2.4 mm/2.7 mm Variable Angle LCPForefoot/Midfoot System …synthes.vo.llnwd.net/o16/Mobile/Synthes North America/Product Support Materials...wedge osteotomy for hallux valgus correction

2.4 mm/2.7 mm Variable Angle LCPForefoot/Midfoot System.Procedure-specific plates for osteotomies,fusions and fractures of the foot.

Technique Guide

Introduction

System Features

Table of Contents

Indications 3

2.4 mm/2.7 mm Variable Angle LCP 5Forefoot/Midfoot System

Compression System 6

2.4 mm/2.7 mm Variable Angle LCP Technology 7

Proximal and Distal Reamers 8

First MTP (Metatarsophalangeal) Fusion Plates 9

Opening Wedge Osteotomy Plates 10

First TMT (Tarsometatarsal) Fusion Plates 11

TMT Fusion Plates 12

T-, L-, Cloverleaf Fusion Plates 13

X- and Straight Fusion Plates 14

Navicular and Cuboid Plates 15

Mesh Plates 16

Modular Sets 17

Image intensifier control

Synthes

2 Synthes 2.4 mm/2.7 mm Variable Angle LCP Forefoot/Midfoot System Technique Guide

Surgical Technique

Product Information

Table of Contents

Compression System Technique 19

2.4 mm/2.7 mm Variable Angle Locking Technique 23

Proximal and Distal Reamers Technique for 37First MTP Fusion

First MTP Fusion 41

Opening Wedge Osteotomy for Correction 45of Hallux Valgus

First TMT Fusion for Correction of Hallux Valgus 51

Second or Third TMT Fusion 55

Navicular and Cuboid Features 59

T-, L-, Cloverleaf, X-, Straight, and Mesh Plates 63

Set Configurations 71

Indications

Indications

The Synthes 2.4 mm/2.7 mm Variable Angle LCPForefoot /Midfoot System is indicated for fixation of osteotomies, fusions, fractures, nonunions, malunions andreplantations of small bones and small bone fragments inadult and adolescent (12–21 years) patients, including thefoot and ankle, and particularly in osteopenic bone.

Synthes 3

System Features

2.4 mm/2.7 mm Variable Angle LCP Forefoot/Midfoot System.Procedure-specific plates for osteotomies, fusions and fractures of the foot.

The system consists of anatomic- andprocedure-specific plates, variable anglelocking and cortex screws, and a com-pression feature, to aid in reconstructivefoot surgery. The implants are availablein stainless steel and titanium alloy.

Synthes 5

Compression System

Features– Tactile compression – Designed within the plate to

minimize additional soft tissuedissection

– Allows final screw fixation aftercompression is achieved


Compressionwire slot

Compressionwire hole

Compression Wires – 1.6 mm diameter, 150 mm overall

length – Thread lengths from 10 mm to

40 mm in 5 mm increments – Stop feature allows quick and easy

preliminarily fixation of the plate tothe bone, eliminating the need forplate holding forceps

– Material: Cobalt chromium alloythat is stiffer than conventionalstainless steel

Compression Forceps – Spherical recess matches the

spherical stops on the compressionwires, to ensure the forceps willgrasp the stop, regardless of thewire insertion angle

– Locking ratchet mechanism holdscompression during screw insertion

– Lightweight device does not requiresupport during screw insertion

The spherical stop is designed to sit above thecompression wire hole or compression slot, and insidevariable angle LCP holes. It allows off-axis insertion ofthe wire, while maintaining compression capability.

2.4 mm/2.7 mm Variable Angle LCP Technology

Synthes 7

Plates feature variable angle lockingholes, with or without the dynamic compression portion. Four columns ofthreads in the variable angle locking holeprovide four points of threaded lockingbetween the plate and the variable anglelocking screw, to create a fixed-angleconstruct at the desired screw angle.– Plate holes accept 2.4 mm and 2.7 mm

variable angle locking screws – Using 2.4 mm or 2.7 mm variable

angle locking screws allows a fixed-angle construct, 15° off-nominal-axis,or variable angulation within a 30° coneof angulation

– Holes are compatible with existing 2.4 mm and 2.7 mm locking screws.However, these screws can only beused coaxially, not off-angle.

– 2.4 mm and 2.7 mm cortex screwscan be used in the locking holes andplate positioning slots for traditionalcompression and fixation

Variable Angle Locking Drill Guide, cone Variable Angle Locking Drill Guide, coaxial

Proximal and Distal Reamers


Proximal Reamers – Concave shape to form a sphere

on the joint surface – Leading-edge radius to prevent

soft tissue damage

Distal Reamers – Convex shape to form a pocket

in the joint surface – Tapered to prevent damage to

the metatarsal head

Features– Used to prepare articulating joint

surfaces for fusion—specifically, between metatarsals and phalanges

– Cannulated for use over a K-wire,for better control

– 14 mm–24 mm reamers accept 1.6 mm K-wires

– 6 mm–12 mm reamers accept 1.25 mm K-wires

– Quick coupling

First MTP (Metatarsophalangeal) Fusion Plates

Synthes 9

0°

5°

10°

Features– Anatomic, low-profile plates

designed specifically for first MTParthrodesis

– 10° of valgus integrated into all firstMTP fusion plates

– Left and right plate designs – Small and medium plates with 3

different dorsiflexion angles: 0°, 5°, 10° – Large plates with 5° dorsiflexion – Revision plates with 0° dorsiflexion and

an extra variable angle locking hole tosecure a bone block

– Each plate is etched with a line indicating the fusion site to ensureproper plate placement

– Include compression feature– Compression wire holes allow

preliminary fixation of the plate to the bone

– Plantar side undercut allows contouringaround medial phalangeal eminence

Opening Wedge MeasuringInstrument – Thin tip slides into osteotomy site

and opens the wedge for the desired correction

– Ratchet mechanism holds osteotomy open

– Measurement scale indicates the appropriate size wedge for the desired opening

Opening Wedge Osteotomy Plates

Features– Anatomic, low-profile plates designed

specifically for metatarsal openingwedge osteotomy for hallux valgus correction

– 6 plates with varying spacer lengths:0 mm, 3 mm, 4 mm, 5 mm, 6 mmand 7 mm spacing

– Spacer includes a tapered tip for eas-ier insertion into the osteotomy site

– Compression wire holes allow for preliminary fixation of the plateto the bone


First TMT (Tarsometatarsal) Fusion Plates

Synthes 11

Features– Anatomic, low-profile plates specifi-

cally designed for first TMTarthrodesis (e.g., Lapidus procedure)

– Standard and large sizes – Designed to be placed dorsomedial

on the medial cuneiform and firstmetatarsal

– Precontoured for slight valgus orplantar positioning of the firstmetatarsal depending on plateplacement

– Include compression feature – Compression wire holes allow

preliminary fixation of the plate to the bone

TMT Fusion Plates

Features– Anatomic, low-profile plate for

fusions of the second and thirdtarsal and metatarsal joints

– Precontoured to fit anatomy – Includes compression feature – Compression wire holes allow

preliminary fixation of the plate tothe bone


T-, L- and Cloverleaf Fusion Plates

Synthes 13

Features– Anatomic, low-profile plates for

a variety of fusions, osteotomies and fractures

– Long T-plate with 3-hole head formore flexibility



X- and Straight Fusion Plates

Features– Low-profile plates designed for

a variety of fusions, osteotomies and fractures

– X-plates available in extra small,small, medium and large

– Straight plates available in 2-holeand 4-hole versions




Synthes 15

Features– Low-profile plates designed specifi-

cally for fixation of navicular andcuboid fractures

– Contourable – May be cut to length

Navicular and Cuboid Plates

Mesh Plate

Features– Low-profile plate – Contourable – May be cut to length


Modular Sets

Features– Modularity allows customized selection of implants – Reduces inventory and overall costs by eliminating

seldom-used implants

Synthes 17

Compression System Technique


1Insert compression wires

Instruments

03.211.410– 1.6 mm Compression Wires, 150 mm 03.211.440 length, 10 mm – 40 mm thread lengths

Place the plate on the bone, ensuring that the plate is placedappropriately according to the specific procedure.

Estimate the appropriate thread length needed for the plateand bone combination.

Note: Bicortical fixation is recommended.

Using a wire driver, insert the compression wire through thecompression wire hole (or compression slot) and through thebone.

To minimize stripping of the bone threads, slow wire insertionwhen the spherical stop nears the plate. Control the insertionfor tactile confirmation of compression between the wire,the plate and the bone.

There should be sufficient force holding the plate to thebone.

For plates with a compression slot, insert a second compressionwire into the far side of the slot (or compression hole).

Synthes 19


2 Compress

Instrument

03.211.400 Compression Forceps

Move the ratchet mechanism to engage as the forceps close,preventing the spring from opening the forceps.

Place the compression forceps into position, with the tipsaround the compression wire spheres.

Compress by squeezing the handles. Do not overcompress,as this may cause the compression wires to strip out of thebone.

If the ratcheting mechanism is in the correct position, hands-free compression can be maintained during radiographic verification of compression and the insertion of screws for final fixation.

After stable fixation is achieved, remove the compressionwires.


Instruments


1.6 mm Compression Wires, 150 mm length

03.211.410 10 mm thread

03.211.415 15 mm thread

03.211.420 20 mm thread

03.211.425 25 mm thread

03.211.430 30 mm thread

03.211.435 35 mm thread

03.211.440 40 mm thread

Synthes 21

2.4 mm/2.7 mm Variable Angle Locking Technique


1Variable angle locking screw insertion—conical(off-nominal-axis)

Instruments

For 2.4 mm variable angle locking screws

03.110.023 1.8 mm Variable Angle Locking Drill Guide,cone

310.509 1.8 mm Drill Bit with depth mark, quick coupling, 110 mm

319.006 Depth Gauge, for 2.0 mm and 2.4 mmcortex screws

For 2.7 mm variable angle locking screws

03.211.003 2.0 mm Variable Angle Locking Drill Guide,variable

319.01 Depth Gauge, for small screws

323.062 2.0 mm Drill Bit with depth mark, quick coupling, 140 mm

To insert the variable angle locking screw off the nominalaxis, insert the cone-shaped drill guide in the desired variableangle locking screw hole in the plate.

The drill guide cone will self-retain in the hole.

Synthes 23


1. Variable angle locking screw insertion—conical (off-nominal-axis) continued

The funnel of the drill guide allows a drilling angle within a30° cone.

When drilling off-axis, the drill guide should remain in placeand the drill bit may be aimed in any direction within the cone.

Verify the drill bit angle and depth under radiographic imagingto ensure the desired angle has been achieved. If necessary,drill at a different angle and verify again under imaging.

Use the depth gauge to measure for the correct screw length.


2Variable angle locking screw insertion—coaxial (fixed angle)

Instrument

For 2.4 mm locking and VA locking screws

03.110.024 1.8 mm Variable Angle Locking Drill Guide,coaxial

For 2.7 mm locking and VA locking screws


Variable angle and standard locking screws can be insertedinto the plate in line with the predefined screw trajectory.

The coaxial drill guide will self-retain in the hole.

Drill to the desired depth. Verify the drill bit depth under radiographic imaging.

Use the depth gauge to measure for the correct screwlength.

Synthes 25


3Preliminary screw placement

Instruments

03.111.038/ Handle with quick coupling311.43

314.467 StarDrive Screwdriver Shaft T8, 105 mm

Insert the correct length variable angle locking screw manually,using a self-retaining T8 StarDrive screwdriver shaft andquick coupling handle. Insert the screw until the screwheadis seated in the variable angle locking hole. Do not overtightenthe screw. Insert additional screws as needed.

Confirm proper alignment, screw placement and screwlength with multiple views under radiographic imaging.

Note: Ensure a screw is inserted on each side of the osteotomy/fusion site before removing the compression forceps.

Remove the compression wires.


Synthes 27

4Lock variable angle screws

Instruments

03.110.002 Torque Limiting Attachment, 1.2 Nm

03.110.005 Handle for Torque Limiting Attachment

314.453 StarDrive Screwdriver Shaft, T8, 55 mm

Alternative instruments

03.111.038 Handle, with quick coupling


511.776 Torque Limiting Attachment, 0.8 Nm

Use the 1.2 Nm torque limiting attachment (TLA) to finaltighten variable angle locking screws. Assemble the torquelimiting attachment to the T8 StarDrive screwdriver shaft andthe handle for torque limiting attachment.

After appropriate screw angle and length have been deter-mined, manually insert the screw using the TLA assembly.

Use of the TLA is mandatory when inserting the screws intovariable angle locking holes to ensure the minimal amount oftorque is applied.

03.110.002 03.110.005

2.4 mm/2.7 mm Variable Angle LCP Technology


Alternative instrument

314.468 Holding Sleeve for StarDrive ScrewdriverShaft

Reduce the plate to the bone using the holding sleeve withvariable angle locking screws.

Slide the holding sleeve onto the screwdriver shaft. Engagethe variable angle locking screw, ensuring the holding sleevecovers the threads on the head of the screw. Insert thescrew.

Once the desired reduction is achieved, slide the holdingsleeve back to expose the screwhead threads. Insert thescrew until the screwhead is seated in the variable anglelocking hole. Do not overtighten the screw.

Screws Used with the 2.4 mm/2.7 mm VA-LCP Forefoot/Midfoot SystemStainless Steel and Titanium

Synthes 29

2.4 mm Variable Angle Locking Screws– Threaded, rounded head locks securely into the variable

angle locking holes – Locked screws allow unicortical screw fixation and load

transfer to the near cortex – Color coded for easier identification – T8 StarDrive recess– Self-tapping tip– 10 mm to 60 mm lengths (2 mm increments)

2.4 mm Cortex Screws– For use in round or Combi holes – Low-profile head – Used to provide compression or neutral fixation – Self-tapping tip – 10 mm to 60 mm lengths (2 mm increments)

2.4 mm Locking Screws– Only for axial insertion in the variable angle locking holes – Threaded, conical head locks securely into the variable

angle locking holes – T8 StarDrive recess– Self-tapping tip – 10 mm to 30 mm lengths (2 mm increments)

All screws are available in implant-quality 316L stainless steel or titanium alloy (Ti-6AI-7Nb)

2.7 mm Variable Angle Locking Screws– Threaded, rounded head locks securely into the variable

angle locking holes – Locked screws allow unicortical screw fixation and load

transfer to the near cortex – Color coded for easier identification – T8 StarDrive recess– Self-tapping tip – 10 mm to 60 mm lengths (2 mm increments)

2.7 mm Cortex Screws– For use in round or Combi holes – Used to provide compression or neutral fixation – Low-profile head – Self-tapping tip – 10 mm to 50 mm lengths (2 mm increments), 55 mm

and 60 mm

2.7 mm Locking Screws– Only for axial insertion in the variable angle locking holes – Threaded, conical head locks securely into the variable

angle locking holes – T8 StarDrive recess– Self-tapping tip – 10 mm to 50 mm lengths (2 mm increments), 55 mm

and 60 mm

Screws for the 2.4 mm/2.7 mm VA-LCP Forefoot/Midfoot System Stainless Steel and Titanium


Instruments for the 2.4 mm/2.7 mm VA-LCP and Cortex Screws

Synthes 31

2.4 mm Instruments

03.110.000 1.8 mm Universal Variable Angle LockingDrill Guide



310.509 1.8 mm Drill Bit with depth mark, quickcoupling, 110 mm

310.530 2.4 mm Drill Bit, quick coupling, 100 mm

310.972 Countersink, for 2.0 mm and 2.4 mmscrews

312.18 2.4 mm/1.8 mm Double Drill Sleeve

319.006 Depth Gauge, for 2.0 mm and 2.4 mmcortex screws

323.202 2.4 mm Universal Drill Guide



Synthes 33

2.7 mm Instruments




310.26 2.7 mm Drill Bit, quick coupling, 100 mm

310.87 Countersink, for 2.7 mm cortex screws







Synthes 35

Common Instruments



311.43 Handle with quick coupling

03.211.001 2.4 mm/2.7 mm Variable Angle LCP PlateHolding Pins

314.453 Short StarDrive Screwdriver Shaft, T8, 55 mm


314.468 Holding Sleeve, for StarDrive ScrewdriverShaft, T8

Proximal and Distal ReamersTechnique for First MTP Fusion

Proximal and Distal Reamers Technique for First MTP Fusion

1 Approach

Make a dorsomedial incision extending from the proximal interphalangeal joint of the hallux to the middle of the firstmetatarsal. This incision should be medial to the extensorhallucis longus tendon. Isolate and retract the superficial nerveand vessel. Make a linear capsular incision to expose the firstmetatarsal head and proximal phalanx base.

Dissect down to the joint. Plantar flex the phalanx down toexpose the joint.

2Insert K-wire

Instrument

292.56 1.6 mm Kirschner Wire, 150 mm, trocarpoints on both ends

Plantar flex the hallux and insert the 1.6 mm K-wire into thehead of the first metatarsal. Ensure the wire is centered inthe canal.

A chielectomy may be necessary, to remove impinging boneand create a flat surface for the plate.

Synthes 37

Proximal and Distal Reamers Technique for First MTP Fusion

3 Proximal reaming

Instrument

03.211.114– Cannulated Reamers, proximal,03.211.124 14 mm–24 mm

Select the appropriate reamer. Always start with a larger sizeand work down to a smaller size.

Slide the proximal reamer over the K-wire. Ream to removecartilage from the joint.

Important: When preparing the joint, it is possible to removetoo much bone, causing shortening. Ream only enough toremove the cartilage and expose the bone surface for fusion.


4 Distal reaming

Instruments

03.211.014– Cannulated Reamers, distal,03.211.024 14 mm–24 mm

292.56 1.6 mm Kirschner Wire, trocar points onboth ends

Bend the toe down to expose the phalanx.

Remove the K-wire from the metatarsal. Insert a K-wire intothe center of the phalanx.

Slide the corresponding distal reamer over the K-wire. Reamto remove cartilage from the joint.

Important: When preparing the joint, it is possible to removetoo much bone, causing shortening. Ream only enough toremove the cartilage and expose the bone surface for fusion.

Remove the reamer and K-wire.

Synthes 39

Instruments

Cannulated Reamers, for 1.25 mm K-wires

Proximal Distal Diameter (mm)

03.211.106 03.211.006 6

03.211.108 03.211.008 8

03.211.110 03.211.010 10

03.211.112 03.211.012 12

Cannulated Reamers, for 1.6 mm K-wires


03.211.114 03.211.014 14

03.211.116 03.211.016 16

03.211.118 03.211.018 18

03.211.120 03.211.020 20

03.211.122 03.211.022 22

03.211.124 03.211.024 24


First MTP Fusion

First MTP Fusion

Required sets

01.210.110 2.4 mm Variable Angle Locking and CortexScrew Instrument Module

01.210.210/ 2.4 mm Variable Angle Locking and Cortex01.210.410 Screw Module

or


01.211.211/ 2.7 mm Variable Angle Locking and Cortex01.211.411 Screw Module

1Select and position plate

Select the plate that allows the desired level of correction.

A sterile flat surface can be placed on the bottom of the footto measure the desired amount of toe dorsiflexion. The platemay be contoured slightly to achieve the desired outcome.

Place the plate on the joint surface, using the etched line asa guide to ensure proper plate position.

Synthes 41

3Insert locking screws

For final fixation, insert the appropriate screws according tothe screw insertion technique described in the Variable AngleLocking Technique.

Variable angle locking screws allow manipulation around theindependent lag screw.


First MTP Fusion

2 Compress

Instruments


03.211.410– 1.6 mm Compression Wires03.211.440 10 mm–40 mm thread

It is recommended to insert an independent lag screw to aidin compression and stabilization. Insert the screw startingmedial and distal to the joint on the phalanx, crossing thejoint and ending in the lateral side of the metatarsal head.

Compression may also be achieved as described in the Compression System Technique.


Implants

Synthes 43

2.4 mm/2.7mm Variable Angle LCP First MTP Fusion Plates,small, 42 mm

Stainless Steel Titanium Right /Left Dorsiflexion

02.211.230 04.211.230 right 0°

02.211.231 04.211.231 left 0°

02.211.232 04.211.232 right 5°

02.211.233 04.211.233 left 5°

02.211.234 04.211.234 right 10°

02.211.235 04.211.235 left 10°

0°

5°

10°

0°

5°

10°

2.4 mm/2.7mm Variable Angle LCP First MTP Fusion Plates,medium, 52 mm


02.211.236 04.211.236 right 0°

02.211.237 04.211.237 left 0°

02.211.238 04.211.238 right 5°

02.211.239 04.211.239 left 5°

02.211.240 04.211.240 right 10°

02.211.241 04.211.241 left 10°

Implants


0°

5°

10°

2.4 mm/2.7mm Variable Angle LCP First MTP Fusion Plates,large, 57 mm


02.211.242 04.211.242 right 5°

02.211.243 04.211.243 left 5°

2.4 mm/2.7mm Variable Angle LCP First MTP Fusion Plates,revision, 53 mm


02.211.244 04.211.244 right 0°

02.211.245 04.211.245 left 0°

Opening Wedge Osteotomy forCorrection of Hallux Valgus

Opening Wedge Osteotomy for Correction of Hallux Valgus

Required sets


01.210.210/ 2.4 mm Variable Angle Locking and Cortex01.210.410 Screw Module (stainless steel or titanium)

or



1 Approach

Make a 3 to 4 cm dorsomedial incision from the first tarsalmetatarsal (TMT) joint, distally along the midline of the firstmetatarsal.

Dissect down to the bone and isolate the medial branch ofthe superficial peroneal nerve.

Synthes 45


2Create osteotomy

Identify a point medial on the metatarsal, approximately 1.5 cm distal to the TMT joint. Create an osteotomy startingfrom the medial side of the metatarsal but do not cutthrough the bone. Leave the lateral cortex intact, to act as a hinge point for opening the wedge.


3 Open and measure

Instrument

03.211.009 Opening Wedge Measuring Instrument

Open the osteotomy using osteotomes or the opening wedgemeasuring instrument. Slide the tip of the opening wedgeinstrument into the osteotomy. Open the osteotomy bysqueezing the handle until the desired correction is achieved.

The measuring instrument should be placed in the final implant position to ensure correct alignment and measurement.

Use radiographic imaging to confirm that the desired correctionhas been achieved.

Read the measurement on the back of the instrument to determine the appropriate spacer size.

Remove the measuring instrument.

Synthes 47


4 Position opening wedge plate

Instruments


Position the plate with the top of the T proximal to the osteotomy.

Insert the plate into the osteotomy. The tip of the spacer has a lead-in design to aid in inserting the wedge into theosteotomy.

Insert the compression wire (as described in the CompressionSystem Technique) through one of the wire holes for prelimi-nary plate fixation.


5 Insert variable angle locking screws

Insert the variable angle locking screws (as described in VariableAngle Locking Technique) starting with a screw in the sideopposite to the compression wire. Insert another lockingscrew in an open locking hole on the same side as the com-pression wire. Remove the compression wire and insert theremaining locking screws.

Pack bone graft into the osteotomy site, as appropriate.

Synthes 49

Product Information

Implants

2.4 mm/ 2.7mm Variable Angle Locking Opening WedgeOsteotomy Plates

Stainless Steel Titanium Spacer (mm)

02.211.210 04.211.210 0

02.211.211 04.211.211 3

02.211.212 04.211.212 4

02.211.213 04.211.213 5

02.211.214 04.211.214 6

02.211.215 04.211.215 7

Instrument



First TMT Fusion for Correction of Hallux Valgus


Required sets



or



1Approach

Make a dorsomedial incision medial to the extensor hallucislongus tendon (lateral to the tibialis anterior tendon). The incision should extend from the medial cuneiform to mid-shaft of the first metatarsal.

Dissect down to bone and isolate the medial branch of thesuperficial peroneal nerve.

Synthes 51

2Prepare joint surface

Remove the cartilage and prepare the joint surface for fusion.The surface of the joint can be manipulated to achieve thedesired correction.

Take care to minimize joint surface removal to prevent short-ening of the first ray.

4 Compress

It is recommended to insert an independent lag screw to aidin compression and stabilization. Insert the screw obliquelyacross the TMT joint.

Compression may also be achieved as described in the Compression System Technique.


3Position plate

Instruments



Select the appropriate size plate and place it over the jointsurface with the compression slot proximal to the joint.

Place the plate dorsomedial on the bone.

The plate is precontoured to help prevent medialization ofthe first metatarsal.

A compression wire can be used to hold the plate in position.

Alternatively, the plate can be placed dorsally; additional contouring may be needed.


Synthes 53

5Insert variable angle locking screws


Variable angle locking screws allow manipulation around theindependent lag screw.


Second or Third TMT Fusion


Required sets



or



1 Approach

Make a long dorsal incision over the third metatarsal starting,at the navicular and extending to the midshaft of themetatarsal. Identify and retract the dorsalis pedis artery andnerve. Dissect down to the bone.

2Prepare joint surface

Remove the cartilage and prepare the joint surface for fusion.The surface of the joint can be manipulated to achieve thedesired correction.

Take care to minimize joint surface removal to prevent short-ening of the second and third rays.

Synthes 55

4Compress

If necessary, compression across the joint can be achieved using the compression wires and forceps as described in theCompression System Technique.


3 Place plate

Instruments



Place the plate dorsally over the joint surface with the com-pression slot distal to the joint.

The plate is precontoured for an anatomic fit.

A compression wire can be used to hold the plate in position.


5Insert variable angle locking screws



Synthes 57

Implants

2.4 mm/2.7mm Variable Angle LCP First TMT Fusion Plates

Stainless Steel Titanium Size Length (mm)

02.211.246 04.211.246 Standard 39

02.211.247 04.211.247 Long 48

2.4 mm/2.7mm Variable Angle LCP TMT Fusion Plates 43 mm

Stainless Steel Titanium

02.211.266 04.211.266


Navicular and Cuboid Fractures


Required sets



or



1 Approach

Option A: NavicularMake a dorsal longitudinal incision from the midneck of thetalus toward the base of the second metatarsal. It is impor-tant to preserve neurovascular and tendinous structures.

It may 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.

Option B: Cuboid Make a linear dorsolateral incision starting at the sinu tarsiand extending to the base of the fourth metatarsal.

Warning: This incision may run parallel to, or directly over,the sural nerve and cross the peroneous tertius. Take care toavoid injuring these structures.

One of the main objectives of cuboid fracture managementis restoration of the lateral column length and articular surface.

Synthes 59


2Contour plate

Instruments

03.211.001 2.4 mm/2.7 mm Variable Angle LCPHolding Pin (2 required)

03.211.005 2.4 mm/ 2.7 mm Variable Angle LCPBending Plier (2 required)

Option A: NavicularApply K-wires and independent lag screws for provisionalbone fixation and stabilization.

The plate is designed to fit the navicular bone, as shown.

Two bending pliers can be used to contour the plate to fitthe navicular. A holding pin can be used to aid in contouring.

The plates can be cut to length for the specific fracture patternor patient anatomy.

Option B: CuboidApply K-wires and independent lag screws for provisionalbone fixation and stabilization.

The plates are designated left and right, however, they canbe used on either left or right foot. By using the oppositeplate on the foot, an extra variable angle locking hole maybe positioned in the lateral cuneiform.

Two bending pliers can be used to contour the plate to fitthe cuboid. A holding pin can be used to aid in contouring.



For final fixation, insert the variable angle locking screws asdescribed in the Variable Angle Locking Technique.

Synthes 61

Implants

2.4 mm/2.7 mm Variable Angle Locking Navicular Plate


02.211.220 04.211.220

2.4 mm/2.7 mm Variable Angle Locking Cuboid Plates

Stainless Steel Titanium Left /Right

02.211.221 04.211.221 left

02.211.222 04.211.222 right


T-, L-, Cloverleaf, X-, Straight, andMesh Plates

T-, L-, Cloverleaf, X-, Straight, and Mesh Plates

Required sets



or



1 Cut plate (mesh only)

Instruments

03.211.007 Mesh Plate Cutters

391.906 Cable Cutter, large

Cut the plate to fit patient anatomy. To cut multiple rows,use the large cable cutter.

A minimum of two rows and two columns are necessary toensure structural integrity.

The mesh plate cutters can be used for finer cuts around thescrew holes. To prevent sharp edges from causing soft tissueirritation, place the mesh plate bottom side down on themesh plate cutter platen.

Synthes 63


2Contour plate

Instruments

03.211.001 2.4 mm/2.7 mm Variable Angle LCP PlateHolding Pins (2 required)

03.211.005 2.4 mm/2.7 mm Variable Angle LCPBending Pliers (2 required)

Contour the plate to fit the specific anatomy and fixation options.

The bending pliers are designed to protect the variable angleholes during contouring by aligning the cloverleaf protrusionon the pliers with the cloverleaf design in the plate. Use twopliers to contour the plate.

Two holding pins can also be used for fine contouring of theplates by placing them in different variable angle holes. Muchlike the bending pliers, the holding pins are designed to protectthe variable angle holes when bending. If significant contour-ing is required, or the plate is too stiff, use the bending pliersfor contouring.


3 Compress (optional)

Instruments



If needed, compression can be achieved using the compressionwires and forceps as described in the Compression SystemTechnique.

Synthes 65



For final fixation, insert the variable angle locking screws asdescribed in the Variable Angle Locking Technique.



Implants

2.4 mm/2.7mm Variable Angle LCP Cloverleaf Fusion PlatesStainless Steel Titanium Size Length (mm)

02.211.250 04.211.250 Short 38

02.211.251 04.211.251 Standard 45

02.211.252 04.211.252 Long 64

2.4 mm/2.7mm Variable Angle LCP T-Fusion PlatesStainless Steel Titanium Size Length (mm)

02.211.253 04.211.253 Short 35

02.211.254 04.211.254 Standard 42

02.211.255 04.211.255 Long 61

02.211.265 04.211.265 Long 92

Synthes 67

Implants

2.4 mm/2.7mm Variable Angle LCP L-Fusion Plates, leftStainless Steel Titanium Size Length (mm)

02.211.257 04.211.257 Short 37

02.211.259 04.211.259 Standard 44

02.211.261 04.211.261 Long 62

2.4 mm/2.7mm Variable Angle LCP L-Fusion Plates, right


02.211.256 04.211.256 Short 37

02.211.258 04.211.258 Standard 44

02.211.260 04.211.260 Long 62


2.4 mm/2.7 mm Variable Angle Locking X-Plates


02.211.201 04.211.201 extra small 24

02.211.202 04.211.202 small 27

02.211.203 04.211.203 medium 32

02.211.204 04.211.204 large 36

2.4 mm/2.7 mm Variable Angle Locking Straight Fusion Plates


02.211.262 04.211.262 2 hole 27

02.211.263 04.211.263 4 hole 40

2.4 mm/2.7 mm Variable Angle Locking Mesh Plate, 5 x 12 holes


02.211.224 04.211.224

Synthes 69

Instruments

03.211.005 2.4 mm/2.7 mm Variable Angle LCP Bending Pliers

– Protects variable angle holes when bending – Cuts 1.6 mm and 2.0 mm K-wires – Integrated file to soften sharp edges


– Allows fine cutting of Mesh Plate


Set Configurations

2.4 mm Variable Angle LCP Forefoot/Midfoot Instrument and Implant Set Stainless Steel (01.211.219)

Graphic Cases 60.116.004 Graphic Case, 2/3 length, 4 bay

60.116.007 Auxiliary Tray, 2/3 length, 1/2 width

60.116.203 Auxiliary Bin, 1/2 length, 1/2 height

60.211.011 2.4 mm/2.7 mm Variable Angle LCPForefoot/Midfoot Label Pack

Instruments 03.211.005 2.4 mm/2.7 mm Variable Angle LCP

Bending Pliers, 2 ea.


Sets01.210.110 2.4 mm Variable Angle Locking and Cortex

Screw Instrument Set

01.210.210 2.4 mm Variable Angle Locking and CortexScrew Set

01.211.112 Proximal and Distal Reamers Set, 14 mm–24 mm

01.211.214 Compression Instruments, X- and StraightPlate Set

01.211.215 TMT Fusion Plate Set

01.211.216 First MTP Fusion Plates Set

01.211.217 Opening Wedge Plates and Instrument Set

01.211.218 Tarsal and Mesh Plates Set

Synthes 71

Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer tohttp://us.synthes.com/Medical+Community/Cleaning+and+Sterilization.htmor to the below listed inserts, which will be included in the shipping container:– Processing Synthes Reusable Medical Devices—Instruments, Instrument Trays

and Graphic Cases—DJ1305– Processing Non-sterile Synthes Implants—DJ1304


2.4 mm Variable Angle LCP Forefoot/Midfoot Instrument and Implant Set Titanium (01.211.419)

Graphic Cases 60.116.004 Graphic Case, 2/3 Length, 4 bay




Instruments

03.211.005 2.4 mm/2.7 mm Variable Angle LCP Bending Pliers, 2 ea.


Sets 01.210.110 2.4 mm Variable Angle Locking and

Cortex Screw Instrument Set

01.210.410 Titanium 2.4 mm Variable Angle Locking andCortex Screw Set

01.211.112 Proximal and Distal Reamers Set, 14 mm– 24 mm

01.211.414 Titanium Compression Instruments, X- and Straight Plate Set

01.211.415 Titanium TMT Fusion Plate Set

01.211.416 Titanium First MTP Fusion Plates Set

01.211.417 Titanium Opening Wedge Plates andInstrument Set

01.211.418 Titanium Tarsal and Mesh Plates Set

2.7 mm Variable Angle LCP Forefoot/Midfoot Instrument and Implant Set Stainless Steel (01.211.220)

Graphic Cases 60.116.004 Graphic Case, 2/3 length, 4 bay




Instruments 03.211.005 2.4 mm/2.7 mm Variable Angle LCP

Bending Pliers, 2 ea.


Sets01.211.111 2.7 mm Variable Angle Locking and

Cortex Screw Instrument Set


01.211.211 2.7 mm Variable Angle Locking and CortexScrew Set

01.211.214 Compression Instruments, X- and StraightPlate Set

01.211.215 TMT Fusion Plate Set

01.211.216 First MTP Fusion Plates Set

01.211.217 Opening Wedge Plates and Instrument Set

01.211.218 Tarsal and Mesh Plates Set

Synthes 73

2.7 mm Variable Angle LCP Forefoot/Midfoot Instrument and Implant Set Titanium (01.211.420)

Graphic Cases 60.116.004 Graphic Case, 2/3 Length, 4 bay




Instruments 03.211.005 2.4 mm/2.7 mm Variable Angle LCP Bending

Pliers, 2 ea.


Sets01.211.111 2.7 mm Variable Angle Locking and Cortex

Screw Instrument Set


01.211.411 Titanium 2.7 mm Variable Angle Locking andCortex Screw Set

01.211.414 Titanium Compression Instruments, X- andStraight Plate Set

01.211.415 Titanium TMT Fusion Plate Set

01.211.416 Titanium First MTP Fusion Plates Set

01.211.417 Titanium Opening Wedge Plates andInstrument Set

01.211.418 Titanium Tarsal and Mesh Plates Set


2.4 mm Variable Angle Locking and Cortex Screw Set Stainless Steel (01.210.210) and Titanium (01.210.410)

Graphic Cases 60.116.050 Screw Module Shell

60.116.058 2.4 Screw Block

60.116.071 2.4 Flip-Up Screw Rack, 2 ea.

60.116.452 Screw Type Push Pin, Blank

60.116.507 Screw Type Push Pin, Cortex

60.116.521 Screw Type Push Pin, VA Locking

60.116.554 Label Pack for 2.4 mm screws andinstruments

01.116.534 Length Market Push Pin Set

Implants 2.4 mm Variable Angle Locking Screws, self-tapping, with T8StarDrive recess

Stainless LengthSteel Titanium (mm) Qty

02.210.110 04.210.110 10 5

02.210.112 04.210.112 12 5

02.210.114 04.210.114 14 5

02.210.116 04.210.116 16 5

02.210.118 04.210.118 18 5

02.210.120 04.210.120 20 5

02.210.122 04.210.122 22 5

02.210.124 04.210.124 24 5

02.210.126 04.210.126 26 5

02.210.128 04.210.128 28 5

02.210.130 04.210.130 30 4

02.210.132 04.210.132 32 4

02.210.134 04.210.134 34 4

02.210.136 04.210.136 36 4

02.210.138 04.210.138 38 4

02.210.140 04.210.140 40 4

02.210.142 04.210.142 42 4

02.210.144 04.210.144 44 4

02.210.146 04.210.146 46 4

02.210.148 04.210.148 48 4

02.210.150 04.210.150 50 4

02.210.152 04.210.152 52 4

02.210.154 04.210.154 54 4

02.210.156 04.210.156 56 4

Synthes 75


Implants continued

2.4 mm Cortex Screws, self-tapping, with T8 StarDrive recess


201.760 401.760 10 5

201.762 401.762 12 5

201.764 401.764 14 5

201.766 401.766 16 5

201.768 401.768 18 5

201.770 401.770 20 5

201.772 401.772 22 5

201.774 401.774 24 5

201.776 401.776 26 5

201.778 401.778 28 5

201.780 401.780 30 4

201.782 401.782 32 4

201.784 401.784 34 4

201.786 401.786 36 4

201.788 401.788 38 4

201.790 401.790 40 4

02.210.942 04.210.942 42 4

02.210.944 04.210.944 44 4

02.210.946 04.210.946 46 4

02.210.948 04.210.948 48 4

02.210.950 04.210.950 50 4

02.210.952 04.210.952 52 4

02.210.954 04.210.954 54 4

02.210.956 04.210.956 56 4


2.4 mm Variable Angle Locking and Cortex Screw Instrument Set (01.210.110)

Graphic Case 60.210.003 2.4mm Variable Angle Locking and Cortex

Screw Instrument Module Case

Instruments 03.110.000 1.8 mm Universal Variable Angle Locking

Drill Guide





03.111.038 Handle with quick coupling

03.211.001 2.4 mm/2.7 mm Variable Angle LCP PlateHolding Pins, 2 ea.

310.509 1.8 mm Drill Bit with depth mark, quickcoupling, 2 ea

310.530 2.4 mm Drill Bit, quick coupling, 100 mm,2 ea.

310.972 Countersink, for 2.0 mm and 2.4 mmscrews


314.453 Short StarDrive Screwdriver Shaft, T8, 55 mm, 2 ea.

314.467 StarDrive Screwdriver Shaft, T8, 105 mm,2 ea.


319.006 Depth Gauge, for 2.0 mm and 2.4 mmscrews


Also Available 03.111.005 Depth Gauge, for 2.4 mm and 2.7 mm

screws

310.162 1.8 mm Drill Bit with Depth Mark, StrykerJ-latch, 110 mm

311.43 Handle with quick coupling

317.872 2.4 mm Drill Bit, Stryker J-Latch, 90 mm

511.776 Torque Limiting Attachment, 0.8 Nm,quick coupling

Synthes 77


Graphic Cases 60.116.050 Screw Module Shell

60.116.059 2.7 mm Screw Block

60.116.072 2.7 mm Flip-Up Screw Rack, 2 ea.

60.116.452 Screw Type Push Pin, Blank

60.116.507 Screw Type Push Pin, Cortex

60.116.521 Screw Type Push Pin, VA Locking

60.116.555 Label Pack for 2.7 mm screws andinstruments

01.116.534 Length Market Push Pin Set

Implants 2.7 mm Variable Angle Locking Screws, self-tapping, with T8StarDrive recess


02.211.010 04.211.010 10 4

02.211.012 04.211.012 12 4

02.211.014 04.211.014 14 4

02.211.016 04.211.016 16 4

02.211.018 04.211.018 18 4

02.211.020 04.211.020 20 4

02.211.022 04.211.022 22 4

02.211.024 04.211.024 24 4

02.211.026 04.211.026 26 4

02.211.028 04.211.028 28 4

02.211.030 04.211.030 30 3

02.211.032 04.211.032 32 3

02.211.034 04.211.034 34 3

02.211.036 04.211.036 36 3

02.211.038 04.211.038 38 3

02.211.040 04.211.040 40 3

02.211.042 04.211.042 42 3

02.211.044 04.211.044 44 3

02.211.046 04.211.046 46 3

02.211.048 04.211.048 48 3

02.211.050 04.211.050 50 3

02.211.052 04.211.052 52 3

02.211.054 04.211.054 54 3

02.211.056 04.211.056 56 3


2.7 mm Cortex Screws, self-tapping, with T8 StarDrive recess


202.870 402.870 10 4

202.872 402.872 12 4

202.874 402.874 14 4

202.876 402.876 16 4

202.878 402.878 18 4

202.880 402.880 20 4

202.882 402.882 22 4

202.884 402.884 24 4

202.886 402.886 26 4

202.888 402.888 28 4

202.890 402.890 30 3

202.892 402.892 32 3

202.894 402.894 34 3

202.896 402.896 36 3

202.898 402.898 38 3

202.900 402.900 40 3

202.962 402.962 42 3

202.963 402.963 44 3

202.965 402.965 46 3

202.966 402.966 48 3

202.967 402.967 50 3

202.968 402.968 55 3

202.969 402.969 60 3

Synthes 79

2.7 mm Variable Angle Locking and Cortex Screw Instrument Set (01.211.111)

Graphic Case 60.211.003 2.7 mm Variable Angle Locking and Cortex

Screw Instrument Module Case

Instruments 03.110.002 Torque Limiting Attachment, 1.2 Nm


03.111.038 Handle with quick coupling

03.211.001 2.4 mm/2.7 mm Variable Angle LCP PlateHolding Pins, 2 ea.




310.26 2.7 mm Drill Bit, quick coupling, 100 mm,2 ea.

310.87 Countersink, for 2.7 mm cortex screws


314.453 Short StarDrive Screwdriver Shaft, T8, 55 mm, 2 ea.

314.467 StarDrive Screwdriver Shaft, T8, 105 mm,2 ea.





Also Available 311.43 Handle with quick coupling

511.776 Torque Limiting Attachment, 0.8 Nm


Compression Instruments, X- and Straight Plate Set Stainless Steel (01.211.214) and Titanium (01.211.414)

Graphic Cases60.116.052 Module Shell

60.211.008 Compression Wires and Forceps Module Bin

Implants2.4 mm/2.7 mm Variable Angle Locking X-Plates◊

Stainless Steel Titanium Size

02.211.201 04.211.201 extra small

02.211.202 04.211.202 small

02.211.203 04.211.203 medium

02.211.204 04.211.204 large

2.4 mm/2.7 mm Variable Angle Locking Straight FusionPlates◊

Stainless Steel Titanium Size

02.211.262 04.211.262 2 hole

02.211.263 04.211.263 4 hole

Instruments 03.211.400 Compression Forceps

1.6 mm Compression Wires, 150 mm, 6 ea.

Thread Length (mm)

03.211.410 10

03.211.415 15

03.211.420 20

03.211.425 25

03.211.430 30

03.211.435 35

03.211.440 40

Synthes 81

◊ Available nonsterile or sterile-packed Add “S” to catalog number to order sterile product

TMT Fusion Plate Set Stainless Steel (01.211.215) and Titanium (01.211.415)

Graphic Case 60.211.006 TMT, First TMT, Cloverleaf, Plate Module Bin

Implants2.4 mm/2.7 mm Variable Angle LCP First TMT Fusion Plates◊


02.211.246 04.211.246 standard 39

02.211.247 04.211.247 long 48

2.4 mm/2.7 mm Variable Angle LCP TMT Fusion Plates, 43 mm◊


02.211.266 04.211.266

2.4 mm/2.7 mm Variable Angle LCP Cloverleaf Fusion Plates◊


02.211.250 04.211.250 short 38

02.211.251 04.211.251 standard 45

02.211.252 04.211.252 long 64

2.4 mm/2.7 mm Variable Angle LCP L-Fusion Plates, right◊


02.211.256 04.211.256 short 37

02.211.258 04.211.258 standard 44

02.211.260 04.211.260 long 62

2.4 mm/2.7 mm Variable Angle LCP L-Fusion Plates, left◊


02.211.257 04.211.257 short 37

02.211.259 04.211.259 standard 44

02.211.261 04.211.261 long 62

2.4 mm/2.7 mm Variable Angle LCP T-Fusion Plates◊

Stainless Steel Titanium Holes Size LengthHead (mm)

02.211.253 04.211.253 2 short 35

02.211.254 04.211.254 2 standard 42

02.211.255 04.211.255 2 long 61

02.211.265 04.211.265 3 extra long 92



Proximal and Distal Reamers Set, 14 mm–24 mm (01.211.112)

Graphic Cases 60.116.052 Module Shell

60.211.009 Proximal and Distal Reamers Module Bin 1

Implant 292.56 1.6 mm Kirschner Wire, 150 mm, trocar

points on both ends, 10/pkg.

Instruments Cannulated Reamers (for 1.6 mm K-Wires)


03.211.114 03.211.014 14

03.211.116 03.211.016 16

03.211.118 03.211.018 18

03.211.120 03.211.020 20

03.211.122 03.211.022 22

03.211.124 03.211.024 24

Also Available 01.211.113 6 mm–12 mm Proximal and Distal Reamer

Set

Graphic Case 60.211.010 Proximal and Distal Reamers Module Bin 2

Implant 292.52 1.25 mm Kirschner Wire, 150 mm, trocar

points on both ends, 10/pkg.

Instruments Cannulated Reamers (for 1.25 mm K-Wires)


03.211.106 03.211.006 6

03.211.108 03.211.008 8

03.211.110 03.211.010 10

03.211.112 03.211.012 12

Synthes 83

First MTP Fusion Plates Sets Stainless Steel (01.211.216) and Titanium (01.211.416)

Graphic Case 60.211.001 First MTP Fusion Module Bin

Implants 2.4 mm/2.7 mm Variable Angle LCP First MTP Fusion Plates,small, 42 mm◊

Stainless Steel Titanium Left/Right Dorsiflexion

02.211.230 04.211.230 right 0°

02.211.231 04.211.231 left 0°

02.211.232 04.211.232 right 5°

02.211.233 04.211.233 left 5°

02.211.234 04.211.234 right 10°

02.211.235 04.211.235 left 10°

2.4 mm/2.7 mm Variable Angle LCP First MTP Fusion Plates,medium, 52 mm◊


02.211.236 04.211.236 right 0°

02.211.237 04.211.237 left 0°

02.211.238 04.211.238 right 5°

02.211.239 04.211.239 left 5°

02.211.240 04.211.240 right 10°

02.211.241 04.211.241 left 10°

2.4 mm/2.7 mm Variable Angle LCP First MTP Fusion Plates,large, 57 mm◊


02.211.242 04.211.242 right 5°

02.211.243 04.211.243 left 5°

2.4 mm/2.7 mm Variable Angle LCP First MTP Fusion Plates,revision, 53 mm◊


02.211.244 04.211.244 right 0°

02.211.245 04.211.245 left 0°



Opening Wedge Plates and Instrument Set Stainless Steel (01.211.217) and Titanium (01.211.417)

Graphic Cases 60.116.052 Module Shell

60.211.007 Opening Wedge Plate and InstrumentModule Bin

Implants 2.4 mm/2.7 mm Variable Angle Locking Opening WedgePlates◊

Stainless Steel Titanium Spacer (mm)

02.211.210 04.211.210 0

02.211.211 04.211.211 3

02.211.212 04.211.212 4

02.211.213 04.211.213 5

02.211.214 04.211.214 6

02.211.215 04.211.215 7

Instrument


Synthes 85


Tarsal and Mesh Plates Set Stainless Steel (01.211.218) and Titanium (01.211.418)

Graphic Case 60.211.005 Tarsal and Mesh Plate Module Bin

Implants2.4 mm/2.7 mm Variable Angle Locking Navicular Plate◊


02.211.220 04.211.220

2.4 mm/2.7 mm Variable Angle Locking Cuboid Plates◊

Stainless Steel Titanium Left/Right

02.211.221 04.211.221 left

02.211.222 04.211.222 right

2.4 mm/2.7 mm Variable Angle Locking Mesh Plate, 5 x 12holes◊


02.211.224 04.211.224



Synthes (USA)1302 Wrights Lane EastWest Chester, PA 19380Telephone: (610) 719-5000To order: (800) 523-0322Fax: (610) 251-9056

Synthes (Canada) Ltd.2566 Meadowpine BoulevardMississauga, Ontario L5N 6P9Telephone: (905) 567-0440To order: (800) 668-1119Fax: (905) 567-3185

© 2010 Synthes, Inc. or its affiliates. All rights reserved. Combi, LCP and Synthes are trademarks of Synthes, Inc. or its affiliates. Printed in U.S.A. 3/11 J9980-B

www.synthes.com

Documents

2.4 mm/2.7 mm Variable Angle LCPForefoot/Midfoot System …synthes.vo.llnwd.net/o16/Mobile/Synthes North America/Product Support Materials...wedge osteotomy for hallux valgus correction