Surgical Technique

Surgical Technique
2
Surgical Techniques
Universal Plates . . . . . .
4
MTP Plates . . . . . . . . .
8
TMT Plates . . . . . . . . .
12
OrthoLink™ Plates . . . . . 16
Y-Shaped Plate . . . . . .
20
3
Surgical Technique
Universal Plates
Figure 1
Step 1: The surgical site is prepared and the fusion or
fracture site is reduced and temporarily stabilized by the
surgeon’s preferred technique.
Step 2: Choose an appropriately sized universal plate based
on size and type of indication. Care must be taken not to
scratch or notch the implants throughout the procedure
(Figure 1).
CAUTION: In pediatric patients, avoid crossing the growth
plate with any implants.
4
Figure 2
Step 3: If necessary, use the bending irons (MXL-050) or
bending pliers (MXS-051) to contour the plate to the bone
surface. When using the bending irons, use your thumbs to
apply pressure to the top while pulling apart at the bottom.
Use the top slots to concave the plate and the bottom slots
to convex the plate. Each bend should be in one direction
only. Reverse or over bending may cause reduced fatigue
life. Avoid excessive bending through the locking holes. If
the plate is contoured through the locking holes, a nonlocking screw is recommended to avoid cross-threading of
the locking screw (Figure 2).
Figure 3
Step 4: The plate is placed with the two “ears” on one side of
the fracture/osteotomy and the other two “ears” are placed
on the opposite side of the fracture. Note that when using
the plates with center slots, they may be placed on either
side of the fracture. The plate may be temporarily held in
place with standard plate holding forceps, 1.1mm k-wires
(through k-wire holes) or olive wires (through locking holes
or compression slots) (Figure 3).
Step 5: The screw holes in the plates are compatible with a variety of screw options. Non-locking
2.7mm, 3.5mm, and 4.0mm screws are offered and can be used in either screw hole. 3.5mm locking
screws are provided for only the threaded locking hole. Screw diameter is chosen based on indication
and surgeon preference; a combination of screws may be used in the same plate.
Step 6: Four drill bits are provided in the system: 1.9mm (Gold), 2.4mm (Magenta) and 2.7mm (Aqua)
outside diameters (OD). The 1.9mm bit is to be used in conjunction with 2.7mm screws and the 2.4mm
bit is to be used in conjunction with 3.5mm screws and the 2.7mm bit is to be used in conjunction
with 4.0mm screws. A 4.0mm (Double Teal Ring) drill bit is also found in the system and can be utilized
for lagging the 4.0mm screws.
5
Step 7: When drilling for non-locking screws, the standard hand-held drill guide should be used
(MFT-071-24, MFT-071-27, or MFT-071-40). The standard drill guides are color coded to match the
appropriate drill bit and screw diameter. When drilling for a locking screw, either the fixed drill guide
(MFT-071-24-F) or the Quick Insertion (QI® Guide) drill guide (MFT-071-24-KG) should be used. The
fixed drill guide threads into the locking hole to provide the proper angle for drilling. To use the QI®
Guide, align the lobes on the tip of the guide with the lobes in the threaded hole and press into the
plate while drilling to ensure proper alignment.
Step 8: Drill to desired depth. Take care to not move the plate after drilling for a locking hole in order
to maintain the proper pilot hole alignment and prevent locking screw cross-threading. Use only the
provided depth gauge to determine screw length. For all screws used throughout procedure, verify
screw length in appropriate gauge on screw caddy. Use the driver to insert the screw into the hole
and drive the screw.
Note: The depth gage reading corresponds to the working length of the screw (from distal tip to underneath
the screw head).
Step 9: Non-locking screws placed in the compression slots can be used to generate inter-fragmentary
compression in the direction of the slot. The direction of the slot is indicated by an arrow.
Figure 4
Step 10: In order to generate compression, the plate is first
fixed on one side of the fusion site using a locking screw
or non-locking screw with bicortical purchase through a
locking hole (Figure 4).
Figure 5
Step 11: Drill into the slot as far from the fusion site as
possible (Figure 5).
6
Figure 6
Step 12: Insert a non-locking screw bi-cortically (Figure 6).
Note: If maximum compression is desired it is advised to use
a 4.0mm screw.
Figure 7
Step 13: Tighten the screw into the slot to generate
compression (Figure 7).
Note: The amount of compression can be modulated from
2mm (maximum) to 0mm by drilling into an area of the
slot closer to the fusion site. The slot may be utilized with no
compression if the non-locking screw is placed in the neutral
side of the slot (area of the slot closest to the fusion site).
Step 14: When a lag technique is desired, use the 4.0mm drill bit (double Aqua ring) with the
corresponding double drill guide to over drill the gliding hole.
Step 15: Do not over torque the screws.
Step 16: Correct placement of the fixation device is verified. The soft tissues are replaced as required
by the operative procedure and surgeon preferred technique.
7
Surgical Technique
MTP Plates
Figure 1
Step 1: Prepare the MTP joint for fusion using the surgeon’s
preferred technique. Care should be taken to remove any
excessive bony prominences to avoid excessive dorsal
flexion of the fused joint (Figure 1).
CAUTION: In pediatric patients, avoid crossing the growth
plate with any implants.
8
Figure 2
Step 2: The appropriate MTP fusion plate is selected.
Standard, Narrow and Revision plates are available for right
and left foot procedures. The plates are pre-contoured to
provide 10 degrees of valgus and 5 degrees of dorsiflexion
(Figure 2).
Figure 3
Step 3: If necessary, use the bending irons or bending
pliers to contour the plate to the bone surface. When using
the bending irons, use your thumbs to apply pressure to
the top while pulling apart at the bottom. Use the top slots
to increase plate dorsiflexion and the bottom slots reduce
the plate dorsiflexion (Figure 3).
Step 4: The bending pliers may be used to adjust the “ears”
of the plate to better fit the bone surface. Each bend should
be done in one direction only. Excessive bending may result
in reduced fatigue life for the plates. Care should be taken
to avoid excessive bending through the locking holes. If
the plate is contoured through the locking holes, a nonlocking screw is recommended to avoid cross-threading of
the locking screw.
Figure 4
Step 5: The plate may be provisionally fixed using the
included olive wires. Ideally, at least one wire will be used
on either side of the fusion site (Figure 4).
Step 6: The screw holes in the MTP plates offer a variety
of screw options. Non-locking 2.7mm, 3.5mm, and 4.0mm
screws are offered and can be used in any screw hole.
3.5mm locking screws are provided for threaded holes only.
9
Note: Use only the screws and instruments provided with the MaxLock Extreme system with the plates.
Step 6: Color coded drill bits are offered corresponding to each of the screw sizes offered in the
system. In addition, a 4.0mm lag bit and drill guide are included if a lag technique is desired for an
inter-fragmentary screw.
Figure 5
Step 7: Drill screw pilot holes with the appropriate drill guide.
When drilling for non-locking screws, the standard handheld drill guide should be used (MFT-071-XX). The standard
drill guides are color coded to match the appropriate drill
bit and screw. When drilling for a 3.5mm locking screw,
either the fixed drill guide (MFT-071-24-F) or the Quick
Insertion (QI®) guide (MFT-071-24-KG) must be used in order
to obtain the proper angle for drilling and screw insertion.
To use the fixed drill guide, thread the guide into a locking
hole (Use caution not to cross thread the guide). To use the
QI® guide, align the lobes on the tip of the guide with the
corresponding lobed cutouts in the locking hole and press
the quick insertion guide into the plate. Hold while drilling
to ensure proper alignment (Figure 5).
Note: Take care to not move the plate after drilling for a
locking hole in order to maintain the proper hole alignment
and prevent locking screw cross-threading.
Step 8: Drill to desired depth. Use only the provided depth gauge to determine screw length. For all
screws used throughout procedure, verify screw length in appropriate gauge on screw caddy.
Note: The depth gage reading corresponds to the working length of the screw (from distal tip to underneath
the screw head).
10
Figure 6
Step 9: In order to generate compression across the fusion
site, place at least two screws in the distal portion of the
plate. Insert both screws before fully tightening the first to
avoid shifting of the plate (Figure 6).
Figure 7
Step 10: Drill appropriate pilot hole at the proximal end of
the compression slot and remove any provisional fixation
from the proximal end of the plate (Figure 7).
Note: If compression is not desired, drill the screw hole in
Figure 7 at the distal end of the compression slot, nearest the
fusion site.
Figure 8
Step 10: Insert a non-locking screw into the pilot hole in
the slot (Figure 8).
Note: If maximum compression is desired it is advised to use
a 4.0mm screw.
Figure 9
Step 11: As the screw is tightened it will drive compression
toward the fusion site (Figure 9).
Figure 10
Step 12: Fill the remaining screw holes as desired (Figure 10).
Step 14: The soft tissues are closed in the usual lay­ered
manner.
11
Surgical Technique
TMT Plates
Figure 1
Step 1: Prepare the TMT joint for fusion using the surgeon’s
preferred technique. Care should be taken to remove any
excessive bony prominences.
Step 2: The appropriate TMT plate is selected. The plates
are available in a flat/contoured, small/standard, and right/
left (Figure 1, Table 1).
TMT Plates (Contoured/Flat and
Small/Standard)
12
CAUTION: In pediatric patients, avoid crossing the growth
plate with any implants.
Table 1
Procedure Plate
Description
Right 1-2
TMT-002-12SR
TMT Fusion
Small
Contoured
TMT-002-12MR
Standard
Contoured
TMT-002-23SL
Small Flat
TMT-002-23ML
Standard Flat
Right 2-3
TMT-002-23SR
TMT Fusion
Small
Contoured
TMT-002-23MR
Standard
Contoured
TMT-002-12SL
Small Flat
TMT-002-12RL
Standard Flat
Left 1-2
TMT-002-12SL
TMT Fusion
Small
Contoured
TMT-002-12ML
Standard
Contoured
TMT-002-23SR
Small Flat
TMT-002-23MR
Standard Flat
Left 2-3
TMT-002-23SL
TMT Fusion
Small
Contoured
TMT-002-23ML
Standard
Contoured
TMT-002-12SR
Small Flat
TMT-002-12MR
Standard Flat
Step 3: If necessary, use the bending pliers to contour
the plate to the bone surface. Each bend should be done
in one direction only. Excessive bending may result in
reduced fatigue life for the plate. Avoid excessive bending
through the locking holes. If the plate is contoured through
the locking holes, a non-locking screw is recommended to
avoid cross-threading of the locking screw.
Step 4: The screw holes in the TMT plates offer a variety
of screw options. Non-locking 2.7mm, 3.5mm, and 4.0mm
screws are offered and can be used in any screw hole.
3.5mm locking screws are provided for threaded holes only.
Note: Use only the screws and instruments provided with the
MaxLock Extreme system with the plates.
Step 5: Color coded drill bits are offered corresponding to
each of the screw sizes offered in the system. In addition, a
4.0mm lag bit and drill guide are included if a lag technique
is desired for an inter-fragmentary screw.
Figure 2
Step 6: Place the plate over the TMT joints with the
compression slots distally. Fix the plate with an olive wire
in one of the compression slots (see Figure 2).
Step 7: Drill screw pilot holes with the appropriate drill
guide. When drilling for non-locking screws, the standard
hand-held drill guide should be used (MFT-071-XX).
The standard drill guides are color coded to match the
appropriate drill bit and screw. When drilling for a 3.5mm
locking screw, either the fixed drill guide (MFT-071-24-F) or
the Quick Insertion (QI®) guide (MFT-071-24-KG) must be
used in order to obtain the proper angle for drilling and
13
screw insertion. To use the fixed drill guide, thread the guide into a locking hole (Use caution not
to cross thread the guide). To use the QI® guide, align the lobes on the tip of the guide with the
corresponding lobed cutouts in the locking hole and press the QI® guide into the plate. Hold while
drilling to ensure proper alignment. Note: Take care to not to remove the olive wire or move the plate
after drilling for a locking hole in order to maintain the proper hole alignment and prevent locking
screw cross-threading.
Figure 3
Step 8: Drill to desired depth in a proximal hole. Use only
the provided depth gauge to determine screw length. For
all screws used throughout procedure, verify screw length
in appropriate gauge on screw caddy (see Figure 3).
Note: The depth gage reading corresponds to the working
length of the screw (from distal tip to underneath the
screw head).
Figure 4
Step 9: Repeat Step 8 for the other proximal hole (see
Figure 4). Note: Insert both screws before fully tightening the
first to avoid shifting of the plate.
Figure 5
Step 10: In order to generate compression across the fusion
site, remove the olive wire and any other provisional fixation
from the plate. Drill the appropriate pilot hole at the distal
end of the compression slot (Figure 5).
14
Figure 6
Note: If compression is not desired, drill the screw hole in
Figure 5 at the proximal end of the compression slot.
Step 11: Insert a non-locking screw into the pilot hole in
the slot (Figure 6). As the screw is tightened it will drive
compression toward the fusion site (Figure 7).
Note: If maximum compression is desired it is advised to use
a 4.0mm screw.
Figure 7
Figure 8
Step 12: Repeat step 11 (Figure 8).
Step 13: Verify correct placement of the plate with
fluoroscopy.
Note: Do not over torque the screws.
Step 14: The soft tissues are closed in the usual layered
manner.
15
Surgical Technique
OrthoLink™ Plates
Step 1: The surgical site is prepared and the fusion or fracture site is reduced and temporarily stabilized
by the surgeon’s preferred technique.
Step 2: Select the appropriate plate to ensure the two holes on the plate span the fracture or fixation
site. Five plate sizes are available: Short, Standard, Long, Three Hole and Standard Locking.
CAUTION: In pediatric patients, avoid crossing the growth plate with any implants.
16
Step 3: If necessary, use the bending pliers to contour the plate to the bone surface. Each bend should
be done in one direction only. Excessive bending may result in reduced fatigue life for the plate. Avoid
excessive bending through the locking holes. If the plate is contoured through the locking holes, a
non-locking screw is recommended to avoid cross-threading of the locking screw.
Step 4: The plate may be temporarily fixed using the included olive wires. Place the wire through the
compression slot and into the bone.
Step 5: The screw holes in the plates are compatible with a variety of screw options.
• Non-locking 2.7mm, 3.5mm, and 4.0mm screws are offered and can be used in either screw hole.
• 3.5mm locking screws are provided for only the threaded locking hole.
Step 6: Color coded drill bits are offered corresponding to each of the screw sizes offered in the
system. In addition, a 4.0mm lag bit and drill guide are included if a lag technique is desired for an
inter-fragmentary screw.
Step 7: Choose the appropriate drill guide.
• When drilling for non-locking screws, the standard hand-held drill guide should be used (MFT-071XX). The standard drill guides are color coded to match the appropriate drill bit and screw.
• When drilling for a 3.5mm locking screw, the fixed drill guide (MFT-071-24-F) must be used in order
to obtain the proper angle for drilling and screw insertion.
Figure 1
• To use the fixed drill guide, thread the guide into a
locking hole. Use caution not to cross thread the guide
(see Figure 1).
Step 8: Drill to desired depth. Use only the provided
depth gauge to determine screw length. For all screws
used throughout procedure, verify screw length in the
appropriate gauge on screw caddy. Note: The depth gage
reading corresponds to the working length of the screw (from
distal tip to underneath the screw head).
17
Figure 2
Step 9: Remove the drill guide and place the appropriate
locking screw in the hole. Tighten the screw firmly (see
Figure 2).
Note: Take care to not move the plate after drilling for
a locking hole in order to maintain the proper hole
alignment and prevent locking screw cross-threading.
Note: A non-locking screw can also be used using the
appropriate drill guide.
Figure 3
Step 10: Remove any provisional fixation from the plate
and drill the appropriate pilot hole at the end of the
compression slot farthest away from the fusion or fracture
(see Figure 3).
Note: If compression is not desired, drill the screw hole in Figure
3 in the area of the slot closet to the fusion or fracture site.
Figure 4
Step 11: Insert a non-locking screw into the pilot hole in
the slot (see Figure 4).
Note: If maximum compression is desired it is advised to use
a 4.0mm screw.
Figure 5
Step 12: As the screw is tightened it will drive compression
toward the fusion or fracture site (see Figure 5).
18
Step 13: Verify correct placement of the plate with fluoroscopy.
Note: Do not over torque the screws.
Note: Use only the screws and instruments provided with the MaxLock Extreme system for fixation.
Step 14: The soft tissues are closed in the usual layered manner.
19
Surgical Technique
Y-Shaped Plates
Step 1: The surgical site is prepared and the fusion or fracture site is reduced and temporarily stabilized
by the surgeon’s preferred technique.
Step 2: Select the Y-shaped plate from the set (Figure 1).
CAUTION: In pediatric patients, avoid crossing the growth plate with any implants.
Figure 1
20
Figure 2
Step 3: If necessary, use the bending irons or bending
pliers to contour the plate to the bone surface. When using
the bending irons, use your thumbs to apply pressure to
the top while pulling apart at the bottom. Use the top slots
to create dorsiflexion and the bottom slots create plantarflexion. The bending pliers may be used to adjust the “ears”
of the plate to better fit the bone surface. Each bend should
be done in one direction only. Excessive bending may result
in reduced fatigue life for the plates. Care should be taken
to avoid excessive bending through the locking holes. If
the plate is contoured through the locking holes, a nonlocking screw is recommended to avoid cross-threading of
the locking screw (Figure 2).
Step 4: The plate may be provisionally fixed using the included olive wires. Ideally, at least one wire
will be used on either side of the fusion site.
Step 5: The screw holes in the Y-plates accepts a variety of screw options. Non-locking 2.7mm, 3.5mm,
and 4.0mm screws are offered and can be used in any screw hole. 3.5mm locking screws are provided
for the threaded holes only.
Note: Use only the screws and instruments provided with the MaxLock Extreme system for fixation.
Step 6: Color coded drill bits are offered corresponding to each of the screw sizes offered in the
system. In addition, a 4.0mm lag bit and drill guide are included if a lag technique is desired for an
inter-fragmentary screw.
Step 6: Drill screw pilot holes with the appropriate drill guide. When drilling for non-locking screws,
the standard hand-held drill guide should be used (MFT-071-XX). The standard drill guides are color
coded to match the appropriate drill bit and screw. When drilling for a 3.5mm locking screw, the fixed
drill guide (MFT-071-24-F) must be used in order to obtain the proper angle for drilling and screw
insertion. To use the fixed drill guide, thread the guide into a locking hole (Use caution not to cross
thread the guide).
Note: Take care to not move the plate after drilling for a locking hole in order to maintain the proper hole
alignment and prevent locking screw cross-threading.
21
Step 7: Drill to desired depth. Use only the provided depth gauge to determine screw length. For all
screws used throughout procedure, verify screw length in appropriate gauge on screw caddy.
Note: The depth gage reading corresponds to the working length of the screw (from distal tip to underneath
the screw head).
Figure 3
Step 8: In order to generate compression across the fusion
site, place two screws in the ears of the plate. Insert both
screws before fully tightening the first to avoid shifting
of the plate. Remove any provisional fixation from the
plate and drill the appropriate pilot hole at the end of the
compression slot away from the fusion or fracture (Figure 3).
Note: If compression is not desired, drill the screw hole in Figure
3 at the end of the slot closest to the fusion or fracture site.
Figure 4
Step 9: Insert a non-locking screw into the pilot hole in the
slot (Figure 4).
Note: If maximum compression is desired it is advised to use
a 4.0mm screw.
Figure 5
Step 10: As the screw is tightened it will drive compression
toward the fusion or fracture site (Figure 5).
22
Figure 6
Step 11: Fill the remaining screw hole (Figure 6).
Step 13: Verify correct placement of the plate with fluoroscopy.
Note: Do not over torque the screws.
Step 14: The soft tissues are closed in the usual layered manner.
23
1065 Medina Road, Suite 500
Medina, OH 44256
Phone: 866-90-HELIX
Fax: 800-507-3166
[email protected]
www.orthohelix.com
Various aspects of OrthoHelix products are protected by U.S. or
International awarded patents or pending patents
are
MaxLock Extreme, QI, “Surgeons Speak. We deliver.” and
registered Trademarks of OrthoHelix Surgical Designs, Inc.
MXE-801-001 Rev. 3
Surgeons speak. We deliver.
Copyright © 2012 Orthohelix Surgical Designs, Inc.
®