At The LV Foot Surgeons we like to stay at the cutting edge of all things Podiatry. Whether it is a new innovation, research or daily tips, we want to keep you in the know. Today we are going to talk about a revolutionary new innovation in minimally invasive bunion surgery. The Nanoplasty™ 3D Bunion Correction® System offers a consistent 3D correction for bunions, using a small, concealed incision on the side of the foot for a more aesthetic outcome. Dr. Vieira is the first podiatrist in Nassau County to successfully perform a bunion correction using this procedure.
Nanoplasty™ 3D Bunion Correction® – Key Steps
The Nanoplasty™ procedure is designed to deliver a repeatable 3D correction of the bunion deformity through a cosmetically appealing, hidden incision on the side of the foot.
Step 1: Surgical Approach
Use a K-wire under lateral and AP fluoroscopy to mark out the medial, longitudinal axis of the 1st metatarsal and the osteotomy site at the metadiaphyseal junction. Insert a K-wire into the intersection of the skin markings. Use the Cut Guide to mark a longitudinal incision. Ensure that the “P” on the Cut Guide is proximal and the “D” is distal. Make a longitudinal incision over the skin marking, then slide the Cut Guide over the K-wire and align with the long axis of the metatarsal. Use a 1.6mm K-wire to pin proximally and a 2.2mm K-wire dorsally and make a complete transverse osteotomy with the sagittal saw.
Step 2: Implant Insertion
Use the Broach or tapered instrument to prepare the metatarsal shaft for implant placement. Insert the implant into the intramedullary canal, ensuring the Inserter is fully seated on the medial edge of the osteotomy and in line with the metatarsal shaft. Tighten the Positioner Cup to stabilize the Inserter and align the implant. The distal portion should be parallel to the 2nd metatarsal shaft to ensure avoidance of hardware palpability. Insert a K-wire through the Positioner Cup. Confirm positioning of the implant and Inserter utilizing AP and lateral fluoroscopy.
Step 3: Translational Correction
Translate the capital fragment to the desired lateral position by turning the Gold Translation Screw using the T8 driver. Once in the desired position, insert the Tail Tack through the Inserter for further stabilization.
Step 4: Rotational Correction
Insert a K-wire into the capital fragment and rotate to gain correction. If using the Rotation Guide, attach it to the Inserter and engage the 2.2mm K-wire. Rotate the metatarsal head to the desired position. Utilize fluoroscopy, AP and lateral, to confirm sesamoid position and ensure alignment of the dorsal and plantar cortices. Once appropriate rotation is achieved, pin the capital fragment by placing two 1.6mm K-wires through the temporary fixation holes in the Inserter.
Step 5: Capital Fragment Fixation
Slide the Drill Guide over the post of the Inserter. Drill the dorsal hole first, then the plantar hole leaving the drill inserted. Place an appropriate size locking screw (e.g. 10mm) in the dorsal hole. Remove drill from the plantar hole drill and place an appropriate size locking screw (e.g. 18mm). Confirm both screws are fully locked under fluoroscopy.
Step 6: Angled Screw Hole Selection
Choose the appropriate angled hole for locking screw insertion that will provide adequate bone bridges on the lateral cortex. The proximal hole is anticipated to be the common selection, while the distal hole may be used for patients with large width metatarsals who require minimal translation.
Step 7a: Proximal Screw Hole Fixation (if selected)
Drill through the proximal angled drill hole on the Inserter. Under fluoroscopy, confirm the drill depth and then determine the screw length using the laser marks on the drill. Remove the drill and insert the locking screw according to the length measured.
Step 7b: Distal Screw Hole Fixation (if selected)
Unthread and remove the Connection Rod using the T8 driver. Drill through the Connection Rod drill hole on the Inserter. Under fluoroscopy, confirm the drill depth and then determine the screw length using the laser marks on the drill. Remove the drill and insert the locking screw according to the length measured.
Step 8: Bicortical Screw Fixation
Under fluoroscopy, determine the desired length of the screw. Remove the Tail Tack. Then insert a fully threaded cannulated screw through the most proximal hole of the implant until the head is fully seated in the medial cortex. Confirm that all screws are fully seated. Turn the Gold Translation Screw counterclockwise to back off the translation. Remove the K-wire and back off the Positioner Cup before removing the Inserter.
Step 9: Medial Spike Removal
The medial spike of the metatarsal shaft can be removed with a wedge burr, rongeur, or the TMC medial spike removal instrument.
Contact The LV Foot Surgeons Today!
If you want to learn more about this new innovative procedure contact The LV Foot Surgeons today. Our specialists Dr. Evan A. Vieira and Dr. Quynh P. Lee will be here to explain the entire process to you and address any of your other foot care needs. Call us at (718) 454-4333 or fill out the form on you contact page