Exactech announced that its Equinoxe Scapula Reconstruction System has received 510(k) clearance from the U.S. Food and Drug Administration, marking the first device specifically designed to treat acromial and scapular spine fractures following reverse total shoulder arthroplasty (rTSA). The clearance addresses a significant unmet clinical need in orthopedic surgery, where no accepted treatment solution previously existed for this challenging complication.
Clinical Need and Market Impact
Acromial and scapular fractures represent a rare but devastating complication that can occur with every rTSA implant design. According to systematic review data, the reported rate of acromial and scapular fractures after rTSA averages 2.8 percent but can reach as high as 10.9 percent for some patient diagnoses. The absence of an established treatment protocol for these fractures has left surgeons with limited options when managing affected patients.
"There is currently no accepted treatment solution for patients with this challenging rTSA complication," the company stated, highlighting the clinical gap that prompted development of the new system.
System Design and Features
The Equinoxe Scapula Reconstruction System was developed by a team of leading orthopedic surgeons including Jonathan Levy, MD, Howard Routman, DO, Peter Cole, MD, George Athwal, MD, Michael McKee, MD, and Joaquin Sanchez-Sotelo, MD, PhD. The system represents the only trauma solution designed specifically to treat acromial and scapular fractures with rTSA considerations in mind.
Chris Roche, Exactech's Sr. Vice President, Extremities, emphasized the collaborative approach: "We organized a world-class design team to develop this comprehensive scapular plating system, bringing together surgeons with deep and diverse experience with rTSA implant designs from nearly every major manufacturer."
The system allows orthopedic surgeons to treat scapular fractures using multiple techniques, including single and dual plating approaches, regardless of the specific rTSA implant design in place. The versatile portfolio features anatomically contoured plates provided in multiple lengths to enable precise fracture management across varying patient anatomy.
Technical Innovation
A key differentiating feature of the Equinoxe Scapula Reconstruction System is its incorporation of integral hooks strategically positioned on each contoured plate. These hooks are located anteriorly on the acromion, laterally on the acromion, and along the medial scapular border to support the scapula and counteract the pull of the deltoid muscle and biomechanical loading from the rTSA prosthesis.
The system addresses fracture patterns across the Levy Type I, II, IIA and IIB fracture classification system. Previous laboratory research has demonstrated that lateral hook plate usage improved fixation of the lateral acromion, supporting the design rationale.
Howard Routman, DO of Atlantis Orthopedics, noted the system's comprehensive approach: "This dual plating system is impactful because it was designed to not only respect the variable scapular anatomy and variable fracture patterns, but also because it respects the unique biomechanics of the rTSA, which stresses the scapular bone uniquely."
Clinical Perspective
Jonathan Levy, MD of Paley Orthopedic and Spine Institute, who has extensively studied acromial fractures, expressed satisfaction with the development: "I've spent the better part of my career trying to figure out how and why acromial fractures occur after reverse shoulder replacement. I am proud of the plating system that we have developed – an implant system for acute treatment which will help bring much-needed attention to manage this often-devastating complication."
Current American Shoulder and Elbow Surgeons President Joaquin Sanchez-Sotelo of Mayo Clinic characterized the system as transformative: "This anatomically contoured dual plating system is designed specifically for treatment of fractures associated with reverse shoulder arthroplasty. It incorporates hooks to brace and support the acromion and is truly a game changer."
Market Launch and Availability
The Equinoxe Scapula Reconstruction System will enter pilot launch with limited availability in the United States later this year. Routman noted the significance of the U.S. market entry: "Finally, a plating system specifically designed for management of this challenging complication will be available in the United States. The release of this implant will represent a new paradigm for open reduction internal fixation of acromial and scapular spine fractures."
