Biomet® Vision™ Pin-To-Bar System

Biomet Vision
Pin-To-Bar System
®
™
Surgical Technique
Calcaneal Reduction Frame
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®
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Biomet Vision Pin-To-Bar System
®
™
Contents
System Overview............................................................................................................................................................2
Indications......................................................................................................................................................................2
Procedural Introduction..................................................................................................................................................2
Pre-operative Planning...................................................................................................................................................3
Incision ........................................................................................................................................................................3
Transfixing Pin Insertion..................................................................................................................................................4
Drill Preparation..............................................................................................................................................................6
Pin Insertion...................................................................................................................................................................7
Pin Clamp......................................................................................................................................................................8
U-Bar Attachment........................................................................................................................................................10
Rod Connector.............................................................................................................................................................11
Distraction and Reduction............................................................................................................................................11
Posterior Facet Elevation..............................................................................................................................................12
Metatarsal Fixation.......................................................................................................................................................13
Neutral Ankle Alignment...............................................................................................................................................14
Post-op Care................................................................................................................................................................14
1
Biomet Vision Pin-To-Bar System
®
™
System Overview
Indications
The Biomet Vision Pin-To-Bar Fixation System allows
independent pin placement for simple, quick, and effective
application of external fixation. The Biomet® Vision™ System
is versatile enough to be used as both temporary and
definitive fixation.
The Biomet® Vision™ Pin-To-Bar Fixation System is
intended for use in the treatment of bone conditions
including osteotomies, arthrodesis, fracture fixation and
other bone conditions amenable to treatment by the use of
the external fixation modality.
Definitive fixation uses include unilateral single bone fixation
and hybrid configuration. It can also be applied to open
book pelvic injuries as a resuscitive frame or a definitive
fixator.
Procedural Introduction
®
™
For delayed open reconstruction in periarticular fractures,
the Biomet® Vision™ Pin-To-Bar Fixation System functions
as an excellent means of temporizing fracture management
to allow for soft tissue healing, as well as the opportunity to
be at home while waiting for their procedure. The system
helps allow the surgeon the ability to release patients
from the hospital quickly, then readmit for a well-planned
surgery or transfer to the appropriate physician.
This surgical technique and postoperative protocol are utilized by John Torregrosa,
DPM, FACFAS, FACFAOM. Biomet as the manufacture of this device does not
practice medicine. Each surgeon is responsible for determining the appropriate
device and technique to utilize on each individual patient.
2
This calcaneal fracture technique was designed to simplify
the traditional ORIF of the calcaneus and preserve limb
function by minimizing operative trauma to anatomical
structures. It combines the use of a simple multiplane
external fixator for reduction of the varus deformity and
of height loss, with minimal incision surgery to elevate the
posterior facet.
Figure 1
Pre-operative Planning
Incision
Review the X-rays and determine that there is a large
enough section of the posterior calcaneus for a 6.0 mm
transfixing screw (Figure 1). Access potential screw site
location based on fracture pattern, involved bone and
associated safe, soft tissue corridor. Position the patient
in the supine position and prep and drape in the usual
sterile fashion.
Make a small incision on the medial aspect of the
posterior calcaneal fragment, proximal to distal to minimize
the chance of damage to the calcaneal nerve. Use blunt
dissection to spread the tissue to give a clear opening for
the transfixing pin.
3
Biomet Vision Pin-To-Bar System
®
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Figure 2
Figure 3
Figure 4
Transfixing Pin Insertion
Under power, insert a 6.0 mm transfixing screw from
medial to lateral. Apply screw in a slightly varus orientation
to match the varus deformity, which occurs with this type
of fracture (Figure 2). Final posterior view will have varus
orientation (Figure 3).
As the lateral skin tents when the screw starts to exit, make
a small incision over the tip to allow the transfixing screw to
pass through (Figure 4).
Note: When inserting the transfixing screw, utilize the split
soft tissue sleeve to allow passage of the threaded portion
of the screw.
6.0 mm Transfixing Screw
(14285)
4
Split Soft Tissue Sleeve
(Vision™ FootRing™ System)
(21460)
Figure 5
Figure 6
Under fluoroscopy, check to make sure the threads are
centered in the calcaneus (Figure 5).
A ratcheting T-handle is included in the Biomet® Vision
Pin-to-Bar tray to facilitate easy screw insertion. Remove
the modular drill tip of the transfixing screw utilizing a
T-handle (Figure 6).
5
Biomet Vision Pin-To-Bar System
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™
Figure 7
Drill Preparation
In the distal 1/3 of the tibia, just medial to the anterior crest,
make a small incision from superior to inferior for the
insertion of a 6/5 mm half pin. Stack a drill sleeve within a
soft tissue sleeve and insert this assembly into the incision
in preparation for drilling.
Using a trocar, create a small pilot dimple by tapping the
hammer on the tip of the trocar stack to facilitate initial
drilling. Remove the trocar and drill bicortically using the
4.8 mm drill bit.
Note: The drill bit should pass in an anterior to posterior
direction with a slight medial to lateral deviation (Figure 7).
Take care not to drill into the soft tissue behind the second
cortex.
Soft Tissue Sleeve, 4.8 mm Drill Sleeve and Trocar Stack
Soft Tissue Sleeve (14-400020)
4.8 mm Drill Sleeve (14-400034)
Trocar (14-400044)
6
Figure 8
Pin Insertion
Remove the drill bit and drill sleeve and insert an
appropriately sized 6/5 mm half pin into the prescribed
screw path.
Under fluoroscopy, place the screw two threads past the
far cortex and stop (Figure 8).
Note: Do not use power to insert the 6/5 mm bone screws.
Doing so increases the risk of driving screws excessively
beyond the far cortex. Because these screws are conical,
they should not be backed out. Backing out conical screw
may compromise purchase and lead to loosening postoperatively.
Ratcheting T-wrench with Screw Retaining Tip
Ratcheting T-handle (03121)
Bone Screw Driver (14-400060)
6/5 mm Bone Screw
7
Biomet Vision Pin-To-Bar System
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™
Figure 9
Pin Clamp
Place a soft tissue sleeve in the bottom hole of a 3-hole
multi-pin clamp and place over the previously placed
tibial screw.
Place soft tissue sleeves and drill guides in the remaining
holes in preparation for drilling. Make small stab incisions
from superior to inferior for insertion of each remaining
6/5 mm half pin.
Insert the 4.8 mm drill bit into the proximal drill sleeve and
drill bicortically. Remove the drill bit and drill sleeve and
insert a 6/5 mm half pin through the soft tissue sleeve.
Once bicortical half pin purchase is achieved, repeat the
above step for the middle screw (Figure 9).
After each of the screws have been inserted, check screw
placement under fluoroscopy with a lateral view to confirm
proper position and depth. The clamp must be tightened
after all screws are in place and all soft tissue sleeves have
been removed.
Note: It is important to keep the clamp an appropriate
distance from the skin for swelling and pin care.
3-Hole Pin Clamp
(14060)
8
Figure 10
Place the posts on either side of the 3-hole clamp
(Figure 10). Using an Allen wrench, definitively tighten
each post.
2-Clamp 3/5 Post
(14-400065)
9
Biomet Vision Pin-To-Bar System
®
™
Figure 11
Figure 12
U-Bar Attachment
Attach a U-Bar to the 6.0 mm transfixing screw using two
Pin-To-Bar Clamps, pointing the bar upward (Figures 11
and 12).
10
Ensure the pin-to-bar clamp is attached as close to the
first bend as possible, while leaving space for additional
clamps anteriorly (Figure 12).
Bent U-Bar
Pin-to-Bar Clamp
190 mm (21280)
220 mm (21285)
250 mm (21290)
(14-400070)
Figure 13
Figure 14
Rod Connector
Distraction and Reduction
On the lateral side of the ankle, use a bar-to-bar clamp
to fixate the 9.5 mm carbon rod to the remaining anterior
portion of the U-Bar. At the proximal interface (post
extending from 3-hole pin clamp), use a bar-to-bar clamp
to connect the distal post end to the carbon rod (Figure 13).
Repeat this procedure and assembly on the medial side.
With both hands, grab the 6.0 mm transfixing screw,
distract the calcaneus to reduce the fracture through
ligamentotaxis, reducing the varus deformity and creating
arthrodiastasis. The direction of distraction should be
mostly plantar but somewhat posterior (Figure 14).
While tension is applied, have an assistant tighten all
bar-to-bar and pin-to-bar clamps to hold reduction.
Confirm reduction of deformity and alignment of the
calcaneal body with an axial view under fluoroscopy.
9.5 mm Carbon Rod
(14160)
Bar-to-Bar Clamp
(14600)
11
Biomet Vision Pin-To-Bar System
®
™
Figure 15
Figure 16
Posterior Facet Elevation
After reduction is accomplished, make a small incision
under the posterior facet on the lateral aspect of the
calcaneus, taking care to avoid the peroneal tendons.
Using a freer or key elevator, elevate the posterior facet
against the talus under fluoroscopy (Figure 15).
Note: If possible, elevate the entire posterior facet at
once by placing the instrument far enough medially before
manipulating the facet. Elevation of the facet may be better
achieved by applying pressure in a slightly anterior and then
dorsal motion. Significant pressure may be applied using
the talar component of the posterior facet as a template.
12
When the posterior facet position has been improved,
insert bone graft material of choice (including InterGro®
DBM*) (Figure 16).
Figure 17
Figure 18
Figure 19
Metatarsal Fixation
Under fluoroscopy, find the center of the base of the first
metatarsal (Figure 17). From the medial side, make a small
incision from proximal to distal. Perform blunt dissection,
prepare and insert an appropriately sized transfixing pin
under power from medial to lateral avoiding joints and
capturing at least three metatarsals. When the transfixing
pin tents the skin on the lateral side, make a small incision
from proximal to distal to allow for exiting of the pin.
Note: When inserting the transfixing pin, utilize the split
soft tissue sleeve to allow passage of the threaded portion
of the pin.
Under fluoroscopy, check to make sure the threads. if
possible, pass through the first three metatarsals. If needed,
the tip of the pin can be cut using large bolt cutters.
Next, attach a pin-to-bar clamp fairly close to the soft
tissue on the medial side of the metatarsal transfixing pin.
Place a 9.5 mm carbon rod onto the pin-to-bar clamp.
Use a bar-to-bar clamp proximally to attach this carbon
rod to the central side of the post. If unable to attach to
the post, the carbon rod may alternatively be connected to
the carbon rod connecting the U-bar to the post. Duplicate
this procedure and assembly on the lateral side (Figures 18
and 19).
13
Biomet Vision Pin-To-Bar System
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Figure 20
Figure 21
Neutral Ankle Alignment
Post-op Care
While these clamps and bars are provisionally held in place,
dorsiflex the foot to achieve a neutral ankle position to
avoid an equinus deformity. Once neutral ankle alignment
is achieved, lock the clamps to maintain this position.
Finally, review the construct’s stability and ensure that
all clamps are definitively tightened. Close the incision on
the lateral side of the calcaneus in layers and dress all pin
sites using standard protocol (Figure 20).
• Daily pin care after first dressing change
Walker Pad
(21235)
14
• Non-weight bearing for one to three weeks
• Partial to full weight bearing with crutches or walker
pad over the next one to two weeks when deemed
appropriate by the treating surgeon
• The frame should be removed when the fracture has
healed radiographically, typically in six to eight weeks
Biomet Trauma
100 Interpace Parkway
Parsippany, NJ 07054
www.biomettrauma.com
800-526-2579
973-299-9300
P/N 060163-01
Rev H
Biomet Osteobiologics
100 Interpace Parkway
Parsippany, NJ 07054
www.biometosteobiologics.com
800-526-2579
LD33-1024
Rev A
04/09
INTERGRO DBM
DYNAFIX VISION AND UNILATERAL SYSTEMS
INDICATIONS
The DynaFix Vision Unilateral System and the DynaFix Vision External Fixation System are
external fixation device intended for use in the treatment of bone conditions including leg
lengthening, osteotomies, arthrodesis, fracture fixation, and other bone conditions amenable to
treatment by use of the external fixation modality.
Additional indications for the Biomet® Vision FootRing System include:
• Correction of deformity
• Revision procedures where other treatments or devices have been unsuccessful
• Bone reconstruction procedures
• Fusions and replantations of the foot
• Charcot reconstruction and Lisfranc dislocations
• Ankle distraction (arthrodiastasis)
CONTRAINDICATIONS
Patients with mental or neurologic conditions who are unwilling or incapable of following postoperative care instructions.
INDICATIONS FOR USE
InterGro DBM products are to be used for filling bony voids or gaps in the extremities and pelvis
that are not intrinsic to the bony stability of the structure, and as an allograft extender in the spine.
InterGro Plus may also be used as a bone void filler in the spine (posterolateral spine). These
defects may be surgically created osseous defects or osseous defects created from traumatic
injury to bone. InterGro DBM may also be used for filling craniofacial defects and craniotomies
that are no larger than 25cm2. Te amount of InterGro DBM products to be used should be based
on the type of procedure and size of the graft site.
CONTRAINDICATIONS
InterGro DBM products are contraindicated in patients with incomplete skull growth.
InterGro DBM products are contraindicated if active or latent infection is observed in or surrounding the implantation site.
For additional information call
Biomet Osteobiologics
800-526-2579
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