CASE REPORT. Antegrade tibia lengthening with the PRECICE Limb Lengthening technology
|
|
- Harry Lamb
- 5 years ago
- Views:
Transcription
1 CASE REPORT Antegrade tibia lengthening with the PRECICE Limb Lengthening technology Austin T. Fragomen, M.D. Hospital for Special Surgery New York, NY 1 1
2 PR O D U CTS CONDITION Nonunion of an attempted ankle arthrodesis with limb length discrepancy Patient History (Continued) PRODUCT 10.7 x 275 mm PRECICE Antegrade Tibial Nail SURGEON Austin T. Fragomen, M.D. Removal of hardware was performed as well astibio-talar revision arthrodesis, deep cultures, and application of external fixation with sparing of the subtalar joint (Fig. 2a, 2b). Intraoperative cultures were positive for methicillin sensitive staph aureus and she was treated with 6 weeks of IV vancomycin. The patient underwent removal of the external fixator 5 months post fusion surgery. Her subtalar joint went on to collapse into valgus over the ensuing 6 months. Patient History The patient is a 58-year-old female with Type II diabetes mellitus and peripheral neuropathy who presented with a nonunion of an attempted ankle arthrodesis. She had sustained an open ankle fracture dislocation treated with external fixation and staged internal fixation. The fracture went on to nonunion and collapse, and she underwent attempted tibio-talar arthrodesis with internal fixation. The fusion surgery resulted in a painful nonunion with a draining sinus and suspicion of deep infection (Fig. 1a, 1b). Eight months after frame removal, the patient had surgery to fuse the subtalar joint and correct deformity with a tricortical iliac crest autograft and internal fixation (Fig. 3a, 3b). Once the subtalar reconstruction was healed, she was allowed full weight bearing with a 3 cm shoe lift. The patient expressed intolerance of the shoe lift and a desire to have limb equalization. A long, standing radiograph showed a 41 mm limb length discrepancy (Fig. 4). Despite being a neuropathic diabetic, she healed the ankle and subtalar fusions and was now infection free. Experienced in external fixation, the patient was completely opposed to tibial lengthening with a frame. The patient was felt to be a reasonable candidate for internal tibial lengthening. Fig. 1a: A/P radiograph 2 of the right foot Fig. 2a: A/P radiograph of the right foot Fig. 2b: Lateral radiograph of the right foot Fig. 3a: A/P radiograph of Fig. 3b: Lateral the right foot radiograph of the right foot Fig. 4: A/P standing radiograph with a 37mm block Fig. 1b: Lateral radiograph of the right foot 3
3 Preoperative Planning The goal was for a 41 mm tibial lengthening. The planning of the lengthening nail required measuring the radiograph (Fig. 5a). The optimal osteotomy position for tibial lengthening with an intramedullary nail is in the metaphyseal-diaphyseal junction, which measured 120 mm distal to the knee joint line. This location provides enough proximal bone for the nail to control the proximal segment while still taking advantage of the superior metaphyseal bone regeneration potential. The canal measured 11 mm at the isthmus, and a 10.7 mm diameter nail was selected. Nail length was measured, and it was determined that 275 mm would give excellent control of the distal segment. The minimum nail length needed can be calculated. The osteotomy site was already selected to be 120 mm distal to the joint line (Fig. 5b). The minimum length of the nail remaining in the distal fragment after lengthening is always 80 mm. The amount of lengthening is 41 mm. This requires a 230 mm length nail at the minimum. Operative Procedure The patient was given spinal anesthesia and sedation, and a well-padded pneumatic tourniquet was placed on the right thigh. The right lower extremity was prepped and draped. The surgery began with a percutaneous fibular osteotomy using multiple drill holes and an osteotome under fluoroscopy (Fig. 6a). The osteotomy site was measured and the drill holes for the osteotomy were created serving as vent holes for the reaming. The posterior blocking screw was inserted posterior to the intended path of the nail in order to prevent insertion of flexion during tibial lengthening. A distal ankle syndesmotic screw was not inserted because the patient had undergone prior lateral malleolar excision. Steinman pins (3 mm) were inserted proximally and distally to mark rotation. A trans-patellar tendon approach was used, and the entry point was created with an acorn reamer. Sequential reaming over a ball-tipped guide wire was performed by 0.5 mm increments up to and including a 12.5 mm reamer tip. The guide wire was removed, the leg extended, and the osteotomy was completed with an osteotome. The knee was flexed again, and the nail was inserted. Proximal locking of the nail was completed, and the targeting device was removed. The rotation was checked and the distal locking was completed using perfect circles under fluoroscopy. A proximal syndesmotic screw was inserted (Fig. 6b). The magnet position was marked on the skin under fluoroscopy. 4 Fig. 5a Fig. 5: (a,b) Standing bipedal radiograph Fig. 5b Fig. 6a Fig. 6: (a,b) C-Arm fluoroscopy Fig. 6b 5
4 Postoperative Management Postoperative care included CPM (continuous passive motion) beginning on postoperative day 1. Venous thromboembolism prophylaxis with XARELTO was started post-op day 2 and continued for 2 weeks. The patient started external magnet adjustments post-op day 7 (Fig. 7a). The tibia was lengthened in 0.25 mm increments, 4 times per day for 4 days and then slowed to three times a day for 49 days. Full tibia radiographs were taken every two weeks during the lengthening process. When the goal of 41 mm was reached, the lengthening process was concluded (Fig. 7b). Interestingly, the fibula did not lengthen at the osteotomy site and instead pulled proximally from its distal aspect. This is common during lengthening after ankle fusion. During consolidation, the patient came in monthly. Results Fig. 7a Fig. 7b Fig. 7: (a,b) Lateral radiographs of the tibia The patient s lengthening site healed with strong callus (Fig. 8a, 8b). The anterior portion is typically slow to fill in completely. She is full weight bearing with no pain. Her foot is plantargrade, and she no longer uses a shoe lift. She continues to be infectionfree. Her IM nail will need to be removed when the anterior cortex is complete. Discussion Complex ankle arthrodesis often results in symptomatic unequal limb lengths. 1 Patients with diabetes and peripheral neuropathy are at increased risk for external fixator related complications. 2 This makes tibial lengthening with an intramedullary implant a very attractive option. This case report highlights the success achieved using an internal lengthening approach in a high risk patient. A staged series of surgeries was used primarily because of the fear of infection from a simultaneous ankle fusion and proximal osteotomy with an internal nail. However, in an ideal candidate the tibial osteotomy and nail insertion can be done while the patient is still wearing the frame provided that the frame fixation is inserted distally in the tibia and the lengthening nail is short, avoiding contact with the pins. References and Suggested Reading Tellisi N, Fragomen A, Ilizarov S, et al. Limb salvage reconstruction of the ankle with fusion and simultaneous tibial lengthening using the Ilizarov/Taylor Spatial Frame. HSS J 2008; 4: Fragomen AT, Borst E, Schachter L, et al. Complex ankle arthrodesis using the Ilizarov method yields high rate of fusion. Clin Orthop Real Res 2012;470(10); Fig. 8a : A/P radiograph of the tibia Fig. 8b: Lateral radiograph of the tibia 7
5 For more information about this exciting technology, please contact your local sales representative. 101 Enterprise, Suite 100 Aliso Viejo, CA Phone: (+1) Fax: (+1) NuVasive, Inc. All rights reserved., NuVasive, and Speed of Innovation are registered trademarks of NuVasive, Inc. PRECICE is a registered trademark of NuVasive Specialized Orthopedics, Inc. NuVasive Specialized Orthopedics, Inc. is a trademark of NuVasive, Inc. Third party trademarks are the property of their respective owners. Rx Only. The PRECICE Intramedullary Limb Lengthening (IMLL) System is composed of an implantable intramedullary nail, locking screws, reusable instruments, and a hand-held External Remote Controller (ERC). The PRECICE nail is a sterile single use device that is surgically implanted using the instruments and locking screws. The ERC is used daily after implantation to non-invasively lengthen or shorten the implant to a prescribed length. The PRECICE System is intended for limb lengthening of the femur and tibia. Contraindications include infection or pathologic conditions of bone such as osteopenia which would impair the ability to securely fix the device, metal allergies and sensitivities, patients whose distance from the surface of the treated limb to the intramedullary canal is greater than 51 mm for the 10.7 and 12.5 mm diameter implants or greater than 38 mm for the 8.5 mm diameter implant, patients with an irregular bone diameter that would prevent insertion of the PRECICE nail, patients in which the PRECICE nail would cross joint spaces or open epiphyseal growth plates, patients in which there is an obliterated medullary canal or other conditions that tend to retard healing such as blood supply limitations, peripheral vascular disease or evidence of inadequate vascularity, patients unwilling or incapable of following postoperative care instructions, patients weighing in excess of 114 Kg for the 10.7 and 12.5 mm diameter implants (models A-G, H, J, K, and U) or weighing in excess of 57 Kg for the 8.5 and 10.7 mm diameter implants models (A-G, H, J, K, U, N, M,P, and Q). The implantable device is only to be used by a trained licensed physician. Please refer to the PRECICE IMLL System instructions for use for complete Important Safety Information. Caution: Federal law restricts this device to sale by or on the order of a physician. 16-NUVA-1016
Case Report. Antegrade Femur Lengthening with the PRECICE Limb Lengthening Technology
Case Report Antegrade Femur Lengthening with the PRECICE Limb Lengthening Technology S. Robert Rozbruch, MD Hospital for Special Surgery New York, NY, USA ABSTRACT This is a case illustrating a 4.5 cm
More informationCASE REPORT. Bone transport utilizing the PRECICE Intramedullary Nail for an infected nonunion in the distal femur
PRODUCTS CASE REPORT Bone transport utilizing the PRECICE Intramedullary Nail for an infected nonunion in the distal femur Robert D. Fitch, M.D. Duke University Health System 1 1 CONDITION Infected nonunion
More informationS. Robert Rozbruch, MD. Chief, Limb Lengthening & Complex Reconstruction Service Professor of Clinical Orthopedic Surgery
S. Robert Rozbruch, MD Chief, Limb Lengthening & Complex Reconstruction Service Professor of Clinical Orthopedic Surgery Small Bone Innovations: consultant and royalties Smith and Nephew: consultant External
More informationSurgical Technique. Fibula Rod System
Surgical Technique Fibula Rod System Acumed is a global leader of innovative orthopaedic and medical solutions. We are dedicated to developing products, service methods, and approaches that improve patient
More informationAdult Posttraumatic Reconstruction Using a Magnetic Internal Lengthening Nail
SUPPLEMENT ARTICLE Adult Posttraumatic Reconstruction Using a Magnetic Internal Lengthening Nail S. Robert Rozbruch, MD Summary: A new generation of internal lengthening nail is now available that has
More informationPractical Reduction Techniques: Diaphyseal Reduction. Philip Wolinsky University of California at Davis Medical Center
OTA Specialty Day 2016 Practical Reduction Techniques: Diaphyseal Reduction Philip Wolinsky University of California at Davis Medical Center 8:55 am 9:55 am Tips and Tricks: Practical Reduction Techniques
More informationADJUSTABLE SOLUTIONS FOR FRACTURES AT RISK. Tibia Technique Guide
ADJUSTABLE SOLUTIONS FOR FRACTURES AT RISK Tibia Technique Guide Contributing Surgeons Roy W. Sanders, M.D. Chairman, USF Dept. of Orthopaedics President, Florida Orthopaedic Institute Chief of Orthopaedics,
More informationThe Vilex FUZETM. Dual Thread Screw & Intramedullary Nail in One Implant. The Ultimate TTC Arthrodesis Internal Fixator
The Vilex FUZETM Dual Thread Screw & Intramedullary Nail in One Implant The Ultimate TTC Arthrodesis Internal Fixator Introduction The Vilex FUZE TM TTC Arthrodesis Compression Nail combines the attributes
More informationCorrection of Traumatic Ankle Valgus and Procurvatum using the Taylor Spatial Frame: A Case Report
The Foot and Ankle Online Journal Official publication of the International Foot & Ankle Foundation Correction of Traumatic Ankle Valgus and Procurvatum using the Taylor Spatial Frame: A Case Report by
More informationPediLoc Extension Osteotomy Plate (PLEO)
PediLoc Extension Osteotomy Plate (PLEO) Left PLEO Plates Sizes: 6, 8 and 10 hole plates Right PLEO Plates Sizes: 6, 8 and 10 hole plates PediLoc Extension Osteotomy Plate The technique description herein
More informationLengthening & Deformity correction with. Fixator Assisted Nailing
Lengthening & Deformity correction with Fixator Assisted Nailing External Fixation Used as *Intra-Op Alignment tool * for lengthening with the main intention of reducing External fixation time! Advantages
More informationEVOS MINI with IM Nailing
Case Series Dr. John A. Scolaro EVOS MINI with IM Nailing A series of studies Introduction Intramedullary nailing has become the standard for many long bone fractures. Fracture reduction prior to nail
More informationAntegrade Tibia Operative Technique
Antegrade Tibia Operative Technique Contributing Surgeons Shawn C. Standard, M.D. Head of Pediatric Orthopedics International Center for Limb Lengthening Sinai Hospital Baltimore, MD John E. Herzenberg,
More informationS U R G I C A L T E C H N I Q U E David A. McQueen, MD Return to Menu
S U R G I C A L T E C H N I Q U E David A. McQueen, MD TOTAL KNEE INSTRUMENTS Wichita Fusion Nail Introduction...1 Preoperative Planning...2 Surgical Technique...3-8 Wichita Fusion Nail Surgical Technique
More informationGAMMA LOCKING NAIL INSTRUMENTS OPERATIVE TECHNIQUE
GAMMA LOCKING NAIL INSTRUMENTS OPERATIVE TECHNIQUE FEATURES AND BENEFITS The One Shot Device is a new component of the Gamma Locking Nail instrumentation system determining the correct position of the
More informationUNDERSTANDING YOUR OPTIONS LIMB LENGTH DISCREPANCY
UNDERSTANDING YOUR OPTIONS LIMB LENGTH DISCREPANCY This booklet provides general information about limb length discrepancy and treatment options for you to discuss with your physician. It is not meant
More informationLCP Anterior Ankle Arthrodesis Plates. Part of the Synthes Locking Compression Plate (LCP) System.
LCP Anterior Ankle Arthrodesis Plates. Part of the Synthes Locking Compression Plate (LCP) System. Technique Guide Instruments and implants approved by the AO Foundation Table of Contents Introduction
More informationFibula Rod System. Lateral Malleolus Fracture Indications:
Fibula Rod System Fibula Rod System Since 1988, Acumed has been designing solutions for the demanding situations facing orthopaedic surgeons, hospitals and their patients. Our strategy has been to know
More informationUS Patent No. 6,309,396B1. G. David Ritland, M.D.
US Patent No. 6,309,396B1 G. David Ritland, M.D. The Femur Finder is designed to direct the guide wire into the medullary canal. Do not use it to manipulate the fracture fragments, reduce the fracture,
More informationWichita Fusion Nail Surgical Technique. David A. McQueen, MD
Wichita Fusion Nail Surgical Technique David A. McQueen, MD The patented design with a dual advantage Generates compression intraoperatively Innovative compression screw (a) locks femoral and tibial components
More informationThe Latest Breakthrough in TTC Fusion Technology
The Latest Breakthrough in TTC Fusion Technology Treatment of Hindfoot Non-Union with DynaNail TTC Fusion System A CASE REPORT Dr. L. Daniel Latt, MD, PhD Background The DynaNail TTC Fusion System is intended
More informationPatient Guide. Intramedullary Skeletal Kinetic Distractor For Tibial and Femoral Lengthening
Patient Guide Intramedullary Skeletal Kinetic Distractor For Tibial and Femoral Lengthening Introduction You have decided to have a limb lengthening operation. The surgery you have chosen uses a device
More informationGREENS SURGICALS. Redefining Excellence INSTRUMENT SYSTEM PREPARED BY: DR. VINAY KUMAR
GREENS SURGICALS Redefining Excellence TIBIA AND FEMUR INSTRUMENT SYSTEM PREPARED BY: DR. VINAY KUMAR OPERATIVE TECHNIQUES INDEX SR.NO CONTENTS 1 LIST OF INSTRUMENT FOR TIBIA AND FEMUR. 2 RADIO GRAPH OF
More informationKnee spanning solutions
Knee spanning solutions System features Indications Intended to be used on adults or pediatric patients as required for fracture fixation (open or closed); post-traumatic joint contracture which has resulted
More informationA Locking IM Rod that won't back out. Simple and straight to the point! SURGICAL TECHNIQUE
A Locking IM Rod that won't back out. Simple and straight to the point! SURGICAL TECHNIQUE The SLIM (Simple Locking IntraMedullary) System is a new generation of pediatric orthopedic nails specifically
More informationIs Distraction Histiogenesis a Reliable Method to Reconstruct Segmental Bone and Acquired Leg Length Discrepancy in Tibia Fractures and Non Unions?
Is Distraction Histiogenesis a Reliable Method to Reconstruct Segmental Bone and Acquired Leg Length Discrepancy in Tibia Fractures and Non Unions? James J Hutson Jr MD Professor Orthopedic Trauma Ryder
More informationArthrodesis of the Ankle
TM Arthrodesis of the Ankle Plantar View of the Foot 1. Make a lateral incision to expose the tibia-talus joint and the talo-calcaneal joint. Prepare the arthrodesis sites surgically with a rasp or an
More informationPediLoc Tibia Surgical Technique
PediLoc Tibia PediLoc Tibia Surgical Technique The technique description herein is made available to the healthcare professional to illustrate the author s suggested treatment for an uncomplicated procedure.
More informationFibula Lengthening Using a Modified Ilizarov Method S. Robert Rozbruch, MD; Matthew DiPaola, BA; Arkady Blyakher,MD
Fibula Lengthening Using a Modified Ilizarov Method S. Robert Rozbruch, MD; Matthew DiPaola, BA; Arkady Blyakher,MD Limb Lengthening Service Hospital for Special Surgery Abstract A unique combination of
More informationSurgical Technique. Customer Service:
Patent and Patent Pending CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician. INDICATIONS FOR USE The Axis Charcot Fixation System in diameters of 5.5, 6.5 and 7.5mm
More informationOverview of the Use of the Intramedullary Skeletal Kinetic Distractor (ISKD) as a Limb Lengthening Technique
Overview of the Use of the Intramedullary Skeletal Kinetic Distractor (ISKD) as a Limb Lengthening Technique Katherine E. Ludwig Introduction The intrameduallry skeletal kinetic distractor (ISKD) is a
More informationJuggerLoc Bone-to-Bone System for Ankle Syndesmosis Fixation. Surgical Technique
JuggerLoc Bone-to-Bone System for Ankle Syndesmosis Fixation Surgical Technique Table of Contents Position and Preparation... 2 Incision... 2 Fracture Reduction... 2 Drill Fibula and Tibia... 3 JuggerLoc
More informationSurgical Technique Guide
Guide CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician. INDICATIONS FOR USE The Align Anterior Ankle Fusion Plate is intended to facilitate arthrodesis of the
More informationZimmer Natural Nail System
Zimmer Natural Nail System Antegrade Femoral Nail Surgical Technique (Piriformis Fossa & Greater Trochanteric Approaches) Zimmer Natural Nail System Antegrade Femoral Surgical Technique 1 Zimmer Natural
More informationCannulated Screw System. Product Overview
Cannulated Screw System Product Overview Acumed Cannulated Screw System The Acumed Cannulated Screw System consists of screws, washers, and instruments and is intended for fixation of fractures, fusions,
More informationA New Benchmark in Tibial Fixation
PediLoc T I B I A S U R G I C A L T E C H N I Q U E A New Benchmark in Tibial Fixation Multiple plate designs for more options in osteotomies and fracture fixation Engineered from exclusive data resulting
More informationSurgical Technique 4.5/8.5MM BEAMING SYSTEM. Customer Service:
Patent and Patent Pending CAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician. INDICATIONS FOR USE The 4.5/8.5 screw system is intended for fixation arthrodesis of
More informationA Clinical Study For Evaluation Of Results Of Closed Interlocking Nailing Of Fractures Of The Shaft Of The Tibia
ISPUB.COM The Internet Journal of Orthopedic Surgery Volume 17 Number 2 A Clinical Study For Evaluation Of Results Of Closed Interlocking Nailing Of Fractures Of The Shaft Of R Gupta, T Motten, N Kalsotra,
More informationLengthening and deformity correction about the knee using a magnetic internal lengthening nail
SICOT J 2017, 3, 25 Ó The Authors, published by EDP Sciences, 2017 DOI: 10.1051/sicotj/2017014 Special Issue: Deformity correction, limb lengthening and reconstruction Guest Editor: Y. ElBatrawy Available
More informationTIBIAL NAILING SYSTEM OPTIONS MADE EASY
S U R G I C A L T E C H N I Q U E TIBIAL NAILING SYSTEM OPTIONS MADE EASY TABLE OF CONTENTS DESIGN SUMMARY INSTRUMENT OVERVIEW AND JIG OPTIONS 1 2 ENTRY AND CANAL PREP NAIL INSERTION LOCKING NAIL REMOVAL
More informationPediLoc 3.5mm and 4.5mm Contour Femur Plate Surgical Technique
PediLoc 3.5mm and 4.5mm Contour Femur Plate Surgical Technique Surgical Technique Contour Femur Plate The technique description herein is made available to the healthcare professional to illustrate the
More informationTHE NANCY NAIL. The End Caps ADVANTAGES OF NANCY NAIL
NANCY NAIL THE NANCY NAIL Nancy nails are manufactured from a specific titanyum alloy with proprietary surface treatment, which provides increased fatigue resistance. Six nail diameters (1.5 mm 2.0 mm
More informationNeoGen Femoral Nail System
NeoGen Femoral Nail System LESS IS MORE TE-2070-04 Surgical Technique BLE OF CONTENT Preface Standard Femoral Mode Recon Mode Post-Operative Management Appendix Products Information Indication Patient
More informationModern Rx of Polio. with Ilizarov & new techniques
Modern Rx of Polio with Ilizarov & new techniques Poliomyelitis Best Teacher of Orthopaedics Teaches Thorough clinical examination Muscle charting Gait Analysis Analysis of Joint Instability Precision
More informationTibial Shaft Fractures
Tibial Shaft Fractures Mr Krishna Vemulapalli Consultant Orthopaedics Surgeon Queens & King George Hospitals Queens Hospital 14/03/2018 Google Maps Map data 2018 Google 10 km Orthopaedics Department Covers
More informationFractures of the tibia shaft treated with locked intramedullary nail Retrospective clinical and radiographic assesment
ARS Medica Tomitana - 2013; 4(75): 197-201 DOI: 10.2478/arsm-2013-0035 Șerban Al., Botnaru V., Turcu R., Obadă B., Anderlik St. Fractures of the tibia shaft treated with locked intramedullary nail Retrospective
More informationPediNail Pediatric Femoral Nail
PediNail Pediatric Femoral Nail Surgical Technique Table of Contents Indications...3 Patient Positioning...3 Approach...4 Reaming...5 Nail Placement...6 Proximal Interlocking...7 Distal Interlocking...8
More informationTHE NATURAL FIT. Surgical Technique. Hip Knee Spine Navigation
THE NATURAL FIT Surgical Technique Hip Knee Spine Navigation MiniMAX Surgical Technique Hip Knee Spine Navigation INTRODUCTION The MiniMAX TM is a cementless anatomic stem available in 9 right sizes and
More informationTechnique Manual Technique Manual Rev. A 01/11/2011
Technique Manual Technique Manual Table of Contents Introduction 4 Indications 5 Instrumentation 6 Frame Assembly 7 Position Guide 8-9 Tips and Tricks 10-13 Cleaning 14 Sterilization 14 Storage Instructions
More informationSupplemental Use Guide Standard Triple Arthrodesis
Acutrak 2 Headless Compression Screw System 4.7 mm and 7.5 mm Screws Supplemental Use Guide Standard Triple Arthrodesis Acumed is a global leader of innovative orthopaedic and medical solutions. We are
More informationOrthopedic Bone Nail System - Distal Femoral Nail Surgical Technique Manual
Orthopedic Bone Nail System - Distal Femoral Nail Surgical Technique Manual Note: The surgical procedures should be performed under the guidance of qualified skilled orthopedic surgeons, and this surgical
More informationThe magnetic intramedullary (IM)-lengthening nail has
SUPPLEMENT ARTICLE Transitioning to an Intramedullary Lengthening and Compression Nail Austin T. Fragomen, MD Summary: The magnetic intramedullary lengthening nail is an innovative technology that allows
More informationMCL Reconstruction Surgical Protocol by Tarek Fahl, M.D.
MCL Reconstruction Surgical Protocol by Tarek Fahl, M.D. Features A unique weave in which a single strand of braided polyethylene is woven through itself twice in opposite directions This construct allows
More informationLapidus Arthrodesis System Instructions for Use
Lapidus Arthrodesis System Instructions for Use Description The AlignMATE Lapidus Arthrodesis System consists of bone plates and bone screws (locking, non-locking and interfragmentary), which are intended
More informationTRK REVISION KNEE Surgical Technique
1 TRK REVISION KNEE Surgical Technique 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. INTERCONDYLAR RESECTION...... page FEMORAL STEM...... page NON CEMENTED FEMORAL STEM...... page TRIAL FEMORAL COMPONENTS...... page
More informationINVISION Total Ankle Replacement System with PROPHECY Preoperative Navigation Revision of a Failed Agility Total Ankle Replacement
016625 REVISION R INVISION Total Ankle Replacement System with PROPHECY Preoperative Navigation Revision of a Failed Agility Total Ankle Replacement CASE STUDY Patient History The patient was a 65-year-old
More informationACL reconstruction with the ACUFEX Director Drill Guide and. ENDOBUTTON CL Fixation System. *smith&nephew. Knee Series Technique Guide ENDOBUTTON CL
Knee Series Technique Guide *smith&nephew ENDOBUTTON CL Fixation System ACL reconstruction with the ACUFEX Director Drill Guide and ENDOBUTTON CL Fixation System Thomas D. Rosenberg, MD ACL Reconstruction
More informationPediatric Tibia Fractures Key Points. Christopher Iobst, MD
Pediatric Tibia Fractures Key Points Christopher Iobst, MD Goals Bone to heal Return to full weight bearing Acceptable alignment rule of 10s 10 degrees of varus 8 degrees of valgus 12 degrees of procurvatum
More informationThe Flower Straight Fibula Plate
The Flower Straight Fibula Plate PROCEDURE GUIDE www.flowerortho.com The Flower Foot & Ankle Application STRAIGHT LOCKING FIBULA PLATE ANTERIOR LATERAL DISTAL TIBIAL PLATE MEDIAL DISTAL TIBIAL PLATE ANATOMIC
More informationInCoreTM Lapidus System
InCoreTM Lapidus System Precision Guided Correction Surgical Technique InCore TM Lapidus System Precision Guided Correction Tri-Planar Correction Targeting Guide is intended to aid and stabilize angular/rotational
More informationSirus Antegrade Femoral Nail System Surgical Technique
Sirus Antegrade Femoral Nail System Surgical Technique The Cannulated Titanium Nail with Anatomical Shape and Lateral Entry Point Disclaimer This document is intended exclusively for experts in the field,
More informationTechnique Guide Small Bone Fusion System
Technique Guide Small Bone Fusion System The Pinit Plate Small Bone Fusion System is a super low profile, modular bone plate and screw system designed to stabilize a bunionectomy with a medial to lateral
More informationClinical. Solutions. Synthes Solutions. Foot and Ankle.
Clinical Solutions Foot and Ankle. Foot and Ankle. Fractures of the tibial shaft Fractures of the distal fibula Fractures of the distal tibia Fractures and osteotomies of the calcaneus Arthrodesis Fractures,
More informationOptiLock Periarticular Plating System For Distal Tibial Fractures. Surgical Technique
OptiLock Periarticular Plating System For Distal Tibial Fractures Surgical Technique Contents Introduction... Page 1 Indications & Contraindications... Page 6 System Features... Page 7 Surgical Technique...
More informationFoot and Ankle Systems Coding Reference Guide
Foot and Ankle Systems Coding Reference Guide Physician Arthrodesis 27870 Arthrodesis, ankle, open 27871 Arthrodesis, tibiofibular joint, proximal or distal 28705 Arthrodesis; pantalar 28715 Arthrodesis;
More informationFoot & Ankle T2. Ankle Arthrodesis Nail. Foot & Ankle
Foot & Ankle T2 Ankle Arthrodesis Nail Operative Technique Foot & Ankle 1 Ankle Arthrodesis Nailing System This publication sets forth detailed recommended procedures for using Stryker devices and instruments.
More informationTechnical Tip: A Simple Method for Proper Placement of an Intramedullary Nail Entry Point for Tibiotalocalcaneal or Tibiocalcaneal Arthrodesis
Open Access Publication Technical Tip: A Simple Method for Proper Placement of an Intramedullary Nail Entry Point for Tibiotalocalcaneal or Tibiocalcaneal Arthrodesis by Ronald Belczyk, DPM 1, Wenjay Sung,
More informationBTB ACL Reconstruction with the ToggleLoc Fixation Device with ZipLoop Technology. Surgical Technique by James R. Andrews, M.D.
BTB ACL Reconstruction with the ToggleLoc Fixation Device with ZipLoop Technology Surgical Technique by James R. Andrews, M.D. Table of Contents Femoral Tunnel Preparation... 4 Prepare ToggleLoc Device...
More informationNeurologic Damage. The most common neurologic injury following intramedullary tibial nailing is injury to the peroneal nerve.
COMPLICATIONS Knee Pain Anterior knee pain was present in 55% Affects younger more than older patients A significant number of the patients with anterior knee pain had pain with kneeling [90%] They also
More informationJOINT RULER. Surgical Technique For Knee Joint JRReplacement
JR JOINT RULER Surgical Technique For Knee Joint JRReplacement INTRODUCTION The Joint Ruler * is designed to help reduce the incidence of flexion, extension, and patellofemoral joint problems by allowing
More informationZimmer ITST Intertrochanteric/ Subtrochanteric Fixation System. Abbreviated Surgical Technique
Zimmer ITST Intertrochanteric/ Subtrochanteric Fixation System Abbreviated Surgical Technique ITST System Abbreviated Surgical Technique Indications The ITST Intramedullary Nail is indicated for use in
More informationOPERATIVE TECHNIQUE. CONSTRUX Mini PTC. Mini PTC Spacer System
OPERATIVE TECHNIQUE CONSTRUX Mini PTC Mini PTC Spacer System TABLE OF CONTENTS Introduction 1 Operative Technique 2 Part Numbers 6 Indications For Use 7 INTRODUCTION 1 INTRODUCTION The CONSTRUX Mini PTC
More informationIMPORTANT MEDICAL INFORMATION Advanced Orthopaedic Solutions INTRAMEDULLARY NAILS Warnings and Precautions (SINGLE USE ONLY)
IMPORTANT MEDICAL INFORMATION Advanced Orthopaedic Solutions INTRAMEDULLARY NAILS Warnings and Precautions (SINGLE USE ONLY) IMPORTANT NOTE Intramedullary nails provide an alternative to open reduction
More informationConversion of Pantalar fusion to total ankle replacement: A case Review. Key words: Pantalar fusion, non-union and total ankle replacement
The Northern Ohio Foot and Ankle Journal Official Publication of the NOFA Foundation Conversion of Pantalar fusion to total ankle replacement: A case Review Author: Bryan Williams DPM 1 and Jonathan Sharpe
More informationNeoGen Tibia Nail System
NeoGen Tibia Nail System LESS IS MORE TE-2070-03 Surgical Technique BLE OF CONTENT Preface Surgical Technique Appendix Products Information Patient Preparation Entry Portal Fracture Reduction Canal Preparation
More informationApproach Patients with Confidence
Surgical Technique Approach Patients with Confidence The ACTIS Total Hip System is the first DePuy Synthes stem specifically designed to be utilized with tissue sparing approaches, such as the anterior
More informationDistal Cut First Femoral Preparation
Surgical Technique Distal Cut First Femoral Preparation Primary Total Knee Arthroplasty LEGION Total Knee System Femoral preparation Contents Introduction...3 DCF femoral highlights...4 Preoperative planning...6
More informationOPERATING MANUAL AND TECHNIQUE GUIDE FOR TITANIUM FEMORAL AND TIBIAL NAILING SYSTEMS
OPERATING MANUAL AND TECHNIQUE GUIDE FOR TITANIUM FEMORAL AND TIBIAL NAILING SYSTEMS ORTHO-MEDICAL GMBH TITANIUM FEMORAL NAIL OPERATIVE TECHNIQUE Introduction: Why a new type of femoral nail? The latest
More informationThe Titanium Tibial Nail System
The Titanium Tibial Nail System Solid Tibial Nails (UTN) and Cannulated Tibial Nails (CTN) Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved
More informationTechnique Guide. 6.5 mm Midfoot Fusion Bolt. For intramedullary fixation of the medial column of the foot.
Technique Guide 6.5 mm Midfoot Fusion Bolt. For intramedullary fixation of the medial column of the foot. Table of Contents Introduction 6.5 mm Midfoot Fusion Bolt 2 AO Principles 4 Indications 5 Surgical
More informationLOCKING TEP LOCKING TITANIUM ELASTIC PIN INTRAMEDULLARY NAIL
LOCKING TEP LOCKING TITANIUM ELASTIC PIN INTRAMEDULLARY NAIL ... Index -3 3-8 8 9 9 0 7 Introduction Features Indicatiıons Surgical Technique Femoral Surgical Technique Tibial Surgical Technique Ulna Radius
More informationExternal Fixator Brochure
External Fixator Brochure Response Ortho is a global orthopaedic trauma solutions manufacturer offering premium products created under its founding principles of innovation, excellence by design and functional
More informationFemoral Fixation for ACL Reconstruction. Surgical Protocol by Mark Gittins, D.O.
Femoral Fixation for ACL Reconstruction Surgical Protocol by Mark Gittins, D.O. Features A unique weave in which a single strand of braided polyethylene is woven through itself twice in opposite directions.
More informationClosing Wedge Retrotubercular Tibial Osteotomy and TKA for Posttraumatic Osteoarthritis With Angular Deformity
ORTHOPEDICS May 2009;32(5):360. Closing Wedge Retrotubercular Tibial Osteotomy and TKA for Posttraumatic Osteoarthritis With Angular Deformity by John P. Meehan, MD; Mohammad A. Khadder, MD; Amir A. Jamali,
More informationToggleLoc Inline Device
ToggleLoc Inline Device with ZipLoop Technology and TunneLoc Tibial Fixation for ACL Reconstruction Surgical Technique Surgical Protocol by Jeffrey M. Conrad, M.D. SPORTS MEDICINE One Surgeon. One Patient.
More informationEXPERT TIBIAL NAIL PROTECT
EXPERT TIBIAL NAIL PROTECT Enhance your first line of defense This publication is not intended for distribution in the USA. CLINICAL EVIDENCE CONTENT AUTHOR TITLE OF CHAPTER PAGE ETN PROtect clinical evidence
More informationFlexible Fragment Fixation. Surgical Technique
Flexible Fragment Fixation Surgical Technique 2 F 3 Flexible Fragment Fixation The F 3 Fragment Plating System offers low profile, yet strong fixation in a locked plating construct that can be contoured
More informationPediLoc 3.5mm and 4.5mm Bowed Femur Plate Surgical Technique
PediLoc 3.5mm and 4.5mm Bowed Femur Plate Surgical Technique 2957 Bow Broch_REV_B.indd 1 2/10/11 12:47 PM Surgical Technique Bowed Femur Plate The technique description herein is made available to the
More informationCASE NO: 1 PATIENT DETAILS : Occupation : Housewife Date Of Admission :11/06/15 Residence : Nalgonda IP NO :
CASE NO: 1 PATIENT DETAILS : Name : XXXX Age : 53yr Sex : Female Occupation : Housewife Date Of Admission :11/06/15 Residence : Nalgonda IP NO : 201518441 CHIEF COMPLAINTS : - Pain in the right knee since
More informationResurfacing Distal Femur. Orthopaedic Salvage System
Resurfacing Distal Femur Orthopaedic Salvage System Primary Arthroplasty OSS 3cm Resurfacing Distal Femur Distal Femoral Resection Drill and ream the distal femur in the following sequence: (Figure 1)
More informationDuaFit. Proximal Interphal angeal Impl ant
DuaFit Proximal Interphal angeal Impl ant DUAFIT - TABLE OF CONTENTS PRODUCT DESCRIPTION 3 INDICATIONS 6 SURGICAL TECHNIQUE #1 7 Without guide wire (DuaFit 0 10 17 ) SURGICAL TECHNIQUE #2 14 With guide
More informationPinit Plate Small Bone Fusion System Bone Plate & Screw System
Pinit Plate Small Bone Fusion System Bone Plate & Screw System Description The Pinit Plate Small Bone Fusion System consists of 2-hole bone plates made available in three length options and two thickness
More informationKnee Surgical Technique
Knee Surgical Technique COMPASS Universal Hinge by Jimmy Tucker, M.D. Orthopaedic Surgeon Director, Arkansas Sports Medicine, P.A. Little Rock, Arkansas Table of contents Design features 3 Indications
More informationFREEDOM. Residual Limb Lengthening System Operative Technique
TM FREEDOM Residual Limb Lengthening System Operative Technique Residual Limb Lengthening System The Residual Limb Lengthening System is designed to treat limb lengthening of the femur following an above-the-knee
More informationFoot and Ankle Technique Guide Metatarsal Shortening Osteotomy
Surgical Technique Foot and Ankle Technique Guide Metatarsal Shortening Osteotomy Prepared in consultation with: Phinit Phisitkul, MD Department of Orthopedics and Rehabilitation University of Iowa Iowa
More informationCOMPARING KIRSCHNER WIRE FIXATION TO A NEW DEVICE USED FOR PROXIMAL INTERPHALANGEAL FUSION
C H A P T E R 3 0 COMPARING KIRSCHNER WIRE FIXATION TO A NEW DEVICE USED FOR PROXIMAL INTERPHALANGEAL FUSION Scott R. Roman, DPM INTRODUCTION The most common fixation for proximal interphalangeal fusion
More informationPIN GUIDE SYSTEM SURGICAL TECHNIQUE. with the SIGMA High Performance Instruments System. This publication is not intended for distribution in the USA.
PIN GUIDE SYSTEM with the SIGMA High Performance Instruments System This publication is not intended for distribution in the USA. SURGICAL TECHNIQUE Pin Guide Surgical Technique The following steps are
More informationQUICK REFERENCE GUIDE. The XCaliber Articulated Ankle Fixator. By Dr. S. Berki, Dr. V. Caiaffa, Dr. F. Lavini and Dr. M. Manca
QUICK REFERENCE GUIDE 18 The XCaliber Articulated Ankle Fixator By Dr. S. Berki, Dr. V. Caiaffa, Dr. F. Lavini and Dr. M. Manca GENERAL POINTS The XCaliber Articulated Ankle Fixator is made of radiolucent
More informationINBONE II. Total Ankle System SURGICAL TECHNIQUE SUPPLEMENT TIBIAL REAMING SPECIFICATION
INBONE II Total Ankle System SURGICAL TECHNIQUE SUPPLEMENT TIBIAL REAMING SPECIFICATION INBONE II Total Ankle System SURGICAL TECHNIQUE SUPPLEMENT Tibial Reaming Specification Contents Chapter 1 4 Product
More informationIMPLANT REMOVAL: AN UNSOLVED CHALLENGE TO ORTHOPAEDICIAN Varunjikar M. D 1, S. C. Joshi 2, Bejoy E Jayan 3, A. M. Varunjikar 4, C. R.
IMPLANT REMOVAL: AN UNSOLVED CHALLENGE TO ORTHOPAEDICIAN Varunjikar M. D 1, S. C. Joshi 2, Bejoy E Jayan 3, A. M. Varunjikar 4, C. R. Joshi 5 HOW TO CITE THIS ARTICLE: Varunjikar M. D, S. C. Joshi, Bejoy
More information