Surgical Technique

DFS® Mini Lengthener for Brachymetatarsia

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Figure 1 Figure 2

DFS Mini-Lengthener

IncisionPerform a stab tenotomy in the plantar sulcus of the toe at

the level of the MPJ releasing the flexors. Make a longitudinal

incision along the axis of the fourth metatarsal (Figure 1).

Perform a dorsal tenotomy and capsulotomy at the MPJ to

release any contracture (Figure 2).

Option: Add a k-wire to the distal toe to distract over

a wire. Place K-wire at base of proximal phalynx and exit

distal phalynx.

Brachymetatarsia Lengthening

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DFS Mini-Lengthener Brachymetatarsia Lengthening

Figure 3 Figure 4

Pin PlacementPlace the first pin so that DFS lengthener will be aligned

perpendicular to the long axis of the thickest part of the

metatarsal head. After placing the first distal pin, use the

parallel pin guide to place the second distal pin (Figure 3).

Repeat for proximal pins so that the patient has two pins distal

and two pins proximal to the intended osteotomy site. This will

establish a parallel relationship between the lengthener and

the desired axis of lengthening.

Allow adequate distance for additional threaded wires or bone

screws and an additional 1 cm between innermost threaded

wires or bone screws for corticotomy (Figure 4).

In the case of a thin metatarsal, consider using the thinner

pins distally. All pins should be bicortical and parallel to one

another and along the bisection of the metatarsal. Larger pins

are recommended for strongest fixation.

Note: Place all pins prior to making the osteotomy. It will be

very difficult to place the pins in an unstable bone.

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Figure 5

Fixator The lengthener C/D nut is turned counterclockwise while

the locking screw on the distal clamp is loosened to allow

for distraction. Attach DFS mini construct to pins with small

hex driver to allow wires through construct. Tighten bolt

with hex driver. Perform on both distal and proximal pins

(Figure 5).

Ensure that the lengthener C/D nut is turned clockwise while

the locking screw on the distal clamp is loose to allow for

compression (Figure 6).

Note: Make sure your construct is able to accommodate the

amount of length you will need to fully get the metatarsal out

to length.

Figure 6

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DFS Mini-Lengthener Brachymetatarsia Lengthening

Figure 7

OsteotomyFrame placement can occur before or after performing the

osteotomy (Figure 7). A small incision is made and soft tissue

dissection is continued to the level of the periosteum. The

periosteum is then incised and reflected circumferentially, sub

periostally away from bone.

Use sagittal saw or cutting device of choice to create

osteotomy.

Note: When using sagittal saw, be mindful to avoid excessive

heat or trauma.

The DFS Mini-Lengthener is distracted intra-operatively

to ensure completeness of osteotomy. Completeness should

also be verified by fluoroscopy, or direct visualization (Figure

8). Flush and compress bone so no gap exists; ends of metatarsal

should touch (Figure 9).

Figure 8

Figure 9

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Figure 10 Figure 11

If 1.6/2.0 mm K-wires are used, trim closer to level of clamp(s).

The wounds are irrigated, the periosteum re-approximated in

layers, and wounds closed in routine fashion with absorbable

suture. Distraction is typically commenced post operatively

between day 7–14. Distraction is achieved three fourths of

a millimeter per day with a maximum of 1 mm per day until

desired length is achieved. Leave fixator on for a latency period

twice the time it takes to distract (typically two weeks to a

month) or for every 1 cm of length distracted 30 days of time.

Follow-up patient weekly to check callous formation. Once

medial oblique callous formation is seen on x-ray (Figure 10),

remove pins and ex-fix.

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DFS Mini-Lengthener Brachymetatarsia Lengthening

DFS Mini Instrument Set

PART NUMBER DESCRIPTION

07000070100702007030070350703707040070500706007065071000712907128M25-04015TM30-07020TM16-07015M20-10015

Small Mini-Fixator KitMedium Mini-Fixator KitLong Mini-Fixator KitMini Fixator Lengthener Kit, 100 mm Mini-Fixator Lengthener Kit, 150 mmMini-Fixator Lengthener Kit, 200 mmMini-Fixator Straight ClampMini-Fixator Lengthener Straight ClampMini-Fixator Distraction NutMini-Lengthener Distraction NutMini-Fixator Wire Extractor1.6 mm Mini-Template Drill Guide2.0 mm Mini-Template Drill Guide2.5/2.0 mm Tapered Mini Cortical Bone Screw3.0/2.5 mm Tapered Mini Cortical Bone ScrewThreaded Wires (4) per set, 1.6 mmThreaded Wires (4) per set, 2.0 mm

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DFS Mini Instrument Set

PART NUMBER DESCRIPTION

0500503105071100504507125071200501007106

T-Handle Bone Screw Wrench3 mm Allen WrenchMini-Fixator Manipulation Forceps (pair)Enhanced 3 mm T-WrenchMini-Fixator Template Convergent Screw GuideMini-Fixator Clamp Template Parallel2.0 mm Drill Bit Complete1.6 mm Drill Bit

DFS Mini Instrument Set

PART NUMBER DESCRIPTION

0713003300

Mini-Fixator Surgical Tray3 mm Bone Screw Covers (20) per set

Notes

INDICATIONS

The Zimmer Biomet X FIX DynaFix® System is a unilateral

external fixation device intended for use in the children and

adults in the treatment of bone conditions including leg

lengthening, osteotomies, arthrodesis, fracture fixation, and

other bone conditions amenable to treatment by use of the

external fixation modality.

CONTRAINDICATIONS

Patients with mental or neurologic conditions who are unwilling

or incapable of following postoperative care instructions.

BMET0215.1 REV0219

Biomet Trauma56 East Bell DriveP.O. Box 587Warsaw, IN 46581USA

www.zimmerbiomet.com

For indications, contraindications, warnings, precautions, potential adverse effects and patient counselling information, see the package insert or contact your local representative; visit www.zimmerbiomet.com for additional product information.

Zimmer Biomet does not practice medicine. This technique was developed in conjunction with a health care professional. This document is intended for surgeons and is not intended for laypersons. Each surgeon should exercise his or her own independent judgment in the diagnosis and treatment of an individual patient, and this information does not purport to replace the comprehensive training surgeons have received. As with all surgical procedures, the technique used in each case will depend on the surgeon’s medical judgment as the best treatment for each patient. Results will vary based on health, weight, activity and other variables. Not all patients are candidates for this product and/or procedure. Caution: Federal (USA) law restricts this device to sale by or on the order of a surgeon. Rx only.

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