Biomet Vision FootRing System · Additional indications for the Biomet® Vision FootRing ... of all...

Surgical Technique

Biomet® Vision™

FootRing™ System

Fixation In A Snap

Contents

Introduction .................................................... Page 1

Indications and Contraindications ................ Page 1

Product Overview ........................................ Page 1

Product And Implant Description And Use .......

Carbon Fiber U-Trak ................................... Page 2

Short And Long Posts ................................. Page 3

Standard Wire Clamp .................................. Page 3

Pins And Wires............................................ Page 4

Bone Screw Clamp ..................................... Page 5

SLM Screw-To-Rod Clamp & Half Pins........ Page 5

Transfixing Pin ............................................ Page 5

Self Drilling, Self-Tapping Bone Screw ........ Page 6

Universal Rod Connector ............................. Page 6

Biomet Vision Rod ...................................... Page 6

Compression/Distraction Assembly ............. Page 7

SLM Rod-To-Rod Clamp ............................. Page 8

Bent U-Bar .................................................. Page 8

Clamps And 3/5 Post .................................. Page 9

Trocar/Drill Sleeve ...................................... Page 10

TS Trocar .................................................... Page 11

Split Tissue Guide ....................................... Page 12

Long Drill .................................................... Page 12

Universal Clamps ........................................ Page 13

Universal Rails ............................................ Page 15

Tensioners .................................................. Page 16

Walker Pad ................................................. Page 16

System Component Sets ............................. Page 17

Half Pin Insertion Technique ........................... Page 21

Thin Wire Insertion Technique ........................ Page 21

Tensioning Wire .............................................. Page 22

Standard Basic Protocol .................................. Page 23

Ankle Spanning Construct ............................... Page 27

Pan-Talar Fusion Construct............................. Page 29

Foot And Ankle Construct ............................... Page 30

Triple Arthrodesis Protocol .............................. Page 31

Further Information ......................................... Page 34

Indications

The DynaFix Vision Unilateral System and the DynaFix Vision

External Fixation System are external fixation device intended

for use in the treatment of bone conditions including leg

lengthening, osteotomies, arthrodesis, fracture fixation, and other

bone conditions amenable to treatment by use of the external

fixation modality.

Additional indications for the Biomet® Vision FootRing System, a

sub system of the DynaFix Vision External Fixation System include:

• Correction of deformity

• Revision procedures where other treatments or devices

have been unsuccessful

• Bone reconstruction procedures

• Fusions and replantations of the foot

• Charcot reconstruction and Lisfranc dislocations

• Ankle distraction (arthrodiastasis)

Contraindications

Patients with mental or neurologic conditions who are unwilling

or incapable of following postoperative care instructions.

Product Overview

The Biomet Vision FootRing System uses Biomet Vision

technology, which enables simplified application of all fixation

components to the carbon fiber U-Track, for one snap fixation.

The system is composed of anodized aluminum alloy, titanium,

carbon reinforced epoxy and stainless steel. All bone screws are

made of 316L stainless steel. Select sizes are available with HA

coating. Each carbon fiber U-Trak is made of lightweight carbon

fiber material that is ideally suited for patient comfort and is

radiolucent. Spanning fixator placement can easily be converted

to the Biomet Vision FootRing System configuration by simply

adding a carbon fiber U-Track with tensioned wires to the

articular fragment. This assembly then connects to the previously

placed pins, clamps and rods. Adaptation to the carbon fiber

U-Trak can be performed with the included components.

1

Introduction

The Biomet Vision FootRing System is a comprehensive

external fixation device intended for use in the treatment of bone

conditions including osteotomies, arthrodesis, fracture fixation,

and other bone conditions amenable to treatment by use of the

external fixation modality. The Biomet Vision FootRing System

(PN’s 421471, 421476 and 14-400076) can be configured in a

multitude of constructs ranging from simple fractures to complex

reconstruction to meet clinical needs.

The simplicity and ease of use make this fixator friendly in

the operating room for quick applications. The Biomet Vision

FootRing System functions as an excellent means of “portable

traction”. This allows the patient the benefit of soft tissue healing

while having the option of being at home and waiting for their

elective procedures. It allows the surgeon the benefits of getting

the patient out of the hospital quickly and re-admitting for well-

planned surgery or for transfer to the appropriate physician.

Product And Implant Description And Use

Carbon Fiber U-Trak

Catalog # Description

21202 150mm, Short

21207 180mm, Short

21212 210mm, Short

Carbon Fiber U-Trak


21200 150mm, Long

21205 1 80mm, Long

21210 210mm, Long

Prior to positioning the carbon fiber U-Trak (PN’s 21202, 21207,

21212, 21200, 21205 or 21210) on the patient, attach proper

size Standard Post (PN 21243 or 21242)

to lobe located on carbon fiber U-Trak.

Magnified View Of Tri-Lobe

2

Standard Short Post


21243 Short Post, 15mm

21354 Open-Ended Combo Wrench

Standard Long Post


21242 Long Post, 30mm

21354 Open-Ended Combo Wrench

After the carbon fiber U-Trak has been positioned, wires are

positioned free hand. The proper size Standard Post (PN 21242

or 21243) connects the wires via the Standard Wire Clamp

(PN 21244) to the carbon fiber U-Trak (PN 21200, 21202,

21205, 21207, 21210 or 21212) and the wires are tensioned to

establish the appropriate fixation required for the procedure. The

Open-Ended Combo Wrench (PN 21354) is used for both sizes

of the Standard Post to allow for counter-rotational torque when

tightening the post, and tensioning if needed.

NOTE: Standard Posts must be attached to the outside lobes of

the carbon fiber U-Trak when utilizing tensioned wires.

Standard Wire Clamp


21244 Standard 2.0mm Wire Clamp

The Standard Wire Clamp is used in conjunction with the

Standard Long or Short Post (PN 21242 or 21243). The Standard

Wire Clamp attaches to a 2.0mm straight wire

or olive wire. The clamp holds position and tension

(if desired).

2.0mm Straight Or Olive Wire

15mm

30mm

3

4

Product And Implant Description And Use (Continued)

Smooth Pin


21395 2.7mm x 350mm Pin, Smooth

Straight Wire


13165 2.0mm x 400mm Straight Wire

21430 2.0mm x 550mm Straight Wire (Packaged Sterile)

Olive Wire


13135 2.0mm x 400mm Olive Wire

21425 2.0mm x 550mm Olive Wire (Packaged Sterile)

The straight wires and olive wires (PN 13165, 21430, 13135 and

21425) are used with the Standard Wire Clamps (PN 21244). The

Standard Wire Clamp attaches to a 2.0mm straight wire or olive

wire. The clamp holds position and tension (if desired).New Spade Tip

Standard Bone Screw Clamp


21256 Standard 4.0mm Bone Screw Clamp


The Standard Bone Screw Clamp (PN 21256 or 21258) is used in

conjunction with the Standard Long or Short Post (PN 21242 or

21243). The Standard Bone Screw Clamp attaches to a 4.0mm

or 6.0mm bone screw shaft.

SLM 4.0-6.0mm Screw-To-Rod Clamp


14-400070 SLM 4.0-6.0mm Screw-To-Rod Clamp Connects A Carbon Fiber U-Trak To: 4.0, 5.0,

6.0mm Self Drilling Bone Screw

14280 4.0mm x 350mm Transfixing Screw



The SLM Screw-To-Rod Clamp (PN 14-400070) was designed

for ease of use and rapid locking. A single step serrated lock

allows for speed of application and secure purchase on rods,

4.0, 5.0, 6.0mm bone screws and 4.0, 5.0, 6.0mm transfixing

screw. This clamp is locked with a 5.0mm Allen Wrench (PN

03110). The key feature of the SLM Screw-To-Rod Clamp is

the ability to snap on to both the rod and the shank of 4.0, 5.0,

6.0mm screws and transfixing screws. This clamp also has the

ability to lock to the shank of 4.0, 5.0, 6.0mm diameter screws.

Threaded Transfixing Pin


21400 2.7mm x 350mm Transfixing Pin




Will Accept 4.0, 5.0, 6.0mm Pin/Screw

MRI Safe

5


6

Carbon Fiber Rod Or C/D Strut

Pivot Articulates 360°

Self-Drilling, Self-Tapping Bone Screw


A60-11030 Cortical – 110/30 (Packaged Sterile)

SD60-15050 Cortical – 150/50 (Packaged Sterile)



A60-18040 Cortical – 180/40 (Packaged Sterile)

NOTE: The bone screws will need to be ordered separately.


21245 Universal Rod Connector (AKA Schnoopy Clamp)

The Universal Rod Connector (PN 21245) allows attachment of a

multitude of Biomet Vision components, including carbon rods,

C/D Assembly, 2-Clamp 3/5 Post. The versatility comes from the

ability of the clamps to rotate and angulate in any direction.

Biomet Vision Rod


14160 Carbon Fiber Rod, 9.5mm Dia. x 150mm








The Biomet Vision Rods are offered in a 9.5mm diameter.

Carbon Fiber Rods have the added benefit of being radiolucent

and extremely lightweight.

Biomet Vision Rod

Standard Long Post

Universal Rod Connector

Standard Wire Clamp

Standard Bone Screw Clamp

Source: Stephen Conti, M.D.

7

Compression/Distraction Assembly


21252 C/D Assembly, 30mm

21420 C/D Wrench

The Compression/Distraction Assembly (PN 21252) connects

to the Universal Rod Connector (PN 21245) or SLM 4.0-6.0mm

Screw-To-Rod Clamp (PN 14-400070) or SLM Rapid Rod-

To-Rod Clamp (PN 14600) to carbon fiber U-Trak (PN 21200,

21202, 21205, 21207, 21210 or 21212) to the proximal support

frame. This is to provide support and compression/distraction

adjustment to the fracture/fusion site. A set-screw is provided to

ensure locking of the strut.

One Complete Revolution = 1.0mm Compression Or Distraction

Posts Are Same Size As Biomet Vision Bar

Set-Screw Ensures Locking MechanismUp To 30mm

Compression Or Distraction


8

SLM Rapid Rod-To-Rod Clamp


14600 SLM Rapid Rod-To-Rod Clamp Connects A Carbon Fiber U-Trak To:

14160 Carbon Rod, 150mm



21252 C/D Assembly, 30mm

The SLM Rapid Rod-To-Rod Clamp (PN 14600) allows

attachment of a smaller range of Biomet Vision components.

Because of the clamps design, adjustment is only in one plane.

The Universal Rod Connector also known as the schnoopy clamp

(PN 21245) is capable of adjusting in two planes.

Bent U-Bar


21280 Bent U-Bar, 190mm



Bent U-Bar, 190mm used with carbon fiber U-Trak, 150mm



The Bent U-Bar (PN’s 21280, 21285, or 21290) is used in

conjunction with the carbon fiber U-Trak (PN’s 21200, 21202,

21205, 21207, 21210, or 21212) via SLM Rapid Rod-To-Rod

Clamps (PN 14600) or Universal Rod Connector (PN 21245). This

allows placement of bone screws more anterior to the carbon

fiber U-Trak. The Bent U-Bar can be used as a replacement to a

carbon fiber U-Trak proximally.

NOTE: Tensioned wires cannot be used with the Bent U-Bars.

MRI Safe

9

3 And 5-Hole Clamps


14060 3-Hole Clamp

14090 5-Hole Clamp

The 3 and 5-Hole Clamps (PN 14060 or 14090) were designed

for multi-pin fixation, which increases frame stiffness. The clamp

cover bolts are locked down with the 5mm Allen Wrench (PN

03110) to secure bone screws within the clamp. The 3/5 Post

can be attached to both sides of the clamp for rod or bone screw

attachment. The 3/5 Post is secured to the 3 or 5-Hole Clamps

with the Ratcheting T-Handle (PN 03122 + PN 03121).

Biomet Vision 2-Clamp 3/5 Post


14-400065 2-Clamp 3/5 Post

The 3/5 Post (PN 14240) is utilized with the 3-Hole and 5-Hole

Clamps (PN 14060 or 14090) primarily for rod attachment, but

can also be used for bone screw clamp attachment. The 3/5 Post

is secured to either the 3-Hole Clamp or the 5-Hole Clamp with

a Ratcheting T-Handle (PN 03122 + PN 03121) or Biomet Vision

9.0mm wrench (PN 14245).


10

Trocar/Drill Sleeve


21370 Use 3.2mm Drill/4.0mm Pin


11

TS Trocar


14-400040 TS Trocar for 3.2mm Drill (60mm Length)

14-400042 TS Trocar 3.2mm Drill (100mm Length)



14-400030 TS 3.2mm Drill Sleeve (60mm Length)






14-400027 TS Soft Tissue Sleeve (125mm Length)



The TS Trocar can be used to protect soft tissue and blunt skin

prior to drilling. The teeth of the TS Trocar is designed to blunt

skin effortlessly.

The design rationale behind the new Triple Stack (TS) comes

from the need to maximize speed of pin insertion, while

minimizing soft tissue damage. The TS contains a friction lock

between the soft tissue and drill sleeve. The TS allows the two

components to remain engaged after the trocar has dimpled the

bone and then been removed. Once the trocar is slid out, the

bone can be drilled, and the drill guide can then be removed.

With the serrated teeth on the soft tissue sleeve, the placement

of the drill hole can be kept while transitioning to inserting the

bone screw. The TS can be used free-hand or through bone

screw clamps.


12

Split Tissue Guide 4.8mm



Split Tissue Guide 3.2mm



4.8mm Long Drill


03015 4.8mm x 240mm Long Drill (A/O Connect)

3.2mm Long Drill


03036 3.2mm x 240mm Long Drill (A/O Connect)

13

Universal Clamp With Compression/Distraction


21260 Universal Clamp With C/D

The Universal Clamp With C/D (PN 21260) allows compression/

distraction to the bone fragment/fusion site to achieve the

desired position or alignment using the Universal Pin Clamp With

Compression/Distraction (PN 21405). These posts allow for a

vertical motion of any of the selected clamps chosen. The post is

threaded, and when combined with a Universal Pin Clamp with

C/D, a gradual compression/distraction force can be applied to

fixation of choice.

Universal Clamp With Compression/Distraction And Pivot


21270 Universal Clamp With C/D And Pivot

After carbon fiber U-Trak (PN 21200, 21202, 21205, 21207 or

21210) has been positioned on the patient, wires are positioned

free hand. The bone fragment/fusion site can be compressed or

distracted to achieve the desired position or alignment utilizing

the Universal Clamps With C/D And Pivot (PN 21270) used for

charcot reconstruction. The Universal Clamp With C/D and Pivot

can compress or distract up to 30mm by using the Universal Pin

Clamp With Compression/Distraction (PN 21405) to allow C/D

between a number of different anatomic segments of the ankle

and foot, i.e. between the talus and calcaneous.

These posts allow for a gradual compressive/distractive force in

multiple directions, due to the pivot and the capability to rotate

the post 360° when combined with a Universal Pin Clamp With

C/D.

Rotates 360°

30mm Threaded Post

Will Angulate Up To 250°

Rotates 360°

25mm Threaded Post


14

Universal Pin Clamp With Compression/Distraction


21405 Universal Pin Clamp With C/D

After carbon fiber U-Trak (PN 21200, 21202, 21205, 21207,

21210 or 21212) has been positioned on the patient, wires are

positioned free hand. The clamp connects the wires or pins

to the carbon fiber U-Trak. The trajectory of the compression/

distraction can be adjusted by pivoting the C/D axis. The bone

fragment/fusion site can be compressed or distracted to achieve

the desired position or alignment. This Universal Pin Clamp With

Compression/Distraction is designed to be utilized with either

of the Universal Post Clamps (PN 21260 or 21270) or Universal

Rails (PN 21440, 21242, 21244 or 21246). It is capable of

accepting a 2.7mm pin up to a 6.0mm pin.

NOTE: The 2.7mm Transfixing Pin (PN 21395 or 21400) cannot

be tensioned.

Universal Pin Clamp


21415 Universal Pin Clamp

After carbon fiber U-Trak (PN 21200, 21202, 21205, 21207,

21210 or 21212) has been positioned on the patient, wires are

positioned free hand. The clamp connects the wires or pins

accepting sizes ranging from a 2.7mm to 6.0mm to the carbon

fiber U-Trak. The Universal Pin Clamp is designed to be utilized

with either of the Universal Clamps (PN 21260 or 21270) or

Universal Rails (PN 21440, 21242, 21244 or 21246). It is capable

of accepting a 2.7mm pin up to a 6.0mm pin. It is important to

note that this clamp is purely for fixation, and does not allow

compression or distraction.

NOTE: The 2.7mm Transfixing Pin (PN 21395 or 21400) cannot

be tensioned.

C/D Nut

15

Universal Rails


21440 Universal Rail, 75mm




The Universal Rails (PN 21440, 21442, 21444 or 21446) can be

used for Triple Arthrodesis in conjunction with the carbon fiber

U-Trak application.

Universal Multi–4.0mm Pin Clamp


21410 Universal Multi–4.0mm Pin Clamp

The Universal Multi Pin Clamp (PN 21410) will accept two 4.0mm

pins to be secured linearly. The Universal Multi Pin Clamp can be

used with both the Universal Clamps (PN 21260 or 21270) or the

Universal Rails (PN 21440, 21242, 21244 or 21246).


16

Pistol Grip Tensioner


21435 Pistol Grip Tensioner

The new Pistol Grip Tensioner (PN 21435) automatically grips on

wire regardless of wire diameter. It has a quick release, which

releases tension and capture of the wire. To use, simply slip the

tensioner over the wire to be tensioned, and slide the tensioner

down until it presses against the clamp to be tensioned. After

confirming that the opposing clamp is completely locked down,

and the clamp you are attached to is locked only to the carbon

fiber U-Trak (PN’s 21200, 21202, 21205, 21207, 21210 or

21212) and the wire carriage is open, you can begin to tension

on the wire. Once an acceptable amount of tension is on the

wire, lock the wire clamp fully, and hit the release switch on the

tensioner depicted below. Once the tensioner is removed, the

wire should be clipped, and twisted to eliminate the sharp wire

point from sticking out. Then repeat with each wire construct as

needed.

Biomet Wire Tensioner


13190 Wire Tensioner Please see thin wire insertion technique on page 21

Walker Pad


21235 Walker Pad

Apply an appropriate sized Walker Pad to patient’s foot. Wrap

each strap around carbon fiber U-Trak (PN 21200, 21202,

21205, 21207, 21210, or 21212). Slide thru the buckle and

double back to secure the strap. Excess strap material may

be cut to proper length after application. The Walker Pad (PN

21235) comes with 16” velcro straps that are adjustable for

flexible positioning.

Top Level

Base Level

Biomet Vision FootRing System Component Set


421471 Biomet Vision FootRing System Component Set (Loaner Set)

21470 Sterilization Tray

17

18

Top Level

Base Level

Biomet Vision FootRing System U-Trak Set


421476 Biomet Vision FootRing System U-Trak Set (Loaner Set)

21475 Sterilization Tray


Biomet Vision Pin-To-Bar System


14-400076 Biomet Vision Pin-To-Bar Set (Loaner Set)

14-400075 Sterilization Tray

The Biomet Vision Pin-To-Bar System is a supplemental system

to the Biomet Vision FootRing System and can also be used

on its own. The Biomet Vision Pin-To-Bar is a modular system

intended for use in treatment of bone conditions including leg

lengthening, osteotomies, arthrodesis, fracture fixation and

other bone conditions amenable to treatment by use of external

fixation modality.

Top Level

Bottom Level

19


20

Base Level

Biomet Vision Pin-To-Bar System (Continued)

Half Pin Insertion Technique Thin Wire Insertion Technique

Using the screw clamp, locate where you want the screw to

be placed. Make a small stab incision into the skin and spread

through the soft tissue carefully. Place a drill sleeve and trocar

either through the screw clamp, or independently through the

skin incision and soft tissue to the bone cortex.

Lightly tap on the trocar dimpling the bone to prevent the drill

from walking. Remove the trocar and insert the appropriate drill

through the drill sleeve to prevent soft tissue damage. Pre drill

the screw hole.

The drill guide is then removed and the appropriate length

screw is inserted. The screw is inserted by hand using the bone

screw t-wrench. This will help to prevent thermal necrosis at the

screw site. To obtain optimal purchase, all bone screws must

be bi-cortical with no less than 2.0mm or two thread lengths

protruding from the far cortex and about 5.0mm remaining

outside the near cortex.

NOTE: When using tapered screws care must be taken to avoid

over-penetration of the far cortex. Tapered screws cannot be

backed out without losing purchase.

A Biomet self-drilling self-tapping bone screw could be used if

the physician elects to do so. The aforementioned technique is

recommended for the use of this screw.

1. Make a small incision and insert the wire (through a safe

zone) until it reaches bone. Be sure to have good contact.

Start the drill and lightly press on the wire until it starts going

through bone on the near cortex. Be sure to avoid thermal

necrosis. You can avoid this by either irrigating with saline

while drilling on the wire or stopping every few seconds to

reduce heat build-up.

2. When the wire has been drilled through the far cortex, stop

advancement of the wire and remove from the drill. Continue

advancement of the wire by using a mallet and pliers through

the rest of the soft tissue.

3. Once the wire reaches the far skin edge, make a small

incision over the tip of the wire and pass the wire through the

skin.

4. Be aware to relieve any tension on the skin that wire

insertion may have caused. This will help reduce soft tissue

complications.

5. Check wire position under fluoroscopy.

21

Tensioning Wire

1. All clamps need to be securely tightened.

2. Before tensioning, make certain the opposite end of the wire

is locked onto the Standard Wire Clamp (wire carriage) and

the carriage is secured firmly on the U-Trak. Watch for wire

bending while securing the wire into the carriage and onto the

carbon fiber U-Trak.

3. Slide the wire through the tensioner until the tensioner

reaches the near wire carriage. Lock the wire onto the

tensioner. The near wire carriage lock nut should be finger

tight to ensure anterior rotation teeth engagement.

4. Once the wire is locked into the tensioner, begin tensioning

by turning the back nut of the tensioner clockwise until

the desired tension is achieved. (Approx. 100-120kg is

recommended). Note: when using olive tip wires you must

tension from the opposite side of the olive tip (mark the wire

carriage on the side of the olive).

5. When the proper tension is achieved lock the near wire

carriage to retain the tension on the wire.

22

23

Standard Basic Protocol

Step 1

Position the patient supine with the affected foot at the very end

of the operating table. A bump should be placed beneath the

ipsilateral buttock to ensure that the foot is pointing straight up.

Step 2

Prior to positioning carbon fiber U-Trak, attach Standard Short or

Long Post to the outside of lobe.

Step 3 (Standard Post)

Position proper size carbon fiber U-Trak with proper size

Standard Post on medial side of foot. The carbon fiber U-Trak

should be adjusted to lie PERPENDICULAR to the TIBIA and

parallel to the weight-bearing surface of the foot. A 150mm long

U-Trak is recommended to use for the average size foot.

To span the ankle by utilizing dissipated forces through the

hindfoot continue to Step 4. To span the ankle by utilizing only

smooth wires through the talus proceed to Step 8.

Step 4 (Calcaneal Pin)

Place a 4.0mm or 6.0mm Transfixing Pin, lateral/medial into

the calcaneous, perpendicular to the long axis of the foot in the

coronal and transverse plane. Pin placement should be below the

carbon fiber U-Trak. Careful soft tissue dissection on the medial

side of the heel will avoid damage to the medial calcaneal nerve.

If the pin is placed in the posterior tuberosity of the calcaneus,

neurovascular damage will be avoided. Pin placement should be

below the anticipated final position of the U-Trak. The carbon

fiber U-Trak frame should be adjusted to lie PERPENDICULAR to

the tibia and, if possible, parallel to the weight-bearing surface

of the foot. Confirmation of pin placement with C-arm may be

desired.

Step 10 (Talar Pin 2)

Place wire, olive or smooth k-wire (olive wire is recommended

to prevent foot from sliding in the frame), anteromedial to

posterolateral to avoid damage to medial neurovascular bundle.

The anterior clamp is above the U-Trak and the posterior clamp

is below the U-Trak. Secure wire assembly to frame. Do not

tension wire at this time. Confirmation of wire placement with

C-arm may be performed at this time.


Step 11 (Standard Wire Clamp)

Place Standard Wire Clamp over Standard Post. The Standard

Wire Clamp and Standard Post is used to attach a 2.0mm

smooth k-wire or olive wire. Secure frame with Standard Wire

Clamp. Do not tension wire at this time.

Step 12 (Tension)

Tension all wires to between 100-120kg using the manual

tensioning device. Be sure that Standard Wire Clamps are

tightened on the opposite side of the tensioner, which is always

the side of the olive, if present. All pin assemblies must be

attached to the lateral side of the U-Trak.

Standard Basic Protocol (Continued)

24

Step 5 (Standard Bone Screw Clamp)

Place the Standard Bone Screw Clamp over the Standard

Post. The Standard Bone Screw Clamp is used to attach a

4.0mm/6.0mm Transfixing Pin. Secure the frame with the

Standard Bone Screw Clamp. Do not tighten the screw assembly

over pin at this time.

Step 6 (Navicular Pin)

Place an olive or smooth k-wire (2.0mm olive is recommended

to prevent foot from sliding medial/lateral in the frame), medial

to lateral into the navicular above the U-Trak. Secure to wire

to the Standard Wire Clamp. Do not tension wire at this time.

Confirmation of wire placement with C-arm may be done at this

time.


Place Standard Wire Clamp over the Standard Post. This is used

to attach a 2.0mm smooth k-wire or olive wire. Secure frame

with Standard Wire Clamp. Do not tension wire at this time.


Place a wire, olive or smooth k-wire (olive wire is recommended

to prevent foot from sliding medial/lateral in the frame),

directly medial to lateral into the talar neck below the U-Trak.

Confirmation of wire placement with C-arm may be desired.


Place Standard Wire Clamp over the Standard Post. This is used

to attach a 2.0mm smooth k-wire or olive wire. Secure Standard

Wire Clamp to frame. Do not tension wire at this time.

Shown here is the insertion of olive wires to prevent foot from sliding in the frame.

25

Step 13 (Universal Rod Connector)

Attach Universal Rod Connector to each lateral side of the

U-Trak. Use Carbon Fiber Rods (150mm, 250mm) to stabilize

the U-Trak to the proximal tibial. Both Carbon Fiber Rods should

be positioned parallel to the tibia and half pins placed mid-shaft

proximal to any anticipated anterior surgical incision. Secure

Universal Rod Connectors and to Carbon Fiber Rods finger tight.

Step 14 (Mid-Shaft Half Pins)

Prior to half pin insertion follow the aforementioned half pin

insertion technique described on page 21. Insert half pins placed

mid-shaft perpendicular to each side. Use appropriate thread

length and overall pin length (generally 110/30). Secure carbon

fiber U-Trak to Universal Rod Connector to Carbon Fiber Rods

with pin to rod clamps (Biomet Vision Clamps), careful to leave

enough room to distract and not to pull the rod through the clamp.

Step 15

Place foot in the desired position, generally perpendicular to leg

and tighten all clamps except for the pin to rod clamp on mid-

shaft Tibia.

Step 16

Manually distract pulling the U-Trak distally with equal force on

lateral and medial side of the U-Trak.

Step 17

Tighten pin to rod clamps on mid-shaft tibia.

Mid-Shaft Half Pin Insertion

Anteriorly Medial

Anteriorly Lateral


Standard Basic Protocol (Continued)

Step 18 (Foot Pad Application)

Apply an appropriate size Walker Pad to patient’s foot. Wrap

each buckle around U-Trak leaving an inch of the buckle so it

can wrap around the U-Trak.

26


27

Ankle Spanning Construct

This frame could be used for:

1. Ankle Arthrodesis

2. Ankle Spanning

3. Distal Tibial Fracture

This system will allow for soft tissue management

and fracture stabilization.

Ankle Spanning Construct

Catalog # Description Qty

21200 Carbon Fiber U-Trak 150mm

21205 Carbon Fiber U-Trak 180mm 1

21210 Carbon Fiber U-Trak 210mm

A60-18040 Bone Screw 180/40 2

14060 3-Hole Clamp 1

14240 3.5 Biomet Vision Post 2

14175 300mm Carbon Rods 2

21242 Standard Long Post 6

21243 Standard Short Post

21244 Standard Wire Clamp 6


21430 2.0mm x 550mm Straight Wire 3



14600 SLM Rapid Rod-To-Rod Clamp 2

21245 Universal Rod Connector 2

Ankle Spanning Construct (Continued)

A. Select the appropriate size carbon fiber U-Trak to be placed

at the level of the foot.

B. Using a carbon fiber U-Trak at the level of the distal

calcaneus secure fixation points using k-wire, half pins, or

transfixation screws. Wires should be parallel and 5.0 to

10mm from a joint surface.

C. A 3 or 5-Hole Clamp and MRI safe Rapid Rod-To-Rod Clamps

or independent pin placement may be used at mid tibia using

haft pin to affix the proximal end of the frame. Carbon rods

would then extend distal to the carbon fiber U-Track and

attach with MRI safe Rapid Rod-To-Rod Clamps.

28

29

Pan-Talar Fusion Construct


1. Ankle Spanning


3. Pilon Fractures

4. Ankle Arthrodesis Over A Nail

For Weight Bearing Patients




21200 Carbon Fiber U-Trak, 150mm

21205 Carbon Fiber U-Trak, 180mm 1


21202 Carbon Fiber U-Trak, 150mm (Short)

21207 Carbon Fiber U-Trak, 180mm (Short) 1


A60-18030 Bone Screw, 180/30

A60-15040 Bone Screw, 150/40 2

A60-18040 Bone Screw, 180/40



13130 2.0mm x 350mm Olive Wire 1



14280 Transfixing Pin, 4.0mm 2

14285 Transfixing Pin, 6.0mm


21242 Standard Long Post 8

21243 Standard Short Post


21256 Standard 4.0mm Bone Screw Clamp 6


21252 C/D Assembly 3

21245 Universal Rod Connector 6

30

Foot And Ankle Construct



2. Triple Arthrodesis

3. Ankle Spanning

4. Pan Talar Arthrodesis For All Midfoot, Hindfoot,

And Ankle Considerations



Foot And Ankle Construct



21205 Carbon Fiber U-Trak, 180mm 2



21207 Carbon Fiber U-Trak, 180mm (Short) 1


A60-18030 Bone Screw 180/30

A60-15040 Bone Screw 150/40 3

A60-18040 Bone Screw 180/40

14160 150mm Carbon Rod 3

13165 Wires 1

14285 Transfixing Pin, 6.0mm 2

14280 Transfixing Pin, 4.0mm

21242 Standard Post (Long) 9

21243 Standard Post (Short)


21270 Universal Clamp with C/D and Pivot 2

21258 Standard 6.0mm Bone Screw Clamp 7


21395 2.7mm x 350mm Smooth Pin 1

21405 Universal Pin Clamp With C/D 2

14600 SLM Rod-To-Rod Clamp 8

31

Triple Arthrodesis Protocol

Step 1

Position the patient supine with the affected foot at the end

of the operating table. A bump should be placed beneath the

ipsilateral buttock to ensure that the foot is pointing straight up.

Step 2

Prior to positioning carbon fiber U-Trak, attach Standard Short or

Long Post to the outside of lobe.

Step 3 (Standard Post)

Position proper size carbon fiber U-Trak with proper size

Standard Post on medial side of foot. The carbon fiber U-Trak

should be adjusted to lie PERPENDICULAR to the ankle joint

(TIBIA) or Standard Long Post to the outside lobe of the carbon

fiber U-Trak and parallel to the weight-bearing surface of the

foot. A 150mm, long carbon fiber U-Trak is recommended to use

for the average size foot.

Step 4 (Calcaneal Pin)

Place a 4.0mm or 6.0mm Transfixing Pin, lateral/medial into

the calcaneous, perpendicular to the long axis of the foot in

the coronal and transverse plane. Two crossing smooth or

olive wires may be used in the posterior calcaneous instead of

a 4.0mm or 6.0mm Transfixing Pin. Pin placement should be

below the carbon fiber U-Trak. Careful soft tissue dissection

on the medial side of the heel will avoid damage to the medial

calcaneal nerve. If the pin is placed in the posterior tuberosity

of the calcaneus, neurovascular damage will be avoided. Pin

placement should be below the anticipated final position of the

carbon fiber U-Trak. The carbon fiber U-Trak frame should be

adjusted to lie PERPENDICULAR to the tibia and, if possible,

parallel to the weight-bearing surface of the foot. Confirmation of

pin placement with C-arm may be desired.

32

Step 5 (Standard Bone Screw Clamp)

Place a Standard Bone Screw Clamp over the Standard Post. The

Standard Bone Screw Clamp is used to attach a 4.0mm/6.0mm

Transfixing Pin or Half Pin. If olive or smooth wires are used,

place Standard Wire Clamp over the Standard Post. The Standard

Wire Clamp is used to attach a 2.0mm smooth k-wire or

olive wire. Secure frame with Standard Bone Screw Clamp or

Standard Wire Clamp. Do not tighten screw assembly over pin at

this time.

Step 6 (Navicular Pin)

Place an olive or smooth k-wire (2.0mm olive wire is

recommended to prevent foot from sliding medial/lateral in the

frame), medial to lateral into the navicular above the carbon fiber

U-Trak. Secure the wire to the frame with Standard Wire Clamp.

Do not tension wire at this time. Confirmation of wire placement

with C-arm may be done at this time.


Place a Standard Wire Clamp over the Standard Post. The

Standard Wire Clamp is used to attach a 2.0mm smooth k-wire

or olive wire. Secure frame with Standard Wire Clamp. Do not

tension wire at this time.


Place a wire, olive or smooth k-wire (olive wire is recommended

to prevent foot from sliding medial/lateral in the frame), directly

medial to lateral into the talar neck below the carbon fiber

U-Trak. Confirmation of wire placement with C-arm may be

desired.


Place Standard Wire Clamp over the Standard Post. The Standard

Wire Clamp is used to attach a 2.0mm smooth k-wire or olive

wire. Secure Standard Wire Clamp to frame. Do not tension wire

at this time.


Place wire, olive or smooth k-wire (olive wire is recommended

to prevent foot from sliding in the frame), anteromedial to

posterolateral to avoid damage to medial neurovascular bundle.

The anterior clamp is above the carbon fiber U-Trak and the

posterior clamp is below the carbon fiber U-Trak. Secure wire

assembly to frame. Do not tension wire at this time. Confirmation

of wire placement with C-arm may be performed at this time.


Place a Standard Wire Clamp over a Standard Post. The Standard

Wire Clamp is used to attach a 2.0mm smooth k-wire or olive

wire. Secure frame with Standard Wire Clamp. Do not tension

wire at this time.

Step 12 (Cuboid Pin Or Wire)

Place a half pin, olive wire or smooth wire into the cuboid (lateral

to medial into the cuboid below the carbon fiber U-Trak). Secure

to frame with appropriate clamp. Do not tension at this time.

Confirmation of wire placement with C-Arm may be done at this

time.

Step 13 (Tension)

Tension all wires to between 100-120kg using the manual

tensioning device. Be sure that Standard Wire Clamps are

tightened on the opposite side of the tensioner, which is always

the side of the olive, if present. All pin assemblies must be

attached to the lateral side of the carbon fiber U-Trak.

Step 14 (Calcaneocuboid Pin)

Apply Universal Rail to lateral calcaneal pin and connect to

the cuboid pin with a Universal Pin Clamp With C/D and static

Universal Pin Clamp.

Triple Arthrodesis Protocol (Continued)

33

Step 15 (Talocalcaneal Pin)

Apply a second Universal Rail to the calcaneal pin and connect

to the talar pin with a Universal Pin Clamp With C/D and static

Universal Pin Clamp.

Step 16 (Talonavicular Pin)

Apply a Universal Rail to medial calcaneal pin and connect to

the navicular pin with a Universal Pin Clamp With C/D and static

Universal Pin Clamp. Apply another Universal Rail from the talar

pin and connect to the navicular pin with a Universal Pin Clamp

With C/D and static Universal Pin Clamp.

Step 17 (Universal Rail)

Tighten all Universal Rails uniformly until appropriate reduction

and compression is achieved.

Step 18 (Walker Pad Application)

Apply Walker Pad to patient’s foot. Wrap each strap around

carbon fiber U-Trak, slide through the buckle and double back

to secure the strap. Excess strap material may be cut to proper

length after application.

34

Further Information

This brochure is presented to demonstrate the surgical technique

utilized by Stephen Conti, M.D. and Marc Conner, D.P.M.

Biomet, as the manufacturer of this device, does not practice

medicine and does not recommend this product or any specific

surgical technique for use on any individual patient. The

surgeon who performs any implant procedure is responsible

for determining the appropriate product(s) and utilizing the

appropriate technique(s) for said implantation in each

individual patient.

For further information, please contact the Customer Service

Department at:

Biomet Trauma

56 East Bell Drive

P.O. Box 587

Warsaw, Indiana 46581-0587

800.348.9500 x 1501

www.biomet.com

Notes:

35

Notes:

36

©2013 Biomet Orthopedics • Form No. BMET0355.0 • REV011513

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 health care professionals. 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 and Biomet’s website.

Responsible ManufacturerBiomet, Inc. P.O. Box 58756 E. Bell DriveWarsaw, Indiana 46581-0587 USA

www.biomet.com

Rx only.

Biomet Vision FootRing System · Additional indications for the Biomet® Vision FootRing ... of all...

Documents

Transcript of Biomet Vision FootRing System · Additional indications for the Biomet® Vision FootRing ... of all...