Axi+LineTM Proximal Bunion CorrectionSystem. Surgical Technique
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1 Axi+LineTM Proximal Bunion CorrectionSystem Surgical Technique
2 A i Line Proximal Bunion Correction System TM Desired angle correction is built into the plate, providing a self-reducing, 5-hole construct with bicortical locking or non-locking screw options to minimize loss of reduction and potential for dorsiflexion malunion Stable, plate fixation provides initial stability and may facilitate earlier weight bearing and rehabilitation Osteotomy guide provides a templated path for a precise osteotomy, minimizing the probability of shortening Instrumentation provides full control of all bone fragments during the procedure and allows for a seamless transition from templating to plating The Long Oblique Osteotomy (Modified Mau) maximizes fusion surface area and provides the ability to correct moderate to large angular deformities The proximal Mau osteotomy avoids violating a healthy metatarsal-cuneiform joint as with Lapidus correction Sterile kit provides added efficiency and convenience for surgical team Corrects both IM angle and frontal plane rotation Actual Size (Left Plate) Actual Size (Right Plate) Bone to Bone Cross Sectional Area The Mau osteotomy creates good bone apposition for fixation, resulting in the most intrinsic stability of all proximal osteotomies. 1 Reference--- 1 Jason P. Glover, DPM, Christopher F. Hyer, DPM, Gregory c. Berlet, MD, and Thomas H. Lee, MD. Early Results of the Mau Osteotomy for Correction of Moderate to Severe Hallux Valgus: A Review of 24 Cases. The Journal of Foot & Ankle Surgery. 2088; 47(3): Dorsal view Axi+Line TM Wedge Cross section
3 Axi+Line TM Proximal Bunion Correction System Surgical Technique Overview Pronation Correction Plate Approximated Pronation Correction Templating Use Axi+Line templates (part no. LIT-1524) to evaluate preoperative images and determine desired degree of correction. 2. Osteotomy Guide Standard medial incision should be made to visualize entire first metatarsal shaft. Resect medial eminence mass as required. Remove exotosis if present. Mark center line of metatarsal shaft (blue line) and place left/right side specific Osteotomy Guide. Avoid placing guide too proximal which may cause the osteotomy to violate base of metatarsal. NOTE: Release adduction hallucix. NOTE: Guide should sit just proximal to the start of the flare start cm Correct positioning Tabs used for vertical alignment Incorrect positioning 3. Pin Insertion Place proximal Threaded Pin, then distal Threaded Pin, making sure to achieve bi-cortical purchase with both pins. 1.0cm
4 Axi+LineTM Proximal Bunion Correction System - Surgical Technique Overview 4. K-Wire Insertion Put non-threaded K-wire in drill driver, place in superior hole and drive through both cortices. K-wire may be left in place for additional stability. Place second K-wire through the second and third diagonal holes, ensuring wire crosses both cortices. Remove both non-threaded K-wires from diagonal holes. NOTE: Put marker on K-wires prior to drilling the three diagonal holes for better visualization when cutting osteotomy. 5. Bushing Removal Leaving Threaded Pins in place, remove Bushing from distal hole using the Hex Shaft and Driver Handle. 6. Osteotomy Guide Remove the Osteotomy Guide.
5 Axi+Line TM Proximal Bunion Correction System - Surgical Technique Overview 7. Cut Keeping saw blade parallel to the proximal Threaded Pin, make a Mau osteotomy by sawing along the line extending through the three holes created by the K-wires. Verify distal fragment mobility. NOTE: Longer blade/angle 8. Plate Placement Based on desired degree of correction determined during templating, select appropriate left or right Axi+Line Plate (5, 7.5, 10 or 12.5 degrees of correction) and place plate over the Threaded Pins as shown. 9. Reduction Place Nuts on each Threaded Pin. Manually reduce with fingers by pinching Plate to bone. Hold Plate to bone as to assist reduction. Starting with the Nut centered in each hole, alternately advance Nuts in small increments, while gently moving the distal fragment, until Nuts are fully seated. Nuts should be finger tight, do not over tighten. Reduction should be complete. Verify position of toe is as desired. WARNING: DO NOT only use Nuts to reduce plate to bone.
6 Axi+Line TM Proximal Bunion Correction System - Surgical Technique Overview Screw Placement Screws 1 and 2 are Non-Locking Screws. Screws 3, A, and B can be either Locking or Non-Locking Screws based on the surgeon s judgement of bone quality or surgical preference. 1 A 2 B 10. Drill Hole #1 Thread Drill Guide into proximal, superior hole. Using the provided AO Drill Bit, drill through both cortices and measure using either the Depth Gauge or using the Drill Bit s laser scale as measured from the top of the Drill Guide. Remove Drill Guide. Verify plate is sitting flush to the proximal bone. If not, loosen both Nuts and retighten while gently moving distal fragment. Select appropriate length Non-Locking Screw and drive using the T10 Driver. NOTE: T10 Shaft may be connected to a power driver if desired. Alligator clamp can be used to hold and reduce osteotomy Drill Holes #2 & #3 Thread Drill Guide into second distal hole and repeat step 10 using appropriate Non-Locking Screw. Repeat for the inferior, transverse hole using either a Locking or Non-Locking Screw. 12. Drill Holes A & B Remove proximal Nut and Threaded Pin from hole A. Place Drill Guide and drill hole. Place appropriate Non-Locking or Locking Screw. Repeat for distal hole B. Finished construct. Close in the usual manner. NOTE: Holes A & B are eccentric holes. Depth Gauge: Demonstrates 24mm depth
7 i 3 TM Delivery System INNOVATIVE INTELLIGENT INTEGRATIVE Nextremity Solutions has a long history of developing disposable, sterlie, single-use systems. The new i3 Delivery System allows us to provide our surgeons with instruments and implants in a more efficient method. The i3 Delivery System utilizes a patented tube-style packaging system to organize the implants for quick identification and ease of presentation to the sterile field. All required instruments for the procedure are also included in a disposable instrument kit. All items are contained in our reusuable i3 Delivery case for easy product transportation and organization. Instrument Kits Screws (Below Instrument Kit) Plates
8 A i Line Proximal Bunion Correction System TM ORDERING INFORMATION - INSTRUMENT KITS & PLATES Part No. KITS AXL-00L AXL-050L AXL-075L AXL-100L AXL-125L Description Include: Osteotomy Guide, 2.2mm Threaded Wire (2), Drill Bushing, 2.6mm Drill, T10 Driver, Hex Shaft, Driver Handle, 1.6mm K-wire (2), Nut (2), Depth Gauge Axi+Line Instrument Kit (LEFT) AXL-00R Axi+Line Instrument Kit (RIGHT) Axi+Line Plate 5.0 degree (LEFT) AXL-050R Axi+Line Plate 5.0 degree (RIGHT) Axi+Line Plate 7.5 degree (LEFT) AXL-075R Axi+Line Plate 7.5 degree (RIGHT) Axi+Line Plate 10.0 degree (LEFT) AXL-100R Axi+Line Plate 10.0 degree (RIGHT) Axi+Line Plate12.5 degree (LEFT) AXL-125R Axi+Line Plate12.5 degree (RIGHT) Part No. Description SCR-3510NL SCR-3512NL SCR-3514NL SCR-3516NL SCR-3518NL 3.5mm Cortical Headed Screw, Non-Locking 10mm Length 3.5mm Cortical Headed Screw, Non-Locking 12mm Length 3.5mm Cortical Headed Screw, Non-Locking 14mm Length 3.5mm Cortical Headed Screw, Non-Locking 16mm Length 3.5mm Cortical Headed Screw, Non-Locking 18mm Length SCR-3510L SCR-3512L SCR-3514L SCR-3516L SCR-3518L 3.5mm Cortical Headed Screw, Locking 10mm Length 3.5mm Cortical Headed Screw, Locking 12mm Length 3.5mm Cortical Headed Screw, Locking 14mm Length 3.5mm Cortical Headed Screw, Locking 16mm Length 3.5mm Cortical Headed Screw, Locking 18mm Length SCR-3520NL SCR-3522NL SCR-3524NL SCR-3526NL SCR-3528NL 3.5mm Cortical Headed Screw, Non-Locking 20mm Length 3.5mm Cortical Headed Screw, Non-Locking 22mm Length 3.5mm Cortical Headed Screw, Non-Locking 24mm Length 3.5mm Cortical Headed Screw, Non-Locking 26mm Length 3.5mm Cortical Headed Screw, Non-Locking 28mm Length SCR-3520L SCR-3522L SCR-3524L SCR-3526L SCR-3528L 3.5mm Cortical Headed Screw, Locking 20mm Length 3.5mm Cortical Headed Screw, Locking 22mm Length 3.5mm Cortical Headed Screw, Locking 24mm Length 3.5mm Cortical Headed Screw, Locking 26mm Length 3.5mm Cortical Headed Screw, Locking 28mm Length SCR-3530NL 3.5mm Cortical Headed Screw, Non-Locking 30mm Length SCR-3530L 3.5mm Cortical Headed Screw, Locking 30mm Length LIT-1517 Axi+Line Fluoroscopic Template (LEFT & RIGHT) Designed & Developed with: Manufactured by: This surgical technique guide provides a recommended procedure for using Axi+Line Proximal Bunion Correction System. The content provided puts forth technique guidance, however, the surgeon must consider the individual needs of the patient making appropriate adjustments when and as required. Nextremity Solutions and Axi+Line are trademarks of Nextremity Solutions, Inc. Patent Pending Nextremity Solutions LIT-1532 Rev.00 Powered by Nextremity Solutions, i3 Strategic Solutions develops innovative, intelligent, and integrated musculoskeletal products. To learn more, visit i3strategicsolutions.com. 210 N. Buffalo St. Warsaw, IN U.S.A. (732) nextremitysolutions.com
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