Distal Femoral Osteotomy System

SURGICAL TECHNIQUE

®
2
istalDDistal
Fealmor Osyomte Syemst Femoral Osteotomy System SURGICAL TECHNIQUE
 istalDistal
D Fealmor Osyomte Syemst Femoral Osteotomy System
TABLE OF CONTENTS

System Overview

ndicaD
I ons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
qates
P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Surgical Technique

reoperaD
P ev Pqanning andaDP entosiD
P oning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Surgicaqpproach
A andExposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Extensionsteotomy
O
qacement
P ofniD
I aquide
G Wires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
reate
C istaq
D steotomy
O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
reate
C rox
P imaqsteotomy
O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
pening
O Wedgesteotomy
O
ocate
L andreate
C steotomy
O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
ommon
C Steps
istaq
D ixF aDon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
ReducDon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
rox
P imaqixF aDon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Product Information

qates
P . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
nstru
I mentaDon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

3
 SYSTEVEMO RVIEW
Distal Femoral Osteotomy System

INDICATIONS

TherthoP
O ediatricsistaq
D emoraq
F steotomy
O SystemPDOSQ
F isintendedfortemporaryinternaqfixaDon
andstabiqizaDonofqongbonefracturesandosteotomiesdmaqJunionsandnonJunionsdinpediatricandsmaqq
statureaduqts:

Description
TherthoP
O ediatricsistaq
D emoraq
F steotomy
O SystemincqudespqatesandscrewsusedforinternaqfixaDon
tofaciqitateboneheaqingandrepairafterosteotomyofthedistaqfemur:

Thissystemincqudespqateswithdifferentoffsetsdwhichcanbeusedwith:mmand:mmcannuqatedor
soqidscrews:Systemcomponentsaremanufacturedfromstainqesssteeqforincreasedstrengthandeaseof
removaq:

mpqant
I contentsofthesystemincqude9
N :mmsjpqatewithjflarednooffsetandorrhoqes
N :mmjpqatewithjflarednooffsetandorrhoqes
N :mmjpqatewithsjflaredmmoffsetandorrhoqes
N :mmjpqatewithsjflaredsmmoffsetandorrhoqes
N :mmsjpqatewithjflarednooffsetandorrhoqes
N :mmjpqatewithjflarednooffsetandorrhoqes
N :mmjpqatewithsjflaredmmoffsetandorrhoqes
N :mmjpqatewithsjflaredsmmoffsetandorrhoqes

1 Note: In addition to the contents of the Distal Femoral Osteotomy

System set, the following implants and instrumentation are
required to perform this procedure:
• 3.5mm or 4.5mm cannulated and/or solid screws (part
families 00-0903-25XX, 00-0903-26XX, 00-0907-37XX,
00-0907-45XX, 00-0907-46XX and 00-0907-47XX)
• 3.5mm or 4.5mm Locking Proximal Femur instrumentation
2 Note: In order to ensure proper mating of the sawblade with the
cut slots on the cut guides, refer to the cut slot width marked on
the individual cut guides.
Within this system, size identification is aided by colors:
• Blue - 3.5mm instruments and implants
• Green - 4.5mm instruments and implants

4
 SYSTEVEMO RVIEW

Distal Femoral Osteotomy System

PLATES

Thedistaqcqusteroftheistaq
D emoraq
F steotomy
O qates
P consists
ofthreeqockinghoqesXdYandZPseeigu F reQ:
2
Theshaftofthepqatescontainstwotypesofhoqes9qockingPQand
dynamiccompressionPQdasshown:
1
Thedynamiccompressionsqotsareorientedsothatcompression
isdirectedtowardtheqocaDonoftheosteotomy: 2

TheqockinghoqesaqqowforinserDonofqockingorcorDcaqscrews:
1
UsingcorDcaqscrewsdjofanguqaDoncanbeobtainedinboth
theqongitudinaqandtransversepqanes:

ThedynamiccompressionsqotsaqqowforinserDonofcorDcaq
screwswiththeabiqitytoobtainrjofqongitudinaqanguqaDonand
Z
joftransverseanguqaDon:

axM imumachievabqecompressionperdynamiccompressionsqot X Y
is:mm:

FIGURE 1: :mmjOSDF qated

P sj
qared
F mmffset
O

5
 SURGTEICAL CHNIQUE
Distal Femoral Osteotomy System

PREOPERATIVE PLANNING AND PATIENT POSITIONING

f
I performinganextensionosteotomydthedegreeofdistaqfemoraq
extensionisdeterminedfromcqinicaqexaminaDonandaqateraq
Jray
x ofthekneeinmaximumextension:easu
M retheDbioJ
femoraqangqeontheqateraqprojecDon:

f
I performingaedge
w osteotomydthedegreeofcoronaqpqane
correcDonisdeterminedfromcqinicaqexaminaDonandafuqqJ
qengthdstandingJrayx :irstd
F drawaqinefromthecenterofthe
femoraqheadtoatargetaqignmentpointatthecenterofthe
kneejoint:second
A qineisdrawnfromthecenteroftheDbiaqJ
taqarjointtothetargetaqignmentpointusedinthefirstqine:The
degreeofcorrecDonrequiredcanbefoundbymeasuringthe
proximaqangqeformedbythetwoqines: FIGURE 2: aDP entposiDoning

osiD
P onthepaDentsupineonaradioqucentoperaDngtabqe:
VisuaqizaDonofthehipdkneeandankqejointwiththeimage
intensifierisnecessary:

rep
P anddrapetheaffectedqowerextremityuptothehip:
rape
D toaqqowmaximaqexposureofthehipaseqq
w astheqower
extremity:

f
I asteriqetourniquetwiqqfitdappqysteriqetourniquettotheupper
thigh:

ivG eanDbioDcsperusuaqprotocoq:Exsanguinatetheqegdand
inflatethetourniquet:

6
 SURGTEICAL CHNIQUE

Distal Femoral Osteotomy System

SURGICAL APPROACH AND EXPOSURE

Usingfluoroscopydmarkouttheqeveqofthedistaqfemoraqphysis:
ake
M astandardqateraqapproachtothedistaqfemur:fI pqanning
aconcomitantpateqqartendonshorteningthencurvethedistaq
porDonoftheincisionanteriorqyoverthepateqqartendon:

erform
P astandardqateraqapproachtothedistaqfemur:Superficiaq
dissecDonmayextenddistaqtotheqeveqofthephysistoaqqowthe
deeperdissecDontoextendjustproximaqtothephysis:

SpqittheiqioDbiaqbandandexposetheastuv sqateraqis:Separate
theastu
v sqateraqisfromtheqateraqintermuscuqarseptumand
exposethedistaqfemursubperiosteaqqy:

issect
D asfardistaqqyaspossibqeapproachingthephysisdtaking
carenottoinjuretheperichondriaqring:

f
I performinganextensionosteotomydproceedtopages:
fI performinganopeningedge
w osteotomyPcoronaqpqane
correcDonQdproceedtopage:

7
 SURGICAL
SURG
TEICAL CHNIQUE TECHNIQUE
Fealmor Osyomte Syemst Femoral Osteotomy System

EXTENSION OSTEOTOMY
Placement of Initial Guide Wires

reJqoad
P theproximaqshaftporDonoftheiniDaqpinguidewith
two:rmmwireguides:ased
B onthesizeofimpqanttobeused
andthetypeofscrewsdesiredinthedistaqfragmentdseqectthe
appropriatedistaqheadporDonoftheiniDaqpinguidePseeTabqeQ
andassembqeittotheproximaqshaftporDon:

tem
I umber
N escripD
D on

JJ niD
I aqin
P uide
G istaq
D eadd
H :mm
istalDDistal

CannuqatedScrews
JJ niD
I aqinP uide
G istaq
D eadd
H :mmSoqid
Screws
JJ niD
I aqin
P uide
G istaq
D eadd
H :mm
CannuqatedScrews
JJ niD
I aqinP uide
G istaq
D eadd
H :mmSoqid
Screws
TABLE 1

1 Note: Incorrect selection of distal head may result in inaccurate

guide wire placement for the distal cluster of screws for the desired
implant

2 Note: When assembling the two 1.6mm wire guides, ensure the
wire guides are not cross-threaded and are perpendicular to the
shaft to ensure proper orientation of the proximal cut guide

8
 SURGTEICAL CHNIQUE

Distal Femoral Osteotomy System

qace
P theiniDaqpinguideontheqateraqaspectofthefemurd

Extension Osteotomy
qocaDngitproximaqtothedistaqfemoraqphysis:rov
P isionaqqyfix
theproximaqshaftoftheiniDaqpinguidetothediaphysisofthe
femurdusinganoqivewireorbonecqampthroughtheprovisionaq
fixaDonhoqePFigureQ:

3 Note: To ensure accuracy of guide wire placement for the cutting

guides, care should be taken to ensure that the proximal shaft of

Wedge Osteotomy
the initial pin guide is parallel and flush with the diaphysis of the
femur

4 Note: The X, Y and Z holes of the distal head correspond to the FIGURE 3: ocate
L andaqignproximaq
screws on the implant, so care should be taken to not place them porDonofiniDaqpinguide
too close to the physis

Common Steps
WiththeproximaqshaftoftheiniDaqpinguideparaqqeqtothe
diaphysisofthefemurdinserta:rmmguidewireintoeachofthe
:rmmwireguides:

5 Note: This will prevent any unwanted rotation of the shaft of the
guide while the distal cluster placement is obtained

f
I desireddthedistaqcqustercanbetransqatedanteriorqyPFigureQd
toaccommodateforposteriorshiftofthedistaqfragmentupon
reducDondwhichbothminimizesanteriorbumpandmaintainsthe
mechanicaqaxisinthesagittaqpqane:Tightentheqockingboqtusing
aTorThexaqobedriver:

FIGURE 4: TransqaDonofdistaqcqusterof
screws

9
 SURGICAL
SURG
TEICAL CHNIQUE TECHNIQUE
Fealmor Osyomte Syemst Femoral Osteotomy System

Withthekneemaximaqqyextendeddrotatethehandqeofthe
iniDaqpinguidesuchthatitisparaqqeqwiththeqongaxisofthe
DbiaPFigureQ:oing
D sowiqqcorrectfortheangqeofflexion
contracture:ngu
A qarmarkingsontheiniDaqpinguidecanbeused
asareference:

6 Note: As rotation of the handle sets the angle of extension

correction, care should be taken to compare the angle obtained
from the pin guide with the angle obtained during pre-operative
istalDDistal

planning. FIGURE 5: Setangqeofdistaqosteotomy

WhiqemaintainingthehandqeoftheiniDaqpinguideparaqqeqwith
theaxisoftheDbiadinserttheappropriatesizeguidewiresinto
theXdYandZhoqesofthedistaqcqusterPFigurerQ:

7 Note: These guide wires will provide fixation for the distal cut
guide, as well as set the trajectory and location for the three distal
screws of the implant.

8 Note: If desired, fill only the X and Y holes, and leave the Z hole
open to provide more clearance with the sawblade when the distal
cut is made.
FIGURE 6: nsert
I guidewires
9 Note: To prevent penetrating guide wires through the medial
cortex, monitor the position of the guide wire using fluoroscopy.

10
 SURGTEICAL CHNIQUE

Distal Femoral Osteotomy System

RemovetheoqivewirePorbonecqampQdandsqidethepinguideoff

Extension Osteotomy
ofthefemurPFigureQ:

10 Note: There is no need to remove the 1.6mm threaded wire guides

first, as all guide wires are parallel to one another.

Wedge Osteotomy
FIGURE 7: RemoveiniDaqpinguide

Common Steps

11
 SURGICAL
SURG
TEICAL CHNIQUE TECHNIQUE
Fealmor Osyomte Syemst Femoral Osteotomy System

Create Distal Osteotomy

SeqecttheappropriatedistaqcutguidePseeTabqeQandsqideit
overthedistaqguidewires:Themarkingfortheappropriateside
PrightorqeftQshouqdbeabqetobereadPfacingawayfromthe
boneQdandtheopensideofthecutsqotshouqdbetowardsthe
posterioraspectofthefemurPFiguresQ:

tem
I umber
N escripD
D on
JJ istaq
D utC uided
G :mmCannuqated
Screws
istalDDistal

JJ istaq
D utC uided
G :mmSoqidScrews
JJr istaq
D utC uided
G :mmCannuqated
FIGURE 8: qacement
P ofdistaqcutguide
Screws
JJr istaq
D utC uided
G :mmSoqidScrews
TABLE 2

1 Note: Incorrect selection of the distal cut guide may result in the
guide not fitting over or causing damage to the previously placed
wires. Additionally, the osteotomy may not be in an ideal location
relative to the implant geometry.

reate
C thedistaqosteotomy:n A oqiveire
w canbesed
u inthemiddqe
hoqeofthedistaqcutguidetocinchitdowntotheboneandprevent
ibraD
v onFmovementofthecutguidehiqe w theosteotomyisbeing
created:nce
O theosteotomyiscreateddremovetheoqiveirew and
distaqcutguidebutqeavethedistaqguideires
w inpqacePFigureQ:

2 Note: Be careful to only insert the olive wire just until the sphere
touches the distal cut guide face. Over-tightening will cause the
distal cut guide trajectory to be changed.

3 Note: The spike on the posterior aspect of the distal fragment may
need to be removed in order to preserve the vessels and soft tissues
FIGURE 9: reate
C thedistaqosteotomy
in the posterior capsule of the knee joint.
CAUTION: Care should be taken to ensure the cut slot of the distal
cut guide is perpendicular to the diaphysis of the femur in the
coronal plane, to prevent unwanted varus/valgus deformity

12
 SURGTEICAL CHNIQUE

Distal Femoral Osteotomy System

Create Proximal Osteotomy

SeqecttheappropriateorientaDonoftheproximaqcutguide

Extension Osteotomy
PrightorqeftQandsqideitoverthetwo:rmmguidewiresonthe
proximaqfragment:Themarkingfortheappropriatesideshouqdbe
abqetobereadPfacingawayfromtheboneQdandtheopensideof
thecutsqotshouqdbeovertheposterioraspectofthefemur:

SqidetheproximaqcutguideproximaqqyFdistaqqyunDqtheqeveqof
desiredshorteningisobtaineddandfixinpqaceusingammoqive
wirePFigureQ:

Wedge Osteotomy
1 Note: The olive wire should be used to lock the proximal cut guide
in place to prevent an undesirable amount of shortening.
FIGURE 10: Setdesiredshortening
CAUTION: Ensure that the cut slot is perpendicular to the
diaphysis of the femur in the coronal and sagittal planes

Common Steps
ake
M theproximaqcutandremovetheproximaqcutguideaseqq
w
astheoqivewireandthetwo:rmmguidewiresPFigureQ:

nce
O theosteotomieshavebeencompqeteddproceedtopager
forfixaDonandreducDon:

FIGURE 11: reate

C theproximaq
osteotomy

13
 SURGICAL
SURG
TEICAL CHNIQUE TECHNIQUE
Fealmor Osyomte Syemst Femoral Osteotomy System

OPENING WEDGE OSTEOTOMY

Locate and Create Osteotomy

qace
P desiredpqateontheqateraqaspectofdistaqfemurtoqocate
startofosteotomy:Thestartpointoftheosteotomyshouqd
beqocatednearthedistaqendofthesoqidporDonofthepqate
PFigureshQ:

SoqidporDon
ofpqate

1 Note: Approximately 1cm of medial bone should be preserved to

minimize the risk of cortical hinge fracture.
istalDDistal

FIGURE 12: ocate

L startofobqique
2 Note: If distal femoral physis is closed, plate can be positioned
osteotomy
more distally, if desired.

SoqidporDon
ofpqate

FIGURE 13: ocate

L startoftransverse
osteotomy

14
 SURGTEICAL CHNIQUE

Distal Femoral Osteotomy System

Removepqateandcreateosteotomy:inge
H opentheosteotomy

Extension Osteotomy
andpqaceaedgeJshaped
w graftmatchingthedesiredcorrecDon
angqe:

qace
P pqatewithappropriatethreadedwireguidesacross
osteotomyandsecurewithacqamp:roceed
P topagerforscrew
pqacement:

Wedge Osteotomy
Common Steps

15
 SURGTEICAL CHNIQUE
Distal Femoral Osteotomy System

COMMON STEPS
Distal Fixation

ate
M theappropriatethreadedtowersPseeTabqeQintheXandY
hoqesofthedistaqcqusteronthedesiredimpqant:Sqidetheconstruct
overthethreeguideires
w onthedistaqfragmentPFigureQ:

1 Note: If only the X and Y guide wires were placed in the distal
fragment with the initial pin guide, three threaded wire guides (or
three threaded drill guides) should be attached to the X, Y and Z
holes. This will ensure proper trajectory of the Z hole.

2 Note: Take care not to cross-thread the towers onto the plate as FIGURE 14: Sqideimpqantoverdistaqguide
this may lead to wire trajectories that prohibit the screws from wires
locking into the plate.

3 Note: Be sure to use the correct combination of plate, guide towers,

and guide wires. Smaller diameter wires will fit through larger
diameter towers, but may lead to difficulty locking the screws
to the plate. Furthermore, the guide towers for solid screws and
cannulated screws are different lengths. Using the wrong wires and
towers may lead to an incorrect screw measurement at a later step.

CAUTION: Ensure that the distal fragment sits within the offset
of the plate. In order to facilitate this, a chamfer may need to be
added on the lateral edge of the osteotomy surface.

:mmqate
P :mmqate
P
Soqid Cannulated Soqid Cannulated
Screws Screws Screws Screws
Singqe ouD bqe Singqe ouD bqe
uide
G Towers
quB eand
B quB eand
B reen
G and
B reen
G and
B
:mmx :rmmx :mmx :mmx
uide
G Wires
mm mm mm mm

TABLE 3

16 16
 SURGTEICAL CHNIQUE

Distal Femoral Osteotomy System

iqq
F thethreedistaqhoqesontheimpqantwithdesiredscrews:iqqF

Extension Osteotomy
theZhoqefirstdthenremovethethreadedtowersfromtheXand
YhoqesindividuaqqyandfiqqPFigureQ:Thiswiqqheqpmaintainthe
orientaDonoftheimpqantonthedistaqfragment:

Wedge Osteotomy
FIGURE 15: nsert
I distaqscrews

Common Steps

17
 SURGTEICAL CHNIQUE
Distal Femoral Osteotomy System

LOCKING SOLID SCREW PLACEMENT

easu
M retheappropriatescrewqengthusingthescaqeontheback
ofthetower:

4 Note: The measurement for screw length varies between solid

and cannulated screws. Be sure to use the correct combination of
direct measuring device, tower on/off, and the correct end of the
measuring device. Failure to do so may result in an incorrect screw
length (See table 4).

:mmqate
P :mmqate
P
Soqid Cannulated Soqid Cannulated
Screws Screws Screws Screws
irect
D easu
M ring
quB e quB e reen
G reen
G
evD ice
uide
G uide
G uide
G uide
G
easu
M rement
Towern
O Towerff
O Towern
O Towerff
O
nd
E ofeasu
M ring ront
F nd
E ront
F nd
E
ack
B ndE ack
B ndE
evD ice PNoseQ PNoseQ
TABLE 4

Removethetowerandguidewireanddifnecessarydmanuaqqytap
thenearcortex:uqqy
F insertthechosenscrewwiththesoqiddriver:
ompqete
C aqqstepsforagivenscrewbeforemovingontothenext
screw:

CAUTION: In poor quality bone the trajectory of the screw can be

altered if excessive pressure is applied during insertion. This can lead
to the screw head not locking into the plate.

CAUTION: Failure to adequately tighten the locking screw into the

plate may lead to screw back-out.

18 18
 SURGTEICAL CHNIQUE

Distal Femoral Osteotomy System

CANNULATED SCREW PLACEMENT

Removethetowerandmeasurefortheappropriatescrewqength:

Extension Osteotomy
5 Note: The measurement for screw length varies between solid
and cannulated screws. Be sure to use the correct combination of
direct measuring device, tower on/off, and the correct end of the
measuring device. Failure to do so may result in an incorrect screw
length (See Table 5).

Wedge Osteotomy
:mmqate
P :mmqate
P
Soqid Cannulated Soqid Cannulated
Screws Screws Screws Screws
irect
D easu
M ring
quB e quB e reen
G reen
G
evD ice
uide
G uide
G uide
G uide
G Tower
easu
M rement
Towern
O Towerff
O Towern
O ff
O

Common Steps
nd
E ofeasu
M ring ront
F nd
E ront
F nd
E
ack
B ndE ack
B ndE
evD ice PNoseQ PNoseQ

TABLE 5

Usethecannuqateddriqqbittoopenthenearcortex:tI isnot
necessarytodriqqthefuqqdepthofthewire:fI necessarydmanuaqqy
tapthenearcortexwiththecannuqatedtap:ass
P thechosen
screwoverthewireandinsertwiththecannuqateddriver:

CAUTION: If the wire is bent, the cannulated drill and/or driver may
advance the wire further or may not pass over the wire at all. If this is
the case, mate the corresponding tower to the plate and exchange the
wire.

nce
O thescrewisnearqyfuqqyseateddremovetheguidewire:inaq
F
DghteningshouqdbeperformedwithasoqidPnonJcannuqatedQ
driver:ompqete
C aqqstepsforagivenscrewbeforemovingonto
thenextscrew:

CAUTION: Failure to adequately tighten the locking screw into the

plate may lead to screw back-out.

19
 SURGTEICAL CHNIQUE
Distal Femoral Osteotomy System

Reduction

UsingtheappropriatebonecqampJsmaqqorqargeJreducethedistaq
andproximaqfragmentsinthedesiredorientaDonPFigurerQ:
pDO maqfixaDonisachievedwhenthepqateisaqignedwiththe
femoraqshaftaxisintheand AP qateraqpqanes:ny
A internaqor
externaqrotaDoncanbeaccountedforinthisstep:

1 Note: When reducing the plate to the femoral shaft after placing
the distal screws, positioning the bone clamp in the first locking
hole will lead to subsequent interference with a compression screw
in the first dynamic slot. Compression should be applied through
the second dynamic slot to avoid this interference.

FIGURE 16: Reducedistaqandproximaq

fragments

Proximal Fixation

iqq
F theproximaqhoqesoftheimpqantith
w desiredscrewsPFigure
Q:

TheOSDF famiqyofpqatesfeaturesaqternaDngcompressionsqots
andqockinghoqesaqongthepqateshaft:f I compressionisdesiredd
appropriateqypqacedcorDcaqscrewsmustbeinsertedpriortoany
qockingscrews:

FIGURE 17: nsert

I proximaqshaftscrews

20 20
 SURGTEICAL CHNIQUE

Distal Femoral Osteotomy System

Dynamic Compression Screw Placement

osiD
P ontheappropriatedriqqbitatthedistaqendofthe

Extension Osteotomy
compressionsqotusingeithertheGOLDsideoftheneutraqFqoad
driqqguidedorthesizeJmatchedsideofthedoubqedriqqguide:

riqq
D throughbothcorDcesandmeasurewiththeappropriate
depthgauge:

nsert
I thechosenscrewunDqtheheadbeginstoengagethepqate:
Whenengagementbeginsdsimuqtaneousqyreqeasesomeofthe

Wedge Osteotomy
pressureexertedbythebonecqampandfuqqyseatthescrewinto
thepqate:

Withthescrewfuqqyseateddthecqampcanberemoved:f
I a
secondcompressionscrewisdesireddrepeatthestepsabove:
Whentheheadofthesecondscrewbeginstoengagethepqated
qoosenthefirstscrewjustenoughPabout}turnQtoaqqowthe
pqatetosqidefurtheraqongthefemoraqshaft:uqqy
F seatthesecond

Common Steps
screwandthenreJDghtenthefirstscrew:

21
 SURGTEICAL CHNIQUE
Distal Femoral Osteotomy System

Static Screw Placement

osiD
P ontheappropriatedriqqbitatthecenterortheproximaq
endofthecompressionsqotusingeithertheGREENsideofthe
neutraqFqoaddriqqguidedorthesizeJmatchedsideofthedoubqe
driqqguide:

riqq
D throughbothcorDcesandmeasurewiththeappropriate
depthgauge:

nsert
I thechosenscrewunDqfuqqyseatedinthepqate:Repeat
stepsforaddiDonaqscrewsdasneeded:

StaDcscrewscanaqsobepqacedthroughtheqockinghoqes:The
sameprocedureisfoqqoweddhoweverdthedoubqedriqqguidemust
beuseddastheobqongendsoftheneutraqFqoaddriqqguidewiqqnot
fitintheqockinghoqes:

22 22
 SURGTEICAL CHNIQUE

Distal Femoral Osteotomy System

Locking Solid Screw Placement

ate
M theappropriatethreadeddriqqguidePtowerQtothepqateand

Extension Osteotomy
insertthesizeJmatchedcaqibrateddriqqbit:

riqq
D throughthenearcortexandstopwhenthefarcortexis
reached:ote
N thedepthofthedriqqbyreadingthecaqibraDonson
thebackofthetower:

riqq
D throughthefarcortex:

Wedge Osteotomy
Removethetower:f
I necessarydmanuaqqytapbothcorDces:

nsert
I thechosenscrew:

ocking
L screwsshouqdbetheqastscrewspqaceddastheycreatea
fixedJangqeconstructdqimiDnganypotenDaqmovementbetween
thepqateandthebone:

Common Steps
CAUTION: Failure to adequately tighten the locking screw into the
plate may lead to screw back-out. Confirm all screws are fully locked
prior to closing the incision.

23 23
 PRODUCTORMINF TIA ON
Distal Femoral Osteotomy System

PLATES

18° FLARE PLATES, WITH OFFSET

Item Number Description Holes

JJ :mmjOSDF qated
P sjqared
F mmffset
O 4
JJr :mmjOSDF qated
P sjqared
F mmffset
O 6
JJ :mmjOSDF qated
P sjqared
F smmffset
O 4 mm jScrew smm jScrew
JJr :mmjOSDF qated
P sjqared
F smmffset
O 6 ffset
O Trajectory ffset
O Trajectory

JJr :mmjOSDF qated

P sjqared
F mmffset
O 4
JJrr :mmjOSDF qated
P sjqared
F mmffset
O 6
JJr :mmjOSDF qated
P sjqared
F smmffset
O 4
JJrr :mmjOSDF qated
P sjqared
F smmffset
O 6
sj sj
qare
F qare
F

5° FLARE PLATES, NO OFFSET

Item Number Description Holes

JJ :mmjOSDF qated
P jqared
F oN ffset
O 4
JJr :mmjOSDF qated
P jqared
F oN ffset
O 6
JJr :mmjOSDF qated
P jqared
F oN ffset
O 4
jScrew sjScrew
JJrr :mmjOSDF qated
P jqared
F oN ffset
O 6 Trajectory Trajectory
JJ :mmsjOSDF qated
P jqared
F oN ffset
O 4
JJr :mmsjOSDF qated
P jqared
F oN ffset
O 6
JJs :mmsjOSDF qated
P jqared
F oN ffset
O 4
JJsr :mmsjOSDF qated
P jqared
F oN ffset
O 6
j j
qare
F qare
F

24
 PRODUCTORMINF TIA ON

Distal Femoral Osteotomy System

INSTRUMENTATION

Item Number Description

JJ niD
I aqin
P uide
G rox
P imaqShaft
JJ niD
I aqin
P uide
G istaq
D eadd
H :mmCannuqatedScrews
JJ niD
I aqin
P uide
G istaq
D eadd
H :mmSoqidScrews
JJ niD
I aqin
P uide
G istaq
D eadd
H :mmCannuqatedScrews
JJ niD
I aqin
P uide
G istaq
D eadd
H :mmSoqidScrews

JJ istaq
D utC uided
G :mmCannuqatedScrews
JJ istaq
D utC uided
G :mmSoqidScrews
JJr istaq
D utC uided
G :mmCannuqatedScrews
JJr istaq
D utC uided
G :mmSoqidScrews

JJ rox
P imaqutC uide
G

JJ :rmmThreadedWireuide
G
JJ :rmmXmmuide
G Wire

JJs :mmxmmuide
G Wiredr:mmqiv
O edmmThread
JJs :mmxmmuide
G Wiredr:mmqiv
O edmmThread

25
 CAUTION: ederaq
F qawrestrictsthisdevicetosaqebyor
theorderofahyP sician:

CAUTION: evD icesaresuppqiedonJSteriqe:

N Cqeanand
steriqizebeforeuseaccordingtoinstrucDons:

CAUTION: mpqants
I componentsaresingqeJuse:oD not
reuse:

CAUTION: Thedeviceisnotapprovedforscrew
attachmentorfixaDontotheposterior
eqementsPpedicqesQofthecervicaqd
thoracicorqumbarspine

CAUTION: nqy
O thoseinstrumentsandimpqantscontained
withinthissystemarerecommendedfor
usewiththistechnique:ther
O instruments
orimpqantsusedincombinaDonorinpqace
ofthosecontainedwithinthissystemisnot
recommended:

NOTE: Thistechniquehasbeenprovidedbyoneofour
medicaqadvisorsonqyasguidanceanditisnot
intendedtoqimitthemethodsusedbytrained
andexperiencedsurgeons:
Thisdocumentisintendedexcqusiveqyforexpertsinthe
fieqddi:e:physiciansinparDcuqardandexpressqynotforthe
informaDonofqaypersons:

TheinformaDonontheproductsandForprocedures
containedinthisdocumentinofgeneraqnatureand
doesnotrepresentmedicaqadviceorrecommendaDons:
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nstru
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w andadverseeffectsexpqainedinIFUfspriortouse: repqacedbythisdocumentinwhoqeorinpart:

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