0x6.000.803 AA.qxp:0x6.000.803 AA 10.12.2008 11:40 … TARSAL PLATES.pdf · Locking Talus Plate 7 Locking Navicular Plate 13 Locking Cuboid Plate 17 Plates 21 Screws 22 Instruments

2.4/2.7 mm Locking Tarsal Plates.Talus Plate, Navicular Plate and CuboidPlate.

Technique Guide

0x6.000.803_AA.qxp:0x6.000.803_AA 10.12.2008 11:40 Uhr Seite Cvr1


Synthes 1

Introduction

Surgical Technique

Product Information

Bibliography 27

2.4/2.7 mm Locking Tarsal Plates 2

AO Principles 4

Indications 5

Clinical Cases 6

Locking Talus Plate 7

Locking Navicular Plate 13

Locking Cuboid Plate 17

Plates 21

Screws 22

Instruments 24

Image intensifier control

WarningThis description is not sufficient for immediate application ofthe instrumentation. Instruction by a surgeon experienced inhandling this instrumentation is highly recommended.

Table of Contents

0x6.000.803_AA.qxp:0x6.000.803_AA 10.12.2008 11:40 Uhr Seite 1

2 Synthes 2.4/2.7 mm Locking Tarsal Plates Technique Guide

Locking Talus Plate

Angular stability– Round locking holes accept 2.4 and 2.7 mm (head

LCP 2.4) locking screws and 2.4 mm cortex screws

Anatomic profile– The plate can be fitted to the talus medially and laterally– The ribs between the plate holes facilitate easy bending

and contouring– Flat plate and screw profile prevents irritation of ligaments

and soft tissues– Plates can be easily cut to length for the specific fracture

pattern or patient anatomy

2.4/2.7 mm Locking Tarsal Plates

Locking Navicular Plate



Anatomic profile– The plate fits the specific anatomic profile of the navicular

bone– The ribs between the plate holes facilitate easy bending





Synthes 3

Locking Cuboid Plate



Anatomic profile– Left and right plates for anatomic fit– The ribs between the plate holes facilitate easy bending






AO Principles

In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation1,2. These principlesas applied to the 2.4 mm/2.7 mm locking tarsal plates, are:

Anatomic reductionThe locking tarsal plates are plates that can be anatomicallyshaped to restore proper anatomic reduction of the Cuboid,Tarsal and Navicular bones in the foot.

Stable fixationThe locking tarsal plates utilize locking technology. Lockingthe screw to the plate creates a fixed angle construct that isa stronger construct compared to a similar nonlocking plateand screw combination. Ideal for osteopenic bone, the loadin a locked construct is shared between the plate and thescrew increasing fixation stability.

Preservation of blood supplyThe plates are anatomic and can be contoured for preciseapplication to the bone minimizing soft tissue and bone dis-section. The plates are low profile to allow for good soft tis-sue coverage and improved blood supply to the fracture site.

Early active mobilizationThe locking tarsal plates combined with the proper AO tech-nique provide stable fracture fixation with minimal trauma tovascular supply. This helps to create an improved environ-ment for bone healing, accelerating the patient’s return toprevious mobility and function.

1 Müller ME, Allgöwer M, Schneider R, Willenegger H (1995) Manual of InternalFixation. 3rd, expanded and completely revised ed. 1991. Berlin, Heidelberg,New York: Springer

2 Rüedi TP, Buckley RE, Moran CG (2007) AO Principles of Fracture Management.2nd expanded ed. 2002. Stuttgart, New York: Thieme


Synthes 5

Indications

The Synthes 2.4 mm/2.7 mm locking tarsal plates are in-tended for the fixation of fractures, osteotomies, nonunions,replantations, and fusions of the Cuboid, Tarsal and Navicu-lar bones, particularly in osteopenic bone.



PostoperativePreoperative

Clinical Cases

Case 1Cuboid fracture

– 18 year old male– Fall from roof

Case 2Talus fracture

– 44 year old male– Motor vehicle accident

Case 3Navicular fracture

– 41 year old male– Motor vehicle accident




Synthes 7

Locking Talus Plate

PreparationThe locking tarsal plates are an addition to the 2.4 mm mod-ule of the compact foot set.

Required Sets

01.282.002 LCP Compact Foot Basic Instrument Setand Screws � 2.7 mm, Stainless Steel

or01.282.004 LCP Compact Foot Basic Instrument Set

and Screws � 2.7 mm, Titanium Alloy(TAN)

182.678 Compact Foot 2.4 (Stainless Steel Implants)or182.677 Compact Foot 2.4 (Titanium Implants)

Complete the preoperative radiographic assessment and pre-pare the preoperative plan. Determine the plate and instru-ments to be used.



Locking Talus Plate

1Approach

Two approaches are necessary to treat talus fractures, to al-low for good visualization of both the medial and lateralsides of the talus.Medially, a slightly dorsal incision is made along the bisectorangle between the anterior and posterior tibialis. This inci-sion is started distally over the tubercle of the tarsal navicularbone and lengthened proximally over the tip of the medialmalleolus, if required.Laterally, a longitudinal incision is made; this is called the Ol-lier approach, from the tip of the lateral malleolus to the dor-solateral part of the talonavicular joint.These incisions are made to the bone, avoiding the dorsalperoneal nerves and vascular structures.

2Contour plate

Instrument

329.922 Bending Pin for LCP Plates 2.4 and 2.7,with thread

Optional instrument

391.962 Bending/Cutting Pliers

Provisional bone fixation can be obtained using k-wires. Inde-pendent lag screws can be used for stabilization.


Synthes 9

Medially, the plate fits on the bone with the concavity up-ward. The posterior portion of the plate is below the medialmalleolar facet and the anterior portion runs above the neck,parallel to the talonavicular joint.

Laterally, the plate fits on the bone with the concavitydownward. The posterior portion of the plate is almost verti-cal in front of the lateral process and the anterior portion ishorizontal, perpendicular to the talonavicular joint.

Thread the bending pins or drill guides into the plate on eachside of the bend location. Ensure the pins are completelyengaged into the plate before bending. Contour the plate.Be careful to avoid overbending and damage to the platethreads. The plates can be cut to length and contoured usingthe Bending/Cutting pliers for the specific fracture pattern orpatient anatomy.


Locking Talus Plate

3Drill and insert 2.4 mm Cortex screw

Instruments

310.509 Drill Bit � 1.8 mm, with marking

310.530 Drill Bit � 2.4 mm, length 100/75 mm

311.430 Handle with quick coupling

314.467 Stardrive Screwdriver Shaft, T8

319.010 Depth Gauge

323.202 Universal Drill Guide 2.4

If a combination of cortex screws and locking screws will beused, a cortex screw should be inserted first.Use the 2.4 mm universal drill guide when inserting the cor-tex screws. Use the 1.8 mm drill bit for the threaded holeand 2.4 mm drill bit for the gliding hole.

Drill to the desired depth. Verify drilling depth using imageintensification. Remove the drill guide and measure for screwlength using the depth gauge.

Insert the cortex screw manually with the self-retainingStardrive screwdriver shaft and handle.



Synthes 11

4Drill and insert locking screw

In the tarsal plates the option of 2.4 mm or 2.7 mm (headLCP 2.4) locking screws can be used.

Instruments



511.776 Torque Limiter, 0.8 Nm

323.029 LCP Drill Sleeve 2.4 for Drill Bits � 1.8 mm


Optional instruments

319.010 Depth Gauge

323.061 LCP Drill Sleeve 2.7, for Drill Bits � 2.0 mm

323.062 Drill Bit � 2.0 mm with double marking

Screw the drill guide into one of the locking holes until it isfully seated. Insert the drill bit through the drill guide to thebone.


Locking Talus Plate

Caution: Do not start drilling until the drill bit touches thebone. Inserting the drill bit into the drill guide while the drillis running may cause damage to the drill bit or drill guide.

Drill to the desired depth. Verify drill depth using imageintensification.

Determine the screw length directly from the mark on thedrill bit and the scale on the threaded drill guide.

Alternatively, screw length can be checked by removing thedrill guide and using the depth gauge.

Insert the locking screw manually with the self-retainingStardrive screwdriver shaft, Torque Limiter 0.8 Nm and han-dle. Carefully tighten the locking screw. Excessive force is notnecessary to lock the screw to the plate.

Repeat for the remaining locking screws.

Under image intensification make a final control to ensurethat all screws are the correct length and correctly placed.



Synthes 13


1Approach

Make a dorsal longitudinal incision from the midneck of thetalus towards the base of the second metatarsal. It is impor-tant to preserve neurovascular and tendinous structures. Itmay be necessary to open the talonavicular joint capsule toallow visualization of the joint. To minimize the potential forvascular damage, strip only a small segment of the capsulefrom the navicular bone.

2Contour the Plate

Instrument

329.922 Bending Pin for 2.4/ 2.7 mm Locking Plates

Optional instrument


Provisional bone fixation can be obtained using K-wires. In-dependent lag screws can be used for stabilization.

The plate is designed to fit the navicular bone in a concaveup direction.

Thread the bending pins or drill guides into the plate on eachside of the bend location. Ensure the pins are completelyengaged into the plate before bending. Contour the plate.Be careful to avoid overbending and damage to platethreads.

The plates can be contoured using the bending/cutting pliersfor the specific fracture pattern or patient anatomy.




3Drill and insert 2.4 mm cortex screw

Instruments





319.010 Depth Gauge


If a combination of cortex screws and locking screws will beused, a cortex screw should be inserted first.

Use the 2.4 mm universal drill guide when inserting the cor-tex screws. Use the 1.8 mm drill bit for the threaded holeand 2.4 mm drill bit for the gliding hole.

Drill to the desired depth. Verify drill depth using imageintensification. Remove the drill guide and measure for screwlength using the depth gauge.



Synthes 15



Instruments







319.010 Depth Gauge










Insert the locking screw manually with the self-retainingStardrive screwdriver shaft , Torque Limiter 0.8 Nm and han-dle. Carefully tighten the locking screw. Excessive force is notnecessary to lock the screw to the plate.

Repeat for the remaining locking screws. Under image inten-sification make a final control to ensure that all screws arethe correct length and correctly placed.



Synthes 17

1Approach

Make a linear dorsolateral incision starting at the sinu tarsiand extending to the base of the fourth metatarsal.Caution, this incision may run parallel to or directly over thesural nerve, and crosses the peroneous tertius, care must betaken to avoid injuring these structures. One of the main ob-jectives of cuboid fracture management is restoration of thelateral column length and articular surface.


2Contour the Plate

Instrument

329.922 Bending Pin for 2.4/ 2.7 mm Locking Plates

Optional instrument


Provisional bone fixation can be obtained using K-wires. Inde-pendent lag screws can be used for stabilization.

The cuboid plate is available in left and right plates to matchthe anatomy of each foot. The longest arm, with 5 screwholes, is designed to be placed proximally.

Thread the bending pins or drill guides into the plate on eachside of the bend location. Ensure the pins are completely en-gaged into the plate before bending. Contour the plate. Becareful to avoid overbending and damage to plate threads.

The plates can be contoured using the bending/cutting pliersfor the specific fracture pattern or patient anatomy.



3Drill and insert 2.4 mm cortex screw

Instruments





319.010 Depth Gauge


If a combination of cortex screws and locking screws will beused, a cortex screw should be inserted first.

Use the 2.4 mm universal drill guide when inserting the cor-tex screws. Use the 1.8 mm drill bit for the threaded holeand 2.4 mm drill bit for the gliding hole.

Drill to the desired depth. Verify drill depth using image in-tensification. Remove the drill guide and measure for screwlength using the depth gauge.




Synthes 19



Instruments







319.010 Depth Gauge










Insert the locking screw manually with the self-retainingStardrive screwdriver shaft, Torque Limiter 0.8 Nm and han-dle. Carefully tighten the locking screw. Excessive force is notnecessary to lock the screw to the plate.

Repeat for the remaining locking screws. Under image inten-sification make a final control to ensure that all screws arethe correct length and correctly placed.



Synthes 21

0X.100.020 Navicular Plate 2.4, locking

0X.100.021 Cuboid Plate 2.4, locking, left

0X.100.022 Cuboid Plate 2.4, locking, right

0X.100.023 Talus Plate 2.4, locking

Plates

X=2 stainless steelX=4 titanium

Implants (or “products" as appropriate) are available nonsterile or sterile packed.Add suffix "S" to article number to order sterile product.



LCP Locking Screw Stardrive � 2.4 mm, self-tapping

– Thread diameter 2.4 mm– Drill bit for threaded hole 1.8 mm– Drill bit for gliding hole 2.4 mm– Core diameter 1.9 mm– Head diameter 3.5 mm– Stardrive T8

2.4 mm locking screws available from 6 mm to 30 mmlengths (2 mm increments)

LCP Locking Screw Stardrive � 2.7 mm (head LCP 2.4),self-tapping


2.7 mm locking screws available from 10 mm to 60 mmlengths (2 mm increments up to 50 mm, 5 mm incrementsup to 60 mm)

Screws


Synthes 23

Cortex Screw Stardrive � 2.4 mm, self-tapping


2.4 mm cortex screws available from 6 mm to 40 mmlengths (1 mm increments up to 14 mm, 2 mm incrementsfrom 16 mm up to 40 mm)

Note: For information on fixation principles using conven-tional and locked plating techniques, please refer to the LCPLocking Compression Plate Technique Guide (036.000.019).

Note: The T8 Stardrive recess in the screw head offers im-proved torque transfer, high strength, and self-retention ofscrews, when compared to cruciform and hexagonal drives.Please note the Stardrive recess in the surgical report. Thiswill remind the surgeon to have a Stardrive screwdriver avail-able when removing these screws.



329.922 Bending Pin for LCP Plates 2.4 and 2.7, with thread






Instruments


Synthes 25

319.010 Depth Gauge








Synthes 27

Tarsal PlatesST Hansen Jr (2000) Functional Reconstruction of the Footand Ankle. Lippincott: Williams and Wilkins

Approach ImagesED McGlamry (1987) Fundamentals of Foot Surgery. Lippin-cott: Williams and Wilkins: 181-184

Bibliography




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Documents

0x6.000.803 AA.qxp:0x6.000.803 AA 10.12.2008 11:40 … TARSAL PLATES.pdf · Locking Talus Plate 7 Locking Navicular Plate 13 Locking Cuboid Plate 17 Plates 21 Screws 22 Instruments