Integra SURGICAL TECHNIQUE External Fixation System · 2017-11-02 · 3 I. Indications The...

SURGICAL TECHNIQUEIntegra® External Fixation System

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Table of Contents

I. Indications and Contraindications ...............................................................................................................................................................3II. Integra External Fixation Product Overview .............................................................................................................................................4III. Frame Assembly ............................................................................................................................................................................................8 a. Initial Assembly .........................................................................................................................................................................................8 b. Provisional Supports ..............................................................................................................................................................................10IV. K-Wires and Half Pins Technique .............................................................................................................................................................. 13 a. K-Wire Insertion ...................................................................................................................................................................................... 13 b. Half Pin Insertion, Self‐Drilling ............................................................................................................................................................ 20 c. Half Pin Insertion, Drill Pilot Holes ...................................................................................................................................................... 21V. Optional Frame Attachments .................................................................................................................................................................... 25Trays ............................................................................................................................................................................................................. 26-30

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I. Indications

The Integra® External Fixation System is an external fixation device intended for adult use in the treatment of bone conditions including leg lengthening, osteotomies, arthrodesis, fracture fixation, and other bone conditions amenable to treatment by use of the external fixation modality.

Additional indications for the Integra External Fixation System include: • Correction of deformity• Revision procedures where other treatments or devices have been unsuccessful• Bone reconstruction procedures• Fusions and replantations of the foot• Charcot reconstruction and Lisfranc dislocations• Ankle distraction (arthrodiastasis)

Contraindications

Conditions that restrict the patient’s ability or willingness to follow post‐operative instructions during the healing process.

Surgical Technique

As the manufacturer of this device, Integra does not practice medicine and does not recommend this or any other surgical technique for use on a specific patient. The surgeon who performs any implant procedure is responsible for determining and using the appropriate techniques for implanting the device in each patient.

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Rings

Ring Type 140mm 160mm 180mm 200mm 220mm

Full Ring ✔ ✔ ✔ ✔ -

Half Ring ✔ ✔ ✔ ✔ ✔

5/8 Ring ✔ ✔ ✔ ✔ ✔

Foot Plates

Part 140mm 160mm 180mm

Foot Plate ✔ ✔ ✔

II. Product Description

The Integra External Fixation System is a single-use modular external fixator consisting of the following components: rings, foot plates, half pin bone screws, straight/olive k-wires, rods, nuts, bolts, clamps, and other modular fixator components. Special instruments (e.g. wrenches) are required for proper assembly of the apparatus. Adjustment of the fixator is possible during the course of treatment. When properly used by an experienced clinician, the Integra External Fixation System may preserve limb function by minimizing operative trauma to anatomical structures and preserving blood supply.

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Two types of K-wires are offered: 2.0 mm Smooth and Olive.

K-wire Type 400mm 530mm

Smooth ✔ -

Olive ✔ ✔

K-Wires

Half-pin Bone Screws

Half Pin (200mm length)

20mm thread 30mm thread 40mm thread 50mm thread

4mm diameter ✔ ✔ ✔ -

5mm diameter - ✔ ✔ ✔

6mm diameter - ✔ ✔ ✔

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Part 20mm 40mm 60mm

Hex Posts ✔ ✔ ✔

Part 20mm 60mm 85mm 115mm 165mm 200mm

Threaded Rods ✔ ✔ ✔ ✔ ✔ ✔

Hex Posts

Threaded Rods

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The slotted posts are available in two sizes. The slotted post starts 10mm off the ring and adds to the maximum distance a wire can be offset from a ring.

PartMinimum

Offset (mm)Maximum

Offset (mm)

Small Slotted Post 10mm 38mm

Large Slotted Post 10mm 48mm

FitsOlive

K-wiresSmooth K-wires

4.0mm Dia Half Pins

5.0 mm Dia Half Pins

6.0 mm Dia Half Pins

Stopper Coin ✔ ✔ ✔ ✔ ✔

Slotted Posts

Rubber Wire/Half-Pin Stopper Coin

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1III. Frame Assembly

When building the frame for the tibia ring fixation block choose: • 1 full pre-sized circular rings • 1 5/8 ring • 1 pre-sized foot plate • 1 pre-sized anterior half ring (optional) • 1 Rockerbottom (optional) This construct is representative of a frame for the tibia ring fixation block. Depending upon the patient and other factors, actual configuration may vary from what is described and illustrated in this guide.

Using 14mm bolts, place four 60mm Hex Posts equidistant from each other between the 5/8 ring and the full ring, allowing for maximum separation between the rings. The 5/8 ring will be above the full ring. Alternatively, threaded rods can be used.

Place each end of the four 200mm threaded rods onto the ring, and secure using 10 mm nuts. Tighten using 10mm wrenches.

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2

3

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NotesOptionally, Speed Nuts may be utilized during initial threaded rod attachment and stabilization. These are illustrated in the construct image below. After inserting the threaded rod through a ring hole, a Speed Nut may be slid down the threaded rod by tilting it slightly to align the through hole. By rotating or turning the Speed Nut, it will engage the threads and lock within a ½ turn. Please note that Speed Nuts are for quick temporary stabilization of the threaded rods and must be removed and replaced with standard nuts prior to completion of procedure

NotesIdeally, the rings will all be of the same diameter.

Round Speed Nut Ref. 12224214

Warning:The Speed Nuts are for temporary holding only. They must be replaced with standard nuts prior to K-wire or half pin insertion.

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4 Using four 10mm bolts, close the open end of the foot plate with the selected anterior half ring. The anterior half ring may only be secured with 10mm bolts.

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Optionally, a cross bar may be attached to the anterior ring using nuts

Optionally, a Rockerbottom can be added to the foot plate using six 18mm bolts

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Provisional Support Assembly Procedure

1 Four Provisional Supports are provided to aid in the alignment of the patient’s limbs to the rings: one support for the calf, one support for the heel, and two supports for the midfoot.

22 Attach the Provisional Supports to

the ring or footplate by sliding them onto the desired ring locations.

33 Hand tighten the thumb screw to secure the Provisional Supports in place.

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44 Extend the alignment arm for each Provisional Support to the desired distance until the limb is stabilized in the desired central location. The alignment arm ratchets and locks in place automatically.

Provisional Midfoot Support

Provisional Calf Support

Provisional Heel Support

Provisional Midfoot Support Ref. 12225060

Provisional Heel Support Ref. 12225050

Provisional Calf Support Ref. 12225040

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6

5 Secure wires and half-pin bone screws to the rings as desired.

6 Release the Provisional Supports by pulling the locking pin on each alignment arm outward, allowing the arms to retract. Loosen the thumb screw and slide the Provisional Supports off the rings.

NotesThe Provisional Supports are re-usable instruments and are not intended to be left on the rings. Remove the Provisional Supports prior to completion of procedure.

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IV. K-wires and Half-Pin Bone Screws

Straight/olive K-wires and half-pin bone screws are the primary methods of connection between the external fixation frame and the bone. K-wires are offered in 2.0mm diameter and have a bayonet point. K-wires are also offered in either smooth or olive configurations. Olive K-wires enhance buttress strength, are more stable than smooth K-wires, and counter act deforming muscle forces especially during limb lengthening procedures. Fine K-wires may be tensioned at a maximum of 90 kg on open rings or posts and up to a maximum of 125 kg on a full closed ring.

Half-pin bone screws are available in 4mm, 5mm, and 6 mm diameters, do not require tensioning, and generally add greater stiffness to the construct. Half-pin bone screws are offered in 20mm, 30mm, 40mm, and 50mm thread lengths and include a self-drilling tip. Half pin bone screws are more limited in orientation placement.

1. K-Wire Guide Instrument1 The standard smooth K-wire is typically drilled percutaneously off the ring to be attached. It is important with K-wire insertion to direct the K-wire flush without pressure on the ring. A K-wire Guide instrument is available to optionally provide guidance when drilling the K-wire.

NotesIf too much pressure is placed when drilling, the K-wire may become directed off the ring proximally and not land flush on the opposite ring side for attachment.

If the K-wire is lifted off the ring, the end of the K-wire may become distally directed. A K-wire not flush with the ring may serve to create uneven forces and undesired displacement of the segment when tensioned.

Technique - K-Wire Insertion and Fixation

K-wire Guide Ref. 12225315

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Close up of K-Wire through Universal Wire Fixation Bolt

Important: The K-wire should be advanced sufficiently so that the farthest end has a minimum of 2 to 3 finger breadths of length beyond the ring, and then secured to the ring using either the central or off-set slot on the Universal Wire Fixation Bolt. Care should be taken when drilling to avoid excessive heat generation in surrounding tissue.

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22 The distal end (sharp) of the K-wire is secured by the universal wire fixation bolt with a 10mm box wrench and a 10mm Universal Bolt Tubular Wrench to avoid displacement of the K-wire during tightening. The Universal Bolt Tubular Wrench mates with the universal wire fixation bolts and the hex nuts.

3 Once secured on the ring, the distal tip of the K-wire is cut and the K-wire is then curled on to the side of the ring with the end buried into one of the adjacent ring holes to avoid injury. A Wire Cutter and Wire Bender are available to facilitate.

44 The proximal side of the K-wire is provisionally secured with a Universal Wire Fixation Bolt and tensioned to a maximum of 125 kg against the ring when fully closed and a maximum of 90kg when the ring is open. A Wire Tensioner instrument is provided to facilitate.

The proximal K-Wire is tensioned using the Wire Tensioner instrument

Tension indicator

Close up view of Wire Tensioner on Universal Wire Fixation Bolt with the use of the tensioner alignment tool

NotesThe maximum tension allowed on a fully closed ring is 125 kg and 90 kg when the ring is open.

10 mm Box Wrench Combination Ref. 12224501

10 mm Universal Bolt Tubular Wrench Ref. 12224504

Wire Bender Ref. 12224507

Wire Cutter Ref. 12224508

Wire Tensioner Ref. 12225300

Tensioner Alignment Tool Ref. 12224300

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After the K-wire is tensioned to the desired stiffness, use a pivoting socket wrench to tighten the nut on the Universal Wire Fixation bolt.

55 To release the Wire Tensioner from the ring, push down on ratchet arm.

66 Once tensioned to the desired amount, the proximal end of the K-wire is then fully secured to Universal Wire Fixation Bolt using the 10-mm box wrench and Universal Bolt Tubular Wrench, again avoiding distortion of the straight line of the K-wire on the ring.

The proximal end of the K-Wire is fully secured to the Universal Wire Fixation Bolt

10 mm Pivoting Socket Wrench Ref. 12224506

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2 The simplest method is to place the second K-wire on the opposite side of the ring and as close to 90° to the other wire as soft tissue structures permit. This minimizes one K-wire hitting and deflecting off the other.

1 In conditions where the configuration does not permit flush seating of the Wire Tensioner to the ring surface, a holed cube may be used to apply or post is used to apply the tension into the K-wire.

Optimal stability of the ring segment is determined by the maximum pin spread, ideally at 90 degrees, and separation of the K-wires off the ring in all planes.

Stability in foot and ankle frames follows the rule-of-twos - 2 limb segments, 2 levels of fixation per segment, and 2 wires per level of fixation.

On the same side of the ring, the 2 K-wires should diverge as close to 90 degrees as the soft tissue allows. In addition, K-wires should be separated on opposite sides of the ring to allow for additional distance between the 2 K-wires.

NotesIn situations where there is insufficient length of K-wire for the Wire Tensioner to capture, a method of in situ tensioning can be utilized. In this case, as the pivoting socket wrench is used to tighten the bolt on the underside of the ring, the fixation bolt is twisted clockwise up to 90 degrees, tightening the captured K-wire. The amount of tension, although not quantified, is dictated by how much the bolt is rotated as it is tightened.

Technique - Achieve optimal distance between K-wires

3 To achieve slight spacing off the ring, the 23mm Universal Wire Fixation Bolt may be used with rectangular washers to avoid bending the K-wire once tensioned on the ring.

3

2 mm Rectangular Washer Ref. 12224201

4 mm Rectangular Washer Ref. 12224202

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4 To achieve greater distances off of the ring, the universal wire fixation bolt can attach to a slotted post. Slotted Posts are available in two sizes. This allows for not only greater distance of the K-wire off the ring, but allows for multiple degrees of freedom in K-wire placement that a standard universal wire fixation bolt does not permit.

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Technique - Mobilize or Compress a Segment

The arched K-wire technique is a method where by the K-wire is intentionally secured a set distance away from the ideal hole on the ring.

Arching toward the segment creates compression, arching away from the segment creates distraction. By securing the universal wire fixation bolts on the ring, tensioning the arched K-wire will apply compressive forces axially between segments. However, the control at the compression site may be poor, resulting in slippage between the two segments. The greater the arching of the K-wire to the ring, the greater compressive forces and potential mobilization of the segments. Conversely, arched K-wires can also be used to distract a segment through the tensioning, with the K-wire positioned in holes away from the target site.

Another method of compression between segments or fragments is through the use of olive K-wire.

1 The olive end of the K-wire is driven in direct opposition to the fragment or segment to be compressed.

1

Slotted Post - Small Ref. 12224228

Slotted Post - Large Ref. 12224229

K-wire Olive, 400 mm Ref. 12220023

K-wire Olive 530 mm Ref. 12220024

Warning:As the K-wire is placed further off of the ring, significant tensioning may result in a bowing effect and warping of the ring. Tensioning of K-wire off of a slotted post should not exceed 90 kg.

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2 Tensioning is applied on the contra-lateral side of the K-wire to pull or reduce the bone captured underneath the olive in the direction of the tensioning. This technique is useful in reducing a butterfly fragment in long bone fractures and is conducive to “docking” a forefoot segment to that of the midfoot or hindfoot segment. This method offers a more controlled compression, since the K-wire is run axially along the length of the segment to be docked.

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NotesCare should be taken when tensioning the contralateral side, as over-tensioning may pull the olive through the bone. To broaden the area of capture on the segment, a K-wire washer is used to enhance the buttress strength and may be added under the olive, increasing the distribution of force applied against the bone.

K-wire Washer Ref. 12220025

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Technique – Half Pin insertion and fixation – self drilling technique

Half pin bone screws, which are placed only on one side of the frame, have greater stiffness relative to K-wires and have the advantage of avoiding soft tissue on the contralateral ring side where compartments with more soft tissue may lead to K-wire irritation if traversed.

Care must still be taken to avoid neurovascular structures and intraarticular penetration.

Half pin bone screws are typically used in the tibia, calcaneous, and forefoot.

Standard half-pin bone screw fixation technique utilizes the Angular Half Pin Fixation Clamp, which consists of a post combined with a centering sleeve and 10-mm bolt.

Important: A minimum of two half pins per ring should be used, with the ideal orientation at 90 degrees and divergent from one another.

1 A small longitudinal stab wound is made where the pin dimples the skin. The incision is spread longitudinally with a small hemostat.

1-3

2 The half-pin bone screws include a self-drilling tip for easy no-drill insertion.

3 The self-drilling method comprises direct insertion of the half-pin bone screw through a cube or the angular Half Pin Fixation clamp. Pins are inserted under power or manually using the T-Handle.

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4 The pin is then stabilized with a 10 mm bolt to affix the pin to either the cube or angular half pin fixation clamp. Cubes are available in four sizes ranging from one hole to four holes.

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Technique – Half-pin bone screw insertion and fixation, drill pilot holes

1 With the drill method, the Half Pin Drill Guide Handle and Half Pin Drill Guide Trocar Tip are connected and dimpled to the skin, followed by a longitudinal stab wound with a number 15 blade.

1-3

2 After spreading with the hemostat clamp, the trocar is gently tapped onto the cortex.

3 The trocar is removed, and the appropriate sized drill bit (2.6mm, 3.2mm, or 4.2mm) with depth markings is drilled bicortically, with care being taken to decrease pressure as penetration of the opposite cortex occurs.

One Hole Cube Ref. 12224222

Two Hole Cube Ref. 12224223

Three Hole Cube Ref. 12224224

Four Hole Cube Ref. 12224225

Angular Half Pin Fixation Clamp Ref. 12225010

Half Pin Drill Guide Handle Ref. 12225020001

Half Pin Drill Guide Trocar Tip Ref. 12225020002

2.6mm Drill for 4.0mm Half Pin - Ref. 122240273.2mm Drill for 5.0mm Half Pin - Ref. 12224028

4.2mm Drill for 6.0mm Half Pin - Ref. 12224029

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4 The required depth of the half-pin bone screw is measured off of the etched drill prior to selection.

4

5 The drill sleeve is removed and the appropriate half-pin bone screw is inserted using power or manually inserted using the T-Handle. All threads should be below the skin, with one to two threads exiting on the opposite cortex.

5

AO T-Handle Ref. 5010001000

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6 The pin is then stabilized with a 10 mm bolt to affix the pin to either the cube or angular half pin fixation clamp.

In cases where there is an oblique fracture or osteotomy, half pin bone screws can be used to minimize shear with axial compressive load. The pins are oriented parallel to the fracture line obliquely, promoting compression.

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Tips on K-wire and half-pin bone screw insertion

1. K-wires, when tensioned, will follow the axial line of the K-wire. It is therefore critical that when placing K-wires without the intention of mobilizing a segment, that the K-wire is attached to its respective ring without any bending.

2. Reference K-wires, in particular, the proximal K-wire, will often traverse the anterior lateral compartment. This K-wire has a tendency postoperatively to be the first to become irritated and may need to be removed in the clinic and not relied on long-term as part of the upper segment stability.

3. In general, either 2 K-wires with a half-pin bone screw, 2 or 3 half-pin bone screws, or 3 K-wires are the minimal requirements for stability per ring in a segment.

4. Half-pin bone screws are best utilized along the medial tibial crest, where there is limited soft tissue in the tibia. They are also useful to stabilize the hindfoot in the calcaneus, directed off the foot ring, or as an adjunct to fixation in the forefoot along the first and fifth metatarsals.

5. While 6mm diameter half-pin bone screws are optimal in the tibia and the hindfoot, the forefoot half-pin bone screws are generally of 4 mm diameter.

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Rubber stopper coins may be used to protect wound site following K-wire and half-pin bone screw insertion

Rubber Wire/Half Pin Stopper Coin Ref. 12224220

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Optional Frame attachments

Universal Joint: up to 90 degrees of angulation when connecting two frame components

Conical washers, (convex and concave) may be used to construct frames with offsetting rings or rings of different diameters

Plates may be used to extend the construct beyond the rings

Universal Joint Ref. 12225221

Conical Washer Concave Ref. 12224208

Conical Washer Convex Ref. 12224209

Three Hole Plate 90 degrees Ref. 12224217

Plate - 40mm Ref. 12224235

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Trays

1234567891011121314151617181920

1234567891011

121314151617

2 mm Washer, Max Qty 104 mm washer, Max Qty 10Convex Washer, Max Qty 10Concave Washer, Max Qty 10Nut, Max Qty 60Half Pin Fixation Clamp, Max Qty 6Half Pin Caps, Max Qty 30Wire-Pin Stopper Coin, Max Qty 30Compression-Distraction Nut, Max Qty 12Bolt, 10 mm, Max Qty 20Bolt, 14 mm, Max Qty 20Bolt, 18 mm, Max Qty 20Slotted Post – Small, Max Qty 6Slotted Post – Large, Max Qty 6Wire Fixation Bolt, 17.5 mm, Max Qty 20Wire Fixation Bolt, 23 mm, Max Qty 201-hole Cube, Max Qty 42-hole Cube, Max Qty 43-hole Cube, Max Qty 44-hole Cube, Max Qty 4

4 mm Half Pin, 20 mm Thread4 mm Half Pin, 30 mm Thread4 mm Half Pin, 40 mm Thread5 mm Half Pin, 30 mm Thread5 mm Half Pin, 40 mm Thread5 mm Half Pin, 50 mm Thread6 mm Half Pin, 30 mm Thread6 mm Half Pin, 40 mm Thread6 mm Half Pin, 50 mm ThreadK-Wire WasherK-Wire Olive, 530 mmK-Wire Olive, 400 mmK-Wire Smooth, 400 mmK-Wire GuideAO AdapterAO T-Handle2.6 mm Drill, 4 mm Half Pin3.2 mm Drill, 5 mm Half Pin4.2 mm Drill, 6 mm Half Pin

1

9 10 11 12

13 14

15 16 17 18 19 20

2 3 4 6

5 7 8

1 7

2 8

3 9

4

5

6

11

10

13

12

14

1516

17

Tray 1 - Top Tray 1 - Bottom

Reference Description

12227011 Tray 1 - Wires, Half-Pins, Nuts, Bolts

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Trays


12227002 Tray 2 - Rods, Hex Posts, Plates

2

3

4

5

6

7 8 9 10 11 12 13 1

Tray 2

1 Threaded Rod, 20 mm, Max Qty 12

2 Threaded Rod, 60 mm





7 Plate, 90 degrees, Max Qty 4

8 Plate, 40 mm, Max Qty 4

9 Universal Joint, Max Qty 6

10 Speed Nut, Max Qty 5

11 Hex Post, 20 mm, Max Qty 8



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Trays


12227013 Tray 3 - Instrument Case

1 2

54

6

7

8

93

1

2 3


4

1 Wire Cutter

2 Wire Bender

3 Provisional Midfoot Support

4 Provisional Heel Support

5 Provisional Calf Support

6 Box Wrench Combination, 10 mm


8 Pivoting Socket Wrench, 10 mm

9 Universal Bolt Tubular Wrench, 10 mm

1 Half Pin Drill Guide Trocar Tip

2 Half Pin Drill Guide Handle

3 Wire Tensioner

4 Tensioner Alignment Tool

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Trays


12227014 Tray 4 - Rings-160mm/180mm, Rocker Bottom

1

1 5

3

2

2 6

3 7

4

4

5 6


1 Anterior Half Ring, 160 mm

2 Cross Bar, 160 mm/180 mm

3 Cross Bar, 140 mm/160 mm

4 Half Ring, 160 mm

5 5/8 Ring, 160 mm

6 Full Ring, 160 mm


2 Half Ring, 180 mm

3 5/8 Ring, 180 mm

4 Full Ring, 180 mm

5 Foot Plate, 160 mm

6 Foot Plate, 180 mm7 Rocker Bottom

30

Trays


12227015 Tray 5 - Rings-140mm/200mm/220mm

1

52

6

3

4

1

2

3

4



2 Half Ring, 140 mm

3 Half Ring, 220 mm

4 5/8 Ring, 220 mm

5 5/8 Ring, 140 mm

6 Full Ring, 140 mm

1 Half Ring, 200 mm

2 5/8 Ring, 200 mm

3 Full Ring, 200 mm

4 Foot Plate, 140 mm

Integra®

External Fixation System

Ascension Orthopedics8700 Cameron Road, Suite 100Austin, Texas 78758 n USA

Manufacturer:

Available in US Only. n Non contractual document. The manufacturer reserves the right, without prior notice, to modify the products in order to improve their quality.n Warning: Applicable laws restrict these products to sale by or on the order of a physician.n Consult product labels and inserts for any indication, contraindications, hazards, warnings, precautions, and instructions for use.

Integra and the Integra logo are registered trademarks of Integra LifeSciences Corporation or its subsidiaries in the United States and/or other countries. ©2017 Integra LifeSciences Corporation. All rights reserved. Printed in USA. 2.5M LC-04-1222-0001 Rev. C 03/17 0516433-3-EN

USA 800-654-2873 n 888-980-7742 faxInternational +1 609-936-5400 n +1 609-750-4259 faxintegralife.com/contact

United States

For more information or to place an order, please contact:

Rings & PlatesReference Description

12224112 Full Ring - 140 mm

12224102 Full Ring - 160 mm

12224122 Full Ring - 180 mm

12224132 Full Ring - 200 mm

12224113 Half Ring - 140 mm

12224103 Half Ring - 160 mm

12224123 Half Ring - 180 mm

12224133 Half Ring - 200 mm

12224143 Half Ring - 220 mm

12224111 5/8 Ring - 140 mm

12224101 5/8 Ring - 160 mm

12224121 5/8 Ring - 180 mm

12224131 5/8 Ring - 200 mm

12224141 5/8 Ring - 220 mm

12224110 Foot Plate - 140 mm

12224100 Foot Plate - 160 mm

12224120 Foot Plate - 180 mm

12225400 Rocker Bottom

12224114 Anterior Half Ring - 140 mm



12225030 Anterior Cross Bar Assembly - 140 mm/160 mm

12225032 Anterior Cross Bar Assembly - 160 mm/180 mm

12224217 Three Hole Plate - 90 degrees

12224235 Plate - 40 mm

Nuts, Bolts & WashersReference Description

12224201 Rectangular Washer, 2 mm

12224202 Rectangular Washer, 4 mm

12224208 Conical Washer - Concave

12224209 Conical Washer - Convex

12224250 Bolt M6 with 10mm Hex, 10 mm length



12224255 Nut M6 with 10 mm Hex

12224220 Rubber Wire/Half Pin Stopper Coin

12224207 Half Pin Caps

12224214 Round Speed Nut

12224216 Extended Compression Distraction Nut, 10 mm

Wires, Pins & Fixation BoltsReference Description

12220021 K-Wire Smooth, 400 mm

12220023 K-Wire Olive, 400 mm

12220024 K-Wire Olive, 530 mm

12220025 K-Wire Washer

12224218 Universal Wire Fixation Bolt, 17.5 mm

12224219 Universal Wire Fixation Bolt, 23 mm

12220032 Half Pin, 200 mm M4 - Thread Length, 20 mm









12225020001 Half Pin Drill Guide Handle

12225020002 Half Pin Drill GuideTrocar Tip

12225010 Angular Half Pin Fixation Clamp

12225315 K-Wire Guide

12224027 2.6 mm Drill for 4.0 mm Half Pin



Threaded Rods & HardwareReference Description







12224222 One Hole Cube

12224223 Two Hole Cube

12224224 Three Hole Cube

12224225 Four Hole Cube

12224210 Hex Post, 20 mm

12224211 Hex Post, 40 mm

12224212 Hex Post, 60 mm

12225221 Universal Joint

12224228 Slotted Post - Small

12224229 Slotted Post - Large

Provisional Support, Trays & CaddiesReference Description

12225040 Provisional Calf Support

12225060 Provisional Midfoot Support

12225050 Provisional Heel Support

InstrumentsReference Description



12224504 Universal Bolt Tubular Wrench, 10 mm

12224506 Pivoting Socket Wrench, 10 mm

12224507 Wire Bender

12224508 Wire Cutter

5010001000 AO T-Handle

5010001 AO Adapter

12225300 Wire Tensioner

12224300 Tensioner Alignment Tool

Integra SURGICAL TECHNIQUE External Fixation System · 2017-11-02 · 3 I. Indications The...

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Transcript of Integra SURGICAL TECHNIQUE External Fixation System · 2017-11-02 · 3 I. Indications The...