Tibia Surgical Technique

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PediLoc® Tibia

PediLoc® Tibia Surgical Technique

The technique description herein is made available to the healthcare professional to illustrate the

author’s suggested treatment for an uncomplicated procedure. In the final analysis, the preferred

treatment is that which addresses the needs of the specific patient.

• PediLoc® Tibia is indicated for fractures and osteotomies of the proximal and distal tibia.

This technique guide is limited to discussion of distal tibial rotational osteotomies.

• Tibial torsion with resultant lever arm dysfunction is a common development in children with Cerebral

Palsy. A distal tibial rotational osteotomy is indicated when this torsion is of functional consequence.

Proximal tibial osteotomies have a higher risk of neurologic damage and compartment syndrome.

• In the majority of cases, a fibular osteotomy is not required. If the correction is significant (>30°)

a fibular osteotomy should be considered.

• A sterile tourniquet is recommended for this procedure. By using a sterile tourniquet, the surgeon can

check the thigh-foot angle intraoperatively prior to and after derotation of the tibia.

• Read and understand indications, warnings and adverse effects as explained in the IFU prior to use.

• The adverse effects and contraindications listed in the IFU are important considerations. These risks

and general surgical risks should be explained to the patient prior to surgery.

• To obtain a copy of the instructions for use (IFU) and cleaning instructions (CI), call OrthoPediatrics®

customer service at 574-268-6379.

®

®

Place the patient supine on a radio-

lucent operating table. A bump may

be placed under the ipsilateral leg in

order to facilitate visualization. If a

tourniquet is to be used, place a well

padded sterile tourniquet around the

proximal thigh of the operative leg.

Position the image intensifier and

flouroscopy monitor on the oppo-

site side of the operating table for

adequate visualization of the surgical

procedure. Alternatively, the mini

C-arm can be used on the ipsilateral

side. Use of flouroscopy is essential

to the success of this procedure.

1

2

Identify and locate the distal tibial

physis using flouroscopy and mark

the incision location. Make a lon-

gitudinal incision anteromedially

with the distal end of the incision

at the level of the physis. Alterna-

tively, make a transverse incision

at the level of the pre-planned

osteotomy. Identify and protect

the saphenous vein. Incise the

periosteum longitudinally, begin-

ning 1.5 cm proximal to the physis

and proceeding as far proximal

as the incision allows. Complete

subperiosteal dissection.

3

Select one of the plates (narrow

medial, wide medial or anterolat-

eral) and position. Once positioned,

confirm its position with the C-arm.

Mark the area of planned osteotomy.

4

Place derotation pins proximal and

distal to the planned osteotomy.

Complete the metaphyseal osteotomy

2.0-2.5 cm proximal to the physis and

derotate the distal fragment.

Note: The osteotomy must be parallel

to the physis and perpendicular to

the long axis of the tibia; otherwise,

derotation will lead to angular

deformity.

25°

Osteotomy

Physis

5

After the osteotomy is complete,

secure the distal fragment by placing

locking or non-locking cortical bone

screws in the distal aspect of the

plate. Alternatively, attach screws

to the distal fragment prior to

completing the osteotomy in order

to maintain control of the distal

fragment.

25°

6

Complete the derotation by

aligning the derotation pins in

the same plane.

Secure the proximal fragment by

placing locking or non-locking screws

in the proximal fragment. The use of

locking screws in the proximal frag-

ment will prevent loss of rotation.

PROD # QTY PRODUCT

00-0903-3302 1 3.5mm Wide Medial Distal Tibial

Locking Compression 2 hole plate left

00-0903-3303 1 3.5mm Wide Medial Distal Tibial

Locking Compression 3 hole plate left

00-0903-3304 1 3.5mm Wide Medial Distal Tibial

Locking Compression 4 hole plate left

00-0903-3305 1 3.5mm Wide Medial Distal Tibial

Locking Compression 5 hole plate left

00-0903-3402 1 3.5mm Wide Medial Distal Tibial

Locking Compression 2 hole plate right

00-0903-3403 1 3.5mm Wide Medial Distal Tibial

Locking Compression 3 hole plate right

00-0903-3404 1 3.5mm Wide Medial Distal Tibial

Locking Compression 4 hole plate right

00-0903-3405 1 3.5mm Wide Medial Distal Tibial

Locking Compression 5 hole plate right

3.5mm Wide Medial

PROD # QTY PRODUCT

00-0903-2102 1 3.5mm Anterolateral Distal Tibial

Locking Compression 2 hole plate left

00-0903-2103 1 3.5mm Anterolateral Distal Tibial

Locking Compression 3 hole plate left

00-0903-2104 1 3.5mm Anterolateral Distal Tibial

Locking Compression 4 hole plate left

00-0903-2202 1 3.5mm Anterolateral Distal Tibial

Locking Compression 2 hole plate right

00-0903-2203 1 3.5mm Anterolateral Distal Tibial

Locking Compression 3 hole plate right

00-0903-2204 1 3.5mm Anterolateral Distal Tibial

Locking Compression 4 hole plate right

3.5mm Anterolateral Medial

PROD # QTY PRODUCT

00-0903-3102 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 2 hole plate left

00-0903-3103 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 3 hole plate left

00-0903-3104 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 4 hole plate left

00-0903-3105 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 5 hole plate left

00-0903-3202 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 2 hole plate right

00-0903-3203 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 3 hole plate right

00-0903-3204 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 4 hole plate right

00-0903-3205 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 5 hole plate right

3.5mm Narrow Medial

PROD # QTY PRODUCT

00-0903-3102 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 2 hole plate left

00-0903-3103 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 3 hole plate left

00-0903-3104 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 4 hole plate left

00-0903-3105 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 5 hole plate left

00-0903-3202 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 2 hole plate right

00-0903-3203 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 3 hole plate right

00-0903-3204 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 4 hole plate right

00-0903-3205 1 3.5mm Narrow Medial Distal Tibial

Locking Compression 5 hole plate right

PROD # QTY PRODUCT

000-0903-2510/2560 53.5mm Self Tapping Cortical Screw with

T15 Hexalobe 10mm through 60mm

00-0903-2565/2570 5 3.5mm Self Tapping Cortical Screw with

T15 Hexalobe 65mm and 70mm

00-0903-2610/2656 5 3.5mm Locking Cortical Screw with T15

Hexalobe 10mm through 56mm

3.5mm Screws

PROD # QTY PRODUCT

01-0903-0003 2 T15 Hexalobe Driver

01-0903-0002 3 2.5 mm Threaded Drill Guide

01-1030-007 1 Self-Holding Screw Forceps

01-1050-0032 2 2.5 Drill Bit, Calibrated

01-1050-0039 6 1.60mm Guide Wire

01-1030-001 1 AO Ratchet Handle

Instruments

PROD # QTY PRODUCT

01-1050-0025 1 Depth Gauge Short, 10-50mm

01-1050-0026 1 Depth Gauge Long, 10-100mm

May use additional instrumentation from the PediLoc® Small Frag system

CAUTION: Federal law restricts this device to sale by

or on the order of a physician.

CAUTION: Devices are supplied non-sterile. Clean

and sterilize before use according to instructions.

CAUTION: Implant components are single-use.

Do not reuse.

CAUTION: This device is not approved for screw

attachment or fixation to the posterior elements

(pedicles) of the cervical, thoracic or lumbar spine.

NOTE: This technique has been provided by one of

our medical advisors only as guidance and is not

intended to limit the methods used by trained and

experienced surgeons.

This document is intended exclusively for experts in the field, i.e. physicians in

particular, and expressly not for the information of laypersons. The information

on the products and/or procedures contained in this document is of general

nature and does not represent medical advice or recommendations.

Since this information does not constitute any diagnostic or therapeutic

statement with regard to any individual medical case, individual examination

and advising of the respective patient are absolutely necessary and are not

replaced by this document in whole or in part.

The information contained in this document was gathered and compiled by

medical experts and qualified OrthoPediatrics® employees to the best of their

knowledge. The greatest care was taken to ensure the accuracy and ease of

understanding of the information used and presented.

OrthoPediatrics® does not assume any liability, however, for the timeliness,

accuracy, completeness or quality of the information and excludes any

liability for tangible or intangible losses that may be caused by the use

of this information.

2850 Frontier Drive Warsaw, Indiana 46582

phone: 574.268.6379 • 877.268.6339 fax: 574.268.6302

www.OrthoPediatrics.com

ST-1050-06-01 Rev A

PediLoc® Tibia Surgical Technique 8/11

IFU, cleaning instructions, and surgical techniques may be obtained by calling OrthoPediatrics® Customer Service

at 574-268-6379. Read and understand indications, warnings, and adverse effects explained in IFU’s prior to use.