Treatment is relatively straightforward, depending on the injury’s severity. Bennett fractures involving dislocations are usually
surgically repaired using wires, plates, pins, or screws, while uncomplicated breaks are simply casted.
Shin is an ardent hardware proponent, having fixed countless
Bennett breaks with pins and casts during his 18-year medical
career. He would have chosen that option for his recreational athlete, too, had the able-bodied man not begged for an expedited
alternative to the traditional six-week healing process.
Shin found that surrogate in the Mini TightRope product
line from Naples, Fla.-based Arthrex Inc. Developed to treat
carpometacarpal (CMC) arthritis, the Mini TightRope procedure stabilizes the thumb with a solid suture and small buttons
after the trapezium is removed (this bone is usually extracted to
relieve“grinding” pain). A Fiber Wire suture construct is passed
through the first and second metacarpal bones and secured
with an oblong stainless steel button on each side. The suture
provides immediate support for the thumb, thereby sparing the
patient’s own tendon.
The product is considered a game-changer by many surgeons
for its biomechanical stability (comparable to K-wire fixation),
faster rehabilitation, and shorter recovery period. Patients undergoing the CMC Mini Tightrope procedure typically begin therapy
in five to seven days rather than the conventional four weeks.
“I’ve become very familiar with the Mini Tightrope, which I’ve
used for my revision thumb CMC joint arthroplasties,”Shin wrote
in a 2016 blog posted on Arthrex’s website. “The Mini Tightrope
does such a good job of suspending the thumb metacarpal af-
ter excision of the trapezium, so why not use this [technique] for
cases of thumb CMC joint instability?”
Good point. Why not?
Shin posed this question to his strapping patient-athlete,
who “jumped” at the option without really knowing anything
about the procedure. Shin used the same surgical approach for
thumb CMC joint arthritis on the athlete’s Bennett fracture, first
passing a FiberWire suture around the thumb metacarpal base
to lasso a bone fragment into place. He tied the knot dorsally
and buried it in the thenar muscles, then placed the Mini Tightrope across the bases of the thumb and index metacarpals to
stabilize the thumb CMC joint.
Within days of the surgery, the athlete was moving his injured
Versatile products like the Mini Tightrope are likely to become
more common in the coming decades with the growing prevalence
of both traumatic and sports-related injuries as well as obesity, diabetes, and geriatric-exclusive conditions like arthritis, osteoporosis,
and osteomyelitis. The global trauma and extremities market is expected to reach $15.9 billion by 2024,1 with internal fixation devices—particularly plates and screws—driving much of the growth
due to their clinical benefits (shorter procedure times, expedited
recovery, early functionality) and multifaceted design.
“With extremities, the intricacy of the anatomy is very different
so we need to develop plates, screws, and solutions that may be
appropriate for the average patient’s anatomy, but it also needs to
be customizable,” noted Emad Abdelnaby, senior director, Trau-
ma and CMF (craniomaxillofacial) at DePuy Synthes Companies.
“Traditional plates and screws won’t necessarily work in such a
complex part of the anatomy.”
Indeed, tradition is often forsaken in the extremities space to
accommodate significantly smaller anatomies and more chal-
lenging repair jobs. Consider DePuy’s Variable Angle Locking
Hand System, for example: Launched last summer, the device is
comprised of 40 basic and specific plates for various types of hand
fractures and hand sizes, thus enabling surgeons to adjust the in-
sertion specific to the patient’s bone anatomy to improve stability.
The first to feature 1.3 mm locking screws for hand plating,
DePuy’s Variable Angle Locking Hand System also includes 1.5
and 2 mm variable angle locking plates. The thin plates have ana-
tomic contours and smooth surfaces to minimize soft tissue ir-
ritation during contact with tendons. Recessed screw heads also
reduce the potential for soft tissue irritation. The plates are avail-
able in both stainless steel and titanium, and intended for both
lateral and direct dorsal application.
“... We manufacture products for spine, for trauma, for cranio-
maxillofacial, for both small and large joints. But customers need
to be served very differently in each of these segments, and it’s im-
portant to recognize that the anatomy is very different, therefore
the products must be different,”Abdelnaby told Orthopedic Design
& Technology. “There is core trauma, which typically encompasses
larger bone structures and then there are extremities. The bone
structure in extremities is different than in a tibia or a hip.”
Markedly different, actually. The tibia and hip have relatively
simple architecture—the tibia (shin bone) forms the knee joint
with the femur and the ankle joint with the fibula and tarsus,
while the hip joint connects the os coxal (hip) and femur, the
latter being the longest, heaviest, and strongest bone in the body.
The hand, conversely, is comprised of 27 distinct bones,
each of which is a fraction of the size of a major joint con-
nector. The scaphoid, for instance—the large carpal bone but-
tressing the radius below the thumb—is roughly the size and
shape of a medium cashew.
Such discrepancies in size and structure require creative yet
comprehensive solutions that integrate fracture pattern, location,
bone quality, and implant placement. One comparable elixir is
offered by Addison, Texas-based OsteoMed, which manufactures
a hand plating system that gives surgeons locking, non-locking,
and cannulated repair options. The solution encompasses five
screw types, three K-Wires, 53 plates, and angled locking tech-
nology up to 22 degrees; the low-profile titanium plates come in
four sizes (1.2-2.4 mm), and are anatomically contoured with a
polished surface for biocompatibility with bone and soft tissue.
Moreover, the system’s headless screws feature narrow trailing
diameters, making them ideal remedies for distal interphalangeal
joint injuries and scaphoid fractures.
Structural diversity is also inherent in Acumed LLC’s Acu-Loc
2 Wrist Plating System, a solution designed to treat multiple fracture patterns of the distal radius and distal ulna. Offering surgeons
48 different wrist plating options, the Acu-Loc 2 features various