SURGICAL TECHNIQUE - PDF document

1 SURGICAL TECHNIQUE IntegraTotal Foot Sys
SURGICAL TECHNIQUE IntegraTotal Foot System Metatarsal Opening Wedge Osteotomy (MOWO) Plate Table of Contents 2System Design DescriptionThis titanium anatomically designed plate comes in various size options for proximal metatarsal osteotomies.Features•2 mm stem size added to address smaller degrees of correction to the IM angle•New size range: 0, 2, 3, 4, 5, and 6mm•Stems deepened and tapered for distraction of osteotomy during insertion and solid contact against cortical bone•Distal screw holes narrowed for an anatomic fit along the distal metatarsal•Stems moved proximally on plate to minimize potential interference with proximal jointIndications For UseIntegra Total Foot System is indicated for skeletally mature patients for the following:•Stabilization and xation of fresh fractures•Intra and Extra articular fractures, joint depression, multi-fragmentary fractures•Revision procedures, joint fusion, and reconstruction of small bones in the feetContraindic

2 ations•Plates and screws are contra
ations•Plates and screws are contraindicated in: active infection, conditions which tend to retard healing such as blood supply limitations, previous infections, insufficient quantity or quality of bone to permit stabilization of the fracture complex, •Cases with malignant primary or metastatic tumors which preclude adequate bone support or screw fixations, unless •Foreign body sensitivity – where material sensitivity is suspected, appropriate tests should be made and sensitivity ruled •These implants are intended as a guide to normal healing, and are NOT intended to replace normal body structure or bear 3Surgical TechniqueThis technique has been developed with the help of Alan Tuckman, MD.As the manufacturer of this device, Integra does not practice medicine and does not recommend this or any other surgical technique for use on a specific patient. The surgeon who performs any implant procedure is responsible for determining and using the appropriate techniques for implanti

3 ng the device in each patient.Caution: F
ng the device in each patient.Caution: Federal law restricts this device to sale by or on the order of a physician or practitioner. Preoperative PreparationStanding radiographs may be used to initially assess the desired amount of correction. 2 - 1 NoteAs a general rule, one millimeter of opening wedge provides approximately 2 degrees of correction to the IM angle. E.g., a 4mm opening wedge plate will provide approximately 8 degrees of correction. The final amount of correction will vary with Additional Corrective ProceduresAlthough beyond the scope of this technique guide, proximal 1st metatarsal opening wedge osteotomies have been used in the correction of hallux valgus, hallux rigidus, and the midfoot sag seen in posterior tibial tendion disfunction. Additional Step 1 1 - 1 A straight medial or dorsomedial incision is made slightly distal to the first tarsometatarsal (TMT) joint. Care should Step 2 2 - 1 A sagittal saw is used to create a perpendicular osteotomy between 1 and 4 3 - 1 A straight o

4 steotome can be used to gradually pry op
steotome can be used to gradually pry open the osteotomy. Care should be taken to prevent fracturing and displacing the lateral cortex. A small laminar spreader placed on the medial cortex may also be used to “dial-in” the desired correction. Care should be taken not to place the laminar spreader into the osteotomy as this may lead to distraction of the lateral cortex. 3 - 1 3 - 2 2- 2 The starting point of the osteotomy will dictate the correction obtained. A direct medial osteotomy will result in valgus Step 3Step 4 4 - 1 Plates are available in 0, 2, 3, 4, 5 and 6mm wedge configurations. 4 - 2 The appropriate opening wedge plate is selected based on intraoperative assessment. The chamfered edge of the wedge will help to push the 4 - 1 5Non-locked plate configurationIf an unlocked plate configuration is preferred the plate can be provisionally fixed using the olive wires in the instrument tray. Locked plate configurationThe locking drill guides are assembled to the appropriate holes

5 in the plate. Olive wires can be used to
in the plate. Olive wires can be used to secure the plate in the Step 6Non-locked plate configurationStep 5 5 - 1 The plate holes provide fixed-angle locking or variable-angle non-locking 5 - 2 Generally, a locked plate configuration is recommended to maximize plate 6 - 1 6 - 2 7 - 1 5 - 1For non-locked plate fixation, screw holes are prepared using the 2.0mm drill 6 - 1 For locked plate fixation, screw holes are prepared using the 2.0mm drill 6 - 2 Each hole is drilled bicortically and then measured using the depth gage from Step 7 7 - 1 Once the screw length is determined, press the screwdriver into the head of 7 - 2 It is recommended that one screw is placed caddy corner on either side of 6Step 8 (Optional) 8 - 1 If desired, autograft or a bone graft substitute such as demineralized bone matrix may be used to pack the wedge site. The graft may be placed before or after plate placement and fixation.Step 9 9 - 1 Prior to closure, fluoroscopy is used to assess the correction of the hallux valgus

6 angle. If sufficient the incision is cl
angle. If sufficient the incision is closed Essential Product InformationWarnings and PrecautionsNo metallic surgical implant should be reused. Any metal implant, once used, should be discarded. Even though it appears •Correct handling of the implant is extremely important. Avoid contouring metallic implants whenever possible. If necessary, or allowed by design, the device should not be bent sharply, reverse bent, notched or scratched. All of these operations can produce defects in the surface finish and internal stress concentrations, which may become the focal point for eventual failure of the appliance.•If metal plates or other metallic devices are to be used together with the Total Foot System, all such devices should be •Correct selection of the implant is extremely important. The potential for success in fracture fixation is increased by the •Postoperative care is extremely important. The patient must be warned that noncompliance with postoperative instructions •The

7 use of Total Foot System provides the su
use of Total Foot System provides the surgeon a means of bone fixation and helps generally in the management of •Failure to immobilize a delayed union or nonunion of bone will result in excessive and repeated stresses which are transmitted •No partial weight bearing or nonweight bearing device can be expected to withstand the unsupported stresses of full •Detailed written instructions on the use and limitations of the device should be given to the patient. If partial weight bearing is recommended or required prior to firm bony union, the patient must be warned that bending or breakage of the device are complications which may occur as a result of the weight bearing or muscle activity. An active patient or a debilitated or demented patient who cannot properly utilize weight support devices may be particularly at risk during postoperative rehabilitation.•While the surgeon must make the final decision on implant removal, whenever possible and practical for the individual patient,

8 fixation devices should be removed once
fixation devices should be removed once their service as an aid to healing is accomplished, particularly in younger more active patients.•The Integra Total Foot System has not been evaluated for safety and compatibility in the MR environment. The Integra Total Foot System has not been tested for heating or migration in the MR environment. Integra®Total Foot System – Titanium Locking and Non-Locking Screws T: 1.2mm 0mm stem28.32.100 2mm stem28.32.102 3mm stem28.32.103 4mm stem28.32.104 5mm stem28.32.105 6mm stem28.32.106Fixation Plates Catalog NumberCatalog Number 28.25.1122.7 x 12mm28.25.1142.7 x 14mm28.25.1162.7 x 16mm28.25.1182.7 x 18mm28.25.1202.7 x 20mm28.25.122 Manufacturer:Availability of these products might vary from a given country or region to another, as a result of specific local regulatory a Non contractual document. The manufacturer reserves the right, without prior notice, to modify the products in order to improve For more information or to place an order, please cont