2.4 mm/2.7 mm Variable Angle LCP Forefoot/Midfoot System.

Transcription

2.4 mm/2.7 mm Variable Angle LCP
Forefoot/Midfoot System.
Procedure-specific plates for osteotomies,
fusions and fractures of the foot.
Technique Guide
Table of Contents
Introduction
System Features
Indications
3
2.4 mm / 2.7 mm Variable Angle LCP
Forefoot/Midfoot System
5
Compression System
6
2.4 mm / 2.7 mm Variable Angle LCP Technology
7
Proximal and Distal Reamers
8
First MTP (Metatarsophalangeal) Fusion Plates
9
Opening Wedge Osteotomy Plates
10
First TMT (Tarsometatarsal) Fusion Plates
11
TMT Fusion Plates
12
T-, L-, Cloverleaf Fusion Plates
13
X- and Straight Fusion Plates
14
Navicular and Cuboid Plates
15
Mesh Plates
16
Modular Sets
17
Image intensiﬁer control
Synthes
Table of Contents
Surgical Technique
Product Information
2
Compression System Technique
19
2.4 mm / 2.7 mm Variable Angle Locking Technique
23
Proximal and Distal Reamers Technique for
First MTP Fusion
37
First MTP Fusion
41
Opening Wedge Osteotomy for Correction
of Hallux Valgus
45
First TMT Fusion for Correction of Hallux Valgus
51
Second or Third TMT Fusion
55
Navicular and Cuboid Features
59
T-, L-, Cloverleaf, X-, Straight, and Mesh Plates
63
Set Configurations
71
Synthes 2.4 mm / 2.7 mm Variable Angle LCP Forefoot / Midfoot System Technique Guide
Indications
Indications
The Synthes 2.4 mm/2.7 mm Variable Angle LCP
Forefoot / Midfoot System is indicated for fixation of
osteotomies, fusions, fractures, nonunions, malunions and
replantations of small bones and small bone fragments in
adult and adolescent (12–21 years) patients, including the
foot and ankle, and particularly in osteopenic bone.
Synthes
3
System Features
2.4 mm / 2.7 mm Variable Angle LCP Forefoot/Midfoot System.
Procedure-specific plates for osteotomies, fusions and fractures of the foot.
The system consists of anatomic- and
procedure-specific plates, variable angle
locking and cortex screws, and a compression feature, to aid in reconstructive
foot surgery. The implants are available
in stainless steel and titanium alloy.
Synthes
5
Compression System
Features
– Tactile compression
– Designed within the plate to
minimize additional soft tissue
dissection
– Allows final screw fixation after
compression is achieved
Compression
wire slot
Compression Wires
– 1.6 mm diameter, 150 mm overall
length
– Thread lengths from 10 mm to
40 mm in 5 mm increments
– Stop feature allows quick and easy
preliminarily fixation of the plate to
the bone, eliminating the need for
plate holding forceps
– Material: Cobalt chromium alloy
that is stiffer than conventional
stainless steel
The spherical stop is designed to sit above the
compression wire hole or compression slot, and inside
variable angle LCP holes. It allows off-axis insertion of
the wire, while maintaining compression capability.
Compression Forceps
– Spherical recess matches the
spherical stops on the compression
wires, to ensure the forceps will
grasp the stop, regardless of the
wire insertion angle
– Locking ratchet mechanism holds
compression during screw insertion
– Lightweight device does not require
support during screw insertion
6
Compression
wire hole
2.4 mm/2.7 mm Variable Angle LCP Technology
Plates feature variable angle locking
holes, with or without the dynamic
compression portion. Four columns of
threads in the variable angle locking hole
provide four points of threaded locking
between the plate and the variable angle
locking screw, to create a fixed-angle
construct at the desired screw angle.
– Plate holes accept 2.4 mm and 2.7 mm
variable angle locking screws
– Using 2.4 mm or 2.7 mm variable
angle locking screws allows a fixedangle construct, 15° off-nominal-axis,
or variable angulation within a 30° cone
of angulation
– Holes are compatible with existing
2.4 mm and 2.7 mm locking screws.
However, these screws can only be
used coaxially, not off-angle.
– 2.4 mm and 2.7 mm cortex screws
can be used in the locking holes and
plate positioning slots for traditional
compression and fixation
Variable Angle Locking Drill Guide, cone
Variable Angle Locking Drill Guide, coaxial
Synthes
7
Features
– Used to prepare articulating joint
surfaces for fusion —specifically,
between metatarsals and phalanges
– Cannulated for use over a K-wire,
for better control
– 14 mm–24 mm reamers accept
1.6 mm K-wires
– 6 mm–12 mm reamers accept
1.25 mm K-wires
– Quick coupling
Proximal Reamers
– Concave shape to form a sphere
on the joint surface
– Leading-edge radius to prevent
soft tissue damage
8
Distal Reamers
– Convex shape to form a pocket
in the joint surface
– Tapered to prevent damage to
the metatarsal head
First MTP (Metatarsophalangeal) Fusion Plates
Features
– Anatomic, low-profile plates
designed specifically for first MTP
arthrodesis
– 10° of valgus integrated into all first
MTP fusion plates
– Left and right plate designs
– Small and medium plates with 3
different dorsiflexion angles: 0°, 5°, 10°
– Large plates with 5° dorsiflexion
– Revision plates with 0° dorsiflexion and
an extra variable angle locking hole to
secure a bone block
– Each plate is etched with a line
indicating the fusion site to ensure
proper plate placement
– Include compression feature
– Compression wire holes allow
preliminary fixation of the plate to
the bone
– Plantar side undercut allows contouring
around medial phalangeal eminence
0°
5°
10°
Synthes
9
Opening Wedge Osteotomy Plates
Features
– Anatomic, low-profile plates designed
specifically for metatarsal opening
wedge osteotomy for hallux valgus
correction
– 6 plates with varying spacer lengths:
0 mm, 3 mm, 4 mm, 5 mm, 6 mm
and 7 mm spacing
– Spacer includes a tapered tip for easier insertion into the osteotomy site
for preliminary fixation of the plate
to the bone
Opening Wedge Measuring
Instrument
– Thin tip slides into osteotomy site
and opens the wedge for the
desired correction
– Ratchet mechanism holds
osteotomy open
– Measurement scale indicates the
appropriate size wedge for the
desired opening
10
First TMT (Tarsometatarsal) Fusion Plates
Features
– Anatomic, low-profile plates specifically designed for first TMT
arthrodesis (e.g., Lapidus procedure)
– Standard and large sizes
– Designed to be placed dorsomedial
on the medial cuneiform and first
metatarsal
– Precontoured for slight valgus or
plantar positioning of the first
metatarsal depending on plate
placement
preliminary fixation of the plate
to the bone
Synthes
11
TMT Fusion Plates
Features
– Anatomic, low-profile plate for
fusions of the second and third
tarsal and metatarsal joints
– Precontoured to fit anatomy
– Includes compression feature
the bone
12
T-, L- and Cloverleaf Fusion Plates
Features
– Anatomic, low-profile plates for
a variety of fusions, osteotomies
and fractures
– Long T-plate with 3-hole head for
more flexibility
the bone
Synthes
13
X- and Straight Fusion Plates
Features
– Low-profile plates designed for
a variety of fusions,
osteotomies and fractures
– X-plates available in extra small,
small, medium and large
– Straight plates available in 2-hole
and 4-hole versions
the bone
14
Navicular and Cuboid Plates
Features
– Low-profile plates designed specifically for fixation of navicular and
cuboid fractures
– Contourable
– May be cut to length
Synthes
15
Mesh Plate
Features
– Low-profile plate
– Contourable
– May be cut to length
16
Modular Sets
Features
– Modularity allows customized selection of implants
– Reduces inventory and overall costs by eliminating
seldom-used implants
Synthes
17
1
Insert compression wires
Instruments
03.211.410–
03.211.440
1.6 mm Compression Wires, 150 mm
length, 10 mm – 40 mm thread lengths
Place the plate on the bone, ensuring that the plate is placed
appropriately according to the specific procedure.
Estimate the appropriate thread length needed for the plate
and bone combination.
Note: Bicortical fixation is recommended.
Using a wire driver, insert the compression wire through the
compression wire hole (or compression slot) and through the
bone.
To minimize stripping of the bone threads, slow wire insertion
when the spherical stop nears the plate. Control the insertion
for tactile confirmation of compression between the wire,
the plate and the bone.
There should be sufficient force holding the plate to the
bone.
For plates with a compression slot, insert a second compression
wire into the far side of the slot (or compression hole).
Synthes
19
2
Compress
Instrument
03.211.400
Compression Forceps
Move the ratchet mechanism to engage as the forceps close,
preventing the spring from opening the forceps.
Place the compression forceps into position, with the tips
around the compression wire spheres.
Compress by squeezing the handles. Do not overcompress,
as this may cause the compression wires to strip out of the
bone.
If the ratcheting mechanism is in the correct position, handsfree compression can be maintained during radiographic
verification of compression and the insertion of screws for
final fixation.
After stable fixation is achieved, remove the compression
wires.
20
Instruments
03.211.400
Compression Forceps
03.211.410
1.6 mm Compression Wires,
150 mm length
10 mm thread
03.211.415
15 mm thread
03.211.420
20 mm thread
03.211.425
25 mm thread
03.211.430
30 mm thread
03.211.435
35 mm thread
03.211.440
40 mm thread
Synthes
21
2.4 mm / 2.7 mm Variable Angle
Locking Technique
2.4 mm/2.7 mm Variable Angle Locking Technique
1
Variable angle locking screw insertion — conical
(off-nominal-axis)
Instruments
For 2.4 mm variable angle locking screws
03.110.023
1.8 mm Variable Angle Locking Drill Guide,
cone
310.509
1.8 mm Drill Bit with depth mark,
quick coupling, 110 mm
319.006
Depth Gauge, for 2.0 mm and 2.4 mm
cortex screws
For 2.7 mm variable angle locking screws
03.211.003
variable
319.01
Depth Gauge, for small screws
323.062
2.0 mm Drill Bit with depth mark,
quick coupling, 140 mm
To insert the variable angle locking screw off the nominal
axis, insert the cone-shaped drill guide in the desired variable
angle locking screw hole in the plate.
The drill guide cone will self-retain in the hole.
Synthes
23
2.4 mm / 2.7 mm Variable Angle Locking Technique
1. Variable angle locking screw insertion—conical (off-nominalaxis) continued
The funnel of the drill guide allows a drilling angle within a
30° cone.
When drilling off-axis, the drill guide should remain in place
and the drill bit may be aimed in any direction within the cone.
Verify the drill bit angle and depth under radiographic imaging
to ensure the desired angle has been achieved. If necessary,
drill at a different angle and verify again under imaging.
Use the depth gauge to measure for the correct screw length.
24
2
Variable angle locking screw insertion—coaxial
(fixed angle)
Instrument
For 2.4 mm locking and VA locking screws
03.110.024
coaxial
For 2.7 mm locking and VA locking screws
03.211.004
coaxial
Variable angle and standard locking screws can be inserted
into the plate in line with the predefined screw trajectory.
The coaxial drill guide will self-retain in the hole.
Drill to the desired depth. Verify the drill bit depth under
radiographic imaging.
Use the depth gauge to measure for the correct screw
length.
Synthes
25
2.4 mm/2.7 mm Variable Angle Locking Technique
3
Preliminary screw placement
Instruments
03.111.038 /
311.43
Handle with quick coupling
314.467
StarDrive Screwdriver Shaft T8, 105 mm
Insert the correct length variable angle locking screw manually,
using a self-retaining T8 StarDrive screwdriver shaft and
quick coupling handle. Insert the screw until the screwhead
is seated in the variable angle locking hole. Do not overtighten
the screw. Insert additional screws as needed.
Confirm proper alignment, screw placement and screw
length with multiple views under radiographic imaging.
Note: Ensure a screw is inserted on each side of the
osteotomy/fusion site before removing the compression
forceps.
Remove the compression wires.
26
4
Lock variable angle screws
Instruments
03.110.002
Torque Limiting Attachment, 1.2 Nm
03.110.005
Handle for Torque Limiting Attachment
314.453
StarDrive Screwdriver Shaft, T8, 55 mm
03.110.002
03.110.005
Alternative instruments
03.111.038
Handle, with quick coupling
314.467
511.776
Use the 1.2 Nm torque limiting attachment (TLA) to final
tighten variable angle locking screws. Assemble the torque
limiting attachment to the T8 StarDrive screwdriver shaft and
the handle for torque limiting attachment.
After appropriate screw angle and length have been determined, manually insert the screw using the TLA assembly.
Use of the TLA is mandatory when inserting the screws into
variable angle locking holes to ensure the minimal amount of
torque is applied.
Synthes
27
2.4 mm/2.7 mm Variable Angle LCP Technology
Alternative instrument
314.468
Holding Sleeve for StarDrive Screwdriver
Shaft
Reduce the plate to the bone using the holding sleeve with
variable angle locking screws.
Slide the holding sleeve onto the screwdriver shaft. Engage
the variable angle locking screw, ensuring the holding sleeve
covers the threads on the head of the screw. Insert the
screw.
Once the desired reduction is achieved, slide the holding
sleeve back to expose the screwhead threads. Insert the
screw until the screwhead is seated in the variable angle
locking hole. Do not overtighten the screw.
28
Screws Used with the 2.4 mm/2.7 mm VA-LCP Forefoot/Midfoot System
Stainless Steel and Titanium
2.4 mm Variable Angle Locking Screws
– Threaded, rounded head locks securely into the variable
angle locking holes
– Locked screws allow unicortical screw fixation and load
transfer to the near cortex
– Color coded for easier identification
– T8 StarDrive recess
– Self-tapping tip
– 10 mm to 60 mm lengths (2 mm increments)
2.4 mm Cortex Screws
– For use in round or Combi holes
– Low-profile head
– Used to provide compression or neutral fixation
2.4 mm Locking Screws
– Only for axial insertion in the variable angle locking holes
– Threaded, conical head locks securely into the variable
angle locking holes
All screws are available in implant-quality 316L stainless steel or titanium alloy (Ti-6AI-7Nb)
Synthes
29
Screws for the 2.4 mm/2.7 mm VA-LCP Forefoot/Midfoot System
Stainless Steel and Titanium
2.7 mm Variable Angle Locking Screws
– Threaded, rounded head locks securely into the variable
angle locking holes
– Locked screws allow unicortical screw fixation and load
transfer to the near cortex
– Color coded for easier identification
2.7 mm Cortex Screws
– For use in round or Combi holes
– Used to provide compression or neutral fixation
– Low-profile head
– 10 mm to 50 mm lengths (2 mm increments), 55 mm
and 60 mm
2.7 mm Locking Screws
– Only for axial insertion in the variable angle locking holes
– Threaded, conical head locks securely into the variable
angle locking holes
– 10 mm to 50 mm lengths (2 mm increments), 55 mm
and 60 mm
30
Instruments for the 2.4 mm/2.7 mm VA-LCP and Cortex Screws
2.4 mm Instruments
03.110.000
1.8 mm Universal Variable Angle Locking
Drill Guide
03.110.023
cone
03.110.024
coaxial
310.509
1.8 mm Drill Bit with depth mark, quick
coupling, 110 mm
Synthes
31
310.530
2.4 mm Drill Bit, quick coupling, 100 mm
310.972
Countersink, for 2.0 mm and 2.4 mm
screws
312.18
2.4 mm/1.8 mm Double Drill Sleeve
319.006
cortex screws
323.202
2.4 mm Universal Drill Guide
32
2.7 mm Instruments
03.211.002
Drill Guide
03.211.003
variable
03.211.004
coaxial
310.26
2.7 mm Drill Bit, quick coupling, 100 mm
Synthes
33
310.87
Countersink, for 2.7 mm cortex screws
312.24
319.01
323.062
coupling, 140 mm
323.26
34
Common Instruments
03.110.002
03.110.005
03.211.001
2.4 mm/2.7 mm Variable Angle LCP Plate
Holding Pins
311.43
314.453
Short StarDrive Screwdriver Shaft, T8,
55 mm
314.467
314.468
Holding Sleeve, for StarDrive Screwdriver
Shaft, T8
Synthes
35
Technique for First MTP Fusion
Proximal and Distal Reamers Technique for First MTP Fusion
1
Approach
Make a dorsomedial incision extending from the proximal
interphalangeal joint of the hallux to the middle of the first
metatarsal. This incision should be medial to the extensor
hallucis longus tendon. Isolate and retract the superficial nerve
and vessel. Make a linear capsular incision to expose the first
metatarsal head and proximal phalanx base.
Dissect down to the joint. Plantar flex the phalanx down to
expose the joint.
2
Insert K-wire
Instrument
292.56
1.6 mm Kirschner Wire, 150 mm, trocar
points on both ends
Plantar flex the hallux and insert the 1.6 mm K-wire into the
head of the first metatarsal. Ensure the wire is centered in
the canal.
A chielectomy may be necessary, to remove impinging bone
and create a flat surface for the plate.
Synthes
37
Proximal and Distal Reamers Technique for First MTP Fusion
3
Proximal reaming
Instrument
03.211.114–
03.211.124
Cannulated Reamers, proximal,
14 mm–24 mm
Select the appropriate reamer. Always start with a larger size
and work down to a smaller size.
Slide the proximal reamer over the K-wire. Ream to remove
cartilage from the joint.
Important: When preparing the joint, it is possible to remove
too much bone, causing shortening. Ream only enough to
remove the cartilage and expose the bone surface for fusion.
38
4
Distal reaming
Instruments
03.211.014 –
03.211.024
Cannulated Reamers, distal,
14 mm–24 mm
292.56
1.6 mm Kirschner Wire, trocar points on
both ends
Bend the toe down to expose the phalanx.
Remove the K-wire from the metatarsal. Insert a K-wire into
the center of the phalanx.
Slide the corresponding distal reamer over the K-wire. Ream
to remove cartilage from the joint.
Important: When preparing the joint, it is possible to remove
too much bone, causing shortening. Ream only enough to
remove the cartilage and expose the bone surface for fusion.
Remove the reamer and K-wire.
Synthes
39
Instruments
Cannulated Reamers, for 1.25 mm K-wires
Proximal
Distal
03.211.106
03.211.006
Diameter (mm)
03.211.108
03.211.008
8
03.211.110
03.211.010
10
03.211.112
03.211.012
12
6
Cannulated Reamers, for 1.6 mm K-wires
Proximal
Distal
Diameter (mm)
03.211.114
03.211.014
14
03.211.116
03.211.016
16
03.211.118
03.211.018
18
03.211.120
03.211.020
20
03.211.122
03.211.022
22
03.211.124
03.211.024
24
40
First MTP Fusion
First MTP Fusion
Required sets
01.210.110
2.4 mm Variable Angle Locking and Cortex
Screw Instrument Module
01.210.210/
01.210.410
Screw Module
or
01.211.111
01.211.211/
01.211.411
Screw Module
1
Select and position plate
Select the plate that allows the desired level of correction.
A sterile flat surface can be placed on the bottom of the foot
to measure the desired amount of toe dorsiflexion. The plate
may be contoured slightly to achieve the desired outcome.
Place the plate on the joint surface, using the etched line as
a guide to ensure proper plate position.
Synthes
41
First MTP Fusion
2
Compress
Instruments
03.211.400
Compression Forceps
03.211.410–
03.211.440
1.6 mm Compression Wires
10 mm – 40 mm thread
It is recommended to insert an independent lag screw to aid
in compression and stabilization. Insert the screw starting
medial and distal to the joint on the phalanx, crossing the
joint and ending in the lateral side of the metatarsal head.
Compression may also be achieved as described in the
Compression System Technique.
3
Insert locking screws
For final fixation, insert the appropriate screws according to
the screw insertion technique described in the Variable Angle
Locking Technique.
Variable angle locking screws allow manipulation around the
independent lag screw.
42
Implants
2.4 mm / 2.7mm Variable Angle LCP First MTP Fusion Plates,
small, 42 mm
Stainless Steel
Titanium
Right / Left
Dorsiflexion
02.211.230
04.211.230
right
0°
02.211.231
04.211.231
left
0°
02.211.232
04.211.232
right
5°
02.211.233
04.211.233
left
5°
02.211.234
04.211.234
right
10°
02.211.235
04.211.235
left
10°
0°
5°
10°
0°
5°
10°
Synthes
43
Implants
medium, 52 mm
Stainless Steel
Titanium
Right / Left
02.211.236
04.211.236
right
Dorsiflexion
0°
02.211.237
04.211.237
left
0°
02.211.238
04.211.238
right
5°
02.211.239
04.211.239
left
5°
02.211.240
04.211.240
right
10°
02.211.241
04.211.241
left
10°
0°
5°
10°
large, 57 mm
Stainless Steel
Titanium
Right / Left
Dorsiflexion
02.211.242
04.211.242
right
5°
02.211.243
04.211.243
left
5°
revision, 53 mm
Stainless Steel
Titanium
Right / Left
Dorsiflexion
02.211.244
04.211.244
right
0°
02.211.245
04.211.245
left
0°
44
Opening Wedge Osteotomy for
Correction of Hallux Valgus
Opening Wedge Osteotomy for Correction of Hallux Valgus
Required sets
01.210.110
01.210.210/
01.210.410
Screw Module (stainless steel or titanium)
or
01.211.111
01.211.211/
01.211.411
1
Approach
Make a 3 to 4 cm dorsomedial incision from the first tarsal
metatarsal (TMT) joint, distally along the midline of the first
metatarsal.
Dissect down to the bone and isolate the medial branch of
the superficial peroneal nerve.
Synthes
45
2
Create osteotomy
Identify a point medial on the metatarsal, approximately
1.5 cm distal to the TMT joint. Create an osteotomy starting
from the medial side of the metatarsal but do not cut
through the bone. Leave the lateral cortex intact, to act as
a hinge point for opening the wedge.
46
3
Open and measure
Instrument
03.211.009
Opening Wedge Measuring Instrument
Open the osteotomy using osteotomes or the opening wedge
measuring instrument. Slide the tip of the opening wedge
instrument into the osteotomy. Open the osteotomy by
squeezing the handle until the desired correction is achieved.
The measuring instrument should be placed in the final
implant position to ensure correct alignment and measurement.
Use radiographic imaging to confirm that the desired correction
has been achieved.
Read the measurement on the back of the instrument to
determine the appropriate spacer size.
Remove the measuring instrument.
Synthes
47
4
Position opening wedge plate
Instruments
03.211.410–
03.211.440
Position the plate with the top of the T proximal to the
osteotomy.
Insert the plate into the osteotomy. The tip of the spacer
has a lead-in design to aid in inserting the wedge into the
osteotomy.
Insert the compression wire (as described in the Compression
System Technique) through one of the wire holes for preliminary plate fixation.
48
5
Insert variable angle locking screws
Insert the variable angle locking screws (as described in Variable
Angle Locking Technique) starting with a screw in the side
opposite to the compression wire. Insert another locking
screw in an open locking hole on the same side as the compression wire. Remove the compression wire and insert the
remaining locking screws.
Pack bone graft into the osteotomy site, as appropriate.
Synthes
49
Product Information
Implants
2.4 mm/ 2.7mm Variable Angle Locking Opening Wedge
Osteotomy Plates
Stainless Steel
Titanium
Spacer (mm)
02.211.210
04.211.210
0
02.211.211
04.211.211
3
02.211.212
04.211.212
4
02.211.213
04.211.213
5
02.211.214
04.211.214
6
02.211.215
04.211.215
7
Instrument
03.211.009
50
First TMT Fusion for Correction
of Hallux Valgus
Required sets
01.210.110
01.210.210/
01.210.410
or
01.211.111
01.211.211/
01.211.411
1
Approach
Make a dorsomedial incision medial to the extensor hallucis
longus tendon (lateral to the tibialis anterior tendon). The
incision should extend from the medial cuneiform to midshaft of the first metatarsal.
Dissect down to bone and isolate the medial branch of the
superficial peroneal nerve.
2
Prepare joint surface
Remove the cartilage and prepare the joint surface for fusion.
The surface of the joint can be manipulated to achieve the
desired correction.
Take care to minimize joint surface removal to prevent shortening of the first ray.
Synthes
51
3
Position plate
Instruments
03.211.400
Compression Forceps
03.211.410 –
03.211.440
10 mm–40 mm thread
Select the appropriate size plate and place it over the joint
surface with the compression slot proximal to the joint.
Place the plate dorsomedial on the bone.
The plate is precontoured to help prevent medialization of
the first metatarsal.
A compression wire can be used to hold the plate in position.
Alternatively, the plate can be placed dorsally; additional
contouring may be needed.
4
Compress
It is recommended to insert an independent lag screw to aid
in compression and stabilization. Insert the screw obliquely
across the TMT joint.
Compression may also be achieved as described in the
52
5
Locking Technique.
Variable angle locking screws allow manipulation around the
independent lag screw.
Synthes
53
Required sets
01.210.110
01.210.210/
01.210.410
or
01.211.111
01.211.211/
01.211.411
1
Approach
Make a long dorsal incision over the third metatarsal starting,
at the navicular and extending to the midshaft of the
metatarsal. Identify and retract the dorsalis pedis artery and
nerve. Dissect down to the bone.
2
Prepare joint surface
Remove the cartilage and prepare the joint surface for fusion.
The surface of the joint can be manipulated to achieve the
desired correction.
Take care to minimize joint surface removal to prevent shortening of the second and third rays.
Synthes
55
3
Place plate
Instruments
03.211.400
Compression Forceps
03.211.410–
03.211.440
Place the plate dorsally over the joint surface with the compression slot distal to the joint.
The plate is precontoured for an anatomic fit.
A compression wire can be used to hold the plate in position.
4
Compress
If necessary, compression across the joint can be achieved
using the compression wires and forceps as described in the
56
5
Locking Technique.
Synthes
57
Implants
2.4 mm / 2.7mm Variable Angle LCP First TMT Fusion Plates
Stainless Steel
Titanium
Size
Length (mm)
02.211.246
04.211.246
Standard
39
02.211.247
04.211.247
Long
48
2.4 mm/2.7mm Variable Angle LCP TMT Fusion Plates 43 mm
Stainless Steel
Titanium
02.211.266
04.211.266
58
Navicular and Cuboid Fractures
Required sets
01.210.110
01.210.210/
01.210.410
or
01.211.111
01.211.211/
01.211.411
1
Approach
Option A: Navicular
Make a dorsal longitudinal incision from the midneck of the
talus toward the base of the second metatarsal. It is important to preserve neurovascular and tendinous structures.
It may be necessary to open the talonavicular joint capsule to
allow visualization of the joint. To minimize the potential for
vascular damage, strip only a small segment of the capsule
from the navicular bone.
Option B: Cuboid
Make a linear dorsolateral incision starting at the sinu tarsi
and extending to the base of the fourth metatarsal.
Warning: This incision may run parallel to, or directly over,
the sural nerve and cross the peroneous tertius. Take care to
avoid injuring these structures.
One of the main objectives of cuboid fracture management
is restoration of the lateral column length and articular surface.
Synthes
59
2
Contour plate
Instruments
03.211.001
Holding Pin (2 required)
03.211.005
2.4 mm/ 2.7 mm Variable Angle LCP
Bending Plier (2 required)
Option A: Navicular
Apply K-wires and independent lag screws for provisional
bone fixation and stabilization.
The plate is designed to fit the navicular bone, as shown.
Two bending pliers can be used to contour the plate to fit
the navicular. A holding pin can be used to aid in contouring.
The plates can be cut to length for the specific fracture pattern
or patient anatomy.
Option B: Cuboid
Apply K-wires and independent lag screws for provisional
bone fixation and stabilization.
The plates are designated left and right, however, they can
be used on either left or right foot. By using the opposite
plate on the foot, an extra variable angle locking hole may
be positioned in the lateral cuneiform.
Two bending pliers can be used to contour the plate to fit
the cuboid. A holding pin can be used to aid in contouring.
60
3
For final fixation, insert the variable angle locking screws as
described in the Variable Angle Locking Technique.
Synthes
61
Implants
2.4 mm / 2.7 mm Variable Angle Locking Navicular Plate
Stainless Steel
Titanium
02.211.220
04.211.220
2.4 mm/2.7 mm Variable Angle Locking Cuboid Plates
Stainless Steel
Titanium
Left / Right
02.211.221
04.211.221
left
02.211.222
04.211.222
right
62
T-, L-, Cloverleaf, X-, Straight, and
Mesh Plates
Required sets
01.210.110
01.210.210/
01.210.410
or
01.211.111
01.211.211/
01.211.411
1
Cut plate (mesh only)
Instruments
03.211.007
Mesh Plate Cutters
391.906
Cable Cutter, large
Cut the plate to fit patient anatomy. To cut multiple rows,
use the large cable cutter.
A minimum of two rows and two columns are necessary to
ensure structural integrity.
The mesh plate cutters can be used for finer cuts around the
screw holes. To prevent sharp edges from causing soft tissue
irritation, place the mesh plate bottom side down on the
mesh plate cutter platen.
Synthes
63
2
Contour plate
Instruments
03.211.001
Holding Pins (2 required)
03.211.005
Bending Pliers (2 required)
Contour the plate to fit the specific anatomy and fixation
options.
The bending pliers are designed to protect the variable angle
holes during contouring by aligning the cloverleaf protrusion
on the pliers with the cloverleaf design in the plate. Use two
pliers to contour the plate.
Two holding pins can also be used for fine contouring of the
plates by placing them in different variable angle holes. Much
like the bending pliers, the holding pins are designed to protect
the variable angle holes when bending. If significant contouring is required, or the plate is too stiff, use the bending pliers
for contouring.
64
3
Compress (optional)
Instruments
03.211.400
Compression Forceps
03.211.410 –
03.211.440
If needed, compression can be achieved using the compression
wires and forceps as described in the Compression System
Technique.
Synthes
65
4
For final fixation, insert the variable angle locking screws as
described in the Variable Angle Locking Technique.
66
Implants
2.4 mm / 2.7mm Variable Angle LCP Cloverleaf Fusion Plates
Stainless Steel
Titanium
Size
Length (mm)
02.211.250
04.211.250
Short
38
02.211.251
04.211.251
Standard
45
02.211.252
04.211.252
Long
64
2.4 mm / 2.7mm Variable Angle LCP T-Fusion Plates
Stainless Steel
Titanium
Size
Length (mm)
02.211.253
04.211.253
Short
35
02.211.254
04.211.254
Standard
42
02.211.255
04.211.255
Long
61
02.211.265
04.211.265
Long
92
Synthes
67
Implants
2.4 mm / 2.7mm Variable Angle LCP L-Fusion Plates, left
Stainless Steel
Titanium
Size
Length (mm)
02.211.257
04.211.257
Short
37
02.211.259
04.211.259
Standard
44
02.211.261
04.211.261
Long
62
2.4 mm / 2.7mm Variable Angle LCP L-Fusion Plates, right
Stainless Steel
Titanium
Size
Length (mm)
02.211.256
04.211.256
Short
37
02.211.258
04.211.258
Standard
44
02.211.260
04.211.260
Long
62
68
2.4 mm / 2.7 mm Variable Angle Locking X-Plates
Stainless Steel
Titanium
Size
Length (mm)
02.211.201
04.211.201
extra small
24
02.211.202
04.211.202
small
27
02.211.203
04.211.203
medium
32
02.211.204
04.211.204
large
36
2.4 mm / 2.7 mm Variable Angle Locking Straight Fusion Plates
Stainless Steel
Titanium
Size
Length (mm)
02.211.262
04.211.262
2 hole
27
02.211.263
04.211.263
4 hole
40
2.4 mm / 2.7 mm Variable Angle Locking Mesh Plate,
5 x 12 holes
Stainless Steel
Titanium
02.211.224
04.211.224
Synthes
69
Instruments
03.211.005
Bending Pliers
– Protects variable angle holes when bending
– Cuts 1.6 mm and 2.0 mm K-wires
– Integrated file to soften sharp edges
03.211.007
Mesh Plate Cutters
– Allows fine cutting of Mesh Plate
70
Set Configurations
2.4 mm Variable Angle LCP Forefoot / Midfoot Instrument and Implant Set
Stainless Steel (01.211.219)
Graphic Cases
60.116.004
Graphic Case, 2/3 length, 4 bay
60.116.007
Auxiliary Tray, 2/3 length, 1/2 width
60.116.203
Auxiliary Bin, 1/2 length, 1/2 height
60.211.011
Forefoot/Midfoot Label Pack
Instruments
03.211.005
03.211.007
Sets
01.210.110
2.4 mm / 2.7 mm Variable Angle LCP
Bending Pliers, 2 ea.
Mesh Plate Cutters
Screw Instrument Set
01.210.210
Screw Set
01.211.112
Proximal and Distal Reamers Set, 14 mm–
24 mm
01.211.214
Compression Instruments, X- and Straight
Plate Set
01.211.215
TMT Fusion Plate Set
01.211.216
First MTP Fusion Plates Set
01.211.217
Opening Wedge Plates and Instrument Set
01.211.218
Tarsal and Mesh Plates Set
Note: For additional information, please refer to package insert.
For detailed cleaning and sterilization instructions, please refer to
http://us.synthes.com/Medical+Community/Cleaning+and+Sterilization.htm
or to the below listed inserts, which will be included in the shipping container:
– Processing Synthes Reusable Medical Devices — Instruments, Instrument Trays
and Graphic Cases — DJ1305
– Processing Non-sterile Synthes Implants — DJ1304
Synthes
71
2.4 mm Variable Angle LCP Forefoot/Midfoot Instrument and Implant Set
Titanium (01.211.419)
Graphic Cases
60.116.004
Graphic Case, 2/3 Length, 4 bay
60.116.007
60.116.203
60.211.011
Instruments
03.211.005
03.211.007
Mesh Plate Cutters
Sets
01.210.110
2.4 mm Variable Angle Locking and
Cortex Screw Instrument Set
01.210.410
Titanium 2.4 mm Variable Angle Locking and
Cortex Screw Set
01.211.112
Proximal and Distal Reamers Set,
14 mm– 24 mm
01.211.414
Titanium Compression Instruments,
X- and Straight Plate Set
01.211.415
Titanium TMT Fusion Plate Set
01.211.416
Titanium First MTP Fusion Plates Set
01.211.417
Titanium Opening Wedge Plates and
Instrument Set
01.211.418
Titanium Tarsal and Mesh Plates Set
72
Stainless Steel (01.211.220)
Graphic Cases
60.116.004
Graphic Case, 2/3 length, 4 bay
60.116.007
60.116.203
60.211.011
Instruments
03.211.005
03.211.007
Sets
01.211.111
Mesh Plate Cutters
2.7 mm Variable Angle Locking and
Cortex Screw Instrument Set
01.211.112
14 mm – 24 mm
01.211.211
Screw Set
01.211.214
Compression Instruments, X- and Straight
Plate Set
01.211.215
01.211.216
First MTP Fusion Plates Set
01.211.217
01.211.218
Synthes
73
Titanium (01.211.420)
Graphic Cases
60.116.004
Graphic Case, 2/3 Length, 4 bay
60.116.007
60.116.203
60.211.011
Instruments
03.211.005
03.211.007
Sets
01.211.111
2.4 mm/2.7 mm Variable Angle LCP Bending
Pliers, 2 ea.
Mesh Plate Cutters
Screw Instrument Set
01.211.112
14 mm – 24 mm
01.211.411
Titanium 2.7 mm Variable Angle Locking and
Cortex Screw Set
01.211.414
Titanium Compression Instruments, X- and
Straight Plate Set
01.211.415
Titanium TMT Fusion Plate Set
01.211.416
Titanium First MTP Fusion Plates Set
01.211.417
Titanium Opening Wedge Plates and
Instrument Set
01.211.418
Titanium Tarsal and Mesh Plates Set
74
2.4 mm Variable Angle Locking and Cortex Screw Set
Stainless Steel (01.210.210) and Titanium (01.210.410)
Graphic Cases
60.116.050
Screw Module Shell
60.116.058
2.4 Screw Block
60.116.071
2.4 Flip-Up Screw Rack, 2 ea.
60.116.452
Screw Type Push Pin, Blank
60.116.507
Screw Type Push Pin, Cortex
60.116.521
Screw Type Push Pin, VA Locking
60.116.554
Label Pack for 2.4 mm screws and
instruments
01.116.534
Length Market Push Pin Set
Implants
2.4 mm Variable Angle Locking Screws, self-tapping, with T8
StarDrive recess
Stainless
Steel
Titanium
Length
(mm)
Qty
02.210.110
04.210.110
10
5
02.210.112
04.210.112
12
5
02.210.114
04.210.114
14
5
02.210.116
04.210.116
16
5
02.210.118
04.210.118
18
5
02.210.120
04.210.120
20
5
02.210.122
04.210.122
22
5
02.210.124
04.210.124
24
5
02.210.126
04.210.126
26
5
02.210.128
04.210.128
28
5
02.210.130
04.210.130
30
4
02.210.132
04.210.132
32
4
02.210.134
04.210.134
34
4
02.210.136
04.210.136
36
4
02.210.138
04.210.138
38
4
02.210.140
04.210.140
40
4
02.210.142
04.210.142
42
4
02.210.144
04.210.144
44
4
02.210.146
04.210.146
46
4
02.210.148
04.210.148
48
4
02.210.150
04.210.150
50
4
02.210.152
04.210.152
52
4
02.210.154
04.210.154
54
4
02.210.156
04.210.156
56
4
Synthes
75
Implants continued
2.4 mm Cortex Screws, self-tapping, with T8 StarDrive recess
Stainless
Steel
Titanium
Length
(mm)
Qty
201.760
401.760
10
5
201.762
401.762
12
5
201.764
401.764
14
5
201.766
401.766
16
5
201.768
401.768
18
5
201.770
401.770
20
5
201.772
401.772
22
5
201.774
401.774
24
5
201.776
401.776
26
5
201.778
401.778
28
5
201.780
401.780
30
4
201.782
401.782
32
4
201.784
401.784
34
4
201.786
401.786
36
4
201.788
401.788
38
4
201.790
401.790
40
4
02.210.942
04.210.942
42
4
02.210.944
04.210.944
44
4
02.210.946
04.210.946
46
4
02.210.948
04.210.948
48
4
02.210.950
04.210.950
50
4
02.210.952
04.210.952
52
4
02.210.954
04.210.954
54
4
02.210.956
04.210.956
56
4
76
2.4 mm Variable Angle Locking and Cortex Screw Instrument Set (01.210.110)
Graphic Case
60.210.003
Instruments
03.110.000
03.110.002
2.4mm Variable Angle Locking and Cortex
Screw Instrument Module Case
Drill Guide
03.110.005
03.110.023
cone
03.110.024
coaxial
03.111.038
03.211.001
Holding Pins, 2 ea.
310.509
coupling, 2 ea
310.530
2.4 mm Drill Bit, quick coupling, 100 mm,
2 ea.
310.972
Countersink, for 2.0 mm and 2.4 mm
screws
312.18
314.453
55 mm, 2 ea.
314.467
StarDrive Screwdriver Shaft, T8, 105 mm,
2 ea.
314.468
Shaft, T8
319.006
screws
323.202
Also Available
03.111.005
310.162
screws
1.8 mm Drill Bit with Depth Mark, Stryker
J-latch, 110 mm
311.43
317.872
2.4 mm Drill Bit, Stryker J-Latch, 90 mm
511.776
Torque Limiting Attachment, 0.8 Nm,
quick coupling
Synthes
77
Graphic Cases
60.116.050
Screw Module Shell
60.116.059
2.7 mm Screw Block
60.116.072
2.7 mm Flip-Up Screw Rack, 2 ea.
60.116.452
Screw Type Push Pin, Blank
60.116.507
Screw Type Push Pin, Cortex
60.116.521
Screw Type Push Pin, VA Locking
60.116.555
Label Pack for 2.7 mm screws and
instruments
01.116.534
Length Market Push Pin Set
Implants
2.7 mm Variable Angle Locking Screws, self-tapping, with T8
StarDrive recess
Stainless
Steel
Titanium
Length
(mm)
Qty
02.211.010
04.211.010
10
4
02.211.012
04.211.012
12
4
02.211.014
04.211.014
14
4
02.211.016
04.211.016
16
4
02.211.018
04.211.018
18
4
02.211.020
04.211.020
20
4
02.211.022
04.211.022
22
4
02.211.024
04.211.024
24
4
02.211.026
04.211.026
26
4
02.211.028
04.211.028
28
4
02.211.030
04.211.030
30
3
02.211.032
04.211.032
32
3
02.211.034
04.211.034
34
3
02.211.036
04.211.036
36
3
02.211.038
04.211.038
38
3
02.211.040
04.211.040
40
3
02.211.042
04.211.042
42
3
02.211.044
04.211.044
44
3
02.211.046
04.211.046
46
3
02.211.048
04.211.048
48
3
02.211.050
04.211.050
50
3
02.211.052
04.211.052
52
3
02.211.054
04.211.054
54
3
02.211.056
04.211.056
56
3
78
2.7 mm Cortex Screws, self-tapping, with T8 StarDrive recess
Stainless
Steel
Titanium
Length
(mm)
Qty
202.870
402.870
10
4
202.872
402.872
12
4
202.874
402.874
14
4
202.876
402.876
16
4
202.878
402.878
18
4
202.880
402.880
20
4
202.882
402.882
22
4
202.884
402.884
24
4
202.886
402.886
26
4
202.888
402.888
28
4
202.890
402.890
30
3
202.892
402.892
32
3
202.894
402.894
34
3
202.896
402.896
36
3
202.898
402.898
38
3
202.900
402.900
40
3
202.962
402.962
42
3
202.963
402.963
44
3
202.965
402.965
46
3
202.966
402.966
48
3
202.967
402.967
50
3
202.968
402.968
55
3
202.969
402.969
60
3
Synthes
79
2.7 mm Variable Angle Locking and Cortex Screw Instrument Set (01.211.111)
Graphic Case
60.211.003
Screw Instrument Module Case
Instruments
03.110.002
03.110.005
03.111.038
03.211.001
2.4 mm / 2.7 mm Variable Angle LCP Plate
Holding Pins, 2 ea.
03.211.002
Drill Guide
03.211.003
variable
03.211.004
coaxial
310.26
2.7 mm Drill Bit, quick coupling, 100 mm,
2 ea.
310.87
Countersink, for 2.7 mm cortex screws
312.24
314.453
55 mm, 2 ea.
314.467
StarDrive Screwdriver Shaft, T8, 105 mm,
2 ea.
314.468
Shaft, T8
319.01
323.062
coupling, 140 mm
323.26
Also Available
311.43
511.776
80
Compression Instruments, X- and Straight Plate Set
Graphic Cases
60.116.052
Module Shell
60.211.008
Compression Wires and Forceps Module Bin
Implants
2.4 mm / 2.7 mm Variable Angle Locking X-Plates◊
Stainless Steel
Titanium
Size
02.211.201
04.211.201
extra small
02.211.202
04.211.202
small
02.211.203
04.211.203
medium
02.211.204
04.211.204
large
2.4 mm / 2.7 mm Variable Angle Locking Straight Fusion
Plates◊
Stainless Steel
Titanium
Size
02.211.262
04.211.262
2 hole
02.211.263
04.211.263
4 hole
Instruments
03.211.400
Compression Forceps
1.6 mm Compression Wires, 150 mm, 6 ea.
Thread Length (mm)
03.211.410
10
03.211.415
15
03.211.420
20
03.211.425
25
03.211.430
30
03.211.435
35
03.211.440
40
◊ Available nonsterile or sterile-packed Add “S” to catalog number to order sterile product
Synthes
81
Graphic Case
60.211.006
TMT, First TMT, Cloverleaf, Plate Module Bin
Implants
2.4 mm / 2.7 mm Variable Angle LCP First TMT Fusion Plates◊
Stainless Steel
Titanium
Size
Length (mm)
02.211.246
04.211.246
standard
39
02.211.247
04.211.247
long
48
2.4 mm/2.7 mm Variable Angle LCP TMT Fusion Plates, 43 mm◊
Stainless Steel
Titanium
02.211.266
04.211.266
2.4 mm / 2.7 mm Variable Angle LCP Cloverleaf Fusion Plates◊
Stainless Steel
Titanium
Size
Length (mm)
02.211.250
04.211.250
short
38
02.211.251
04.211.251
standard
45
02.211.252
04.211.252
long
64
2.4 mm / 2.7 mm Variable Angle LCP L-Fusion Plates, right◊
Stainless Steel
Titanium
Size
Length (mm)
02.211.256
04.211.256
short
37
02.211.258
04.211.258
standard
44
02.211.260
04.211.260
long
62
2.4 mm / 2.7 mm Variable Angle LCP L-Fusion Plates, left◊
Stainless Steel
Titanium
Size
Length (mm)
02.211.257
04.211.257
short
37
02.211.259
04.211.259
standard
44
02.211.261
04.211.261
long
62
2.4 mm / 2.7 mm Variable Angle LCP T-Fusion Plates◊
Stainless Steel
Titanium
Holes
Head
Size
Length
(mm)
02.211.253
04.211.253
2
short
35
02.211.254
04.211.254
2
standard
42
02.211.255
04.211.255
2
long
61
02.211.265
04.211.265
3
extra long
92
82
Proximal and Distal Reamers Set, 14 mm–24 mm (01.211.112)
Graphic Cases
60.116.052
Module Shell
60.211.009
Proximal and Distal Reamers Module Bin 1
Implant
292.56
points on both ends, 10/pkg.
Instruments
Cannulated Reamers (for 1.6 mm K-Wires)
Proximal
Distal
Diameter (mm)
03.211.114
03.211.014
14
03.211.116
03.211.016
16
03.211.118
03.211.018
18
03.211.120
03.211.020
20
03.211.122
03.211.022
22
03.211.124
03.211.024
24
Also Available
01.211.113
Graphic Case
60.211.010
Implant
292.52
6 mm–12 mm Proximal and Distal Reamer
Set
Proximal and Distal Reamers Module Bin 2
points on both ends, 10/pkg.
Instruments
Cannulated Reamers (for 1.25 mm K-Wires)
Proximal
Distal
03.211.106
03.211.006
Diameter (mm)
03.211.108
03.211.008
8
03.211.110
03.211.010
10
03.211.112
03.211.012
12
6
Synthes
83
First MTP Fusion Plates Sets
Graphic Case
60.211.001
First MTP Fusion Module Bin
Implants
2.4 mm / 2.7 mm Variable Angle LCP First MTP Fusion Plates,
small, 42 mm◊
Stainless Steel
Titanium
Left/Right
02.211.230
04.211.230
right
Dorsiflexion
0°
02.211.231
04.211.231
left
0°
02.211.232
04.211.232
right
5°
02.211.233
04.211.233
left
5°
02.211.234
04.211.234
right
10°
02.211.235
04.211.235
left
10°
medium, 52 mm◊
Stainless Steel
Titanium
Left/Right
Dorsiflexion
02.211.236
04.211.236
right
0°
02.211.237
04.211.237
left
0°
02.211.238
04.211.238
right
5°
02.211.239
04.211.239
left
5°
02.211.240
04.211.240
right
10°
02.211.241
04.211.241
left
10°
large, 57 mm◊
Stainless Steel
Titanium
Left/Right
Dorsiflexion
02.211.242
04.211.242
right
5°
02.211.243
04.211.243
left
5°
revision, 53 mm◊
Stainless Steel
Titanium
Left/Right
02.211.244
04.211.244
right
Dorsiflexion
0°
02.211.245
04.211.245
left
0°
84
Graphic Cases
60.116.052
60.211.007
Module Shell
Opening Wedge Plate and Instrument
Module Bin
Implants
2.4 mm/2.7 mm Variable Angle Locking Opening Wedge
Plates◊
Stainless Steel
Titanium
Spacer (mm)
02.211.210
04.211.210
0
02.211.211
04.211.211
3
02.211.212
04.211.212
4
02.211.213
04.211.213
5
02.211.214
04.211.214
6
02.211.215
04.211.215
7
Instrument
03.211.009
Synthes
85
Graphic Case
60.211.005
Tarsal and Mesh Plate Module Bin
Implants
2.4 mm/2.7 mm Variable Angle Locking Navicular Plate◊
Stainless Steel
Titanium
02.211.220
04.211.220
2.4 mm/2.7 mm Variable Angle Locking Cuboid Plates◊
Stainless Steel
Titanium
Left/Right
02.211.221
04.211.221
left
02.211.222
04.211.222
right
2.4 mm/2.7 mm Variable Angle Locking Mesh Plate, 5 x 12
holes◊
Stainless Steel
Titanium
02.211.224
04.211.224
86
Synthes (USA)
1302 Wrights Lane East
West Chester, PA 19380
Telephone: (610) 719-5000
To order: (800) 523-0322
Fax: (610) 251-9056
© 2010 Synthes, Inc. or its affiliates. All rights reserved.
Synthes (Canada) Ltd.
2566 Meadowpine Boulevard
Mississauga, Ontario L5N 6P9
Telephone: (905) 567-0440
To order: (800) 668-1119
Fax: (905) 567-3185
Combi, LCP and Synthes are trademarks of Synthes, Inc. or its affiliates.
www.synthes.com
Printed in U.S.A. 3/11 J9980-B

2.4 mm/2.7 mm Variable Angle LCP Forefoot/Midfoot System.

Transcription

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