Open ankle arthrodesis using Ankle Fix 40 plate (Zimmer-Biomet)
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Ankle arthrodesis is an established treatment for painful, end-stage ankle arthritis. Over the last century, a number of operative techniques have been popularised, with modifications reflecting technological advances. These have ranged in methods of fixation from the Charnley external clamps through to all manner of crossed/parallel screw fixation techniques.
However, managing deformity, poor bone quality or bone loss remain difficult issues to resolve using traditional techniques. As a result, biomechanical studies into the properties of angle-stable devices such as blade plates and non-anatomic locking plates have found some mechanical advantages over screws in stabilising an ankle arthrodesis, thus potentially offering a solution. Therefore, in Sheffield, Mr Mark Davies and Mr Chris Blundell developed a new anatomically contoured, fixed angled lateral locking ankle arthrodesis plate – the Ankle Fix 4.0. Manufactured by ZimmerBiomet, we have successfully used this device for open ankle fusion surgery especially in more challenging clinical situations. The rationale behind the plate design was formed after both authors had gained experience using an inverted PHILOS plate. It was felt that a set of divergent screws within a low-profile talar section would offer a significant pull-out strength in cancellous bone and similarly that convergent screws in the tubular, cortical bone would provide robust tibial fixation. These screws were specifically designed to be 4.0 mm in size to allow clustering of the screws which contrasts with the larger, less versatile plate designs that were on the market at the time of design in 2009.
With limited literature on the wealth of new locking ankle fusion plates, the plate designers present these results and discuss their large series in the December 2017 issue of the journal Techniques in Foot and Ankle Surgery.
Author: Mark Davies FRCS (Tr & Orth)
Institution: The Northern General Hospital ,Sheffield ,UK.
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Question 1 of 14
Which one of the following techniques is not a recognised method of achieving an isolated ankle arthrodesis?CorrectIncorrect
Question 2 of 14
In considering using a locked ankle arthrodesis plate, in which one of the following clinical situations would it be least necessary?CorrectIncorrect
Question 3 of 14
Which one of the following would be least appropriate as a long term treatment of end-stage ankle arthritis?CorrectIncorrect
Question 4 of 14
In preparing the patient for surgery in the operating room, which one of the following options is not considered mandatory in order to perform an ankle arthrodesis with an Ankle Fix plate?CorrectIncorrect
Question 5 of 14
When performing the dissection through skin towards to fibula, which one of the following structures is most at risk of iatrogenic injury?CorrectIncorrect
Question 6 of 14
After resection of the fibula, which one of the following vessels is worthwhile identifying and cauterising?CorrectIncorrect
Question 7 of 14
Which one of the following features is not integral to the design of the lateral Ankle Fix 4.0 plate?CorrectIncorrect
Question 8 of 14
Which one of the following options is not a recommended step in seating the Ankle Fix plate against the arthrodesis site?CorrectIncorrect
Question 9 of 14
When preparing the joint surfaces for a domed arthrodesis with a flexible chisel, which one of the following statements is incorrect?CorrectIncorrect
Question 10 of 14
Which one of the following is not considered as one of the optimal parameters in the position of an ankle arthrodesis?CorrectIncorrect
Question 11 of 14
When applying the “home run” screw, which one of the following is not appropriate?CorrectIncorrect
Question 12 of 14
After insertion of the “home run” screw, which one of the following statements is not true when applying the lateral Ankle Fix plate?CorrectIncorrect
Question 13 of 14
When using the external compressor, which one of the following statements is not true?CorrectIncorrect
Question 14 of 14
When considering the use of plating techniques for primary ankle fusion, which one of the following statements is not true about using fixed angle locking plates?CorrectIncorrect