Surgical Procedure, INBONE Fusion System

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REVISION B
INBONE Fusion System
Patented and other patents pending
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• Fusion Plates
• Fusion Plates are coated with a titanium plasma
  to enhance bone in-growth
• Available in several sizes
• Can be used with compression screws
• Joint preparation is done through the bony trough
  for the plate. Sub-talar joint rarely needs any
  preparation

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Fusion Plate Sizing
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• Templating can be done pre-op or intra
  operatively.
• X-ray templates are 11 scale
• There are two types of Intra-Op templates
  provided. One will measure length and thickness
  and the other will show length and depth

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• Inter-operatively
• Insert the holding tool into the length/depth
  template
• Under fluoroscopy take AP view
• Template for length/thickness using a lateral
  view under fluoroscopy.

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• The plate should be equidistant from the center
  of the joint space
• Plate is positioned at the superior/inferior
  center of the bones
• Plate depth should be centered between cortices

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• Incisions
• A longitudinal incision is made on the medial
  side of the foot for all foot fusions, except for
  the calcaneo-cuboid joint, which requires a
  lateral incision.

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• Using fluoroscopy guidance, the pre- selected
  plate is placed laterally/medially against the
  joint
• The plate must be equidistant relative to the
  joint space

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• CORRECT

• INCORRECT

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• Note Due to the transverse arch the anatomical
  position of the bones are not directly in line
  with one another
• The implant should be slightly upwards to
  accommodate for the transverse arch

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• Insert the 2.0 mm guide wires through the two
  holes of the plate and into the bones.

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• The drill bit has depth gauge marking on it
• When using a 30 mm depth plate one should drill
  between 32 and 34 mm. Use fluoroscopy to confirm
  depth

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• Remove the plate
• Place the 6 mm cannulated drill bit over the
  guide wires and drill
• When drilling, stop just shy of the opposite
  cortex

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• Remove drill bit
• Using the adjustable saw, slip the posts over the
  guide wires and into the holes made by the 6mm
  drill

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• Saw guide should sit flush against the bone
• Note The saw guide is 18 mm in depth

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• Use of saw is surgeon preference
• The Micro-Aire Small Orthopedic System or the
  Stryker OrthoPower 80 series are recommended
• Saw blades with 10 mm depth increments are
  included for OrthoPower 80

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• The saw guide may vibrate during bone cuts
• Use one hand to steady the guide
• Surgical assistant can support
• Clean joint with curette

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• Verify saw cut depth
• For Example
• If the plate is 30 mm deep, and the saw guide is
  18 mm deep, saw to 50-52 mm
• Confirm under fluoroscopy
• The extra 2-4 mm will allow for bone graft

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• Remove guide wires
• Compress the joint manually
• Implant the plate with the revision/removal
  (threaded) hole outward

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• Manually seat the plate in the cavity a few
  millimeters
• Use T-Handle if necessary
• Bar Bell design will give 2 mm of compression

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• Using the nail set, insert the tip in one hole of
  the plate and using a mallet begin to impact
  plate
• Use provisional impacting until plate is fully
  inserted
• Plate can also be impacted from center hole
• Plate should be inset of the cortical wall 2-4 mm.

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• Pack bone graft into the space between the plate
  and cortical wall
• Close

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• Fusion Rods
• Fusion Rods are coated with a titanium plasma to
  enhance bone in-growth
• Three sided anti-rotation design
• Tapered tip for easy insertion
• Available in 3 mm and 7 mm sizes
• Can be used with compression screws
• Joint preparation is done through the bony trough
  for the rod. Sub-talar joint rarely needs any
  preparation

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Fusion RodSizing additional 7 mm sizes
may be available upon request
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• 3 mm Rods
• Insert 1.4 mm guide wire across joint to be fused
• Can be inserted through the Talus or the
  Calcaneus
• 3 mm Rods use a 3.0 mm drill

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• 7 mm Rods
• Insert 2.4 mm guide wire across joint to be fused
• 7 mm Rods use a 7.0 mm or 7.5 mm drill

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• Slide the cannulated drill bit over the guide
  wire and drill to desired depth
• Drill bit has a depth gauge measuring in
  millimeters

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• Attach cannulated broach to slap hammer
• Insert broach over the guide wire

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• Do not use the slap hammer to broach.
• Use a mallet to impact the broach
• Use slide hammer to steady the assembly
• Confirm distance of broach under fluoroscopy

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• On the broach is a depth gauge in 1 cm increments
• Use appropriate sized fusion rod for depth desired

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• Remove the broach by using the slap hammer

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• Insert the implant over the guide wire, cut the
  guide wire approximately 30 mm
• This ensures the guide wire is not impacted with
  the implant
• Implant rod with threads outward

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• Place the cannulated impact tool over the guide
  wire so it is on top of the rod
• Using a mallet insert the rod to desired position
• Broach can be used to impact implant if
  additional depth is required
• Verify using fluoroscopy
• Remove impact tool and guide wire
• Close

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Postoperative Care

• The patient is placed in a non-weight bearing
  cast for six weeks.
• Remove sutures and check the wound at week two
• X-ray at 6 weeks
• If the postoperative x-rays show a well fixated
  implant, without a halo surrounding it, weight
  bearing and physical therapy can be initiated.
• If there is doubt as to the fixation of the
  implants, or the patient has tenderness over the
  operative joints, then a period of non-weight
  bearing should be reinitiated

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Revision Adapters
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• Revision History

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