depuy synthes select compact ankle fracture system technique guide

COMPACT
ANKLE FRACTURE
SYSTEM
Consolidated ankle fracture
solution for surgery centers
SURGICAL TECHNIQUE
TABLE OF CONTENTS
INTRODUCTION
SURGICAL TECHNIQUE
PRODUCT INFORMATION
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
Technique for Distal Fibula Fracture
12
3.5 mm LCP Hook Plate Technique
for Distal Fibula Fracture
20
4.0 mm Cannulated Screw Technique
for Medial Malleolus Fracture
26
Implants
32
Instruments
36
Set List
42
Image intensifier control
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
CONSOLIDATED ANKLE FRACTURE SOLUTION
FOR SURGERY CENTERS
DePuy Synthes Select
offers surgical device systems
designed for use in the most
common orthopedic and
podiatric procedures
performed in Ambulatory
Surgery Centers (ASCs).
The Select compact systems
feature the same high-quality
DePuy Synthes products used
in hospitals, but combined
into consolidated sets to
help improve efficiency
for our ASC customers.
The configuration of the Compact Ankle Fracture System contains general
instruments, Locking Compression Plates (LCP ®) such as fibula 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 fibula fractures that results in a fixedangle construct and obtains fixation 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
s Color-coded layout for instrument
identification
s Includes general instruments; all
instrumentation is grouped by screw
size, making it easier for surgical teams
to quickly locate related components
s Contains precontoured fibula plates,
1/3 tubular plates, and hook plates
enabling surgeons to choose the
appropriate option based on the
complexity of the fracture
s Also contains solid and cannulated
screws for syndesmotic repair and
medial malleolus fractures
s Plates are designed to accomodate
various fracture patterns and the
patient’s anatomy
s Locking and conventional screws
allow for appropriate bone fixation
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
3
Compact Ankle Fracture System
COLOR CODING
A 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
4
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.
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
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
Compact Ankle Fracture System
ORDER OF USE LAYOUT
The layout of instruments is focused on order of use to
correlate with the surgical steps and therefore assist with
the intra-operative sequence.
1. REDUCE
Instruments are arranged by groups (general instruments,
2.7 mm screw instrumentation, etc.). The handling flows
from left to right and from top to bottom. E.g. general
instruments are typically used first and are therefore
placed on the left. Hence, implant specific instruments
are located on the right side in order of the surgical steps:
• Drill bit
• Drill guide
• Measuring device
• Screwdriver
• TLA
Left
General
instruments
2. DRILL
Right
Implant specific
instruments
3. MEASURE
2, 3, 4
2.7 mm screw
instruments
1
2, 3, 4
3.0 mm cortex/
4.0 mm cancellous
screw instruments
2, 3, 4
4. INSERT SCREW
3.5 mm locking
screw instruments
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
5
Compact Ankle Fracture System
IMPLANTS
2.7 MM / 3.5 MM LCP LATERAL DISTAL FIBULA PLATE
• Anatomically contoured distal
fibula plates
• Multiple screw options in the head
of plate
• Locking screws offer a fixed-angle
construct and obtain fixation in
osteoporotic bone
• Coaxial screw holes help minimize
screw head prominence and create
a low profile construct
• Allows technique of clamp reduction,
followed by independent lag screw,
and neutralization plate placement
in typical spiral fracture patterns
• For valgus failure fibular fractures
with comminution and for bridge
plating of comminuted fractures
LCP ONE-THIRD TUBULAR PLATE
• Plate can be contoured to patient
anatomy
• Locking screws offer a fixed-angle
construct and obtain fixation 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
6
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
Compact Ankle Fracture System
Implants
3.5 MM LCP HOOK PLATE
• Low profile
• Hooks provide additional point
of fixation
• Locking screws offer a fixed-angle
construct and obtain fixation in
osteoporotic bone
• Precontoured shape to provide
spring-effect, to aid in reduction
• Dual hook configuration facilitates
placement
• Nonlocking hole between the hooks
allows fracture compression with a
lag screw
4.0 MM CANNULATED SCREWS
• Used with 1.25 mm diameter guide wire
• Hemispherical head ensures optimal
annular contact with washers and
Synthes plates when screws are angled
• Low-profile head reduces possibility of
soft tissue irritation
• Standard 2.5 mm hexagonal drive is
compatible with screwdrivers in other
commonly used Synthes sets
• Reverse-cutting flutes assist in screw
removal
• Thread lengths:
– Short thread (1/3 the screw length)
– Long thread (1/2 the screw length)
• Cancellous thread profile 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
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
7
AO PRINCIPLES
In 1958, the AO formulated four basic principles, which
have become the guidelines for internal fixation.1 They are:
Anatomic reduction
Fracture reduction and fixation to restore anatomical
relationships.
Stable fixation
Stability by fixation or splintage, as the personality of the
fracture and the injury requires.
Preservation of blood supply
Preservation of the blood supply to soft tissue and bone
by careful handling.
Early, active mobilization
Early, active mobilization of the part and patient.
1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation.
3rd ed. Berlin Heidelberg New York: Springer. 1991.
8
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
INDICATIONS
2.7 mm /3.5 mm LCP Distal Fibula Plate
The 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 fibula,
especially in osteopenic bone.
LCP One-Third Tubular Plates
The LCP One-Third Tubular Plates are intended for fixation
of fractures, osteotomies and nonunions of the clavicle,
scapula, olecranon, humerus, radius, ulna, pelvis, distal
tibia, and fibula, particularly in osteopenic bone.
3.5 mm LCP Hook Plate
The 3.5 mm LCP Hook Plate is indicated for fractures,
osteotomies and nonunions of small bones including
the ulna, radius, tibia and fibula, particularly in
osteoporotic bone.
4.0 mm Cannulated Screws
For fracture fixation of small bones and small
bone fragments.
Warning: This device is not approved for screw
attachment or fixation to the posterior elements
(pedicles) of the cervical, thoracic or lumbar spine.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
9
CLINICAL CASES
Case 1*
2.7 mm /3.5 mm LCP Lateral Distal
Fibula Plate
Postoperative lateral
Postoperative AP
Postoperative lateral
Postoperative AP
Case 2*
LCP One-Third Tubular Plates
* Case studies are not necessarily predictive of results in other cases.
Results in other cases may vary.
10
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
PREPARATION
Required set
01.119.021
ASC Ankle Fracture Set
Complete the preoperative radiographic assessment and
plan. Determine procedure, type of fixation, 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.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
11
2.7 MM/3.5 MM LCP LATERAL DISTAL FIBULA PLATE
TECHNIQUE FOR DISTAL FIBULA FRACTURE
The techniques for implanting the lateral distal fibula
plate and one-third tubular plate are similar. The following
describes implantation of a lateral distal fibula plate.
1
Reduce fibular fracture
Instruments
398.41
Reduction Forceps with points
399.99
Reduction Forceps with serrated jaw
292.12
1.25 mm Kirschner Wire, 150 mm
292.16
1.6 mm Kirschner Wire, 150 mm
292.20
2.0 mm Kirschner Wire, 150 mm
Expose and clean the fracture site and reduce the fracture.
It is critical that fibular 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.
12
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
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.
Technique tip: 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 plate 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.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
13
2.7 mm /3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture
2
Insert plate
Expose the fibula 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 fibular shaft and
positioned with the distal end of the plate approximately
5 mm from the tip of the fibula.
3
Position plate and fix provisionally
Temporarily hold the plate in position using any of the
following options. These options also prevent plate
rotation while inserting the first 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 fluoroscopy. Ensure proper reduction before inserting
the first locking screw. Once locking screws are inserted,
further reduction is not possible without loosening the
locking screws.
Verify plate placement under image intensification to
determine if final screw and plate placement are acceptable.
14
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
2.7 mm /3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture
4
Distal screw insertion
Determine the combination of screws to be used for
fixation. If a combination of locking and cortex screws
will be used, cortex screws should be inserted first.
Note: To secure the plate to the fibula before locking
screw insertion, it is recommended to pull the plate
to the bone using a cortex screw.
Nonlocking screw insertion —fixation with 2.7 mm
cortex screws
Instruments
03.119.014
2.0 mm Drill Bit, quick coupling,
125 mm, Orange
03.119.015
2.7 mm Drill Bit, quick coupling,
100 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.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
15
2.7 mm /3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture
4. Distal screw insertion continued
Locking screw insertion —fixation with 2.7 mm
locking screw
If a locking screw will be used as the first 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
03.119.014
2.0 mm Drill Bit, quick coupling,
125 mm, Orange
03.119.019
StarDrive Screwdriver Shaft, T8,
Purple /Orange
314.468
Holding Sleeve for StarDrive Screwdriver
Shaft, T8
311.43
Handle, with quick coupling
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.
16
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
2.7 mm /3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture
5
Shaft screw insertion
Nonlocking screw insertion—fixation with 3.5 mm
cortex screws
Instruments
311.43
Handle, with quick coupling
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).
Measure for screw length using the depth gauge.
Select and insert the appropriate 3.5 mm cortex screw
using a small hexagonal screwdriver shaft.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
17
2.7 mm /3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture
5. Shaft screw insertion continued
Locking screw insertion —fixation 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
511.773
Torque Limiting Attachment, 1.5 Nm,
quick coupling
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.
18
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
2.7 mm /3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture
6
Confirm reduction and fixation
Carefully assess the final reduction and fixation via direct
visualization and image intensification. Confirm the
stability of the fixation and that there is unrestricted
motion at the ankle joint. Using AP and lateral fluoroscopic
visualization, confirm reduction and appropriate positioning
of the plate and screws.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
19
3.5 MM LCP HOOK PLATE TECHNIQUE FOR DISTAL
FIBULA FRACTURE
1
Fracture reduction and primary fixation
Instrument
292.16
1.6 mm Kirschner Wire, 150 mm
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 intensification.
20
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture
2
Position plate
Instruments
03.119.014
2.0 mm Drill Bit, quick coupling,
125 mm, Orange
03.119.018
2.7 mm Universal Drill Guide, Orange
292.16
1.6 mm Kirschner Wire
329.04
Bending Iron for 2.7 mm
and 3.5 mm Plates
329.05
Bending Iron for 2.7 mm
and 3.5 mm Plates
Contour the plate to fit 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.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
21
3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture
3
Insert cortex screws
Determine the combination of screws to be used for
fixation. If a combination of locking and cortex screws
will be used, cortex screws should be inserted first.
Note: To secure the plate to the fibula before locking
screw insertion, it is recommended to pull the plate
to the bone using a cortex screw.
Instruments
03.119.002
2.5 mm Drill Bit, quick coupling,
110 mm, Yellow
03.119.003
3.5 mm Drill Bit, quick coupling,
110 mm, Yellow
03.119.009
3.5 mm Universal Drill Guide, 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
314.06
Holding Sleeve
319.01
Depth Gauge
Use the 2.5 mm drill bit through the 3.5 mm universal
drill guide to predrill the bone.
Measure for screw length using the depth gauge.
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 screw
may also be used in this step.
22
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture
4
Insert screw between hooks (optional)
Instruments
03.119.002
2.5mm Drill Bit, quick coupling,
110 mm, Yellow
03.119.003
3.5 mm Drill Bit, quick coupling,
110 mm, Yellow
03.119.009
3.5 mm Universal Drill Guide, Yellow
03.119.005
3.5 mm/2.5 mm Insert, 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
311.43
Handle with Quick Coupling
314.06
Holding Sleeve
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.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
23
3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture
5
Insert locking screws
Instruments
03.119.029
2.8 mm Drill Bit, quick coupling,
165 mm, Black
312.648
2.8 mm Threaded Drill Guide
03.119.008
Stardrive Screwdriver Shaft, T15, Black
311.43
Handle with Quick Coupling
319.01
Depth Gauge
511.773
Torque Limiting Attachment, 1.5 Nm,
quick coupling
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 when
using power to insert screws.
Alternatively, follow the appropriate steps for inserting a
3.5 mm cortex screw into this hole.
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DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture
6
Confirm reduction and fixation
Carefully assess the final reduction and fixation via direct
visualization and image intensification. Confirm the
stability of the fixation and that there is unrestricted
motion at the ankle joint. Using AP and lateral fluoroscopic
visualization, confirm reduction and appropriate positioning
of the plate and screws.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
25
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.
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DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture
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 intensification.
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
03.119.024
2.7 mm/1.25 mm Double Drill Sleeve,
Grey
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 intensification if necessary.
Care must be taken to avoid penetration of the ankle joint.
In some cases, especially in cancellous bone, the
self-drilling flutes of the 4.0 mm cannulated screw make
predrilling unnecessary.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
27
4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture
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.
28
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture
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
U If using power to insert screws, use of the holding
sleeve will reduce the risk of stripping the hex
recess
U To prevent the screw head from sinking into the
thin malleolar cortex, the use of a washer is
recommended, especially in osteoporotic bone
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
29
4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture
6
Confirm reduction and fixation
Carefully assess the final reduction and fixation via direct
visualization and image intensification. Confirm the
stability of the fixation and that there is unrestricted
motion at the ankle joint. Using AP and lateral fluoroscopic
visualization, confirm reduction and appropriate positioning
of the screws.
30
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture
7
Cleaning cannulations
Instruments
319.25
1.35 mm Cleaning Brush
319.38
1.25 mm Cleaning Sylet
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.
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
31
IMPLANTS
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 fixation 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 fixation
• 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 fixation and load
transfer to the near cortex
• T15 StarDrive recess
3.5 mm Low-profile Cortex Screws, self-tapping1,2
• For use in round or Combi holes
• Used to provide compression or neutral fixation
• 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 fixation
• Fully or partially threaded shaft
• 2.5 mm Hex recess
Screws are available in:
1. 316L stainless steel
2. commercially pure (CP) titanium
3. titanium alloy (Ti-6AI-7Nb)
32
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
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 steel
2. commercially pure (CP) titanium
3. titanium alloy (Ti-6AI-7Nb)
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
33
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 steel
2. 22Cr-13Ni-5Mn stainless steel
3. commercially pure (CP) titanium
4. titanium alloy (Ti-6AI-7Nb)
34
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
Implants
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 steel
2. 22Cr-13Ni-5Mn stainless steel
3. commercially pure (CP) titanium
4. titanium alloy (Ti-6AI-7Nb)
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
35
INSTRUMENTS
03.119.002
2.5 mm Drill Bit, quick coupling,
110 mm, Yellow
03.119.003
3.5 mm Drill Bit, quick coupling,
110 mm, Yellow
03.119.004
Countersink for 3.5 mm Cortex and
4.0 mm Cancellous Screws, Yellow
03.119.005
3.5 mm /2.5 mm Insert, Yellow
03.119.006
Small Hexagonal Screwdriver Shaft,
Yellow/Grey
03.119.007
Holding Sleeve for Cannulated 2.5 mm
Hexagonal Screwdriver
03.119.008
Stardrive Screwdriver Shaft, T15, Black
36
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
Instruments
03.119.009
3.5 mm Universal Drill Guide, Yellow
03.119.014
2.0 mm Drill Bit, quick coupling,
125 mm, Orange
03.119.015
2.7 mm Drill Bit, quick coupling,
100 mm, Orange
03.119.017
Countersink for 2.7 mm Cortex Screws,
Purple /Orange
03.119.018
2.7 mm Universal Drill Guide, Orange
03.119.019
Stardrive Screwdriver Shaft, T8,
105 mm, Purple /Orange
03.119.024
2.7 mm/1.25 mm Double Drill
Sleeve, Grey
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
37
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
03.119.027
Cannulated 2.5 mm Hexagonal
Screwdriver Shaft, Grey
03.119.029
2.8 mm Drill Bit, quick coupling,
165 mm, Black
292.12
1.25 mm Kirschner Wire, 150 mm,
trochar point
292.16
1.6 mm Kirschner Wire, 150 mm,
trochar point
292.20
2.0 mm Kirschner Wire, 150 mm,
trochar point
38
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
Instruments
311.43
Handle with quick coupling
312.648
2.8 mm Threaded Drill Guide
313.353
Drill Sleeve for 2.0 mm Drill Bit
314.06
Holding Sleeve
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
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
39
Instruments
319.25
1.35 mm Cleaning Brush
319.38
1.25 mm Cleaning Stylet
319.39
Sharp Hook
319.97
Screw Forceps
324.024
Push-Pull Reduction Device
329.04
Bending Iron for 2.7 mm
and 3.5 mm Plates
329.05
Bending Iron for 2.7 mm
and 3.5 mm Plates
398.41
Reduction Forceps with Points, broad
40
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
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
399.99
Reduction Forceps with serrated jaw
511.773
Torque Limiting Attachment, 1.5 Nm,
quick coupling
511.776
Torque Limiting Attachment, 0.8 Nm,
quick coupling
900.722
1.25 mm Threaded Guide Wire, 150 mm
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
41
COMPACT ANKLE FRACTURE INSTRUMENT
AND IMPLANT SET–ASC (01.119.021)
Graphic Case
60.119.020
Instruments
03.119.002
Compact Ankle Fracture Graphic
Case –ASC
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
03.119.005
3.5 mm /2.5 mm Insert, Yellow
03.119.006
Small Hexagonal Screwdriver Shaft,
Yellow/Grey
03.119.007
Holding Sleeve for Cannulated 2.5 mm
Hexagonal Screwdriver
03.119.008
Stardrive Screwdriver Shaft, T15, Black
03.119.009
3.5 mm Universal Drill Guide, Yellow
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
03.119.018
2.7 mm Universal Drill Guide, Orange
03.119.019
Stardrive Screwdriver Shaft, T8, 105 mm,
Purple /Orange
03.119.024
2.7 mm/1.25 mm Double Drill Sleeve, Grey
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
03.119.027
Cannulated 2.5 mm Hexagonal
Screwdriver Shaft, Grey
03.119.029
2.8 mm Drill Bit, quick coupling, 165 mm,
Black, 2 ea.
For detailed cleaning and sterilization instructions, please refer to:
www.synthes.com/cleaning-sterilization
In Canada, the cleaning and sterilization instructions will be provided with
the Loaner shipments.
42
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
Compact Ankle Fracture Instrument and Implant Set – ASC (01.119.021)
Instruments continued
292.12
1.25 mm Kirschner Wire, 150 mm,
trochar point, 10/pkg.
292.16
1.6 mm Kirschner Wire, 150 mm,
trochar point, 10/pkg.
292.20
2.0 mm Kirschner Wire, 150 mm,
trochar 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.
314.06
Holding Sleeve
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
319.25
1.35 mm Cleaning Brush
319.38
1.25 mm Cleaning Stylet
319.39
Sharp Hook
319.97
Screw Forceps
324.024
Push-Pull reduction device
329.04
Implants
2.7 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
Bending Iron for 2.7 mm and
3.5 mm Plates
241.401
10
117
329.05
Bending Iron for 2.7 mm and
3.5 mm Plates
3.5 mm LCP Hook Plate
398.41
Reduction Forceps with Points, broad
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.
399.99
Reduction Forceps with serrated jaw
511.773
Torque Limiting Attachment, 1.5 Nm,
quick coupling
511.776
Torque Limiting Attachment, 0.8 Nm,
quick coupling
900.722
1.25 mm Threaded Guide Wire,
150 mm, 10 ea.
†
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).
Stainless steel* Holes
Length (mm)
02.113.103
62
3
2.7 mm Locking Screws, self-tapping,
with T8 StarDrive recess, 5 ea.
Length
Stainless steel** (mm)
Length
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
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
43
Compact Ankle Fracture Instrument and Implant Set – ASC (01.119.021)
Implants continued
3.5 mm Cortex Screws, with low-profile head, self-tapping,
hex drive recess
2.7 mm Cortex Screw, self-tapping,
with T8 StarDrive recess, 3 ea.
Stainless steel* Length (mm)
Qty.
02.206.010
10
6
02.206.012
12
6
Stainless steel**
Length
(mm)
Stainless steel**
Length
(mm)
202.870
10
202.892
32
02.206.014
14
6
202.872
12
202.894
34
02.206.016
16
6
202.874
14
202.896
36
02.206.018
18
6
202.876
16
202.898
38
02.206.020
20
3
202.878
18
202.900
40
02.206.022
22
3
202.880
20
202.962
42
02.206.024
24
3
202.882
22
202.963
44
02.206.026
26
3
202.884
24
202.965
46
02.206.028
28
3
202.886
26
202.966
48
02.206.030
30
3
202.888
28
202.967
50
02.206.032
32
3
202.890
30
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
3.5 mm Locking Screws, self-tapping,
with StarDrive recess, 3 ea.
Stainless steel**
Length
(mm)
Stainless steel**
Length
(mm)
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
*
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).
44
DePuy Synthes Select
Compact Ankle Fracture System
Surgical Technique
Compact Ankle Fracture Instrument and Implant Set – ASC (01.119.021)
Implants continued
Also available
4.0 mm Cancellous Bone Screws, fully threaded, 3 ea.
Length
Stainless steel* (mm)
Length
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
01.119.022
Titanium Compact Ankle Fracture
Instrument and Implant Set
4.0 mm Cancellous Bone Screws, partially threaded, 3 ea.
Length
Stainless steel* (mm)
Length
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.
Length
Stainless steel** (mm)
Length
Stainless steel** (mm)
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
*
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).
Compact Ankle Fracture System
Surgical Technique
DePuy Synthes Select
45
Synthes Inc.
1302 Wrights Lane East
West Chester, PA 19380
Telephone: (610) 719-5000
To order: (800) 523-0322
Synthes (Canada) Ltd.
2566 Meadowpine Boulevard
Mississauga, Ontario L5N 6P9
Telephone: (905) 567-0440
To order: (800) 668-1119
Fax: (905) 567-3185
www.depuysynthes.com
© DePuy Synthes Trauma, a division of DOI 2013. All rights reserved.
J12439-A 9/13