Variable Angle LCP Opening Wedge Plates 2.4/2.7. Part of the Variable Angle LCP Forefoot/Midfoot System 2.4/2.7. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation. Table of Contents Introduction Variable Angle LCP Opening Wedge Plates 2.4 / 2.7 2 Indications 4 Screw Insertion Techniques 5 Surgical Technique Approach 6 Implantation 7 Implant Removal 20 Product Information Screws 21 Plates 23 Instruments 24 MRI Information 28 Image intensifier control Warning This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of m ulti-part instruments, as well as processing guidelines for i mplants, please contact your local sales representative or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance Variable Angle LCP Opening Wedge Plates 2.4/2.7 Surgical Technique DePuy Synthes 1 Variable Angle LCP Opening Wedge Plates 2.4/2.7. Part of the Variable Angle LCP Forefoot/Midfoot System 2.4/2.7. Features and Benefits Compression wire holes for prelimi- Variable angle nary fixation of the plate to the bone Screw holes allow up to 15° off-axis screw angulation in all directions Minimized soft tissue irritation Low profile plates with rounded edges and highly polished surface minimize soft tissue irritation Spacer includes a tapered tip for easier insertion into the osteotomy site 6 plates with varying spacer lengths: – 3 mm, 4 mm, 5 mm, 6 mm and 7 mm – One plate without spacer Anatomic, low profile designed specifically for opening wedge osteo­ tomies for hallux valgus correction and other foot deformities 2 DePuy Synthes Variable Angle LCP Opening Wedge Plates 2.4/2.7 Surgical Technique Opening Wedge Measuring Instrument Ratchet mechanism holds osteo tomy open Thin tip slides into osteotomy site and opens the wedge for the desired correction Measurement scale indicates the appropriate size wedge for the desired opening Variable Angle LCP Opening Wedge Plates 2.4/2.7 Surgical Technique DePuy Synthes 3 Indications The Opening Wedge Plate of the Variable Angle LCP Fore- foot/Midfoot System 2.4/2.7 is indicated for deformations (e.g. hallux valgus), nonunions, and replantations of the first metatarsal bone, particularly in osteopenic bone. 4 DePuy Synthes Variable Angle LCP Opening Wedge Plates 2.4/2.7 Surgical Technique Screw Insertion Techniques The plate holes of the Variable Angle LCP Technology 2.4 / 2.7 accept 2.4 mm and 2.7 mm Variable Angle (VA) Locking Screws. Screws can be inserted using two different techniques: – Variable angle technique – Pre­defined nominal angle technique Variable angle technique To drill variable angle holes at a ±15° deviation from the nominal trajectory of the locking hole, insert the tip of the VA-LCP drill sleeve, conical, for Drill Bits (03.211.003/03.110.023) conical VA-LCP drill sleeve (03.211.003 / 03.110.023) and key into the cloverleaf design of the VA-LCP hole. Precaution: It is important not to angulate more than 15° from the central axis of the screw hole. Overangulation may result in difficulty while locking the screw and inadequate screw locking. Pre-defined nominal angle technique The fixed­angle VA­LCP drill sleeve (03.211.004 / 03.110.024) Use of funnel-shaped VA-LCP Drill Sleeve only allows the drill bit to follow the nominal trajectory of the locking hole. VA-LCP Drill Sleeve, coaxial, for Drill Bits (03.211.004/03.110.024) Variable Angle LCP Opening Wedge Plates 2.4/2.7 Surgical Technique DePuy Synthes 5 Approach Make a 3 to 4 cm dorsomedial incision from the first tarsal metatarsal (TMT) joint, distally along the midline of the first metatarsal. Dissect down to the bone and isolate the medial branch of the superficial fibular nerve. 6 DePuy Synthes Variable Angle LCP Opening Wedge Plates 2.4/2.7 Surgical Technique Implantation 1 Create osteotomy Identify a point medial on the metatarsal, approximately 1.5 cm distal to the TMT joint. Create an osteotomy starting from the medial side of the metatarsal but do not cut through the bone. Leave the lateral cortex intact to act as a hinge point for opening the wedge. Variable Angle LCP Opening Wedge Plates 2.4/2.7 Surgical Technique DePuy Synthes 7 Implantation 2 Open osteotomy and measure Instrument 03.211.009 Opening Wedge Measuring Device Open the osteotomy using osteotomes or the opening wedge measuring device. Slide the tip of the opening wedge device into the osteotomy. Open the osteotomy by squeez- ing the handle until the desired correction is achieved. The measuring instrument should be placed in the final im- plant position to ensure correct alignment and measurement. Use image intensifier control to confirm that the desired correction has been achieved. Read the measurement on the back of the instrument to determine the appropriate spacer size. Remove the measuring instrument. 8 DePuy Synthes Variable Angle LCP Opening Wedge Plates 2.4/2.7 Surgical Technique