S U R G I C A L T E C H N I Q U E

DARCOLPS Plate

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IndicationsContraindications

DARCO™ LPS Plate

Intended Use

Indications/Contraindications

Design Rationale

Preoperative Planning

Surgical Technique

Surgical Approach

Joint Preparation

Surgical Fixation

Closure and Post-op Protocol

Ordering Information

DARCO™ Implants

DARCO™ Instruments

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Preface 4

Chapter 1 5

Chapter 2 6

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Appendix 11

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Contents

INDICATIONS

The DARCO™ Locking Bone Plate System is intended for use in stabilization of fresh fractures, revision procedures, joint fusion and reconstruction of small bones of the feet, ankles and toes. The system can be used in both adult and pediatric patients.

This implant should only be used with a DARCO™ plate and screw system.Combination with other implants or instruments is not permissible.

CONTRAINDICATIONS

No product specific contraindications.

Proper surgical procedures and techniques are the responsibility of the medical professional. The following guidelines are furnished for information purposes only. Each surgeon must evaluate the appropriateness of the procedures based on his or her personal medical training and experience. Prior to use of the system, the surgeon should refer to the product package insert for complete warnings, precautions, indications, contraindications and adverse effects. Package inserts are also available by contacting the manufacturer. Contact information can be found on the back of this surgical technique and the package insert is available on the website listed.

Please contact your local Wright representative for product availability.

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Pref

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DARCO™ LPS Plate

Design Rationale

The DARCO™ LPS Locked Plate offers an innovative, stable method of fixation for fusion of the 1st tarsometatarsal (TMT) joint.

Advantages of Lapidus Procedure with DARCO™ LPS Locked Plate

» Extremely stable locked-screw fixation.

» Incremented step-off design permits accurate plantarization of the metatarsal to counter 1st ray shortening.

» Low profile, anatomically contoured plate minimizes soft tissue irritation due to hardware prominence.

» Pre-determined locked screw positions eliminate screw collision, potentially shortening operative time.

DARCO™ LPS Plate

In addition to standard small-joint instrumentation, the following items should be planned for in the operating room:

» intra-operative fluoroscopy

» powered handpiece with k-wire driver, jacobs chuck and sagittal saw

» straight and curved osteotomes of varying widths

» straight and curved bone curettes

» bone graft substitute, as indicated by procedure

Chapter 1 Preoperative Planning

Preoperative PlanningSurgical Technique as described by Christopher F. Hyer, DPM; Greg Berlet, MD; Thomas Lee, MD; and Ernst Orthner, MD

DARCO® LPS Plate

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2Surgical Technique

Chapter 2 Surgical Technique

Surgical Approach

Plan a dorso-medial approach to the proximal 1st TMT, just medial to the EHL tendon. The approach should extend 2-3 cm on either side of the TMT. | Figure 1 Create the skin incision taking care to identify and protect any overlying neurovascular structures. Deepen the incision through the fascial layers to the dorsal capsule of the TMT; use blunt dissection to release the EHL off the TMT and retract the tendon laterally. | Figure 2 Confirm the location of the 1st TMT joint either directly or using flouroscopy; a 22g needle or k-wire may be used to mark the joint. | Figure 3 Perform a capsulotomy at the superior aspect of the 1st TMT to expose the entire joint. Care should be taken to ensure complete exposure of the plantar and lateral aspects of this joint, which is quite deep. | Figure 4 A pin-based distractor can be used for easier joint debridement.

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Chapter 2 Surgical Technique

Joint Preparation

Take down the cartilage of the 1st TMT joint using a ¼ inch curved osteotome and bone curettes. Remove the cartilage thoroughly until dense subchondral bone is completely exposed on both sides of the joint. | Figure 5 Thoroughly perforate the subchondral plates with a small diameter drill or k-wire until rich cancellous bone is exposed. | Figure 6 The ¼ inch osteotome is then used to perform a “fish scaling” technique to further prepare the joint surfaces. At the surgeon’s discretion, the intermetatarsal joint between the 1st and 2nd bases may be similarly prepared. This is done to allow some lateralization of the 1st metatarsal (MT) base and create an additional fusion surface for added stability.

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Surgical Fixation

Three separate fixation elements are used to facilitate proper correction and fixation of the TMT joint:

» A 3.5 or 4.0mm cannulated compression screw, directed from the base of the 1st MT into the cuneiform. The screw applies compression across the TMT joint prior to fixation of the locked LPS plate.

» The LPS plate itself, which determines plantarization of the MT base and provides definitive fixation.

» A provisional k-wire, placed distally between the 1st and 2nd MT. This wire may be used to close and adjust the intermetatarsal angle.

Compression Screw Wire

Drive the wire for the cannulated screw through the center of the TMT joint, out the medial plantar aspect of the MT, and out through the skin. | Figure 7 Advance the wire until countersunk in the joint; it will be retrograded back into the cuneiform in a later step.

Provisional Plate Placement

If the 1st ray has any shortening, translate the base of the MT plantarly to compensate. Select the LPS plate that has the corresponding amount of step-off. Place the plate dorsally over the TMT joint and provisionally fix with 2 k-wires; make sure that the distal k-wire is placed at the most distal extent of the compression slot. | Figure 8 (In the case of Metatarsus Primus Varus, the plate may also be placed dorso-medially, which would translate the MT base both plantarly and laterally).

Intermetatarsal Angle Adjustment

Correct widening of the 1st intermetatarsal angle by using a k-wire distally between the 1st and 2nd metatarsals. | Figure 9 Verify correction flouroscopically.

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Chapter 2 Surgical Technique

Cannulated Screw Placement

Holding the great toe in dorsiflexion, retrograde the screw k-wire proximally from the MT into the cuneiform under fluoroscopic guidance until in contact with the lateral/proximal cortex. | Figure 10 Percutaneously place cannulated compression screw per normal protocol. | Figure 11

Plate Fixation

Recheck the positioning of the DARCO™ LPS plate using fluoroscopy and adjust if needed. Thread the Locking Drill Guide (P/N DC4180) into one of the proximal screw holes; it is imperative to use the Locking Guide for locking screw application. Use the 2.5mm Drill (P/N DC6136) to drill through the guide. | Figure 12 Bicortical fixation may be considered in the case of osteoporotic bone, but is generally not required with locked plating systems. Measure using the Depth Gauge (P/N DC4263-2) | Figure 13 and advance the appropriate screw until flush with the plate. | Figure 14

In the event that a locking screw interferes with the cannulated compression screw, the drill may be redirected freehand within the screwhole and a non-locking screw used in that location. Use caution going far off the normal drilling axis, as this may result in unwanted screw head prominence.

Each of the 4 screws are inserted in the same fashion. If subtle contouring of the plate is required, both Locking Drill Guides can be used as in-situ benders. This method allows the plate to perfectly fit the anatomy while protecting the locking threads within the plate.

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DARCO™ LPS Plate10 Chapter 2 Surgical Technique

Closure and Post-op Protocol

The incision is closed in layers per the surgeon’s technique. A well-padded post-operative splint is recommended for the first 10-14 days as the incision heals. Post-operative care and time to weightbearing is the responsibility of the surgeon.

Explant Informaiton

Removal of the plate may be performed by first extracting the plate screws using the hexagonal cannulated screwdriver (40140036) and then removing the plate from the bone.

If the removal of the implant is required due to revision or failure of the device, the surgeon should contact the manufacturer using the contact information located on the back cover of this surgical technique to receive instructions for returning the explanted device to the manufacturer for investigation.

Ordering Information

DARCO™ LPS Plate

Kit List

Part No. Description Quantity

DMRSKITA Implant Kit DMRSKIT1 Instrument Kit

Locked ScrewsDC 2820-014 14mm x 3.5mm 5DC 2820-016 16mm x 3.5mm 5DC 2820-018 18mm x 3.5mm 5DC 2820-020 20mm x 3.5mm 5DC 2820-022 22mm x 3.5mm 5DC 2820-024 24mm x 3.5mm 5DC 2820-026 26mm x 3.5mm 5DC 2820-028 28mm x 3.5mm 5DC 2820-030 30mm x 3.5mm 5DC 2820-035 35mm x 3.5mm 5DC 2820-040 40mm x 3.5mm 5

Non-Locked ScrewsDC 2820-114 14mm x 3.5mm 2DC 2820-116 16mm x 3.5mm 2DC 2820-118 18mm x 3.5mm 2DC 2820-120 20mm x 3.5mm 2DC 2820-122 22mm x 3.5mm 2DC 2820-124 24mm x 3.5mm 2DC 2820-126 26mm x 3.5mm 2DC 2820-128 28mm x 3.5mm 2DC 2820-130 30mm x 3.5mm 2DC 2820-135 35mm x 3.5mm 2DC 2820-140 40mm x 3.5mm 2

Instruments and accessoriesDC 35 Box System tray assembly 1DC 70-481 Bending forceps 1DC 4180 Drill guide 2DC 4263-2 Depth gauge 1DC 4197 Forceps 140140036 Screwdriver, hexagonal, cannulated 1DC 6136 Drill bit, 2.5mm 2 NO 2228-012 K-wire 140 × 1.1mm 6 DC 4584 Screw holding and bending iron 1

Part No. Description Placement in Trays

LPS (Lapidus Plating System)

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DARCO™ LPS Plate

DC 2801-000 0mm stepDC 2801-001 1mm stepDC 2801-002 2mm stepDC 2801-003 3mm stepDC 2801-004 4mm stepDC 2801-005 5mm stepDC 2801-006 6mm step

PIA (Poly Interpositioning Arthrodesis)DC 2802-000 0mm spacerDC 2802-002 2mm spacerDC 2802-004 4mm spacerDC 2802-006 6mm spacerDC 2802-008 8mm spacer

UPS 3.5 (Universal Plating System)DC 2801-012 12mmDC 2801-016 16mmDC 2801-020 20mmDC 2801-024 24mmDC 2801-030 30mm

RPS (Rearfoot Plating System)DC 2803-006 37mm, 6 holesDC 2803-008 50mm, 8 holesDC 2803-014 66mm, 14 holes

AFP (Arthrodesis Flat Plate)DC 2804-004 12mmDC 2804-005 14mmDC 2804-006 16mm

DPS (Displacement Plating System)DC 2806-106 6mm stepDC 2806-108 8mm stepDC 2806-110 10mm step

CPS (Calcaneus Plating System)DC 2805-001 S: 54mmDC 2805-002 M: 64mmDC 2805-003 L: 74mm

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010463B_May 31-2017

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