Stabilis™ Surgical Technique (PDF) - Tornier DX

F O O T A N D A N K L E Solutions by Tornier ® 

Stabilis 

A N K L E A r T h r O D E S i S p L A T i N g S Y S T E M 

surgical technique

T O r N i E r ® S t a b i l i S a n k l e a r t h r o d e S i S P l a t i n g S y S t e m 

Indications for Use: 

The Tornier Stabilis Ankle Arthrodesis Plating System is intended for arthrodesis of the ankle 

joint and distal tibia, fractures, osteotomies, and fusions of small bones including the foot 

and ankle. 

Contraindications: 

The Stabilis Ankle Arthrodesis Plating System is contraindicated for the following conditions: 

Anterior Tibio-Talar Plate (AFPATTL and AFPATTH) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9 

Lateral Joint Preparation for Lateral TT and TTC Plates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-13 

Lateral Tibio-Talar Plate (AFPTTL and AFPTTH) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14-18 

Lateral Tibio-Talar-Calcaneal Plate (AFPTTC). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-25 

Instrument Trays 

• Sepsis, systemic infection, elevated White Blood Cell count, fever and/or local inflammation. 

• Complete talar necrosis or inadequate bone stock to permit stabilization of the arthrodesis. 

• Persisting skin lesion or poor skin coverage around the ankle joint that would make the 

procedure unjustifiable. 

• Neuromuscular or psychiatric disorders which might jeopardize fixation and post-operative care. 

• Suspected or documented metal allergy or intolerance. 

• Inadequate neurovascular status. 

• Severe longitudinal deformity. 

Preoperative Planning: 

It is important for the physician to evaluate the patient regarding leg length discrepancy and axial alignment 

of the entire involved lower extremity. Sometimes a prior proximal fracture in the femur or the tibia may 

leave elements of malalignment that may need to be recognized and planned for in the later performance 

of an ankle or hindfoot arthrodesis. Evaluation of the patient in a standing and sitting position, with special 

attention to translation at the ankle joint, varus/valgus of the hindfoot, rotational abnormalities and axial 

malalignment must all be recognized with both clinical and radiographic evaluation. Uncommonly, a more 

proximal osteotomy may be necessary to realign the extremity prior to the definitive ankle or hindfoot 

surgery. On occasion, a compensatory arthrodesis may realign the extremity at the ankle joint or hindfoot. 

Note: all system components (implants and instruments), are intended to be sterilized in the instrumentation tray. 

Top Tray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 

Bottom Tray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Anterior Tibio-Talar Plate (AFPATTL and AFPATTH) 

Step 1 

Position the patient in the supine position on the table, with 

the heel at end of the table. Place a bump proximal to the 

ankle. The leg is exsanguinated and a thigh tourniquet 

is inflated. 

An extensile approach to the ankle is made between the 

anterior tibial and extensor hallucis longus tendons. The 

incision is followed by careful subcutaneous dissection. 

The superficial peroneal nerve is identified and retracted. 

The extensor retinaculum is divided between the anterior 

tibial and extensor hallucis longus tendons. Retraction of 

the tendons exposes the anterior aspect of the distal tibia, 

ankle joint, and talonavicular joint. The deep neurovascular 

structures are identified, mobilized, and protected. This allows 

for an anterior release and broad arthrolysis with resection of 

all the osteophytes. The top of the dome as well as the angles 

between the pilon and each of the malleoli can be identified 

precisely using this incision. 

Step 2 

Put the foot in plantar flexion to facilitate distraction. Distract the 

joint with the Joint Distractor and accompanying 2.5 x 100 mm 

Pins. Place the two Distractors on either side of the ankle at an 

approximate 70° angle from each other. Insert one pin in the talus 

and one pin in the tibia to hold each Distractor in place. Push the 

Distractor against the bone. Tighten the knobs on the handles to 

secure the Distractors to the pins. Distract the joint by squeezing 

the handles. Tighten the thumb screws on the proximal ends to 

lock the ratchets in place. 

2.5 x 100 mm Pins 

Step 3 

Joint Distractor 

Prepare the joint by removing osteophytes and cartilage on 

both the tibial and talar articular surfaces. Prepare the entire 

tibial side of the joint, and as much of the talar side as necessary. 

Prepare the gutter of the medial malleolus if necessary. The 

plate will not compromise the tibio-fibular joint. 

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Step 4 

If appropriate, micro-fracture the joint surfaces with a pick, 

drill or burr to the depth of the soft, cancellous bone. Pack the 

joint with bone graft as necessary. Remove the Distractors and 

associated pins. 

Step 5 

Step 6 

Drill Guide 2.7 mm Drill Bit 

Align the foot in the appropriate position for fusion. Hold the 

foot with the Foot Holding Device if desired. Verify alignment 

with fluoroscopy. 

Foot Holding Device 

If desired, a cross-joint compression screw can be inserted, such 

as the NexFix 6.5 Compression Screw with patented threaded 

washers. Insert the screw posteriorly from the distal tibia to the 

talus to help with the compression of the joint. Follow specific 

surgical steps pertaining to inserting the compression screw. 

Take care that the additional hardware does not hinder plate 

and screw placement. 

Temporarily fix the joint in place with 2.0 x 150 mm Pins 

medial and lateral of where the plate will sit. Avoid the 

subtalar joint. 

2.0 x 150 mm Pins NexFix 6.5 mm Compression Screw Tray

Step 7 

Use the X-ray template to select the appropriate Anterior Plate 

and position the plate for implantation. 

Two Anterior plates are available: 

- 107.5° distally angled portion against the talus (AFPATTL) 

- 95° distally angled portion against the talus (AFPATTH) 

Anterior Tibio-Talar Plate 

Step 8 

Remove all ostheophytes and prepare the bone of the talar 

neck for a proper fit of the plate. 

Generally, the plate should be positioned immediately 

posterior to the dorsal margin of the talonavicular joint 

avoiding impingement when dorsiflexing the navicular. 

Evaluate plate fit to the tibia. Bend the plate with the 

Plate Benders if necessary. Prepare bone surfaces additionally 

if necessary. 

Plate Benders 

Step 9 

Temporarily fix the plate to the tibia with a 2.0 x 150 mm Pin 

through the proximal pin hole. The pin hole is oriented from 

anterior-proximal to posterior-distal to help hold the plate 

against the bone. If desired, use additional pins through the 

other pin holes in the plate to further fix the plate to the tibia. 

2.0 x 150 mm Pins 

Anterior TT Plate 

High Talar Neck Low Talar Neck 

Part # AFPATTH Part # AFPATTL 

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Step 10 

Attach the Talus Hole Guide to the distal portion of the plate. 

Pivot the post to the side to avoid interference with the 

other instrumentation. 

Anterior Talus Hole Guide 

Step 11 

Insert the Drill Guide into the most distal hole in the Talus Hole 

Guide. Make sure that the laser etched line on the Drill Guide 

sits flush with the Hole Guide. Drill the screw hole in the talus, 

avoiding penetration into the subtalar joint. 

Use the Depth Gauge to measure the hole’s depth. 

Step 12 

Drill Guide 2.7 mm Drill Bit Depth Gauge 

Select the appropriate screw length. Use the Star Screw Driver 

and Ratcheting AO Driver to insert the Screw. 

Bone Screw 

Star Screw Driver 

Ratcheting AO Driver Handle

Step 13 

Drill and insert the two proximal screws through the Talus 

Hole Guide in the same fashion. Verify positions in the bone 

with fluoroscopy. 

Step 14 

Remove the Talus Hole Guide. Use the screw driver for a final 

tightening of the talar bone screws. Attach the Talar CoverLoc® 

to the plate. Use the driver to tightly secure the CoverLoc and 

stabilize each bone screw underneath it. 

Step 15 


Depth Gauge 

Talar CoverLoc 

for Anterior Plate 

Star Screw Driver Bone Screw 


Check the plate fit against the tibia. If necessary, place the foot 

in plantar flexion and use the Plate Benders to bend the plate 

at the bending points. 

Attach the Tibia Hole Guide to the plate. Pivot the 

post to the side to avoid interference with the 


Plate Benders Tibia Hole Guide 


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Step 16 

Remove all cross-joint pins. Insert one end of the Compressor 

in the proximal hole of the Tibia Hole Guide as shown. Push it 

down fully to the bottom of the hole. Position the other distal 

end of the Compressor on the tibia, above the proximal end 

of the plate, leaving sufficient room so not to interfere with 

the plate when compression is applied. Typically a 10 mm gap 

or more is adequate between the proximal end of the plate 

and the Compressor. Position the proximal Compressor collet 

longitudinally in line with the plate. Insert a 2.5 x 100 mm Pin 

through the collet on this compressor end and drive it into the 

tibia bicortically. Turn the knob to tighten the collet against 

the pin. Keep the Compressor fully seated in the hole of the 

Tibial Hole Guide during this step, and avoid rotating the 

Compressor handles towards the proximal pin. If necessary, 

loosen the knob and realign the Compressor and tighten the 

knob again. Squeeze the Compressor handles. Tighten the 

thumb screw on the back of the Compressor to lock the 

ratchet in place. 

2.5 x 100 mm Pins Joint Compressor 

Surgical Note: 

Keeping the Compressor straight will typically result in a small 

gap between the tibial cortex and the proximal Compressor 

end on the pin. This is acceptable. 

Take care to compress the joint evenly. Avoid rotating the tibia 

during compression and creating a gap in the posterior joint 

space. Verify reduction under AP and lateral fluoroscopy. If 

necessary, release the compression, remove the Compressor, 

plantarflex the ankle and use the Plate Benders to bend the 

plate at the two bending zones for a better fit or even compression. 

Step 17 

Insert the Drill Guide into each of the proximal screw holes. 

Seat the guide squarely on the shoulder in the hole. Drill the 

proximal plate screw hole. Use the Depth Gauge to measure 

the hole’s depth. Select the appropriate screw length and 

place the screw. Repeat the process for the other screw hole. 


Depth Gauge Bone Screw 

Ratcheting AO 

Driver Handle 


Alternatively, two Compressors may be used to compress the 

joint. Position one on either side of the plate, across the joint, at 

approximately 70° from each other – like the Distractors were 

positioned in Step 2. Use 2.5 x 100 mm Pins to secure one end 

of each Compressor into the tibia and other end in the talus. 

Tighten the collets against the pins. Squeeze both handles to 

compress the joint.

Step 18 

Insert Drill Guide into one of the distal holes in the Tibia Hole 

Guide. Make sure that the laser etched line on the Drill Guide 

sits flush with the Hole Guide. Drill the screw hole in the tibia. 

Use the Depth Gauge to measure the hole’s depth. Select 

the appropriate screw length. Use the Driver Bit and Driver 

Handle to insert the screw. Drill and insert the other distal 

screw through the Tibia Hole Guide in the same fashion. 

Verify positions in the bone with fluoroscopy. 



Step 19 

Remove the Compressor and associated pin. Insert the Drill 

Guide into the proximal hole of the Tibia Hole Guide and drill 

the proximal screw hole. Use the Depth Gauge to measure the 

hole’s depth. Select the appropriate screw length and insert 

the screw. 



Step 20 

Remove the Tibia Hole Guide. Use the Driver for final tightening 

of each tibial bone screw. Attach the Tibial CoverLoc® to the 

plate. Use the driver to tightly secure the CoverLoc and stabilize 

each bone screw underneath it. Verify positions in the 

bone with fluoroscopy. 

Close the incision with appropriate surgical technique. A closed 

suction drainage system may be used at the surgeon’s discretion. 

Tibial CoverLoc 



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T O r N i E r ® T O r N i E r S t a b i l i S a n k l e a r t h r o d e S i S P l a t e S y S t e m 

® S t a b i l i S a n k l e a r t h r o d e S i S P l a t i n g S y S t e m 

Lateral Joint Preparation for Lateral TT and TTC Plates 

Step 1 

Position the patient in a semisupine position with a bump under 

the ipsilateral hip. This allows exposure of both the medial and 

the lateral ankle and assists in assessing correction of rotational 

deformities. It also allows for placement of medial and lateral 

compression and distraction clamps. A thigh tourniquet is 

placed, the leg is exsanguinated and the tourniquet is inflated. 

Palpate the lateral ankle and foot to identify the fibula. 

Make a lateral longitudinal incision to expose the fibula and 

tibio talar (TT) joint. Have the incision extend approximately 

10 to 11 cm up proximally from the distal tip of the fibula. Avoid 

the peroneal tendons and sural and superficial peroneal nerves. 

Step 2 

Dissect and remove the distal fibula (approximately 9 to 

10 cm). The fibula and bone shavings may be morselized 

if an autogenous graft is desired. 

Step 3 

Prepare a flat surface on the lateral surface of the exposed 

distal tibia and adjacent part of the talus with rongeurs 

and/or other appropriate surgical instruments. 

Align the foot in the appropriate position for fusion. Support the 

foot with the Foot Holding Device to help determine appropriate 

plantar/dorsiflexion of the fusion if desired. A wrap can be used to 

hold the foot to the Foot Holding Device. 

Foot Holding Device

Step 4 

Evaluate the arc of the tibio-talar joint and select the appropriate 

Lateral Cutting Guide set (radius of 25 mm or 40 mm) that 

best approximates the joint curvature. Position the Cutting Guide 

on the exposed lateral walls of the tibia and talus. The longer 

piece of the Cutting Guide with the concave surface aligns with 

the tibial wall and the shorter piece aligns with the talar wall. The 

curved intersection between the two guide pieces should align 

with the tibio-talar joint. Pull each half slightly back from the ends 

of the bones to ensure that the drill holes align with subchondral 

bone, so that all cartilage will be removed after drilling. Either end 

of the Cutting Guide may be pulled further back from the joint 

area if the removal of additional bone is needed. 

Lateral Cutting Guide 

Step 5 

Make sure the Cutting Guide sits flush on the lateral wall of the 

tibia and talus. If necessary, further prepare the tibial and talar 

surfaces to fit the guide. Fix the tibial component of the cutting 

guide to the bone by inserting two 2.5 x 60 mm Pins in the 

X-marked holes in the tibial half. 

2.5 x 60 mm Pins 

Step 6 

Put the 2.7 mm Drill Bit in the tibial portion of the Cutting 

Guide. Verify alignment with AP fluoroscopy. Change the position 

of the Cutting Guide by lifting it proximally or distally and 

reinserting the pin if varus or valgus misalignment is noticed. 

Insert the Drill to the appropriate depth to remove the distal 

tibial cartilage and make note of the depth. 

2.7 mm Drill Bit 

Lateral Joint Preparation 

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Step 7 

Hold the guide to the bone. Insert 2.5 x 100 mm Pins on the 

lateral sides of the Cutting Guide to secure the guide. 

Drill through each distal cutting hole and across the underlying 

bone. Hold the drill straight, advance slowly. Be careful not to 

drill too far medially, beyond the talus or across the medial gutter 

and into the medial malleolus. Fluoroscopy or direct visualization 

can be used to determine the accuracy of this osteotomy. 

2.5 x 100 mm Pins 

Step 8 

Attach the talar component of the Cutting Guide with the 

U-rail to the tibial component. Open the space between the 

tibial and talar component to the desired width so that all 

the cartilage will be removed after drilling. Place two 2.5 x 

60 mm Pins in the marked holes in the talar half. Insert pins 

deep enough so a drill can be fully driven into the cutting 

holes in the guide. 

2.5 x 60 mm Pins 

Step 9 

2.7 mm Drill Bit 

Hold the guide against the bone. Insert 2.5 x 100 mm Pins 

on the lateral sides of the Cutting Guide to secure the guide. 

Remove the U-rail. 

Drill through each distal cutting hole and across the underlying 

bone. Hold the drill straight, advance slowly, and use an “in and 

out” motion to prevent the drill from skiving. Drill through the 

entire width of the talus. 

Remove Cutting Guide and pins from each side except for 

two that can be used to anchor the Distractor. 

2.5 x 100 mm Pins 

2.7 mm Drill Bit

Step 13 

Use a Distractor and two accompanying 2.5 x 100 mm Pins to 

distract the joint. Place the Distractor across the tibio-talar joint. 

Open the Distractor enough so there is access to the joint for 

instrumentation. Insert one pin in the talus and one in the tibia 

to hold the Distractor in place. Push the Distractor’s ends down 

against the bone. Tighten the knobs to secure the Distractor to 

the pins. Squeeze the handles to distract the joint. Tighten the 

thumb screw on the proximal end of the Distractor to lock the 

ratchet in place. 


Step 14 

Use osteotomes and mallet to remove the arc segments of 

bone from both sides of the joint. 

Step 15 

2.5 x 100 mm Pins 

Test the reduction of the joint. If there is either excessive 

valgus or varus, the resection of the tibial or talar surface may 

vary. Further bone may need to be resected to correct coronal 

plane deformities of the ankle joint. Intraoperative fluoroscopy 

is helpful from a lateral aspect to inspect the curvature of the 

resection and from an anterior position to assess the varus/ 

valgus position of the alignment. Remove the Distractor. Verify 

the alignment with fluoroscopy. 

Align the foot in the appropriate position for arthrodesis. 

Temporarily fix the ankle joint in position with pins on either 

side of where the plate will sit (anteriorly and posteriorly to 

the plate). Avoid inserting pins into the talonavicular joint 

and subtalar space. The blue posterior foot holding device 

is helpful in ensuring appropriate dorsiflexion and plantar 

flexions have been obtained. At this point assess rotation of 

the joint, the presence of anterior posterior translation as well 

as the varus/valgus position of the proposed arthrodesis. 

Separate fixation screws or pins may be applied prior to 

attaching the plate. Ensure that additional hardware does 

not hinder plate and screw placement. 

Lateral Joint Preparation 

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Lateral Tibio-Talar Plate (AFPTTL and AFPTTH) 

For Lateral Joint preparation, see pages 10-13. 

Step 16 

Use the X-ray template to select the Lateral TT Plate that best 

fits the Talar anatomy. 

Two TT plates are available: 

- 15˚ distally angled portion against the talus (AFPTTL) 

- 30˚ distally angled portion against the talus (AFPTTH) 

Step 18 

Lateral Tibio-Talar Plate 

Step 17 

Use 2.0 x 150 mm Pins to temporarily fix the joint. Position the 

plate on the bone. Ensure that the distal end of the plate sits 

fully on the talus and does not extend down into the subtalar 

space or onto the calcaneus. Evaluate plate fit to the tibia. Bend 

the plate with the Plate Benders if necessary. Pin the plate to 

the talus (it is not recommended to use two pins in the talar 

part of the plate to prevent interference with the bone screw 

insertions later in the procedure). Attach the Talus Hole Guide 

to the Plate. Attach Driver Handle to the Guide Post if desired. 

Remove any protuberances that interfere with plate fit. 

Lateral Talus Hole Guide 2.5 x 150 mm Pins 

Insert Drill Guide into one of the proximal holes in the Talus 

Hole Guide. Make sure that the laser etched line on the Drill 

Guide sits flush with the Hole Guide. Drill the screw hole in 

the talus, avoiding penetration into the subtalar joint. 



Use the Depth Gauge to measure the hole. Select the 

appropriate screw length. Use the Driver Bit and Ratcheting 

AO Driver Handle to insert the screw. 


Depth Gauge 


Plate Benders 

Bone Screw 

Ratcheting 

AO Driver Handle 

High Talar Flare 

Part # AFPTTH 

Low Talar Flare 

Part # AFPTTL

Step 19 

Drill and insert the other two talar screws in the same 

fashion. Verify position of these screws in the bone with 

fluoroscopy. Multiple views are necessary to ensure that the 

talar screws do not intrude or penetrate the subtalar joint. 

Step 20 


tightening of the talar bone screws. Attach the Talus CoverLoc® 

to the plate. Use the driver to tightly secure the CoverLoc 

and stabilize each bone screw underneath it. Remove all 

temporary fixation pins from the plate and the joint. 

Lateral Talus 

CoverLoc 


Lateral TT Plate 

15


Step 21 

2.5 x 225 mm Pins are now placed from anterior lateral to 

anterior medial across the tibia and the talus in order to 

compress the ankle arthrodesis site. These pins should be 

placed just anterior to the placement of the tibial portion of the 

plate and just anterior to the talar portion of the plate. These 

pins will penetrate the medial aspect of the distal tibia and 

talus and puncture wounds are made as these pins penetrate 

the skin. Care is taken to avoid injury to the posterior tibial 

neurovascular bundle. The compression device is used to 

determine the distance separating these two cross pins. (The 

Achilles complex tends to give counter compression forces to 

oppose the anterior compression devices.) Joint Compressors 

are placed both medially and laterally. 

Step 22 

Joint Compressors 

2.5 x 225 mm Pins 

Squeeze the Compressor handles to compress the joint. Take 

care to compress the joint evenly. Tighten the thumb screws 

on the back of the Compressors to lock the ratchets in place. 

Verify reduction with fluoroscopy. 

More compression may be placed either medially or laterally 

depending upon the joint preparation, and alignment desired. 

Bone graft may be inserted to assist in the alignment process 

prior to adding compression. Tighten the knobs on the 

Compressor to hold the pins in place. 

At this point a Guide Pin may be placed from the anterior 

cortex of the distal tibia in a distal posterior direction into 

the talus. A 6.5 mm cannulated screw such as the NexFix 

Compression Screw with patented threaded washers can be 

placed to strengthen compression of the construct. Care must 

be taken to avoid the cross-screws in the talus. Attention must 

be directed to the proposed screw route in the tibia as well. 

This screw may also be placed following the placement of the 

cross-screws fixating the plate. 

NexFix 6.5 mm Compression Screw Tray 

16

Step 23 

Attach the Tibia Hole Guide to the Plate. Insert the Drill 

Guide into one of the distal holes in the Tibia Hole Guide. 

Make sure that the laser etched line on the Drill Guide sits 

flush with the Hole Guide. Drill the screw hole in the tibia. 



Step 24 


appropriate screw length. Use the Driver Bit and Driver 

Handle to insert the screw. Insert the other screws in the 

same fashion. Verify positions in the bone with fluoroscopy. 

Depth Gauge 

Step 25 

Drill Guide 2.7 mm Drill Bit Tibia Hole Guide 


Remove Tibia Hole Guide. Use the Driver for final tightening of 

all tibial bone screws. Attach the Tibial CoverLoc® to the plate. 

Use the driver to tightly secure the CoverLoc and stabilize each 

bone screw underneath it. 



Lateral TT Plate 

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Step 26 

Insert the Drill Guide into each of the remaining proximal screw 

holes. Seat the guide squarely on the shoulder in the hole. Drill 

the screw hole. Measure, select and insert each screw using the 

technique described above. Repeat the process for the other 

screw hole. 

Step 27 

Remove the Compressors and pins. Verify implant 

position both clinically and with fluoroscopic control or 

with biplanar fluoroscopy. 

If desired, use the Augmentation Plate on the anterior lateral 

aspect of the tibio-talar fusion site. Slide the plate through 

the lateral incision onto the appropriate anterior surface. 

If necessary, bend the plate to fit to the bone surface. Drill 

the screw holes and insert screws using the same steps 

described above. 

Close the incision with appropriate surgical technique. 

A closed suction drainage system may be used at the 

surgeon’s discretion. 

Augmentation Plate

Lateral Tibio-Talar-Calcaneal Plate (AFPTTC) 

prepare the TT joint prior to preparing the subtalar (TC) 

joint (see pages 10-13 for Steps 1-15.) 

Step 16 

The incision for a TTC plate must be longer than for a lateral 

TT plate to expose the TC joint. Prepare the talocalcaneal (TC) 

joint. Use a Distractor and accompanying 2.5 x 100 mm Pins 

to distract the joint. Follow the same procedure for Distractor 

operation detailed in Lateral Joint Preparation, pages 11-13. 

Care is taken to avoid injuring the medial neurovascular 

structures with the placement of the pins. Alternatively, one or 

two lamina spreaders may be used to distract the joint. 


Step 17 

2.5 x 100 mm Pins 

Use osteotomes and a mallet to remove the cartilage from 

the subtalar joint. 

If appropriate, micro-fracture the joint surfaces with a pick, 

drill or burr to the depth of the soft, cancellous bone. Pack the 

joint with bone graft as necessary. Remove the Distractors and 

associated pins. 

Step 18 

Align the foot in the appropriate position for fusion. Support 

the foot with the Foot Holding Device to help determine 

appropriate plantar/dorsiflexion of the fusion if desired. A 

wrap can be used to hold the foot to the Foot Holding Device. 

Foot Holding Device 

Lateral TTC Plate 

For Lateral Joint preparation, see pages 10-13. 

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20 


Step 19 

Position the TTC plate on the bone. Remove any protuberances 

that interfere with plate fit. Evaluate plate fit to the tibia. Bend 

the plate with the Plate Benders if necessary. It is important 

to avoid excessive valgus or varus in the placement of the 

TTC plate. 

Lateral Tibio-Talo 

Calcaneal Plate 

Surgical Note: 

With an arthrodesis of both the ankle and subtalar joint, 

excessive varus or valgus is generally poorly tolerated with 

ambulation since there is no motion at these joints. 

Step 20 

Temporarily fix the joint with 2.0 x 150 mm Pins and fit the 

Plate to the bone with 2.0 x 150 mm Pins. (Note: it is not 

recommended to use two pins in the talar part of the 

plate due to the chance of interference with the bone 

screw insertions later in the procedure.) 

2.0 x 150 mm Pins 

Step 21 

Attach the Talus Hole Guide loosely to the TTC plate using 

the guidepost. The talus is fixed initially followed by the 

adjacent calcaneus and tibial bones. 

Lateral Talus Hole Guide 

Plate Benders

Step 22 

Insert the Drill Guide into one of the proximal holes in the Talus 

Hole Guide. Make sure that the laser etched line on the Drill 

Guide sits flush with the Hole Guide. Drill the screw hole in the 

talus, avoiding penetration into the subtalar joint. Pivot the post 

to the side to avoid interference with the other instrumentation. 

If the temporary cross joint pin interferes with the Drill or screw 

insertion, remove the pin, insert an additional pin in the tibial 

part of the plate, and take care to keep the plate in its intended 

position throughout the process. 


appropriate length screw. Use the Driver Bit and Ratcheting 

AO Driver Handle to insert the screw. 

Step 23 

Drill and insert the other two talar screws in the same fashion. 

Verify position of these screws in the bone with fluoroscopy. 

Multiple views are necessary to ensure that the talar screws 

do not intrude or penetrate the subtalar joint. 

Step 24 




tightening of the talar bone screws. Attach the Talus CoverLoc® 

to the plate. Use the driver to tightly secure the CoverLoc and 

stabilize each bone screw underneath it. Remove the temporary 

fixation pins only from the subtalar joint. 

Lateral Talus 

CoverLoc 

Bone Screw 


Depth Gauge 

Ratcheting 

AO Driver Handle 


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Step 25 

2.5 x 225 mm Pins are now placed from anterior lateral to 

anterior medial across the talus and the calcaneus in order to 

compress the subtalar arthrodesis site. These pins should be placed 

just anterior to the placement of the talar portion of the plate and 

just anterior to the calcaneal portion of the plate. These pins will 

penetrate the medial aspect of the distal talus and calcaneus and 

puncture wounds are made as these pins penetrate the skin. Care 

is taken to avoid injury to the posterior tibial neurovascular 

bundle. The compression device is used to determine the 

distance separating these two cross pins. Joint Compressors are 

placed both medially and laterally. 

Step 26 










Step 27 


2.5 x 225 mm Pins 

Attach the Calcaneal Hole Guide to the Plate. Insert Drill Guide 

into one of the distal holes in the Hole Guide. Make sure that 

the laser etched line on the Drill Guide sits flush with the Hole 

Guide. Drill the screw hole in the calcaneus. Pivot the post to 

the side to avoid interference with the other instrumentation. 


appropriate screw length. Use the Driver Bit and Driver 

Handle to insert the screw. 

Drill and insert the other three calcaneal screws in the same 

fashion. Verify position of these screws in the bone with 

fluoroscopy. Verify position with fluoroscopy. 

Calcaneal Hole Guide 

Drill Guide 

2.7 mm Drill Bit Depth Gauge 

Bone Screw

Step 28 

Remove the Calcaneal Hole Guide. Use the screw driver for a final 

tightening of the calcaneal bone screws. Attach the Calcaneal 

CoverLoc® to the plate. Use the driver to tightly secure the CoverLoc 

and stabilize each bone screw underneath it. Remove Compressors 

and Pins. Remove the temporary fixation pins from the TT joint. 

Step 29 

A similar compression technique is now used to compress the 

TT joint. 2.5 x 225 mm Pins are now placed from anterior lateral 

to anterior medial across the tibia and the talus in order to 

compress the ankle arthrodesis site. These pins should be placed 

just anterior to the placement of the tibial portion of the plate 

and just anterior to the talar portion of the plate. These pins will 

penetrate the medial aspect of the distal tibia and talus and 

puncture wounds are made as these pins penetrate the skin. 

Care is taken to avoid injury to the posterior tibial neurovascular 

bundle. The compression device is used to determine the distance 

separating these two cross pins. (The Achilles complex tends to give 

counter compression forces to oppose the anterior compression 

devices.) Compressors are placed both medially and laterally. 

Step 30 

Calcaneal CoverLoc 


2.5 x 225 mm Pins 










At this point a Guide Pin may be placed from the anterior 

cortex of the distal tibia in a distal posterior direction into 

the talus. A 6.5 mm cannulated screw such as the NexFix 

Compression Screw with patented threaded washers can be 

placed to strengthen compression of the construct. Care must 

be taken to avoid the cross-screws in the talus. Attention 

must be directed to the proposed screw route in the tibia as 

well. This screw may also be placed following the placement 

of the cross-screws fixating the plate. 

NexFix 6.5 mm Compression Screw Tray 


23

24 


Step 31 

Attach the Tibia Hole Guide to the Plate. Insert the Drill Guide 

into one of the distal holes in the Tibia Hole Guide. Make sure 

that the laser etched line on the Drill Guide sits flush with the 

Hole Guide. Drill the screw hole in the tibia. Pivot the post to 

the side to avoid interference with the other instrumentation. 

Tibia Hole Guide Drill Guide 2.7 mm Drill Bit 

Step 32 


appropriate screw length. Use the Driver Bit and Driver Handle 

to insert the screw. Insert the other screws in the same fashion. 

Verify positions in the bone with fluoroscopy. 

Depth Gauge 

Step 33 

Remove Tibia Hole Guide. Use the Driver for final tightening 

of all tibial bone screws. Attach the Tibial CoverLoc® to 

the plate. Use the driver to tightly secure the CoverLoc and 

stabilize each bone screw underneath it. 



Star Screw Driver

Step 34 

Insert the Drill Guide into each of the remaining proximal 

screw holes. Seat the guide squarely on the shoulder in the 

hole. Drill the screw hole. Measure, select and insert each 

screw using the technique described above. Repeat the 

process for the other screw hole. 

Step 35 


Depth Gauge 


Bone Screw 

Remove the Compressors and Pins. Verify implant position 

both clinically and with fluoroscopic control or with 

biplanar fluoroscopy. 

If desired, use the Augmentation Plate on the anterior lateral 

aspect of the tibio-talar fusion site. Slide the plate through 

the lateral incision onto the appropriate anterior surface. 

If necessary, bend the plate to fit to the bone surface. Drill 

the screw holes and insert screws using the same steps 

described above. 

Close the incision with appropriate surgical technique. 

A closed suction drainage system may be used at the 

surgeon’s discretion. 

Augmentation Plate 


25

26 


Top Tray: 

2 

Item Description Part # Quantity 

iNSTruMENTS 

1 Joint Distractor AFPDISTR 2 

2 Joint Compressor AFPCOMPR 2 

3 Lateral Cutting Guide 40 mm AFPCG40 1 

4 Lateral Cutting Guide 25 mm AFPCG25 1 

5 Pins Ø2.5 X 225 mm AFPK25225 5 

6 Pins Ø2.0 X 150 mm AFPK20150 5 

7 Pins Ø2.5 X 100 mm AFPK25100 5 

8 Pins Ø2.5 X 60 mm AFPK2560 5 

9 Hole Guide, Anterior Talus AFPHGDAT 1 

10 Hole Guide, Lateral Talus AFPHGDLT 1 

11 Hole Guide, Tibia AFPHGDT 1 

12 Hole Guide, Calcaneus AFPHGDC 1 

13 Screw Pick-Up Forceps NCS-45SF 1 

14 AO-Trinkle Power Driver Adaptor NCS-PA45 1 

15 2.7 mm Drill Bit Ø2.7 mm AFPDR 2 

16 Star Driver AFPSDRIV 2 

17 Drill Guide AFPDRG 1 

18 Ratcheting AO Driver Handle AFPDRAO 2 

19 Plate Bender AFPBEND 2 

20 Depth Gauge AFPDGA 1 

1 

4 

3 

5 

6 

7 

8 

15 16 17 

9 

13 

10 

18 

11 

12 

19 

14 

20

Bottom Tray: 


pLATES AND COvErS 

1 Plate, Anterior TT, High Talar Neck (95°) AFPATTH 2 

Plate, Anterior TT, Low Talar Neck (107.5°) AFPATTL 2 

Plate, Lateral TT, Low Talar Flare (15°) AFPTTL 2 

Plate, Lateral TT, High Talar Flare (30°) AFPTTH 2 

Plate, TTC AFPTTC 2 

Plate, Augmentation AFPAUG 2 

CoverLoc® , Tibia AFPCPT 4 

CoverLoc, Lateral Talus AFPCPLT 2 

CoverLoc, Calcaneus AFPCPC 2 

CoverLoc, Anterior Talus AFPCPAT 3 

1 


SCrEwS 

2 Bone Screw, Ø4.5x14 mm AFPSC4514 2 

Bone Screw, Ø4.5x16 mm AFPSC4516 2 


















Off-Plate Screw Washer AFPW 2 

MiSC 

4 

3 Foot Holding Device AFPALGN 1 

4 Space for Additional Instruments 

2 3 

27

Tornier, Inc. 

Edina, MN 55435 

USA 

+ 1 888 867 6437 

+ 1 281 494 7900 

www.tornier.com/us 

© 2010 Tornier, Inc. All rights reserved. Stabilis and NexFix are trademarks of Tornier, Inc. CoverLoc and Tornier are registered trademarks of Tornier, Inc. 

19-5126 rev. B 12/10

Stabilis™ Surgical Technique (PDF) - Tornier DX

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