consolidated ankle fracture solution for surgery centers ...synthes.vo.llnwd.net/o16/llnwmb8/us...

Consolidated Ankle Fracture Solution for Surgery Centers

Compact AnkleFracture SystemSurgical Technique

Fracture SystemFracture SystemSurgical TechniqueSurgical Technique

Image intensifier control

Compact Ankle Fracture System Surgical Technique DePuy Synthes 1

Introduction

Surgical Technique

Product Information

Table of Contents

Compact Ankle Fracture System 2

AO Principles 8

Indications 9

Clinical Cases 10

Preparation 11

2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate 12 Technique for Distal Fibula Fracture

3.5 mm LCP Hook Plate Technique 20for Distal Fibula Fracture

4.0 mm Cannulated Screw Technique 26for Medial Malleolus Fracture

Implants 32

Instruments 36

Set List 42

MR Information The Compact Ankle Fracture System has not been evaluated for safety and compatibility in the MR environment. It has not been tested for heating, migration or image artifact in the MR environment. The safety of the Compact Ankle Fracture System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury.

2 DePuy Synthes Compact Ankle Fracture System Surgical Technique

Consolidated Ankle Fracture solution for Surgery Centers


DePuy Synthes offers surgical device systems designed for use in the most common orthopedic and podiatric procedures performed in Ambulatory Surgery Centers (ASCs). The compact systems feature the same high-quality products used in hospitals, but combined into consolidated sets to help improve effi ciency for our ASC customers.

The confi guration of the Compact Ankle Fracture System contains general instruments, Locking Compression Plates (LCP®) such as fi bula plates, 1/3 tubular plates, hook plate, as well as screws for syndesmotic repair and medial malleolus fractures. The LCP 1/3 Tubular Plate is a commonly used implant for a high number of distal fi bula fractures that results in a fi xed-angle construct and obtains fi xation in osteoporotic bone. Additionally the LCP Distal Fibula Plates are anatomically contoured and offer multiple screw options in the head of the plate.

Flexibility in the Operating Room

• Color-coded layout for instrument identifi cation

• Includes general instruments; all instrumentation is grouped by screw size, making it easier for surgical teams to quickly locate related components

• Contains precontoured fi bula plates, 1/3 tubular plates, and hook plates enabling surgeons to choose the appropriate option based on the complexity of the fracture

• Also contains solid and cannulated screws for syndesmotic repair and medial malleolus fractures

• Plates are designed to accommodate various fracture patterns and the patient’s anatomy

• Locking and conventional screws allow for appropriate bone fi xation


Compact Ankle Fracture System

Color CodingA comprehensive color coding system highlights groups of instruments and associated screw sizes/types. Drill bits, drill guides, screwdriver shafts as well as the graphic case trays and screw racks are color-coordinated to facilitate pre-, intra-, and post-operative handling of the sets.

Color Screw size (mm)

Screw type Drill size (mm)Threaded hole= one color band

Drill size (mm)Gliding hole= two color bands

Shaft size

Orange 2.7 Cortex 2.0 2.7 T8

Yellow 3.5/4.0 Cortex/Cancellous 2.5 3.5 2.5 mm Hex

Black 3.5 Locking 2.8 – T15

Gray 4.0 Cannulated 2.7 – 2.5 mm Hex

In addition to the color for each screw size/type a band system distinguishes the drill size for the threaded hole (= one color band) and the gliding hole (= two color bands). The one band/two band principle is also replicated on the drill guides.


Order of Use Layout

2, 3, 42.7 mm screwinstruments

2, 3, 43.0 mm cortex/4.0 mm cancellous screw instruments

2, 3, 43.5 mm locking screw instruments

RightImplant specifi c instruments

LeftGeneral instruments

The layout of instruments is focused on order of use to correlate with the surgical steps and therefore assist with the intra-operative sequence.

Instruments are arranged by groups (general instruments, 2.7 mm screw instrumentation, etc.). The handling fl ows from left to right and from top to bottom, eg, general instruments are typically used fi rst and are therefore placed on the left. Hence, implant specifi c instruments are located on the right side in order of the surgical steps:• Drill bit• Drill guide• Measuring device• Screwdriver• TLA


1

1. Reduce

3. Measure

2. Drill

4. Insert screw


Implants

• Anatomically contoured distal fi bula plates

• Multiple screw options in the head of plate

• Locking screws offer a fi xed-angle construct and obtain fi xation in osteoporotic bone

• Coaxial screw holes help minimize screw head prominence and create a low profi le construct

• Allows technique of clamp reduction, followed by independent lag screw, and neutralization plate placement in typical spiral fracture patterns

• For valgus failure fi bular fractures with comminution and for bridge plating of comminuted fractures

• Plate can be contoured to patient anatomy

• Locking screws offer a fi xed-angle construct and obtain fi xation in osteoporotic bone

• Available with 3–10 holes (33 mm–117 mm lengths) and 12 holes (141 mm)

• Plate contains only locking holes, that accept 3.5 mm locking screws, 3.5 mm cortex screws, and 2.7 mm cortex screws

2.7 mm/3.5 mm LCP® Lateral Distal Fibula Plate

LCP One-Third Tubular Plate


4.0 mm Cannulated Screws

Compact Ankle Fracture SystemImplants

• Low profi le• Hooks provide additional point

of fi xation• Locking screws offer a fi xed-angle

construct and obtain fi xation in osteoporotic bone

• Precontoured shape to provide spring-effect, to aid in reduction

• Dual hook confi guration facilitates placement

• Nonlocking hole between the hooks allows fracture compression with a lag screw

• Used with 1.25 mm diameter guide wire• Hemispherical head ensures optimal

annular contact with washers and DePuy Synthes plates when screws are angled

• Low-profi le head reduces possibility of soft tissue irritation

• Standard 2.5 mm hexagonal drive is compatible with screwdrivers in other commonly used DePuy Synthes sets

• Reverse-cutting fl utes assist in screw removal

• Thread lengths: – Short thread (1/3 the screw length) – Long thread (1/2 the screw length)• Cancellous thread profi le uses deep

cutting threads with a large pitch to increase resistance to pullout. The large pitch also accelerates screw insertion and removal

• Self-drilling, self-tapping screw tip facilitates screw insertion by eliminating the need for predrilling and tapping in most cases

3.5 mm LCP Hook Plate


AO Principles


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4_Priciples_03.pdf 1 05.07.12 12:08

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique

AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, 2.

1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.

2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1, 2

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; 1991.

2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart New York: Thieme; 2007.

2.7 mm/3.5 mm LCP Distal Fibula PlateThe 2.7 mm/3.5 mm LCP Distal Fibula Plates are indicated for fractures, osteotomies and nonunions of the metaphyseal and diaphyseal region of the distal fi bula, especially in osteopenic bone.

Indications

4.0 mm Cannulated ScrewsThe DePuy Synthes 4.0mm Cannulated Screws are intended for the fi xation of fractures, fusions, osteotomies, nonunions, and malunions of small bones and small bone fragments in adults and in both children (2-12 years) and adolescents (12-21 years) in which growth plates have fused or in which growth plates will not be crossed by screw fi xation.

Warning: This device is not approved for screw attachment or fi xation to the posterior elements (pedicles) of the cervical, thoracic or lumbar spine.

LCP One-Third Tubular PlatesThe LCP One-Third Tubular Plates are intended for fi xation of fractures, osteotomies and nonunions of the clavicle, scapula, olecranon, humerus, radius, ulna, pelvis, distal tibia, and fi bula, particularly in osteopenic bone.

3.5 mm LCP Hook PlateThe 3.5 mm LCP Hook Plate is indicated for fractures, osteotomies and nonunions of small bones including the ulna, radius, tibia and fi bula, particularly in osteoporotic bone.


Clinical Cases

Case 1*

2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate

Postoperative lateral Postoperative AP

Case 2*

LCP One-Third Tubular Plates

Postoperative lateral Postoperative AP

* Case studies are not necessarily predictive of results in other cases. Results in other cases may vary.


Required set

01.119.021 ASC Ankle Fracture Set

Complete the preoperative radiographic assessment and plan. Determine procedure, type of fi xation, screw/plate size and implant locations to ensure proper implant selection and position.

Use the appropriate method for surgical incision and exposure of the fracture as needed.

Preparation


2.7 mm/3.5 mm LCP® Lateral Distal Fibula Plate Technique for Distal Fibula Fracture

The techniques for implanting the lateral distal fi bula plate and one-third tubular plate are similar. The following describes implantation of a lateral distal fi bula plate.

1. Reduce fi bular fracture

Instruments

398.41 Reduction Forceps with points

399.99 Reduction Forceps with serrated jaw

292.12 1.25 mm Kirschner Wire, 150 mm



Expose and clean the fracture site and reduce the fracture. It is critical that fi bular length, alignment and rotation are accurately restored.

In spiral or oblique fracture patterns, a clamp can be applied for reduction. Provisional reduction can be maintained with pointed reduction forceps or K-wires.


2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture

1. Reduce fibular fracture continued

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.

Note: Application of an external fixator or distractor may facilitate obtaining fibular length, fracture reduction and visualization of the distal tibiofibular joint.

Confirm the reduction with image intensification. Temporary reduction can be obtained with clamps, multiple Kirschner wires, or independent lag screws if the fracture pattern allows. K-wires can be placed through the distal end of the plate to assist with temporary maintenance of the reduction and for plate placement. Options for maintaining the reduction depend on the fracture configuration and include:• Independent lag screws• Lag screws through the plate• Locking screws through the plate

Locking screws do not provide interfragmentary compression; compression must be achieved with standard lag screws or by using the plate itself to compress the fracture. The fracture must be reduced and compressed before fixation of the LCP Distal Fibula Plates with locking screws in simple fracture configurations. If a bridge plate technique is planned, the implant can be secured proximally and distally using locking screws, if the fibular length, alignment and rotation are correct.



2. Insert plateExpose the fi bula proximally as needed for plate application. In the majority of circumstances, an open approach for plate application will be performed.

Occasionally, a submuscular plate insertion will be performed using a minimally invasive technique. The plate can be slid along the lateral fi bular shaft and positioned with the distal end of the plate approximately 5 mm from the tip of the fi bula.

3. Position plate and fi x provisionallyTemporarily hold the plate in position using any of the following options. These options also prevent plate rotation while inserting the fi rst locking screw:• Standard plate holding forceps• K-wires placed through the plate distally and/

or proximally• 2.7 mm cortex screw placed in one of the distal holes• 3.5 mm cortex screw placed in a Combi hole

After plate insertion, check plate placement and alignment using fl uoroscopy. Ensure proper reduction before inserting the fi rst locking screw. Once locking screws are inserted, further reduction is not possible without loosening the locking screws.

Verify plate placement under image intensifi cation to determine if fi nal screw and plate placement are acceptable.



4. Distal screw insertionDetermine the combination of screws to be used for fi xation. If a combination of locking and cortex screws will be used, cortex screws should be inserted fi rst.

Note: To secure the plate to the fi bula before lockingscrew insertion, it is recommended to pull the plateto the bone using a cortex screw.

Nonlocking screw insertion—fi xation with 2.7 mm cortex screws

Instruments

03.119.014 2.0 mm Drill Bit, quick coupling, 125 mm, Orange


03.119.018 2.7 mm Universal Drill Guide, Orange

03.119.019 StarDrive Screwdriver Shaft, T8, Purple/Orange

311.43 Handle, with quick coupling

319.01 Depth Gauge

Use the 2.0 mm drill bit through the 2.7 mm universal drill guide to predrill the bone.

Measure for screw length using the depth gauge.

Select and insert the appropriate 2.7 mm cortex screw using the StarDrive™ Screwdriver shaft.



4. Distal screw insertion continued

Locking screw insertion—fi xation with 2.7 mm locking screw

If a locking screw will be used as the fi rst screw, be sure the fracture is reduced and the plate is held securely to the bone. This prevents plate rotation as the screw is locked to the plate.

Instruments


03.119.019 StarDrive Screwdriver Shaft, T8, Purple/Orange

314.468 Holding Sleeve for StarDrive Screwdriver Shaft, T8


313.353 Drill Guide

319.01 Depth Gauge

511.776 Torque Limiting Attachment, 0.8 Nm, quick coupling

Insert the 2.0 mm threaded drill guide into a 2.7 mm locking hole until fully seated. Use the 2.0 mm drill bit to drill to the desired depth. Remove the 2.0 mm threaded drill guide.

Use the depth gauge to determine screw length.

Select and insert the appropriate 2.7 mm locking screw using the StarDrive Screwdriver shaft.

Precaution: When determining appropriate screw length, ensure that the screw tip will not protrude past the articular surface.



5. Shaft screw insertionNonlocking screw insertion—fi xation with 3.5 mm cortex screws

Instruments


314.06 Holding Sleeve

319.01 Depth Gauge

03.119.002 2.5 mm Drill Bit, Yellow

03.119.003 3.5 mm Drill Bit, Yellow

03.119.006 Small Hexagonal Screwdriver Shaft, Yellow/Gray

03.119.009 3.5 mm Universal Drill Guide, Yellow

Use the 2.5 mm drill bit through the 3.5 mm universal drill guide to predrill the bone. For the neutral position, press the drill guide down in the nonthreaded hole. To obtain compression, place the drill guide at the end of the nonthreaded hole away from the fracture (do not apply downward pressure on the spring-loaded tip).


Select and insert the appropriate 3.5 mm cortex screw using a small hexagonal screwdriver shaft.



5. Shaft screw insertion continued

Locking screw insertion—fi xation with 3.5 mm locking screw

Instruments

03.119.008 StarDrive Screwdriver Shaft, T15, Black

03.119.029 2.8 mm Drill Bit, Black

312.648 2.8 mm Threaded Drill Guide

319.01 Depth Gauge


Insert the 2.8 mm threaded drill guide into a locking hole or Combi hole until fully seated. Use the 2.8 mm drill bit to drill to the desired depth. Remove the drill guide.

Use the depth gauge to determine screw length.

Select and insert the appropriate 3.5 mm locking screw using the StarDrive Screwdriver shaft.




6. Confi rm reduction and fi xationCarefully assess the fi nal reduction and fi xation via direct visualization and image intensifi cation. Confi rm the stability of the fi xation and that there is unrestricted motion at the ankle joint. Using AP and lateral fl uoroscopic visualization, confi rm reduction and appropriate positioning of the plate and screws.


3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture

1. Fracture reduction and primary fi xation

Instrument


In multifragmentary fractures, care must be taken to avoid excessive stripping of the periosteum as well as devascularization of the fragments.

Indirect reduction usually is obtained by longitudinal traction, either on the foot, or of the main distal fragment using a bone hook.

If the distal fragment is large enough, insert one or two K-wires to hold the reduction.

The correct length, rotation and alignment must be checked under image intensifi cation.



2. Position plate

Instruments



292.16 1.6 mm Kirschner Wire

329.04 Bending Iron for 2.7 mm and 3.5 mm Plates


Contour the plate to fi t the bone using the bending irons.

Place the tip of the hooks inside the bone as distally as possible. Optionally predrill two holes for hook placement using the plate as a guide. Be careful not to damage the surgical gloves or the patient’s surrounding soft tissues with the sharp hooks.

Note: If required, the plate can be bent using bending pliers. Pay attention not to bend the plate over the Combi holes to prevent deformity of the locking portion. The plate hooks must not be bent.


3. Insert cortex screwsDetermine the combination of screws to be used for fi xation. If a combination of locking and cortex screws will be used, cortex screws should be inserted fi rst.

Note: To secure the plate to the fi bula before lockingscrew insertion, it is recommended to pull the plateto the bone using a cortex screw.

Instruments

03.119.002 2.5 mm Drill Bit, quick coupling, 110 mm, Yellow



03.119.005 3.5 mm/2.5 mm Insert, Yellow

03.119.006 Small Hexagonal Screwdrive Shaft, Yellow/Grey

311.43 Handle with Quick Coupling


319.01 Depth Gauge

Use the 2.5 mm drill bit through the 3.5 mm universal drill guide to predrill the bone.


Select and insert the appropriate 3.5 mm cortex screw using the small hexagonal screwdriver shaft and the handle with quick coupling.

Note: In osteopenic bone, a 4.0 mm cancellous screwmay also be used in this step.



4. Insert screw between hooks (optional)

Instruments

03.119.002 2.5mm Drill Bit, quick coupling, 110 mm, Yellow




03.119.004 Countersink for 3.5 mm Cortex and 4.0 mm cancellous Screws, Yellow

03.119.006 Small Hexagonal Screwdrive Shaft, Yellow/Grey



319.01 Depth Gauge

Drill a screw hole between the hooks with the 2.5 mm drill bit. Be sure to angle the drill away from the long axis of the plate to avoid colliding with other screws in the plate.

Measure for screw length, using the depth gauge.

Ensure that the screw will not collide with the reduction Kirschner wires.

Insert and tighten a 3.5 mm cortex screw using the small hexagonal screwdriver shaft and the handle with quick coupling. Alternatively, use a 2.7 mm cortex screw in this hole.



5. Insert locking screws

Instruments

03.119.029 2.8 mm Drill Bit, quick coupling, 165 mm, Black




319.01 Depth Gauge


Insert the threaded drill guide into the locking portion of an open elongated Combi hole in the plate shaft until fully seated.

Use the 2.8 mm drill bit to the desired depth. Remove the drill guide and use the depth gauge to determine the screw length.

Insert a 3.5 mm locking screw using the StarDrive Screwdriver shaft with torque limiting attachment and the handle with quick coupling.

Remove the 1.6 mm Kirschner wires.

Note: Always use a torque limiting attachment whenusing power to insert screws.

Alternatively, follow the appropriate steps for inserting a 3.5 mm cortex screw into this hole.





6. Confi rm reduction and fi xationCarefully assess the fi nal reduction and fi xation via direct visualization and image intensifi cation. Confi rm the stability of the fi xation and that there is unrestricted motion at the ankle joint. Using AP and lateral fl uoroscopic visualization, confi rm reduction and appropriate positioning of the plate and screws.


4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture

1. Reduction

Instrument

398.41 Reduction Forceps with Points, broad

Reduce the fracture anatomically with the use of small pointed reduction forceps, taking care with the soft tissues.

Do not strip the periosteum more than necessary.



2. Insert guide wires

Instruments

03.119.024 2.7 mm/1.25 mm Double Drill Sleeve, Grey

900.722 1.25 mm Threaded Guide Wire

Insert the 1.25 mm guide wires through the 2.7 mm/1.25 mm double drill sleeve to the appropriate depth. Check placement of the wire under image intensifi cation. Remove the drill sleeve.

As decided in preoperative planning, these K-wires should occupy the future position of the lag screws.

The direction of the K-wires/screws should be as perpendicular as possible to the fracture plane.

3. Predrill (optional)

Instruments


03.119.025 2.7 mm Cannulated Drill Bit, Grey

In dense bone, it may be helpful to use a 2.7 mm cannulated drill bit to penetrate the near cortex prior to screw insertion.

Use the 2.7 mm cannulated drill bit with the 2.7 mm/1.25 mm double drill sleeve to drill the near cortex only. Use image intensifi cation if necessary.

Care must be taken to avoid penetration of the ankle joint.

In some cases, especially in cancellous bone, the self-drilling fl utes of the 4.0 mm cannulated screw make predrilling unnecessary.



4. Measure

Instrument

319.15 Cannulated Screw Measuring Device

The length of the screw shaft must be chosen so that the threaded part of the screw lies fully within the opposite bone fragment, but does not penetrate beyond the denser epiphyseal cancellous bone.

Slide the tapered end of the cannulated screw measuring device over the guide wire, down to the bone. Read the scale at the end of the guide wire to determine appropriate screw length. This reading will place the screw 5 mm short of the tip of the guide wire, allowing the threaded portion of the guide wire to remain in the bone during screw insertion.



5. Insert screw

Instruments

03.119.027 Cannulated 2.5 mm Hexagonal Screwdriver Shaft, Grey

03.119.007 Holding Sleeve for Cannulated 2.5 mm Hexagonal Screwdriver

311.43 Handle with quick coupling

Place the appropriate length screw over the guide wire. Use the cannulated hexagonal screwdriver shaft, and holding sleeve to insert the screw. Insert the screw without excessive tightening. The screw should come to rest with its threads completely beyond the fracture line. Remove and discard the guide wire.

Notes:• If using power to insert screws, use of the holding

sleeve will reduce the risk of stripping the Hex recess.

• To prevent the screw head from sinking into the thin malleolar cortex, the use of a washer is recommended, especially in osteoporotic bone.



6. Confi rm reduction and fi xationCarefully assess the fi nal reduction and fi xation via direct visualization and image intensifi cation. Confi rm the stability of the fi xation and that there is unrestricted motion at the ankle joint. Using AP and lateral fl uoroscopic visualization, confi rm reduction and appropriate positioning of the screws.



7. Cleaning cannulations

Instruments

319.25 1.35 mm Cleaning Brush

319.38 1.25 mm Cleaning Stylet

Note: Cleaning the cannulation in each instrument is imperative for proper function and component life.

Instruments should be cleared intraoperatively with the cleaning stylet to prevent accumulation of debris in the cannulation and potential binding of the instruments about the guide wire. Instruments should be cleaned postoperatively with both the stylet and cleaning brush.


Implants

Screws are available in:1. 316L stainless steel2. commercially pure (CP) titanium3. titanium alloy (Ti-6AI-7Nb)

2.7 mm Locking Screws, self-tapping1,3

• Threaded, conical head locks securely into the threaded holes in the plate to provide angular stability

• Locked screws allow unicortical screw fi xation and load transfer to the near cortex

• T8 StarDrive Recess

2.7 mm Cortex Screws, self-tapping1,3

• For use in round or Combi holes• Used to provide compression or neutral fi xation• T8 StarDrive Recess

3.5 mm Locking Screws, self-tapping1,3 • Threaded, conical head locks securely into the threaded

holes in the plate to provide angular stability• Locked screws allow unicortical screw fi xation and load

transfer to the near cortex• T15 StarDrive Recess

3.5 mm Low-profi le Cortex Screws, self-tapping1,2

• For use in round or Combi holes• Used to provide compression or neutral fi xation• 2.5 mm Hex recess

4.0 mm Cancellous Bone Screws1,2 • For use in round or Combi holes• Used to provide compression or neutral fi xation• Fully or partially threaded shaft• 2.5 mm Hex recess


Implants

4.0 mm Cannulated Screws, short thread1,3

• Cannulated shaft accepts 1.25 mm diameter guide wires

• Thread length = 1/3 screw length• 2.5 mm Hex recess

Washer, 7.0 mm1,3

• To prevent screw head from sinking into osteoporotic bone

Screws are available in:1. 316L stainless steel2. commercially pure (CP) titanium3. titanium alloy (Ti-6AI-7Nb)


Implants

2.7 mm/3.5 mm LCP Lateral Distal Fibula Plates2,4

• Right and left designs• Lengths from 86 mm to 151 mm

LCP One-Third Tubular Plates, with collar1,3

• Available with 4–10 holes (45 mm–117 mm lengths) • Plate contains only locking holes, that accept

3.5 mm locking screws, 3.5 mm cortex screws, 2.7 mm cortex screws and 4.0 mm cancellous screws

Plates are available in:.1. 316L stainless steel2. 22Cr-13Ni-5Mn stainless steel3. commercially pure (CP) titanium4. titanium alloy (Ti-6AI-7Nb)


3.5 mm LCP Hook Plate1,3

• One plate design for right and left• 3 Shaft holes• Length 62 mm

Plates are available in:.1. 316L stainless steel2. 22Cr-13Ni-5Mn stainless steel3. commercially pure (CP) titanium4. titanium alloy (Ti-6AI-7Nb)

Implants


Instruments



03.119.004 Countersink for 3.5 mm Cortex and 4.0 mm Cancellous Screws, Yellow


03.119.006 Small Hexagonal Screwdriver Shaft, Yellow/Grey




Instruments




03.119.017 Countersink for 2.7 mm Cortex Screws, Purple/Orange


03.119.019 StarDrive Screwdriver Shaft, T8, 105 mm, Purple/Orange



Instruments

03.119.025 2.7 mm Cannulated Drill Bit, quick coupling, 160 mm, Grey

03.119.026 Cannulated Countersink for 5.0 mm and 4.0 mm cannulated screws, Grey


03.119.029 2.8 mm Drill Bit, quick coupling, 165 mm, Black

292.12 1.25 mm Kirschner Wire, 150 mm, trocar point

292.16 1.6 mm Kirschner Wire, 150 mm, trocar point

292.20 2.0 mm Kirschner Wire, 150 mm,trocar point


Instruments

311.43 Handle with quick coupling


313.353 Drill Sleeve for 2.0 mm Drill Bit


314.468 Holding Sleeve for 314.467

319.01 Depth Gauge for 2.7 mm and 3.5 mm Cortex and 4.0 Cancellous Screws

319.15 Cannulated Screw Measuring Device for 3.5 mm and 4.0 mm screws


Instruments



319.39 Sharp Hook

319.97 Screw Forceps

324.024 Push-Pull Reduction Device





Instruments

399.19 Hohmann Retractor, 8 mm width

399.36 Periosteal Elevator, 6 mm width, round edge, curved blade

399.49 Hohmann Retractor, 15 mm width




900.722 1.25 mm Threaded Guide Wire, 150 mm


Compact Ankle Fracture Instrument and Implant Set–ASC (01.119.021)

Graphic Case60.119.020 Compact Ankle Fracture Graphic

Case–ASC

Instruments03.119.002 2.5 mm Drill Bit, quick coupling, 110 mm,

Yellow, 2 ea.

03.119.003 3.5 mm Drill Bit, quick coupling, 110 mm, Yellow, 2 ea.

03.119.004 Countersink for 3.5 mm Cortex and 4.0 mm Cancellous Screws, Yellow


03.119.006 Small Hexagonal Screwdriver Shaft, Yellow/Grey




03.119.014 2.0 mm Drill Bit, quick coupling, 125 mm, Orange, 2 ea.

03.119.015 2.7 mm Drill Bit, quick coupling, 100 mm, Orange, 2 ea.

03.119.017 Countersink for 2.7 mm Cortex Screws, Purple/Orange


03.119.019 StarDrive Screwdriver Shaft, T8, 105 mm, Purple/Orange


03.119.025 2.7 mm Cannulated Drill Bit, quick coupling, 160 mm, Grey, 2 ea.

03.119.026 Cannulated Countersink for 5.0 mm and 4.0 mm Cannulated Screws, Grey


03.119.029 2.8 mm Drill Bit, quick coupling, 165 mm, Black, 2 ea.


Note: For additional information, please refer to package insert.

For detailed cleaning and sterilization instructions, please refer towww.depuysynthes.com/hcp/cleaning-sterilization or sterilization instructions, if provided.


Instruments continued

292.12 1.25 mm Kirschner Wire, 150 mm, trocar point, 10/pkg.



311.43 Handle with quick coupling, 2 ea.

312.648 2.8 mm Threaded Drill Guide, 2 ea.

313.353 Drill Sleeve for 2.0 mm Drill Bit, 2 ea.


314.468 Holding Sleeve for 314.467

319.01 Depth Gauge for 2.7 mm and 3.5 mm Cortex, and 4.0 Cancellous Screws

319.15 Cannulated Screw Measuring Device for 3.5 mm and 4.0 mm screws



319.39 Sharp Hook

319.97 Screw Forceps

324.024 Push-Pull reduction device




399.19 Hohmann Retractor, 8 mm width, 2 ea.

399.36 Periosteal Elevator, 6 mm width, round edge, curved blade

399.49 Hohmann Retractor, 15 mm width, 2 ea.




900.722 1.25 mm Threaded Guide Wire, 150 mm, 10 ea.

Implants2.7 mm/3.5 mm LCP Lateral Distal Fibula Plates

Stainless steel† Holes Length (mm)

02.112.138 4 86 right

02.112.139 4 86 left

02.112.140 5 99 right

02.112.141 5 99 left

02.112.142 6 112 right

02.112.143 6 112 left

02.112.148 9 151 right

02.112.149 9 151 left

LCP One-Third Tubular Plates, with collar

Stainless steel* Holes Length (mm)

241.341 4 45

241.351 5 57

241.361 6 69

241.371 7 81

241.381 8 93

241.401 10 117

3.5 mm LCP Hook Plate

Stainless steel* Holes Length (mm)

02.113.103 3 62

2.7 mm Locking Screws, self-tapping, with T8 StarDrive Recess, 5 ea.

Length Length Stainless steel** (mm) Stainless steel (mm)

202.210 10 202.222 22

202.212 12 202.224 24

202.214 14 202.226 26

202.216 16 202.228 28

202.218 18 202.230 30

202.220 20† 22Cr-13Ni-5Mn stainless steel. Plates are also available in titanium alloy (Ti-6Al-7Nb).

* 316L stainless steel. Plates/screws are also available in Commercially pure (CP) titanium.

** 316L stainless steel. Plates/screws are also available in titanium alloy (Ti-6Al-7Nb).



Implants continued

2.7 mm Cortex Screw, self-tapping, with T8 StarDrive Recess, 3 ea.

Length Length Stainless steel** (mm) Stainless steel** (mm)

202.870 10 202.892 32

202.872 12 202.894 34

202.874 14 202.896 36

202.876 16 202.898 38

202.878 18 202.900 40

202.880 20 202.962 42

202.882 22 202.963 44

202.884 24 202.965 46

202.886 26 202.966 48

202.888 28 202.967 50

202.890 30

3.5 mm Locking Screws, self-tapping, with StarDrive Recess, 3 ea.


212.101 10 212.107 22

212.102 12 212.108 24

212.103 14 212.109 26

212.104 16 212.110 28

212.105 18 212.111 30

212.106 20

3.5 mm Cortex Screws, with low-profile head, self-tapping, Hex drive recess

Stainless steel* Length (mm) Qty.

02.206.010 10 6

02.206.012 12 6

02.206.014 14 6

02.206.016 16 6

02.206.018 18 6

02.206.020 20 3

02.206.022 22 3

02.206.024 24 3

02.206.026 26 3

02.206.028 28 3

02.206.030 30 3

02.206.032 32 3

02.206.034 34 3

02.206.036 36 3

02.206.038 38 3

02.206.040 40 3

02.206.042 42 3

02.206.044 44 3

02.206.046 46 3

02.206.048 48 3

02.206.050 50 3

02.206.052 52 3

02.206.054 54 3

02.206.056 56 3

02.206.058 58 3

02.206.060 60 3





Implants continued

4.0 mm Cancellous Bone Screws, fully threaded, 3 ea.

Length Length Stainless steel* (mm) Stainless steel* (mm)

206.010 10 206.018 18

206.012 12 206.020 20

206.014 14 206.022 22

206.016 16 206.024 24

4.0 mm Cancellous Bone Screws, partially threaded, 3 ea.

Length Length Stainless steel* (mm) Stainless steel* (mm)

207.030 30 207.050 50

207.035 35 207.055 55

207.040 40 207.060 60

207.045 45

4.0 mm Cannulated Screws, short thread, 3 ea.


207.620 20 207.636 36

207.622 22 207.638 38

207.624 24 207.640 40

207.626 26 207.642 42

207.628 28 207.644 44

207.630 30 207.646 46

207.632 32 207.648 48

207.634 34 207.650 50

Washer, 7.0 mm

Stainless steel** Qty.

219.98 6



Also available01.119.022 Titanium Compact Ankle Fracture

Instrument and Implant Set


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Synthes USA, LLC 1101 Synthes AvenueMonument, CO 80132

Manufactured or distributed by:Synthes USA Products, LLC 1302 Wrights Lane EastWest Chester, PA 19380

To order (USA): 800-523-0322 To order (Canada): 844-243-4321

Note: For recognized manufacturer, refer to the product label.

www.depuysynthes.com

Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed.

Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information.

CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.

Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada.

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