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

1. 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 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 identifed 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, partially- threaded screw was then inserted across the plantar medial NC joint in order to obtain initial static compression and prevent any plantar gapping. • 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 confgurations offers superior compression and strength2,3 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. 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). INDICATIONS Primary arthrodesis of the NC joint in the absence of infection, fracture, or nickel allergy. 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 2. Final intra-operative AP and lateral radiographs Figure 1. Pre-operative AP and lateral radiographs

2. DYNACLIP FORTE® 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. 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 frst time in a year. 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 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. 2. MedShape Research & Development. In Vivo Compression Performance of MedShape DynaClip Forte Bone Fixation System [White Paper], 2020. Oliver Schipper, MD is a board-certifed 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. 1575 Northside Drive NW Suite 440 Atlanta, GA 30318 T: 877-343-7016 F: 877-343-7017 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. CAUTION: Federal (USA) law restricts this device to sale by or on the order of a physician. ©MedShape, 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.