Tomofix

Manufactured by DePuy

Sourced in Switzerland

TomoFix is a surgical implant designed to facilitate bone fixation during orthopedic procedures. It is composed of stainless steel and is intended to provide stable support for the alignment and stabilization of bone fragments.

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Lab products found in correlation

Tris medial hto plate system, by Olympus (1 mentions) Traumacad, by Brainlab (1 mentions)

Close spelling variants of this product

TomoFix plate (10 citations) TomoFix™ MHT plate fixator (3 citations) TomoFix® Medial High Tibial Plate (3 citations) Tomofix distal femoral plate (2 citations) TomoFix MDF plate (2 citations) TomoFix medial high tibial plates and screws (2 citations)

7 protocols using tomofix

Biplanar Opening-Wedge HTO for Valgus Correction

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HTO was performed using biplanar opening-wedge technique with rigid plate fixation [3 (link)]. The amount of angular correction was planned preoperatively aiming to achieve tibiofemoral anatomical valgus of 10° in a one-leg standing radiograph postoperatively. The osteotomy gap was filled with two wedged blocks of β-TCP with 60% porosity (Osferion, Olympus Terumo Biomaterials. Corp., Tokyo, Japan) and fixed with TomoFix (DePuy Synthes, Zuchwil, Switzerland).
Patients started a postoperative rehabilitation program including isometric quadriceps and range-of-motion exercises the day after surgery. A non-weight-bearing regimen was prescribed for 1 week, followed by full weight-bearing exercise. Casts or supportive devices were not applied.

Otoshi A., Kumagai K., Yamada S., Nejima S., Fujisawa T., Miyatake K, & Inaba Y. (2021). Return to sports activity after opening wedge high tibial osteotomy in patients aged 70 years and older. Journal of Orthopaedic Surgery and Research, 16, 576.

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Biplanar Medial Open-Wedge High Tibial Osteotomy Technique

Cited 1 time

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Conventional biplanar MOWHTO was performed under fluoroscopic control after concomitant arthroscopic procedures. During the approach, the superficial medial collateral ligament tibial attachment was partially reflected until the posteromedial cortex of the proximal tibia bone was exposed, and the pes anserinus was retracted distally. The osteotomy was performed using osteotomes, and a calibrated distractor was used to open the osteotomy site to achieve the target hip-knee-ankle axis of 3° valgus, as planned preoperatively.^{18 (link)} The intraoperative alignment was confirmed under fluoroscopy using an alignment rod through a line intersecting the knee joint between the center of the femoral head and the ankle joint center.^{30 (link)} Fixation of the osteotomy was performed using an anatomic locking plate (Tomofix; Depuy Synthes) without a gap filler. Patients were encouraged to start passive range of knee motion and active quadriceps strengthening exercises the day after surgery with hinged knee brace protection. Partial weightbearing with crutches and a brace was maintained for 4 weeks, followed by full weightbearing as tolerated. Patients with Takeuchi classification^{38 (link)} types 2 and 3 LHF kept partial weightbearing until 12 weeks.

Lee S.J., Kim J.H., Baek E., Ryu H.S., Han D, & Choi W. (2021). Incidence and Factors Affecting the Occurrence of Lateral Hinge Fracture After Medial Opening-Wedge High Tibial Osteotomy. Orthopaedic Journal of Sports Medicine, 9(10), 23259671211035372.

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Medial Opening-Wedge High Tibial Osteotomy

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Medial opening-wedge HTO was performed in every patient included in this study, in accordance with the standard techniques by experienced orthopaedic surgeons. The preoperative digital planning was performed using a landmark-based software (mediCAD, Hectec GmbH, Germany), and the degree of the correction was adjusted according to the criteria published previously. ^{15 (link)} Medial opening-wedge HTO was performed using a biplanar technique as described previously ^{16 (link)} and an internal fixation locking plate (Tomofix, DePuySynthes, Switzerland; or Peek-Power-Plate ^® -II. generation-, Arthrex Inc., USA) was used for the fixation of the osteotomy. All procedures were performed under general anesthesia. Intravenous antibiotics (cefuroxim, 1.5 mg) and standard thromboembolic prophylaxis (low-dose heparin) were used.
The post-operative rehabilitation consisted of free range of motion immediately after surgery, with partial weight-bearing (20 kg) for 2 weeks. After two weeks postoperatively, weight-bearing was increased by 20 kg each week, until full weight-bearing was reached. Sport activities were allowed at 3 months after surgery.

Gersing A.S., Jungmann P.M., Schwaiger B.J., Zarnowski J., Kopp F.K., Landwehr S., Sauerschnig M., Joseph G.B., Imhoff A.B., Rummeny E.J., Kirschke J.S, & Baum T. (2018). Longitudinal changes in subchondral bone structure as assessed with MRI are associated with functional outcome after high tibial osteotomy. Journal of ISAKOS, 3(4), 205-212.

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Correcting Knee Mechanical Axis with OWHTO

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The aim of OWHTO is to correct the mechanical axis of the knee joint [13 (link)]. Preoperative planning for HTO first considers the intended postoperative mechanical axis, which passes through the lateral tibial eminence on the coronal view. This axis was determined using the digital planning software (TraumaCaD; Brainlab, Feldkirchen, Germany) in the Picture Archiving and Communication System. Arthroscopy was routinely performed prior to surgery to evaluate the degree of cartilage degeneration, quantified using the International Cartilage Repair Society (ICRS) grading system [14 (link)]. The surgical procedure used for OWHTO has previously been described [15 (link)]. Briefly, the medial proximal tibia was exposed using a J-shaped incision, and the superficial medial collateral ligament and the pes anserinus were released. Two Kirschner wires (K-wires) were inserted into the proximal tibiofibular joint 35–40 mm inferior to the knee joint line, fixed with a locking plate (TomoFix; DePuy Synthes, Solothurn, Switzerland, or Tris Medial HTO Plate System; Olympus, Tokyo, Japan) and used as a guide. The gap created by the osteotomy was filled with β-tricalcium phosphate (Olympus). All surgery was performed by the same surgeon (senior author). Rehabilitation was initiated on postoperative day 2, with full weight-bearing permitted as tolerated by the patient.

Otsuki S., Ikeda K., Wakama H., Okuno N., Okamoto Y., Okayoshi T., Miyamoto Y, & Neo M. (2020). Preoperative flexion contracture is a predisposing factor for cartilage degeneration at the patellofemoral joint after open wedge high tibial osteotomy. Knee Surgery & Related Research, 32, 55.

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Biplanar Open-Wedge High Tibial Osteotomy

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HTO was performed as previously described.^{7 (link),8 (link)} Briefly, after the exclusion of any contraindication for HTO, a longitudinal skin incision along the anteromedial proximal tibia was made. The proximal part of the pes anserinus and the distal part of medial collateral ligament were released to prevent postoperative medial compartment overload. Then, an ascending biplanar OWHTO was performed, leaving the tibial tubercle on the distal fragment. The intended correction was documented and confirmed by fluoroscopy, and the osteotomy was fixed using an angular stable locking system (Surfix [Surfix-Integra] or TomoFix [DePuy Synthes]), followed by standard wound closure.
Patients were kept touchdown weightbearing for 6 weeks without limitation of range of motion, followed by progression to full weightbearing as tolerated.

Ackermann J., Waltenspül M., Germann C., Vlachopoulos L, & Fucentese S.F. (2022). Restoration of Native Leg Length After Opening-Wedge High Tibial Osteotomy: An Intraindividual Analysis. Orthopaedic Journal of Sports Medicine, 10(1), 23259671211063787.

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Biplanar Osteotomy for Knee Alignment

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OWHTO was performed using biplanar osteotomy technique. 16 (link) The weight-bearing line, which extends from the centre of the femoral head to the midpoint of the superior articular surface of the talus, was used to determine the alignment. The point at which the weight-bearing line passed the level of the tibial articular surface was aimed at 65% of the width of the tibial articular surface from its medial margin. After achieving the target alignment, two wedge-shaped blocks composed of β-tricalcium phosphate (OSferion 60; Olympus Terumo Biomaterials, Tokyo, Japan) were placed in the gap. 1 (link) The osteotomy site was fixed using a locking compression plate (TomoFix, DePuy Synthes, Solothurn, Switzerland; or TriS Plate, Olympus Terumo Biomaterials). 16 (link) Knee range of motion exercises and muscle strengthening were started a few days after surgery. Patients were permitted to begin partial weight-bearing gait exercises 1 week after surgery and full weight-bearing at 2 weeks.

Yamada Y., Nakamura N., Hiramatsu K, & Mitsuoka T. (2021). Abrasion arthroplasty promotes improvement of degenerated femoral trochlear cartilage after medial open wedge high tibial osteotomy. Journal of ISAKOS : joint disorders & orthopaedic sports medicine, 6(3).

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Proximal Tibial Osteotomy and Cartilage Management

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Preoperatively, supine whole-leg radiographs were used to plan the osteotomy size for a target axial load goal of 57.5–62.5% [4 (link)]. Intraoperatively, an arthroscope was first used to evaluate the state of the cartilage, menisci, and ligaments. Depending on the condition of the knee joint, microfracture or meniscal procedures, such as a meniscectomy or meniscal repair, were performed. Then, according to a pre-surgical plan, either biplane or transverse osteotomy of the proximal tibia was completed, and intraoperative imaging was used to confirm lower extremity alignment and adjust osteotomy size. The portion of the proximal tibia that underwent osteotomy was filled with a 60% porosity β-tricalcium phosphate block and hydroxyapatite block and was fixed using a TriS Medial HTO plate (Olympus Terumo Biomaterials, Tokyo, Japan), Position HTO plate (B. Braun Aesculap, Tuttlingen, Germany), or TomoFix (DePuy Synthes, Bettlach, Switzerland).

Maeda S., Chiba D., Sasaki E., Oyama T., Sasaki T., Otsuka H, & Ishibashi Y. (2021). The difficulty of continuing sports activities after open-wedge high tibial osteotomy in patient with medial knee osteoarthritis: a retrospective case series at 2-year-minimum follow-up. Journal of Experimental Orthopaedics, 8, 68.

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