Talonavicular Fusion Utilizing Memory Staple Technology: Activize Inc. is proud to provide The Memodyn Memory Staple System which offers surgeons a cost effect, uncompromised dynamic fixation alternative to traditional methods of static fixation used for procedures such as arthrodesis, osteotomy, or fracture fixation.

TN Procedure Necessities: Implants Selection: 2 ea. – CSU  20-­‐20  (20 x 20mm 2 leg single staples.) 1 ea. - QOC 20-12 ‘Quad’ Staple. (20mm long x 12mm wide x 15mm leg length – 4 legs) Instruments: The heat activation method is safe and complemented by simple, effective instrumentation providing the surgeon with quick, reproducible results. The instrument kit includes Black handle single staple drill guide, Gray QUAD drill guide, 2.7mm drill bits, staple clamps, sterile heat loops, and staple punches to ensure a flush fit of the staple. Single Leg MEMODYN Staple Surgical Protocol:

1- Dissection and exposure of the talonavicular joint.

2- Decorticate the articular surfaces with instrumentation of choice.

3- Coaptate both bone segments, assuring congruity, and temporarily fixate with K-wires.

4- Using the BLACK handled adjustable drill guide, set the guide width by loosening the handle and sliding the calibrated guide bar adjusted  to  21mm  wide.  (This  wider  selection  on  the  drill  guide  will  provide  some  tension  upon  insertion  of  Memodyn  staple.)  Then re-tighten the handle.

5- Pre-­‐drill  the  holes  using  a  2.7mm  Drill  Bit,  to  a  depth  of  at  least  20mm. Drill  holes  should  be  

equidistant  from  the  center  of  the  joint.  Here  the  surgeon  drills the dorsal cortex of the Navicular first. At this point the surgeon can choose to leave the drill in place and proceed to drill the second hole with a second drill, preparing for the second drill hole located in the Talus.

6- Select  a  CSU  20-­‐20  (20mm  wide  x  20mm  legs)  Memodyn  Staple.  Insert the staples using the appropriate staple clamp and push flush to the dorsal cortex with the appropriate staple punch.

7- Repeat steps 4 -6 after the first staple compression, to insert the second staple.

8- Once  each  staple  is  correctly  positioned  and  tamped  flush  to  the  bone  surface,  apply  heat  with  

the  BOVIE  as  recommended:    Using  the  recommended  BOVIE  UNIT        —  Set  on  40  Watts  CUT,  Monopolar.      1-­‐ Take  the  cleaned  Bovie  tip  and  activate  it  right  before  touching  the  Memodyn  staple  

surface.  This  will  achieve  an  arc  or  blue  spark  between  the  bovie  tip  and  the  Memodyn  staple.  

2-­‐ For  each  staple,  achieve  this  arc  for  5  seconds  on  each  corner  and  in  the  middle  of  the  Memodyn  staple.

Single Staple Procedural Pearls: Surgeon may have to osteotome or burr the T-N joint, so that the bone surface between the joint will allow the Memodyn staples to fit flush. Two staples are usually suggested for this fusion, crossing the talonavicular joint. Drill  holes  should  be  equidistant  from  the  center  of  the  joint. When using the adjustable drill guide, first drill the distal perpendicular hole. At this point the surgeon can choose to leave the drill in place and proceed to drill the second hole with a second drill. The surgeon can then drill the 2nd proximal perpendicular hole.

QUAD (4 leg) MEMODYN Staple Surgical Protocol:

1- Follow steps 1 – 3 as above.

2- Select the GRAY Quad Drill Guide placing it flush to the bone surface on the TN joint. Pre-Drill holes using a 3.0mm Drill Bit, to a depth of at least 15mm. Drill holes should be equidistant from the center of the joint. Mark each hole for staple implantation.

Note: (** Surgeon may decide to drill one hole and leave a drill bit in the hole to help facilitate correct placement of drill guide while drilling the other 3 holes.)

3- Select the QOC20-12 Quad Memodyn Staple (20mm long x 12mm wide x 15mm leg length)

4- Here, the black block between the legs is removed and the clear slide on the holder is used as a tamp, while holding the black handle. This will allow the surgeon to “push” off the QOC 20-12 from the holder into the predrilled hole.

5- Insert the QUAD staple tapping it or firmly push it so that it sits flush to each bone surface.

6- Once the staple is correctly positioned and tamped flush to the bone surface, apply hear with the BOVIE as recommended:

Using the recommended BOVIE UNIT—Set on 40 Watts CUT, monopolar. Take the cleaned Bovie tip and activate it right before touching the Memodyn staple surface. This will achieve an arc or blue spark between the Bovie tip and the Memodyn staple. Achieve this arc for 5 seconds on each corner and in the middle of the Memodyn staple.

Quad Fixation Principles & Advantages: The QUAD MEMODYN staple works under the same characteristics as the MEMODYN single staple but has four legs and an open top for additional fixation. The open top of the QUAD MEMODYN staple allows for compression on top of the fusion site, as well as the four legs compressing the joint together. This affords the device to bow for additional dynamic compression. Suggested Indications:

- Painful degeneration of the subtalar and talonavicular joints. Contraindications:

- Comminuted bone surface which would militate against staple placement. - Pathologic conditions of bone such as osteopenia which would impair the ability to securely fix

the staple. - Foreign body sensitivity to metals including nickel. Where material sensitivity is suspected,

appropriate tests should be made prior to implantation.

For additional information contact Activize Inc. @ (610)346-1992