Top 10 Innovations in Podiatry 2022: Trigon Stand-Alone Wedge Fixation System by Nvision Biomedical Technologies

Dr. DeHeer discloses that he is a consultant for Nvision Biomedical.

Hello, I'm Patrick DeHeer from Indianapolis, Indiana. I am part of Upperline Health and I'm the residency director at Ascension St. Vincent's Indianapolis. I've been practice in for 30 years. I'm board certified by the American Board of Foot and Ankle Surgery, and a fellow of the American College of Foot and Ankle Surgeons.

I'm here today to talk about the Trigon Stand-Alone Wedge Fixation System from Nvision Biomedical. The Trigon wedges are utilized for the Evans and Cotton osteotomies. They are a hydroxyapatite impregnated PEEK wedge system that has an internal fixation that prevents the need for plating with the screws. The thing that makes the Trigon Stand-Alone Wedges innovative is the material. The wedges were originally utilized in spine surgery, and they've been adapted from that to meet the needs for foot and ankle surgeons for the Evans and Cotton procedures. One of the key things to consider regarding the Evans and Cottons is maintenance of correction. And there's been some literature that has shown that allographs can subside and degrade with the osteointegration of the allograft and can have some loss of correction. One way to prevent that is bridge plating. And bridge plating is not without consequences. I published an article in 2020 that showed bridge plating with the Evans procedure required a 31% hardware removal rate. And this system not only maintains correction because of the material, the PEEK material, but also eliminates the need for bridge plating with the internal screw fixation within the graft itself.

I become very focused on the forefoot varus correction with flat foot surgery. So I think it's particularly important with our Cotton procedures. I've really started to go more towards the larger Cotton sizes as opposed to smaller Cotton sizes. Because recent literature shows a lot of the correction we get from a flat foot surgery, whether it's a pediatric patient or an adult patient, comes from stabilization of the medial column, and that's where the current procedure becomes such an important option. And the Evans procedure also, you want to maintain lateral column length. And with the PEEK material not shrinking down in size like an allograft will and loss of correction that can occur with that, also becomes very important. I think maintaining the graft dimensions as osteointegration occurs throughout the HA incorporated PEEK graft is really important for the success of any kind of extra-articular flat foot surgery. The utilization of the grafts with the system that was designed for the Trigon wedges for insertion and then screw placement is very user-friendly and efficient and really reduces OR time comparative to other types of modalities.