but not ideal.
  • The longest plate extends to 170mm.
  • Plate thickness is adequate.
  • 2.7 and 3.5 screw options are available and specialized.
  • Suggestion: Create a dedicated distal tibia tray with all necessary options.

Other Plates

  • Osteum one-third tubular plates with locking are desirable.
  • Hook plate preferences are divided; alternative plate preferred.
  • Anterior medial option should be explored.
  • For the tibia, medial and lateral pillars are crucial for fixation; medial often addressed percutaneously.
  • Smaller 2.7 frag plates may be needed for distal tibia fragments.

Screw Options

  • Two ankle sets: one with separate VA screws, one with universal screws.
  • Screws: Omni-head, any hole, any plate.
  • The other screws are specialized for 2.7 and 3.5 systems.
  • Desire for a system with 3.5 heads and 2.7 shafts.
  • Rare indication for 4.0 diameter screws in ankle fractures, primarily used in ankle fusions.
  • Consideration of a medial tibial blade.

Set Organization

  • Tibia/pilon and fibula options should be readily available.
  • Distal tibia fracture solutions from Acumed lack a comprehensive recommendation.

Ankle Fusion System

  • Mostly negative feedback due to excessive thickness compared to competitors.
  • Competitors offer simpler designs with fewer screws.
  • The fusion system should remain separate from other systems.
  • Trauma in foot and ankle, but remove the fusion

Tibial Nailing

  • Consideration of full tibial nails for leg fractures, especially in older patients with diabetes.
  • TTC nails can be used for fusion and fracture reduction.
    • Anterior fusion plates could be improved

Fusion Plate Placement

  • Posterior plates are rarely used due to alternative approaches (anterior, transfibular, arthroscopic).
  • Anterior plates are prioritized.

Plate Design

  • The design that goes into the Yeah.
  • Anterior design requires removal of a thick part of the anterior cortex.

Screw Placement & Compression

  • Screw placement in the talus helps bring the talus up on the posterior aspect
  • The compression comes from the transfixation screws, but
    • Need to shape the bone to fit the plate

MTP Fusion

  • Transarticular screws
  • The thing that is great from this plate is that you can put, like, four

Fibula Nail

  • Proximal locking screw on a regular basis.

Fibula

  • The idea is perfect
  • FN1 and FN2 screw, the locking and non-headed is perfect

Blades

  • Are they still the leader?

Snydismosis

  • Expensive
  • Has a Nautilus device
  • Good device but price is the issue

Sutures

  • Five Five and four five? Five five is rare
  • Three fine and Four Fine
  • Use PEEK suture
  • Preference peek on X-Ray

Calcaneal Plate

  • Calcaneal Plate
  • Better than the Acumid Calcaneal
  • Nobody is doing it
  • Need variable angle

MTP Plate

  • Is the same
  • to thick- thinner plate
  • The Extra Plates - is better

Screws

  • Make it Omni Heads
  • Mix between 2.7 -3.5
  • Latinos concept

Foot Fusion

  • Five Degree of Valgus- or left/ right