InCore TMT System
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Precision Guided Correction Surgical Technique

Precision Guided Correction • Fully Guided • Post and Targeting Guide utilize anatomical land marks to facilitate fixation placement • Solid Intermedullary Construct • Solid 4.9mm Titanium Post provides large surface area engagement in the cancellous bone of the cuneiform • Headless compression screws thread directly into the 4.9mm post • Post and screws construct may reduce hardware prominence and resultant hardware removal due to pain or irritation related to such hardware prominence • Joint Preparation • Targeting Guide provides distraction of the joint for visualization and joint...

Prepare instrumentation by first ensuring the top line of the Compression-Distraction Fixture is aligned with the start line of the Targeting Guide. The T8 Driver is used to rotate the Screw, causing the Compression-Distraction Fixture to travel along the Targeting Guide. Improper alignment may restrict potential distraction and compression travel of the Compression-Distraction Fixture. Targeting Guide CompressionDistraction Fixture Assemble the InCore TMT Post to the Targeting Guide. Thread the Post Fastener into the implant Post, with the Targeting Guide positioned between. The Targeting...

Sighting the holes in the Targeting Guide, alignment can be visualized to ensure proper assembly and left/right foot selection. The medial hole of the Targeting Guide aligns with the plantar hole in the Post. The lateral hole of the Targeting Guide aligns with the dorsal hole of the Post. Plantar Hole Medial Hole Lateral Hole Make a dorsal incision over the tarsometatarsal joint. Perform soft tissue releases to ensure full mobility of the 2nd or 3rd metatarsal to the desired correction position. Position the Post Guide so that the paddle is aligned with the TMT joint line on the 2nd or 3rd...

Before placing a 2mm K-wire, loosely place the K-wire into the Post Guide and observe the angle of the K-Wire to be perpendicular to the long axis of the metatarsal. Adjust as necessary and place K-wire through the Post Guide and into the bone. NOTE: If planning to cut the cuneiform for bone preparation, you may consider making cut prior to placing K-wire. Remove the Post Guide, leaving the 2mm K-wire in the bone. NOTE: The guide is configured to aid in placing the K-wire perpendicular to the long axis of the metatarsal. The angle of the K-wire with respect to the medial aspect of the...

Insert the 4.9mm Post Drill over the 2mm K-wire and drill to the hard stop. Assembly hole 10. Insert the Post and Targeting Guide Guide is atinto thebelowlocated in the cuneiform. Fully seat the Post into the bone ensuring the Targeting or just bone surface. NOTE: Light malleting may be required to fully seat post.

11. Manipulate the metatarsal to achieve desired positioning. With the Compression-Distraction Fixture over the metatarsal, place Implant Bushings through the Targeting Guide holes. Evaluate the anticipated screw entry points on the metatarsal to ensure that the lateral screw and the medial 2mm K-wires will have bone purchase. Proper depth of the Post, rotation of the Targeting Guide about the Post, and degree of bone removal during joint preparation are elements that can affect the entry point of screws in the metatarsal. Once the metatarsal and targeting guide are positioned in the...

13. Using the T8 driver, turn the Screw in the Compression-Distraction Fixture counter-clockwise to distract the tarsometatarsal joint. NOTE: Soft tissue release may be required to achieve desired distraction and optimal visualization. 14. After desired distraction is achieved, continue to prepare the joint with curettage, microfracture, and other preferred bone preparation methods. NOTE: If performing this procedure on both 2nd and 3rd TMT joints, consider preparing both joints at the same time while the 2nd TMT joint is distracted. 15. Following bone preparation, turn the Screw clockwise...

16. Once desired position is achieved and secured in compression, place the Implant Bushing into the medial hole in the Targeting Guide. Ensure the Implant Bushing chosen is the longest bushing that will fully seat against the Targeting Guide without touching the metatarsal. Once the Implant Bushing is in place, insert the matching Drill Bushing into the Implant Bushing. Drill Bushing Implant Bushing 17. Ensure the post is fully seated, then introduce the 2.8mm Drill Bit into the Drill Bushing. Do NOT begin drilling until the Drill Bit engages the bone. Peck drill as needed to prevent...

and place the Depth Measuring Probe the Bushing 18. Remove the Drill Bushing contact with bone. It may be necessary to through boneImplantthat could until the Probe makes firm remove debris impede measurement. Then read the measurement at the guide surface which correlates with the suggested 2.7mm Screw length. Based on measurement, select the corresponding 2.7mm Screw. If measurement is between sizes, consider a shorter screw option to ensure the screw is not too prominent. 19. Insert 2.7mm Screw through pre-drilled tunnel until it reaches the Post and the rear screw head reaches the bone....

20. Repeat the process of choosing the correct Implant Bushing and Drill Bushing, drilling, measuring for 2.7mm Screw length, and screw placement for the lateral screw. 21. To aid in removing K-Wires, slightly reduce the compression by turning Compression-Distraction Fixture Screw counter-clockwise and remove all K-wires. Twist Post Fastener to release from Post and remove Targeting Guide. 22. Once both 2.7mm Screws are locked into the Post, thread the Post Plug Screw into the top of the Post. 23. Close in the usual manner. 10

Revision Surgical Technique 1. Make a dorsal incision over the tarsometatarsal joint. Locate the Post in the cuneiform and clear bone to gain access. Remove the Post Plug Screw using the T8 Driver. Locate the 2.7mm Screws in the metatarsal and clear bone to gain access. Remove both 2.7mm Screws using the T8 Driver. NOTE: Reattaching Targeting Guide to post can aid in locating 2.7mm screws in metatarsal.