Stryker Foot & Ankle

Plating Systems

Operative Technique
Anchorage® 2 CP
 Anchorage 2 CP

Indications For Use

The Stryker Anchorage 2 CP System is intended for use in internal fixation, reconstruction and treatment of
fractures in the foot and ankle in adult and adolescent patients (12-21 years).
Indications include:
• Replantation
• Joint fusions
• Corrective osteotomies
• Osteopenic bone
Note: Circular holes in plate are compatible with VariAx 2 T10 3.5/2.7mm and T8 2.7/2.4mm screws ONLY.

Precautions
The Stryker Anchorage 2 CP System has not been evaluated for safety and compatibility in the MR environment
and has not been evaluated for safety and compatibility in Magnetic Resonance (MR) environment and has not
been tested for heating or migration in the MR environment, unless specified otherwise in the product labeling.

Contraindications
The physician’s education, training and professional judgement must be relied upon to choose the most
appropriate device and treatment. Conditions presenting an increased risk of failure include:
• Any active or suspected latent infection or marked local inflammation in or about the affected area.
• Compromised vascularity that would inhibit adequate blood supply to the fracture or the operative site.
• Bone stock compromised by disease, infection or prior implantation that can not provide adequate support
and/or fixation of the devices.
• Material sensitivity, documented or suspected.
• Obesity. An overweight or obese patient can produce loads on the implant that can lead to failure of the
fixation of the device or to failure of the device itself.
• Patients having inadequate tissue coverage over the operative site.
• Implant utilization that would interfere with anatomical structures or physiological performance.
• Any mental or neuromuscular disorder which would create an unacceptable risk of fixation failure or
complications in postoperative care.
• Other medical or surgical conditions which would preclude the potential benefit of surgery.

This publication sets forth detailed recommended procedures for using Stryker devices and instruments. It offers guidance
that you should heed, but, as with any such technical guide, each surgeon must consider the particular needs of each patient
and make appropriate adjustments when and as required. A workshop training is recommended prior to performing your first
surgery. All non-sterile devices must be cleaned and sterilized before use. Follow the instructions provided in our reprocessing
guide (L24002000). Multi-component instruments must be disassembled for cleaning. Please refer to the corresponding
assembly / disassembly instructions. Please remember that the compatibility of different product systems have not been tested
unless specified otherwise in the product labeling. See package insert (Instruction for Use) [V15011, V15013] for a complete list
of potential adverse effects, contraindications, warnings and precautions. The surgeon must discuss all relevant risks including
the finite lifetime of the device with the patient when necessary.
Acknowledgments:
Stryker acknowledges the following surgeons for their support in the development of this technique guide: Keith L. Wapner, M.D.

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 VariAx 2 System Technology

VariAx 2 System
Screw Racks
All VariAx 2 screws can be stored in an easy-to-use storage rack. Our
screw rack assembly can be stored independently on the operative room
(OR) table and features a sloped design for easy access. Each screw
rack can either clip into the tray, or sit individually on a flat surface with
a rotating standing aid on the bottom of the rack for stabilization. The
storage rack’s transparent lid allows for identification of the content. All
four screw racks combined can hold up to 680 locking and non-locking
screws – 3.5mm T10, 2.7mm T8 and 2.4mm T8. Each rack features a
spot for up to 4 washers.

Comprehensive Locking and Non-locking System

Our color-coded polyaxial screws offer a wide array of both locking
and non-locking screw options and incorporates a color code for easy
identification for screw diameters. Each VariAx 2 foot plate screw hole
incorporates patented SMARTLock1 technology. As the locking screw
is inserted into the screw hole, the Ti6Al4V titanium alloy screw forms
its own thread into the pure titanium plate. Each hole also accepts non-
locking screws. With a single plate comes more options. The genius of
SMARTLock is its simplicity.

Compression and Locking in One Step

Compression can be achieved when a screw is inserted and tightened
into an oval compression hole. If a locking screw is used, the screw can
then be locked into the plate in a single step.

Polyaxial Locking
SMARTLock technology goes one step further. Every screw hole in
the VariAx 2 foot plate (except the compression slots) permits polyaxial
screw placement. Locking screws can be angled up to 15˚ in each
direction for a total range of 30˚. Simply place the polyaxial drill guide
in the screw hole to select the appropriate angle. Each plate allows a
surgeon to insert locking or non-locking screws at a variable angle of
their choice.

3
 VariAx 2 System Technology
VariAx 2 System

Locking Non-locking Locking Non-locking Locking Non-locking Locking Non-locking

NOTE: Optional implant and

correlating instrumentation
for 2.7mm T10 interface. This
screw is not included in the
VariAx 2 Foot dedicated system.

2.4mm screws 2.7mm screws 3.5mm screws 2.7mm screws

T8 interface T8 interface T10 interface T10 interface

Screwdriver blade Screwdriver blade

Color Coding
The VariAx 2 screws and instruments follow a comprehensive color-coding
scheme whereby the screw anodization color matches the corresponding
instrument’s color. This allows for easy handling in the OR environment.
Overdrills and drill guides for interfragmentary lagging technique are
available for all screw sizes. The drill bits, lagging drill guides and screws
are also color coded to facilitate ease of use. Drill guides and screwdrivers
are also identified with a T10 or T8 symbol for quick reference.

Locking or Non-Locking Screws

Locking and non-locking screws are available in 3.5mm, 2.7mm and
2.4mm diameters. The circular holes in the locking plates provide an
option for locking and non-locking screws.
Note: Locking screws are laser marked with a ‘dot’ and ‘ring’ marking
Locking Non-Locking
on the screw head to differentiate them from non-locking screws.

One-Size-Fits-All Washer
A 7.0mm washer is available that works with all screw sizes (T8 or T10)
when non-locking screws are used independently from the plate.

4
 VariAx 2 System Technology

VariAx 2 System
Plating Instrumentation
Drill bit, 2.6mm, scaled
Overdrills and drill guides for interfragmentary lagging technique are
available for all screw sizes. The drill bits, lagging drill guides and
screws are also color coded to facilitate ease of use.
VariAx 2 offers three standard types of drill guides: a 2.0mm for use
with all T8 screws, a 2.0mm for use with optional T10 2.7mm screws
and a 2.6mm for use with T10 3.5mm screws.
Drill guide for 3.5mm screws
The 2.0mm drill guide for T8 screws facilitates drilling a 2.0mm pilot
hole for a 2.4 or 2.7mm T8 screw centrically for locking or non-locking
screws. Additionally, the opposite side of the guide facilitates eccentric
drilling for use in a compression hole when compression is desired.
The 2.0mm drill guide for T10 screws facilitates drilling a 2.0mm pilot
hole for a 2.7mm T10 screw centrically for locking or non-locking
Overdrill, AO, 3.5mm x 122mm screws. Additionally, the opposite side of the guide facilitates eccentric
drilling for use in a compression hole when compression is desired.
The 2.6mm drill guide facilitates drilling a 2.6mm pilot hole for a 3.5mm
screw centrically for locking or non-locking screws. Additionally, the
opposite side of the guide facilitates eccentric drilling for use in a
compression hole when compression is desired.
Lag overdrill guide for 3.5mm screws Note: When drilling eccentrically, the arrow marked on the
compression side of the drill guide should be pointing toward
the fracture line/osteotomy site. The compression drill guide must
be inserted perpendicularly into the compression hole and can
not be angulated. When angulating the drill guide or using the
wrong instrument, there is a risk that the screw will not properly
sit in the plate or slip through the hole.

Drill bit, 2.0mm, scaled

Accordingly, there are a variety of drills offered in the system. The
2.0mm drill for T8 (purple and blue color rings) is used to drill the pilot
hole for 2.4 and 2.7mm T8 screws. The 2.0mm drill for T10 screws
(double turquoise color rings) is used to drill the pilot hole for the
optional 2.7mm T10 screws. Lastly, the 2.6mm drill (double orange
color rings) is used to drill the pilot hole for the 3.5mm T10 screws.
All drills are scaled and designed so as to correctly evaluate the
Drill guide for 2.4/2.7mm screws, appropriate screw length.
locking/compression
Note: Always match the color ring marking on the drill bit with the
color marking on the drill guide. Additionally, always match the
screw anodization color with at least one of the color ring markings.

Overdrill, AO, 2.7mm x 122mm

Lag overdrill guide for 2.7mm screws

5
 VariAx 2 System Technology
VariAx 2 System

Joystick for Plate Positioning

and Temporary Fixation
The joystick for T10 holes can be used in any large VariAx circular
hole and the joystick for T8 holes can be used in any small VariAx
circular hole to aid in plate positioning. Additionally, they can
also be used to temporarily fix the plate to the bone by inserting
a K-wire with a diameter up to 1.4mm through a joystick that is
already engaged in the plate hole.
Note: Do not insert a K-wire through a joystick on the
compression side of the fracture if compression is needed.
After inserting the joystick tip in the circular hole, turn the knob
on the upper part of the joystick clockwise to fix it in the hole. To
remove the joystick, simply remove any K-wire and turn the knob
counter-clockwise to disengage the tip from the hole.
Note: Do not use the engaged joystick to apply bending to
the plate as this may damage the plate or joystick.

Joint Distraction Forceps

VariAx 2 offers joint distraction forceps with a ratcheting function
for aid in achieving and holding a reduction.

Depth Measurement Options

VariAx 2 offers various options to evaluate the screw length. As
previously mentioned, all drills are scaled so that the surgeon
may quickly evaluate the screw length when using the drill
through the dedicated drill guides.
A SpeedGuide is also offered that allows the surgeon to drill and
measure the hole depth in one step with a single instrument.
For further information on the SpeedGuide, please refer to the
SpeedGuides
SpeedGuide Operative Technique.
Lastly, a standard depth gauge may be used
either independently or through a plate hole.
Depth Gauge

6
 VariAx 2 System Technology

VariAx 2 System
Taps and Countersink
Tap for 2.7mm screws
2.4, 2.7 and 3.5mm taps are available in the system. Although all
screws are self-tapping, it is recommended to use a tap if excessive
Tap for 3.5mm screws
resistance is felt during insertion or if the bone is dense.
A countersink is also available for reducing the screw head
prominence when the screw is used independently of a plate.
Countersink

Modular Handle
VariAx 2 offers a fully modular handle system. This is composed of
two handle grip sizes (medium and large) that can be interchanged
with either a bi-directional ratcheting AO-coupling insert or a
Large handle standard AO-coupling insert.
Both handle sizes are equipped with a spin-cap to allow insertion
using a two-finger technique. In order to disengage the insert from
the handle, push down on the button on the distal part of the handle
and pull the insert away from the handle.
Note: The inserts must be removed from the handles before
cleaning.
The ratcheting insert can work in three modes: clockwise ratcheting,
Ratcheting insert counter-clockwise ratcheting or neutral. To switch between the
different modes, simply twist the distal part of the insert to the desired
driving direction.
Note: To ensure appropriate ratcheting function, perform
appropriate maintenance on the insert by applying medical-
Medium handle grade lubricant oil through the marked cut-outs.

7
 VariAx 2 System Technology
VariAx 2 System

Modular System Design

The trays for the Foot & Ankle Plating Systems utilize interchangeable
modules to allow you to customize the contents of your tray to better meet
your specific needs. Select the appropriate interchangeable modules to
build in extra inventory of frequently used parts or to seamlessly integrate
other components of the Stryker Foot & Ankle portfolio.

Foot & Ankle Plating System trays feature swing clip

locks to create additional modularity and ease of use

Level 1 (T10 /T8 instruments)

Level 2 (reduction instruments) Level 3 (T10/T8 screws)

Tray configuration specific to

Stryker Foot & Ankle, other
configurations may exist

Level 4 (plates)
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 Anchorage 2 CP System Technology

Anchorage 2 CP Two-Level Add-On Tray

The combination of the VariAx SMARTLock1 and Anchorage
2 CP technology offers a plate design that advances the
standard of care when treating your forefoot and midfoot

Anchorage 2 CP
reconstruction cases. The VariAx SMARTLock allows
the option of T10 3.5/2.7mm or T8 2.7/2.4mm locking
screws capable of locking at up to 15˚ off axis to the plate.
Additionally, the indication-specific Anchorage 2 CP
plates merge the advantages of rigid plate fixation and
incorporates compression generated through the plate with
either a T10 4.1mm or T8 3.6mm partially threaded screw
across the fusion site at variable angle (varies on CP plate).

Level 1 Level 2
• 4 Plate Modules: MTP/Universal Module, • F&A Reduction Instruments 3: K-wire
Midfoot Module, Lapidus, Left Module, Cutter (1), Pointed Reduction Clamp (1)
Lapidus, Right Module (2 CP plates each)
• Reamer Inlay: Cup & Cone Reamers
NOTE: Templates do not have a module on their 14mm-22mm (1 of each)
own. They are found within the corresponding
plate module, and are to be used with the
VariAx 2 T10 or T8 cannulated joysticks.
• CP Instrument Inlay: K-wire 1.4mm x 100mm (5),
T10 and T8 CP Drill Guides (1 of each),
CP Reamers (2)
• CP Screw Rack (1)

NOTE: The CP Screw Rack can either clip

into the drawer or sit individually on a flat
surface with a rotating standing aid on the
bottom of the rack for stabilization.

9
 Anchorage 2 CP System Technology
Anchorage 2 CP

Universal CP Plate MTP CP Plate Lapidus CP Plate Midfoot CP Plate

Anchorage 2 CP Screws
CP Lag Screw Lengths Hole Size Anatomical Indications

Universal CP and MTP

3.6mm screws 20-44mm CP Plates

Lapidus CP and Midfoot

4.1mm screws 20-70mm CP Plates

VariAx 2 Screws
Screw Type Lengths Hole Size Anatomical Indications

2.4mm screws 8-38mm

Universal CP and MTP
CP Plates
2.7mm screws 8-50mm

Lapidus CP and Midfoot

3.5mm screws 8-70mm
CP Plates

Anchorage 2 CP was created in order to provide a complete, modular system which contains various plates
– each with their own specific indications – for reconstructive and trauma procedures for the foot and ankle.
The addition of the four new plates is intended to fill procedure gaps in the VariAx and VariAx 2 Foot Systems.
The Anchorage 2 CP System features a two-level tray that is compatible with the VariAx 2 four-level tray.
Anchorage 2 CP plates feature a CP hole that allows for a variable screw angle. All other holes feature VariAx
SMARTLock1 technology, which allows for +/- 15˚ screw insertion.
The Anchorage 2 CP Plating System contains pre-contoured, anatomic locking plates. Screw locations have
been designed to maximize bone purchase for each respective fusion without violating joint lines.
• Plate thickness: 1.5mm
• Plates are either T10 or T8 plates. T10 plates accept 4.1mm CP screws. T8 plates accept 3.6mm CP screws.
• Screws and instruments are color coded for ease of identification
• Screw material: Ti6Al4V ELI
• Plate material: Titanium grade 2
Anchorage 2 CP foot plates are designed to have a low profile. Additionally the VariAx 2 screws have
minimal screw head prominence and therefore may reduce the risk of soft tissue irritation. The Anchorage 2
CP screws have no screw head prominence when inserted through CP hole.

10
 Anchorage 2 CP System Technology

T8 Cross Plates
Only VariAx 2 screws (locking/non-locking, T8 2.7/2.4mm) must
be used in circular holes, and only T8 3.6mm partially threaded
CP screws must be used in the MTP and Universal CP holes.

Anchorage 2 CP
VariAx 2 T8 drill bit and screwdriver blades are compatible with
both VariAx 2 and Anchorage 2 CP screws. The Anchorage 2
CP specific drill guide (T8) is needed for the CP screw holes of
the MTP and Universal CP plates.

T8 3.6mm partially threaded CP screw is intended

for use with the Lapidus and Midfoot CP plates.

T10 Cross Plates

Only VariAx 2 screws (locking/non-locking, T10 3.5/2.7mm)
must be used in circular holes, and only T10 4.1mm partially
threaded CP screws must be used in the Midfoot and Lapidus
CP holes. VariAx 2 T10 drill bit and screwdriver blades are
compatible with both VariAx 2 and Anchorage 2 CP screws.
The Anchorage 2 CP specific drill guide (T10) is needed for
the CP screw holes of the Midfoot and Lapidus CP plates.

T10 4.1mm partially threaded CP screw is intended

for use with the Lapidus and Midfoot CP plates.

Cup & Cone Reamers

The Anchorage 2 CP System contains cannulated cup
and cone reamers for accurate joint preparation designed
to promote fusion of the first Metatarsophalangeal (MTP)
joint. Color coded to assist identifying proper sizes.

Concave surfacing reamer Convex surfacing reamer

14-22mm (size up by 2mm) 14-22mm (size up by 2mm)

11
 Anchorage 2 CP System Technology

Anchorage 2 CP Plate Templates

The Anchorage 2 CP plate templates allow for proper plate
placement on the bone and accurately targets the correct
bone area to accommodate the cannulated CP reamer.
Anchorage 2 CP

• VariAx 2 joystick snaps into the large hole.

• Template lays on the bone in the desired position.
• The raised edge on the template indicates the joint line.
• The laser-etched lines on the template show possible
variable angles when using CP screws.

Lapidus MTP Midfoot Universal

VariAx 2 basic instrument

joystick (T8 or T10)

Joint line is indicated

by laser marking line
on dorsal side

Laser marking line shows

range of possible angulation
Holes indicate position of
plate screw holes (smaller Same shape as plate
Ø than screw)

Raised edge
on plantar side

Cannulated CP Reamer
The cannulated CP reamer is advanced over the 1.4mm x
100mm K-wire to the appropriate depth limit. This reamer is
sharp with new aggressive cutting flutes. Please apply light
pressure on the bone and always use caution when operating.

12
 Anchorage 2 CP System Technology
Introduction to Cross Plate (CP) Technology

CP Screws
The Anchorage 2 CP System uses an inset diagonal,
partially threaded screw to develop mechanical
compression across the fusion site. This approach

Anchorage 2 CP
minimizes the need for separate, independent stabilization
and is designed to create compression. The Anchorage 2
CP screws are self-tapping and feature an advanced new
conical pitch thread and cutting flute that catches the far
cortex faster and allows for maximum compression across
the joint, resulting in successful unions.

Cross Joint Compression

Step 1 Step 2
The Anchorage 2 CP System uses an inset diagonal,
cross-joint screw to develop mechanical compression
across the fusion site. This approach minimizes the
need for separate, independent stabilization and is
designed to create compression.
All Anchorage CP Plates include:
• Oblique screw design, which offers an immediate
stable construct
• Low profile design
• Cannulated instrumentation, which helps promote
Step 3
surgical efficiency
The CP plate concept was designed to allow maximum
transmission of compression force across the joint,
without the risk of the head of the screw fracturing the
cortex and thus loosing stability. By creating a recess
for the counterbore in the plate, it allows positioning
of a compression screw through the plate. By first
fixing the plate to the bone, the force of compression
is borne by the plate and screw as the compression
screw is set. This allows maximum compression and
plate fixation to be accomplished in one step. This
Step 4 combination affords the compression of lag screw
fixation combined with the stability of plate fixation.
The Anchorage 2 CP plates feature the patented VariAx
SMARTLock1 technology. The T10 and T8 locking screw
heads are designed with threads on the underside,
which upon insertion, engage the circular “lip” within
any hole on the plate. The locking mechanism allows
free angulation in all directions through a 30˚ cone.

Quick Tip

Do not apply VariAx 2 plate benders on Anchorage 2 CP plates. Bending

of the plates will weaken the plate and compromise the CP technology.
13
 Anchorage 2 CP System Technology
CP Screw Angulation

Anchorage 2 CP Plates Variable Angle Fixed Angle

Note: CP screws are to be used
within a CP plate hole ONLY and
not as an independent lag screw.
Anchorage 2 CP

35° angle

Midfoot CP Plate
+/- 15°
angle

35° angle

Lapidus CP Plate

25°
angle

50° angle
Universal CP Plate

+/- 15°
angle

35° angle

MTP CP Plate

+/- 7.5°
angle

14
Anchorage 2 CP System Technology
MTP Joint Preparation Options

Option 1: Flat Cuts

Perform a dorsal approach to expose the metatarsal
head and the base of the proximal phalanx. Remove
the articular surface of metatarsal head perpendicularly

Anchorage 2 CP
to the shaft. Hold the phalanx in position (15˚ Valgus;
10-15˚ Dorsiflexion). Make a parallel cut on proximal
phalanx and proceed to the Medial Eminence Removal.
Place a guidewire into the middle of the base of the
proximal Phalanx and drive it out distal medial. Reduce
the joint and then drive the pin back in a retrograde
fashion into the metatarsal shaft for provisional fixation.

Option 2: Cup and Cone Technique

Metatarsal Preparation
Displace the phalanx plantarly or laterally, according
to the approach chosen to expose the metatarsal
head. Using a powered drill, place a 1.4mm x 100mm
K-wire (45-80200) proximally through the center of the
metatarsal head and into the diaphysis. The largest
diameter concave reamer (22mm) (XFR004222) is
inserted over the K-wire. Reaming is performed until
bleeding subchondral bone becomes visible on the
joint surface. To ensure proper sizing, begin by using
the largest size concave reamer, and then downsizing
to match the diameter of the metatarsal head.
NOTE: Check the progress of the reamer
frequently to prevent excessive shortening of the
metatarsal. Take note of the last reamer size used.
Once metatarsal reaming is complete, the K-wire
can be used to elevate the metatarsal head to
enable the removal of bone on the plantar aspect.
Phalangeal Preparation
The proximal phalanx is plantarflexed using a
Hohmann retractor (700664, 700665, 700667).
A 1.4mm x 100mm K-wire is inserted into the center
of the articular cartilage and directed through the
diaphysis. Care should be taken not to penetrate the
interphalangeal joint. Reaming is initiated using the
smallest size convex reamer (14mm) (XFR004214)
inserted over the K-wire. Progressively increase the
diameter of reamer used until the proximal phalanx is
prepared with the same diameter utilized to prepare
the metatarsal. If the metatarsal reaming stopped
at 18mm, the last and largest reamer used on the
phalanx will be 18mm (XFR004218).
NOTE: The metatarsal head should be protected
when reaming the proximal phalanx.

15
 Anchorage 2 CP
MTP CP – Surgical Technique

Incision/Exposure
A dorsal longitudinal incision is commonly used for
MTP joint exposure. A medial approach may also be
considered according to surgeon experience and
Anchorage 2 CP

patient indication. The incision is deepened and the

EHL tendon retracted laterally. The joint capsule is
released medial to the EHB tendon and retractors are
placed to expose the base of the proximal phalanx and
metatarsal head. An exostosectomy can be performed
if necessary. A simulation of correction (metatarsus
varus and pronation) is performed.

Preparation of
Metatarsophalangeal Joint
The first MTP joint is prepared using flat cuts technique
or the provided cup and cone reamers within the
Anchorage 2 CP set (Refer to page 15 for detailed
MTP exposure). Once prepared, the cup and cone
surfaces can be aligned into desired position and
temporarily stabilized using either a 1.4 x 100mm
guidewire or a 1.6 x 200mm fully threaded wire.

Stabilization
Proper positioning can be evaluated by placing a
support against the plantar surface of the foot. Once
the desired position has been achieved, drive a K-wire
1.6mm x 200mm from the mid portion of the base
of the proximal phalanx distally out the medial side.
Then reduce the joint and drive it back in a retrograde
fashion into the metatarsal for provisional fixation.

MTP CP Preparation
The MTP CP template is oriented either R (705178) or
L (705177). Loosen and insert VariAx joystick for T8
screw holes (703927) into the large hole of the MTP
template. After inserting the joystick tip in the circular
hole, turn the knob on the upper part of the joystick
clockwise to fix it. Proper template position is achieved
when the raised edge on the MTP CP template
is directly over the metatarsophalangeal joint line. A
1.4mm x 100mm K-wire (45-80200) is inserted through
the cannulated VariAx joystick. Once the K-wire is
positioned, the template and joystick are removed.

16
 MTP CP Preparation (continued)
The CP reamer (705172) is advanced over the same
K-wire until the upper edge of the reamer is flush with
the bone surface. The plate is positioned and temporarily

Anchorage 2 CP
fixated on the distal aspect of plate with a 1.4mm x 100mm
K-wire . Once fixated, the proximal holes are drilled with
T8 drill bits and filled with appropriate T8 screws.
Note: All circular holes accommodate both locking
and non-locking T8 VariAx 2 screws (2.7mm and
2.4mm) with the exception of the CP hole.

Proximal Screw Insertion

A 2.0mm drill bit (703896) for T8 VariAx 2 screws can
be used in conjunction with the appropriate T8 drill guide
to prepare the circular proximal holes for screw insertion.
Insert proximal screws on metatarsal after determining
screw length with the VariAx 2/CP depth gauge (705170)
to measure the appropriate length T8 screw to be inserted.

CP Screw
After proximal fixation is achieved, the T8 CP drill guide
(705173) is positioned in the CP plate hole. A drill bit
(703896) for T8 screws is used to drill to the plantar
cortex of the proximal phalanx. Use the VariAx 2/CP
depth gauge (705170) to measure the appropriate length
T8 CP screw to be inserted. Once appropriate screw
is measured, place through the CP hole. As CP screw
seats in plate, all temporary fixation is removed. Final
tightening of T8 CP screw develops compression across
the joint with lag effect.

Distal Screw Insertion

Once compressed, the remaining distal screws can be
inserted and verified with X-Ray.
Note: To avoid any risk of conflict with the
cross joint screw, a maximum 12mm size screw
is recommended. VariAx 2 screws can also be
Instruments angulated to avoid the CP screw.

K-wire CP Reamer Drill Guide for VariAx 2

45-80200 705172 T8 Cross-Plates T8 Drill Guide
705173 703684

Drill Bit, AO, Dia Convex/Concave VariAx 2 Joystick Template for MTP
2.0mm x 135mm, Surface Reamers for T8 Screw Holes Cross-Plate, Left
Scaled 703896 703927 705177

17
 Anchorage 2 CP
Midfoot TN – Surgical Technique
Anchorage 2 CP

Triple Arthrodesis Procedure

The triple arthrodesis is a surgical procedure that relieves
pain in the rear part of the foot by fusing the three main
joints of the hindfoot: the subtalar joint, talonavicular joint,
and the calcaneocuboid joint. This procedure improves
the stability of the foot and in some cases corrects the
deformity of the foot. After the foot is properly aligned
and the fusion of subtalar joint is performed, fixation of
the talonavicular joint is next.

Incision/Exposure
Incision for the talonavicular joint is made dorsomedially,
beginning at the tip of the medial malleolus and in line
with the medial border of the foot, extending 6-7cm
toward the great toe longitudinally and ending between
the anterior and posterior tibial tendons. Once exposed,
all of the remaining cartilage from the joints is removed
and prepared for fusion.

Preparation of Talonavicular Joint

The Midfoot CP template comes in either short (705176)
or long (705183) depending on the anatomy. The correct
template size is chosen based on the length of the plate
that spans the fusion site and leaves an adequate bony
bridge between the plate screws. Loosen and insert the
VariAx joystick for T10 screw holes (703928) into the
appropriate Midfoot CP template hole.

18
Midfoot CP Preparation
After inserting the joystick tip in the circular hole, turn
the knob on the upper part of the joystick clockwise
to fix it. Proper position is achieved when the raised

Anchorage 2 CP
edge on the Midfoot CP template is directly over the
talonavicular joint line. A 1.4mm x 100mm K-wire
(45-80200) is inserted through the cannulated VariAx
joystick. Once the K-wire is positioned, the template
and joystick are removed. The CP reamer (705172) is
advanced over the same K-wire until the upper edge
of the reamer is flush with the bone surface.
Note: All circular holes accommodate both locking
and non-locking T10 VariAx 2 screws (3.5mm and
2.7mm) with the exception of the CP hole.

Distal Screw Insertion

A 2.6mm drill bit (703691) for T10 VariAx 2 screws can
be used in conjunction with the appropriate T10 drill
guide to prepare the hole for screw insertion. Insert distal
screws on navicular after determining the screw length
with the VariAx 2/CP depth gauge (705170) to measure
the appropriate length T10 screw to be inserted.

CP Screw
The T10 CP drill guide (705171) is positioned inside the
CP hole. Use the 2.6mm drill bit to accommodate the
4.1mm CP screw. Once drilled, use the VariAx 2/CP
depth gauge to measure the appropriate length for the
T10 CP screw to be inserted. When the appropriate
screw length is measured, place the 4.1mm CP screw
through the CP hole. As the CP screw is seated in
the plate, all the temporary fixation is removed. Final
tightening of the T10 CP screw develops compression
across the joint with lag effect. Insert remaining proximal
screws on the talus side of the joint and position under
fluoroscopy.

19
 Anchorage 2 CP
Midfoot NC – Surgical Technique

Incision/Exposure
The incision can be extended distally for access to the cuneiforms,
first metatarsal base and naviculocuneiform and intertarsal joints.
Remove cartilage in the naviculocuneiform joint. If there is significant
Anchorage 2 CP

damage to tissue in the joints between the navicular and cuneiform,

the remaining cartilage is removed. If the foot is misaligned, the
bones need to be positioned correctly using a K-wire.

Midfoot CP Preparation
The Midfoot CP template comes in either short (705176) or long
(705183) depending on the anatomy. The correct template size
is chosen based on the length of plate that spans the fusion site
and leaves an adequate bony bridge between the plate screws.
Loosen and insert the VariAx joystick for T10 screw holes (703928)
into the appropriate Midfoot CP template hole. After inserting the
joystick tip in the circular hole, turn the knob on the upper part of
the joystick clockwise to fix it. Proper position is achieved when
the raised edge on the Midfoot CP template is directly over the
naviculocuneiform joint line. A 1.4mm x 100mm K-wire (45-80200)
is inserted through the cannulated VariAx joystick. Once the K-wire
is positioned, the template and joystick are removed. The CP
reamer (705172) is advanced over the same K-wire until the
upper edge of the reamer is flush with the bone surface.
Note: All circular holes accommodate both locking and
non-locking T10 VariAx 2 screws (3.5mm and 2.7mm) with
the exception of the CP hole.

Distal Screw Insertion

A 2.6mm drill bit (703691) for T10 VariAx 2 screws can be used in
conjunction with the appropriate T0 drill guide to prepare the hole for
screw insertion. Insert distal screws on cuneiform after determining
screw length with the VariAx 2/CP depth gauge (705170) to
measure the appropriate length T10 screw to be inserted.

CP Screw
The T10 CP drill guide (705171) is positioned inside the CP hole.
Use the 2.6mm drill bit to accommodate the 4.1mm CP screw.
Once drilled, use the VariAx 2/CP depth gauge to measure the
appropriate length for the T10 CP screw to be inserted. When
the appropriate screw length is measured, place 4.1mm CP
screw through the CP hole. As the CP screw sits in the plate, all
temporary fixation is removed. Final tightening of T10 CP screw
develops compression across the joint with lag effect. Insert
remaining proximal screws on the navicular side of the joint and
position under fluoroscopy.

20
 Anchorage 2 CP
Midfoot CC – Surgical Technique

Incision/Exposure
Expose the calcaneocuboid joint through a lateral (Ollier) incision.
Distract the joint with a lamina spreader, and sharply debride
the articular cartilage to expose the bleeding subchondral bone.

Anchorage 2 CP
Completely remove the cartilage from the calcaneocuboid joint.

Midfoot CP Preparation
The Midfoot CP template comes in either short (705176) or long
(705183) depending on the anatomy. The correct template size is
chosen based on the length of plate that spans the fusion site and
leaves an adequate bony bridge between the plate screws. Loosen
and insert the VariAx joystick for T10 screw holes (703928) into the
appropriate Midfoot CP template hole. After inserting the joystick tip
in the circular hole, turn the knob on the upper part of the joystick
clockwise to fix it. Proper position is achieved when the raised edge
on the Midfoot CP template is directly over the calcaneocuboid
joint line. A 1.4mm x 100mm K-wire (45-80200) is inserted through
the cannulated VariAx joystick. Once the K-wire is positioned, the
template and joystick are removed. The CP reamer (705172) is
advanced over the same K-wire until the upper edge of the reamer
is flush with the bone surface.
Note: All circular holes accommodate both locking and
non-locking T10 VariAx 2 screws (3.5mm and 2.7mm) with
the exception of the CP hole.

Distal Screw Insertion

A 2.6mm drill bit (703691) for T10 VariAx 2 screws can be used in
conjunction with the appropriate T10 drill guide to prepare the hole
for screw insertion. Insert distal screws on Cuboid after determining
screw length with the VariAx 2/CP depth gauge (705170) to
measure the appropriate length T10 screw to be inserted.

CP Screw
The T10 CP drill guide (705171) is positioned inside the CP hole.
Use the 2.6mm drill bit to accommodate the 4.1mm CP screw.
Once drilled, use VariAx 2/CP depth gauge to measure the
appropriate length for the T10 CP screw to be inserted. When
appropriate screw length is measured, place the 4.1mm CP
screw through the CP hole. As the CP screw sits in the plate,
all temporary fixation is removed. Final tightening of the T10 CP
screw develops compression across the joint with lag effect. Insert
remaining proximal screws on calcaneus side of the joint and
position under fluoroscopy.

Quick Tip - Dr. Keith Wapner

Extend CP screw across the length of the joint so to reach the plantar side of the bones. CP
orientation can be applied in either direction so that the CP screw can go from cuboid to calcaneus or
from calcaneus to cuboid. In post traumatic cases, this will often be dictated by the shape of the bone.
21
 Anchorage 2 CP
Lapidus Arthrodesis – Surgical Technique

Incision and Preparation of

Tarsometatarsal Joint
An incision is made over the dorsal medial aspect of the first
tarsometatarsal joint. Dissection is carried down through the
Anchorage 2 CP

subcutaneous tissues with care to identify and protect the Anterior

Tibial Tendon as it passes along the medial side of the medial
cuneiform to insert on the plantar base of the first metatarsal. A
dorsal capsulotomy is performed and the joint surfaces are debrided
back to bleeding bone. After the joint preparation, reduce the
fragments and temporarily fixate using 1.6mm x 200mm K-wires.

Lapidus CP Preparation
The Lapidus CP template is oriented either R or L (705180,
705179). Loosen and insert the VariAx joystick for the T10 screw
holes (703928) into the appropriate Lapidus CP template hole.
After inserting the joystick tip in the circular hole, turn the knob on
the upper part of the joystick clockwise to fix it. Proper position
is achieved when the raised edge on the Lapidus CP template is
directly over the tarsometatarsal joint line. A 1.4mm x 100mm K-wire
(45-80200) is inserted through the cannulated VariAx joystick. Once
the K-wire is positioned, the template and joystick are removed. The
CP reamer (705172) is advanced over the same K-wire until the
upper edge of the reamer is flush with the bone surface.
Note: All circular holes accommodate both locking and
non-locking T10 VariAx 2 screws (3.5mm and 2.7mm) with
the exception of the CP hole.

Distal Screw Insertion

A 2.6mm drill bit (703691) for the T10 VariAx 2 screws can be
used in conjunction with the appropriate T10 drill guide to prepare
the hole for screw insertion. Insert distal screws into first metatarsal
after determining screw length with the VariAx 2/CP depth gauge
(705170) to measure the appropriate length of T10 screw inserted.

CP Screw
The T10 CP drill guide (705171) is positioned inside the CP hole.
Note: The Anchorage 2 CP Lapidus CP plate can be angulated
in one direction only.
Use the 2.6mm drill bit to accommodate the 4.1mm CP screw.
Once drilled, use the VariAx 2/CP depth gauge to measure the
appropriate length for the T10 CP screw to be inserted. When the
appropriate screw length is measured, place the 4.1 CP screw
through the CP hole. As the CP screw sits in the plate, all temporary
fixation is removed. Final tightening of the T10 CP screw develops
compression across the joint with lag effect. Insert remaining
proximal screws and position under fluoroscopy.

22
Anchorage 2 CP
Universal CP – Surgical Technique

Universal CP Preparation
Insert the VariAx joystick for the T8 screw holes (703927) into
the Universal CP template hole (705182). After inserting the
joystick tip in the circular hole, turn the knob on the upper part

Anchorage 2 CP
of the joystick clockwise to fix it. Proper position is achieved
when the raised edge on the Universal CP template is directly
over the joint line. A 1.4mm x 100mm K-wire (45-80200) is
inserted through the cannulated VariAx joystick. Once the
K-wire is positioned, the template and joystick are removed.
The CP reamer (705172) is advanced over the same K-wire
until the upper edge of the reamer is flush with the bone surface.
Note: All circular holes accommodate both locking and
non-locking T8 VariAx 2 screws (2.7mm and 2.4mm) with
the exception of the CP hole.

Distal Screw Insertion

A 2.0mm drill bit (703896) for the T8 VariAx 2 screws can be
used in conjunction with the appropriate T8 drill guide (703684)
to prepare the hole for screw insertion. Insert the distal screws
into metatarsal after determining the screw length with the
VariAx 2/CP depth gauge (705170) to measure the appropriate
length of the T8 screw inserted.

CP Screw
After the T8 distal screws are fixated, the T8 CP drill guide
(705173) is positioned in the CP plate hole. A 2.0mm drill
bit (703896) for the T8 screws is used to drill to the proximal
cortex. Use the VariAx 2/CP depth gauge (705170) to measure
the appropriate length T8 CP screw to be inserted. When
appropriate screw length is measured, place the 3.6mm
CP screw through the CP hole. As the CP screw sits in the
plate, all temporary fixation is removed. Final tightening of the
T8 CP screw develops compression across the joint with lag
effect. Insert remaining proximal screws and position under
fluoroscopy.

Proximal Screw Insertion

Once compressed, the remaining proximal screws can be
inserted into the cuneiform and verified with X-Ray.

23
References Manufacturer:
1. Licensed from Prof. Wolter Stryker GmbH
This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or her own professional Bohnackerweg 1
clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense 2545 Selzach
medical advice and recommends that surgeons be trained in the use of any particular product before using it in surgery. Switzerland
The information presented is intended to demonstrate a Stryker product. A surgeon must always refer to the package insert, www.stryker.com
product label and/or instructions for use, including the instructions for Cleaning and Sterilization (if applicable), before using any
Stryker product. Products may not be available in all markets because product availability is subject to the regulatory and/or
medical practices in individual markets. Please contact your Stryker representative if you have questions about the availability of
Stryker products in your area.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service
marks: Anchorage, SMARTLock, Stryker, VariAx. All other trademarks are trademarks of their respective owners or holders.
The products listed above are CE marked.
Content ID: AN-ST-2, Revision 1, 4-2016
Copyright © 2016 Stryker