EpiFIX TM GROWTH CONTROL PLATING SYSTEM · Cannulated T20 Screwdriver 4.5mm Cannulated Screws A significant number of children suffer from the discomfort of angular limb deformities

© 2019 WishBone Medical, Inc.

EpiFIXTM GROWTH CONTROL PLATING SYSTEMSURGICAL TECHNIQUE

TM

TABLE OF CONTENTS

Introduction

System Overview .................................................................................................................................................................................. 3

Kit Components .......................................................................................................................................................................... 3

Plate Features .......................................................................................................................................................................... 4-5

Screws ................................................................................................................................................................................................ 6

Indications .............. ................................................................................................................................................................................... 6

Surgical Technique

Plate Sizing & Fixation ...........................................................................................................................................................................7

Guide Wire Insertion ..................................................................................................................................................................... 7-8

Screw Sizing .............................................................................................................................................................................................. 8

Screw Insertion ........................................................................................................................................................................................ 9

Final Control and Closure ................................................................................................................................................................. 10

Order Information

Curved 2-Hole EpiFIXTM Plate, 12mm Procedure Kits ......................................................................................................... 11

Curved 2-Hole EpiFIXTM Plate, 16mm Procedure Kits ......................................................................................................... 11

Curved 4-Hole EpiFIXTM Plate, 22mm Procedure Kits ....................................................................................................... 12

Curved 4-Hole EpiFIXTM Plate, 26mm Procedure Kits ....................................................................................................... 12

WISHBONE MEDICAL EpiFIXTM GROWTH CONTROL SURGICAL TECHNIQUE 3

Introduction

WISHBONE MEDICALEpiFIXTM GROWTH CONTROL PLATING SYSTEM

Curved 2-Hole Plate, Ti (12 or 16mm) or Curved 4-Hole Plate, Ti (22 or 26mm)

1.6mm Guide Wire (x3)

1.7mm Cannulated Plate Holder

SYSTEM COMPONENTS

Wire Sleeve

Variable Angle Locking Drill Guide

Double-Ended Drill Guide

Direct Measurement Device

2.8mm x 175mm Cannulated Drill Bit

Cannulated T20 Screwdriver

4.5mm Cannulated Screws

A significant number of children suffer from the discomfort of angular limb deformities — congenital and acquired.3 WishBone Medical’s EpiFIXTM System is an effective growth control plating solution for temporary hemiepiphysiodesis, a proven treatment with low complication rates.1

WishBone EpiFIXTM curved plates are designed for use in both upper and lower extremities. The application of the plate allows the physician to redirect the growth angle of the long bone, gradually correcting the angular deformity in pediatric patients with open physis.2, 3

This surgical solution is recommended as a first line of treatment, preferred over major surgical intervention, such as osteotomies1 Immediately following the procedure, the patient is allowed mobility and weight bearing.2


SYSTEM FEATURES: 2-HOLE PLATES

Protruding bosses designed to elevate plate for

reduced contact with growth plate and periosteum

Central pilot hole designed to

precisely place plate over physis

Threaded and recessed screw

holes are designed to hold the

drill guides securely and allow

low-profile screw seating

Low-profile plates designed to

conform to patient anatomy

PLATE LENGTHS

Curved 12.0, 16.0mm

EVERYTHING YOU NEED, BRAND NEW EVERY TIME.Complete procedure kits in sterile packaging eliminate set processing and help avoid delays or cancellations attributed to missing components.

Readily available for immediate use, individual kits deliver sharp and pristine instruments, new for each procedure.


SYSTEM FEATURES: 4-HOLE PLATES

Protruding bosses designed to elevate plate for

reduced contact with growth plate and periosteum

Central pilot hole designed to

precisely place plate over physis

Threaded and recessed screw

holes are designed to hold the

drill guides securely and allow

low-profile screw seating

Low-profile plates designed to

conform to patient anatomy

PLATE LENGTHS

Curved 22.0, 26.0mm

EpiFIXTM PLATE TEMPLATE

4-hole plates provide additional

fixation with four screws.

The EpiFIXTM plate template may be use for implant selection and temporary

plate positioning. The template is not intended for screw positioning.

Available separately as a sterile packed accessory item (ITEM #: EFTEMP)

Inside perimeters/dashed lines on templates represent smaller implant sizes (22mm 4-hole plate | 12mm 2-hole plate).

Outside perimeters/solid lines on templates represent larger implant sizes (26mm 4-hole plate | 16mm 2-hole plate).


4.5mm CANNULATED SCREWS

SYSTEM FEATURES: SCREWS

WishBone Medical EpiFIXTM Plates utilize the following screws:

16mm, 24mm, or 32mm cannulated self-tapping

cancellous screws included in each 2-hole kit

(24mm and 32mm included in 4-hole kits)

System designed to allow for screw angulation,

which facilitates guided growth of limbs 1, 2, 3

Fully threaded shaft designed to resist pull out

forces and to facilitate screw removal

T20 hexalobe drive

For product information, including indications, contraindications, warnings, precautions and potential adverse effects, visit WishBone Medical’s Instructions for Use page online: www.WishBoneMedical.com/IFU.


Patient PositioningPlace the patient in a supine position with the leg abducted for fluoroscopy access and sterile prep in a customary fashion.

Before the Surgery

SURGICAL TECHNIQUE

Before the incision, select the appropriate size and type of growth control plate that best fits the patient’s anatomy. The EpiFIXTM plate template is available as a separate sterile packed accessory item.

Once the location is determined a 3cm longitudinal incision is made. The skin and the fascia is divided, avoiding damage to the periosteum.

Plate Sizing and Fixation

Thread the wire sleeve into the variable angle locking drill guide, then thread the assembly onto the plate. The plate holder is then removed.

A second 1.6mm guide wire with graduated markings is introduced through the guide wire sleeve of the variable angle locking drill guide and into the epiphysis to a suitable depth (fig 3). The double-ended drill guide may also be used to insert the guide wire.

Epiphyseal Guide Wire Insertion

fig. 1A

fig. 2

Note: Proximal and distal

guide wire holes are offered

for additional or alternative

temporary fixation.

Warning: Take care not to damage the physis during guide wire insertion.

fig. 3

fig. 1B

Caution: Due to the notch sensitivity of titanium, take care not to notch plate when bending. The plate must never be unbent or reverted to its original shape once it has been contoured. Do not bend plates excessively.

A 1.6mm guide wire is inserted to determine the location of the physis. Thread the plate holder into the center hole of the plate, and slide the plate/plate holder construct over the guide wire (fig 1).

Introduce the plate into the surgical site (fig 2). The guide wire and plate position are verified using fluoroscopy.


Metaphyseal Guide Wire Insertion

The 1.6mm ball tip guide wire sleeve of the double-ended drill guide is used to pass a third guide wire into the metaphyseal region to an appropriate depth (fig 4). The variable angle locking drill guide assembly may also be used to insert the guide wire.

Screw Sizing

SURGICAL TECHNIQUE (CONT.)

Three lengths of cannulated screws are available:

16mm

24mm

32mm

A measurement of the appropriate screw length can be taken with the direct measurement device over the guide wire, off the top of the variable angle drill guide assembly (guide wire sleeve top feature) or directly off the bone (fig 5).

Read the depth of the wire from the gauge off the end of the guide wire if measuring off of the

Fluoroscopic A/P and lateral images are taken to assure that the wires are within the epiphysis and the metaphysis.

guide wire sleeve or by using the mark on the guide wire and the direct measurement device (fig 6).

Select the screw length accordingly.

fig. 4

fig. 5 fig. 6

Warning: Take care not to damage the physis during guide

wire insertion. Note: Be sure to use the appropriate end of the

double-ended drill guide. The ball tip end of the guide is used

for position the guide wire, and 2.8mm drill guide end is used

when drilling for screw preparation.



For the epiphyseal screw hole drilling, remove the guide wire sleeve, leaving the variable angle locking drill guide in place. Alternatively, the double-ended drill guide may be used (see metaphyseal screw insertion section for images). The 2.8mm cannulated drill bit is passed over the 1.6mm guide wire, and through the drill guide (fig 7). The bone is drilled to the appropriate depth under fluoroscopic examination. The drill is then withdrawn ensuring that guide wire remains in place.

Screw Insertion (Epiphyseal)

For the metaphyseal screw hole drilling, pass the drill guide over the guide wire. The 2.8mm cannulated drill bit is passed over the 1.6mm guide wire, and through the double-ended drill guide (fig 9). Alternatively, the variable angle locking drill guide may be used (see epiphyseal screw insertion section).

Note: Drill is calibrated to be used with the variable angle locking drill guide or with the double-ended drill guide.

Metaphyseal screw is inserted in the same fashion as the epiphyseal screw.

After the drill is withdrawn, the drill guide is removed. The appropriate screw is selected and seated on the tip of the screwdriver and passed over the guide wire into the plate (fig 10).

The screw is lightly tightened into place, and the screwdriver is withdrawn, and guide wire removed.

After the drill is withdrawn, the drill guide is removed. The appropriate screw is selected and seated on the tip of the screwdriver and passed over the guide wire into the plate (fig 8).

The screw is lightly tightened into place, and the screwdriver is withdrawn, and guide wire removed.

Screw Insertion (Metaphyseal)

fig. 7

fig. 8 fig. 10

fig. 9

Caution: Ensure guide wire is not unintentionally advanced

during drilling.

Caution: Ensure guide wire is not unintentionally advanced during drilling.

Note: Be sure to use the appropriate end of the double-ended drill guide. The ball tip end of the guide is used for position the guide wire, and 2.8mm drill guide end is used when drilling for screw preparation.

The bone is drilled to the appropriate depth under fluoroscopic examination. The drill is then withdrawn ensuring that guide wire remains in place.

Caution: Use manual force only with a screwdriver, do not use power.Caution: Use manual force only with a screwdriver,

do not use power.


Removal


Screws and plate are imaged fluoroscopically in

order to ensure that screws are fully seated with

no gap between plate-bone interfaces.

Wound is closed in the customary fashion.

Tighten both screws (fig11).

Before removing the screws, the 1.7mm plate holder is threaded into the central hole of the plate for plate extraction.

Assemble the screwdriver to screws as described above and remove the screws. After screw removal, the plate may be lifted from the surgical site using the plate holder.

Remove the physeal guide wire prior to final screw tightening.

Final Control and Closure

fig. 11

fig. 12

fig. 13

Caution: Undercorrection and overcorrection are common

issues with guided growth. Careful preoperative planning

and follow-up as needed can minimize complications and

allow for deformity correction with minimal morbidity.4

Caution: Use manual force only with a screwdriver,

do not use power.


ORDER INFORMATION

ITEM DESCRIPTION QTY

Curved 2-Hole x 12mm EpiFIX Plate, Ti 1

EpiFIX 1.6mm Guide Wire 3

1.7mm Cannulated Plate Holder 1

EpiFIX Wire Sleeve 1

EpiFIX 2.8mm Variable Angle Locking Drill Guide 1

EpiFIX 1.6/2.8mm Double-Ended Drill Guide 1

EpiFIX Direct Measurement Device 1

2.8mm x 175mm Cannulated Drill Bit 1

Cannulated T20 Screwdriver 1

4.5mm x 16mm Ti EpiFIX Cannulated Screw 2



Curved 2-Hole EpiFIXTM Plate, 12mm Procedure Kit

KIT # PK-EFC0212T















KIT # PK-EFC0216T

The EpiFIX plate template is available as a separate sterile packed accessory item ( EFTEMP )


ORDER INFORMATION














KIT # PK-EFC0422T














KIT # PK-EFC0426T

The EpiFIX plate template is available as a separate sterile packed accessory item (ITEM #: EFTEMP)


REFERENCES

1. Danino B, Rödl R, Herzenberg JE, Shabtai L, Grill F, Narayanan U, Segev E, Wientroub S. Guided growth: preliminary results of a multinational study of 967 physes in 537 patients. J Child Orthop 2018;12:91-96. DOI 10.1302/1863-2548.12.170050.

2. Stevens PM. Guided Growth for Angular Correction. J Pediatr Orthop. Volume 27, Number 3. April/May 2007.

3. Balla MS, Bruce CE, Nayagam S. Correcting genu varum and genu valgum in children by guided growth. J Bone Joint Surg. Vol. 92-B, No. 2, February 2010.

4. Saran N, Rathjen KE. Guided growth for the correction of pediatric lower limb angular deformity. J Am Acad Orthop Surg. 2010;18:528–36.

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WishBoneMedical.com

© 2019 WishBone Medical, Inc. | LBL-ST-EF REV CTMTM

All trademarks herein are the property of WishBone Medical, Inc. or its subsidiaries unless otherwise indicated. This material is intended for the sole use and benefit of Health Care Professionals and the WishBone Medical Sales Force. It is not to be redistributed, duplicated or disclosed without the express written consent of WishBone Medical. All WishBone EpiFIXTM Growth Control Plating System kits are only available as single-use, sterile packed kits. Always confirm product expiration date prior to use.

For product information, including indications, contraindications, warnings, precautions and potential adverse effects, visit WishBone Medical’s Instructions for Use page online: www.WishBoneMedical.com/IFU.

Documents

EpiFIX TM GROWTH CONTROL PLATING SYSTEM · Cannulated T20 Screwdriver 4.5mm Cannulated Screws A significant number of children suffer from the discomfort of angular limb deformities