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Proximal Tenodesis Kit for Unicortical Biceps Tenodesis

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proximal tenodesis kitThe Proximal Tenodesis Kit is an excellent option for subpec biceps tenodesis, particularly for unicortical button fixation since the smaller implant size allows for easier deployment in the intramedullary canal. 

The Proximal Tenodesis Kit  includes: 

  • Proximal Tenodesis Button on a threaded inserter
  • 3.2 mm Drill Pin
  • #2 FiberLoop
  • Free Needle with a Nitinol loop
  • Shoehorn Cannula


The 2.6 mm x 8.5 mm Proximal Tenodesis Button has the same angled edges as the Pec Button, which helps promote a toggle effect when the button contacts the opposite cortex, but it is 2.5 mm shorter to help flip in the canal of smaller patients. The sutures can be loaded into the button to perform the tension slide technique, which makes drawing the biceps tendon onto the humerus easy and reliable.

Arthrex Inc. and Parcus Medical, LLC Settle Trade Secret and Patent Infringement Litigation

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FOR IMMEDIATE RELEASE
Contact: John Schmieding, VP Legal Counsel
239-643-5553
John.Schmieding@Arthrex.com


Arthrex Inc. and Parcus Medical, LLC Settle Trade Secret and Patent Infringement Litigation

NAPLES, FL – August 26, 2014 – Arthrex and Parcus have been involved in litigation in which Arthrex has asserted the unlawful taking of Arthrex’s patented and trade secret technology in the field of orthopedics. As part of the settlement, Parcus acknowledges that certain ex-Arthrex employees took proprietary information, including product manufacturing programming and manufacturing know-how, from Arthrex relating to Arthrex products and that this information was found in Parcus’ possession without Arthrex’s authorization. The parties have agreed on remedial measures, including purging of the Arthrex proprietary information from Parcus and compensation to Arthrex.

Parcus further acknowledges that certain Parcus drill guides use the patented technology in Arthrex’s United States Patent No. 5,993,451. Parcus acknowledges that this patent is valid, and regrets the use of this technology without Arthrex’s authorization.

In matters unrelated to the litigation between the parties, Parcus also admits that some of its products use Arthrex’s technology in United States United States Patent No. 8,343,186, United States Patent No. 8,623,052, and United States Patent No. 8,801,755. Parcus has now agreed to pay a royalty for the use of the patented features in these patents.

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Mini Suture Cutter

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MiniSutureCutter
The new Mini Suture Cutter was designed to fit through the 2.9 mm PushLock® Metal Cannula. The metal cannula allows for percutaneous placement of the 2.9 mm PushLock for labral repairs and transtendinous insertion of the 4.5 mm PEEK and Bio-Corkscrew® FT Suture Anchors for the repair of PASTA lesions.

This Mini Suture Cutter eliminates the need to switch portals to cut suture tails. With the release of this new device, we have completed the instruments needed to pass, retrieve and cut sutures through the 4.7 mm inside diameter cannula. This Mini Suture Cutter also provides the opportunity to cut two LabralTape tails at once.

Minimally Invasive Quad Tendon Harvest System

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cutterQuadricep tendon grafts offer unique benefits for cruciate ligament reconstruction such as a predictably large diameter, low morbidity and a preferable stiffness profile for knee ligament reconstruction.

The Minimally Invasive Quad Tendon Harvest System was designed based on published anatomic studies. It allows surgeons to safely harvest a graft of a desired length and diameter through a small incision in a time-efficient manner. The system has the versatility to create grafts to meet the surgeon’s needs whether it be all soft tissue, bone soft tissue, all-inside or transtibial.
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Knotless Hip Labral Reconstruction Kit

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Knotless Hip Labral Reconstruction Kit
Arthroscopic acetabular labral reconstructions are typically done in revision hip arthroscopy where a labrectomy was previously performed or the labral tissue is degenerative and no longer amenable to a repair. Complete with an arthroscopic measurement probe to measure the segmental labral defect, the Knotless Hip Labral Reconstruction Kit provides surgeons the necessary sutures, implants and instruments for the procedure in a convenient single package.

Arthrex's Innovations in Foot & Ankle Cadaver Lab September 21 at IFFAS/AOFAS Annual Meeting

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AOFASArthrex's Innovations in Foot & Ankle Cadaver Lab will take place on September 21 from 2:30 p.m. to 4:30 p.m. during this year’s IFFAS/AOFAS Annual Meetings at the Hyatt Regency Chicago. The workshop will feature presentations on Achilles Midsubstance SpeedBridge by Dr. James McWilliam, InternalBrace Ligament Augmentation Repair by Dr. Troy Watson, Ankle Fusion Plating by Dr. Anand Vora and the Deltoid Ligament Reconstruction Implant Kit by Dr. George Lian. 

Participants will leave with knowledge of the best practices in foot and ankle surgery innovations from Arthrex and will have the opportunity to experience hands-on training in the cadaver lab following the presentations. The course format consists of lectures, case discussions, hands-on labs and question and answer sessions. For more information and to register, please contact your local Arthrex representative.

Arthrex Senior Clinical Specialist George Rego Named 2015-2016 President of Florida Academy of Physician Assistants

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George RegoSenior Sports Clinical Specialist George Rego, MPH, PA-C, has been named the 2015-2016 President of the Florida Academy of Physician Assistants (FAPA), the statewide professional association of PAs. FAPA's 7,000 members accomplish joint professional goals of continuing medical education, communications and legislative advocacy. 

As a senior clinical specialist within Medical Education, George
 teaches orthopaedic surgical techniques to surgeons from around the world in the Arthrex Surgical Skills Lab. He is also responsible for training the sales force to serve as technical consultants in the operating room environment. 

"It is an amazing honor for a truly amazing person," said Medical Education Director Chris Adams. "We're very proud of George and what exceptional people we have here at Arthrex!" 

For six years, George garnered top-tier experience in the field of orthopaedic surgery while working with Dr. Leon Mead. During his tenure with GulfCoast Orthopaedic Specialists, George assisted in over 5,000 surgical procedures, which included, total knee/hip replacements, arthroscopic rotator cuff repairs, and Anterior Cruciate Ligament (ACL) reconstruction, among many other procedures. During that time, George also provided medical coverage for the Barron Collier High School Football program and helped organize volunteers for an annual event where physical exams were given at no cost to athletes with financial need.  

Better healing for torn Achilles' tendon with minimally-invasive surgery


What's In My Bag? Compression FT Screws with Steven Shin, MD

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Dr. Steven ShinQ. What made you decide to use headless screws over a four-corner fusion plate for a four-corner fusion? 
A. I used different four-corner fusion plates for several years and was never completely satisfied with the results, especially with the nonunions. I also did not like the large amount of dorsal reaming required to make the concave recess necessary for placement of the plate. With the excellent compression provided by Headless Compression Screws, their ease of placement and their completely buried locations within the carpal bones, I quickly made the transition to using them for intercarpal fusions, including four-corner fusions. I have been very pleased with the results. Nonunions have become very rare in my experience with these screws and even when they do occur, they are often times not painful due to the rigid fixation provided by the screws.

Q. What is your preferred placement for these screws? 
A. For four-corner fusions, my preferred placement is as follows: one retrograde 3.5 mm screw across the capitolunate joint (with a starting point at the dorsal base of the third metacarpal), one ulnar-volar to radial-dorsal 3.5 screw across the lunotriquetral joint and one ulnar-dorsal to radial-volar 3.5 mm screw across the triquetrum-hamate-capitate joints. An alternative construct is using four screws, one for each of the intercarpal joints, but I’ve found that three screws do just as well.

screwsQ. Are there any advantages with the new Compression FT Screws over screws that you were previously using?
A. The Compression FT Screws provide excellent compression and fixation, similar to other Headless Compression Screws that I was using before. One advantage I saw immediately when using the screw for the first time was that the guidewire did not become stuck and routinely come out with the cannulated drill bit after drilling. This saves time and money. I did not have to fiddle with trying to find the drill hole with a new guidewire and I did not have to ask for a new drill bit for the next screw. Another advantage is the star-drive design of the screw head, which allows for increased torque with the screwdriver and less risk of stripping. The straight outer diameter, or nonconical shape of the screw, is another advantage. If you end up undersizing or oversizing the length of the screw, you can insert the same diameter screw with a different length and still get excellent compression and fixation. The straight diameter drill bit means that you’re not obligated to leave the screw in or go to a larger diameter screw.

Q. How have your results been after your first few cases?
A. My results after my first few cases using the Compression FT Screws for four-corner fusions have been great. No nonunions, no loose screws, and very satisfied patients! 

Q. What is your post-op protocol for this case?
A. Due to the excellent compression and fixation with these screws, I allow gentle active range of motion (ROM) (no passive) after the first postoperative visit (7-10 days after surgery). I give the patient a wrist orthosis they can remove for bathing and exercises. I allow passive ROM and strengthening once I see evidence of bony union on radiographs or CT scan, around 6-8 weeks postoperatively.

Q. What are some other indications for which you would use Headless Compression Screws? 
A. I use Headless Compression Screws for a number of other indications in the hand and wrist, including scaphoid fractures, radial styloid fractures, large ulnar styloid fractures (with DRUJ instability), other intercarpal fusions, and thumb and finger fusions. Specifically with the Compression FT Screws, I’ve used them across the scapholunate (SL) joint for chronic SL ligament tears (without arthrosis) and lunate dislocations (one across the SL joint and one across the LT joint).

Distal Radius Wrist Plating System

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Distal RadiusThe Wrist Plating System provides a comprehensive solution for distal radius fracture management. A wide array of plates are available in narrow, standard, and wide, as well as multiple shaft lengths. A variety of screw fixation options, aiming guides and instrumentation allows for customization according to the surgeon’s needs, and the complexity of the fracture – developed to provide the answer to all your distal radius fixation needs.

Advantages:
  • Anatomic – Plates are developed to fit the anatomy and contours of the distal radius for a low profile repair and anatomic reduction of the fracture.
  • Comprehensive– In addition to a comprehensive plate selection, multiple screw options are available including fixed angle locking, variable angle locking and nonlocking options.
  • Options– Fracture patterns pose unique challenges and the variety of fixation options included allow multiple solutions for even the more complex fracture patterns.
  • Straightforward Instrumentation – The instrumentation for the 2.4 and 3.5 mm screws are easy to identify in specific modules. The screws sit in a graduated tray to ensure the proper length is given to the surgeon, reducing the time needed to measure screws by hand.

Surgical Tips and Pearls: CMC Mini TightRope and SLAM

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CMC Mini TightRope

CMC SLAMDrilling with the C-Ring Guide– To avoid skiving while holding the C-Ring guide in place, first insert the K-wire in the approximate trajectory wanted in the base of the thumb. The guide can then be assembled on and around the K-wire. Advance the K-wire with the help of the C-Ring Guide to achieve the correct trajectory.

Drilling Freehand– It is often easier to drill from the second metacarpal to the base of the first metacarpal. By drilling in this direction, the knot stack will be on the base of the thumb. The best way to avoid soft tissue irritation is to bury the knots under the APL.

Placing the Mini TightRope– To make sure that the thumb is maintained in an anatomic position, place the Mini TightRope before performing the trapeziectomy. Throw two to three provisional knots on the Mini TightRope, perform your trapeziectomy, and verify the tension of the construct. Proceed with tying down the last few knots or loosen and adjust the tension.

A good rule of thumb for tensioning is to place Kelly forceps under the second button and tie over it. This will prevent overtightening the construct.

SLAM

Drill Separately– The two holes in the lunate and the scaphoid can be drilled independently as well as with the SLAM guide. Place one K-wire perpendicularly into the dorsal side of the lunate and another into the scaphoid. Using these two K-wires as joysticks, open up the scapholunate joint and visualize the articular surface of the lunate. Using the stepped drill, drill into the center of the lunate until you feel the second cortex and stop. 

Insert the graft anchor loaded with the Palmaris longus graft and optional LabralTape into the lunate hole. The LabralTape provides extra strength and prevents any elongation of the graft. Tap the graft anchor into the undersized hole until seated firmly.

Visualize the articular surface of the scaphoid. Aiming for the center axis of the scaphoid, drill completely through both cortices until the larger stepped part of the drill exits radially.

Using a tendon passer or a Nitinol wire, pass the Palmaris suture tails exiting the lunate through the scaphoid from the ulnar pole to the radial pole. Secure with a 4 mm Tenodesis Screw and continue the procedure as outlined in the surgical technique.

Arthrex Announces Jim Hamer as 2014 Presidential Leadership Award Recipient

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This year's Annual Leadership Dinner, held on Tuesday, September 17, 2014, provided a special opportunity for the senior management team to gather together and reflect on the many accomplishments of their teams over the past year. Arthrex is fortunate to experience continued growth and success throughout the world, and this is a direct result of the hard work and enthusiasm of each of our dedicated employees. 

During the Leadership Dinner, the Presidential Leadership Award is presented to an individual who has achieved excellence and demonstrated three key qualities throughout the year: leadership, dedication and contribution. 
While so many are deserving of this esteemed award, Jim Hamer, Global Director of Quality Assurance and Regulatory Affairs, was selected to receive the 2014 Presidential Leadership Award. Arthrex Founder and President Reinhold Schmieding personally presented Jim with the award while sharing the highlights of his outstanding career accomplishments at Arthrex.  
Jim Hamer and Reinhold Schmieding
"As the leader of Arthrex's Quality Assurance team for more than 12 years, Jim has built the department from a handful of engineers to a global team of more than 75 Quality and Regulatory team members," said Reinhold. "Jim has consolidated all of the individual Quality Systems at all of the Arthrex facilities into a single, global Quality Assurance System, all reporting in through him and his team. Jim is tireless in his efforts to continue to improve and streamline the Global QA Systems, and the savings in manpower and resources, both internally and externally, we've seen under his leadership are almost immeasurable." 

Jim is responsible for all global QA/RA activities at Arthrex, and has led many successful compliance audits from the U.S. FDA, BSi (CE Mark Notified Body), and the regulating government agencies of Japan, Korea and Brazil. Most recently, under Jim's leadership, Arthrex volunteered to be the first company to host a joint audit as part of a pilot program between the U.S. FDA, the European Union, Canada, Australia, and Brazil.  

Congratulations to Jim on his 
many accomplishments and well-deserved recognition! 

Arthrex looks forward to recognizing many more loyal 
employees who will be celebrating their 5, 10, 15 and 20 years of service at an awards ceremony on Tuesday, October 7, 2014.

What's In My Bag? CMC TightRope with Jeffrey Yao, MD

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Dr. YaoQ. How long have you been using the Mini TightRope for CMC arthritis? 

A. Six years 

Q. What are the overall benefits of using the TightRope versus a more traditional ligament reconstruction tendon interposition (LRTI) or hematoma distraction arthroplasty?

A. By using the TightRope, I don’t have to wait for soft tissue reconstruction to heal (LRTI, APL suspensionplasty) and I also don’t have to leave any external K-wires to maintain the trapeziectomy space (hematoma distraction arthroplasty). Therefore, I can initiate a rehabilitation protocol as early as 5–7 days after surgery with this implanted device, maintaining my trapeziectomy space. CMC Mini TightRope 

Q. What type of patient is the TightRope indicated for?

A. Any patient with thumb carpometacarpal joint arthritis that fails nonsurgical treatment measures (such as splints, injections, activity modifications and therapy).

Q. How has this changed your post-op protocol? 

A. This device has been a game changer for me because instead of immobilizing my patients for four weeks (with or without an external K-wire), I am able to accelerate the post-op protocol by starting it 5–7 days following surgery. I don’t start therapy immediately because I do believe a week is appropriate to allow the skin and other soft tissues to heal, but I suppose immediate therapy would be ok as well with this technique.

Q. How many patients have you performed this procedure on?

A. Over 50.

Q. How have your patients responded to the CMC Mini TightRope in contrast to previous technique options? 

A. The overall recovery is much faster with this technique. Typical full recovery is around three months as compared to 3–6 months or more for my previously-preferred techniques (arthroscopic hemitrapeziectomy and pinning for four weeks or APL suspensionplasty). It has been most telling in my patients who had one of those previous procedures on one thumb and then had the TightRope suspensionplasty on the second thumb and they have been universally happier with the TightRope procedure because of the decreased recovery time.

Arthrex Proudly Commits to Three-Year Sponsorship of Naples Equestrian Challenge

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NECAs a long-standing supporter of the Naples Equestrian Challenge (NEC), Arthrex is proud to announce it has recently become the nonprofit organization's Champion Sponsor with a three-year commitment to NEC's existing programs and events. In addition, Arthrex has made a substantial donation to NEC's Barn Raising Capital Campaign to fund its much needed expansion. 

Naples Equestrian Challenge, Inc., based in Naples, FL, has a mission of improving the lives of children and adults with special needs through therapeutic riding and other equine-related programs.  

“We are proud to support and partner with Naples Equestrian Challenge as the organization’s mission aligns well with Arthrex’s overall commitment to the health and well-being of our community,” said Lisa Gardiner, Arthrex spokeswoman and a member of the Arthrex Charitable Committee.

NECArthrex has applied its expertise in orthopaedics and biologics for humans to develop more than 100 products for treating horses and dogs through its Arthrex Vet Systems division, which manufactures treatments for conditions that often affect NEC’s therapy horses, such as arthritis and soft tissue injuries. Over the last few years, a representative of Arthrex has regularly visited NEC to administer the Arthrex ACP and IRAP II injections to the NEC therapy horses that need them.  

“Without Arthrex’s commitment to and compassion for NEC’s therapy horses, NEC would never be in a position to afford these highly beneficial treatments,” said NEC Executive Director Kim Minarich. “The Arthrex ACP and IRAP II injections ensure that our horses can comfortably carry out their therapy work with our riders with special needs.”

The ACP treatment delivers a high concentration of plasma rich platelets to soft tissue injury sites, increasing the amount of growth factors which help the injury heal. The IRAP II is an anti-inflammatory therapy that blocks one of the major inflammatory substances the body releases in the event of injury or arthritis.

To learn more about Arthrex Vet Systems, visit www.ArthrexVetSystems.com. For more information about NEC, visit www.NaplesEquestrianChallenge.org.

The ScaphoLunate Axis Method (SLAM)

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Scorpion2
The ScaphoLunate Axis Method (SLAM) reconstruction is performed with the Graft Anchor Implant Delivery System. It is indicated for dynamic and static scapholunate instability where there is inadequate ligament to repair, the carpal cartilage is preserved (no arthrosis), and the carpus is reducible. The two-tailed tendon graft is fixed in the lunate bone and scaphoid bone to minimize the creep (“bungee-cord effect”) of the graft.The remaining tendon graft is fixed to the dorsal aspect of the carpus, thus reconstructing the scapholunate ligament from inside and outside the carpus. This reconstruction not only addresses the dorsal scapholunate ligament, but also restores the scapholunate articulation along its axis. 

Arthrex Recognizes Employees for Years of Service with Special Honoree Charlie Cremin Celebrating 20 Years

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Arthrex hosted its annual Years of Service awards ceremony for Inc. and AMI on Tuesday, October 7 and recognized an impressive total of 118 employees celebrating five years of service, 21 employees celebrating 10 years, eight celebrating 15 years and an amazing 20 years of service from one employee everyone knows and loves - Maintenance Technician II Charlie Cremin!   

Charlie CreminDuring Reinhold's presentation of Charlie's Years of Service plaque, he spoke from his heart about how he met Charlie more than 20 years ago on a fishing charter that Charlie was working on at the time. Charlie asked Reinhold if there might be a job at Arthrex for him and Reinhold gave him his business card. A year later, after meeting Reinhold again on his charter, Reinhold hired Charlie on in inventory and the rest is history. Over the years, Charlie has held several jobs at Arthrex, including working in Receiving driving a forklift, assembly in the machine shop, performing maintenance duties on the facilities team and in recent years, Charlie has taken on the role of lead shuttle driver for employees and guests traveling between buildings on the Inc. campus. 

"Charlie is the best ambassador for Arthrex with his friendly demeanor and warm smile," said Reinhold. "Throughout his 20 years at Arthrex, he has always come ready to work with a smile on his face each day. Charlie knows just about all of our employees and always does his best to make the shuttle ride fun and enjoyable, including telling our guests about the history of Arthrex."    

Charlie's knack for names is in fact, inspired by Reinhold.  

Charlie Cremin and Reinhold Schmieding"It's been a pleasure working with Reinhold - he's always led by example. I've learned from Reinhold the importance of being personable, being a good listener and remembering people's names. Just to see his work ethic and drive over the years has been amazing." 

It seems Charlie has also learned from Reinhold that persistence pays off. Reinhold shared how impressed he was that when Charlie took his 20-year trip to Europe over the summer, he made it a point to stop by the new GmbH office in Freiham, Germany and waited for two hours to see him while Reinhold was in a meeting.  "I would have waited a lot longer," says Charlie. "It's always been a goal of mine to see Germany and it was an exciting time to be there with the new office opening." 

Charlie says what he has liked best about working for Arthrex over the last 20 years is he's had the opportunity to do a wide variety of jobs and has gotten to meet so many guests and people at all levels in the company – from new hires to VPs.

Since last January alone, 
Arthrex has already 
hired 367 new employees and we look forward to celebrating the success of many more employees in the years to come. Thanks to all Arthrex employees for their dedication to Arthrex and for the contributions made each and every day to healthcare product innovation and Making People Better.  

Arthrex Presents at Collier County Schools iSTEM Conference

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Maria HernandezArthrex was honored to take part in Collier County's 4th Annual iSTEM (Science, Technology, Engineering, Math) Conference once again this year on Saturday, October 11, with presentations from Arthrex Manufacturing HR Content Designer Maria Hernandez and Sterilization Engineer Beau Rollins.  

More than 400 teachers, parents, students, community members and school district staff participated in 35 exciting break-out sessions where they got hands-on with science, technology, engineering and math. Participants engineered robots, built solar cars, learned about sustainable gardening, integrated the arts into STEM, and so much more. Students from high school career academies also demonstrated their STEM-related work. 

Click here to view the iSTEM Conference's video footage (Maria and Beau's presentation is at the two-minute mark).  

Thank you to Maria, 
Beau and Arthrex Manufacturing HR Manager Mike Boose who has presented at iSTEM in the past, for representing Arthrex so well and bringing to life why STEM education is so important for students' futures.   

Collier County Honor Flight Oct. 25 - Join Arthrex in Helping to Welcome Veterans Home!

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Honor FlightOn Saturday, October 25, Collier County Honor Flight (CCHF) will take off on its fourth mission, bringing 50 WWII and Korean War Veterans to Washington, D.C. to visit the monuments erected in their honor with help from Arthrex. Arthrex, along with Moorings Park, is sponsoring this mission and will be well-represented. In addition to CCHF Secretary Linda Valentine, Arthrex Executive Chef William Blum, Director of Arthroplasty, Finance & Business Development Derrick Romine and Derrick’s wife Karen will be going as guardians. Also for the first time, CCHF will be taking a select group of local ROTC students, including Database Administrator Bill Canfield’s son Will, as guardians and honor guards. Once again Arthrex Photographer Chris Toalson will be the flight’s official photographer, and Southern Hemisphere team member Marli Carvalho will be doing her second stint as a volunteer assisting veterans and guardians with their tickets and getting safely on the flight.

Guardians are volunteers who are assigned to escort a veteran from the 4 a.m. start to the 10 p.m. landing. They play a critical role for the veteran during the day as the veterans of this era range in age from late eighties to early nineties. Throughout the day, a guardian sees to their veteran’s every need, taking them from place to place, often by wheelchair, listening to colorful stories of the war and forging what often becomes a life-long friendship with the veteran.   

As a Gulf War Veteran, Derrick Romine knows first-hand the sacrifices these veterans have made and is thrilled to be a part of this fourth mission, along with his wife Karen. The Romines traveled the world during Derrick’s active duty with the Air Force and Derrick remains in service today as a dedicated member of the United States Air Force Reserve. 

This will be the first trip to include local ROTC students. Bill Canfield and his family attended the third mission's Welcome Home Celebration at Southwest Florida International Airport (RSW) where his son Will got a taste of the Honor Flight experience. Along with guardian activities, ROTC students will participate in a wreath-laying ceremony at the Tomb of the Unknowns at Arlington National Cemetery and Bill reports his son is excited and honored to be part of the upcoming trip. 

Honor FlightThe Welcome Home celebration at RSW is the perfect ending to a perfect day for the veterans, and something every Arthrex team member and family is welcome to participate in. For veterans and their families, the Welcome Home is often the highlight of  the day and the memory they most treasure. Open to the general public, entire families return time and time again to this moving display of gratitude and patriotism. Veterans are often moved to tears by the children who stay up long past their bedtime who stand and salute, shake hands and wave flags. It is a sight to behold and an experience no American family should miss! 

Click here to view a slideshow from the last Honor Flight by the Knights of Columbus. For more information on Collier County Honor Flight, please visit www.CollierHonorFlight.org.

What's In My Bag? 3.5 mm SwiveLock with Steven Lee, MD

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LeeQ. What made you start using the SwiveLock anchor for scapholunate dissociations?

A. Currently, treatments of scapholunate dissociations are suboptimal and often unsatisfactory. Direct repairs are rarely successful and typically fall apart so we rely on a secondary procedure like a capsulodesis to help control DISI deformity. Therefore, a reconstruction makes more sense. However, current reconstructions are either too complex to perform or have weak fixation strength. SwiveLocks are easy to use and have unbelievably strong fixation strength, allowing the tendon to heal into the bone as opposed to the surface of the bone.

Q. Can you describe your operating technique when using these SwiveLocks?

SwiveLockA. The operative technique entails using a tendon graft to reconstruct the dorsal portion of the scapholunate interosseous ligament as well as to control the relationship of the lunate to the distal pole of the scaphoid. After restoring the DISI deformity to normal alignment using K-wires, the tendon graft along with a 2-0 FiberLoop is dunked into the proximal pole of the scaphoid with a modified 3.5 mm PEEK SwiveLock. Both the tendon graft and the FiberLoop are dunked into the lunate and secured with another 3.5 mm SwiveLock. Then the graft and FiberLoop is dunked into the distal pole of the scaphoid with a third SwiveLock. The tendon graft is reinforced with the double-stranded 2-0 FiberLoop as an internal brace to provide extra fixation strength during the time that the tendon graft is healing into the bone. I have been leaving the K-wires in for added provisional fixation, and taking them out at about six weeks.

Q.What are a few of the significant advantages over current techniques you have tried?

A. The advantages of this technique are that it does not rely on the healing of the native ligament which in my mind usually does not heal after a direct repair (sort of like an ACL). Therefore, it can be used acutely or chronically as long as significant arthritis hasn’t set in and the carpal bones are still reducible. Also, this repair is super strong — much stronger than anything I am currently using, and this reconstruction addresses not only SLIL, but also the flexion of the scaphoid and the extension of the lunate. Finally, it’s relatively easy and fast to do. Typically this surgery takes about 30-45 minutes to perform.

Q.What is your post-op protocol?

A. I put the patient into a plaster thumb spica splint immediately post-op, then change them over to an orthoplasty type thumb spica splint, which stays on until about six weeks post-op. I take out the K-wires and start on a hand therapy program that typically goes for about six weeks.

Stainless steel wire versus FiberWire suture cerclage fixation to stabilize the humerus in total shoulder arthroplasty

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Source: Journal of Shoulder and Elbow Surgery Volume 23, Issue 10, Pages 1568–1574, October 2014
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