Name: Plantar Lapidus Plate
Uploaded: 2016-11-09T00:00:00Z
Channel: Arthrex
Description: James McWilliam, MD, (New York, NY) demonstrates a lapidus fusion using the Arthrex ® Plantar Lapidus Plate.

<p>James McWilliam, MD, (New York, NY) demonstrates a lapidus fusion using the Arthrex<sup>®</sup> Plantar Lapidus Plate.</p>

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VID1-00882-EN | B | Plantar Lapidus Plate

James McWilliam

Human

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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Surgical Technique Videos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Plantar Lapidus Plate

So we're going to do a bunion correction via this procedure using the Arthrex plantar lapidis plate. The planar lapidis plate is side specific, both right and left, and it comes in a large and a small. Because this foot's relatively large, we're going to use the large plate. I've marked out some landmarks here. Here's a navicular tuberosity in the posterior tibial tendon. The body the navicular. This is the medial cuneiform. And the first metatarsal. Here we see the tibialis anterior inserting onto the medial cuneiform. Occasionally this insertion will go onto the base of the first metatarsal as well. And finally we have the abductor hallucis muscle. So our incision will be just on the dorsal edge of the abductor hallucis muscle. I'll usually extend from the near articular surface of the medial cuneiform approximately halfway down the first metatarsal shaft. If I'm really doing a bunion ectomy, I'll extend the incision distally and do my capsulotomy and median eminence excision through the same incision. So here's the muscle belly of our abductor hallucis. We're going to try to maintain as much of that fascia as possible, which can be a challenge in a cadaver. We're basically going to take that down off of the planar aspect of the metatarsal and cuneiform. So here's the base of the metatarsal. That's going to be good exposure. We'll perform our reduction maneuver which once again involves a pronation of the metatarsal with a lateral deviation of the metatarsal. And we'll provisionally fix it with a K-wires. So we're using the locking guide as sort of a handle or a joystick for placement of the plate. A nice rule of thumb for placement of the plate is to have the proximal medial drill hole aligned just at the posterior edge of the tibialis anterior tendon. When we fix the plate distally and engage the lag screw here. That's going to cause a proximal shift of the plate. And that way we ensure that we miss the tibialis anterior tendon. We'll fix the plate distally first. You could use a locking or a non-locking screw depending on the bone quality. I typically use a locking screw because it's a one step placement that allows you to drill and measure at the same time, so that'll be a 14. This is a 3.5mm locking screw. Now one of the benefits of this plate is that it's very low profile, as the vast majority of the plate is on the plantar aspect of the foot. So hardware irritation and the subsequent necessity for hardware removal is minimized occasionally because of patient anatomy variations. This part of the plate, the distal medial hole, might be riding a little bit higher than you'd like. It might be a little bit more prominent than you would like. In those cases, you can get a little final bend by placing a cortical screw. Here, even though I'm using a cortical screw, it's still beneficial to use a drill guide. And in this case we'll measure using a standard depth gauge. [00:03:25] Yep. Thank you. Okay. So that's a 20. So this is a cortical screw that I'm inserting. In this case I'm hoping to contour the plate a little more closely to the medial cortex of the metatarsal. And you can see the plate's bending nicely down to the metatarsal there. Well the screws are for cancellous screw. I'm using a 400 drill in the metatarsal so I can create a lag effect. Now I use the 2.5 guide that will go into my furrow hole. So I create a concentric 2.5mm drill hole into the medial cuneiform. Cartiform I'll go at or even through the dorsal cortex here. So now we're going to drill our 2.5mm screw hole into the medial cuneiform. If it looks like I'm about to violate the navicular cuneiform joint, I'll stop right there. So I'll measure my drill hole. And this measures about a 34. But you might notice that the plate is actually off of the bone of the first metatarsal and middle cuneiform. And if I measure that distance it's about eight millimeters. So this lag screw is actually going to cause this plate to this plate. And the metatarsal to migrate proximally to the extent that this part of the plate might actually be opposing bone. So instead of using a 34 screw I'm going to knock off about six millimeters and I'm going to take a 28. So I'm going to insert the screw until it engages the plate. Once it engages the plate I'm going to remove the BB-Tak. And I'm going to remove our provisional fixation K-wires. So now that we've engaged the plate with the head of the screw, you're going to see the plate and the first metatarsal migrate proximally, creating compression at the joint surface. So now the plate's migrated such that it's contacting the planar aspect of the first metatarsal base, as well as the planar aspect of the medial Cartiform. And you see here also that the plate is no longer on top of the tibialis anterior tendon. So we'll place our final two screws into the medial cuneiform. I'll typically use a locking screw here, as well as allow me to avoid violating the dorsal cortex. So I don't get hardware irritation with shoe wear. And our last locking screw will be in the medial cortex of the medial cuneiform. This is a uni cortical screw. You could actually go into the middle cuneiform if you want to affect inner cuneiform stability. So we have a rigidly fixed tarsometatarsal fusion with a lag screw that's creating compression across the fusion site. The planar placement of the plate will create a tension band effect that will transform our dorsiflexion moment into compression across the dorsal aspect of the plate, and we'll convert the tendency for planar gapping with dorsiflexion with weight bearing into compression. I've used a 3.5mm cortical screw here to contour the plate to the metatarsal if enhanced stability is desired. This could certainly be changed out to a 3.5mm locking screw, particularly since I used a locking guide to drill the hole.

Plantar Lapidus Plate

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