Orthopedic Foot Instruments. Dedicated instruments for reconstructive foot surgery.

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1 Orthopedic Foot Instruments. Dedicated instruments for reconstructive foot surgery. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.

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3 Table of Contents Introduction Orthopedic Foot Instruments 2 Indications 4 Handling Techniques Compression/Distraction Device Set 5 Bone Harvesting Set 11 Chisel Set 18 Product Information Instruments 21 Sets 24 Replacement Articles 27 Image intensifier control Warning This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: Orthopedic Foot Instruments Surgical Technique DePuy Synthes 1

4 Orthopedic Foot Instruments. Dedicated instruments for reconstructive foot surgery. System Overview The Orthopedic Foot Instruments have been designed to perform specific procedures on the foot more efficiently. The system consists of three modular sets: Compression/Distraction Device Set, Bone Harvesting Set and Chisel Set. Compression/Distraction Device Set, in modular tray Fields of application Compression and distraction of joints or bones Fracture treatment Arthrodeses (e.g. subtalar arthrodesis) Osteotomies (e.g. lateral calcaneal lengthening osteotomy) Bone Harvesting Set, in modular tray Fields of application Bone harvesting (e.g. from the calcaneus, proximal tibia or iliac crest) Bone biopsies 2 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

5 Features and Benefits Chisel Set, in modular tray Fields of application Preparation of joints for arthrodeses Removal of joint cartilage and bone Removal of exostoses Removal of osteophytes Compression/Distraction Device Set Placement of 2.0, 2.5 and 3.0 mm Kirschner wires at various angles Precise compression/distraction mechanism Two extra Kirschner wire holes for more stability Bone Harvesting Set Different trephine diameters enable accurate local bone grafting Corresponding extraction attachments enable the correct removal of bone graft Chisel Set Different shapes of chisels and a cartilage remover facilitate proper joint preparation Silicon handles for optimal grip Orthopedic Foot Instruments Surgical Technique DePuy Synthes 3

6 Indications Fractures in the foot and ankle Skeletal deformities and/or skeletal defects in the foot and ankle Instability of the foot and ankle Tumors in bones and cartilage in the foot and ankle Non-unions of small and large bones in the foot and ankle Pseudoarthrosis in the foot and ankle Osteoarthritis in the foot and ankle Rheumatoid arthritis in the foot and ankle Exostoses in the foot and ankle 4 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

7 Handling Techniques Compression/Distraction Device Set Set Compression/Distraction Device Set for Orthopedic Foot Instruments, with Lid, with Contents Set content Compression/Distraction Device for Foot and Ankle Holding Sleeve B 2.0 mm for Compression/Distraction Device for Foot and Ankle Holding Sleeve B 2.5 mm for Compression/Distraction Device for Foot and Ankle Holding Sleeve B 3.0 mm for Compression/Distraction Device for Foot and Ankle Kirschner Wire B 2.5 mm with trocar tip, length 150 mm, Stainless Steel Kirschner Wire B 2.5 mm with threaded tip, length 150/15 mm, Stainless Steel Kirschner Wire B 2.0 mm with threaded tip, length 150/15 mm, Stainless Steel Kirschner Wire B 3.0 mm with threaded tip, length 150/15 mm, Stainless Steel Holding Sleeve Tightening Device for Compression/Distraction Device Orthopedic Foot Instruments Surgical Technique DePuy Synthes 5

8 Handling Techniques Compression/Distraction Device Set 1 Preparation Expose the indicated area. The approach will depend on the surgical procedure. 2 Prepare Compression/Distraction Device Instruments Compression/Distraction Device for Foot and Ankle Holding Sleeve B 2.0 mm for Compression/Distraction Device for Foot and Ankle Holding Sleeve B 2.5 mm for Compression/Distraction Device for Foot and Ankle Holding Sleeve B 3.0 mm for Compression/Distraction Device for Foot and Ankle Thread the corresponding holding sleeves into the threaded fixation holes of the fixation arms. For 2.0 mm Kirschner wires use 2.0 mm holding sleeves. For 2.5 mm Kirschner wires use 2.5 mm holding sleeves. For 3.0 mm Kirschner wires use 3.0 mm holding sleeves. Note: Do not tighten holding sleeves at this point. 6 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

9 Open all locking-clamps of the compression/distraction device. Adjust the rotation and distance of the arms until initial alignment for the surgical procedure is defined. Note: lock the rotational mechanism first lock both arms adjust space between the arms Note: A range of different adjustment approaches may be used. Orthopedic Foot Instruments Surgical Technique DePuy Synthes 7

10 Handling Techniques Compression/Distraction Device Set 3 Insert Kirschner wires Instruments Kirschner Wire B 2.5 mm with trocar tip, length 150 mm, Stainless Steel Kirschner Wire B 2.5 mm with threaded tip, length 150/15 mm, Stainless Steel Kirschner Wire B 2.0 mm with threaded tip, length 150/15 mm, Stainless Steel Kirschner Wire B 3.0 mm with threaded tip, length 150/15 mm, Stainless Steel Holding Sleeve Tightening Device for Compression/Distraction Device Position the device in such a way that the ends of the holding sleeves are as close to the bone as possible. Drill two Kirschner wires through the corresponding holding sleeves into the bone. 8 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

11 Finger-tighten the holding sleeves. This will fix the device to the Kirschner wires. The blue tightening device may be used to achieve a stronger fixation between the holding sleeve and the Kirschner wire. Precaution: Apart from the blue tightening device, do not use any other instruments to tighten or loosen the holding sleeves as they may cause damage. If more stability is desired, additional 2.0 mm or 2.5 mm Kirschner wires can be drilled through the extra Kirschner wire holes of the arms. Orthopedic Foot Instruments Surgical Technique DePuy Synthes 9

12 Handling Techniques Compression/Distraction Device Set 4 Compress or distract Perform the surgical procedure once the Kirschner wires have been inserted. Choose whether compression or distraction is desired by adjusting the switch mechanism. Turn the wing bolt to compress or distract. Warning: Avoid excessive distraction. Too much distraction can damage the surrounding soft tissue. 5 Remove compression/distraction device Loosen the holding sleeves first, then open the locking clamps. Note: Use the blue tightening device to loosen the holding sleeves. Carefully remove the device. Remove Kirschner wires. 11 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

13 Handling Techniques Bone Harvesting Set Set Bone Harvesting Set for Orthopedic Foot Instruments, with Lid, with Contents Set content Handle, long, with Quick Coupling or Handle, short, with Quick Coupling Guide Wire B 3.2 mm with Stop, tip 1.6 mm, Stainless Steel Shaft for Trephine and Extraction Attachment Stylet for Trephine and Extraction Attachment Trephine Attachment B 5.5 mm Trephine Attachment B 7.0 mm Trephine Attachment B 8.5 mm Trephine Attachment B 9.5 mm Trephine Attachment B 10.5 mm Trephine Attachment B 12.5 mm Trephine Attachment B 14.0 mm Extraction Attachment B 5.5 mm Extraction Attachment B 7.0 mm Extraction Attachment B 8.5 mm Orthopedic Foot Instruments Surgical Technique DePuy Synthes 11

14 Handling Techniques Bone Harvesting Set Extraction Attachment B 9.5 mm Extraction Attachment B 10.5 mm Extraction Attachment B 12.5 mm Extraction Attachment B 14.0 mm Warning: Trephines have sharp cutting edges that may cause injury. Handle the attachments with care. Damage to the cutting edges may cause failure and will alter the precision of the instrument. Only use instruments with sharp edges. 11 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

15 1 Preparation Expose the indicated area. The approach will depend on the surgical procedure. 2 Place guide wire Instrument Guide Wire B 3.2 mm with Stop, tip 1.6 mm, Stainless Steel Drill the guide wire into the location where bone removal is required. Precaution: Drill the 3.2 mm guide wire until the stop at the end of the 1.2 mm tip. Note: In case that insertion of the guide wire by hand is not possible, use a power tool to drill the guide wire into the bone. Orthopedic Foot Instruments Surgical Technique DePuy Synthes 11

16 Handling Techniques Bone Harvesting Set 3 Cut bone graft Instruments Handle, long, with Quick Coupling or Handle, short, with Quick Coupling Shaft for Trephine and Extraction Attachment Trephine Attachment B 5.5 mm Trephine Attachment B 7.0 mm Trephine Attachment B 8.5 mm Trephine Attachment B 9.5 mm Trephine Attachment B 10.5 mm Trephine Attachment B 12.5 mm Trephine Attachment B 14.0 mm Attach the shaft for trephine and extraction attachments to a handle. Select the preferred trephine size and attach it to the shaft. Slide the trephine over the guide wire to the bone. Note: The trephine cannot be disengaged from the shaft when it is inserted over the guide wire. 11 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

17 Use gentle rotational movements to cut into the bone. Use the guide wire to read the length of the bone graft. Cut to the desired depth. The extracted bone graft should remain in the trephine. Note: If the bone graft cannot be removed with the trephine, use the bone extraction attachment to remove the bone graft from the bone. This technique is described on page 18. Orthopedic Foot Instruments Surgical Technique DePuy Synthes 11

18 Handling Techniques Bone Harvesting Set 4 Remove bone graft from trephine Instrument Stylet for Trephine and Extraction Attachment Remove the handle and insert the stylet into the back of the trephine shaft (1). Push the bone graft carefully out from the front of the trephine along with the guide wire (2) DePuy Synthes Orthopedic Foot Instruments Surgical Technique

19 Removal of bone graft with the bone extraction attachment Instruments Handle, long, with Quick Coupling or Handle, short, with Quick Coupling Shaft for Trephine and Extraction Attachment Extraction Attachment B 5.5 mm Extraction Attachment B 7.0 mm Extraction Attachment B 8.5 mm Extraction Attachment B 9.5 mm Extraction Attachment B 10.5 mm Extraction Attachment B 12.5 mm Extraction Attachment B 14.0 mm Note: All trephines have a corresponding size extraction attachment. Slide the extraction attachment over the guide wire and insert it until you reach the limited depth (the handle should not rotate). To break the graft dowel free, turn the holder slowly until you hear a cracking noise or feel no more resistance in turning. Remove the holder. Both the bone dowel and the guide wire remain in the extraction attachment. The technique to remove the bone graft is the same as when using a trephine. Note It is possible to use a hammer in combination with the handles. Use light, controlled hammer blows. Orthopedic Foot Instruments Surgical Technique DePuy Synthes 11

20 Handling Techniques Chisel Set Set Chisel Set for Orthopedic Foot Instruments, with Lid, with Contents Set content Handle, long, with Quick Coupling or Handle, short, with Quick Coupling Cartilage Remover, for Foot Chisel, for Foot, straight, narrow, width 10 mm, length 124 mm Chisel, for Foot, straight, wide, width 15 mm, length 124 mm Chisel, for Foot, 20 bend, narrow, width 10 mm, length 124 mm Chisel, for Foot, 20 bend, wide, width 15 mm, length 124 mm Chisel, for Foot, curved, narrow, width 10 mm, length 124 mm Chisel, for Foot, curved, wide, width 15 mm, length 124 mm Precaution Chisels and cartilage remover have sharp cutting edges that may cause injury. Handle the instruments with care. Damage to the cutting edges may cause failure and will alter the precision of the instrument. Only use instruments with sharp edges. 11 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

21 1 Preparation Expose the indicated area. The approach will depend on the surgical procedure. 2 Choose instrument Instruments Handle, long, with Quick Coupling or Handle, short, with Quick Coupling Cartilage Remover, for Foot Chisel, for Foot, straight, narrow, width 10 mm, length 124 mm Chisel, for Foot, straight, wide, width 15 mm, length 124 mm Chisel, for Foot, 20 bend, narrow, width 10 mm, length 124 mm Chisel, for Foot, 20 bend, wide, width 15 mm, length 124 mm Chisel, for Foot, curved, narrow, width 10 mm, length 124 mm Chisel, for Foot, curved, wide, width 15 mm, length 124 mm Attach the desired chisel or the cartilage remover to a handle. Orthopedic Foot Instruments Surgical Technique DePuy Synthes 11

22 Handling Techniques Chisel Set 3 Prepare joints and/or bones Note: It is possible to use a hammer in combination with the handles. Use light, controlled hammer blows. 22 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

23 Instruments Compression/Distraction Device for Foot and Ankle Holding Sleeve B 2.0 mm for Compression/Distraction Device for Foot and Ankle Holding Sleeve B 2.5 mm for Compression/Distraction Device for Foot and Ankle Holding Sleeve B 3.0 mm for Compression/Distraction Device for Foot and Ankle * Kirschner Wire B 2.5 mm with trocar tip, length 150 mm, Stainless Steel * Kirschner Wire B 2.5 mm with threaded tip, length 150/15 mm, Stainless Steel * Kirschner Wire B 2.0 mm with threaded tip, length 150/15 mm, Stainless Steel * Kirschner Wire B 3.0 mm with threaded tip, length 150/15 mm, Stainless Steel Handle, long, with Quick Coupling Holding Sleeve Tightening Device for Compression/Distraction Device *Add suffix «S» to article number to order sterile product. Orthopedic Foot Instruments Surgical Technique DePuy Synthes 21

24 Instruments Handle, short, with Quick Coupling Cartilage Remover, for Foot Chisel, for Foot, straight, narrow, width 10 mm, length 124 mm Chisel, for Foot, straight, wide, width 15 mm, length 124 mm Chisel, for Foot, 20 bend, narrow, width 10 mm, length 124 mm Chisel, for Foot, 20 bend, wide, width 15 mm, length 124 mm Chisel, for Foot, curved, narrow, width 10 mm, length 124 mm Chisel, for Foot, curved, wide, width 15 mm, length 124 mm Shaft for trephine and extraction attachment * Guide Wire B 3.2 mm with Stop, tip 1.6 mm, Stainless Steel Stylet for trephine and extraction attachment *Add suffix S to article to order sterile product. 22 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

25 Trephine Attachments Trephine Attachment B 5.5 mm Trephine Attachment B 7.0 mm Trephine Attachment B 8.5 mm Trephine Attachment B 9.5 mm Trephine Attachment B 10.5 mm Trephine Attachment B 12.5 mm Trephine Attachment B 14.0 mm Extraction Attachments Extraction Attachment B 5.5 mm Extraction Attachment B 7.0 mm Extraction Attachment B 8.5 mm Extraction Attachment B 9.5 mm Extraction Attachment B 10.5 mm Extraction Attachment B 12.5 mm Extraction Attachment B 14.0 mm Orthopedic Foot Instruments Surgical Technique DePuy Synthes 23

26 Sets Compression/Distraction Device Set for Orthopedic Foot Instruments, with Lid, with Contents Art. no. Description Quantity Compression/Distraction Device for Foot and Ankle Holding Sleeve B 2.0 mm for Compression/Distraction Device for Foot and Ankle Holding Sleeve B 2.5 mm for Compression/Distraction Device for Foot and Ankle Holding Sleeve B 3.0 mm for Compression/Distraction Device for Foot and Ankle Kirschner Wire B 2.5 mm with trocar tip, length 150 mm, Stainless Steel, pack of 10 units Kirschner Wire B 2.5 mm with threaded tip, length 150/15 mm, Stainless Steel, pack of 10 units Kirschner Wire B 2.0 mm with threaded tip, length 150/15 mm, Stainless Steel, pack of 10 units Kirschner Wire B 3.0 mm with threaded tip, length 150/15 mm, Stainless Steel, pack of 10 units Lid for Instrument Tray, size ¼ Tray for Compression/Distraction Device, for Orthopedic Foot Instruments, without Lid, without Contents 1 24 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

27 Chisel Set for Orthopedic Foot Instruments, with Lid, with Contents Art. no. Description Quantity Handle, short, with Quick Coupling Cartilage Remover, for Foot Chisel, for Foot, straight, narrow, width 10 mm, length 124 mm Chisel, for Foot, straight, wide, width 15 mm, length 124 mm Chisel, for Foot, 20 bend, narrow, width 10 mm, length 124 mm Chisel, for Foot, 20 bend, wide, width 15 mm, length 124 mm Chisel, for Foot, curved, narrow, width 10 mm, length 124 mm Chisel, for Foot, curved, wide, width 15 mm, length 124 mm Lid for Instrument Tray, size ¼ Tray for Chisel, for Orthopedic Foot Instruments, without Lid, without Contents Module for Chisels, for Orthopedic Foot Instruments, without Lid, without Contents 2 Orthopedic Foot Instruments Surgical Technique DePuy Synthes 22

28 Sets Bone Harvesting Set for Orthopedic Foot Instruments, with Lid, with Contents Art. no. Description Quantity Handle, long, with Quick Coupling Shaft for Trephine and Extraction Attachment Guide Wire B 3.2 mm with Stop, tip 1.6 mm, Stainless Steel Stylet for Trephine and Extraction Attachment Trephine Attachment B 5.5 mm Trephine Attachment B 7.0 mm Trephine Attachment B 8.5 mm Trephine Attachment B 9.5 mm Trephine Attachment B 10.5 mm Optional Trephine Attachment B 12.5 mm Optional Trephine Attachment B 14.0 mm Optional Extraction Attachment B 5.5 mm Extraction Attachment B 7.0 mm Extraction Attachment B 8.5 mm Extraction Attachment B 9.5 mm Extraction Attachment B 10.5 mm Optional Extraction Attachment B 12.5 mm Optional Extraction Attachment B 14.0 mm Optional Tray for Hollow Reamer and Instruments for Bone Graft Harvesting, for Orthopedic Foot Instruments, without Lid, without Contents Lid for Instrument Tray, size ¼ Module for Bone Harvesting Trephines, for Orthopedic Foot Instruments, without Lid, without Contents Module for Bone Harvesting Instruments, for Orthopedic Foot Instruments, without Lid, without Contents 1 22 DePuy Synthes Orthopedic Foot Instruments Surgical Technique

29 Replacement Articles Spring for Handles Spring for Compression/Distraction Device For detailed information ask your Synthes sales representative. Orthopedic Foot Instruments Surgical Technique DePuy Synthes 22

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32 DSEM/TRM/0815/ /15 Synthes GmbH Eimattstrasse Oberdorf Switzerland Tel: Fax: This publication is not intended for distribution in the USA. All surgical techniques are available as PDF files at DePuy Synthes Trauma, a division of Synthes GmbH All rights reserved