FRSÃ¢Â„Â¢ SCREW FOREFOOT RECONSTRUCTION SYSTEM – Biomet · · FRSÃ‚Â® Fusion and Reconstruction System Standard Staple. BAROUK Screw Developed by yntheses of small bones / fragments Threaded head can be countersunk. S.1 This easy to use fixation device has been. 2 Contents BAROUK Screw 2 FRS Screw 3 TWISTOFF Screw 4 MEMORY 12 and 20 Staples 5 VARISATION Staple 6 BAROUK Screw Surgical Technique 7.
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Hallux Valgus Osteotomies Scre Osteosynthesis 1. Fixation of fracture or osteotomies of the foot such as: Osteotomies of the lesser metatarsal such as a Weil osteotomy Twist-off feature allows for a clean break between shank and screw, as screw head engages bone Titanium alloy construction for increased implant strength and biocompatibility Design enables tightening or removal with a dedicated screwdriver One-piece design that supports direct connection to a drill or large diameter pin driver Compression capabilities with a threadfree segment that achieves automatic compression at the osteotomy site Self-drilling and self-tapping with a tapered flat head to ensure cortical drilling Size configuration: The staple has built-in elasticity which provides dynamic compression, even when secondary osteoporotic resorption occurs at fragment ends.
Indications for the 12 mm Memory Staple: Osteotomies of the first phalanx of the foot Indications for the 20 mm Memory Staple: Arthrodesis of the first metatarsal phalangeal joint Permanent compression gives the construct immediate and lasting stability Construct that increases stability: Extra-articular osteotomies of the forefoot Sizes include 1 mm diameter and 8 and 10 mm wide Stainless steel construction Dedicated instrumentation designed to ease implant insertion Straight and oblique designs 6.
This incision is extended anteriorly and the abductor hallucis is released from barou, phalangeal insertion.
Foot and Ankle Solutions by Zimmer Biomet
Thus, following Scarf osteotomy, the metatarsal head will position itself above sesamoid bones Figure 2. Figure 1 Figure 2 Approach and Exostosectomy Proximal midplantar dissection provides exposure of the barou margin and the plantar surface, which are fundamental references for the longitudinal cut.
Longitudinal resection is performed in the alignment of the medial aspect of the metatarsal shaft.
Care should be taken to avoid damage to the medial plantar artery Figure 3. Figure 3 Scarf cuts – Longitudinal cut On the medial aspect, it should parallel the proximal medial border, and therefore be oblique and directed anteriorly and dorsally. It reaches the head 3 mm under its superior margin.
Then the oblique longitudinal cut parallels the plantar surface, runs laterally, and ends close to the inferior margin. This preserves the lateral aspect of the dorsal fragment which constitutes a sagittal beam, and allows major lateral displacements as well as metatarsal head lowering Figure 4. This provides better fragment coaptation as well as a larger interfragmental surface area. Having a slight posterior obliquity, they are perpendicular to the second metatarsal Figure 6.
Figure 5 Figure 6 Displacements Among the five displacements allowed by Scarf osteotomy, three are extremely useful and easy to perform: Horizontal displacements, shortening and lowering.
Rotation in the transverse plane 4. Initial placement of two 1. Figure 7 The Scarf drill is inserted over the K-wires straight or tapered step. The drill features a countersink for the screw head Figure barou. A screw length gauge is used to determine the appropriate length of the distal screw. This screw will have to be 6 mm less than the measured length to avoid cartilage penetration. The screw head must be completely countersunk.
Penetration of the plantar fragment occurs laterally, close to the inferior margin, bzrouk bone is the hardest Figure 9. Oblique screwing does not adversely affect the holding capacity of the screw or the displacement of fragments.
Anteromedial resection is possible because of the lateral position of the distal screw. Medial capsular tightening is performed. It is particularly useful in medium and major displacements.
Medial Resection and Capsular Tightening Anteromedial resection is possible because of the lateral position of the distal screw. It is particularly useful in medium and major displacements Figure Distal chevron osteotomy 4.
Fixation of basal osteotomy for raising of a middle metatarsal 5. Fixation of Weil osteotomy of the lateral rays to avoid pain associated with screw heads particularly the fifth ray 3. Basal osteotomy of metatarsals In the example below screw placement is demonstrated on a Scarf osteotomy. Distal Fixation Figure 1 With the osteotomy line completed, the displacement is fixed using the dedicated bsrouk and a 0.
The measurement is taken using the reverse ruler Figure 2. Figure 2 Figure 3 The length of the screw must be 5 mm less than the measurement obtained. A drill bit matching the screw diameter selected is used with a K-wire to prepare the screw hole Figure 3.
The K-wire can then be withdrawn.
scdew Figure 4 Proximal Screw Placement The proximal screw is introduced in the same way, taking care not to place it in the lateral part of the dorsal aspect of the metatarsal Figure 5. Since the proximal screw is bicortical the size is determined by taking a direct reading from the rule.
A single saw cut is sufficient to raise the metatarsal by 3 mm Figure 6. Figure 6 Fixation is generally achieved by introducing a 0. Placing of a 2. Figure 7 Post operative Rehabilitation Protocol Post operative rehabilitation protocol This protocol is the same as that following solid screw fixation of an osteotomy or fracture site. The stable result obtained with the FRS screw is such that early weight bearing and rapid functional rehabilitation are possible.
Walking is resumed on the day following surgery, using the post operative shoe to relieve the forefoot. Two weeks later use shoes allowing weight bearing of the whole foot. Foot and toe physiotherapy begins on the day after the operation. Incision is initiated within the intermetatarsal space and extends to the web space.
Osteotomy Skin retraction provides exposure of both extensor muscles; an incision is made between these two muscles, extending distally as far as possible. The joint is dislocated by placing the toe in plantar flexion, thus exposing the metatarsal head. Placing one Hohman retractor on each side of the metatarsal will make this manoeuvre much easier. The use of a modified Hinge spreader ensures a safe osteotomy by providing adequate protection.
The cut is made horizontal and parallel to the sole. It starts in the cartilage of the head, near the dorsal margin, and should be at least 2.
The direction of the cut should be adjusted according to the condition of the forefoot. In case of pes cavus, the cut may be too short and the resection level should therefore be raised.
In case of pes planus or for the fourth and fifth metatarsalsthe cut may be too long scrfw the resection level should be lowered. However, it should be controlled. The appropriate metatarsal formula is: Then, metatarsal lengths follow scfew geometrical progression 3 mm – 6 mm – 12 mm.
The assistant holds the head against the metatarsal sdrew the forefinger. The placement of a dorsal Banaleck Clamp allows accurate head positioning as desired. When its head abuts against the dorsal cortex, the support snaps off.
However, in osteoporotic bone this will have to be done by moving the drill forward.
Plates & Screws | Cannulated Screw System | Zimmer Biomet
Compression can then be optimised with the use of the dedicated screwdriver. Final step Resection of the peak is the final step of this procedure. Despite shortening, Z-shaped release of extensor muscles is often necessary.
Make osteotomy cuts Closing wedge osteotomy to correct Hallux Valgus Interphalangeus.
A standard medial based closing wedge osteotomy is performed. The proximal cut is performed first, leaving the lateral cortex intact. When the distal cut is made, the osteotomy is closed with a greenstick manoeuver Figure 1.
Figure 1 For derotation of the proximal phalanx.
Foot and Ankle Solutions
The osteotomy is made completely through the shaft of the phalanx. This is done either in isolation if no valgus deformity is present or after a closing wedge osteotomy if no valgus correction is desired Figure 2. Place a temporary axial pin A temporary axial pin prevents displacement of the fragments when the staple is introduced.
It is important to maintain dorsal and medial bone contact to allow the osteotomy to heal.
Figure bzrouk Figure 3 Position drill guide The osteotomy should be positioned between the two arms of the drill guide. The distal arm of the drill guide should rest on the medial side of the proximal phalanx. This stage is essential because it ensures the oval part of the staple is correctly applied to the diaphyseal region of the proximal phalanx Figure 4. Figure 4 Step 4: Insert proximal guide wire Baoruk the drill guide in proper position, insert the proximal guide wire to penetrate both the medial and lateral cortices Figure 5.
Remove the drill guide. Position the cannulated drill bit The cannulated drill bit is badouk over the screq wire that is already inserted, making it possible to drill the two cortices and prepare for the insertion of the proximal leg of the staple. Leave csrew cannulated drill bit in position and remove the guide wire Figure 6.
Figure 6 Step 6: Position the drill guide and drill distally with a non-cannulated drill bit The drill guide is put back onto the cannulated drill bit, then the distal hole is drilled using the solid drill bit. Because of the contour of the proximal phalanx, it is advisable to insure that the solid drill bit is parallel to the cannulated drill bit Figure 7.
Select the MEMORY staple size Using standard technique, the depth gauge allows the determination of the length of each arm of the staple. In order to ensure good bicortical purchase, the surgeon should select a staple arm length 1 mm longer than the reading Figure 8. Figure 8 Step 8: