Zimmer A.L.P.S. Total Foot System Owner's Manual
विज्ञापन
विज्ञापन
A.L.P.S.
™
Total Foot System
Design Rationale and
Surgical Technique
TRAUMA
One Surgeon. One Patient.
® Over 1 million times per year, Biomet helps one surgeon provide personalized care to one patient.
The science and art of medical care is to provide the right solution for each individual patient. This requires clinical mastery, a human connection between the surgeon and the patient, and the right tools for each situation.
At Biomet, we strive to view our work through the eyes of one surgeon and one patient. We treat every solution we provide as if it’s meant for a family member.
Our approach to innovation creates real solutions that assist each surgeon in the delivery of durable personalized care to each patient, whether that solution requires a minimally invasive surgical technique, advanced biomaterials or a patient-matched implant.
When one surgeon connects with one patient to provide personalized care, the promise of medicine is fulfilled.
A.L.P.S.
™ Total Foot System
Table of Contents
Introduction .............................................................................................................................................................. 2
1 st Metatarsal Fusion Plate Technique ..................................................................................................................... 7
Lapidus Plate Technique ........................................................................................................................................ 23
Single Joint Fusion Plate Technique ...................................................................................................................... 33
Dorsal Mid-Foot Fusion Plate Technique ............................................................................................................... 47
Lateral Column Lengthening Plate Technique ....................................................................................................... 57
Medial Column Fusion Plate Technique ................................................................................................................. 65
Locking Calcaneal Plate Technique ....................................................................................................................... 75
Navicular Fracture Plate Technique ....................................................................................................................... 85
Talar Neck Fracture Plate Technique ..................................................................................................................... 93
Compression Wire Technique .............................................................................................................................. 101
2.5 Screw Options and Insertion Techniques ...................................................................................................... 105
Small Frag Screw Options and Insertion Techniques .......................................................................................... 113
Ordering Information ............................................................................................................................................ 126
1
A.L.P.S.
™ Total Foot System
Introduction
The A.L.P.S.
™ Foot System offers a comprehensive set of plating options anatomically contoured to address — osteotomies, fusions and fractures in the forefoot, midfoot and hindfoot. The attention to anatomic detail is further enhanced by deliberate regions of flexibility to accommodate individual anatomic variation without compromising strength.
The A.L.P.S.
™ Foot System also offers a wide array of both locking and non-locking screw options and incorporates industry leading F.A.S.T. Guide ® technology. The result is a comprehensive yet flexible system that improves operating room efficiency and ease of use.
Indications for Use
System is intended for use in stabilization and fixation of fractures, revision procedures, fusions, reconstructions (osteotomy) and non-unions of the bones of the hand, foot, wrist, ankle, finger, toe, humerus, olecranon, clavicle, scapula and pelvis, particularly in osteopenic bone. The system can be used in both adult and pediatric patients (adolescents
[>12-21 years of age]), where the implant would not cross open epiphyseal plates in skeletally immature patients.
The A.L.P.S.
™ Total Foot System was designed and developed in conjunction with
Mark S. Myerson, M.D. and Roy Sanders, M.D.
Biomet as the manufacturer of this device, does not practice medicine and does not recommend any particular device or technique. Each surgeon is responsible for determining the appropriate device and technique to utilize on each individual patient.
2
Low Profile, Anatomically Contoured Foot Plates
The A.L.P.S.
™ Total Foot System is a comprehensive set of anatomically contoured implants to address a wide array of fusions and fractures in the forefoot, midfoot and hindfoot. The anatomic design of the plates are meant to closely match the natural anatomy. However, in-situ contouring is available for fine adjustment and patient specific customization.
• Low profile plate design helps minimize discomfort and soft tissue irritation.
• Engineered from TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over stainless steel.
• A smooth implant surface for minimized soft tissue irritation.
• Contoured plates mimic the anatomy of the foot.
• Adapters available for fixed angle K-wire placement for provisional fixation.
3
4
A.L.P.S.
™ Total Foot System
Fast, Accurate Surgeries F.A.S.T. Guide
®
Inserts and F.A.S.T. Tabs
®
technologies
The A.L.P.S.
™ Total Foot System comes pre-loaded with Fixed Angle Screw Targeting Guides—F.A.S.T.
Guides ® —that direct the trajectory of the drill right through the plate. Additionally, F.A.S.T. Tabs ® technology allows for in-situ contouring for patient specific customization.
F.A.S.T. Guide ® Technology
Pre-loaded and disposable F.A.S.T. Guides ® facilitate accurate drilling and reduce intraoperative assembly, saving time in the OR
F.A.S.T. Tabs ® Technology
F.A.S.T. Tabs ® Technology enables in-situ contouring for true plate-to-bone conformity.
Provisional Fixation
Easy K-wire placement through provisional fixation holes
Locking, Non-Locking, and Multi-Directional Locking
Screw options
Choose locking, non-locking, or multi-directional locking screws according to need and without compromising plate profile.
• Tapered, threaded screws lock into plate when tightened to establish a fixed angle construct for strong fixation or when bone quality is poor and optimal screw purchase is required.
• 2.5 mm Locking Multi-Directional Threaded Pegs (MDTP) allow up to a 20 degree cone, while the 3.5 mm Locking
Multi-Directional Screws (MDS) allow a 25 or 30 degree cone depending on plate. These Cobalt Chrome screws lock into plate by creating their own thread limiting the risk of cold welding.
• Low profile non-locking screws provide the same profile as locking screws.
• Unidirectional compression holes allow for axial compression.
5
These are images of models with bones shown with plates in place and not real patients.
They are provided to show positioning and not intended to suggest immediate weight bearing.
A.L.P.S.
™ Total Foot System
1
st
Metatarsal Fusion Plate Technique
The A.L.P.S.
™ 1 st Metatarsophalangeal (MTP) Joint
Fusion plates are made of titanium alloy (Ti6Al4V) with a proprietary TiMAX ® treatment for increased fatigue strength compared to the standard alloy.
1 The low-profile anatomic design and highly contoured surface minimizes potential soft tissue irritation.
The 1 st MTP Plates are available in Small (2.5 mm) and Large (3.5 mm) sizes with both right and left options and a predetermined dorsiflexion and valgus angle for excellent anatomic alignment. Offset fixation screws provide a convenient corridor for additional interfragmentary screw fixation; if desired, and have convergent trajectories for plate stability. Proprietary
F.A.S.T. Guide ® technology provides a number of unique features to promote operating room efficiency and facilitate implant selection. The system offers multiple screw options defined by plate selection, including 2.5, 2.7, 3.5 and 4.0 mm Cortical Locking,
2.5 and 3.5 mm Cortical Non-Locking, and 2.5 and 3.5 mm Multi-Directional Locking Screws, all designed to maintain a low profile.
Cup and Cone Reamers are now available in the
A.L.P.S.
™ Total Foot System and may be used to prepare the first (and lesser) metatarsophalangeal joints for arthrodesis.
7
8
A.L.P.S.
™ Total Foot System
1
st
Metatarsal Fusion Plate – 2.5 mm
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over Stainless Steel
Pre-contoured high strength center section with 14 degrees of dorsiflexion and 5 degrees of valgus
Central region of the plate is contourable along the long axis
Threaded holes accept locking 2.5 mm, as well as
2.5 mm Non-Locking Screws
Low profile construct with highly contoured surfaces
2.5 mm Multi-Directional Locking
Screws allow for up to a 20 degree cone of angulation
F.A.S.T. Tab ® technology allows for in situ contouring for anatomic fit
F.A.S.T. Guide ® inserts for easy accurate drilling Distal
The plate has an integrated fixation corridor designed to facilitate interfragmentary screw fixation
Proximal
Left (Lime) Right (Rose)
1
st
Metatarsal Fusion Plate – 3.5 mm
Slotted hole allows for up to 1.25 mm of compression when used with a
3.5 mm Low Profile Non-Locking Screw
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over Stainless Steel
Pre-contoured high strength center section with
7 degrees of dorsiflexion and 5 degrees of valgus
Central region of the plate is contourable along the long axis
Hole for autograft or allograft fixation to plate with Non-Locking
3.5 mm Screw
Threaded holes accept 2.7 mm and 3.5 mm Locking Screws, as well as 3.5 mm Multi-Directional
Locking Screws and 3.5 mm
Non-Locking Screws
Low profile construct with highly contoured surfaces
F.A.S.T. Tab ® technology allows for in situ contouring to match patient anatomy
3.5 mm Multi-Directional
Locking Screws allow for up to a 30 degree cone of angulation
F.A.S.T. Guide ® inserts for easy accurate drilling Distal
The plate has an integrated fixation corridor designed to facilitate interfragmentary screw fixation
Left (Lime) Right (Rose)
Proximal
9
A.L.P.S.
™ Total Foot System
Exposure and Plate Placement
Figure 1
The following surgical technique applies to the fusion of the 1 st Metatarsophalangeal (MTP) joint.
Step 1: Exposure & Alignment
Perform a longitudinal incision beginning just proximal to the interphalangeal joint and extend over the 1 st MTP joint medial to the extensor hallucis longus. Expose the proximal phalanx and metatarsal head and denude all cartilage surfaces exposing the bleeding subchondral bone. If shortening of the metatarsal is a concern, place autograft or allograft within the arthrodesis site. Use a
1.6 mm K-wire (Cat. No. 14425-6) to provisionally fix the joint at the desired angle. If an interfragmentary cross screw is used, position the guide wire prior to positioning the plate.
Optional: Cup & Cone Reamers
If utilizing cup and cone reamers to prepare the joint, determine the appropriate size of cone reamer by placing it over the metatarsal head to ensure adequate coverage.
Cup and cone reamers range from 14-24 mm in diameter and have an AO quick connect attachment. Place a 1.6 mm
K-wire into the center of the metatarsal head and drive it proximally into the diaphysis.
Place the cone reamer over the K-wire and begin reaming until all cartilage has been denuded and bleeding subchondral bone has been exposed (Figure 1). Be sure to protect the soft tissue and sesamoids during this step.
10
Figure 2 Figure 3
To prepare the joint surface of the phalanx, utilize the same size cup reamer as was used on the metatarsal for congruent surfaces. Insert a 1.6 mm K-wire into the center of the base of the proximal phalanx and drive it distally into the phalangeal diaphysis. Place the cup reamer over the
K-wire and begin reaming until all cartilage is denuded and bleeding subchondral bone has been exposed (Figure 2).
Step 2: Plate Placement
Small 2.5 mm 1 st MTP Fusion Plate
The plate should be placed dorsally such that it permits the placement of the screws adjacent to the joint line.
Partially insert a 2.5 mm Non-Locking Screw (Cat. No.
SPXX000) through the oval hole of the plate to allow distal to proximal optimization of the plate (Figure 3).
Note: A detailed technique for screw insertion can be found in the 2.5 mm screw section of this technique guide.
Caution: To avoid excessive reaming, the reamers should be turning at slow speed prior to contact with the bone.
11
A.L.P.S.
™ Total Foot System
Optional Plate Contouring
Figure 4 Figure 6
Figure 5 Figure 7
Step 2: Plate Placement (cont.)
Remove only the two inner most F.A.S.T. Guides ® from the high strength region (Figure 4).
Note: The high strength sections of the A.L.P.S.
™ Foot 1 st
MTP plates are pre-contoured. If bending of this section is required to match patient specific anatomy, use the following technique to further contour the plate.
Use the slotted end of the Double F.A.S.T. Guide ® Bender
(Cat. No. 2142-88-005) (Figure 5).
Reduce or increase dorsiflexion angle by bending in one continuous direction only (Figure 6).
Caution: Each bend should be in one direction only; reverse or over bending may weaken or cause plate to break.
With the plate contoured, replace the F.A.S.T. Guides
(Figure 7).
® Do not alter the flexion angle by more than 7 degrees in either direction.
Note: New Plate Benders (Cat. No. 2320-12-212) are now available in the A.L.P.S.
™ Total Foot System which no longer require the removal of F.A.S.T. Guides ® . These are described in detail on pages 16 and 17 of this section.
Note: To replace the F.A.S.T. Guides ® and prevent possible cross threading, it is helpful to initially turn the F.A.S.T.
Guide ® counter clockwise ¼ turn before fully inserting the
F.A.S.T. Guide ® .
12
Optional Interfragmentary Screw Fixation
Figure 8 Figure 9 Figure 10
The A.L.P.S.
™ Foot 1 st MTP plate has an offset screw, which provides a convenient corridor for interfragmentary screw fixation. Figure 8 demonstrates the most suitable trajectory for the interfragmentary screw. Figure 9 demonstrates how positioning the interfragmentary screw can interfere with the plate and screw construct.
Note: It is also possible to utilize the 2.5 mm Multi-
Directional Locking Screw (Cat. No.1312-11-1XX) or a
2.5 mm Non-Locking Screw (Cat. No. SPXX000) to avoid the interfragmentary cross screw or joint line.
Suggestion: After placing an interfragmentary screw across the joint for compression, use fluoroscopic guidance to the plate with respect to the screw, prior to finalizing plate. (Figure 10).
Once the optimal plate has been identified, fully insert the 2.5 mm Non-Locking Screw to provisionally fix the plate to bone. With the plate provisionally fixed, proceed to Step 3.
13
A.L.P.S.
™ Total Foot System
In Situ Contouring Screw Fixation
Figure 11 Figure 12
Step 3: In Situ Contouring
It is possible to intra-operatively contour the proximal and distal ends of the plate to establish a more patient specific fit using the Gold benders. (Cat. No. 2312-20-101 and
Cat. No. 2312-20-100)
Step 4: Screw Fixation
With the plate contoured and the 2.5 mm Non-Locking
Screw: (Cat. No. SPXX000) fully inserted for provisional fixation, fill the remaining holes with, 2.5 mm Locking
Screws: (Cat. No. FPXX) or 2.5 mm Multi-Directional
Locking Screws: or 2.5 mm Non-Locking Screws (Cat.
No. SPXX000) (Cat. No. 1312-11-1xx) (Figure 12).
To bend the most proximal or distal node of the plate along the long axis, place the long end of the bender into the
F.A.S.T. Guides ® of adjacent nodes. Hold one bender as an anchor and manipulate the other (Figure 11).
Note: A detailed technique for screw insertion can be found in the 2.5 mm screw section of this technique guide.
14
Exposure and Placement
Figure 13 Figure 14 Figure 15
Step 1: Plate Placement
Large 3.5 mm 1 st MTP Fusion Plate
Utilize the technique for exposure of the joint and plate alignment in the previous section for the Small 2.5 mm 1 st
MTP Fusion Plate.
Note: It is also possible to utilize the 3.5 mm Multi-
Directional Locking Screw to avoid the interfragmentary cross screw or joint line.
Suggestion: After placing an interfragmentary screw across the joint for compression, use fluoroscopic guidance to position the plate with respect to the screw position, prior to finalizing plate position (Figure 15).
The Large 3.5 mm A.L.P.S.
™ 1 st MTP Fusion Plate has an offset screw position, which provides a convenient corridor for interfragmentary screw fixation. Figure 13 demonstrates the most suitable trajectory for the interfragmentary screw. Figure 14 demonstrates how positioning the interfragmentary screw can interfere with the plate and screw construct.
15
A.L.P.S.
™ Total Foot System
Optional Plate Contouring
Optional Plate Contouring
Note: The high strength sections of the Small and Large
1 st MTP plates are pre-contoured. If bending of these sections are required for more precise anatomic fit, use the following technique to further contour the plates, prior to plate fixation.
1 st MTP Fusion Plate Bending Technique
The new dedicated 1 st MTP Plate Benders (Cat. No.
2312-20-212) can be utilized to contour both the Small
2.5 mm plate and the Large 3.5 mm plate, and are marked at each end with the size of plate in which it corresponds, and for both left or right plates. The F.A.S.T. Guides ® should not be removed, as indicated in the previous section for the Small 2.5 mm plate. Two Plate Benders are required for this function.
Note: A Large 3.5 mm 1 st MTP Fusion Plate (Left) will be used for the following bending steps. The larger end of the plate bender is clearly marked to accept the Large
3.5 mm plate, whereas the smaller end of the plate bender will accept the Small 2.5 mm plate.
16
Figure 16 Figure 17
Figure 18
Figure 19
Step 1: Slide the F.A.S.T. Guide ® on one end of the plate at a 45° angle into the plate bender slot marked 3.5 mm,
Left (Figure 16).
Step 2: Rotate the plate parallel to the bender so that the
F.A.S.T. Guide ® located nearest the center hole of the plate slides into the slot at the end of the bender (Figure 17).
Step 3: Using a second plate bender, from the opposite side of the plate, insert the plate into the plate bender at a 45° angle (Figure 18).
Step 4: Rotate the bender so that the center F.A.S.T.
Guide ® slides into the slot on the end of the bender and both benders are in line, or parallel with the plate (Figure 19).
17
A.L.P.S.
™ Total Foot System
Optional Plate Contouring
Increase dorsiflexion angle up to 7°
Decrease dorsiflexion angle up to 7°
Figure 20
1 st MTP Fusion Plate Bending Technique (cont.)
To increase or reduce the amount of dorsiflexion, the plate may be bent in the direction desired using the plate benders by applying pressure to the benders either upward (to increase dorsiflexion), or downward (to decrease dorsiflexion) (Figure 20).
Caution: The plate should be bent continuously no more than 7° in one direction or the other, but not both. Reverse or over bending may weaken or cause the plate to break.
Note: If the new plate benders are not available in the set, utilize the technique described previously for the 2.5 mm plate, and utilize the slotted end of the Double F.A.S.T.
Guide ® Benders (Cat. No. 2142-88-005).
18
In Situ Contouring and Screw Fixation
Figure 21 Figure 22
Step 2: In Situ Contouring
It is possible to intra-operatively contour the proximal and distal ends of the plate to establish a more patient specific fit using the Multi Planar Plate Benders (Cat. No. 2142-
88-004).
To bend the most proximal or distal nodes of the plate along the long axis, place the long end of the bender into the F.A.S.T. Guides ® of adjacent nodes. Hold one bender as an anchor and manipulate the other (Figure 21).
Step 3: Screw Fixation
If additional compression is desired in addition to the compression achieved with the interfragmentary screw, the slotted compression hole can be utilized by first placing a screw in one of the three distal holes on the plate, located over the phalanx, to anchor the plate to the bone. Then insert a 3.5 mm Low Profile Non-Locking Screw into the most proximal end of the slotted compression hole following the described technique in the screw insertion section of this technique guide.
With the plate contoured and provisionally fixated to the bone, fill the remaining holes with 2.7 or 3.5 mm Locking,
3.5 mm Non-Locking, or 3.5 mm Multi-Directional Screws
(Figure 22).
Note: A detailed technique for screw insertion can be found in the 3.5 mm screw section of this technique guide.
19
A.L.P.S.
™ Total Foot System
1
st
Metatarsal Fusion Plate – 2.5 mm
5º
10 mm
45 mm
1.65 mm
14º
Specifications & Screw Options – for 2.5 mm plate
Screw Type
Locking
Screws
2.5 mm
(Cat. No. FPXX)
Drill Bit
Drill Bit Fast
2.0 mm
(Cat. No. FDB20)
Handle Driver
Depth
Gauge
Length
Options
Quick
Connect
Handle
(Cat. No. QCH)
1.3 mm Square
(Cat. No. 2312-18-012)
2.5 mm
Depth Gauge
(Cat. No. 2312-20-125)
8 – 40 mm
Non-Locking
(Low Profile) 2.5 mm
(Cat. No. SPXX000)
Drill Bit Fast
2.0 mm
(Cat. No. FDB20)
Quick
Connect
Handle
(Cat. No. QCH)
1.3 mm Square
(Cat. No. 2312-18-012)
2.5 mm
Depth Gauge
(Cat. No. 2312-20-125)
8 – 40 mm
(MDTP) Multi-
Directional 2.5 mm
(Cat. No. 1312-11-1XX)
Drill Bit Fast
2.0 mm
(Cat. No. FDB20)
Quick
Connect
Handle
(Cat. No. QCH)
MDTP Driver
(Cat. No. 2142-88-007)
2.5 mm
Depth Gauge
(Cat. No. 2312-20-125)
10 – 30 mm
20
1
st
Metatarsal Fusion Plate – 3.5 mm
5º
13 mm
55 mm
2.18 mm
7º
Specifications & Screw Options – for 3.5 mm plate
Screw Type Diameter Options
3.5 mm
(Cat. No. 8161-35-0XX)
Drill Bit
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Handle Driver Depth Gauge
Length
Options
Torque
Limiting
(Cat. No.
2141-18-001)
T-15 tapered
(Cat. No. 2142-15-070)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
10 – 50 mm
Locking
2.7 mm
(Cat. No. 8163-27-0XX)
2.0 mm
Marked Drill
Bit Short
(Cat. No.
2142-88-008)
Torque
Limiting
(Cat. No.
2141-18-001)
T -15 tapered
(Cat. No. 2142-15-070)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
2.0 mm Drill
Meas Sleeve
Short
(Cat. No. 2142-88-006)
10 – 50 mm
Non-Locking
(Low Profile)
(MDS) Multi-
Directional
3.5 mm
(Cat. No. 1312-18-0XX)
3.5 mm
(Cat. No. 8163-35-0XX)
2.5 mm
Drill Bit
(Cat. No.
8290-29-070)
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(NON-L line)
(Cat. No. 2142-35-100)
14 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.
2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
20 – 50 mm
21
These are images of models with bones shown with plates in place and not real patients.
They are provided to show positioning and not intended to suggest immediate weight bearing.
A.L.P.S.
™ Total Foot System
Lapidus Plate Technique
The Lapidus Plate is designed primarily for arthrodesis of the first metatarsocuneiform joint, and is made of a titanium alloy (Ti6Al4V) with a TiMAX ® treatment for increased fatigue strength compared to the standard alloy.
1 The low-profile anatomic design (2 mm) and recessed screw heads minimize possible irritation to the soft tissue and skin. The Lapidus Plate provides up to 1.25 mm of compression and provides the benefits of locking technology. This plate offers numerous screw options consisting of 4.0 mm
Cancellous Locking, 3.5 mm Cortical Locking, 3.5 mm
Multi-Directional Locking, 2.7 mm Cortical Locking, and 3.5 mm Low Profile Non-Locking Screws.
23
A.L.P.S.
™ Total Foot System
Lapidus Plate
Open box area of the plate allows for visualization of the TMT joint when compressing
Slotted holes provide up to 1.25 mm compression per hole when used in conjunction with 3.5 mm
Low Profile Non-Locking Screw
Threaded holes accept locking
2.7 mm, 3.5 mm, 4.0 mm, and
3.5 mm Multi-Directional Screws as well as 3.5 mm Low Profile
Non-Locking Screws
3.5 mm Multi-Directional Locking
Screws allow for up to a 30 degree cone of angulation
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over
Stainless Steel
F.A.S.T. Tabs ® can be removed by bending tab up with plate benders, and then down towards bone
F.A.S.T. Guide ® Adapter for provisional fixation through F.A.S.T. Guide ®
F.A.S.T. Guide ® inserts for easy accurate drilling
Double F.A.S.T. Guide ®
Benders allow for bending along two axes
Screw heads are recessed into the plate providing an overall low profile construct with either Locking or Non-Locking Screws
24
F.A.S.T. Tabs ® are designed to allow for bending in multiple planes
Approach and Plate Placement
Figure 1
Perform a longitudinal incision either medially or dorsally over the 1 st metatarsocuneiform joint. Expose the joint and denude all cartilage surfaces to expose the bleeding subchondral bone. To avoid shortening and elevation of the metatarsal, place allograft or autograft within the arthrodesis site. A guide pin may be needed to reduce the prepared joint surfaces, and a cannulated screw may be used to provide initial compression and stability of the joint prior to plate placement. The cannulated screw should be placed distal-dorsal to proximal-plantar across the metatarsocuneiform joint, and the head of the screw should be countersunk to minimize soft tissue irritation.
Step 1: Plate Placement
The plate should be placed dorsal-medially such that the joint line is centered in the middle of the open box
(between the proximal three holes of the plate, and the two holes just proximal to the compression slot) to ensure that screws are sufficiently clear of the joint line prior to screw insertion (Figure 1).
25
A.L.P.S.
™ Total Foot System
Provisional Fixation
Figure 2 Figure 3
Step 2: Provisional Fixation
For provisional fixation, the 2.0 mm F.A.S.T. Guide ®
Adapters (Cat. No. 2312-18-007) can convert any
F.A.S.T. Guide ® into a K-wire fixation hole (Figure 2).
Suggestion: Using fluoroscopic guidance to the Lapidus
Plate can be especially helpful to ensure adequate purchase of both the Locking and Compression screws in the cuneiform and metatarsal bones (Figure 3).
Note: Provisional fixation with the 2.0 mm F.A.S.T. Guide ®
Adapter and 2.0 mm K-wire has the added advantage of allowing the surgeon to predict the trajectory of a locking screw construct under fluoroscopy.
If the trajectory is deemed inadequate, the surgeon has several options; bend the plate intra-operatively, employ a 3.5 mm Multi-Directional Screw, or use a 3.5 mm Low-
Profile Non-Locking Screw to establish a new trajectory.
26
In Situ Contouring
Figure 5a
Figure 4 Figure 5b
Step 3: In Situ Contouring
With the plate provisionally attached to the bone, it is possible to intra-operatively contour the plate to establish a more patient specific fit using the Foot Multi-Planar
Bender (Cat. No. 2142-88-004) (Figure 4).
Note: The Foot Multi-Planar Benders are double sided for use with a variety of bending techniques. The end of the plate bender with three teeth (Figure 5a), allows for bending in multiple planes.
Place the round end of the bender into the F.A.S.T.
Guides ® of adjacent nodes. Hold the bender fixed with the round end as an anchor and manipulate the other end with either side of the benders to bend or twist along a single axis (Figure 5b).
27
A.L.P.S.
™ Total Foot System
Screw Insertion
Figure 6 Figure 7
Step 3: In Situ Contouring (cont.)
Caution: Each bend should be in one direction only; reverse or repeated bending may weaken or cause the plate to break.
Step 4: Screw Insertion
To ensure adequate load distribution, all screw holes should be filled according to the screw insertion technique section of this guide. If a combination of Locking and Non-
Locking Screws will be used, Non-Locking Screws should be inserted first to secure the plate snugly to the bone
(Hybrid Locking) (Figure 7).
The distal F.A.S.T. Tab ® my be cut or bent off if not needed by placing the round end of the Foot Multi-Planar Plate
Bender in the last hole, and another in the hole adjacent to it, slightly bending the tab upward, and then back down towards the bone until the tab breaks off completely
(Figure 6). Bending downward will minimize the possibility of a sharp edge that could cause soft tissue irritation.
Note: A detailed technique for screw insertion can be found in the screw section of this technique guide.
28
Lapidus Plate
F.A.S.T. Tabs ® are designed to allow for bending in multiple planes
Caution: Each bend should be in one direction only; reverse or repeated bending may weaken or cause plate to break.
29
A.L.P.S.
™ Total Foot System
Lapidus Plate
61 mm
22 mm
1.4 mm
Specifications & Screw Options
Screw Type Diameter Options
3.5 mm
(Cat. No. 8161-35-0XX)
4.0 mm
(Cat. No. 8161-40-0XX)
Drill Bit
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Handle Driver Depth Gauge
Length
Options
Torque
Limiting
(Cat. No.
2141-18-001)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
T-15 tapered
(Cat. No. 2142-15-070)
2.7 mm Drill
Meas Sleeve
(Cat. No. 8163-01-005)
10 – 50 mm
Locking
Non-Locking
(Low Profile)
(MDS) Multi-
Directional
2.7 mm
(Cat. No. 8163-27-0XX)
3.5 mm
(Cat. No. 1312-18-0XX)
3.5 mm
(Cat. No. 8163-35-0XX)
2.0 mm
Marked Drill
Bit Short
(Cat. No.
2142-88-008)
2.5 mm
Drill Bit
(Cat. No.
8290-29-070)
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Torque
Limiting
(Cat. No.
2141-18-001)
T -15 tapered
(Cat. No. 2142-15-070)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
2.0 mm Drill
Meas Sleeve
Short
(Cat. No. 2142-88-006)
10 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(NON-L line)
(Cat. No. 2142-35-100)
14 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.
2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
20 – 50 mm
30
31
These are images of models with bones shown with plates in place and not real patients.
They are provided to show positioning and not intended to suggest immediate weight bearing.
A.L.P.S.
™ Total Foot System
Single Joint Fusion Plate Technique:
• Compression Fusion Plate
• Closed Compression Fusion Plates
• In-Line Fusion Plates
The A.L.P.S.
™ Single Joint Fusion family of plates are made of a titanium alloy (Ti6Al4V) with a TiMAX ® treatment for increased fatigue strength compared to the standard alloy.
1 The low-profile design and recessed screw heads minimize possible irritation to the soft tissue and skin.
The Single Joint Fusion family of plates contain a
Compression Fusion Plate, a Small and Large Closed
Compression Fusion Plate, and a Small (2.5 mm) and
Large (3.5 mm) In-Line Fusion Plate, providing a wide array of options for single joint arthrodeses. Each
3.5 mm plate offers up to 1.25 mm of compression, and up to 0.5 mm of compression with the Small
2.5 mm In-Line Fusion plate when utilized with a
2.5 mm Non-Locking Screw and a washer, with all designs providing the benefits of locking technology.
These plates are designed for specific single joint arthrodeses, such as the lesser tarsometatarsal (TMT) joints, whereas plates such as the Dorsal Midfoot
Fusion Plate or Medial Column Fusion Plate are designed for multiple joint arthrodesis with the use of a single plate.
The In-Line Fusion plates are generically shaped and easily contourable, and can be used in various areas of the foot and hand, in both dorsal and medial applications.
33
A.L.P.S.
™ Total Foot System
Compression Fusion Plate
Slotted holes provide up to 1.25 mm compression per hole when used in conjunction with 3.5 mm
Low Profile Non-Locking Screw
Central region of the plate is contourable along the long axis
Threaded holes accept locking 2.7 mm, 3.5 mm,
4.0 mm, and 3.5 mm
Multi-Directional Screws as well as 3.5 mm Low
Profile Non-Locking Screws
3.5 mm Multi-Directional Locking
Screws allow for up to a 30 degree cone of angulation
4.0 mm Cancellous Screw
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over Stainless Steel
F.A.S.T. Guide ® adapter for provisional fixation through F.A.S.T. Guide ®
F.A.S.T. Guide ® inserts for easy accurate drilling
F.A.S.T. Tabs ® are designed to allow for bending in multiple planes
Screw heads are recessed into the plate providing an overall low profile construct with either Locking or
Non-Locking Screws
34
Closed Compression Fusion Plate
Slotted holes provide up to 1.25 mm compression per hole when used in conjunction with 3.5 mm
Low Profile Non-locking Screw
3.5 mm Cortical Locking Screw
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over
Stainless Steel
4.0 mm Cancellous Locking Screw
Closed Box design provides strength
Threaded holes accept locking 2.7 mm,
3.5 mm, 4.0 mm, and 3.5 mm Multi-
Directional Screws as well as 3.5 mm
Low Profile Non-Locking Screws
3.5 mm Multi-Directional Locking
Screws allow for up to a 30 degree cone of angulation
F.A.S.T. Guide ® adapter for provisional fixation through F.A.S.T Guide ®
F.A.S.T. Guide ® inserts for easy accurate drilling
F.A.S.T. Tabs ® are designed to allow for bending in multiple planes
Screw heads are recessed into the plate providing an overall low profile construct with either Locking or
Non-Locking Screws
35
A.L.P.S.
™ Total Foot System
Small 2.5 mm and Large 3.5 mm In-Line Fusion Plates
2.5 mm Multi-Directional Screw for up to 20° cone of angulation to avoid joints or other screws
Slotted holes provide up to .5 mm compression per hole when used in conjunction with 2.5 mm Non-Locking Screw with a washer
Note: If compression is not desired, the non-locking
2.5mm screw may be used in this hole.
Central region of the plate is contourable along the long axis
Threaded holes accept locking
2.5 mm Locking, Non-Locking and Multi-Directional Screws
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over
Stainless Steel
Slotted holes provide up to 1.25 mm of compression when used with a 3.5 mm Low Profile
Non-Locking Screw
Central region of the plate is contourable along the long axis
Threaded holes accept locking 2.7 mm and 3.5 mm screws, 3.5 Multi-Directional
Screws, and 3.5 mm Non-Locking
Cortical Screws
3.5 mm Multi-Directional
Locking Screws allow for up to a 30 degree cone of angulation
F.A.S.T. Guide ® adapter for provisional fixation through
F.A.S.T. Guide ®
Plate benders are designed for in situ contouring of the plate in multiple planes
Screw heads are recessed into the plate providing an overall low profile construct with either Locking or
Non-Locking Screws
36
Approach and Plate Placement
Figure 1a Figure 1b
Perform a longitudinal incision either medially or dorsally over the selected lesser metatarsocuneiform joint.
Expose the joint and denude all cartilage surfaces to expose the bleeding subchondral bone. To avoid shortening and elevation of the metatarsal, place autograft or allograft within the arthrodesis site. A guide pin may be needed to reduce the prepared joint surfaces prior to plate placement.
Step 1: Plate Placement
Care should be taken to position the plate such that the joint lines are located between the center holes of the plate, to ensure screws are sufficiently clear of the joint line prior to screw insertion (Figures 1a, 1b).
37
A.L.P.S.
™ Total Foot System
Small and Large In-Line Fusion Plates
Figure 2a Figure 2b
Step 2: Provisional Fixation
For provisional fixation, the F.A.S.T. Guide ® Adapters can convert any F.A.S.T. Guide ® into a K-wire fixation hole
(Figures 2a, 2b).
Note: Provisional fixation for a Large 3.5 mm plate using the 2.0 mm F.A.S.T. Guide ® Adapter (Cat. No. 2312-
18-007) and a 2.0 mm K-wire (Cat. No. 14179-6.), or provisional fixation for a Small 2.5 mm plate using a 1.6 mm K-wire (Cat. No. 14425-6) has the added advantage of allowing the surgeon to predict the trajectory of a locking screw construct under fluoroscopy.
38
Small and Large In-Line Fusion Plates
Figure 3a Figure 3b
If the trajectory is deemed inadequate, the surgeon has several options; bend the plate intra-operatively, employ a 3.5 mm Multi-Directional Screw, or use a 3.5 mm Low-
Profile Non-Locking Screw to establish a new trajectory on a 3.5 mm plate. Utilize a 2.5 mm Multi-Directional Screw, or a 2.5 mm Non-Locking Screw with a Washer for a
2.5 mm plate.
Suggestion: Using fluoroscopic guidance to the single joint fusion family of plates can be especially helpful to ensure adequate purchase of both the Locking and
Compression Screws in the cuneiforms and metatarsal bones (Figures 3a, 3b).
39
A.L.P.S.
™ Total Foot System
Approach and Plate Placement
Figure 4a
Figure 4b
Figure 4 Figure 4c
Step 3: In Situ Contouring
With the plate provisionally attached to the bone, it is possible to intra-operatively contour the plate to establish a more patient specific fit using plate benders from the system that correspond to either the small or large plates.
(Figure 4).
In Situ contouring of the Small 2.5 mm In-Line Fusion Plate can be accomplished using the 2.0 mm Bending Irons
(Cat. No. 2312-20-100) (Figure 4c).
Note: The Foot Multi-Planar Benders are double sided for use with a variety of bending techniques. The end with three teeth allows for bending in multiple planes (Figure
4a). The opposite round end, is used for single plane bending or twisting (Figure 4b).
Caution: Each bend should be in one direction only; reverse or repeated bending may weaken or cause plate to break.
40
Approach and Plate Placement
Figure 5a Figure 5b
Step 4: Screw Insertion
To ensure adequate load distribution, all screw holes should be filled according to the screw insertion technique section of this guide. If a combination of Locking and Non-
Locking Screws will be used, Non-Locking Screws should be inserted first to secure the plate snugly to bone (Hybrid
Locking) (Figures 5a, 5b).
Note: A detailed technique for screw insertion can be found in the screw section of this technique guide.
41
A.L.P.S.
™ Total Foot System
Single Joint Fusion Plates
In-Line Fusion Plates
Compression Fusion Plate
Closed Compression Fusion Plates
42
Single Joint Fusion Plates
42 mm
18.5 mm 17.5 mm
26.5 mm
16.5 mm
30.5 mm
2.2 mm
Compression Fusion Plate
2.2 mm 2.2 mm
Closed Compression Fusion Plate
Specifications & Screw Options
Screw Type Diameter Options Drill Bit
3.5 mm
(Cat. No. 8161-35-0XX)
4.0 mm
(Cat. No. 8161-40-0XX)
Handle Driver Depth Gauge
Length
Options
Torque
Limiting
(Cat. No.
2141-18-001)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
T-15 tapered
(Cat. No. 2142-15-070)
2.7 mm Drill
Meas Sleeve
(Cat. No. 8163-01-005)
10 – 50 mm
Locking
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Non-Locking
(Low Profile)
(MDS) Multi-
Directional
2.7 mm
(Cat. No. 8163-27-0XX)
3.5 mm
(Cat. No. 1312-18-0XX)
3.5 mm
(Cat. No. 8163-35-0XX)
2.0 mm
Marked Drill
Bit Short
(Cat. No.
2142-88-008)
2.5 mm
Drill Bit
(Cat. No.
8290-29-070)
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Torque
Limiting
(Cat. No.
2141-18-001)
T -15 tapered
(Cat. No. 2142-15-070)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
2.0 mm Drill
Meas Sleeve
Short
(Cat. No. 2142-88-006)
10 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(NON-L line)
(Cat. No. 2142-35-100)
14 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.
2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
20 – 50 mm
43
A.L.P.S.
™ Total Foot System
Single Joint Fusion Plates
30.5 mm
6.5 mm
1.8 mm
Specifications & Screw Options
In-Line Fusion Plate (Small – 2.5 mm)
Screw Type
Locking
Screws
2.5 mm
(Cat. No. FPXX)
Drill Bit
Drill Bit Fast
2.0 mm
(Cat No. FDB20)
Handle Driver
Depth
Gauge
Length
Options
Quick
Connect
Handle
(Cat No. QCH)
1.3 mm Square
(Cat No. 2312-18-012)
2.5 mm
Depth Gauge
(Cat No. 2312-20-125)
8 – 40 mm
Non-Locking
(Low Profile) 2.5 mm
(Cat. No. SPXX000)
Drill Bit Fast
2.0 mm
(Cat No. FDB20)
Quick
Connect
Handle
(Cat No. QCH)
1.3 mm Square
(Cat No. 2312-18-012)
2.5 mm
Depth Gauge
(Cat No. 2312-20-125)
8 – 40 mm
(MDTP) Multi-
Directional 2.5 mm
(Cat. No. 1312-11-1XX)
Drill Bit Fast
2.0 mm
(Cat No. FDB20)
Quick
Connect
Handle
(Cat No. QCH)
MDTP Driver
(Cat No. 2142-88-007)
2.5 mm
Depth Gauge
(Cat No. 2312-20-125)
Note: The 2.5 mm Compression Washer (Cat. No. 1312-20-025) is ONLY meant for use with the 2.5 mm Locking Cortical Screw.
10 – 30 mm
44
Single Joint Fusion Plates
7.4 mm
36.7 mm
2.2 mm
Specifications & Screw Options
In-Line Fusion Plate (Large – 3.5 mm)
Screw Type Diameter Options
3.5 mm
(Cat. No. 8161-35-0XX)
Drill Bit
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Handle Driver Depth Gauge
Length
Options
Torque
Limiting
(Cat. No.
2141-18-001)
T-15 tapered
(Cat. No. 2142-15-070)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
10 – 50 mm
Locking
2.7 mm
(Cat. No. 8163-27-0XX)
2.0 mm
Marked Drill
Bit Short
(Cat. No.
2142-88-008)
Torque
Limiting
(Cat. No.
2141-18-001)
T -15 tapered
(Cat. No. 2142-15-070)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
2.0 mm Drill
Meas Sleeve
Short
(Cat. No. 2142-88-006)
10 – 50 mm
Non-Locking
(Low Profile)
(MDS) Multi-
Directional
3.5 mm
(Cat. No. 1312-18-0XX)
3.5 mm
(Cat. No. 8163-35-0XX)
2.5 mm
Drill Bit
(Cat. No.
8290-29-070)
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Ratcheting
Handle
(Cat No.
8261-66-000)
2.2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(NON-L line)
(Cat. No. 2142-35-100)
14 – 50 mm
Ratcheting
Handle
(Cat No.
8261-66-000)
2.
2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
20 – 50 mm
45
These are images of models with bones shown with plates in place and not real patients.
They are provided to show positioning and not intended to suggest immediate weight bearing.
A.L.P.S.
™ Total Foot System
Dorsal Mid-Foot Fusion Technique
The A.L.P.S.
™ Dorsal Mid-Foot Fusion Plate (DMFP) is made of titanium alloy (Ti6Al4V) with a TiMAX ® treatment for increased fatigue strength compared to the standard alloy.
1 The plate is designed to fit the specific anatomic profile of the mid foot and is available in two different sizes; the small plate is designed to compress and fuse two tarsometatarsal joints, the large plate fuses two tarsometatarsal joints and has additional locking tabs for fusing the
Naviculocuneiform joint. The closed box design provides strength while the integrated window improves joint access for placement of autograft or allograft within the arthrodesis site and improved postoperative visualization on x-ray versus a solid plate. The low-profile anatomic design (2 mm) and recessed screw heads minimize possible irritation of the ligaments and soft tissue. In addition to the specific anatomic design, strategic regions of the plate permit the user to contour the plate on bone with specially designed bending irons to match variations in individual patient anatomy. Each unidirectional compression slot provides up to 1.25 mm of compression and is available in both the small and large plate options (maximum compression
2.5 mm). The plate offers numerous screw options including: 4.0 mm Cancellous Locking, 3.5 mm
Cortical Locking, 3.5 mm Multi-Directional Locking,
2.7 mm Cortical Locking, and 3.5 mm Low Profile
Non-Locking Screws.
47
A.L.P.S.
™ Total Foot System
Dorsal Mid-Foot Fusion Plate
Threaded holes accept locking 2.7 mm,
3.5 mm, 4.0 mm, and 3.5 mm Multi-
Directional Screws as well as 3.5 mm
Low Profile Non-Locking Screws
Additional tabs on the Dorsal
Midfoot Fusion Large provide additional points of fixation for the navicular bone and can be contoured in three planes with the Foot-Multi
Planar Bender
Closed Box design provides strength
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over Stainless Steel
Screw heads are recessed into the plate providing an overall low profile construct with either Locking or
Non-Locking Screws
3.5 mm Multi-Directional Locking
Screws allow for up to a 30 degree cone of angulation
F.A.S.T. Guide ® adapter for provisional fixation through F.A.S.T. Guide ®
F.A.S.T. Tabs ® are designed to allow for bending in multiple planes
Unidirectional compression slots provide up to
1.25 mm compression per hole when used in conjunction with
3.5 mm Low Profile
Non-Locking Screw
48
F.A.S.T. Guide ® inserts for easy accurate drilling
Double F.A.S.T. Guide ® Benders allow for bending along two axes
Approach and Plate Placement
Figure 1 Figure 2
The following surgical technique applies to the fusion of the 2 nd and 3 rd tarsometatarsal joints. This general technique can also be applied to the fusion of the 1 st and 2 nd tarsometatarsal joints or for fixation of a Lisfranc fracture/dislocation.
Step 2: Plate Placement
Both the large and small Dorsal Midfoot Fusion plates are tapered proximal to distal, the widest segment should be positioned over the cuneiforms with the more narrow distal segment positioned over the metatarsals. Care should be taken to the plate such that the joint lines are located between the holes of the plate, to ensure screws are sufficiently clear of the joint line prior to screw insertion
(Figure 1).
Step 1: Exposure
Perform a longitudinal incision over the 3 rd metatarsocuneiform joint. Expose the 2 nd and 3 rd metatarso- cuneiform joints and denude all cartilage surfaces exposing the bleeding subchondral bone. To avoid shortening and elevation of the metatarsals place autograft or allograft within the arthrodesis site.
Suggestion: Using fluoroscopic guidance to the Small
Dorsal Midfoot Fusion plate can be especially helpful to ensure adequate purchase of both the locking screws and compression screws in the cuneiform and metatarsal bones (Figure 2).
Using fluoroscopic guidance to the Large Dorsal Midfoot
Fusion plate ensures that the navicular tabs are adequately centered within the navicular bone while maintaining proper alignment of the distal locking holes and compression slots within the 2 nd and 3 rd metatarsals.
49
A.L.P.S.
™ Total Foot System
Contouring
Figure 3 Figure 4
Step 3a: Plate Contouring
To establish a more patient specific fit, it is possible to contour the large and small Dorsal Midfoot Fusion plates using the Double F.A.S.T. Guide ® Bender (Cat. No. 2142-
88-005) (Figure 3)
Step 3b: Tab Contouring
With the plate provisionally fixed to bone, it is possible to contour the tabs of the Large Dorsal Midfoot Fusion plate in multiple planes using the Foot-Multi Planar Bender (Cat.
No. 2142-88-004) and the Double F.A.S.T. Guide ® Bender
(Cat. No. 2142-88-005) (Figure 4).
Note: The Double F.A.S.T. Guide ® Benders are double sided for use in various bending techniques. The boxed end, shown in Figure 3, allows for concave bending in one plane. The opposite end, with a slit and post, is used for convex single plane bending across a single bridge.
Note: The Foot Multi-Planar Benders are double sided for use in various bending techniques. The bender end with three teeth, shown in Figure 4, allows for bending in multiple planes. The opposite end of the bender is used for single plane bending.
Caution: Each bend should be in one direction only; reverse or over bending may weaken or cause plate to break.
Note: The Dorsal Midfoot Fusion Small Template (Cat. No.
2142-74-001) and Dorsal Midfoot Fusion Large Template
(Cat. No. 2142-74-003) can be useful in assessing the plate to bone contour prior to inserting the plate onto the bone.
50
Provisional Fixation
Figure 5 Figure 6
Step 4: Provisional Fixation
For provisional fixation, the 2.0 mm F.A.S.T. Guide ® adapters (Cat. No. 2312-18-007) can convert any F.A.S.T.
Guide ® into a K-wire fixation hole (Figure 5).
Suggestion: Obtaining two points of provisional fixation with the F.A.S.T. Guide ® adapters has the added advantage of allowing the surgeon to accurately predict the trajectory of a locking screw construct under fluoroscopic guidance
(Figure 6).
If a trajectory is deemed inadequate, the surgeon has two options; employ a 3.5 mm Multi-Directional Screw or utilize a 3.5 Low-Profile Non-Locking screw.
51
A.L.P.S.
™ Total Foot System
Screw Insertion (Non-Locking, Compression)
Figure 7 Figure 8
Step 5: Non-Locking Screw
Insertion (Compression)
To obtain maximum compression with the Small Dorsal
Midfoot Fusion Plate, partially insert 3.5 mm Low Profile
Non-Locking screws into all four of the unidirectional compression slots using the following series of steps.
Identify the appropriate screw length by using the Small
Fragment Depth Gauge (Cat.No. 2142-35-100) and taking a direct reading from the NON-L (Non-Locked) line
(Figure 8).
Place the 2.5 mm end of the 2.5/3.5 mm Drill Guide (Cat.
No. 8241-96-000) eccentrically in the narrowest portion of the unidirectional slot and drill through both cortices using the 2.5 mm Drill Bit (Cat. No. 8290-29-070) (Figure 7).
52
Figure 10
Figure 9 Figure 11
Partially advance the screw using the black ratchet handle
(Cat. No. 8261-66-000) with the 2.2 mm Square Driver
(Cat. No. 8163-01-000) being careful not to engage the screw head with the plate (Figure 9).
Once each unidirectional compression slot is filled with a partially inserted 3.5 mm Low Profile Non-Locking Screw:
First, remove all provisional fixation components (Figure
10). Next, fully insert each 3.5 mm Low Profile Non-
Locking Screw one by one (Figure 11).
Note: A detailed technique for screw insertion can be found in the screw section of this technique guide.
53
A.L.P.S.
™ Total Foot System
Screw Insertion (Locking)
Figure 12 – Small Plate
Step 6
Fill the remaining locking holes with locking screws in each corner to complete the locking construct (Figure 12 and 13).
Note: A detailed technique for screw insertion can be found in the screw section of this technique guide.
Figure 13 – Large Plate
54
Dorsal Midfoot Fusion Plates
24 mm 27 mm
54 mm 37 mm
2 mm
Dorsal Midfoot Fusion Large Plate
2 mm
Dorsal Midfoot Fusion Small Plate
Specifications & Screw Options
Screw Type Diameter Options Drill Bit
Locking
3.5 mm
(Cat. No. 8161-35-0XX)
4.0 mm
(Cat. No. 8161-40-0XX)
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Handle Driver Depth Gauge
Length
Options
Torque
Limiting
(Cat. No.
2141-18-001)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
T-15 tapered
(Cat. No. 2142-15-070)
2.7 mm Drill
Meas Sleeve
(Cat. No. 8163-01-005)
10 – 50 mm
Non-Locking
(Low Profile)
(MDS) Multi-
Directional
2.7 mm
(Cat. No. 8163-27-0XX)
3.5 mm
(Cat. No. 1312-18-0XX)
3.5 mm
(Cat. No. 8163-35-0XX)
2.0 mm
Marked Drill
Bit Short
(Cat. No.
2142-88-008)
2.5 mm
Drill Bit
(Cat. No.
8290-29-070)
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Torque
Limiting
(Cat. No.
2141-18-001)
T -15 tapered
(Cat. No. 2142-15-070)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
2.0 mm Drill
Meas Sleeve
Short
(Cat. No. 2142-88-006)
10 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(NON-L line)
(Cat. No. 2142-35-100)
14 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.
2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
20 – 50 mm
55
These are images of models with bones shown with plates in place and not real patients.
They are provided to show positioning and not intended to suggest immediate weight bearing.
A.L.P.S.
™ Total Foot System
Lateral Column Lengthening Plate Technique:
Calcaneal Cuboid Joint and Calcaneal Osteotomy
The A.L.P.S.
™ Lateral Column Lengthening Plates
(LCLP) are made of a titanium alloy (Ti6Al4V) with a TiMAX ® treatment for increased fatigue strength compared to the standard alloy.
1 The Lateral Column
Lengthening plates are designed to be used with either calcaneal osteotomy or calcaneocuboid arthrodesis lengthening procedures. The implants are available in four different sizes - a no wedge, 8 mm wedge, 10 mm wedge or 12 mm wedge. The lowprofile anatomic design (2 mm) and recessed screw heads minimize possible irritation of the peroneal tendons and skin. In addition, the plate’s profile has been designed with multiple radii of curvature to further minimize the possibility of tendon irritation.
The wedges are tapered dorsal to plantar to minimize the possibility of an unnatural tilt of the cuboid. The wedges are also tapered laterally to medially for a more anatomically correct wedge shape. The wedge plates have also been designed to maintain ample space for the application of autograft or allograft materials.
57
A.L.P.S.
™ Total Foot System
Compression Fusion Plate
Low profile 2 mm thickness reduces possibility of tendon and soft tissue irritation
Screw heads are recessed into the plate providing an overall low profile construct with either Locking or
Non-Locking Screws
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over Stainless Steel
Threaded holes accept locking
2.7 mm, 3.5 mm, 4.0 mm, and 3.5 mm
Multi-Directional Screws as well as 3.5 mm
Low Profile Non-Locking Screws
3.5 mm Multi-Directional
Locking Screws allow for up to a 30 degrees cone of angulation
Four different sizes to choose from:
• No wedge • 10 mm wedge
• 8 mm wedge • 12 mm wedge no wedge wedge
58
Wedges have a dorsal to plantar taper
F.A.S.T. Guide ® adapter for provisional fixation through F.A.S.T
™ Guide
Lateral to medial wedge taper for a more anatomically correct shape
F.A.S.T. Guide ® inserts for easy accurate drilling
Approach and Plate Placement
Figure 1
The following surgical technique applies to the Evans lateral column lengthening osteotomy. This general technique can also be applied to other lateral column lengthening procedures of the foot such as a calcaneocubiod joint distraction for a lateral column lengthening procedure.
Step 2: Osteotomy and Plate Placement
Next, perform the osteotomy usually 1 to 1.2 cm proximal to the calcaneocuboid joint. With the osteotomy properly distracted to between 8 and 12 mm, choose the appropriate plate. If the lateral column lengthening wedge plate is used, ensure that the wedge sides are in close contact with either side of the joint surface (Figure 1). The T-15
Taper driver (Cat. No. 2142-15-070) can be used in to aid in plate insertion (Figure 1).
Step 1: Approach
Make an oblique incision, just proximal to the calcaneocuboid joint and 1 cm below the tip of the fibula.
Take care to avoid the intermediate dorsal cutaneous and sural nerves and to protect and retract the peroneal tendons. Using a blunt retractor, continue dissection and exposure with the release of dorsal and plantar soft tissue from the planned osteotomy site.
Note: The widest portion of the wedge should be placed dorsally to minimize the possibility of an unnatural tilt of the cuboid.
Note: The Lateral Column Lengthening family of plates are not designed with flexible plating technology. Therefore, the F.A.S.T. Guide ® inserts are intended for fast and accurate drilling purposes only and cannot be used for bending purposes.
59
A.L.P.S.
™ Total Foot System
Provisional Fixation
Figure 2 Figure 3
Step 3: Provisional Fixation
For provisional fixation, the 2.0 mm F.A.S.T. Guide ® adapters (Cat. No. 2312-18-007) can convert any
F.A.S.T. Guide ® into a K-wire fixation hole (Figure 2).
Note: Provisional fixation has the added advantage of allowing the surgeon to accurately predict the trajectory of a locking screw construct under fluoroscopic guidance
(Figure 3).
60
Screw Insertion
Figure 4 Figure 5
If a trajectory is deemed inadequate (Figure 3), the surgeon has two options; employ a 3.5 Low-Profile
Non-Locking Screw or a 3.5 mm Multi-Directional Screw as demonstrated in Figure 4.
Note: It is helpful to have two points of fixation prior to attempting to remove F.A.S.T. Guides ® from the lateral column. (Figure 5)
61
A.L.P.S.
™ Total Foot System
Screw Insertion
Figure 6 Figure 7
Step 4: Screw Insertion
If a combination of locking and non-locking screws will be used, Non-Locking Screws should be inserted first to secure the plate in close apposition to bone.
Note: The trajectories of the locking holes in the plate are designed not to interact at lengths up to 26 mm. In addition, the trajectories aim away from the plate center, helping to avoid screws passing through the joint or osteotomy site (Figure 7).
All screw holes should be filled to ensure adequate load distribution of the locking construct and plate to bone fixation (Figure 6).
Note: A detailed technique for screw insertion can be found in the screw section of this technique guide.
62
Lateral Column Lengthening Plate
25 mm
8 mm
17 mm 12 mm
25 mm
2 mm
2.35 mm
6 mm
4.5 mm
2.35 mm
28 mm
10 mm
12 mm
8 mm
4.5 mm
2.35 mm
29 mm
12 mm
12 mm
10 mm
4.5 mm
LCLP No Wedge
Note: Plate profile, length and width matches
LCLP Small plate size.
LCLP Small LCLP Medium LCLP Large
Specifications & Screw Options
Screw Type Diameter Options Drill Bit
3.5 mm
(Cat. No. 8161-35-0XX)
4.0 mm
(Cat. No. 8161-40-0XX)
Handle Driver Depth Gauge
Length
Options
Torque
Limiting
(Cat. No.
2141-18-001)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
T-15 tapered
(Cat. No. 2142-15-070)
2.7 mm Drill
Meas Sleeve
(Cat. No. 8163-01-005)
10 – 50 mm
Locking
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Non-Locking
(Low Profile)
(MDS) Multi-
Directional
2.7 mm
(Cat No. 8163-27-0XX)
3.5 mm
(Cat. No. 1312-18-0XX)
3.5 mm
(Cat. No. 8163-35-0XX)
2.0 mm
Marked Drill
Bit Short
(Cat. No.
2142-88-008)
2.5 mm
Drill Bit
(Cat. No.
8290-29-070)
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Torque
Limiting
(Cat. No.
2141-18-001)
T -15 tapered
(Cat. No. 2142-15-070)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
2.0 mm Drill
Meas Sleeve
Short
(Cat. No. 2142-88-006)
10 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(NON-L line)
(Cat. No. 2142-35-100)
14 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.
2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
20 – 50 mm
63
These are images of models with bones shown with plates in place and not real patients.
They are provided to show positioning and not intended to suggest immediate weight bearing.
A.L.P.S.
™ Total Foot System
Medial Column Fusion Technique
The A.L.P.S.
™ Medial Column Fusion Plate (MCF) is made of titanium alloy (Ti6Al4V) with a TiMAX ® treatment for increased fatigue strength compared to the standard alloy.
1 It has an anatomical shape corresponding to the anatomy of the navicular, medial cuneiform and first metatarsal. The low-profile anatomic design (2 mm) and recessed screw heads minimize potential irritation of the ligaments and soft tissue. In addition to the specific anatomic design, strategic regions of the plate permit the user to contour the plate to bone after provisional fixation to match variations in individual patient anatomy.
The implant is designed to provide up to 1.25 mm of compression in both the naviculo-cuneiform and tarso-metatarsal joints. The Medial Column Fusion
(MCF) plate offers numerous screw options; 4.0 mm
Cancellous Locking, 3.5 mm Cortical Locking, 3.5 mm
Multi-Directional Locking, 2.7 mm Cortical Locking, and 3.5 mm Low Profile Non-Locking Screws.
65
A.L.P.S.
™ Total Foot System
Medial Column Fusion Plate
Closed Box design provides strength
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over Stainless Steel
Additional tabs on the Dorsal aspect of the Medial
Column Fusion plate provide additional points of fixation and can be contoured in three planes with the Foot-Multi Planar Bender
Unidirectional compression slots provide up to
1.25 mm compression per hole when used in conjunction with
3.5 mm Low Profile
Non-Locking Screw
Threaded holes accept locking
2.7 mm, 3.5 mm, 4.0 mm, and 3.5 mm
Multi-Directional Screws as well as
3.5 mm Low Profile Non-Locking Screws
3.5 mm Multi-Directional Locking
Screws allow for up to a 30 degree cone of angulation
Left (Lime) F.A.S.T. Guide ® adapter for provisional fixation through
F.A.S.T. Guide ®
Screw heads are recessed into the plate providing an overall low profile construct with either locking or non-locking screws
F.A.S.T. Tabs ® are designed to allow for bending in multiple planes
F.A.S.T. Guide ® inserts for easy accurate drilling
66
Right (Rose)
Double F.A.S.T. Guide ® benders allow for bending along one plane
Approach and Plate Placement
Figure 1
Step 1: Exposure
Perform a longitudinal incision medially extending from the proximal border of the navicular to the shaft of the first metatarsal. Expose and denude the cartilage surfaces of both the naviculo-cuneiform and the tarso-metatarsal joints, exposing the bleeding subchondral bone. To avoid shortening and elevation of the first ray, place adequate autograft or allograft within the arthrodesis site. A guide pin may be used to maintain bony alignment prior to plate placement.
Step 2: Plate Placement
The plate should be positioned medially and extend from the navicular, across the medial cuneiform to the first metatarsal. If compression is desired, care should be given to ensure that the two unidirectional compression slots are located within the medial cuneiform and the first metatarsal, and that the screws are sufficiently clear of the joint line prior to screw insertion (Figure 1).
Note: Depending on surgeon preference and exposure of the anterior tibial tendon, the surgeon has two options; resect and reattach the tendon after plate placement or dissect and spare the tendon by sliding the plate under the anterior tibial tendon.
If the anterior tibial tendon is dissected and spared, it is recommended to pre-contour the plate and remove the
5 most distal F.A.S.T. Guides ® prior to inserting the plate beneath the tendon.
67
A.L.P.S.
™ Total Foot System
Plate Contouring
Figure 2 Figure 3
Step 3: Plate Contouring
Suggestion: Precontouring the Medial Column Fusion
Plate can be difficult. Therefore, it is helpful to obtain the general anatomic profile of the medial surfaces of navicular, medial cuneiform and first metatarsal bones using the Medial Column Fusion bending template (Cat.
No. 2142-76-101) (Figure 2).
Note: The Double F.A.S.T. Guide ® Benders are double sided for use in various bending techniques. The boxed end, shown in Step 3a, allows for convex bending in one plane. The opposite end, with a slit and post, is used for concave single plane bending.
With the template removed, match the anatomic profile with the Medial Column Fusion plate using either the
Double F.A.S.T. Guide ® Benders (Cat. No. 2142-88-005) for bending along a single plane or Multi Planer benders
(Cat. No. 2142-88-004) when bending in multiple planes.
Note: Concave uni planar bending using the reverse bending nodes of the Double F.A.S.T. Guide ® Bender
(Figure 3).
Caution: Each bend should be in one direction only; reverse or over bending may weaken or cause plate to break.
68
Figure 5
Figure 4 Figure 6
Step 4: Provisional Fixation
For provisional fixation, the 2.0 mm F.A.S.T. Guide ® adapters (Cat. No. 2312-18-007) can convert any F.A.S.T.
Guide ® into a K-wire fixation hole (Figure 4).
Note: Provisional fixation with the 2.0 mm F.A.S.T. Guide ® adapter and 2.0 mm K-wire has the added advantage of allowing the surgeon to accurately predict the trajectory of a locking screw construct under fluoroscopy.
If the trajectory is deemed inadequate, the surgeon has several options; bend the plate intra-operatively, employ a
3.5 mm Multi-Directional Screw, or use a 3.5 Low-Profile
Non-Locking Screw to establish a new trajectory.
Suggestion: Using fluoroscopic guidance to the Medial
Column Fusion plate can be especially helpful to ensure that the Unidirectional Compression Slots are within the borders of the medial cuneiform and first metatarsal bones while still maintaining adequate purchase within the navicular bone (Figure 5).
Note: Natural variations in the navicular bone make identifying screw trajectories especially important when positioning the medial column fusion plate. It is often necessary assess the trajectory of the most posterior inferior screw and insert a 3.5 mm Multi-Directional Screw in order to avoid the talonavicular joint (Figure 6).
69
A.L.P.S.
™ Total Foot System
In Situ Contouring Screw Insertion
(Locking and Non-Locking)
1
2
3
Figure 7 Figure 8
Step 5: Contour To Bone
With the plate provisionally fixed, it is also possible to further contour the plate to bone for a more patient specific fit using the Foot-Multi Planar Bender (Cat. No.
2142-88-004).
Step 6: Screw Insertion
(Locking and Non-Locking)
To obtain up to 1.25 mm of compression across both the naviculo-cuneiform and tarso-metatarsal joints using the Medial Column Fusion Plate, sequentially fix and compress each joint beginning with the naviculocuneiform joint using the following series of steps.
The Foot Multi-Planar Benders are double sided for use in various bending techniques. The end with three teeth allows for bending in multiple planes. The opposite end, is used for single plane bending or twisting (Figure 7).
Note: A detailed technique for screw insertion can be found in the screw section of this technique guide.
Caution: Each bend should be in one direction only; reverse or over bending may weaken or cause plate to break.
Reduce and fix the plate to the navicular bone by: First, placing a Non-Locking Screw in the center hole of the navicular section. Next, fix the plate to the navicular bone by obtaining at least two cortices of fixation with the remaining locking screw holes (Figure 8).
70
4 7
5 6
Figure 10 Figure 9
Compress the naviculocuneiform joint by fully inserting a 3.5 mm Non-Locking Screw in the unidirectional compression slot located over the medial cuneiform
(Figure 9).
Fix the plate to the medial cuneiform by obtaining at least two corticies of fixation with the locking screws
(Figure 10).
71
A.L.P.S.
™ Total Foot System
Screw Insertion
(Locking and Non-Locking)
9
Figure 11
8 11
Figure 12
10
Step 6: Screw Insertion
(Locking and Non-Locking) (cont.)
Compress the Tarsometatarsal joint by fully inserting a 3.5 mm Non-Locking Screw in the unidirectional compression slot located over the 1 st metatarsal (Figure 11).
Fix the plate to the metatarsal by obtaining at least two corticies of fixation with the locking screws (Figure 12).
72
Medial Column Fusion Plate
27 mm
64 mm
2.2 mm
Specifications & Screw Options
Screw Type Diameter Options Drill Bit
3.5 mm
(Cat. No. 8161-35-0XX)
4.0 mm
(Cat. No. 8161-40-0XX)
Handle Driver Depth Gauge
Length
Options
Torque
Limiting
(Cat. No.
2141-18-001)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
T-15 tapered
(Cat. No. 2142-15-070)
2.7 mm Drill
Meas Sleeve
(Cat. No. 8163-01-005)
10 – 50 mm
Locking
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Non-Locking
(Low Profile)
(MDS) Multi-
Directional
2.7 mm
(Cat No. 8163-27-0XX)
3.5 mm
(Cat. No. 1312-18-0XX)
3.5 mm
(Cat. No. 8163-35-0XX)
2.0 mm
Marked Drill
Bit Short
(Cat. No.
2142-88-008)
2.5 mm
Drill Bit
(Cat. No.
8290-29-070)
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Torque
Limiting
(Cat. No.
2141-18-001)
T -15 tapered
(Cat. No. 2142-15-070)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
2.0 mm Drill
Meas Sleeve
Short
(Cat. No. 2142-88-006)
10 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(NON-L line)
(Cat. No. 2142-35-100)
14 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.
2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
20 – 50 mm
73
These are images of models with bones shown with plates in place and not real patients.
They are provided to show positioning and not intended to suggest immediate weight bearing.
A.L.P.S.
™ Total Foot System
Locking Calcaneal Plate Technique
The A.L.P.S.
™ Locking Calcaneal Plate is made of a titanium alloy (Ti6Al4V) with a TiMAX ® treatment for increased fatigue strength compared to the standard alloy.
1 This locking plate offers a high strength, low profile design that closely matches the anatomy of the calcaneus. The anatomical shape of the plate is further enhanced by pre-described screw trajectories corresponding to the anatomy of the subtalar joint.
The plate is available in two different sizes with right and left options. Its thickness is 2.5 mm, with reduced bridge thickness between screws to facilitate contouring to the bone. The prescribed trajectory of the most superior locking screw is angled downward to closely match the geometry of the articular surface for subarticular support while minimizing the potential of penetrating the posterior articular facet. The two adjacent locking screws have trajectories that angle superiorly into the sustentaculum to support the middle facet. The plate offers numerous screw options including: 4.0 mm Cancellous Locking,
3.5 mm Cortical Locking, 3.5 mm Multi-Directional
Locking, 2.7 mm Cortical Locking, and 3.5 mm Low
Profile Non-Locking Screws.
75
A.L.P.S.
™ Total Foot System
Locking Calcaneal Plate
Closed Box perimeter design provides strength
Pre-contoured anatomical design with screw trajectories corresponding to the anatomy of the subtalar joint
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over Stainless Steel
Threaded holes accept Locking
2.7 mm, 3.5 mm,
4.0 mm, and 3.5 mm
Multi-Directional
Screws as well as
3.5 mm Low Profile
Non-Locking Screws
3.5 mm Multi-Directional
Locking Screws allow for up to a 30 degree cone of angulation
F.A.S.T. Guide ® adapter for provisional fixation through F.A.S.T. Guide ®
Left (Lime) Offered in right and left with large and small size options
Screw heads are recessed into the plate providing an overall low profile construct with either
Locking or Non-Locking Screws
F.A.S.T. Guide ® inserts for easy accurate drilling
F.A.S.T. Tabs ® are designed to allow for
In-Situ Contouring
76
Right (Rose)
Approach, Reduction and Plate Placement
Figure 1 Figure 2
Step 1: Approach
The calcaneus is approached through an extensile lateral incision which minimizes the sequelae of peroneal tendinitis and devascularization of the anterior skin flap, as well as preserving the sural nerve which should be entirely within the flap. The calcaneo-fibular ligament is taken with the flap.
The full thickness flap is then retracted using the “no touch” technique by the use of three K-wires, one up the fibular shaft, one in the talar neck and one in the cuboid. Next, a short Schanz pin is inserted into the calcaneus at posterior inferior corner of the wound to be used as a handle for subsequent reduction.
Step 2: Reduction and Plate Placement
After adequate exposure and irrigation of hematoma, the fracture should be reduced and provisionally stabilized with
K-wires. The subtalar reduction is verified on a fluoroscopic mortise view of the ankle, and again with the foot externally rotated, into the supine and dorsiflexed. A modified Harris heel view is then obtained to verify that the heel is out of varus. Once reduction is verified, the plate is sized and positioned on the lateral surface such that the most superior
F.A.S.T. Guide ® lies just under the posterior articular facet and the most superior anterior F.A.S.T. Guide ® is positioned just in line with the anterior superior portion of the anterior articular facet (Figure 1). Final verification of plate size and placement is easily confirmed under fluoroscopy (Figure 2).
Note: The Calcaneal Bending Templates (Small Cat. No.
2142-08-001; Large Cat. No. 2142-08-003) can be useful in determining plate to bone contouring and size prior to inserting the plate onto the bone.
With the template removed, match the anatomic profile using either the Double F.A.S.T. Guide ® Benders for bending along a single plane or Multi Planer Benders when bending in multiple planes.
77
A.L.P.S.
™ Total Foot System
Provisional Fixation Non-Locking Screw Insertion
Figure 3 Figure 4
Step 3: Provisional Fixation
For provisional fixation with a K-wire, the 2.0 mm F.A.S.T.
Guide ® adapters (Cat. No. 2312-18-007) can convert any
F.A.S.T. Guide ® into a K-wire fixation hole.
Step 4: Non-Locking
Screw Fixation
With the plate provisionally fixed at three points, exchange the three provisional points of fixation with 3.5 mm Low
Profile Non-Locking Screws to reduce the plate to bone
(Step 4 and 5).
Provisional fixation has the added advantage of allowing the surgeon to predict the trajectory of a plate/screw construct relative to important articular structures with fluoroscopy. If a trajectory is deemed inadequate, the surgeon has several options; bend the plate intraoperatively, employ a 3.5 mm Multi-Directional Screw, or use a 3.5 Low-Profile Non-Locking Screw to establish a new trajectory.
Note: A detailed technique for screw insertion can be found in the Small Frag screw section of this technique guide.
Suggestion: Provisional fixation should be obtained at three points, one in the anterior facet, one in the portion of the plate under the posterior tuberosity and one in the portion of the plate that sits underneath the posterior facet.
78
In Situ Contouring
Figure 5 Figure 6
Step 5: In Situ Contouring
With the plate reduced to bone with Non-Locking Screws, it is rarely necessary to further contour the plate. If this is required however, it can be performed using the Foot-Multi
Planar Bender (Cat. No. 2142-88-004).
Note: The Locking Calcaneal Plate is designed to be contoured along a single axis. Therefore, only the end of the bender without tabs can be used when contouring or adjusting the plate and screw trajectories. In addition, only one bridge section should be contoured at a time (Figure 6).
Caution: Each bend should be in one direction only; reverse or over bending may weaken or cause the plate to break.
79
A.L.P.S.
™ Total Foot System
Screw Insertion (Non-Locking, Compression)
Figure 7 Figure 8
Step 6: Locking Screw Fixation
Additional locking screws can then be placed as needed to secure the fracture (Figure 7).
Note: The anatomical shape of the plate is further enhanced by pre-described screw trajectories corresponding to the anatomy of the subtalar joint line.
While the trajectories are directed at the sustentaculum tali, these trajectories can be further refined with either
3.5 mm Multi-Directional Locking Screws or 3.5 mm
Low Profile Non-Locking Screws (Figure 8).
Note: A detailed technique for screw insertion can be found in the screw section of this technique guide.
80
81
A.L.P.S.
™ Total Foot System
Locking Calcaneal Plate
36 mm
60 mm
Small
2.5 mm
42 mm
76 mm
1.5 mm
X-Large
2.5 mm
37 mm
67 mm
Large
1.5 mm 2.5 mm
82
Specifications & Screw Options
Screw Type
Locking
Diameter Options
3.5 mm
(Cat. No. 8161-35-0XX)
4.0 mm
(Cat. No. 8161-40-0XX)
Drill Bit
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Handle Driver Depth Gauge
Length
Options
Torque
Limiting
(Cat. No.
2141-18-001)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
T-15 tapered
(Cat. No. 2142-15-070)
2.7 mm Drill
Meas Sleeve
(Cat. No. 8163-01-005)
10 – 50 mm
Non-Locking
(Low Profile)
(MDS) Multi-
Directional
2.7 mm
(Cat. No. 8163-27-0XX)
3.5 mm
(Cat. No. 1312-18-0XX)
3.5 mm
(Cat. No. 8163-35-0XX)
2.0 mm
Marked Drill
Bit Short
(Cat. No.
2142-88-008)
2.5 mm
Drill Bit
(Cat. No.
8290-29-070)
2.7 mm
Calibrated
Drill Bit
(Cat. No.
2142-27-070)
Torque
Limiting
(Cat. No.
2141-18-001)
T -15 tapered
(Cat. No. 2142-15-070)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
2.0 mm Drill
Meas Sleeve
Short
(Cat. No. 2142-88-006)
10 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(NON-L line)
(Cat. No. 2142-35-100)
14 – 50 mm
Ratcheting
Handle
(Cat. No.
8261-66-000)
2.
2 mm Square
(Cat. No. 8163-01-000)
Small Frag
(LOCK line)
(Cat. No. 2142-35-100)
20 – 50 mm
83
These are images of models with bones shown with plates in place and not real patients.
They are provided to show positioning and not intended to suggest immediate weight bearing.
A.L.P.S.
™ Total Foot System
Navicular Fracture Plate Technique
The A.L.P.S.
™ Navicular Fracture Plates (NFP) are made of a titanium alloy (Ti6Al4V) with a TiMAX ® treatment for increased fatigue strength compared to the standard alloy.
1 The low-profile anatomic design (1.65 mm thickness) and uniform plate screw construct minimize potential irritation of the ligaments and soft tissue. The Navicular Fracture Plate has been precontoured to closely match the natural anatomy of the navicular bone. In addition to the specific anatomic design, strategic regions of the plate permit the user to intra-operatively contour the plate to match variations in individual patient anatomy.
Proprietary F.A.S.T. Guide ® technology provides a number of unique features that increase flexibility and efficiency in the OR. The plate offers numerous screw options including: 2.5 mm Cortical Locking, 2.5 mm
Cortical Non-Locking, and 2.5 mm Multi-Directional
Locking Screws.
85
A.L.P.S.
™ Total Foot System
Navicular Fracture Plate
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over Stainless Steel
2.5 mm Multi-Directional Locking
Screws allow for up to a 20 degree cone of angulation
Very Low profile construct with either Locking or
Non-Locking screws
86
Achieve temporary fixation with the 1.6 mm K-wire inserted directly through any of the available F.A.S.T. Guides ®
Left (Lime)
Right (Rose)
F.A.S.T. Tabs ® are designed to allow for bending in multiple planes
Approach, Reduction and Plate Placement
Figure 1
Step 1: Approach
Make a dorsal longitudinal incision from the midneck of the talus towards the base of the second metatarsal. It may be necessary to make a second longitudinal incision medially from the midneck of the talus to the middle portion of the medial cuneiform. Additionally, it may be necessary to open the talo-navicular and naviculo-cuneiform joint capsule to allow visualization of the joint.
Step 2: Reduction and Plate Placement
After adequate exposure and irrigation of hematoma, the fracture should be reduced and provisionally stabilized with K-wires and/or Reduction Clamps. The plate should be positioned such that the widest portion of the plate is medial (Figure 1).
Note: The plate is designed to fit the navicular bone with the majority of screw fixation extending from medial to lateral.
87
A.L.P.S.
™ Total Foot System
Provisional Fixation In Situ Contouring
Figure 2 Figure 3
Step 3: Provisional Fixation
Achieve temporary fixation with the 1.6 mm K-wire (Cat.
No. 144256) inserted directly through any of the available
F.A.S.T. Guides ® (Figure 2).
Step 4: Implant Contouring
With the plate provisionally reduced and or partially fixated to bone, it is possible to further contour the plate with the
2.0 mm Plate Bender (Cat. No. 2312-20-100) and 2.0 mm
Plate Bender End (Cat. No. 2312-20-101) (Figure 3).
Note: Based on the plate geometry, the majority of contouring will most likely be on the dorsal aspect of the bone.
Suggestion: Depending on the fracture pattern and exposure, it may be necessary to pre-contour the plate prior to insertion. More importantly, minimal exposure will require the user to remove some F.A.S.T. Guides ® prior to inserting the plate, therefore pre contouring is recommended.
88
Screw Insertion
Figure 4 Figure 5
Note: The Navicular Fracture Bending Templates (Cat. No.
2142-72-001) can be useful in determining plate to bone contouring prior to inserting the plate onto the bone.
Step 5: Reduction and Plate Placement
Each locking hole provides the option for either a Locked
Fixed Angle, Locked Multi-Directional, or Non-Locking
Screw. Screws can then be placed as needed to secure the fracture (Figure 5).
Caution: Each bend should be in one direction only; reverse or over bending may weaken or cause plate to break.
If a combination of Non-Locking Screws and Locking
Screws will be used, Non-Locking Screws should be inserted first.
Provisionally fix the plate to bone directly through the
F.A.S.T. Guides ® (Figure 4).
Suggestion: Completely reduce the plate to the bone with three Non-Locking Screws placed sequentially within the dorsal third, middle third and medial third of the plate prior to placing Locking Screws for final fixation.
Additional Locking Screws can then be placed as needed to secure the fracture.
89
A.L.P.S.
™ Total Foot System
Navicular Fracture Plate
53 mm
15 mm
1.65 mm
Specifications & Screw Options
Screw Type Screws Drill Bit
Locking
2.5 mm
(Cat. No. FPXX)
Drill Bit Fast
2.0 mm
(Cat. No. FDB20)
Handle Driver
Depth
Gauge
Length
Options
Quick
Connect
Handle
(Cat. No. QCH)
1.3 mm Square
(Cat. No. 2312-18-012)
2.5 mm
Depth Gauge
(Cat. No. 2312-20-125)
8 – 40 mm
Non-Locking
(Low Profile)
2.5 mm
(Cat. No. SPXX000)
Drill Bit Fast
2.0 mm
(Cat. No. FDB20)
Quick
Connect
Handle
(Cat. No. QCH)
1.3 mm Square
(Cat. No. 2312-18-012)
2.5 mm
Depth Gauge
(Cat. No. 2312-20-125)
8 – 40 mm
(MDTP) Multi-
Directional 2.5 mm
(Cat. No. 1312-11-1XX)
Drill Bit Fast
2.0 mm
(Cat. No. FDB20)
Quick
Connect
Handle
(Cat. No. QCH)
MDTP Driver
(Cat. No. 2142-88-007)
2.5 mm
Depth Gauge
(Cat. No. 2312-20-125)
10 – 30 mm
90
91
These are images of models with bones shown with plates in place and not real patients.
They are provided to show positioning and not intended to suggest immediate weight bearing.
A.L.P.S.
™ Total Foot System
Talar Fracture Technique
The A.L.P.S.
™ Talar Fracture Plates (TFP) are made of a titanium alloy (Ti6Al4V) with a TiMAX ® treatment for increased fatigue strength compared to the standard alloy.
1 The low-profile anatomic design (1.65 mm thickness) and uniform plate screw construct permits the placement of screws in an extra-articular location into the posterior part of the talar body and into the talar head. The Talar Fracture Plate has been precontoured to closely match the natural anatomy of the lateral aspect of the talar neck. Proprietary F.A.S.T. Guide
® technology provides a number of unique features that increase flexibility and efficiency. The plate offers numerous screw options including: 2.5 mm Cortical
Locking, 2.5 mm Cortical Non-Locking, and 2.5 mm
Multi-Directional Locking screws.
93
A.L.P.S.
™ Total Foot System
Talar Fracture Plate
Low profile construct with either locking or non-locking screws
2.5 mm Multi-Directional
Locking Screws allow for up to a 20 degree cone of angulation
Threaded holes accept locking 2.5 mm, as well as 2.5 mm Non-Locking Screws
TiMAX ® for strength, biocompatibility and enhanced imaging capabilities over Stainless Steel
94
K-wire hole for provisional fixation
F.A.S.T. Guide ® inserts for easy accurate drilling
F.A.S.T. Tabs ® are designed to allow for bending in multiple planes
Approach, Reduction and Plate Placement
Figure 1
Step 1: Approach
Placement of the Talar Fracture Plate for talar body fractures with displacement, comminution, or an associated talar neck fracture require an anterolateral surgical approach.
An anteromedial approach may also be required to obtain additional exposure when addressing medial side comminution. The fractures are reduced, and provisional
K-wires placed prior to plate placement.
Step 2: Reduction and Plate Placement
After adequate exposure and irrigation of hematoma, the fracture should be reduced and provisionally stabilized with
K-wires. The plate should be positioned laterally within the neck of the talus such that it permits the placement of screws in an extra-articular location into the posterior part of the talar body and into the head of the talus (Figure 1).
95
A.L.P.S.
™ Total Foot System
Optional Plate Contouring
Figure 2 Figure 3
Note: The Talar Fracture Bending Templates (Cat. No.
2142-75-001) can be useful in determining plate to bone contouring prior to inserting the plate onto the bone.
Figure 3 demonstrates the general positioning of 2.0 mm
Bending Irons to increase the concavity of the plate.
Figure 2 demonstrates the general positioning of 2.0 mm
Bending Irons to reduce the concavity of the plate.
96
Provisional Fixation In Situ Contouring
Figure 4 Figure 5
Step 3: Provisionally Fixation
Achieve temporary fixation with a 1.6 mm K-wire (Cat. No.
14425-6), or a Short Compression Wire (Cat. No. 8242-99-
101) through the K-Wire hole in the plate (Figure 4).
Note: A detailed technique for using compression wires can be found in the Compression Wire Technique section of this technique guide.
Step 4: In Situ Contouring
With the plate provisionally reduced to the bone, it is possible, although technically challenging due to limited access, to further contour the plate intraoperatively with the
2.0 mm Plate Bender (Cat. No. 2312-20-100) and 2.0 mm
Plate Bender End (Cat. No. 2312-20-101) (Figure 5).
Caution: Each bend should be in one direction only; reverse or over bending may weaken or cause plate to break.
Suggestion: To preserve the reduction and assist with multi-planar intraoperative contouring the plate should have two points of fixation. Therefore, applying one screw to either side of the most superior aspect of the plate will provide a more stable construct for intraoperative customization and help maintain the reduction.
97
A.L.P.S.
™ Total Foot System
Screw Fixation
Figure 6 Figure 7
Step 5: Screw Fixation
Insert screws in all screw holes (Figure 6).
Each locking hole provides the option for either a locked fixed angle, Locked Multi-Directional, or Non-Locking Screw.
Suggestion: Using fluoroscopic x-ray ensures that all screws are correctly placed and are of the correct length
(Figure 7).
If a combination of Non-Locking Screws and Locking
Screws are used, Non-Locking Screws should be inserted first.
Note: Additional cannulated screws used outside the plate may be required to further stabilize the fracture at the surgeon’s discretion (Figure 7).
Note: A detailed technique for screw insertion can be found in the screw section of this technique guide.
98
Talar Fracture Plate
13.6 mm
1.65 mm
18.4 mm
Specifications & Screw Options
Screw Type Screws Drill Bit
Locking
2.5 mm
(Cat. No. FPXX)
Drill Bit Fast
2.0 mm
(Cat. No. FDB20)
Handle Driver
Depth
Gauge
Length
Options
Quick
Connect
Handle
(Cat. No. QCH)
1.3 mm Square
(Cat. No. 2312-18-012)
2.5 mm
Depth Gauge
(Cat. No. 2312-20-125)
8 – 40 mm
Non-Locking
(Low Profile) 2.5 mm
(Cat. No. SPXX000)
Drill Bit Fast
2.0 mm
(Cat. No. FDB20)
Quick
Connect
Handle
(Cat. No. QCH)
1.3 mm Square
(Cat. No. 2312-18-012)
2.5 mm
Depth Gauge
(Cat. No. 2312-20-125)
8 – 40 mm
(MDTP) Multi-
Directional 2.5 mm
(Cat. No. 1312-11-1XX)
Drill Bit Fast
2.0 mm
(Cat. No. FDB20)
Quick
Connect
Handle
(Cat. No. QCH)
MDTP Driver
(Cat. No. 2142-88-007)
2.5 mm
Depth Gauge
(Cat. No. 2312-20-125)
10 – 30 mm
99
A.L.P.S.
™ Total Foot System
Compression Wire Technique:
Provisional Fixation
The choice is yours; Biomet’s innovative plating technology provide several ways in which to achieve provisional plate fixation to the bone using the
A.L.P.S.
™ Total Foot System and other A.L.P.S.
™ platform plating options. Standard K-wires through
K-wire holes is an option, as well as K-wires through
F.A.S.T. Guides ® , K-wires through F.A.S.T. Guide ®
Adapters, Fixation Pins, or plate to bone clamps. The use of Compression Wires has an added advantage over standard K-wires in that the plate is compressed to the bone with the bead on the wire, not allowing the plate to rise back up, which is possible with standard K-wires. These Compression Wires can be utilized with the smaller 2.5 mm A.L.P.S.
™ plates, and also the larger 3.5 mm plates in the A.L.P.S.
™ Total
Foot System.
101
A.L.P.S.
™ Total Foot System
Compression Wires
Recommended Length Combinations
Table 1
SHORT Compression Wire
(23 mm)
MEDIUM Compression Wire
(28 mm)
LONG Compression Wire
(48 mm)
K-Wire Hole
•
2.5 F.A.S.T Guide ®
(2.5 mm Plate)
3.5 F.A.S.T. Guide ®
(3.5 mm Plate)
2.0 F.A.S.T. Guide ®
Adapter (Over 3.5
F.A.S.T. Guide ® )
•
•
• •
23 mm
28 mm
48 mm
SHORT (Cat. No. 8242-99-101)
MEDIUM (Cat. No. 8242-99-104)
LONG (Cat. No. 8242-99-105)
Compression Wires
Compression Wires can be used through F.A.S.T. Guides ® to provisionally position and hold a plate down on the bone. In addition, the 2.0 mm F.A.S.T. Guide ® Adapters
(Cat. No. 2312-18-007) can also be used to convert
3.5 mm plate F.A.S.T. Guides ® into provisional fixation holes as necessary.
If concentric positioning is not as critical, Compression
Wires may be used through F.A.S.T. Guides ® as well as directly through the locked holes, and length may be chosen according to bone geometry.
Recommended Compression Wire lengths and F.A.S.T.
Guide ® combinations ensure that the wires are used with the appropriate guide with adequate functional wire length, and allows for controlled wire positioning with regards to the locked hole (Table 1).
102
Figure 1: Short Figure 3: Long
Figure 2: Medium Figure 4
Provisional Fixation
2.5 mm Plate
Once the position of a 2.5 mm plate has been established over the bone/joint, a Short Compression Wire (Cat. No.
8242-99-101) can be drilled directly through the F.A.S.T.
Guide ® until the distal side of the bead on the wire bottoms out on the F.A.S.T. Guide ® , and the plate is held down to the bone as shown in (Figure 1). A Medium Compression
Wire (Cat. No. 8242-99-104) can also be utilized if a longer
K-wire is preferred (Figure 2).
Provisional Fixation
3.5 mm Plate
When a 3.5 mm plate has been selected and the position established over the bone/joint, a Long Compression Wire
(Cat. No. 8242-99-105) can be drilled through the 3.5 mm
F.A.S.T. Guide ® , or through a 2.0 mm F.A.S.T. Guide ®
Adapter inserted into a F.A.S.T. Guide ® to hold the plate down to the bone (Figure 3).
Currently, the Talar Neck Fracture Plate (Cat. No. 8240-
75-001) is the only plate in the A.L.P.S.
™ Total Foot System that has a K-wire hole in which a Short Compression
Wire may be utilized to provisionally compress the plate to the bone (Figure 4). Compression wires may also be utilized with other A.L.P.S.
™ platform plates that have
K-wire holes in the plate.
103
A.L.P.S.
™ Total Foot System
Screw Options and Insertion Techniques
The choice is yours; Biomet’s innovative locked plating technology offers the surgeon a comprehensive array of low profile screw options. Choose locking, nonlocking, or multi-directional locking screws according to need and without compromising plate profile.
Each threaded hole gives the surgeon an option of placing a non-locking screw within a locking hole.
105
A.L.P.S.
™ Total Foot System
Screw Options
2.5 mm Locking Screw:
(Cat. No. FPXX)
• Larger core diameter and shallower thread pitch for improved bending and shear strength compared to a standard 2.5 mm Cortical Screw
• Self tapping tip minimizes the need for pre-tapping and eases screw insertion
• Locking Screw head minimizes screw back-out and construct pullout
• When paired with the 2.5 mm Compression
Washer, it can be used as a compression screw in the 2.5 mm plate compression holes
• Square drive
• Available in lengths of 8 – 40 mm
2.5 mm Multi-Directional Threaded Peg:
(Cat. No. 1312111XX)
• CoCr Screws create new thread path in the plate
• Multi-Directional capability offers a 20 degree cone of angulation
• Locking Screw head minimizes screw back-out and construct pullout
• Square drive
• Available in lengths of 10 – 30 mm
2 .5 mm Non-Locking Screw:
(Cat. No. SPXX000)
• Self tapping tip minimizes the need for pre-tapping and eases screw insertion
• Square drive
• Available in lengths of 8 – 40 mm
2.5 mm Compression Washer:
(Cat. No. 1312-20-025)
• Convert only the 2.5 mm Locking Cortical Screw into a compression screw
• Designed to be used in the compression holes in the 2.5 mm plates
• Compression Washer is ONLY meant for use with the 2.5 mm Locking Cortical Screw
106
2.5 mm Locking/Non-Locking Screw Insertion
2.5 mm Cortical Locking Screw
(Cat. No. FPXX)
2.5 mm Non-Locking Screw
(Cat. No. SPXX000)
Figure 1 Figure 2
Step 1: Drill
Center the F.A.S.T. 2.0 mm Drill Bit w/ Mini-Quick
Connect (Cat. No. 2312-20-204) into the F.A.S.T. Guide ® , drill to desired length (Figure 1).
Step 2: Remove F.A.S.T. Guide
®
Using the 1.3 mm Square Screwdriver (Cat. No. 2312-18-
012) coupled to the Mini-Quick Connect Handle (Cat. No.
MQC) to remove the F.A.S.T. Guide ® (Figure 2).
Note: Plate compression to the bone must be achieved prior to the insertion of any locking screws. Compression can be achieved by the use of 2.5 mm Non-Locking
Screws. Also, the plate benders can be used with the
F.A.S.T. Guide ® to anatomically reduce the plate to the bone in-situ.
Caution: Do not begin drilling until the drill bit is perpendicular to and touches the bone. Inserting the drill bit into the F.A.S.T. Guide ® while the drill is on may cause damage to the drill bit or F.A.S.T. Guide ® .
107
A.L.P.S.
™ Total Foot System
2.5 mm Locking Screw Insertion
Figure 3 Figure 4
Step 3: Measure
Using the 2.0 mm/2.5 mm Bone Depth Gauge (Cat. No.
2312-20-125) measure screw length by taking a reading from the NON-F.G. line of the depth gauge (Figure 3).
Note: If the F.A.S.T. Guide ® is not removed before gauging the screw depth, use the FG scale on the Depth Gauge.
Step 4: Insertion
Insert the appropriate length Locking or Non-Locking
Screw with the 1.3 mm Square Screwdriver (Cat. No.
2312-18-012) and Mini-Quick Connect Handle (Cat. No.
MQC) (Figure 4).
108
2.5 mm Multi-Directional Locking Screw Insertion
2.5 mm Multi-Directional Locking Screw
(Cat. No. 1312111XX)
Figure 5 Figure 6
Step 1: Remove F.A.S.T. Guide
®
Using the 2.5 mm MDTP Driver (Cat. No. 2142-88-
007) coupled to the Min-Quick Connect Handle
(Cat. No. MQC) remove the F.A.S.T. Guide ® (Figure 5).
Step 2: Drill
Using the 2.7/2.0 mm Double Drill Guide (Cat. No. 9399-
99-435) and the F.A.S.T. 2.0 mm Drill Bit w/Mini-Quick
Connect (Cat. No. 2312-20-204) drill off-axis at an angle no greater than 10 degrees off center (20 degree cone)
(Figure 6).
109
A.L.P.S.
™ Total Foot System
2.5 mm Multi-Directional Locking Screw Insertion
Figure 7 Figure 8
Step 3: Measure
Using the 2.0 mm/2.5 mm Bone Depth Gauge (Cat. No.
2312-20-125) measure screw length by taking a reading from the NON-F.G. line (Figure 7).
Step 4: Insert Locking Screw
Insert the locking screw with the MDTP driver (Cat. No.
2142-88-007) and MQC Driver (Cat. No. MQC) (Figure 8).
Note: It is possible, with enough force, to drive the 2.5 mm
MDTPs through the plate. Stop inserting when the head of the screw is flush with the surface of the plate.
Note: Using a power screwdriver is not recommended for insertion of any locking screw. If using power, it should be at a slow speed, with the Torque-Limiting Adapter.
Perform all final screw tightening by hand.
110
111
A.L.P.S.
™ Total Foot System
Small Fragment Screw Options and Insertion Techniques
The choice is yours; Biomet’s innovative locked plating technology offers the surgeon a comprehensive array of low profile screw options. Choose locking, nonlocking, or multi-directional locking screws according to need and without compromising plate profile.
With the added feature of the low profile non-locking screw, each tapered threaded hole gives the surgeon an option of placing a non-locking screw within a locking hole.
113
A.L.P.S.
™ Total Foot System
Small Frag Screw Options
2.7 mm Locking Cortical Screw:
(Cat. No. 8163-27-0XX)
• Low profile head design reduces prominence beyond the plate
• Self tapping tip eases screw insertion
• Tapered screw head and triple lead thread helps ensure alignment of the screw head into the plate hole
• Tapered threaded head minimizes screw back-out and construct pullout
• T-15 drive
• Available in lengths of 10 – 50 mm
• Screw uses a 2.0 mm Marked Drill Bit Short
(Cat. No. 2142-88-008)
3.5 mm Locking Cortical Screw:
(Cat. No. 8161-35-0XX)
• Larger core diameter and shallower thread pitch for improved bending and shear strength compared to a standard 3.5 mm Cortical Screw
• Self tapping tip minimizes the need for pre-tapping and eases screw insertion
• Tapered screw head and triple lead thread helps ensure alignment of the screw head into the plate hole
• Tapered threaded head minimizes screw back-out and construct pullout
• T-15 drive
• Available in lengths of 10 – 50 mm
• Screw uses a 2.7 mm Drill Bit (Cat. No. 2141-27-070)
4.0 mm Locking Cancellous Screw:
(Cat. No. 8161-40-0XX)
• Larger thread diameter and an aggressive thread pitch for improved pull-out strength compared to the 3.5 mm Locking Cortical Screw, for revision and rescue operations.
• Self tapping tip minimizes the need for pre-tapping and eases screw insertion
• Tapered screw head an triple lead thread helps ensure alignment of the screw head into the plate hole
• Tapered threaded head minimizes screw back-out and construct pullout
• T-15 drive
• Available in lengths of 10 – 50 mm
• Screw uses a 2.7 mm Drill Bit (Cat. No. 2141-27-070)
114
Screw Options
3.5 mm Locking Multi-Directional Screw:
(Cat. No. 8163-35-0XX)
• Cobalt-Chrome screw with large core diameter
• Multi-Directional capability offers a 30 degree cone of angulation
• Creates own thread in plate to help provide strong and stable construct
• Self tapping tip minimizes the need for pre-tapping and eases screw insertion
• 2.2 mm Square Drive
• Available in lengths of 10 – 50 mm
• Screw uses the 2.7 mm Drill Bit (Cat. No. 2142-27-070)
3.5 mm Low Profile Non-Locking Screw:
(Cat. No.1312-18-0XX)
• Low profile head design reduces prominence beyond the plate
• Self tapping tip eases screw insertion
• Square drive for maximum torque delivery
• Type 2 anodized material for increased fatigue strength compared to 316 stainless steel and standard Ti alloy
• Available Low Profile Washer converts screw head to traditional Non-Locking Screw head (for use when the surgeon decides to use the screw on its own)
(Cat. No. 1312-18-000)
• Screw uses a 2.5 mm Drill Bit (Cat. No. 8290-29-070) and can be installed in any of the plates threaded holes
• Available in lengths of 10 – 50 mm
3.5 mm Low Profile Cortical Washer:
(Cat. No. 1312-18-000)
• Convert only the 3.5 mm Low Profile Non-locking
Screw into a compression screw
• Compression Washer is ONLY meant for use with the 3.5 mm Non-Locking Cortical Screw
115
A.L.P.S.
™ Total Foot System
2.7 mm Locking Screw Insertion
2.7 mm Cortical Locking Screw
(Cat. No. 8163-27-0XX)
Figure 1 Figure 2
Note: Plate compression to the bone must be achieved prior to the insertion of any locking screws. Compression can be achieved by the use of Reduction Forceps, Bone
Clamp, Provisional Fixation Pins or 3.5 mm Low Profile
Non-Locking Screws. Also, the plate benders can be used with the F.A.S.T. Guide ® to anatomically reduce the plate to the bone in-situ.
Step 1a: Drill and measure
Before drilling place the 2.0 Adapter Drill Sleeve (Cat. No.
2142-88-006) into the F.A.S.T. Guide ® . Next, insert the
2.0 mm Marked Drill Bit Short (Cat. No. 2142-88-008) into the F.A.S.T. Guide ® and slide 2.0 Adapter Drill Sleeve Short
(Cat. No. 2142-88-006) completely on top of the F.A.S.T.
Guide ® . Now drill to the desired depth, remove the drill while leaving the Measuring Sleeve in place and use the scale on the 2.0 Adapter Drill Sleeve Short to identify the appropriate length screw (Figure 1).
116
Do not begin drilling until the Drill Bit touches the bone. Inserting the drill bit into the F.A.S.T. Guide ® while the drill is on may cause damage to the Drill
Bit or F.A.S.T. Guide ® .
Step 1b: Measure alternative
Alternatively, the Small Frag Depth Gauge (Cat. No. 2142-
35-100) may be used to measure screw length after the
F.A.S.T. Guide ® is removed with the T-15 Driver by taking a direct reading from the LOCK line from the Small Frag
Depth Gauge.
Step 2: Remove F.A.S.T. Guide
®
Remove the F.A.S.T. Guide ® using the T-15 Driver (Cat.
No. 2142-15-070) (Figure 2).
Figure 3 Figure 4
Step 3: Insertion
Insert the Locking Screw with the T-15 Taper Driver
(Cat. No. 2142-15-070) coupled with the Torque-Limiting
Screw Driver Handle (Cat. No. 2141-18-001) (Figure 3).
Step 4: Alternative Insertion
Alternatively, the screw may be inserted under power using the T-15 Taper Driver (Cat. No. 2142-15-070) coupled to the Torque Limiting Power Adapter (Cat. No. 2312-18-020)
(Figure 4).
Note: Using a power screwdriver is not recommended for insertion of any locking screw. If using power, it should be at a slow speed, with the Torque-Limiting Adapter.
Perform all final screw tightening by hand.
117
A.L.P.S.
™ Total Foot System
3.5 mm & optional 4.0 mm Locking Screw Insertion
3.5 mm Cortical Locking Screw
(Cat. No. 8161-35-0XX)
4.0 mm Cancellous Locking Screw*
(Cat. No. 8161-40-0XX)
Figure 5 Figure 6
Note: Plate compression to the bone must be achieved prior to the insertion of any Locking Screws. Compression can be achieved by the use of Provisional Fixation Pins
(Cat. No. 8242-99-001) or 3.5 mm Low Profile Non-
Locking Screws. Also, the plate benders can be used with the F.A.S.T. Guide ® to anatomically reduce the plate to the bone in-situ.
Caution: Do not begin drilling until the Drill Bit touches the bone. Inserting the drill bit into the
F.A.S.T. Guide ® while the drill is on may cause damage to the Drill Bit or F.A.S.T. Guide ® .
Step 1a: Drill and Measure
Before drilling insert the 2.7 mm Calibrated Drill Bit (Cat.
No. 2142-27-070) into the F.A.S.T. Guide ® and slide the
Drill Measuring Sleeve (Cat. No. 8163-01-005) completely on top of the F.A.S.T. Guide ® . Next, drill to the desired depth, remove the drill while leaving the Measuring Sleeve in place and use the scale on the calibrated drill bit to identify the appropriate length screw (Figure 5).
Step 1b: Measure alternative
Alternatively, the Small Frag Depth Gauge may be used to measure screw length after the F.A.S.T. Guide ® is removed with the T-15 Driver by taking a direct reading from the LOCK line from the Small Frag Depth Gauge
(Cat. No. 2142-35-100).
Step 2: Remove F.A.S.T. Guide
®
Remove the F.A.S.T. Guide ® using the T-15 Driver (Cat.
No. 2142-15-070) (Figure 6).
118
*4.0 mm Cancellous Locking Screws are optional and can be obtained in the A.L.P.S.
™ Locking Small Fragment System
Figure 7 Figure 8
Step 3: Insertion
Insert the Locking Screw with the T-15 Taper Driver
(Cat. No. 2142-15-070) coupled with the Torque-Limiting
Screwdriver Handle (Cat. No. 2141-18-001) (Figure 7).
Step 4: Alternative Insertion
Alternatively, the screw may be inserted under power using the T-15 Taper Driver (Cat. No. 2142-15-070) coupled to the Torque Limiting Power Adapter (Cat. No.
2312-18-020) (Figure 8).
119
A.L.P.S.
™ Total Foot System
3.5 mm Multi-Directional Locking Screw Insertion
3.5 mm Multi-Directional Locking Screw (MDS)
(Cat. No. 8163-35-0XX)
Figure 9 Figure 10
Step 1: Remove F.A.S.T. Guide
®
Remove the F.A.S.T. Guide ® using the T-15 Driver (Cat.
No. 2142-15-070) (Figure 9).
Step 2: Drill
Choose the trajectory of the screw using the 2.7 mm end of the 2.0/2.7 mm Drill Guide (Cat. No. 9399-99-
435) and drill to the desired depth with up to 15 degrees of angulation from center (30 degree cone) through a threaded locking hole (Figure 10).
120
Figure 11 Figure 12
Step 3: Measure
Choose the appropriate the Multi-Directional Screw
(Cat. No. 8163-35-0XX) length with the Small Frag Depth
Gauge (Cat. No. 2142-35-100) by taking a direct reading from the LOCK line (locked line) reading of the Small Frag
Depth Gauge (Figure 11).
Step 4: Insertion
Insert the screw using T-15 driver (Cat. No. 8163-01-000) coupled to the Ratchet Handle (Cat. No. 8261-66-000)
(Figure 12).
Note: It is important not to use the Torque-Limiting Driver handle because it does not generate the necessary torque required to fully seat the MDS Screw into the threaded locking hole.
121
A.L.P.S.
™ Total Foot System
3.5 mm Multi-Directional Locking Screw Insertion
Figure 13
Step 4: Insertion (cont.)
Multi-Directional Locking Screws (MDS) allows up to 15 degrees of angulation from center (Figure 13).
122
3.5 mm Non-Locking Low Profile Screw Insertion
3.5 mm Cortical Low Profile Non-Locking Screw
(Cat. No.1312-18-0XX)
Figure 14 Figure 15
Step 1: Remove F.A.S.T. Guide
®
If non-locking screws are to be used through a locking hole, the F.A.S.T. Guide ® is removed using the T-15 Driver
(Cat. No. 2142-15-070) (Figure 14).
Step 2a: Threaded Hole Insertion
Place the 2.5 mm end of the 2.5/3.5 mm Drill Sleeve
(Cat. No. 8241-96-000) within the threaded hole and drill through both cortices with the 2.5 mm Drill Bit (Cat. No.
8290-29-070) (Figure 15).
123
A.L.P.S.
™ Total Foot System
3.5 mm Non-Locking Low Profile Screw Insertion
N
Neutral Position
E
N
E
Compressive
Position
Figure 16 Figure 17
The compression slots of the A.L.P.S.
™ Foot system are unidirectional and provide as much as 1.25 mm of compression per slot if drilled eccentricly. The direction of compression can be identified by observing the asymmetric nature of the compression slot.
Step 2b: Compression Hole
Insertion; Neutral insertion of
Non-Locking Screw
Place the 2.5 mm end of the 2.5/3.5 mm Drill Sleeve
(Cat. No. 8241-96-000) within the widest portion of the unidirectional compression slot and drill to the desired depth with the 2.5 mm Drill Bit (Cat. No. 8290-29-070)
(Figure 16).
Step 2c: Compression Hole
Insertion; Eccentric Insertion/
Dynamic Compression of
Non-Locking Screw
With the adjacent bone segment rigidly fixed to the plate with a screw, place the 2.5 mm end of the 2.5/3.5 mm
Drill Guide (Cat. No. 8241-96-000) eccentrically in the narrowest portion of the unidirectional slot and drill through both cortices using the 2.5 mm Drill Bit (Cat. No. 8290-
29-070) (Figure 17).
124
Figure 18 Figure 19
Step 3: Measure
Identify the appropriate screw length using the Small Frag
Depth Gauge (Cat. No. 2142-35-100) by taking a direct reading from the NON-L (Non-Locked) line (Figure 18).
Step 4: Insert
Insert the appropriate length 3.5 mm Low-Profile Non-
Locking Cortical Screw using the 2.2 mm Square Driver
(Cat. No. 8163-01-000) and Ratchet Handle (Cat. No.
8261-66-000) (Figure 19).
125
A.L.P.S.
™ Total Foot System
A.L.P.S.
™ Foot 2.7 – 3.5 Module
Instrumentation
Part Number
8299-60-030
2312-18-010
9399-99-435
8241-96-000
2142-15-070
8163-01-000
2142-35-100
Description
A.L.P.S.
™ Foot 2.7 – 3.5 Module
2.0 mm FG Converter Handle
Double Drill Guide 2.7/2.0 mm
Double Drill Guide 2.5/3.5
T-15 Tapered Driver
2.2 mm Square Driver
Small Frag Depth Gauge
Disposables
Part Number
8290-32-070
2142-88-008
2142-27-070
8290-29-070
2142-88-006
8163-01-005
Description
Drill Twist Scp 3.5 X 70 mm
Marked Drill Bit Short 2.0 mm
2.7 mm Calib Drill Bit
Drill Bit 2.5 mm
2.0 mm Drill Measuring Sleeve Short
2.7 mm Measuring Drill Sleeve
Implants
Product
2.7 mm Cortical
Locking Screws
Part Number
8163-27-010
8163-27-012
8163-27-014
8163-27-016
8163-27-018
8163-27-020
8163-27-022
8163-27-024
8163-27-026
8163-27-028
8163-27-030
8163-27-032
8163-27-034
8163-27-036
8163-27-038
8163-27-040
8163-27-042
8163-27-044
8163-27-046
8163-27-048
8163-27-050
Description
2.7 mm Cortical Locking Screw 10 mm
2.7 mm Cortical Locking Screw 12 mm
2.7 mm Cortical Locking Screw 14 mm
2.7 mm Cortical Locking Screw 16 mm
2.7 mm Cortical Locking Screw 18 mm
2.7 mm Cortical Locking Screw 20 mm
2.7 mm Cortical Locking Screw 22 mm
2.7 mm Cortical Locking Screw 24 mm
2.7 mm Cortical Locking Screw 26 mm
2.7 mm Cortical Locking Screw 28 mm
2.7 mm Cortical Locking Screw 30 mm
2.7 mm Cortical Locking Screw 32 mm
2.7 mm Cortical Locking Screw 34 mm
2.7 mm Cortical Locking Screw 36 mm
2.7 mm Cortical Locking Screw 38 mm
2.7 mm Cortical Locking Screw 40 mm
2.7 mm Cortical Locking Screw 42 mm
2.7 mm Cortical Locking Screw 44 mm
2.7 mm Cortical Locking Screw 46 mm
2.7 mm Cortical Locking Screw 48 mm
2.7 mm Cortical Locking Screw 50 mm
126
Implants
Product
3.5 mm Cortical
Locking Screws
3.5 mm CoCr
Multi Directional Screws
8161-35-046
8161-35-048
8161-35-050
8163-35-020
8163-35-022
8163-35-024
8163-35-026
8163-35-028
8163-35-030
8163-35-032
8163-35-034
8163-35-036
8163-35-038
8163-35-040
8163-35-042
8163-35-044
8163-35-046
8163-35-048
8163-35-050
Part Number
8161-35-010
8161-35-012
8161-35-014
8161-35-016
8161-35-018
8161-35-020
8161-35-022
8161-35-024
8161-35-026
8161-35-028
8161-35-030
8161-35-032
8161-35-034
8161-35-036
8161-35-038
8161-35-040
8161-35-042
8161-35-044
Description
3.5 mm Cortical Locking Screw 10 mm
3.5 mm Cortical Locking Screw 12 mm
3.5 mm Cortical Locking Screw 14 mm
3.5 mm Cortical Locking Screw 16 mm
3.5 mm Cortical Locking Screw 18 mm
3.5 mm Cortical Locking Screw 20 mm
3.5 mm Cortical Locking Screw 22 mm
3.5 mm Cortical Locking Screw 24 mm
3.5 mm Cortical Locking Screw 26 mm
3.5 mm Cortical Locking Screw 28 mm
3.5 mm Cortical Locking Screw 30 mm
3.5 mm Cortical Locking Screw 32 mm
3.5 mm Cortical Locking Screw 34 mm
3.5 mm Cortical Locking Screw 36 mm
3.5 mm Cortical Locking Screw 38 mm
3.5 mm Cortical Locking Screw 40 mm
3.5 mm Cortical Locking Screw 42 mm
3.5 mm Cortical Locking Screw 44 mm
3.5 mm Cortical Locking Screw 46 mm
3.5 mm Cortical Locking Screw 48 mm
3.5 mm Cortical Locking Screw 50 mm
3.5 mm Multi Directional Locking Screw 20 mm
3.5 mm Multi Directional Locking Screw 22 mm
3.5 mm Multi Directional Locking Screw 24 mm
3.5 mm Multi Directional Locking Screw 26 mm
3.5 mm Multi Directional Locking Screw 28 mm
3.5 mm Multi Directional Locking Screw 30 mm
3.5 mm Multi Directional Locking Screw 32 mm
3.5 mm Multi Directional Locking Screw 34 mm
3.5 mm Multi Directional Locking Screw 36 mm
3.5 mm Multi Directional Locking Screw 38 mm
3.5 mm Multi Directional Locking Screw 40 mm
3.5 mm Multi Directional Locking Screw 42 mm
3.5 mm Multi Directional Locking Screw 44 mm
3.5 mm Multi Directional Locking Screw 46 mm
3.5 mm Multi Directional Locking Screw 48 mm
3.5 mm Multi Directional Locking Screw 50 mm
127
A.L.P.S.
™ Total Foot System
A.L.P.S.
™ Foot 2.7 – 3.5 Module
Implants
Product
3.5 mm Low Profile
Non-Locking Cortical Screws
Part Number
1312-18-014
1312-18-016
1312-18-018
1312-18-020
1312-18-022
1312-18-024
1312-18-026
1312-18-028
1312-18-030
1312-18-032
1312-18-034
1312-18-036
1312-18-038
1312-18-040
1312-18-042
1312-18-044
1312-18-046
1312-18-048
1312-18-050
1213-18-000
Description
3.5 mm Low Profile Cortical 14 mm
3.5 mm Low Profile Cortical 16 mm
3.5 mm Low Profile Cortical 18 mm
3.5 mm Low Profile Cortical 20 mm
3.5 mm Low Profile Cortical 22 mm
3.5 mm Low Profile Cortical 24 mm
3.5 mm Low Profile Cortical 26 mm
3.5 mm Low Profile Cortical 28 mm
3.5 mm Low Profile Cortical 30 mm
3.5 mm Low Profile Cortical 32 mm
3.5 mm Low Profile Cortical 34 mm
3.5 mm Low Profile Cortical 36 mm
3.5 mm Low Profile Cortical 38 mm
3.5 mm Low Profile Cortical 40 mm
3.5 mm Low Profile Cortical 42 mm
3.5 mm Low Profile Cortical 44 mm
3.5 mm Low Profile Cortical 46 mm
3.5 mm Low Profile Cortical 48 mm
3.5 mm Low Profile Cortical 50 mm
3.5 mm Low Profile Cortical Washer
128
A.L.P.S.
™ Foot 2.5 Module
Instrumentation
Part Number
8299-60-040
2312-20-101
2312-20-100
2312-20-110
QCH
2312-18-014
2312-20-125
2142-88-007
2312-18-012
2142-75-001
2142-72-001
Description
A.L.P.S.
™ Foot 2.5 Module
2.5 End Bender
2.5 Bender
2.5 Plate Holder
Handle Quick Connect
2.5 mm Counterbore
2.5 mm Bone Depth Gage
MDTP Driver
1.3 mm Square Screwdriver
Template Talar Neck
Template Navicular
Disposables
Part Number
FDB20
Description
Drill Bit Fast 2.0 mm
Implants
1 st
Product
Low Profile Cortical Washer
MTP Fusion
Talar Neck Plate
Navicular Plate
Metatarsal Fracture Plates*
Part Number
1312-20-025
8240-71-001
8240-71-101
8240-75-001
8240-72-001
8240-72-101
1312-20-251
1312-20-255
1 st
Description
2.5 mm Threaded Washer
1 st MTP Fusion Left
MTP Fusion Right
Talar Neck Plate
Navicular Plate Left
Navicular Plate Right
2.5 mm Locking Plate, Straight
2.5 mm Locking Plate, Web
* For stabilization and fixation of small bone fragments in fresh fracture, revision procedures, joint fusion and reconstruction
of small bones of the hand, foot, wrist, humerus, scapula, finger, toe, pelvis and craniomaxillofacial skeleton, particularly in osteopenic bone.
129
A.L.P.S.
™ Total Foot System
A.L.P.S.
™ Foot 2.5 Module
Implants
Product
2.5 mm FP Locking Screw
2.5 mm Multi Directional
Threaded Peg
FP38
FP40
1312-20-025
1312-11-110
1312-11-112
1312-11-114
1312-11-116
1312-11-118
1312-11-120
1312-11-122
1312-11-124
1312-11-126
1312-11-128
1312-11-130
FP22
FP24
FP26
FP28
FP30
FP32
FP34
FP36
Part Number
FP08
FP10
FP12
FP14
FP16
FP18
FP20
Description
Peg Full Thread 2.5 X 8 mm
Peg Full Thread 2.5 X 10 mm
Peg Full Thread 2.5 X 12 mm
Peg Full Thread 2.5 X 14 mm
Peg Full Thread 2.5 X 16 mm
Peg Full Thread 2.5 X 18 mm
Peg Full Thread 2.5 X 20 mm
Peg Full Thread 2.5 X 22 mm
Peg Full Thread 2.5 X 24 mm
Peg Full Thread 2.5 X 26 mm
Peg Full Thread 2.5 X 28 mm
Peg Full Thread 2.5 X 30 mm
Peg Full Thread 2.5 X 32 mm
Peg Full Thread 2.5 X 34 mm
Peg Full Thread 2.5 X 36 mm
Peg Full Thread 2.5 X 38 mm
Peg Full Thread 2.5 X 40 mm
2.5 mm Compression Washer
Multi Directional Threaded Peg 2.5 X 10 mm
Multi Directional Threaded Peg 2.5 X 12 mm
Multi Directional Threaded Peg 2.5 X 14 mm
Multi Directional Threaded Peg 2.5 X 16 mm
Multi Directional Threaded Peg 2.5 X 18 mm
Multi Directional Threaded Peg 2.5 X 20 mm
Multi Directional Threaded Peg 2.5 X 22 mm
Multi Directional Threaded Peg 2.5 X 24 mm
Multi Directional Threaded Peg 2.5 X 26 mm
Multi Directional Threaded Peg 2.5 X 28 mm
Multi Directional Threaded Peg 2.5 X 30 mm
130
Implants
Product
2.5 mm SP
Non-Locking Screws
Part Number
SP08000
SP10000
SP12000
SP14000
SP16000
SP18000
SP20000
SP22000
SP24000
SP26000
SP28000
SP30000
SP32000
SP34000
SP36000
SP38000
SP40000
Description
Peg Screw 2.5 X 8 mm
Peg Screw 2.5 X 10 mm
Peg Screw 2.5 X 12 mm
Peg Screw 2.5 X 14 mm
Peg Screw 2.5 X 16 mm
Peg Screw 2.5 X 18 mm
Peg Screw 2.5 X 20 mm
Peg Screw 2.5 X 22 mm
Peg Screw 2.5 X 24 mm
Peg Screw 2.5 X 26 mm
Peg Screw 2.5 X 28 mm
Peg Screw 2.5 X 30 mm
Peg Screw 2.5 X 32 mm
Peg Screw 2.5 X 34 mm
Peg Screw 2.5 X 36 mm
Peg Screw 2.5 X 38 mm
Peg Screw 2.5 X 40 mm
131
A.L.P.S.
™ Total Foot System
A.L.P.S.
™ Foot 3.5 Plates and Instruments Module
Instrumentation
Part Number
8299-60-020
2142-88-003
2142-88-004
2142-88-005
2312-18-007
2142-08-001
2142-08-003
2142-74-001
2142-74-003
Description
A.L.P.S.
™ Foot 3.5
Plates and Instruments
Compression Distraction Device
Foot Multi-Planar Bender
Double F.A.S.T. Guide ® Benders
2.0 mm F.A.S.T. Guide ® Adapter
Template Locking Calc Sm
Template Locking Calc Lg
Template Midfoot Fusion Sm
Template Midfoot Fusion Lg
Part Number
2142-77-020
2142-76-101
2142-77-021
2142-77-022
Disposables
Part Number
14425-6
14179-6.
2142-88-009
Description
Template Compression Fusion
Template Medial Clmn Fusion
Template Closed Fusion Sm
Template Closed Fusion Lg
Description
1.6 mm X 6In K-Wire
2.0 mm X 6In K-Wire
4.5 mm Canc Self-Drill Pin Ao
Implants
Product
Single Joint Fusion Plate
Lateral Column Lengthening Plate
Midfoot Fusion Plate
Medial Column Fusion Plate
Locking Calcaneus Plate
Part Number
8240-77-020
8240-77-021
8240-77-022
8240-73-000
8240-73-001
8240-73-002
8240-73-003
8240-74-001
8240-74-003
8240-76-001
8240-76-101
8162-08-001
8162-08-003
8162-08-004
8162-09-001
8162-09-003
8162-09-004
Description
Compression Fusion Plate
Closed Fusion Plate Small
Closed Fusion Plate Large
No Wedge
Small Wedge
Medium Wedge
Large Wedge
Midfoot Fusion Plate Small
Midfoot Fusion Plate Large
Medial Column Fusion Plate Left
Medial Column Fusion Plate Right
Locking Calcaneus Plate Small Left
Locking Calcaneus Plate Large Left
Locking Calcaneus Plate XL Left
Locking Calcaneus Plate Small Right
Locking Calcaneus Plate Large Right
Locking Calcaneus Plate XL Right
132
A.L.P.S.
™ Foot Instruments Tray
Product
Foot Instrument Tray
Part Number
8299-60-002
2312-18-020
8261-66-000
2141-18-001
2312-18-021
2142-88-003
Description
A.L.P.S.
™ Foot Instrument Tray
Trq Lmt Pwr Adpt Ao 2Nm
Ratchet Screwdriver Handle Sm
Sm Torque Limiting Driver
T-15 Tapered Driver Short
Distraction/Compression Device
133
A.L.P.S.
™ Total Foot System
A.L.P.S.
™ Foot Line Extension Components
Instrumentation Cases and Trays
Part Number
010000363
010000364
010000365
010000366
010000367
110010566
010000368
010000369
010000370
010000371
010000372
110010565
2312-18-007
2312-20-212
Disposables
Part Number
8242-99-101
8242-99-104
8242-99-105
14425-6
Description
Cup Reamer 14 mm
Cup Reamer 16 mm
Cup Reamer 18 mm
Cup Reamer 20 mm
Cup Reamer 22 mm
Cup Reamer 24 mm
Cone Reamer 14 mm
Cone Reamer 16 mm
Cone Reamer 18 mm
Cone Reamer 20 mm
Cone Reamer 22 mm
Cone Reamer 24 mm
2.0 mm F.A.S.T. Guide ® Adapter
1 st MTP Fusion Plate Bender
Description
Compression Wire Short
Compression Wire Medium
Compression Wire Long
K-Wire 1.6 mm x 6 In Bayonet
Part Number
8299-60-003
8299-60-004
8299-60-005
8299-60-006
8299-60-007
8299-60-008
Implants
Part Number
8240-76-002
8240-71-001
8240-71-101
8240-71-002
8240-71-102
8240-77-023
8240-77-024
Description
A.L.P.S.
™ Foot Extension Lid
A.L.P.S.
™ Foot Extension Base
A.L.P.S.
™ Foot Extension Case
A.L.P.S.
™ Cup and Cone Reamer Case
A.L.P.S.
™ Cup and Cone Reamer Base
Cup and Cone Reamer Lid
Description
Lapidus Plate
1 st MTP Fusion Plate Left
1 st MTP Fusion Plate Right
1 st MTP Fusion Plate Large Left
1 st MTP Fusion Plate Large Right
Small 2.5 mm In-Line Fusion Plate
Large 3.5 mm In-Line Fusion Plate
134
Indications and Contraindications
INDICATIoNS FoR USE
FoR A.L.P.S.
™ ToTAL FooT SySTEm:
For stabilization and fixation of fractures, revision procedures, fusions, reconstructions (osteotomy) and non-unions of the bones of the hand, foot, wrist, ankle, finger, toe, humerus, olecranon, clavicle, scapula and pelvis, particularly in osteopenic bone. The system can be used in both adult and pediatric patients (adolescents [>12-21 years of age]), where the implant would not cross open epiphyseal plates in skeletally immature patients.
Important: This Essential Product Information does not include all of the information necessary for selection and use of a device. Please see full labeling for all necessary information.
The use of metallic surgical appliances provides the orthopaedic surgeon a means of bone fixation and helps generally in the management of fractures and reconstructive surgeries. These implants are intended as a guide to normal healing, and are NOT intended to replace normal body structure or bear the weight of the body in the presence of incomplete bone healing. Delayed unions or nonunions in the presence of load bearing or weight bearing might eventually cause the implant to break due to metal fatigue. All metal surgical implants are subjected to repeated stress in use, which can result in metal fatigue.
CoNTRAINDICATIoNS
Screws, plates, intramedullary nails, compression hip screws, pins and wires are contraindicated in: active infection, conditions which tend to retard healing such as blood supply limitations, previous infections, insufficient quantity or quality of bone to permit stabilization of the fracture complex and/or fusion of the joints, conditions that restrict the patient’s ability or willingness to follow postoperative instructions during the healing process, foreign body sensitivity, and cases where the implant(s) would cross open epiphyseal plates in skeletally immature patients.
ADDITIoNAL CoNTRAINDICATIoN
FoR oRThoPAEDIC SCREwS AND PLATES oNLy
Cases with malignant primary or metastatic tumors which preclude adequate bone support or screw fixations, unless supplemental fixation or stabilization methods are utilized.
wARNINGS AND PRECAUTIoNS
In using partial weight bearing or nonweight bearing appliances
(orthopaedic devices other than prostheses), a surgeon should be aware that no partial weight bearing or nonweight bearing device can be expected to withstand the unsupported stresses of full weight bearing.
ADvERSE EvENTS
The following are the most frequent adverse events after fixation with orthopaedic screws, plates, intramedullary nails, compression hip screws, pins and wires: loosening, bending, cracking or fracture of the components or loss of fixation in bone attributable to nonunion, osteoporosis, markedly unstable comminuted fractures; loss of anatomic with nonunion or malunion with rotation or angulation; infection, both deep and superficial; and allergies and other adverse reactions to the device material. Surgeons should take care when targeting, drilling and placing proximal screws through all tibials nail which include oblique locking options. Care should be taken as the drill bit is advanced to penetrate the far cortex. Advancing the drill bit too far in this area may cause injury to the deep peroneal nerve. Fluoroscopy should be used to verify correct positioning of the drill bit.
NoTE: Do NOT remove F.A.S.T. Guide ® inserts prior to sterilization.
135
References
1. Internal data on file DVA-107504.
All trademarks herein are the property of Biomet, Inc. or its subsidiaries unless otherwise indicated.
This material is intended for the sole use and benefit of the Biomet sales force and physicians. It is not to be redistributed, duplicated or disclosed without the express written consent of Biomet.
For product information, including indications, contraindications, warnings, precautions and potential adverse effects, see the package insert herein and Biomet’s website.
©2013 Biomet Trauma • Form No. BMET0008.4 • REV1213
Responsible Manufacturer
Biomet Trauma
P.O. Box 587
56 E. Bell Drive
Warsaw, Indiana 46581-0587
USA www.biomet.com
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