arthrodesis of the ankle -...

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Arthrodesis of the Ankle

Plantar View of the Foot

1. Make a lateral incision to expose the tibia-talus joint and

the talo-calcaneal joint. Prepare the arthrodesis sites

surgically with a rasp or an osteotome to denude the

arthrodesis sites for better union.

2. Make a plantar incision to expose the calcaneus for the

insertion of a 2.5x300 mm Steinman pin, to serve as the

“guide wire” for all subsequent steps.

Drive Guide Wire

3. Align the tibia over the talus in the desired position before

advancing the Steinman pin through either joint. The use

of a C-arm is essential. The Steinman pin should be

centered with respect to both the talus and the tibia.

This step may require a slight forward shift of the tibia.

Advance the Steinman pin according to the following

guide. Stop advancing the Steinman pin after the

corresponding limit for each FUZE length is reached.

THE VILEX FUZE – ARTHRODESIS OF THE ANKLE

Drill FuzeTM Path

4. Use a cannulated 7.5 mm drill with 2.5 mm cannulation

to drill a hole from the plantar surface of the calcaneus

through the talus and the articular surface of the tibia.

Visualize the progress of the drill. The drill should reach

the intramedullary canal of the tibia.

5. Remove the drill and use a cannulated orthopedic

reamer to clear a path for the implant within the

intramedullary canal. Start with the smallest reamer

diameter and go to the next size depending on the

FUZE size. The reamed hole diameter should not

exceed the minor diameter of the implant’s thread.

6. Push the foot against the tibia to compress the joints manually

and to close the tibia-talus and talus-calcaneus gaps.


Implant FuzeTM

7. Insert the implant and drive it manually with the 5.5 mm hex

cannulated screwdriver.

Stop Advancing

8. Before the implant head reaches the calcaneus, and while the

implant head is at least 20 mm outside the foot, remove the

Steinman pin altogether and lock the hex screwdriver to the

FUZE. Note the FUZE and the screwdriver lock together in

only one position. Make sure there is no foreign material within

the head cavity that might

cause misalignment.

Remove Guide Wire


Lock Driver to FuzeTM



Lock Driver to FuzeTM

9. Continue to advance the FUZE with the hex screwdriver.

10. When the middle thread of the implant engages the distal

tibia and the head engages the calcaneus, the talus-tibia and

talus-calcaneus joints tighten at first. When the middle thread

clears the talus, the implant compresses the joints.

11. Advance the implant until the FUZE head is flush with the

bone surface. The notch in the hex screwdriver handle

should face towards the toes.

Attaching Targeting Tool

12. Attach the Targeting Frame/Jig to the

FUZE head. Align the notch of the

implant with the protrusion pin in the

middle leg of the metal support of

the Targeting Frame/Jig.

Attaching Targeting Tool


Alignment Notch

Targeting Tool Mounted


Targeting Tool Locked


NOTE: The FUZE-screwdriver assembly

locks into the Targeting Frame/Jig in

only one position. Tighten the locking

nut to secure the Targeting Frame/Jig

to the FUZE-hex screwdriver assembly.

Locking Nut

Targeting Tool Locked


Locking Nut

Plantar View

Introducing Locking Screws

9. Insert the 150 mm drill guide

P460-35A into a proximal

Targeting Frame/Jig hole

(corresponding to the leading

tip of the implant). Insert a

3.5 mm drill, Z400-150-35,

into the drill guide and drive it

into the tibia, through the FUZE,

and into the distal wall of the

tibia. The drilling provides a pilot

hole for the 5.0 mm locking

screws.


Proximal LM Hole Distal LM Hole

Measuring Screw Length



Introducing Locking

Screws

14. Insert the 150 mm drill

guide P460-35A into

a proximal Targeting

Frame/Jig hole

(corresponding to the

leading tip of the

implant). Insert a

3.5 mm drill,

Z400-150-35, into

the drill guide and

drive it into the tibia, through the FUZE, and into the distal wall of the tibia.

The drilling provides a pilot hole for the 5.0 mm locking screws.


Proximal Locking Screws

15. Finish the placement of cross screws

as desired. Vilex recommends the

insertion of at least 4 four screws:

two distally through the tibia, one

within the middle thread, and one

through the calcaneus.

Proximal AP Screw

LM ScrewProximal


Distal Locking Screws

16. Add more screws as

desired. Screw the end

cap and close.

Distal LM ScrewDistal LM Screw

Distal LM Screw



16. Add more screws

as desired. Screw

the end cap and

close.

Inserting Slanted Screw From Talus to Calcaneus



16. Add more screws

as desired. Screw

the end cap and

close.

Advance Drill through Heal & Retrograde


All Screws Inserted

Fibula Removed


The FuzeTM Tray

Tray Cover


The FuzeTM Tray

Top Tray


The FuzeTM Tray

Lower Tray

Screw Tray

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Lower TrayLower Tray

arthrodesis of the ankle -...

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