Distal Fibular Locking Plate

Distal Fibular Locking Plate Distal Fibular Locking Plate

INDEX

Warning

Caution

This publication describes the recommended procedures for using Double Engine devices and instruments.

It offers guidance that you should pay attention to. But as with any such technical guide, the guide alone

does not provide sufficient background for direct use of the instrument set, each surgeon should also

consider the particular needs of each patient and make appropriate adjustments when required. Instruction

by experienced surgeon is still highly recommended.

All non-sterile devices must be cleaned and sterilized before use. Multi-component instruments must be

disassembled for cleaning. Please follow the instructions provided in our Reprocessing, Care and

Maintenance Guide (RCMG-2012).

Please refer to Package Insert 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.

The implants are designed for temporary fixation of fractured bone fragments until the bone heals.

Therefore, if bone does not heal or bone consolidation is delayed or not sufficient, the system may break.

Post-operative care under the guidance of the surgeon is also very important and it must be to ensure the

promotion of bone consolidation.

Indications

Patient Position

Surgical Technique

– Step 1 Approach

– Step 2 Reduction

– Step 3 Plate Bending

– Step 4 Temporary Fixation

– Step 5 Drilling

– Step 6 Length Determination

– Step 7 Locking Screw Insertion

– Step 8 Drilling For Shaft Screw

– Step 9 Length Determination

– Step 10 Shaft Screw Insertion

– Step 11 Final Locking

– Step 12 Confirmation

Distal Fibular Locking Plate Distal Fibular Locking Plate

Patient in supine position with a sandbag (bump) underneath the buttock of the affected side is usually chosen. This allows the foot to lie in a neutral position and prevents the normal external rotation of the leg. Lift and rest the leg on a pad with the knee slightly flexed to assist placement in a neutral position.Visualization of the distal fibula under fluoroscopy in both the lateral and AP views is recommended.

Patient Position

3 4

Surgical Technique

STEP 1APPROACH

STEP 2REDUCTION

Expose the fibular fracture, the distal fibula, and the fibular diaphysis

after making a straight lateral or posterolateral surgical incision.

Alternatively, the incision can be placed along the posterolateral border of the fibula where there is improved soft tissue coverage.

Take care not to damage the superficial peroneal nerve proximally anteriorly, or the sural nerve posteriorly. Deep dissection allowing

exposure of the fibula proximal to the fracture is usually preferred.

STEP 4TEMPORARY FIXATION

STEP 3PLATE BENDING

Indications

Expose and clean the fracture site and make a reduction. Fibular

Distal fibular fracture

length, alignment and rotation should be correctly restored. A reduction forceps with points can be applied for reduction in spiral or

oblique fracture patterns. Alternatively, in some fracture patterns,

the plate can be used to assist with and guide the reduction. This may be especially important in comminuted fractures where a bridging technique is used. Check the reduction condition under

image intensifier.

Note: Bone lever and bone holding forceps, self-centering can be used if necessary.

110040100 Guide Wire110041600 Drill Sleeve, for guide wire, φ1.5

Temporarily hold the plate using guide wires through drill sleeves.

Ensure proper reduction before inserting the first locking screw.

Check screw placement under image intensification to determine if screw and plate placement are suitable.

Note: Once locking screws are inserted, further reduction is not

possible without loosening the locking screws.

110040600 Bending Iron, left110041800 Bending Iron, right

Expose the needed part of the fibula for pale placement. An open approach is performed in most cases.

If necessary, use bending irons to bend the plate so to fit the

anatomic structure before inserting plate. However, repeated bending is forbidden because it would damage the strength of the plate.

Distal Fibular Locking Plate Distal Fibular Locking Plate

STEP 5

DRILLING

STEP 8

DRILLING FOR SHAFT SCREW

STEP 12CONFIRMATION

5 6

110040300 Drill Sleeve, for drill bit, φ2.8110040200 Drill Bit, φ2.8

Insert the drill sleeve into the 3.5mm locking hole until fully seated.

Use the φ2.8 drill bit through the sleeve to drill to the desired depth.

110040400 Depth Gauge

Remove the drill bit and drill sleeve. Use the depth gauge to determine screw length.

Note: When determine appropriate screw length, ensure that the

screw tip will not protrude past the articular surface.

110040900 Screwdriver, hexagonal, φ2.5

Select and insert the appropriate 3.5mm locking screw using the

hexagonal screwdriver.

Note: After insert the first screw in the distal fibula, a fixation of

locking screw in the shaft could avoid the upward of the plate. However, cortex screw to make a compression in next step is

forbidden in such case. If cortex screw is predetermined, then keep guide wire and drill sleeve for guide wire attached on the plate.

110040300 Drill Sleeve, for drill bit, φ2.8

110040200 Drill Bit, φ2.8

If a locking screw will be used first in the shaft, ensure the fracture is reduced and the plate is held securely to the bone.

Insert the drill sleeve into the 3.5mm locking hole or combi-hole until

it is fully seated. Use φ2.8 drill bit through the sleeve to drill to the desired depth.

Note: If a combination of locking and cortex screws will be used, cortex screws should be inserted first.

110040400 Depth Gauge

Remove the drill bit and drill sleeve and use the depth gauge to

determine screw length.

Carefully assess the final reduction and fixation via direct

visualization and image intensification. Check the reduction and the

placement of plate and screws under AP and lateral fluoroscopic visualization. Confirm the stability of the fixation and make sure that the motion of the ankle joint is not restricted.

STEP 6

LENGTH DETERMINATION

STEP 9

LENGTH DETERMINATION

STEP 10SHAFT SCREW INSERTION

STEP 11FINAL LOCKING

STEP 7LOCKING SCREW INSERTION

110040900 Screwdriver, hexagonal, φ2.5

Select and insert the appropriate 3.5mm locking screw using the hexagonal screwdriver.

1110040800 Torque Indicating Screwdriver, 1.5Nm

After inserting all predetermined screws, use the torque indicating screwdriver to make a final locking. Make sure that the screws are

fully tightened by hand.

Distal Fibular Locking Plate Distal Fibular Locking Plate7 8

Instruments 110580000

110040100 Guide Wire, φ1.5, length 150mm

110040200 Drill Bit, φ2.8

110040900 Screwdriver, hexagonal, φ2.5

110041000 Holding Sleeve

110040300 Drill Sleeve for Drill Bits, φ2.8

110040400 Depth Gauge for Locking Screws

110040500 Drill Bit, φ2.5

110040600 Bending Iron, left

110040700 Tap for Cortex Screws φ3.5

110040800

110041100 Double Drill Guide, φ2.5/φ3.5

110041200 Extraction Screw for Screws, φ2.5

110041300 Broken Screw Extractor

110041400 T-Handle with Quick Coupling

110041500 Screw Forceps, self-holding

110041600 Drill Sleeve, for Guide Wire φ1.5, short Torque Indicating Screwdriver, 1.5Nm

Distal Fibular Locking Plate Distal Fibular Locking Plate9 10

110041700 Screwdriver Shaft, hexagonal, φ2.5

110041800 Bending Iron, right

110041900 Reduction Forceps with Points

110042000 Bone Holding Forceps, self-centering

110042100 Periosteal Elevator, round edge

110042200 Periosteal Elevator, straight

110042300 Bone Lever, small

110042400 Bone Lever, large

110042500 Holding Sleeve for Torque Indicating Screwdriver

110580001 Instrument Case

Instruments 110580000

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