Lapifuse Procedure Steps

Question 1

Pre step 1: positioning

Answer 1

Patient positioning
Supine position with small bump under hip so foot is neutral

Question 2

Step 1: incision

Answer 2

First metatarsal joint exposure
Create incision
20-25 mm on either side of the Tmt joint
Access the first metatarsal joint to remove cartilage

Question 3

Step 2: joint prep

Answer 3

1. Insert threaded pin
   Place body of distractor laterally over foot.
   Use as guide to place second, parallel pin into base of first metatarsal
   Distract joint 10-15mm
2. Hand prep the joint and remove cartilage using joint prep kit
   osteotome- scrape the cartilage
   2 curettes for edges
   Single use kit

subcondral drilling and fish scaling to access the subcondral bone plate
Subcondral- bone that sits underneath cartilage in a joint

Question 4

Step 3 - drill

Answer 4

Use 2.5mm drill to fenestrate the surfaces of the bone
Reduce the joint

Question 5

Step 4 - second incision

Answer 5

Create medial incision over first mtp joint
Insert 1.4mm k wire in medial head of metatarsal.

Question 6

Step 5 - third incision

Answer 6

Create incision between 1st and 2nd metatarsals.

Question 7

Step 6 - Im angle reduction

Answer 7

Use lapifuse clamp for Triplanar correction
Insert Hook of clamp in incision
Insert base of clamp on to the kwire
Reduce to the desired IM angle by compressing the ratcheting clamp

allows you to rotate the first metatarsal head and get first 1 2 metatarsal angle corrected

Question 8

Step 7- targeting guide

Answer 8

Use targeting guide to place inter fragmentary screw
Base of first metatarsal, through medial cuneiform, into body f intermediate cuneiform

Assemble targeting guide and insert 2 1.4mm kwires
Assemble so nose of guide is between wires
Place 1. 1.4mm k wire through guide to temporarily secure joints

Question 9

Step 8: lag screw

Answer 9

Remove targeting guide from the k wire
Replace with lag screw depth gauge
Use 2.7mm drill and drill guide to prep hole
Insert interfragmentary screw

Question 10

Step 9: Tmt fixation

Answer 10

Tmt fixation
Select plate
Place locking and/ or non locking screws in Lapifuse plate ‘
If additional compression is desired, utilize compression slot. Drill hole, drive non locking screw into bone
2 in medial cuneform, proximal
3 in metatarsal
If

Question 11

Interfragmentary screw

Answer 11

Available in screw lengths from 35mm to 45mm in 2.5mm increments
Single diameter of 4.0mm
First screw put in at angle from first metatarsal to medial cuneiform to body of intermediate cuneiform.