Incision/Exposure

• Extend a plantar-lateral incision from approximately the base of the proximal 5th metatarsal tuberosity to midshaft of the 5th metatarsal. Take care not to disrupt tendon and nerve structures. The abductor digiti minimi muscle is reflected in a plantar direction. Dissect to the bone to expose the fracture.

Plate and Sterile Instrument Kit Selection

• Use the Plantar Plate Trial to determine if a 4-Hole or 5-Hole Plantar Plate will be used. This Plate Trial has a laser mark reference for the 4-Hole Plantar Plate length. The fracture should be positioned behind the solid center area of the Plate Trial.
• Determine if the regular Plantar Plate (2.4/2.7mm screws) or the large Plantar Plate (3.0mm screws) should be used.
• With appropriate plate size chosen, select the corresponding Sterile Packaged Instrument Kit to supplement the Plate Screw implantation.

Site Preparation

• If required, apply bone graft or demineralized bone matrix prior to compressing the fracture with the provided clamp.
• The provided 5MS Reduction Forceps can maintain alignment and compression of the fracture during provisional fixation. The barbed end should be inserted into the midshaft of the bone to the distal side of the fracture. For hard bone, use the 0.062” Guide Wire to puncture the lateral cortex for purchase of the barbed end of the Forceps. Spike the curved end into the proximal tuberosity and reduce the fracture.

Plate Positioning

• Select and open the chosen sterile Plantar Plate.
• Place the Plate on the bone with the solid section over the fracture and the compression slot to the distal side. If additional contouring is needed, use the supplied Plate Benders to anatomically form the Plate. Take care not to bend across a plate hole.
• Place an Olive Wire through the most distal hole, with a second Olive Wire through the 2nd most proximal hole.

Screw Placement

• Insert the first Screw into the most proximal hole (recommended non-locking to reduce the chance of plate step-off.) Using the color-coded Non-Locking Drill Guide, drill the most proximal hole, aiming generally toward the 5th tarsometatarsal joint, taking care to not violate the joint space. Note: For the large Plantar Plate, use the larger 2.5mm drill for the 3.0mm screw when inserting into hard bone. Depth markings on the drill can be used to estimate Screw length against the top surface of the Drill Guide.
• Use the Depth Gauge for a more precise depth measurement. Size the Screw short of the joint space.
• Load the Screw onto correctly sized driver tip (T7 = 2.4/2.7, T8 = 3.0 Screws) and insert the screw through the Plate. Use fluoroscopy to ensure the Screw has not violated the joint space. Remove the proximal Olive Wire.
• The second screw should be inserted into the compression slot. Using the Non-Locking Drill Guide (or optional Compression Drill Guide with arrow pointing proximal), drill concentric to the beveled side of the slot. Use Depth Gauge to measure for Screw length. Start the Non-Locking Screw in the compression slot (approximately 1mm of compression) and remove the distal Olive Wire. Once the Olive Wire is removed, continue to seat the Non-Locking screw. If no compression is desired, position Drill Guide into the counterbore and drill to desired depth.

Final Implantation

• Remove the proximal Olive Wire and any provisional fixation. Finish inserting the remaining screws; locking screws are recommended.
• Close by preferred methods.