Specialized Solutions for Upper ExtremitiesJul 08, 2015 · Specialized Solutions for Upper...

Specialized Solutions for Upper Extremities

Commitment to ExcellenceAs the premier biologics and extremities focused company, Wright Medical is dedicated to the continual development of new technologies that allow surgeons to more effectively address unique surgical challenges and improve patient outcomes. Our organization’s goal is to provide surgeons with a high quality, comprehensive range of elbow, forearm and hand solutions, as well as training opportunities with some of the most skilled and experienced upper extremity surgeons in the world. Thank you for taking the time to learn more about our visions.

Commitment to Medical Education

Commitment to Customer Service

Commitment to Quality

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Table of Contents

Radial Head Arthroplasty Page 4

Radial Head and Coronoid Repair Page 10

Olecranon and Distal Humerus Page 16

Hand Fixation 4

Finger Arthroplasty Page 36

Wrist Treatment Solutions Page 30

Thumb Arthroplasty Page 38

Tendon Reconstruction Page 42

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EVOLVE® Proline Radial Head System

SIZE 18mm SIZE 20mm SIZE 22mm SIZE 24mm SIZE 26mm SIZE 28mm

SIZE 18mm/ +2 SIZE 20mm/ +2 SIZE 22mm/ +2 SIZE 24mm/ +2 SIZE 26mm/ +2 SIZE 28mm/ +2

9 9.5 10 10.5 118.5

11 11.5 12 12.5 1310.5

SIZE 18mm/ +4 SIZE 20mm/ +4 SIZE 22mm/ +4 SIZE 24mm/ +4 SIZE 26mm/ +4 SIZE 28mm/ +4

13 13.5 14 14.5 1512.5

18 20 22 24 26 28

18 20 22 24 26 28

18 20 22 24 26 28

STANDARD HEAD SIZES

+ 2 HEAD SIZES

+ 4 HEAD SIZES

STANDARD STEM IMPLANTS

+ 2 STEM IMPLANTS

+ 4 STEM IMPLANTS

SIZE 4.5mm SIZE 5.5mm SIZE 6.5mm SIZE 7.5mm SIZE 8.5mm SIZE 9.5mm

SIZE 4.5mm/ +2 SIZE 5.5mm/ +2 SIZE 6.5mm/ +2 SIZE 7.5mm/ +2 SIZE 8.5mm/ +2 SIZE 9.5mm/ +2

SIZE 4.5mm/ +4 SIZE 5.5mm/ +4 SIZE 6.5mm/ +4 SIZE 7.5mm/ +4 SIZE 8.5mm/ +4 SIZE 9.5mm/ +4

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R A D I A L H E A D A R T H R O P L A S T Y

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The Market LeaderWith over 50,000 implantations and more than 12 years of clinical history, the EVOLVE® Proline Modular Radial Head Replacement is the market leader. Its symmetric smooth stem is polished to a mirror finish, allowing for movement within the canal. Cement is not needed, and a rigid press-fit is not required. With this design, the surgeon has the freedom to select a smaller diameter stem even after the initial reaming and bone preparation. This dynamic spacer design is therefore more forgiving than press-fit stems with respect to making implant size adjustments after trialing or even placing the definitive implant. This design also makes the EVOLVE® implant a strong implant choice for revising failed press-fit devices that have loosened and become painful. The radioulnar and humeroradial joints form an important complex with multiple areas of articulation. The EVOLVE® smooth stem design allows for movement of the stem inside the canal: e.g., a 5.5mm diameter stem inside a 6.5mm diameter intramedullary canal. With this movement, the native soft tissues can move the spacer as the arm bends and rotates, creating dynamic biomechanics that rough, rigid, press-fit stems cannot achieve.

VersatileFully interchangeable sizing. Match any size stem with any size head to match the highly variable anatomy. Loose fit allows for self-correction against multiple articular surfaces.

Head and Neck Specific Sizing*

More sizes than any competitor. 324 combinations for unsurpassed surgical versatility.*Journal of Arthroplasty Vol. 16 No. 1 2001. An Anthropomorphic Study of the Radial Head. Implications in the Design of a Prosthesis.

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EffectiveThe EVOLVE® smooth stem has been used more than any other radial stem**, and an independent study supports using smooth stems because “Loosening of press-fit radial head prostheses is common, occurs early, often leads to severe osteolysis of the proximal radius, and commonly requires removal of the prosthesis.”

SimpleNo polyethylene debris, no cement debris, no set-screw to tighten or loosen. Other systems can add surgical steps and make a relatively simple operation much more complicated than it has to be. The EVOLVE® implant has a simple, elegant design with an anatomic dish that can move and self-center on the capitellum.

Independently StudiedIn 2012, a study was published in the British JBJS. Neither Wright Medical nor the EVOLVE® design surgeons were involved with this study. Five surgeons in Finland studied press-fit stems that were meant to in-grow. A high number of patients in the study experienced early failure of stem ingrowth which resulted in pain and the need for removal. These stems are markedly different from the EVOLVE® design. Rather than being polished to a mirror finish, press-fit stems have to be very rough in order to encourage ingrowth. When they loosen, they behave differently in the canal. The rough surface can move and damage the cancellous bone. The conclusions were that “loose-fitting stems and cemented bipolar prostheses have better mid-term radiological results, and in (their) opinion, should be considered superior to press-fit prostheses.”*

The top and sides of the EVOLVE® Radial Head are designed to allow for self-correction and self-stabilization, rather than being rigidly fixed by a press-fit stem. The device can move side-to-side, up-and-down, spin, and piston. Since it is symmetrical, no matter which direction it faces, an ideally shaped flat side with rounded top and bottom will be articulating with the ulna, and the dished surface can self-center on the capitellum. A rigid stem, if it stays fixed, dictates the position of the head, even if this means edge-loading against the humeral cartilage. The design intent of the EVOLVE® is to allow the native capitellum to dictate movement of the device, which is semi-constrained by the loose stem, the ulna, and the soft tissues such as the annular ligament. This design also eliminates the need to obtain a tight fit, which means that you don’t have to implant the device with a mallet, which means a mode of fracture to the proximal radius can be avoided by using a loose, smooth stem.


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Evidence by the numbers* Press-fit ingrowth stems don’t always in-grow.

*Flinkkilä study SO656-812. Short- to mid-term results of metallic press-fit radial head arthroplasty in unstable injuries of the elbow. J Bone Joint Surg. VOL. 94-B, No. 6, JUNE 2012.

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25Well-Fixed

PATIENTSwith competitive press-fit stems9

Removed because of loosening

3Remained implanted

but were loose

**Market leadership and longevity data on file.

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EVOLVE® Proline Modular Radial Head System

• More sizes than any competitor

• 324 combinations for unsurpassed surgical versatility

• No polyethylene debris

• No cement debris

• No set-screw to tighten or loosen

• Simple, elegant design

• Anatomic dish that can move and self-center on the

Capitellum

• Articular surfaces are polished to a mirror finish.

• Implanted over 50,000 times over more than 10 years.

• Arguably the simplest solution for radial head

replacement


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In the vast majority of cases, the implant is assembled on the back table with its proven morse taper design, and then implanted in monoblock fashion per the pictorial to the right. If in situ assembly is preferred, an in situ locker device is available.

Implant can be inserted at an angle when the stem diameter is smaller than

the canal diameter, making implantation easier.

The “Baby Hohman” retractor is slowly

relaxed as the implant moves into place.

The smooth, polished, rounded dish surface moves

under the capitellum, and the axial orientation does not matter since it is circular, can

spin and move, and does not have a set screw location to be oriented away from the proximal radial ulnar joint.

Fully seated. Unlike other implants, there is no set screw to tighten. This

means you do not have to apply torque to a press-fit stem that is intended for ingrowth. Lastly, you also do not have

to be concerned about pain from a rough, press-fit, ingrowth stem that has

loosened and is damaging the canal, because the smooth stem is designed

to move with the elbow as the arm bends and rotates.

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EVOLVE® Proline Modular Radial Head System


EVOLVE® TRIAD™ Fixation System

Polyaxial locking or non-lockingAnatomic plates feature a low-profile design and soft edges, minimizing the risk of soft-tissue irritation.

Radial Head and Neck Plates

• Polished Stainless Steel material• Optimized screw trajectories allow for fixation of multiple fragments• ORTHOLOC® Mini Polyaxial Locking design allows for off axis

placement of locking screws up to 10 degrees• Round holes compatible with Locking or Non-Locking Screws

o 2.0mm ORTHOLOC® Mini Polyaxial Locking Screws o 2.0mm EVOLVE® TRIAD™ Non-Locking Bone Screws

R A D I A L H E A D A N D C O R O N O I D R E P A I R

Repair or Replace

• Fixation system kitted together with the EVOLVE® Proline radial head prosthesis

• Radial head and neck plates with 2.0 locking and non-locking polyaxial screws

• ORTHOLOC® Mini Stainless Steel Technology

• Bendable coronoid plates for variable anatomy

• Small 1.5 bone screws and cannulated 2.5 bone screws for more fixation options

• Repair or replace – you decide with EVOLVE® TRIAD™

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A continuum of careThree radial head kit options are available: a set with only the EVOLVE® Proline prosthesis, a “Proline Plus” configuration that has the prosthesis plus radial head and neck plates, 2.0 locking/non-locking screws and 2.5 mm cannulated screws, and finally, the full EVOLVE® TRIAD™ set, which has all of the above, plus coronoid plates and smaller 1.5mm screws.

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Coronoid Fractures


• Coronoid plates

• Three sizes available for multiple fracture types

• Accept 2.0mm EVOLVE® TRIAD™ Non-Locking Bone Screws

• Low profile

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In situ bending The coronoid specific in situ plate bender is useful to fine tune the contouring of the plate once preliminary screw fixation has been achieved.

Contour and buttressThe coronoid plates come in three sizes and are designed to be contoured to fit the highly variable fractures encountered in “terrible triad” elbow injuries.


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Fracture Fixation with Screws 1.5 mm, 2.0 mm, and 2.5 mm cannulated options, all fully threaded.

Small Screws for Small FragmentsVery small 1.5mm fully threaded screws are available for repairing smaller fragments and a larger diameter screw is not needed.

Larger and Cannulated When Needed2.0 non-locking bone screws and 2.5 fully-threaded cannulated bone screws are included to create a comprehensive kit for treatment of “terrible triad” injuries to the elbow.


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EVOLVE® EPS Elbow Plating System

O L E C R A N O N A N D D I S T A L H U M E R U S

Comprehensive Plate and Screw OptionsThe EVOLVE® EPS Elbow Plating System perfectly complements the EVOLVE® TRIAD™ Fixation System, consisting of 25 plates to address individual fracture patterns. For the distal humerus, both orthogonal and parallel plating is supported so that the surgeon may choose the best approach and fixation method for the situation at hand. For each plate type, multiple lengths are available to best match the extent of the fracture. All of the plates accommodate 2.7mm cortical and 3.5mm cortical and cancellous locking and non-locking screws in every threaded hole.

Polished Stainless Steel MaterialEVOLVE® EPS plates and screws are made from polished stainless steel for excellent strength and hardness. This allows for a low profile plate design. The screws are made of a harder stainless steel than the plates. This proprietary formulation minimizes the incidence of screws stripping or breaking during insertion or removal. Furthermore, stainless steel may be less likely to adhere to soft tissue than other materials such as titanium, possibly reducing joint stiffness and easing removal if necessary.*

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ContouredThe system was designed using a proprietary CT scan database to closely match patient anatomy to reduce the need for bending and act as a guide for reconstruction of complex fractures.

VersatileThe ORTHOLOC® 3DSi plate thread creates multiple points of screw/plate engagement for maximum holding power and stiffness. The locking screws are made of a proprietary stainless steel alloy that is harder than the steel of the plate, allowing the screw to deform the threads and increase locking strength further.

0o

15o

15o

*The use of titanium and stainless steel in fracture fixation, Expert Rev. Med.

Devices 7(6), 843–853 (2010), JS Hayes and RG Richards.

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EVOLVE® EPS Elbow Plating System Distal humeral plate, medial side, standard length, with extended head feature, size 1 of 2 extension sizes.

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Proximal UlnaThe proximal ulna (olecranon) plates are available in four (4) lengths (Short, Standard, Medium, Long). The Short and Standard plates are for right or left application. The Medium and Long plates have individual right and left plates to accommodate the normal radial bow of the proximal ulna.

The Short plate does not require splitting the triceps; the Standard, Medium, and Long plates require a triceps split with the plate sitting on the bone, underneath the triceps, enabling an easier muscle repair.

Low-ProfileAnatomic plates feature a low-profile design with an undercut, curved bone interface, minimizing the risk of soft-tissue irritation.

NarrowMany competitive designs are bulkier, as per the above illustration. By contrast, the EVOLVE® EPS Olecranon plates are not only low-profile, but also narrow in design. This design rationale is intended to minimize the likelihood of wound complications such as dehiscence, as well as to reduce the percentage of re-operations for plate removal.

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Coronal Shear PlateThis unique plate features four bendable “fingers” that are designed to capture fragments while its stem anchors the plate to more proximal cortical bone. Selected fingers may also be removed as needed to avoid interference with the joint space. The plate is designed to address complicated shear fractures of the capitellum. Both 2.7 and 3.5mm diameter non-locking and polyaxial locking screws may be used interchangeably in all threaded plate holes, and both 2.7 and 3.5mm diameter screws have heads that accept a standard T10 hexalobe or “Star Drive” design for convenience during surgery.

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Distal Humeral PlatesFixation of the distal humerus normally requires dual plating using a medial plate and a posterolateral plate (orthogonal) or a medial plate and lateral plate (parallel).

Plate holes accept both 2.7 and 3.5mm non-locking and polyaxial locking screws, allowing for multiple trajectories and configurations.

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EVOLVE® EPS Elbow Plating System Distal humeral plate, postlateral, medium size left shown.


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Distal Humeral PlatesFixation of the distal humerus normally requires dual plating using a medial plate and a posterolateral plate (orthogonal) or a medial plate and lateral plate (parallel).

Plate holes accept both 2.7 and 3.5mm non-locking and polyaxial locking screws, allowing for multiple trajectories and configurations.

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EVOLVE® EPS Elbow Plating System Distal humeral plate, lateral, standard size left shown.


EVOLVE® EPS Elbow Plating System Distal humeral plate, medial, medium size shown.

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EVOLVE® EPS Elbow Plating System The straight plate is designed for bone fixation and is designed for a right or a left application and is

available in one (1) length. This plate can accommodate extended diaphyseal fractures.

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ORTHOLOC® 3DSi Screws

One driver for different diameters

The system offers both Non-Locking and Polyaxial Locking screws. Screws are available in 2.7 and 3.5mm diameters and may be used interchangeably in all plate holes; locking screw only works in the threaded holes (does not work in the oval holes). All screw heads are a standard T10 hexalobe or “Star Drive” design that has been optimized for use with the self retaining driver. The screws also are available with both cortical (2.7 and 3.5mm diameter) and cancellous threads (3.5mm diameter) for flexibility during surgery.

Polyaxial Locking Screws

The locking screws are designed for optimal engagement into the ORTHOLOC® 3DSi threads of the plates. When fully locked into the plate, the screw and internal plate threads create a secure construct that maximizes surgical flexibility without sacrificing stability. The geometry of the screw head allows it to be placed in a locked polyaxial orientation in any screw hole at angles from 0-15° off axis. The technology does not preclude screw trajectories of more than 15° off axis. The surgeon can place screws more than 15° off axis as needed with the knowledge that the head/plate interface may not lock. This is important to know so that the surgeon can be best prepared to manage complex elbow fractures.

Non-Locking Screws

Non locking screws are designed with rounded low profile heads to allow for polyaxial insertion with minimal head prominence. The non-locking screws are available in 2.7mm and 3.5mm diameters and a wide selection of lengths.

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EPS 3.5mmcortical locking

EPS 3.5mmcortical non-locking

EPS 2.7mmcortical locking

EPS 2.7mmcortical non-locking

EPS 3.5mmcancellous locking

EPS 3.5mmcancellous non-locking

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Minimally invasive option for a frequent injury

• Titanium alloy (Ti-6Al-4V ELI)

• Universal configuration for left and right wrists

• Available in five anatomical sizes

• Zero profile

The MICRONAIL® II Intramedullary Distal Radius System is primarily designed for minimally-invasive fixation of extra-articular fractures and simple intra-articular fractures of the distal radius. It is particularly useful for treatment of patients who have failed non-operative treatment and malunion of such fractures.

Three 2.5mm fixed-angle locking screws buttress the subchondral plate and secure the distal fracturefragment(s) to the nail. The distal screws are anatomically configured to approximate the radial inclination while the volar-dorsal angle divergence provides stable, three-point fixation. The distal screw heads are completely recessed below the surface of the nail.

A 2.0mm hole located in the proximal body allows for temporary fixation using a K-wire during fracture reduction.

Two 2.7mm self-tapping, bi-cortical, proximal screws resist shortening and angulation of the distal fracture fragment. The screws are placed through the proximal body of the nail while the low-profile head rests on the dorsal surface of the bone.

MICRONAIL® II Intramedullary Distal Radius System

W R I S T T R E A T M E N T S O L U T I O N S

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MICRONAIL® II Intramedullary Wrist System


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RAYHACK® Ulnar and Radial Shortening Osteotomy System

Ulnar Shortening Generation II Low-Profile Locking SystemThe low-profile plate design is intended to decrease the incidence of plate removal and to provide additional surgical approach options. The new universal surfacemount ulnar saw guide is placed directly on the surface of the ulna when using the volar placement, thus minimizing disruption of the interosseous membrane and soft tissues surrounding the ulna. A titanium plate and screw option is available in the RAYHACK® Generation I non-locking design.

Kienbock Radial Shortening SystemThe Kienbock system features reliable dedicated instrumentation for oblique radial shortening and a precision cutting block for accurate radial resections. The compression device is narrow in order to permit smooth osteotomy apposition with the plate already in place, and the plate itself is anatomically flared to conform to the volar radius.


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RAYHACK® Ulnar and Radial Shortening Osteotomy Systems


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FUSEFORCE® Hand Fixation System

H A N D F I X A T I O N

FUSEFORCE® Nitinol Compression StapleFUSEFORCE® is a shape-memory, compression-ready fixation system that can be used in fixation for fractures, fusions or osteotomies of the bones in the hand. The compressive properties and stepped-tooth design help resist pull-out. Implants and instrumentation are stored in a convenient, single-use, sterile packaged kit.

Single-Use PackagingSterilized, pre-packaged kits include Implant, Inserter, Reamer, Reamer Guide and Locator Pin.

Dynamic CompressionNitinol design provides constant compression across the fusion site.

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H A N D F I X A T I O N

FUSEFORCE® Hand Fixation System

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Titanium grommets: durable and abrasion-resistantThe SWANSON Finger Joint Grommets** are thin bone liners designed for use at the metacarpophalangeal joint level to protect the flexible implant midsection from the shearing forces of sharp bone edges. The press-fit encircling grommet is fabricated from unalloyed titanium and its shape conforms to the contours of the implant midsection and stem junctions.

*Data on file at Wright

F I N G E R A R T H R O P L A S T Y

SWANSON Flexible Fingers

• A preferred solution for hands disabled by osteoarthritis and post-traumatic arthritis.

• Dorsal hinge design shows no sign of failure after 10 million flexion cycles.*

• Confidence in over 45 years of clinical use.

• Improves range of motion (especially extension)

• Adequate lateral stability

• Good pain relief

• Maintains joint space and alignment

• Orients and supports joint encapsulation

• Makes results more predictable, reproducible, and durable

• Early postoperative motion

SWANSON Flexible Fingers

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F I N G E R A R T H R O P L A S T Y

T H U M B A R T H R O P L A S T Y

SWANSON Titanium Basal Thumb

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Titanium basal thumb implant fits into prepared concave surface of the trapezium

TIE-IN® Trapezium Implant

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TIE-IN® Trapezium implant replaces the trapezium and is inserted in the first metacarpal.

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T H U M B A R T H R O P L A S T Y

SWANSON Trapezium Implant features a triangular cross section to prevent rotation of the stem in the intramedullary canal.

SWANSON Trapezium Implant

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ORTHOSPHERE® Spherical Interpositional Implant

ORTHOSPHERE® Implant acts as a dynamic spacer. Does not require complete excision of the trapezium.

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HUNTER Active/Passive Tendon Implant

T E N D O N R E C O N S T R U C T I O N

HUNTER Standard Tendon Silicone Implant with woven polyester core.

HUNTER Active Tendon (ATPC) features dual end fixation in 5 lengths.

Silicon Tendon Implants are intended to be implanted temporarily in order to encourage the formation of a pseudosynovial sheath which

will later nourish and lubricate an autogenous tendon graft.

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HUNTER Passive Tendon Implant with stainless steel distal fixation component.

Silicon Tendon Implants are intended to be implanted temporarily in order to encourage the formation of a pseudosynovial sheath which

will later nourish and lubricate an autogenous tendon graft.

SWANSON Silicone Tendon Spacer Non-polyester core option.

HUNTER Tendon Rods

General Description

Spacer for tendon sheath for tendon transfer/ graft in hand and wrist. For flexors and extensors. Passive – No fixation or one end fixation to soft tissue/ bone (PTX00000, TRX00000, 2427000X). Temporary Implantation. Proprietary Silicone Material.

Spacer for tendon sheath for tendon transfer/ graft in hand and wrist. For flexors and extensors. Active – Dual end fixation to soft tissue and bone (ATPCXX40) Screw end and tie end. Temporary Implantation. Proprietary Silicone Material.

These do not have a polyester core that runs through the middle.

24370001 = sizer SET number - these are the only sizers for HUNTER or SWANSON: 3, 4, 5, and 6 - green, blue, yellow, and red.

Polyester Core? Yes Yes No No

Use the Sizers? The colored sizes match the 2427000X series; please see p45 for comparison.

The colored sizes match the 2427000X series; please see p45 for comparison. Yes. Use of sizers not required, but they are available. (These are the sizers)

HUNTER Tendon Rods Passive HUNTER Tendon Rods Active SWANSON Tendon Spacers Sizers

HUNTER Standard Tendon Implant | 24.5cm Length

TR200000 2mm Wide

TR300000 3mm Wide

TR400000 4mm Wide

TR600000 5mm Wide

TR500000 6mm Wide

HUNTER Passive Tendon Implant | 25cm Length

PT300000 3mm Wide

PT400000 4mm Wide

PT500000 5mm Wide

PT600000 6mm Wide

SWANSON Tendon Spacer

24270003 24cm x 3mm

24270004 24cm x 4mm

24270005 24cm x 5mm

24270006 24cm x 6mm

HUNTER Active Tendon Implant PC | 4mm Width

ATPC1640 16cm Long ATPC1840 18cm Long ATPC2040 20cm Long ATPC2240 22cm Long ATPC2640 26cm Long

• The HUNTER Standard Tendon Implant features a woven polyester core covered with silicone elastomer (barium-impregnated for radiopacity). The smooth, inert material aids pseudosynovial sheath formation and ease of insertion and gliding through the finger, palm and forearm.

• The HUNTER Active Tendon (ATPC) features dual end fixation and is offered in 6 lengths.

• The HUNTER Passive Tendon Implant features a distal fixation component made of type 316 stainless steel. A hole in the fixation component accommodates a stainless steel bone screw (not provided) which is used to secure the device of the phalanx. It is offered in 5 widths.

• The SWANSON Silicone Tendon Spacer does not have a polyester core, and is offered in 4 widths.

• Silicone Tendon Implants are intended to be implanted temporarily in order to encourage the formation of a pseudosynovial sheath which will later nourish and lubricate an autogenous tendon graft.

T E N D O N R E C O N S T R U C T I O N

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Notes

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1023 Cherry RoadMemphis, TN 38117800 238 7117901 867 9971www.wright.com

10801 Nesbitt Avenue SouthBloomington, MN 55437888 867 6437952 426 7600www.tornier.com

™ and ® denote Trademarks and Registered Trademarks of Wright Medical Group N.V. or its affiliates. ©2016 Wright Medical Group N.V. or its affiliates. All Rights Reserved.

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Specialized Solutions for Upper ExtremitiesJul 08, 2015 · Specialized Solutions for Upper...

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