VariAx Distal Radius Locking Plate System - Stryker MedEd · PDF fileVariAx Distal Radius...

VariAx Distal RadiusLocking Plate System

• Anatomical & Universal Volar Plates• Dorsal Plates• Fragment Specific Plates

Operative Technique

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Indications:

Intra-articular and extra-articular fractures of the distal radius.Reconstruction of the distal radius.

The 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 Specific Solutions.

• 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.

• Anatomical Volar Plate Encourages articular support with Locking screws & pegs, provides buttressing to the volar lunate facet and stable fixation 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 fixation requirements.

• Anodization Type II Increases the strength of all VariAx Distal Radius Locking Plates and reduces the incidence of tissue adherence.

This operative technique was developed with Richard Rogachefsky, MD.

Introduction

SmartLock* Locking Technology:

New T7 Drive Screw Head Design

• Axial stability• Friction fit• 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.

• 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°

*The SmartLock Technology is patented (US 6, 322, 562; DE 43 43 117) by Professor Dietmar Wolter, Hamburg, Germany.

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Locking Screw

Bone Screw

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 Plate

2. The FCR tendon is retracted ulnarly and dissection is carried down through the floor 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 fixation may be helpful. If necessary, bone graft materials may be used as an adjunct to the plate to provide an optimal bone void filler. The use of AP/Lateral fluoroscopy 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 flexion creases.

3. The Pronator Quadratus is identified and dissected in its entirety off of the volar surface of the radius as an ulnarly based flap.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 fixation while evaluating the placement of the plate.

10. The first 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 confirmation of the correct positioning of the anatomic volar plate by use of fluoroscopy, tighten the first 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 specified locking range and severely compromise the locking capabilities.

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Operative Technique

Note: If the insertion of the 2.7mm screw is hindered, it is recommended to use the 2.3mm cortical drill bit in conjunction with the 2.3mm drill guide.

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 fluoroscopy to ensure that neither penetrate the joint.18. Close the incision.

Pre-determined Screw Pattern

Note: In order to prevent toggling, this drill guide is designed to fit 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 flexibility of choosing an angle. It is designed to fit 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 fixation 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 if the insertion is hindered. This drill guide can only be used in a fixed 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 flexion creases.

2. The FCR tendon is retracted ulnarly and dissection is carried down through the floor of the FCR sheath. This exposes the FCR muscle belly, which may be retracted ulnarly as well.

3. The Pronater Quadratus is identified and dissected in its entirety off of the volar surface of the radius as an ulnarly based flap.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 fixation could be helpful.If necessary, bone graft materials may be used as an adjunct to the plate to provide an optimal bone void filler.

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/Latfluoroscopy is helpful to determine correct fracture reduction and plate position.8. K-Wires can be used for temporary fixation.

9. The first 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 confirmation of the correct positioning of the volar plate by use of fluoroscopy, tighten the first 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 fluoroscopy to ensure that neither penetrates the joint.

Universal Volar Plate

16. Close the incision.

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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 fixation may be helpful. If necessary, bone graft materials may be used as an adjunct to the plate to provide an optimal bone void filler. 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 confirmed by use of fluoroscopy. The first 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. Confirm proper plate positioning by use of fluoroscopy and then tighten the first 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. Confirm correct placement by useof fluoroscopy.

Dorsal Plate

14. Verify proper placement of screws and pegs by use of fluoroscopy to ensure that neither penetrates the joint.15. Close the incision.

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Operative TechniqueRadial 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 fixation 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 fixation.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


Narrow, Left


Standard, Right


Standard, Left


Narrow, Right, Long


Narrow, Left, Long


Standard, Right, Long


Standard, Left, Long

Universal Volar DR Plate

Narrow, Short


Standard, Short


Wide, Short


Narrow, Long


Standard, Long


Wide, Long


Narrow, XLong


Standard, XLong


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 Specific Plates

The Variax Distal Radius Plating System incorporates plate designs originating from the Matrix Distal Radius Plating System developed by Stryker in conjunction with Richard Rogachefsky, MD.

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53-27716 E

53-27718 E

53-27720 E

53-27722 E

53-27724 E

53-27726 E

16

18

20

22

24

26

Ti Length REF mm

2.7 mm Partially Threaded Locking Pegs

53-20616 E

53-20618 E

53-20620 E

53-20622 E

53-20624 E

53-20626 E

16

18

20

22

24

26

Ti Length REF mm

2.0mm Locking Pegs

53-23610 E

53-23612 E

53-23614 E

53-23616 E

53-23618 E

53-23620 E

53-23622 E

53-23624 E

53-23626 E

53-23628 E

53-23630 E

53-23632 E

53-23634 E

53-23636 E

53-23638 E

10

12

14

16

18

20

22

24

26

28

30

32

34

36

38

Ti Length REF mm

2.3mm Locking Screws

53-27610 E

53-27612 E

53-27614 E

53-27616 E

53-27618 E

53-27620 E

53-27622 E

53-27624 E

53-27626 E

10

12

14

16

18

20

22

24

26

Ti Length REF mm

2.7mm Locking Screws

Ti Length REF mm

53-23210 E

53-23212 E

53-23214 E

53-23216 E

53-23218 E

53-23220 E

53-23222 E

53-23224 E

53-23226 E

53-23228 E

53-23230 E

53-23232 E

53-23234 E

53-23236 E

53-23238 E

10

12

14

16

18

20

22

24

26

28

30

32

34

36

38

2.3mm Bone Screws

Ti Length REF mm

53-27116 E

53-27118 E

53-27120 E

53-27122 E

53-27124 E

53-27126 E

16

18

20

22

24

26

2.7mm Partially Threaded Bone Screws

Note:All screws/pegs may be ordered sterile by replacing “E” by “S” at the end of the respective Cat.Nr.All screws are single packed.All Drills may be ordered sterile by replacing “60” by “91-” in their respective Cat.Nr.

Twist DrillsREF Description

2.3mm, Stryker shaft end

2.3mm, AO shaft end

2.3mm, Dental shaft end


2.0mm, AO shaft end



1.9mm, AO shaft end


60-23141

60-23341

60-23441

60-20185

60-20385

60-20485

60-19140

60-19340

60-19440

Ti Length REF mm

53-27210 E

53-27212 E

53-27214 E

53-27216 E

53-27218 E

53-27220 E

53-27222 E

53-27224 E

53-27226 E

10

12

14

16

18

20

22

24

26

2.7mm Bone Screws

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REF Description

62-20290

62-27015

56-01250

56-01255

56-01260

62-00016

64-20117

64-20118

64-20129

Screwdriver Ratcheting Handle

Screwdriver Blade, T72.3mm/2.7mm

Polyaxial Drill Guide2.3mm/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

* Order Quantity: Packages of 5** Order Quantity: Packages of 10

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Now Stryker Osteosynthesis offers you a wide variety of solutions for the treatment of all your Upper Extremity & Hand Injuries.

Complementary Products

TwinFix

KnifeLight

Hoffmann II Micro Lengthener

Hoffmann II Compact MRI

Profyle and VariAx Hand

T2 Humeral Nail

T2 Proximal Humeral NailAsnis III 4.0 Cannulated ScrewsAxSOS Proximal Humeral Plate

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Notes

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Notes

15

Notes

1275

Stryker Leibinger GmbH & Co. KGBötzinger Straße 41D-79111 FreiburgGermany

www.osteosynthesis.stryker.com

This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in surgery. 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 including the instructions for Cleaning and Sterilization (if applicable) before using any Stryker products. 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.

Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Stryker, TwinFix, T2, KnifeLight, Hoffmann II Micro, Hoffmann II Compact MRI, Profyle Modular, AxSOS, Asnis and VariAx .

All other trademarks are trademarks of their respective owners or holders.The products listed above are CE marked.

Literature Number: 90-07799 LOT A5008

Copyright © 2008 Stryker

VariAx Distal Radius Locking Plate System - Stryker MedEd · PDF fileVariAx Distal Radius...

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