VariAx. Hand & Wrist. Distal Radius Locking Plate System

Transcription

1 Hand & Wrist VariAx Distal Radius Locking Plate System Hand & Wrist Operative Technique Anatomical & Universal Volar Plates Dorsal Plates Fragment Specific Plates XXL Anatomical Volar Plates

2 VariAx Distal Radius Locking Plate System This publication sets forth detailed recommended procedures for using Stryker Osteosynthesis devices and instruments. It offers guidance that you should heed, but as with any such technical guide, each surgeon must consider the particular needs of each patient and make appropriate adjustments when and as required. A workshop training is recommended prior to first surgery. All non-sterile devices must be cleaned and sterilized before use. Follow the appropriate instructions for use (IFU). For additional information please refer to the instructions in our reprocessing guide (L ). Multi-component instruments must be disassembled for cleaning. Please refer to the corresponding assembly/disassembly instructions. See package insert ( , ) for a complete list of potential adverse effects, contraindications, warnings and precautions. The surgeon must discuss all relevant risks, including the finite lifetime of the device, with the patient, when necessary. Warning: Fixation Screws: Stryker Osteosynthesis bone screws are not approved or intended for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic or lumbar spine. 2

3 Contents Page 1. Indications, Precautions & Contraindications 5 Intended Use 5 Precautions 5 Indications 5 Contraindications 5 2. Features and Benefits 6 3. Overview 8 Plate Options 8 Screw/Peg Options 8 4. Operative Technique 11 Anatomical Volar Plate 11 Universal Volar Plate 13 Dorsal Plate 15 Lateral Distal Radius Plate 17 Aiming Block 18 Ordering Information Plates 20 Ordering Information Cross Pin Screws 23 Ordering Information T7 Drive Screws 25 Ordering Information Instruments 27 Ordering Information Plate Trials 28 Complementary Products 30 3

4 Indications, Precautions & Contraindications The VariAx Distal Radius Plating System represents the Next Generation of Bone Fixation for your Distal Radius Fracture Needs. Intended Use The VariAx Distal Radius Locking System including the XXL Volar Distal Radius Plates is intended for internal fixation of small bone fractures, primarily including distal radius fractures. Precautions Stryker Osteosynthesis systems have not been evaluated for safety and use in MR environment and have not been tested for heating or migration in the MR environment, unless specified otherwise in the product labeling. Indications Compression, intra-articular and extra-articular fractures, and displaced fractures. Following additional indications apply only for the XXL Volar Distal Radius Plates: Osteotomies, non-unions, and malunions. Contraindications Inadequate bone quantity and quality. Patients with active infections. Patients with metal allergies and foreign body sensitivity. Severely non-compliant patients with mental or neurological conditions who are unwilling or incapable of following postoperative care instructions. Patients with limited blood supply or insufficient quality or quantity of bone. Patients with unstable physical and/or mental health conditions. 4

5 Features and Benefits System Features Comprehensive Plating System Providing Anatomical Volar and Dorsal, Universal Volar and Fragment Specific Solutions. Anatomical Volar Plate Encourages articular support with Locking screws & pegs, promotes buttressing to the volar lunate facet and stable fixation of radial styloid fragments with two screws. XXL Anatomical Volar Plates Extra long volar plates are needed for cases where the metaphyseal comminution extends to the radial shaft. They follow the curvature of the bone as it extends toward the proximal end of the radius. 4 lengths: right, left, standard and narrow plates are offered. Fixed Angle Drill Guide Helps to assure 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. Range of 2.0mm to 2.7mm Locking and Non-Locking screws & pegs offering intraoperative solutions for different fracture fixation requirements. All pegs and screws may be used in any round hole in the plate. Anodization Type II Fixation of radial styloid with 2 screws locking capability 5

6 Features and Benefits T7 Drive and Cross-Pin Screw Head Designs Both screw head designs allow axial stability, friction fit screw retention, and easy screw pick up from screw rack. T7 Drive SmartLock** Locking Technology 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, to engage the circular lip within any hole on the plate, except the oblong hole in the shaft. One-step Locking Can be achieved by simply inserting a Locking Screw or Peg within the polyaxial locking range of ±15 degrees, without the need for further steps. Cross-Pin Aiming Block and Scaled Drill bits The Aiming Block provides a simple option for screw placement with pre-determined screw trajectories. The Aiming Block accommodates the variable angle* drill guide, allowing for single-step drilling and screw length determination without the need for a separate depth gauge. Screws can be implanted through the Aiming Block while it is attached to the plate. The Joystick handle allows for easy manipulation, fixation and removal of plate and Aiming Block assembly. The Joystick handle can be removed after initial fixation of the Aiming Block to allow for accessible working environment. K-Wire holes approximate the trajectories of the distal screws. Left Right Scaled drill bits provide another option for screw length measurement and allow for one step drilling and measuring. * When used through the Aiming Block, the variable angle drill guide will only allow for screws to be placed in pre-determined screw trajectories. ** The SmartLock Technology is patented (US 6, 322, 562; DE ) by Professor Dietmar Wolter, Hamburg, Germany. 6

7 Overview Plate Options Left Right Anatomical Volar Plates Universal Volar Plates Dorsal Plates Lateral DR Plate Dorsal Medial DR Plate Screw/Peg Options 2.0mm Smooth Locking Peg 2.3mm Locking Screw XXL Anatomical Volar Plates 2.7mm Locking Screw 2.7mm Partial Thread Locking Screw 2.3mm Non- Locking Screw 2.7mm Non- Locking Screw Note: Plates are not scaled to size. 2.7mm Partial Thread Non-Locking Screw T7 Drive Cross-Pin Locking Screw Locking Screw Bone Screw Bone Screw Note: Locking and Non-Locking screws can be used in any round hole. To avoid disengagement of the screwdriver blade from the screw during insertion, axial pressure is recommended. 7

8 Overview Fixed Angle Drill Guide ( ) This drill guide can be used to help ensure placement of screw options at a fixed angle. It is designed to fit in the pre-tilted lips within the holes on the plate by simply pressing the drill guide into the hole. 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. 18 distal 12 lateral 15 distal 15 lateral 15 distal 15 lateral 0 5 proximal 0 18 distal 12 lateral 12 proximal 5 proximal Pre-determined Screw Pattern 0 10 proximal 5 proximal 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-degree cone and every angle in this range will be a locking position. This may allow the surgeon to aim where the screw/peg should be placed. 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. 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 compromise the locking capabilities. 8

9 Overview 2.3mm Drill Guide/K-Wire Guide ( ) The 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-degree locking cone as the SmartLock Polyaxial 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. Depth Gauges Silver ( ); Black ( ) A choice of 2 Depth Gauge designs allows for a reliable screw measurement depending on surgeon preference. 9

10 Operative Technique Anatomical Volar Plate 1. An incision is made approximately 5-8cm 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. 2. The FCR tendon is retracted ulnarly and dissection is carried down through the floor of the FCR sheath. 3. The Pronator Quadratus muscle 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 and reduced. 6. The use of external traction, and/ or the use of K-Wires for temporary fixation may be helpful. The use of AP/Lateral fluoroscopy is helpful to determine correct fracture reduction and plate position. 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 oblong gliding hole using the appropriate drill guide. 11. Use the depth gauge to determine screw length. 10

11 Operative Technique Anatomical Volar Plate 12. A non-locking screw is placed in the oblong 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. 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. Note: In hard, cortical bone a 2.3mm cortical drill bit ( ) or the 2.7mm tap ( ) may be used to insertthe 2.7mm screw to help reduce the risk of screw breakage during insertion. 11

12 Operative Technique Universal Volar Plate 1. An incision is made approximately 5-8cm 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. 3. The Pronator Quadratus muscle 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. 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/Lat fluoroscopy 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 oblong 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 oblong gliding hole but not completely tightened to allow adjustment of the plate in distal or proximal directions. 12

13 Operative Technique Universal Volar Plate 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 depends on 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. 16. Close the incision. 13

14 Operative Technique Dorsal Plate 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 terminal branches of the posterior interosseous nervemay be excised 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. 5. If necessary, adapt the plate for correct anatomical position. Removal of Lister's Tubercle 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 positioning of the plate should be confirmed by use of fluoroscopy. The first pilot hole should be drilled in the oblong gliding hole. 7. Measure the depth of the hole to determine screw length. 8. The screw is placed in the oblong gliding hole but not completely tightened to allow adjustment of the plate in a distal or proximal direction. 14

15 Operative Technique Dorsal Plate 9. Confirm proper plate positioning by use of fluoroscopy and then tighten the first screw. Note: Screw length may need to be changed after plate is fully seated on bone. 12. Confirm correct placement by use of fluoroscopy. 13. Verify proper placement of screws and pegs by use of fluoroscopy to ensure that they do not penetrate the joint. 14. Close the incision. 10. 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. 11. Place bone or locking screws in the proximal end of the plate. 15

16 Operative Technique Lateral Distal Radius Plate 1. An incision is made along the radial column. 2. Care must be taken to avoid injury to the superficial branch of the radial nerve. 3. The first dorsal compartment is released. The tendons are retracted volarly. 4. The fracture should be reduced and stabilized with a K-Wire placed from the distal radial styloid and aimed dorsal and proximal. Note: Fragment specific plates should not be used in isolation. 16

17 Operative Technique Lateral Distal Radius Plate 5. The plate is slipped over the K-Wire and placed along the radial column. 6. A cortical screw placed in the oblong hole will compress the plate to the shaft, and by pulling the plate proximally will compress the fracture site. 17

18 Operative Technique Lateral Distal Radius Plate 7. The 3 in 1 K-Wire bender/cutter/ inserter is used to bend K-Wires distally. 8. 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. 9. After insertion, the tamp and mallet can be used to further insert the K-Wires. 10. K-Wires and screws can be placed in conjunction for more rigid fixation. 11. The incision is closed. 18

19 Operative Technique Aiming Block a. b. c. 1. Choose Aiming Block that corresponds to the plate that will be used (left/right, narrow/standard). Place peg on underside of block into shaft hole on plate. 2. Remove joystick from tray. a. Insert the joystick into fixation pin and tighten black grasping sleeve onto fixation pin (Turn Clockwise). b. Turn the silver knob on the joystick counter-clockwise to open fixation pin (approx 2 turns). c. Pull joystick upward to remove pin assembly from tray. 3. The surgeon should choose which hole to place the pin in the block to mount the Aiming Block to the plate. Any hole may be used, except the most distal radial styloid hole because that hole has no slot to accommodate the tab on the pin. Then align the tab on the fixation pin with the slot on the Aiming Block as shown in the highlighted area. 4. Place joystick / fixation pin assembly though Aiming Block and into the plate. * The wings on the underside of the pin must be closed in order for the pin to fit through the hole in the plate. 5. Verify that the fixation pin protrudes from the bottom of the plate. * If the pin does not fully protrude through the plate, slowly turn the joystick counterclockwise to close the pin. As the wings on the pin close, you will hear a click to verify the pin is fully through the plate. 6. Turn the joystick knob clockwise to spread the wings on the pin and tighten Aiming Block to plate (approx 2 turns). Attention: Fixation pin should not be overly tightened as this may damage the threads on the pin. Only moderate effort is needed. (Finger tighten only). Attention: Once the block is mounted to the plate, verify the alignment by passing a K-Wire through the K-Wire holes. This should be done prior to mounting the block to the bone. 19

20 Operative Technique Aiming Block 7. The joystick may be used to help position the plate on the bone. After plate is positioned, remove the joystick by loosening the black grasping sleeve from the fixation pin (counter clockwise). Caution: Aiming Block cannot be used with plates that have been intraoperatively contured or bent. 8. K-Wires may be used through the plate / block assembly for temporary fixation. 9. The variable angle drill guide can be used in any hole to drill for the pre-determined trajectory. 10. Drill through drill guide. The scale on drill bit can be used to determine appropriate screw length. Attention: To prevent damage to Aiming Block and/or plate, the variable angle drill guide must be used. 11. Measure depth with depth gauge and choose appropriate screw. Ensure that tip of measuring gauge is fully seated onto the plate. 12. Screw can be inserted through Aiming Block. Confirm screw placement under fluoroscopy. 20

21 Operative Technique Aiming Block a. b. 13. Removal of Aiming Block a. Attach joystick to fixation pin by tightening black grasping sleeve. (clockwise) b. Turn joystick knob counterclockwise to open fixation pin. (approx 2 turns) 14. Remove joystick / fixation pin assembly from Aiming Block. Optional Steps: Under fluoroscopy, the K-Wire will approximate the trajectory of the adjacent screw on the ulnar side. Note: There is no K-Wire hole to approximate the distal most radial styloid screw. 15. Remove Aiming Block from plate. If necessary a screw can be placed in hole used for fixation of the Aiming Block. Ensure that all screw heads are fully seated onto the plate and fully tightened. Note: Left block is shown. 21

22 Ordering Information Plates Anatomical Volar Plates Length Profile Height Description mm mm 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 76 2 Universal Volar Plates Length Profile Height Description mm mm 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

23 Ordering Information Plates XXL Anatomical VOLAR Plates Profile Height Profile Height Length Distal Shaft Description mm mm mm S XXL Volar DR Plate, Stand, LE (15 holes) S XXL Volar DR Plate, Stand, RI (15 holes) S XXL Volar DR Plate, Stand, LE (11 holes) S XXL Volar DR Plate, Stand, RI (11 holes) S XXL Volar DR Plate, Stand, LE (8 holes) S XXL Volar DR Plate, Stand, RI (8 holes) S XXL Volar DR Plate, Stand, LE (5 holes) S XXL Volar DR Plate, Stand, RI (5 holes) S XXL Volar DR Plate, Narrow, LE (15 holes) S XXL Volar DR Plate, Narrow, RI (15 holes) S XXL Volar DR Plate, Narrow, LE (11 holes) S XXL Volar DR Plate, Narrow, RI (11 holes) S XXL Volar DR Plate, Narrow, LE (8 holes) S XXL Volar DR Plate, Narrow, RI (8 holes) S XXL Volar DR Plate, Narrow, LE (5 holes) S XXL Volar DR Plate, Narrow, RI (5 holes)

24 Ordering Information Plates Dorsal Plates Length Profile Height Description mm mm 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 Fragment Specific Plates Length Profile Height Description mm mm Lateral DR Plate, Short* Lateral DR Plate, Long* Dorsal Medial DR Plate, Short, Right** Dorsal Medial DR Plate, Short, Left** Dorsal Medial DR Plate, Long, Right** Dorsal Medial DR Plate, Long, Left** 53 1 Note: Fragment specific plates should not be used in isolation. * Formerly labelled as Radial Column Plate ** Formerly labelled as Ulnar Column Plate 24

25 Ordering Information Plate Trials XXL Anatomical volar Plate trials Description T XXL Volar DR Trial, Narrow, LE (11 holes) T XXL Volar DR Trial, Narrow, RI (11 holes) T XXL Volar DR Trial, Narrow, LE (8 holes) T XXL Volar DR Trial, Narrow, RI (8 holes) 25

26 Ordering Information Plate Trials X-RAY TEMPLATES Description X-Ray Template XXL Volar DR Plates (Scale 1:1) X-Ray Template XXL Volar DR Plates (Scale 1.15:1) Markers Description 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 Aiming Blocks Description Volar DR Aiming Block, narrow, right Volar DR Aiming Block, narrow, left Volar DR Aiming Block, standard, right Volar DR Aiming Block, standard, left VariAx DR Aiming Block Fixation Pin Variax DR Aiming Block Fixation Joystick Variax DR Aiming Block, Tray Insert 26

27 Ordering Information Cross-Pin Screws 2.0mm Locking Pegs 2.7mm Locking Screws Ti Length mm Ti Length mm E E E E E E 26 For the 2.0mm Locking Pegs, please use the following 2.0mm drill ref: , and E E E E E E E E E 26 For the 2.7mm Locking Screws, please use the following 2.0mm drill ref: , and mm Locking Screws 2.7mm Partially Threaded Locking Screws Ti Length mm Ti Length mm E E E E E E E E E E E E E E E E E E E E E 26 For the 2.7mm Partially Threaded Locking Screws, please use the following 2.0mm drill ref: , and For the 2.3mm Locking Screws, please use the following 1.9mm drill ref: , and

28 Ordering Information Cross-Pin Screws 2.3mm Non-Locking Screws 2.7mm Partially Threaded Non-Locking Screws Ti Length mm Ti Length mm E E E E E E E E E E E E E E E E E E E E E 26 For the 2.7mm Partially Threaded Screws, please use the following 2.0mm drill ref: , and For the 2.3mm Screws, please use the following 1.9mm drill ref: , and mm Non-Locking Screws Twist Drills, Tap and Blade Ti Length mm E E E E E E E E E 26 For the 2.7mm Screws, please use the following 2.0mm drill ref: , and Description Tap for 2.7mm Screws, Hex Tap for 2.7mm Screws, AO Screwdriver Blade, Self-Retaining, Cross-Pin, Hex Drill Bits Drill Drill End Diameter AO Stryker Dental 1.9mm mm mm

29 Ordering Information T7 Drive Screws 2.0mm Locking Pegs 2.7mm Locking screws Ti Length mm Ti Length mm E E E E E E 26 For the 2.0mm Locking Pegs, please use the following 2.0mm drill ref: , and E E E E E E E E E 26 For the 2.7mm Locking Screws, please use the following 2.0mm drill ref: , and mm Locking Screws 2.7mm Partially Threaded Locking Screws Ti Length mm Ti Length mm E E E E E E E E E E E E E E E E E E E E E 26 For the 2.7mm Partially Threaded Locking Screws, please use the following 2.0mm drill ref: , and For the 2.3mm Locking Screws, please use the following 1.9mm drill ref: , and

30 Ordering Information T7 Drive Screws 2.3mm Non-Locking Screws 2.7mm Partially Threaded Non-Locking Screws Ti Length mm Ti Length mm E E E E E E E E E E E E E E E E E E E E E 26 For the 2.7mm Partially Threaded Screws, please use the following 2.0mm drill ref: , and For the 2.3mm Screws, please use the following 1.9mm drill ref: , and mm Non-Locking Screws Twist Drills, Tap and Blade Ti Length mm E E E E E E E E E 26 Description Tap for 2.7mm Screws, Hex Tap for 2.7mm screws, AO Screwdriver Blade, Self-Retaining, T7, Hex Screwdriver Blade, compatible with Capture Sleeve, T7, Hex Capture Sleeve for 2.3mm & 2.7mm T7 screws For the 2.7mm Screws, please use the following 2.0mm drill ref: , and Drill Bits Drill Drill End Diameter AO Stryker Dental 1.9mm mm mm

31 Ordering Information Instruments Instrumentation Implant Module Description Description Screwdriver Ratcheting Handle Polyaxial Drill Guide 2.3mm/2.7mm Fixed Angle Drill Guide 2.3mm/2.7mm mm Overdrill and K-Wire Guide Plate Bending Pliers K-Wire Bending Pliers VariAx Distal Radius Locking Implant & Recessed Screw Module* Module * Recessed Screw Module to be used with Self-Retaining Blades ( T7 Blade or Cross-Pin Blade) VariAx Distal Radius Implant Module, Compatible with Capture Sleeve* * Capture Sleeve for 2.3mm & 2.7mm T7 screws. (Capture Sleeve to be used with Screwdriver Blade) Instrumentation Forceps with Grasping Lips Inlay for Anatomical Volar Distal Radius Plates Description Inlay for Universal Volar Distal Radius Plates Lobster Bone Holding Forceps Lewin Bone Holding Forceps, Sharp Tip Inlay for Volar Anatomical XXL DR Plates Elevator, Double sided, Narrow&Wide, Hohmanns Sterilizing Container Description Elevator, Double sided, Strong&Light Curved VariAx Lid for Sterilizing Container Bone Hook Mallet (250g) Tamp Sterilizing Container, Half-size, w/o VariAx Lid Depth Gauges Description VariAx Distal Radius Plating Instrument Tray K-Wires VariAx Distal Radius Depth Gauge for 2.3/2.7 mm Screws, black Depth Measuring Gauge Inlay for Universal Volar Distal Radius Plates Description K-Wire with Olive Stop, 1.4mm * K-Wire, 1.1x160mm ** * Order Quantity: Packages of 5 ** Order Quantity: Packages of 10 31

32 Now Stryker Osteosynthesis offers you a wide variety of solutions for the treatment of Upper Extremity & Hand Injuries. TwinFix KnifeLight T2 Humeral Nail Hoffmann II Micro Lengthener Hoffmann II Compact MRI Profyle and VariAx Hand AxSOS Proximal Humeral Plate Asnis III 4.0 Cannulated Screws T2 Proximal Humeral Nail 32

33 Notes 33

34 Notes 34

35 Notes 35

36 Manufactured by: Stryker Leibinger GmbH & Co. KG Bötzinger Straße 41 D Freiburg Germany 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 is intended to demonstrate a Stryker product. A surgeon must always refer to the package insert, product label and/or instructions for use, including the instructions for Cleaning and Sterilization (if applicable), before using any Stryker product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in 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: Asnis, AxSOS, Hoffmann, Knifelight, Profyle, SmartLock, Stryker, T2, TwinFix, VariAx. All other trademarks are trademarks of their respective owners or holders. Distributed by: Stryker 325 Corporate Drive Mahwah, NJ t: The products listed above are CE marked. Literature Number: LVX-OT Rev 4 Copyright 2012 Stryker