VariAx Distal Radius LockingPlateSystem

Osteosynthesis

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

Operative Technique

�

Introduction

The NEW VariAx Distal Radius Plating System represents the Next Generation of Bone Fixation for your Distal Radius Fracture Needs.

System Features:

• Comprehensive Plating System Providing Anatomical Volar and Dorsal, Universal Volar and Fragment Specific Solutions, even for the most complex distal radius fracture.

• Fixed Angle Drill Guide Assures placement of screws & pegs in a pre-determined angle.

• Polyaxial Drill Guide Allows locking with an additional angulation of ±15 degrees in any hole on the plate, except the oblong hole in the shaft.

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

SmartLock* Locking Technology:

Cross-Pin Screw Head Design

• Optimal 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.

• Unique one-step Locking Is achieved by simply inserting a Locking Screw or Peg within the polyaxial locking range of ±15 degrees, without the need for further steps.

-15° +15°

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

�

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

�

Anatomical Volar Plate

�. 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.

�. The Pronator Quadratus is identified and dissected in its entirety off of the volar surface of the radius as an ulnarly based flap.�. 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.

1�. 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.1�. After confirmation of the correct positioning of the anatomic volar plate by use of fluoroscopy, tighten the first screw. 1�. 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.

5

18. Close the incision.

Operative Technique

Note: In very dense bone it is recommended to use the 2.3mm drill bit in conjunction with the 2.3mm drill guide for a 2.7mm screw.

15. Using the desired drill guide, repeat

drilling, measuring and placement of screws/

pegs in the distal holes.

16. Place locking or non-locking screws in the proximal end of the plate.

17. Verify proper placement of screws/pegs by use of fluoroscopy to ensure that neither penetrate the joint.

15° distal15° lateral

12° proximal

5° proximal

5° proximal

18° distal12° lateral

0°

0°

18° distal12° lateral

15° distal15° lateral

10° proximal

5° proximal

0°

Pre-determined Screw Pattern

Note: In order to prevent toggling, this drill guide is designed to 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 in dense bone. This drill guide can only be used in a fixed angle.

6

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.

�. 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.

�. The Pronater Quadratus is identified and dissected in its entirety off of the volar surface of the radius as an ulnarly based flap.

�. 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.6. 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.

1�. After confirmation of the correct positioning of the volar plate by use of fluoroscopy, tighten the first screw.1�. 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.

1�. 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.16. Close the incision.

Universal Volar Plate

7

Operative Technique

1. Longitudinal incision is made just ulnar to Lister’s tubercle at the distal radius region.

�. Dissection is performed down to the extensor retinaculum. The third compartment is opened and the extensor pollicis longus is displaced radially.

�. 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.

�. 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.1�. Place bone or locking screws in the proximal end of the plate.

1�. Confirm correct placement by useof fluoroscopy.1�. Verify proper placement of screws andpegs by use of fluoroscopy to ensure that neitherpenetrates the joint.15. Close the incision.

Dorsal Plate

8

Operative Technique

Radial Column Plate

1. Incision is made along the radial column.�. Care must be taken to avoid injury to dorsal sensory branch of the radial nerve.

�. First dorsal compartment is freed from dorsal to volar to allow plate placement.

�. 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.

9

Ordering Information

54-25384

54-25374

54-25386

54-25376

54-25385

54-25375

54-25387

54-25377

54-25394

54-25396

54-25398

54-25395

54-25397

54-25399

54-25391

54-25392

54-25393

Anatomical Volar DR Plate

Narrow, Right

Anatomical Volar DR Plate

Narrow, Left

Anatomical Volar DR Plate

Standard, Right

Anatomical Volar DR Plate

Standard, Left

Anatomical Volar DR Plate

Narrow, Right, Long

Anatomical Volar DR Plate

Narrow, Left, Long

Anatomical Volar DR Plate

Standard, Right, Long

Anatomical Volar DR Plate

Standard, Left, Long

Universal Volar DR Plate

Narrow, Short

Universal Volar DR Plate

Standard, Short

Universal Volar DR Plate

Wide, Short

Universal Volar DR Plate

Narrow, Long

Universal Volar DR Plate

Standard, Long

Universal Volar DR Plate

Wide, Long

Universal Volar DR Plate

Narrow, XLong

Universal Volar DR Plate

Standard, XLong

Universal Volar DR Plate

Wide, XLong

54-25290

54-25291

54-25292

54-25293

54-25294

54-25295

54-25296

54-25297

54-25400

54-25401

54-25402

54-25403

54-25404

54-25405

Dorsal DR Plate

Standard, Right

Dorsal DR Plate

Standard, Left

Dorsal DR Plate

Wide, Right

Dorsal DR Plate

Wide, Left

Dorsal DR Plate

Standard, Right, XLong

Dorsal DR Plate

Standard, Left, XLong

Dorsal DR Plate

Wide, Right, XLong

Dorsal DR Plate

Wide, Left, Xlong

Radial Column Plate

Short

Radial Column Plate

Long

Ulnar Column Plate

Short, Right

Ulnar Column Plate

Short, Left

Ulnar Column Plate

Long, Right

Ulnar Column Plate

Long, Left

REF Description

Volar Plates

REF Description

REF Description

Dorsal Plates

Fragment Specific Plates

10

Ordering Information

52-27716

52-27718

52-27720

52-27722

52-27724

52-27726

16mm

18mm

20mm

22mm

24mm

26mm

Ti Length REF mm

�.7 mm Partially Threaded Locking Pegs *

52-20616

52-20618

52-20620

52-20622

52-20624

52-20626

16mm

18mm

20mm

22mm

24mm

26mm

Ti Length REF mm

�.0mm Locking Pegs *

52-23610

52-23612

52-23614

52-23616

52-23618

52-23620

52-23622

52-23624

52-23626

52-23628

52-23630

52-23632

52-23634

52-23636

52-23638

10mm

12mm

14mm

16mm

18mm

20mm

22mm

24mm

26mm

28mm

30mm

32mm

34mm

36mm

38mm

Ti Length REF mm

�.�mm Locking Screws *

52-27610

52-27612

52-27614

52-27616

52-27618

52-27620

52-27622

52-27624

52-27626

10mm

12mm

14mm

16mm

18mm

20mm

22mm

24mm

26mm

Ti Length REF mm

�.7mm Locking Screws *

Ti Length REF mm

52-27010

52-27012

52-27014

52-27016

52-27018

52-27020

52-27022

52-27024

52-27026

10mm

12mm

14mm

16mm

18mm

20mm

22mm

24mm

26mm

�.7mm Bone Screws *

Ti Length REF mm

52-23010

52-23012

52-23014

52-23016

52-23018

52-23020

52-23022

52-23024

52-23026

52-23028

52-23030

52-23032

52-23034

52-23036

52-23038

10mm

12mm

14mm

16mm

18mm

20mm

22mm

24mm

26mm

28mm

30mm

32mm

34mm

36mm

38mm

�.�mm Bone Screws *

Ti Length REF mm

52-27116

52-27118

52-27120

52-27122

52-27124

52-27126

16mm

18mm

20mm

22mm

24mm

26mm

�.7mm Partially Threaded Bone Screws *

* Order Quantity: Packages of 5

Twist DrillsREF Description

2.3mm, Stryker shaft end

2.3mm, AO shaft end

2.3mm, Dental shaft end

2.0mm, Stryker shaft end

2.0mm, AO shaft end

2.0mm, Dental shaft end

1.9mm, Stryker shaft end

1.9mm, AO shaft end

1.9mm, Dental shaft end

60-23141

60-23341

60-23441

60-20185

60-20385

60-20485

60-19140

60-19340

60-19440

11

Ordering Information

REF Description

62-20290

62-27007

56-01250

56-01255

56-01260

62-00016

64-20117

64-20118

64-20129

Screwdriver Ratcheting

Handle

Cross-Pin Blade

2.3mm/2.7mm

Polyaxial Drill Guide

2.3mm/2.7mm

Fixed Angle Drill Guide

2.3mm/2.7mm

2.3mm Overdrill and K-Wire

Guide

Depth Measuring Gauge

Plate Bending Pliers

K-wire Bending Pliers

Forceps with Grasping Lips

Instrumentation

REF Description

07-30600

07-30111

07-10006

07-10021

07-10175

43-09830

64-00011

Lobster Bone Holding Forceps

Lewin Bone Holding Forceps,

Sharp Tip

Elevator, Double sided,

Narrow&Wide, Hohmanns

Elevator, Double sided,

Strong&Light Curved

Bone Hook

Mallet (250g)

Tamp

Bone Reduction Instruments

29-27001

29-27002

29-27003

VariAx Distal Radius

Locking Implant Module,

double-sized

Inlay for Anatomical Volar

Distal Radius Plates

Inlay for Universal Volar

Distal Radius Plates

REF Description

Implant Module

29-13012

29-13013

29-13114

29-13024

VariAx Lid for Sterilizing

Container

Sterilizing Container, Half-

size, w/o VariAx Lid

VariAx Distal Radius Plating

Instrument Tray

VariAx Distal Radius Bone

Reduction Tray

REF Description

Sterilizing Container

62-00017

50-23501

50-27500

50-20501

50-23001

50-27000

50-27001

50-27501

50-23502

Depth Measuring Gauge

(Aluminium, UDR Version)

Marker - Locking Screws 2.3mm

Marker - Locking Screws 2.7mm

Marker - Locking Pegs 2.0mm

Marker - Bone Screws 2.3mm

Marker - Bone Screws 2.7mm

Marker - PT Bone Screws 2.7mm

Marker - PT Locking Pegs 2.7mm

Marker - 2.3mm

REF Description

Optional Items

56-40281

07-40281

K-wire with Olive Stop *

K-wire, 1.1x160mm **

K-wiresREF Description

Note: Following Drills may be ordered sterile by replacing “60-” by “91-” in their respective Cat.Nr.: 60- 20185 / 20385 / 19340 / 19440

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

1�

NowStrykerOsteosynthesisoffersyouawidevarietyofsolutionsforthetreatmentofallyourUpperExtremity&HandInjuries.

Complementary Products

TwinFix

KnifeLight

Hoffmann II Micro Lengthener

Hoffmann II Compact MRI

Profyle Modular

T� Humeral Nail

T� Proximal Humeral NailAsnis III �.0 Cannulated ScrewsAxSOS Proximal Humeral Plate

1�

Notes

1�

Notes

15

Notes

Biologics

Surgical Products

Neuro & ENT

Trauma, Extremities & Deformities

Biologics

Surgical Products

Neuro & ENT

Trauma, Extremities & Deformities

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

www.osteosynthesis.stryker.com

The information presented in this brochure is intended to demonstrate a Stryker product. Always refer to the package insert, product label and/or user instructions before using any Stryker product. Surgeons must always rely on their own clinical judgment when deciding which products and techniques to use with their patients. Products may not be available in all markets. Product availability is subject to the regulatory or medical practices that govern individual markets. Please contact your Stryker representative if you have questions about the availability of Stryker products in your area.

Stryker Corporation or its subsidiary owns the registered trademark: StrykerStryker Corporation or its subsidiary owns, uses or has applied for the following trademarks: VariAx, AxSOS, T2, Hoffmann II Copact, Asnis

Literature Number: 90-07800 LOT D0908

Copyright © 2008 Stryker