Wright Medical Technology Ortholoc 3Di Foot Reconstruction System: Lapidus Fusion Plates

Jeffrey E. McAlister, DPM

Christopher F. Hyer, DPM, MS, FACFAS

 

Fig 1. WMT Lapidus Plate
Fig 1. WMT Lapidus Plate

Wright Medical Technology (WMT) has introduced a new locking plate set called Ortholoc 3Di with redesigned plates and screw technology for a multitude of applications.  Here we highlight the lapidus fusion plating system.

The Lapidus fusion plates are designed with ease of use in mind and specific to the anatomy of the 1 and specific to the anatomy of the 1st tarsometatarsal (TMT) joint.  The options given to foot and ankle surgeons with these plates are geared towards achieving either neutralization or compression. In many instances, a separate lag screw outside the plate may be used to set the corrected position and achieve interfragmentary compression. The plate can add additional compression through use of its ramped compression slot as well.

Lapidus Plate Positioning
Fig 2. Lapidus Plate Positioning

The plate also has options aimed at varying degrees of displacement of the first metatarsal in the sagittal plane. The plate step-off sizes range from 0-mm to 4-mm. The screw sizes and options are similar to the first metatarsophalangeal joint fusion plates: 2.7-mm and 3.5-mm screws, both in a non-locking and locking variety. These screws are polyaxial, as well, or locking in a 30-degree diameter off-axis.

There is a compression slot available on the distal portion of the plate, if one desires to add a non-locking screw for added compression. It is important that the proximal screws in the plate are locked down first if the slotted compression hole is to be used. Once the proximal portion of the plate is secured to the medial cuneiform,eccentric drilling on the most distal end of compression slot will allow a bi-cortical, non-locking screw to gain even more compression.

Locking Screw Pre-Drill
Fig 3. Locking Screw Pre-Drill

Another tool useful in these fusions is the X-Track compression/distraction device, especially when operating without assistance.  This device is unique because one is able to use multiple sized pins, compress AND distract, and it is jointed in multiple planes.  The X-Track is helpful for any foot and ankle surgeon with multiple forefoot, midfoot and hindfoot pathologies.

Overall, this Lapidus plate and the Ortholock 3Di system is an excellent addition to any surgeon’s hallux valgus correction toolbox.

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Figures 1 – 4 detail plate application during a lapidus procedure after a compression screw is placed.

 

Technique Tips:

  • The authors prefer an aggressive curettage and minimal planar resection of the joint surfaces prior to plate application to minimize shortening. It is important that complete violation and destruction of the subchondral plate is performed, however, to achieve high fusion rates.

    Fig 3. Plate Application
    Fig 4. Plate Application

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  • The authors prefer to utilize a 4.0-mm partially threaded, cannulated screw for compression from the first metatarsal base to the intermediate cuneiform.This is typically directed from the proximal medial base of the 1st metatarsal obliquely across the 1st TMT joint and ending in the intermediate cuneiform proximal-lateral corner. This screw gives good compression at the 1st TMT but also creates additional stabilization of the 1st and 2nd columns.

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  • The most biomechanically stable position to place the plate is dorsomedial and this also prevents dorsal irritation from shoegear.

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  •  Do not remove provisional reduction of the intermetatarsal angle (e.g. tenaculum or Steinmann pins or Kirschner wires) until the plate is applied.

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  • If placing the plate dorsally, make certain the distal screws are in the metatarsal.  It is often easy to miss the metatarsal and not realize it.

 

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Jeffrey E. McAlister, DPM is a current fellow at the Orthopedic Foot and Ankle Center Fellowship and is involved with residency programs at OhioHealth Doctors Hospital and The Ohio State University Medical Center.

Christopher F. Hyer completed his medical training at the Ohio College of Podiatric Medicine, and he completed his surgical internship and residency at The Ohio State University Medical Center. He received additional advanced fellowship training at OFAC. Dr. Hyer is a fellow of the American College of Foot and Ankle Surgeons and a member of the American Podiatric Medical Association. He is board certified in reconstructive rearfoot/ankle surgery and foot surgery with the American Board of Podiatric Surgery.

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The Unbiased Authority: There are no conflicts of interest or financial association / assistance between SurgicalFixation and Wright Medical Technology. 

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