NeoFit. Metatarsophal angeal Arthrodesis Pl ate

Transcription

1 NeoFit Metatarsophal angeal Arthrodesis Pl ate

2 2 NEOFIT - TABLE OF CONTENTS PRODUCT DESCRIPTION 3 INDICATIONS 6 Download «PRINT» version (white background) SURGICAL TECHNIQUE Incision Preparation of the surfaces Adjustment of the arthrodesis Transfocal screw Presentation of the impl ant Choice of size of the impl ant Shaping of the pl ate Insertion of the compression screw (oblong hole) Fix ation of the pl ate Closure 14 REFERENCES 15

3 3 NEOFIT - PRODUCT DESCRIPTION (1/3) The NeoFit MTP arthrodesis plate is manufactured in Ti6Al4V titanium alloy. The NeoFit plate is available in three sizes for the right side and in three sizes for the left side. The plate is delivered straight but may be shaped when installed so that it precisely matches the patient s metatarsophalangeal angulation. It is delivered sterile. LOW PROFILE The NeoFit plate is specifically designed to avoid conflicts with surrounding tissue. 1 FIXATION Different fixation resources can be used: locking screws, non-locking screws. The oblong hole offers a compression system 1 enables good contact with the arthrodesis site.

4 4 NEOFIT - PRODUCT DESCRIPTION (2/3) TORX IMPRINT The range of screws for the NeoFit system has a Torx (T8) imprint: The star shape enables better distribution of the tightening stresses, and thus protects the screw imprint during tightening and untightening. ANGLE OF ATTACK The thread profile enables its self-tapping properties to be ensured. The round tip of the NeoFit screws limits the occurrence of plantar conflicts. Product name Screw diameter Color code Screw type Screw imprint Length* 2mm incremental NeoFit screw mm locking and non-locking Torx 8 10 > 20mm NeoFit screw mm locking and non-locking Torx 8 10 > 20mm * Screws, L. 22 and 24mm, are available upon request

5 5 NEOFIT - PRODUCT DESCRIPTION (3/3) INSTRUMENTATION The NeoFit set contains the following instrumentation: METATARSAL REAMERS 1 PHALANGEAL REAMERS 2 DRILL GUIDES 3 MODULAR DRILL GUIDE 4 NEOFIT PLATE BENDERS 5 TRIAL PLATES / DRILL GUIDES 6 CANNULATED SCREWDRIVER T8 7 SCREWDRIVER T8 AXIS 8 ORANGE MODULAR HANDLE 9 NON STERILE K-WIRE 10 DRILL DIAMETER 2.0MM LG 125* 10 DEPTH GAUGE AND MEASURER * FD CE marked by SMAO

6 6 NEOFIT - INDICATIONS INDICATIONS The NeoFit MTP arthrodesis system is indicated in the fixation of fractures, osteotomies and arthrodesis of the first metatarsophalangeal articulation, and in particular in the case of: Hallux rigidus Severe hallux valgus (IM angle >20 - HV angle >40 ) Deformation due to rheumatoid arthritis Post-trauma arthrosis Neuromuscular instability The addition of an oblique compression screw through the joint is necessary (for example IBS screw) in order to ensure the closure of the plantar hinge and reinforce the stability of the arthrodesis. CONTRAINDICATIONS The implant should not be used in a patient who has currently, or who has history of: Acute or chronic inflammations, whether local or systemic Active infections Sensitivity/allergies to the implant materials

7 7 Surgical Technique In2Bones as the manufacturer of this device, 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 implanting the device in each patient. THIS TECHNIQUE WAS DEVELOPED IN COLLABORATION WITH M. WILFRID GRAFF AND M. ANTOINE MOUTON, HÔPITAL DES DIACONESSES, PARIS.

8 8 NEOFIT - SURGICAL TECHNIQUE (1/7) 1 - INCISION The incision is preferentially medial, centred on the metatarsophalangeal (MP1) interline. It extends to the junction of dorsal/plantar skin until level with the first dorsal skin crease of the interphalangeal. This distance is taken back from above the MP1. The arthrotomy is performed without capsular excision. This excision will be performed if necessary at the end of the intervention. The metatarsophalangeal articulation is exposed, and then the upper part of the metatarsal, then that of the phalanx and its inferomedial proximal metaphysis. The dorsal incision is more an Anglo-Saxon approach. The designers stress that an excessively dorsal incision may render the positioning of the lower screw a more delicate procedure.

9 9 NEOFIT - SURGICAL TECHNIQUE (2/7) 2 - PREPARATION OF THE SURFACES 1 The upper and medial osteophytes are removed with the saw or gouge-tongs. The cut of the articular surfaces is performed using a flat or spherical method according to usual practice of the surgeon. For spherical cut there are reamers of different sizes. The choice of their diameter will depend on that of the metatarsal articular surface. This should be performed size by size. A pin of diameter 1.6 mm is used to guide the reamers. Diam. 14mm Diam. 16mm Diam. 18mm Metatarsal reamer P P P Phalangeal reamer P P P It is recommended in the first instance that the metatarsal surface should be prepared before working on the phalangeal surface. Once reaming has been completed, the surfaces can be drilled to encourage blood flow in the bone fusion zone. 1

10 10 NEOFIT - SURGICAL TECHNIQUE (3/7) 3 - ADJUSTMENT OF THE ARTHRODESIS Adjustment of the arthrodesis depends on the usual practices of the surgeon. We recommend adjustment such that the projection of the axis of the phalanx, on a foot in a load bearing profile, should pass between the calcaneum and the floor. The position selected is fixed temporarily using a pin of diameter 1.6mm, oblique dorsal trans P1M1

11 11 NEOFIT - SURGICAL TECHNIQUE (4/7) 4 - TRANSFOCAL SCREW 5 - PRESENTATION OF THE IMPLANT NeoFit Left NeoFit Right Size 3 : 50mm Size 2 : 45mm Size 1 : 40mm Insertion of a 1mm pin at the level of the P1 metaphysis and which crosses the interline MP1. An In2bones compression screw of 3.0 or 3.5 mm is installed (using the Torx T8 screwdriver) without engaging the head of the screw into the bone, for subsequent application of compression. The NeoFit MTP plate is available in 3 sizes (40, 45 and 50mm). Size 1 L. 40mm Size 2 L. 45mm Size 3 L. 50mm NeoFit RIGHT P10 ST 140 P10 ST 145 P10 ST 150 NeoFit LEFT P10 ST 240 P10 ST 245 P10 ST 250

12 12 NEOFIT - SURGICAL TECHNIQUE (5/7) 6 - CHOICE OF SIZE OF THE IMPLANT 7 - SHAPING OF THE PLATE 3 Dorsal face Plantar face 1 2 Choose the size of the plate using the corresponding trial plate. This is positioned straddling the articular interline, with points of reference M and P enabling a simplified orientation of M for the Metatarsal and P for the Phalanx. The trial plate may be positioned using one or two 1mm pins. At this stage, the test plate may optionally be used as a drilling guide for the two phalangeal screws, if a perpendicular drilling in relation to the plate is desired. The angulation of the plate may at this point be adapted to the patient s anatomy using the plate bender in dorsal or plantar flexion. Dorsal flexion: The plate must be inserted with the dorsal face upwards in the upper grooves of the plate benders Position the plate between the two plate benders such that the articular line is located at their junction. 1 Manoeuvre the plate benders to achieve the desired flexion. 2 The reading of the angle of flexion is taken directly from the plate benders. 3 Under no circumstances should the plates be bent excessively or undergo repeated bending or in different directions In the case of a plantar flexion, position the plate with the plantar face oriented upwards and proceed as described above.

13 13 NEOFIT - SURGICAL TECHNIQUE (6/7) 8 - INSERTION OF THE COMPRESSION SCREW (OBLONG HOLE) The definitive implant is positioned on the k-wire. The Oblong drilling guide P is positioned, the point of reference M should coincide with the point of reference M on the implant 1. The guide enables drilling on the longitudinal axis of the plate 2, enabling the application of compression on the arthrodesis, The length of the screw is determined using a depth gauge. 4 The screw is inserted into the metatarsal using the T8 screwdriver, without being locked. 5 This screw guides the plate during the compression phase for the transfocal screw. Drilling is performed using a. 2.0 mm diameter drill. 3

14 14 NEOFIT - SURGICAL TECHNIQUE (7/7) 9 - FIXATION OF THE PLATE D C B A For the holes A, C and D, locking or nonlocking screws are available according to the preference of the surgeon. Holes C and D are prepared in the phalanx using the drilling guide for a cylindrical hole and the 2.0 mm diameter drill. The screws are inserted after having determined their lengths using the depth gauge. 1 The screw for the oblong hole B is locked. 2 The transfocal compression screw is screwed full in. 3 Finally, the preparation and positioning of the screw A is performed. 4 If the stability of the assembly is considered to be insufficient, the path of the second transfocal pin can be used to insert a second I.B.S. screw C or N CLOSURE : Medial bone regularisation then lavage. Closure is on three planes. A rigid sole postoperative shoe should be used during 6 weeks.

15 15 NEOFIT - REFERENCES IMPLANTS NeoFit P10ST140 NeoFit Right Sterile Size 1-40 mm P10ST145 NeoFit Right Sterile Size 2-45 mm P10ST150 NeoFit Right Sterile Size 3-50 mm P10ST240 NeoFit Left Sterile Size 1-40 mm P10ST245 NeoFit Left Sterile Size 2-45 mm P10ST250 NeoFit Left Sterile Size 3-50 mm Screw* V27ST010 Screw diam. 2.7mm - Titanium Sterile L. 10mm V27ST012 Screw diam. 2.7mm - Titanium Sterile L. 12mm V27ST014 Screw diam. 2.7mm - Titanium Sterile L. 14mm V27ST016 Screw diam. 2.7mm - Titanium Sterile L. 16mm V27ST018 Screw diam. 2.7mm - Titanium Sterile L. 18mm V27ST020 Screw diam. 2.7mm - Titanium Sterile L. 20mm V27ST110 Screw diam. 2.7mm - Titanium - Locking Sterile L. 10mm V27ST112 Screw diam. 2.7mm - Titanium - Locking Sterile L. 12mm V27ST114 Screw diam. 2.7mm - Titanium - Locking Sterile L. 14mm V27ST116 Screw diam. 2.7mm - Titanium - Locking Sterile L. 16mm V27ST118 Screw diam. 2.7mm - Titanium - Locking Sterile L. 18mm V27ST120 Screw diam. 2.7mm - Titanium - Locking Sterile L. 20mm V30ST010 Screw diam. 3.0mm - Titanium Sterile L. 10mm V30ST012 Screw diam. 3.0mm - Titanium Sterile L. 12mm V30ST014 Screw diam. 3.0mm - Titanium Sterile L. 14mm V30ST016 Screw diam. 3.0mm - Titanium Sterile L. 16mm V30ST018 Screw diam. 3.0mm - Titanium Sterile L. 18mm V30ST020 Screw diam. 3.0mm - Titanium Sterile L. 20mm INSTRUMENTS P NeoFit Container P Metatarsal reamer diam 14mm P Metatarsal reamer diam 16mm P Metatarsal reamer diam 18mm P Phalangeal reamer diam14mm P Phalangeal reamer diam16mm P Phalangeal reamer diam18mm P Drill guide P Drill guide - Oblong Right P Drill guide - Oblong Left P Modular drill guide P NeoFit plate bender Left P NeoFit plate bender - Right P Trial plate - Drill guide 40mm P Trial plate - Drill guide 45mm P Trial plate - Drill guide 50mm G Cannulated screwdriver T8 G Screwdriver T8 axis G modular handle G Kwires tube holder K10 NS100 Non sterile kwire diam. 1mm L. 100mm K10 NS102 Non sterile kwire diam. 2mm L. 100mm K10 NS150 Non sterile kwire diam. 1.6mm L. 150mm FD2907 Drill - diam. 2mm - L. 125mm (CE marked by SMAO) G Depth gauge G Measurer V30ST110 Screw diam. 3.0mm - Titanium - Locking Sterile L. 10mm V30ST112 Screw diam. 3.0mm - Titanium - Locking Sterile L. 12mm V30ST114 Screw diam. 3.0mm - Titanium - Locking Sterile L. 14mm V30ST116 Screw diam. 3.0mm - Titanium - Locking Sterile L. 16mm V30ST118 Screw diam. 3.0mm - Titanium - Locking Sterile L. 18mm V30ST120 Screw diam. 3.0mm - Titanium - Locking Sterile L. 20mm * Screws, L. 22 and 24mm, are available upon request

16 16 NEOFIT - LEGAL INFORMATION RECOMMANDATION It is recommended to carefully read the instructions for use available in the package insert. DEVICES Plate and screw : EC Class IIb - CE0499 Instruments : Instruments with a measuring function : EC class Im - CE0499 Instruments connected to a power driver and trial plate : EC class IIa - CE0499 Reusable surgical instruments : EC class I - CE Drill diam 2.0mm - L 125mm - CE marked by SMAO CE1014 REIMBURSEMENT Reimbursement may vary from countries to countries. Check with local authorities. MANUFACTURER In2Bones SAS 28, chemin du Petit Bois Ecully FRANCE Tél : +33 (0) Fax : +33 (0) DOCUMENT Reference : ST-NeoFit -En Revision date: 09/2014 Version 01 Availability of these products might vary from a given country or region to another, as a result of specific local regulatory approval or clearance requirements for sale in such country or region. Always refer to the appropriate instructions for use for complete clinical instructions. Non contractual document. The manufacturer reserves the right, without prior notice,to modify the products in order to improve their quality. WARNING: Applicable laws restrict these products to sale by or on the order of a physician. NeoFit, I.B.S., In2Bones and the In2Bones logo are trademarks or registered trademarks of In2Bones or its subsidiaries

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