Visualize, stabilize, mobilize. Wristore * Distal Radius Fracture Fixator Abbreviated Surgical Technique

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1 Visualize, stabilize, mobilize Wristore * Distal Radius Fracture Fixator Abbreviated Surgical Technique

2 Wristore Distal Radius Fracture Fixator 1 Pin Placement Identify anatomy and make a direct (open) incision on the mid-lateral aspect of the radial shaft centered approximately 8.0cm proximal of radial styloid tip. Use Pin Guide with Powered Driver to place 3.0mm Self-drilling Pins into the radius in a parallel fashion. Identify anatomy and make a direct incision on the radial side of the second metacarpal approximately 5.0mm distal to the metacarpal/carpal joint. Use Pin Guide to place 2.5mm Self-drilling Pins into the second metacarpal. Pins can also be placed percutaneously. Care should be taken to protect the superficial radial nerve at all times. 2 Fixator Application Thumb Wheel (P/S) 2 1 (C/D) (F/E) (R/U) Loosen (but do not remove) all screws on Fixator Assembly. Place Fixator Body on Radial Pins using dorsal holes, tighten blue Locking Screws labeled #1 and leave approximately 1.5cm of skin to fixator clearance. (Dovetail Slide and Dorsal Outrigger may need to be temporarily applied for measurement.) Place Metacarpal Segment onto Metacarpal Pins and again tighten blue Locking Screws labeled #2 and leave approximately 1.5cm of skin to fixator clearance. Manual manipulation of the distracted joint should be performed to achieve anatomic reduction. While holding hand in position, Radial/Ulnar Deviation (R/U), Pronation/Supination (P/S) and Flexion/Extension (F/E) adjustments can be performed with the loosening or tightening of the three black screws. Compresssion/Distraction (C/D) adjustments can be performed by adjusting the gray Thumb Wheel. Confirm fracture reduction with fluoroscopy and adjust if necessary.

3 3 K-Wire Fixation According to preoperative planning, place first 1.6mm K-wire in the tip of the radial styloid, passing obliquely to the proximal radial cortex. Place second K-wire, dorsal to volar, in the void between the second/third and fourth dorsal extensor compartments. Check finger and thumb motion to ensure that all extensor tendons have motion and have not been captured by a K-wire. NOTE: Intra-articular fractures may require variations in pin configurations to achieve fracture stability. Confirm K-wire placement using fluoroscopy. 4 Outrigger Application Dovetail Slide Dorsal Outrigger Loosely attach Dovetail Slide to the Fixator Body and then Dorsal Outrigger to Dovetail Slide. The Dorsal Outrigger should be positioned within 1.0cm of the radiocarpal joint with cm of dorsal clearance.

4 5 K-Wire Connection Universal Wire Arm Wire Holder Stem Tower Disassemble the Stem from the Tower on the Universal Wire Arm, and loosen all screws. Slide Wire Holder over the K-wire(s) and align stem over the Dorsal Outrigger. Slide attachment base into appropriate slot on the Dorsal Outrigger and reintroduce the Stem into the Tower without placing tension on the K-wire. Use blade tip end of Wrench/Driver to tighten Locking Screws of Wire Holder. Tighten remaining screws of Universal Wire Arm. Then use open hex end to tighten hex nut on attachment base, securing Universal Wire Arm to the Dorsal Outrigger. Tighten screws on Dovetail Slide. NOTE: Wire holder(s) should be positioned off the skin. If necessary the K-wire(s) can be bent degrees away from skin. Additional K-wires can be placed using the Universal Wire Arms to guide their insertion. 6 Final Adjustments Wrench/Driver Once fixation is complete, relax traction and return hand to a more neutral position. NOTE: Ensure tightening of the gray Locking Screw at the Threaded Bar. Snug Thumb Wheel against the main body. Ensure interphalangeal and metacarpal phalangeal joints can achieve 90 degrees of passive flexion. Use fluoroscopy to confirm fracture reduction and pin/wire placement. Confirm all screws are locked tight. If desired, cut K-wires off and place pin and wire caps. Postoperative Protocol: For comminuted, unstable fractures, maintain distraction for approximately 3 4 weeks. Encourage finger and thumb movement. As healing progresses, the Metacarpal Segment of the Fixator Body and the Metacarpal Pins may be removed to mobilize the wrist. Wrist range-of-motion exercises can be initiated. A custom thermoplast splint can be worn for comfort and removed for wrist and finger therapy and showering.

5 Complete Sterile Kit The Wristore Fixator is available in a sterile-pack kit that includes all fixator components and instruments in one tray. The kit includes: A) Fixator Body B) Pin Inserter/Remover C) Five pin caps D) Pin Guide E) Two 3.0mm Radial Pins F) Two 2.5mm Metacarpal Pins G) Dorsal Outrigger H) Dovetail Slide I) Five K-wire caps J) Four 1.6mm K-wires K) Two Universal Wire Arms L) Wrench/Driver The surgical technique steps are illustrated on the underside of the lid. B A C D L E F K J I G H Ordering Information Prod. No. Description Wristore Sterile Pack Wristore Wrench/Driver Wristore Pin Inserter/Remover

6 Wristore Fixator Components 2.5mm Self-Drilling/ Self-Tapping Metacarpal Pins Metacarpal Segment 1.6mm K-Wires Universal Joint Universal Wire Arms Threaded Bar (Main Adjusting Screw) Fixator Body Dorsal Outrigger 3.0mm Self-Drilling/ Self-Tapping Radial Pins Dovetail Slide Locking Screw * Wristore is a trademark of Millennium Medical Technologies, Inc. Radial Body Segment Contact your Zimmer representative or visit us at Contact your Zimmer representative or visit us at ML Printed in USA 2005 Zimmer, Inc.

The NBX Non-Bridging External Fixator A Non-Bridging External Fixator/Locking Plate capturing a series of.062mm K-wires and 3mm half-pins that are

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