New Plate And Screw System May Facilitate Improved Fracture Repair

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By Robi Garthwait, Contributing Editor

     Foot and ankle surgeons may have yet another option for rearfoot reconstruction. The CalFix™ Calcaneal Plate and Screw System is indicated for fractures and osteotomies of the calcaneus including, but not limited to, extra-articular, intra-articular, joint depression, tongue type and severely comminuted fractures, according to its manufacturer OsteoMed.      The system features titanium alloy screws, either locking or non-locking, and titanium plates in lengths of 56 mm, 65 mm and 74 mm with a thickness of 1.0 mm at the webs to 1.4 mm at the screw holes. Plates have 14 holes, each with locking abilities. Depending on the plate size, there are four or five guide wires available, according to OsteoMed.       “My experience with the CalFix system has been very positive,” notes Keith Cook, DPM, the Director of Podiatric Medical Education at the University of Medicine and Dentistry of New Jersey. “Applying the calcaneal plate and screws has been relatively easy and the fixation has been solid.”      Ritchard Rosen, DPM, the Chief of Podiatric Surgery at Holy Name Hospital in Teaneck, N.J., agrees.       “The construct of the plate makes for ease of placement across the fracture fragments due to the large number of holes. This allows for flexibility of placement of the plate as well as screw placement to obtain maximum rigid internal fixation,” says Dr. Rosen.

What Are The System’s Advantages?

Both Drs. Rosen and Cook point to the CalFix system’s low profile as a key advantage.       “This product is unique because of its extremely low profile, which, in my opinion, helps to decrease the likelihood of soft tissue irritation and wound complications,” offers Dr. Cook.      He also points out that the system’s low profile allows for easy contouring to the shape of the calcaneus while reducing the lateral wall blowout often associated with joint depression calcaneus fractures. Dr. Rosen says he has seen a decrease in postoperative peroneal tenosynovitis due to the device’s low profile.      Dr. Cook cites the beneficial placement of the screw holes. He also points out that the availability of the calcaneal plate in various sizes is advantageous for accommodating a variety of fracture patterns or fragments that surgeons may encounter.       “Studies have shown that the polyaxially locked screws provide greater stability than uniaxial screws,” maintains Dr. Cook. “They also allow screw angulation, which may be necessary when reducing and fixating calcaneal fractures.”

Other Pertinent Points

     Dr. Rosen acknowledges that the current trend is for all calcaneal plates to be low profile with locking screws due to the anatomical makeup of the calcaneus.      However, Dr. Cook feels that the CalFix system’s unique features make it superior to other products that are currently available.       “This system is an improvement upon calcaneal plating systems previously placed on the market,” notes Dr. Cook. “I would recommend this product for any surgeon who treats intra-articular joint depression calcaneal fractures.”      Dr. Rosen can cite no specific disadvantages regarding the product. However, he notes that, similar to the use of other plates, one should avoid combining the use of titanium and stainless steel.      On the rare occasion that one would need to shorten a plate or remove screw holes, Dr. Cook admits “it can be difficult to cut the plate flush with a screw hole without leaving a sharp edge.” However, one can prevent this by utilizing a smaller plate or rasping the cut edge, according to Dr. Cook. Ms. Garthwait is a freelance writer who lives in Downingtown, Pa.

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