A Closer Look At An Emerging External Fixation System

By Brian McCurdy, Managing Editor

The System for Externally Aligning Limbs (SEAL) combines angular correction clamps and a rail system that can help surgeons achieve greater alignment of the foot and ankle.

As the manufacturer DNE notes, the biggest advantage of the two components is how they work together. Adding the angular correction clamps to the circular frame system gives the surgeon the advantage of unlimited compression and distraction and rotational ability, according to the company.

The SEAL’s rail system also has a unique modular collet system, which DNE says will allow surgeons to utilize a 3 mm, 4 mm or 5 mm pin by simply inserting one small collet into the clamp. Between the circular system and the rail system, the company says one can address any fracture, fusion, deformity or angular correction in the foot and ankle.

Andrew Rader, DPM, notes one can combine the rail system and adjust the struts for additional compression, bone transport or gradual angular correction. Surgeons can attach the rails to each other, yielding “seemingly unlimited construction options” for simple or complex deformities, according to Dr. Rader. Thomas Rocchio, DPM, will combine two rails to form a bilateral construct that can stabilize larger rearfoot procedures such as triple arthrodesis. 

Dr. Rocchio has been using the SEAL products for two years for surgical cases such as ankle fusion, rearfoot Charcot reconstruction and comminuted fractures involving the tibia. He calls the rail system, released in the last year, unique and customizable. Dr. Rocchio says he has used the rail mainly to perform an individual rail medial column arthrodesis, Lapidus and hallux arthrodiastasis.

Dr. Rader started using SEAL for Charcot reconstruction cases because it provided many more options for dynamic frame construction. After becoming more familiar with the versatility of the system, he has expanded his use of it to more traditional Ilizarov applications, including torsional and angular deformities of the lower limb. 

“For the complex deformities best suited for Ilizarov techniques, there is no better system,” says Dr. Rader, who is in private practice at Indiana Foot and Ankle. “Nothing even comes close.” 

In comparison with many lengthy rearfoot reconstructive procedures, the SEAL system has an ease of use, according to Dr. Rocchio. He notes the circular device’s innovative strut can not only afford an angular correction but also has the ability to slide (compress or distract) the entire length of the strut.

“I look at the new SEAL small rail system as the third generation of this type of rearfoot fixation,” says Dr. Rocchio, a Fellow of the American College of Foot and Ankle Surgeons, who is in private practice at PA Foot and Ankle Associates in Pennsylvania. “Using a collet pin fixation, aluminum construct and low profile design, this new device offers a great improvement that has saved valuable time in the OR.”

Having a smooth OR experience with the SEAL, says Dr. Rocchio, directly correlates to the patients’ long-term success. He has seen solid clinical results due to the fact that the fixation elements of the SEAL frame do not loosen in the post-op period. Many of his patients have been fully weightbearing within weeks of triple arthrodesis and flatfoot corrections with successful fusions have occurred.

“The angular correction clamps give an unprecedented ability to construct rings very close together or at angles to each other that are very difficult to create using traditional sets,” adds Dr. Rader.