Osteosynthesis VariAxTM Distal Radius Locking Plate System
Transcript of Osteosynthesis VariAxTM Distal Radius Locking Plate System
VariAxTM Distal Radius LockingPlateSystem
Osteosynthesis
• Anatomical & Universal Volar Plates• Dorsal Plates• Fragment Specific Plates
Operative Technique
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Introduction
The NEW VariAx™ Distal Radius Plating System represents the Next Generation of Bone Fixation for your Distal Radius Fracture Needs.
System Features:
• Comprehensive Plating System Providing Anatomical Volar and Dorsal, Universal Volar and Fragment Specifi c Solutions, even for the most complex distal radius fracture.
• Fixed Angle Drill Guide Assures placement of screws & pegs in a pre-determined angle.
• Polyaxial Drill Guide Allows locking with an additional angulation of ±15 degrees in any hole on the plate, except the oblong hole in the shaft.
• New Anatomical Volar Plate Encourages articular support with Locking screws & pegs, provides optimal buttressing to the volar lunate facet and stable fi xation of radial styloid fragments with two screws.
• Full range of 2.0mm to 2.7mm Locking and Non-Locking screws & pegs Offering intraoperative solutions for different fracture fi xation requirements.
• Anodization Type II Increases the strength of all VariAx™ Distal Radius Locking Plates and reduces the incidence of tissue adherence.
SmartLock Locking Technology:
Cross-Pin Screw Head Design
• Optimal axial stability• friction fi t• Easy screw pick up
• Patented SmartLock Locking Technology Encourages “locked” screw to plate interface due to combination of Grade II - Ti Plates and Grade V - Ti Screws & Pegs.
• SmartLock Locking Screws & Pegs Designed with threads on the underside of the screw head, which upon insertion engage the circular “lip” within any hole on the plate, except the oblong hole in the shaft.
• Unique one-step Locking Is achieved by simply inserting a Locking Screw or Peg within the polyaxial locking range of ±15 degrees, without the need for further steps.
-15° +15°
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Overview
2.7mm Locking
2.3mm Locking
Screw/Peg Options
2.0mm Smooth Locking
2.3mm Non- Locking
2.7mm Non- Locking
2.7mm Partial Thread Non-Locking
2.7mm Partial Thread Locking
Anatomical Volar Plates
Universal Volar Plates
Dorsal Plates Radial
Column Plates Ulnar Column Plates
Plate Options
Left
Right
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Anatomical Volar PlateAnatomical Volar Plate
2. The FCR tendon is retracted ulnarly and dissection is carried down through the fl oor of the FCR sheath. This exposes the FCR muscle belly, which may be retracted ulnarly as well.
5. The fracture is visualized and reduced.6. The use of external traction, and/or the use of K-wires for temporary fi xation may be helpful. If necessary, bone graft materials may be used as an adjunct to the plate to provide an optimal bone void fi ller. The use of AP/Lateral fl uoroscopy is helpful to determine correct fracture reduction and plate position.
1. An incision is made approximately 8cm long just radial to the FCR tendon. If more exposure is necessary, the incision can be extended radially at 45 degrees along the wrist fl exion creases.
3. The Pronator Quadratus is identifi ed and dissected in its entirety off of the volar surface of the radius as an ulnarly based fl ap.4. The insertion of the Brachioradialis may be released.
Operative Technique
7. Choose the appropriate implant according to patient anatomy and fracture pattern.
8. The plate should be placed slightly below the distal edge of the radius to support the volar articular fracture fragments and also to avoid inserting screws or pegs into the joint. 9. Zebra striped K-wires and/or Olive K-wires can be used for temporary fi xation while evaluating the placement of the plate.
10. The fi rst pilot hole should be drilled in the oval gliding hole using the appropriate drill guide.11. Use the depth gauge to determine screw length.
12. A non-locking screw is placed in the oval gliding hole but not completely tightened to allow adjustment of the plate in distal or proximal directions.13. After confi rmation of the correct positioning of the anatomic volar plate by use of fl uoroscopy, tighten the fi rst screw. 14. Once the position of the plate has been determined, it is time to decide which drill guide to use based upon preference and/or fracture pattern.
RightLeft
Note: Using one of the provided drill guides for screw hole preparation is mandatory. Not using a drill guide may lead to drilling out of specifi ed locking range and severely compromise the locking capabilities.
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18. Close the incision.
Operative Technique
Note: In very dense bone it is recommended to use the 2.3mm drill bit in conjunction with the 2.3mm drill guide for a 2.7mm screw.
15. Using the desired drill guide, repeat
drilling, measuring and placement of screws/
pegs in the distal holes.
16. Place locking or non-locking screws in the proximal end of the plate.
17. Verify proper placement of screws/pegs by use of fl uoroscopy to ensure that neither penetrate the joint.
15° distal15° lateral
12° proximal
5° proximal
5° proximal
18° distal12° lateral
0°
0°
18° distal12° lateral
15° distal15° lateral
10° proximal
5° proximal
0°
Pre-determined Screw Pattern
Note: In order to prevent toggling, this drill guide is designed to fi t very tightly into the holes of the plate. When utilizing this instrument follow the same trajectory of the pre-tilted lips to facilitate its placement.
• SmartLock Polyaxial Drill Guide Allows for ±15 degrees of custom angulation and may be used for more complex fractures. A lip on the drill sleeve will engage and allow toggling in the hole. The range in which the drill guide toggles will create a 30 degrees cone and every angle in this range will be a locking position. This may allow for the surgeon to aim where the screw/peg should be placed.
• 2.3mm Drill Guide/K-Wire GuideThe K-wire guide provides an option to assess potential screw positions by inserting a 1.1mm K-wire prior to any drilling or screw insertion. By using the same technique, this K-wire guide offers the same 30 degrees locking cone as the SmartLock Polyaxial
• Fixed Angle Drill Guide This drill guide will ensure the same placement of screw options in every case and therefore does not allow the fl exibility of choosing an angle. It is designed to fi t in the pre-tilted lips within the holes on the plate by simply pressing the drill guide in to the hole.
Also, depending on the placement of the plate, there may be a need to angle a screw/peg out of the fracture line.
Note: First fully engage the drill guide in the hole and then aim the drill in the desired direction.
Drill Guide. It may also be utilized to provide temporary fi xation to smaller fragments, while catching these with adjacent locking screws.
The 2.3mm drill guide can be used as an overdrill to lag 2.3mm screws if compression is desired or as a pilot hole for 2.7mm screws in dense bone. This drill guide can only be used in a fi xed angle.
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Operative Technique
1. An incision is made approximately 8cm long directly over the FCR tendon. If more exposure is necessary, the incision can be extended radially at 45 degrees along the wrist fl exion creases.
2. The FCR tendon is retracted ulnarly and dissection is carried down through the fl oor of the FCR sheath. This exposes the FCR muscle belly, which may be retracted ulnarly as well.
3. The Pronater Quadratus is identifi ed and dissected in its entirety off of the volar surface of the radius as an ulnarly based fl ap.
4. The insertion of the Brachioradialis may be released.
5. The fracture is visualized.6. The fracture is reduced. The use of external traction, and/or the use of K-wires for temporary fi xation could be helpful.If necessary, bone graft materials may be used as an adjunct to the plate to provide an optimal bone void fi ller.
7. The plate should be placed slightly below the distal edge of the distal radius to avoid inserting screws or pegs into the joint. The use of AP/Latfl uoroscopy is helpful to determine correct fracture reduction and plate position.6. K-wires can be used for temporary fi xation.
9. The fi rst pilot hole should be drilled in the oval gliding hole using the appropriate drill guide.10. Measure the depth of the hole to determine screw length.11. The screw is placed in the oval gliding hole but not completely tightened to allow adjustment of the plate in distal or proximal directions.
12. After confi rmation of the correct positioning of the volar plate by use of fl uoroscopy, tighten the fi rst screw.13. Repeat drilling, measuring and placing of screws/pegs in the distal holes of the plate. The position and number of screws applied dependson the type of fracture.
14. Place the bone or locking screws in the proximal end of the plate.15. Verify proper placement of screws and pegs by use of fl uoroscopy to ensure that neither penetrates the joint.16. Close the incision.
Universal Volar PlateUniversal Volar Plate
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Operative Technique
1. Longitudinal incision is made just ulnar to Lister’s tubercle at the distal radius region.
2. Dissection is performed down to the extensor retinaculum. The third compartment is opened and the extensor pollicis longus is displaced radially.
3. The second compartment wrist extensors are subperiosteally elevated radially and the fourth compartment is subperiosteally elevated ulnarly. The dorsal interosseous nerve might be cut off for pain reduction.
4. The fracture is reduced. The use of an external traction device and/or K-wires for temporary fi xation may be helpful. If necessary, bone graft materials may be used as an adjunct to the plate to provide an optimal bone void fi ller. 5. If necessary, adapt the plate for correct anatomical position. Removal of tuberculum listeri might be necessary.
6. The plate should be placed slightly below the distal edge of the distal radius to avoid inserting screws/pegs into the joint. Correct positioningof the plate should be confi rmed by use of fl uoroscopy. The fi rst pilot hole should be drilled in the oval gliding hole.7. Measure the depth of the hole to determine screw length.
8. Check the screw length on the measuring scale of the implant module (optional).
9. The screw is placed in the oval gliding hole but not completely tightened to allow adjustment of the plate in a distal or proximal direction.
10. Confi rm proper plate positioning by use of fl uoroscopy and then tighten the fi rst screw.
11. Repeat drilling, measuring, and placing of screws/pegs into the distal holes of the plate. The position and number of screws applied depends on the type of fracture.12. Place bone or locking screws in the proximal end of the plate.
13. Confi rm correct placement by useof fl uoroscopy.14. Verify proper placement of screws andpegs by use of fl uoroscopy to ensure that neitherpenetrates the joint.15. Close the incision.
Dorsal Plate
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Operative Technique
Radial Column Plate
1. Incision is made along the radial column.2. Care must be taken to avoid injury to dorsal sensory branch of the radial nerve.
3. First dorsal compartment is freed from dorsal to volar to allow plate placement.
4. Plate is placed along the radial column.
5. Screws or distal K-wires can beplaced for fi xation options.
6. The 3 in 1 K-wire bender/cutter/inserter is used to place K-wires distally.7. It is recommended only one K-wire be placed distally at a time in order to make proper use of the bender/cutter/inserter instrument.
8. After insertion, the tamp and mallet can be used to further insert the K-wires.
9. K-wires and screws can be placed inconjunction for more rigid fi xation.10. The incision is closed.
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Ordering Information
54-25384
54-25374
54-25386
54-25376
54-25385
54-25375
54-25387
54-25377
54-25394
54-25396
54-25398
54-25395
54-25397
54-25399
54-25391
54-25392
54-25393
Anatomical Volar DR Plate
Narrow, Right
Anatomical Volar DR Plate
Narrow, Left
Anatomical Volar DR Plate
Standard, Right
Anatomical Volar DR Plate
Standard, Left
Anatomical Volar DR Plate
Narrow, Right, Long
Anatomical Volar DR Plate
Narrow, Left, Long
Anatomical Volar DR Plate
Standard, Right, Long
Anatomical Volar DR Plate
Standard, Left, Long
Universal Volar DR Plate
Narrow, Short
Universal Volar DR Plate
Standard, Short
Universal Volar DR Plate
Wide, Short
Universal Volar DR Plate
Narrow, Long
Universal Volar DR Plate
Standard, Long
Universal Volar DR Plate
Wide, Long
Universal Volar DR Plate
Narrow, XLong
Universal Volar DR Plate
Standard, XLong
Universal Volar DR Plate
Wide, XLong
54-25290
54-25291
54-25292
54-25293
54-25294
54-25295
54-25296
54-25297
54-25400
54-25401
54-25402
54-25403
54-25404
54-25405
Dorsal DR Plate
Standard, Right
Dorsal DR Plate
Standard, Left
Dorsal DR Plate
Wide, Right
Dorsal DR Plate
Wide, Left
Dorsal DR Plate
Standard, Right, XLong
Dorsal DR Plate
Standard, Left, XLong
Dorsal DR Plate
Wide, Right, XLong
Dorsal DR Plate
Wide, Left, Xlong
Radial Column Plate
Short
Radial Column Plate
Long
Ulnar Column Plate
Short, Right
Ulnar Column Plate
Short, Left
Ulnar Column Plate
Long, Right
Ulnar Column Plate
Long, Left
REF Description
Volar Plates
REF Description
REF Description
Dorsal Plates
Fragment Specifi c Plates
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Ordering Information
52-27716
52-27718
52-27720
52-27722
52-27724
52-27726
16mm
18mm
20mm
22mm
24mm
26mm
Ti Length REF mm
2.7 mm Partially Threaded Locking Pegs *
52-20616
52-20618
52-20620
52-20622
52-20624
52-20626
16mm
18mm
20mm
22mm
24mm
26mm
Ti Length REF mm
2.0mm Locking Pegs *
52-23610
52-23612
52-23614
52-23616
52-23618
52-23620
52-23622
52-23624
52-23626
52-23628
52-23630
52-23632
52-23634
52-23636
52-23638
10mm
12mm
14mm
16mm
18mm
20mm
22mm
24mm
26mm
28mm
30mm
32mm
34mm
36mm
38mm
Ti Length REF mm
2.3mm Locking Screws *
52-27610
52-27612
52-27614
52-27616
52-27618
52-27620
52-27622
52-27624
52-27626
10mm
12mm
14mm
16mm
18mm
20mm
22mm
24mm
26mm
Ti Length REF mm
2.7mm Locking Screws *
Ti Length REF mm
52-27010
52-27012
52-27014
52-27016
52-27018
52-27020
52-27022
52-27024
52-27026
10mm
12mm
14mm
16mm
18mm
20mm
22mm
24mm
26mm
2.7mm Bone Screws *
Ti Length REF mm
52-23010
52-23012
52-23014
52-23016
52-23018
52-23020
52-23022
52-23024
52-23026
52-23028
52-23030
52-23032
52-23034
52-23036
52-23038
10mm
12mm
14mm
16mm
18mm
20mm
22mm
24mm
26mm
28mm
30mm
32mm
34mm
36mm
38mm
2.3mm Bone Screws *
Ti Length REF mm
52-27116
52-27118
52-27120
52-27122
52-27124
52-27126
16mm
18mm
20mm
22mm
24mm
26mm
2.7mm Partially Threaded Bone Screws *
* Order Quantity: Packages of 5
Twist DrillsREF Description
2.3mm, Stryker shaft end
2.3mm, AO shaft end
2.3mm, Dental shaft end
2.0mm, Stryker shaft end
2.0mm, AO shaft end
2.0mm, Dental shaft end
1.9mm, Stryker shaft end
1.9mm, AO shaft end
1.9mm, Dental shaft end
60-23141
60-23341
60-23441
60-20185
60-20385
60-20485
60-19140
60-19340
60-19440
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Ordering Information
REF Description
62-20290
62-27007
56-01250
56-01255
56-01260
62-00016
64-20117
64-20118
64-20129
Screwdriver Ratcheting
Handle
Cross-Pin Blade
2.3mm/2.7mm
Polyaxial Drill Guide
2.3mm/2.7mm
Fixed Angle Drill Guide
2.3mm/2.7mm
2.3mm Overdrill and K-Wire
Guide
Depth Measuring Gauge
Plate Bending Pliers
K-wire Bending Pliers
Forceps with Grasping Lips
Instrumentation
REF Description
07-30600
07-30111
07-10006
07-10021
07-10175
43-09830
64-00011
Lobster Bone Holding Forceps
Lewin Bone Holding Forceps,
Sharp Tip
Elevator, Double sided,
Narrow&Wide, Hohmanns
Elevator, Double sided,
Strong&Light Curved
Bone Hook
Mallet (250g)
Tamp
Bone Reduction Instruments
29-27001
29-27002
29-27003
VariAx™ Distal Radius
Locking Implant Module,
double-sized
Inlay for Anatomical Volar
Distal Radius Plates
Inlay for Universal Volar
Distal Radius Plates
REF Description
Implant Module
29-13012
29-13013
29-13114
29-13024
VariAx™ Lid for Sterilizing
Container
Sterilizing Container, Half-
size, w/o VariAx™ Lid
VariAx™ Distal Radius
Plating Instrument Tray
VariAx™ Distal Radius Bone
Reduction Tray
REF Description
Sterilizing Container
62-00017
50-23501
50-27500
50-20501
50-23001
50-27000
50-27001
50-27501
50-23502
Depth Measuring Gauge
(Aluminium, UDR Version)
Marker - Locking Screws 2.3mm
Marker - Locking Screws 2.7mm
Marker - Locking Pegs 2.0mm
Marker - Bone Screws 2.3mm
Marker - Bone Screws 2.7mm
Marker - PT Bone Screws 2.7mm
Marker - PT Locking Pegs 2.7mm
Marker - 2.3mm
REF Description
Optional Items
56-40281
07-40281
K-wire with Olive Stop *
K-wire, 1.1x160mm **
K-wiresREF Description
56-40281
07-40281
Note: Following Drills may be ordered sterile by replacing “60-” by “91-” in their respective Cat.Nr.: 60- 20185 / 20385 / 19340 / 19440
* Order Quantity: Packages of 5, ** Order Quantity: Packages of 10
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NowStrykerOsteosynthesisoffersyouawidevarietyofsolutionsforthetreatmentofallyourUpperExtremity&HandInjuries.
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Stryker Leibinger GmbH & Co. KGBötzinger Straße 41D-79111 FreiburgGermany
www.osteosynthesis.stryker.com
The information presented in this brochure is intended to demonstrate a Stryker product. Always refer to the package insert, product label and/or user instructions before using any Stryker product. Surgeons must always rely on their own clinical judgment when deciding which products and techniques to use with their patients. Products may not be available in all markets. Product availability is subject to the regulatory or medical practices that govern individual markets. Please contact your Stryker representative if you have questions about the availability of Stryker products in your area.
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