CANNULINK. Intraossous Fixation System SURGICAL TECHNIQUE

Transcription

1 CANNULINK Intraossous Fixation System SURGICAL TECHNIQUE

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3 Contents Chapter 1 4 Introduction The CANNULINK Advantage Indications for Use Preoperative Planning Chapter 2 5 Surgical Technique CANNULINK Standard and MAX Implant CANNULINK EXT Implant Angled CANNULINK Implant Chapter 3 11 Implants and Instruments Proper surgical procedures and techniques are the responsibility of the medical professional. The following guidelines are furnished for information purposes only as techniques used by the design surgeons. Each surgeon must evaluate the appropriateness of the procedures based on his or her personal medical training and experience. Prior to use of the system, the surgeon should refer to the product package insert for complete warnings, precautions, indications, contraindications and adverse effects. Package inserts are also available by contacting Wright Medical Technology, Inc. Contact information can be found on the back of this surgical technique, and the package insert is available at Please contact your local Wright representative for product availability.

4 Introduction chapter 1 The CANNULINK Advantage Design Feature Advantage CANNULINK EXT Angled Max Cannulation Cancellous Threads Threaded Implant Extension Angled Expandable Barbs Provides surgeons the option to pin across the DIP and MTP joints to address mallet toe and floating toe Robust distal threads optimize pull-out in the poor bone quality of the middle phalanx Versatility to address compromised bone quality by providing additional purchase in the proximal phalanx, increasing the fixation of the overall construct 10 of planer angulation to match anatomy Maximizes bone purchase and pullout strength in the proximal bone X X X X X X X X X Indications for Use The CANNULINK Intraosseous Fixation System is indicated to stabilize and aid in fixation of fractures, fusions, and osteotomies of the phalanges. Preoperative Planning a) Cases where the patient has very poor bone quality or density, CANNULINK Max or CANNULINK EXT Implants may be requested in addition to the standard tray configuration in order to provide additional purchase in the proximal phalanx. b) The CANNULINK System affords the physician the optionality to use the implant with or without temporary guide wire fixation. Use of the guide wire may help minimize MTP subluxation postoperatively. c) Complications with temporary guide wire fixation, such as possible pin tract infections and patient discomfort, could exist with this method. The final treatment option determination can be made intraoperatively at the discretion of the physician. 4 Chapter 1 Introduction

5 Surgical Technique chapter 2 Joint Preparation Step 1 Create an incision over the dorsal aspect of the PIP joint. Perform a transverse capsulotomy with release of the collateral ligaments off the head of the proximal phalanx. Figure 1 The joint dissection and access should provide complete visualization of the articular surfaces of the middle and proximal phalanges. Step 2 Figure 1 A straight toe orientation is achieved when the cuts are perpendicular to the long axis of each phalanx. Resect the distal head of the proximal phalanx. Figure 2 Slight resection is also required of the subchondral bone on the proximal aspect of the middle phalanx. Note: If the toe is desired to be fused at an angle, it is necessary to prepare the resection of the bones at the appropriate angle. Consider using the CANNULINK Angled implants. Reference this surgical technique on page 14. Tip: Assemble the bones after the cuts have been made to ensure they fit together as desired. Note: If using the CANNULINK EXT implant to increase proximal fixation, reference page 10 for implantation of the EXT implants. Figure 2 Implant Sizing Step 3 Determining the appropriate size is a critical step to the procedure. After the necessary resection has been accomplished, the appropriate implant size can now be chosen. There are four implant trial sizers in the set, one for each implant size. Hold the trial sizer on the dorsal and lateral aspects of the bone and take fluoroscopic images in both dorsal-plantar and medial-lateral views. It is imperative that the entire profile of the trial sizer fit within the medullary canal of the phalange (and not overlap with any of the cortical shell). Figure 3 Note: There are two ends on some of the trial sizers. Use the end labeled Neutral for the Standard 2.2, 2.4, 2.7 and 2.9 mm CANNULINK implants and the end labeled Deployed for the 2.4 mm and 2.9 mm CANNULINK Max implants. Figure 3 Both of these states on the sizer represent the splayed state after the guide wire has been inserted through the implant. CAUTION: Do not insert the trial sizer into the bone. Lay the sizer over top of the bone for proper sizing. Chapter 2 Surgical Technique 5

6 CANNULINK Implants CAUTION: Correct implant sizing is critical. Implants that are oversized for a given anatomy can prevent the implant from being completely inserted into the proximal phalanx which may lead to the inability to fully reduce the joint. Implant Selection 12mm 13mm Step 4 Select the implant size (determined from Step 3) and corresponding guide wire. ø2.2 mm ø2.4 mm Implant Part Number Implant Size Wire Size IFS ø2.2 mm 0.8 mm IFS N ø2.4 mm 1.1 mm IFS N ø2.7 mm 1.4 mm IFS N ø2.9 mm 1.6 mm 13mm 14mm Note: Use only the guide wires supplied with the system. CANNULINK Max Optional Implants Implant Part Number Implant Size Wire Size IFS ø2.4 mm 1.1 mm IFS ø2.9 mm 1.6 mm ø2.7 mm ø2.9 mm Proximal Phalanx Preparation Step 5 Based on the size selected, insert the trocar tip of the corresponding guide wire into the proximal phalanx along its central axis. Verify the correct position of the guide wire with dorsal-plantar and medial-lateral fluoroscopy views. After the wire location has been verified, continue to advance the wire until it reaches the desired depth. Figure 4 CAUTION: Correct trajectory is critical as incorrect placement of the wire may cause difficulty implanting the device or misalignment of the joint. Tip: If pinning the MPJ is desired, it is recommended for the trocar tip to pierce the distal cortex of the metatarsal at this time. Figure 4 Instruments depicted throughout the remainder of the technique are used in conjunction with the 2.4 mm CANNNULINK implant. 6 Chapter 2 Surgical Technique

7 Step 6 Figure 5 Based on implant selection, choose the appropriate cannulated drill bit. Color-coded drill bits that correspond with the implant are provided in the system. The 2.2 mm implants correspond with the 1.7 mm diameter yellow drill bit, the 2.4 mm implants correspond with the 2.0 mm diameter green drill bit Figure 5, the 2.7 mm implants correspond with the 2.3 mm diameter magenta drill bit and the 2.9 mm implants correspond with the 2.5 mm diameter blue drill bit. Drill over the guide wire until the boss of the bit abuts the cut surface of the proximal phalanx. Figure 6 CAUTION: If the pilot hole is not drilled to the indicated depth, fully implanting the proximal, barbed portion of the implant may be difficult or not possible. Tip: If the bone is very dense and the cannulated drill is unable to drill to the appropriate depth, utilize the solid drill bits instead (the guide wire will need to be removed). Figure 6 Step 7 If the proximal phalanx is composed of moderate or dense bone and pinning to the MPJ is desired, the drilled pilot hole may require a lead-in. Select the appropriate reamer and attach it to the handle. Place the reamer over the wire and rotate until the boss of the reamer abuts the cut surface of the proximal phalanx. Figure 7 CAUTION: If guide wire fixation is not desired or the bone quality is poor, no reaming is advised. Figure 7 IFS Middle Phalanx Preparation Step 8 Remove the guide wire from the proximal phalanx and insert the trocar tip of the guide wire into the middle phalanx along its central axis. Verify the correct position of the guide wire with dorsal-plantar and medial-lateral fluoroscopy views. After the position has been verified, continue to drive the guide wire distally through both the middle and distal phalanges until it exits the toe. Continue to drive the guide wire distally (by engaging the wire driver s collet on the distal end of the guide wire and pulling) until the laser etched line on the conical tipped end of the wire just contacts the cut surface of the middle phalanx. Figure 8 Figure 8 Chapter 2 Surgical Technique 7

8 Figure 9 Step 9 A countersink is provided to ensure the implant drive feature can be buried below the cut surface of the middle phalanx. Insert the countersink into the handle provided. Figure 9 Place the countersink over the exposed wire and rotate several times so that the countersink shoulder bottoms out on the cut surface of the middle phalanx. Figure 10 Device Implantation and Toe Fixation Figure 10 Step 10 Select the implant that is preloaded onto the driver socket and attach the socket to the handle. Place the implant/handle assembly over the guide wire. Figure 11 Drive the threaded portion of the implant into the middle phalanx by screwing it in place. Continue to drive the threaded portion until the rim of the driver socket is completely within the pocket created by the countersink in the middle phalanx. Remove and dispose of the driver socket from the implant leaving the barbed portion of the implant exposed. Figure 12 Figure 11 CAUTION: Do not insert the implant over the wire unless it is retracted to the laser line because the implant will not be able to be inserted over the wire to the appropriate level and therefore unable to fully engage the middle phalanx. Note: If the guide wire was not advanced to the laser etched line in order to preserve the DIP joint, remove the guide wire prior to driving the implant into the middle phalanx. Figure 12 Step 11 Position the implant in axial alignment with the proximal phalanx drill hole. FIGURE 13 Insert the barbed portion of the implant into the pre-drilled hole in the proximal phalanx. Apply axial force (firmly compress the joint) until appropriate apposition is achieved between the middle and proximal phalanges. Figure 14 Confirm with fluoroscopy in multiple views. Any overhanging bone at the fusion site should be excised. CAUTION: Be aware that the sharp guide wire tip is exposed when implanting. Figure 13 Figure 14 8 Chapter 2 Surgical Technique

9 Tip: The impactor may be used to aid in fully seating the implant in the proximal phalanx. To use the impactor, assemble the impactor into the handle and place it over the wire and onto the distal phalanx. Tap the end of the handle until the middle and proximal phalanx meet. IFS-060 Step 12 Drive the conical tip of the guide wire proximally through the implant and back into the metatarsal to stabilize the MTP joint if desired. Figure 15 This will cause the barbed portion of the implant to splay and increase purchase in the proximal phalanx. Figure 16 Based on the surgeon s discretion, the guide wire fixation of the toe to the metatarsal can be left in place for the initial recovery period to allow the soft tissues to heal and prevent MTP joint subluxation. Optimal fixation strength is obtained by leaving the wire in the implant. Figure 15 Figure 16 CAUTION: If the guide wire does not pass through the implant following application of moderate force, turn off the wire driver. Use fluoroscopy to investigate any implant size or trajectory issues. If a guide wire does not pass through the implant following 2 3 brief attempts, the guide wire should be removed and the implant should be used without it, or a smaller diameter guide wire from the set may be inserted. CAUTION: The 0.8 mm guide wire should not be used to pin across the MPJ. Step 13 Verify the correction and the implant position in multiple views using fluoroscopy. Closure and Post-Operative Care Step 14 Close the surgical site according to surgical preference. If the guide wire is temporarily left in place, trim with wire cutters, and cover exposed end with a Jurgan ball. Post-operative care regimen should be assigned according to surgeon preference. NOTE: Surgeon discretion should be used when considering the appropriate guide wire diameter and duration of temporary fixation provided by the guide wire as wire fracture and pin tract infections are possible. Chapter 2 Surgical Technique 9

10 CANNULINK WITH EXT Step 1-2: See previous technique Step 3 The EXT implants are used in conjunction with the CANNULINK Standard implants that dock within the base of the EXT implant. The EXT implants are named and color coded according to the size of the CANNULINK Neutral implant they are compatible with. Primary Surgery: For use during a primary surgery the implants can be selected by evaluating the EXT implant over a guide wire under fluoroscopy. The profile of the EXT implant should fit within the outer boundary of the cortical shell of the proximal phalanx. Figure 17 Revision Surgery: For the revision of a previously implanted CANNULINK Neutral implant, select the correspondingly named EXT implant. CANNULINK Implant Part Number IFS N IFS N IFS N EXT Implant Part Number IFS N-15S IFS N-18S IFS N-15S IFS N-18S IFS N-16S IFS N-19S Wire Size 1.1 mm 1.4 mm 1.6 mm Note: Use only the guide wires supplied with the system. Proximal Phalanx Preparation Step 4 Figure 18 Base on the implant selected; insert the trocar tip of the corresponding guide wire (the side without the laser etched band) into the proximal phalanx along its central axis. Figure 18 Verify the correct position of the guide with dorsal-plantar and medial-lateral fluoroscopy views. The face planer can be used to correct the cut face of the proximal surface if it is not aligned to the trajectory of the wire. With the face planer loaded into the handle, rotate it back and forth over the guide wire until the bone surface is adequately prepped. Any residual bone on the margins of the phalanx can be removed with a rongeur. CAUTION: Correct trajectory is critical as incorrect placement of the wire may cause difficulty implanting the device or misalignment of the joint. Face Planer IFS-070-P CAUTION: When using the Face Planer, take care not to resect too much bone, especially on the middle phalanx. 10 Chapter 2 Surgical Technique

11 Step 5 Color-coded drill bits that correspond with each EXT implant are provided in the EXT caddy. The 2.4 mm implants correspond with the 3.3 mm diameter green drill bit, Figure 19 the 2.7 mm implants correspond with the 3.6 mm diameter magenta drill bit and the 2.9 mm implants correspond with the 3.8 mm diameter blue drill bit. Drill over the guide wire until the boss of the bit hits the cut surface of the proximal phalanx. Figure 20 Figure 19 Note: The smaller tip diameter of the EXT implant is self-drilling and self-tapping, therefore, it does not require predrilling the entire length of the EXT implant. CAUTION: If the pilot hole is not drilled to the indicated depth, fully implanting the base portion of the EXT implant may be difficult or not possible TIP: If the bone is very dense and the cannulated drill is unable to drill to the appropriate depth, utilize the solid drill bits (the guide wire will need to be removed). Figure 20 EXT Implantation Step 6 Insert the EXT implant into the proximal phalanx using the corresponding color-coded driver. Figure 21 Thread the EXT implant into the proximal phalanx until the hexagonal shoulder hits the resected face. Note: The hexagonal shoulder of the EXT implant must be left proud out of the proximal phalanx, but will reside within the countersink created in the middle phalanx. Figure 21 CAUTION: Driving the EXT implant too far into the proximal phalanx will prevent engagement of the CANNULINK Neutral implant. Middle Phalanx Preparation Step 7 Figure 22 Remove the guide wire from the proximal phalanx and insert the trocar tip of the guide wire into the middle phalanx along its central axis. Verify the correct position of the guide wire with dorsal-plantar and medial-lateral fluoroscopy views. After the position has been verified, continue to drive the guide wire distally through both the middle and distal phalanges until it exits the toe. Continue to drive the guide wire distally (by engaging the wire driver s collet on the distal end of the guide wire and pulling) until the laser etched line on the conical tipped end of the wire just contacts the cut surface of the middle phalanx. Figure 22 CAUTION: If excessive guide wire length is exposed from the middle phalanx, the implant will not be able to be inserted over the wire to the appropriate level and therefore unable to fully engage the middle phalanx. Tip: If guide wire fixation is not desired, do not disrupt the DIP joint or pass the wire distally out the toe. Chapter 2 Surgical Technique 11

12 Step 8 A countersink is provided to ensure the implant drive feature can be buried below the cut surface of the middle phalanx. Figure 23 Insert the countersink into the handle provided. Place the countersink over the exposed wire and rotate several times so that the countersink shoulder bottoms out on the cut surface of the middle phalanx. Figure 24 Figure 23 Figure 24 Device Implantation and Toe Fixation Step 9 Select the CANNULINK Standard implant that is preloaded onto the driver socket and attach the socket to the handle. Place the implant/handle assembly over the guide wire. Figure 25 Drive the threaded portion of the implant into the middle phalanx by screwing it in place. Continue to drive the threaded portion until the rim of the driver socket is completely within the pocket created by the countersink in the middle phalanx. Remove and dispose of the driver socket from the implant leaving the barbed portion of the implant exposed. Figure 26 Figure 25 CAUTION: Do not insert the implant over the wire unless it is retracted to the laser line because the implant will not be able to be inserted over the wire to the appropriate level and therefore unable to fully engage the middle phalanx. Note: If the guide wire was not advanced to the laser etched line in order to preserve the DIP joint, remove the guide wire prior to driving the implant into the middle phalanx. Figure Chapter 2 Surgical Technique

13 Step 10 Position the CANNULINK Standard implant in axial alignment with the EXT implant. Insert the barbed portion of the Standard implant into the EXT implant. Apply axial force (firmly compress the joint) until the implants dock with each other. Ensure apposition is achieved between the middle and proximal phalanges. Confirm with fluoroscopy in multiple views. Any overhanging bone at the fusion site should be excised. Tip: The impactor may be used to aid in fully seating the implant in the proximal phalanx. To use the impactor, assemble the impactor into the handle and place it over the wire and onto the distal phalanx. Tap the end of the handle until the middle and proximal phalanx meet. Note: The hex of the CANNULINK Standard implant must fully engage inside of the EXT for the construct to properly assemble. If engagement cannot be achieved with axial force, use the EXT driver to unthread (counter-clockwise rotation) the EXT implant by a half rotation. If the implant components still do not engage, use the hex driver for the Standard implant to unthread (counter-clockwise rotation) the Standard implant from the middle phalanx by a quarter rotation. Step 11 If desired, drive the conical tip of the guide wire proximally through the implant assembly and back into the metatarsal to stabilize the MTP joint. Based on the surgeon s discretion, the guide wire fixation of the toe to the metatarsal can be left in place for the initial recovery period to allow the soft tissues to heal and prevent MTP joint subluxation. Step 12 Verify the implant position in multiple views using fluoroscopy. Closure and Post-Operative Care Step 13 Close the surgical site according to surgical preference. If the guide wire is temporarily left in place, trim with wire cutters, and cover exposed end with a Jurgan ball. Post-operative care regimen should be assigned according to surgeon preference. NOTE: Surgeon discretion should be used when considering the appropriate guide wire diameter and duration of temporary fixation provided by the guide wire as wire fracture and pin tract infections are possible. Chapter 2 Surgical Technique 13

14 10 Figure 27 ANGLED CANNULINK TECHNIQUE Joint Preparation Step 1 Create an incision over the dorsal aspect of the PIP joint. Perform a transverse capsulotomy with release of the collateral ligaments off the head of the proximal phalanx. The joint dissection access should provide complete visualization of the articular surfaces of the middle and proximal phalanges. Figure 27 Step 2 Resect the distal head of the proximal phalanx just posterior to the head of the phalange. To utilize the angled implants, cut the proximal phalanx at a 10 degree angle in the plantar direction. Slight resection is also required of the subchondral bone on the proximal aspect of the middle phalanx. Figure 28 Figure 28 Figure 29 Tip: Place the middle and proximal phalanx as desired for fusion to verify the bones mate as desired. Figure 29 Implant Sizing Step 3 Determining the appropriate size implant is a critical step to the procedure. After the necessary resection has been accomplished, the appropriate implant size can be chosen. There are implant trial sizers in the set, one for each implant size. Select the neutral side of the sizer and hold it on the dorsal and lateral aspects of the bone and take fluoroscopic images in both dorsal-plantar and medial-lateral views. Figure 30 It is imperative that the entire profile of the trial sizer fit within the medullary canal of the phalange (it must not overlap the cortical shell). CAUTION: Do not insert the trial sizer into the bone. Lay the sizer over top of the bone for proper sizing. Figure 30 CAUTION: Correct implant sizing is critical. Implants that are oversized for a given anatomy can prevent the implant from being completely inserted into the proximal phalanx which may lead to the inability to fully reduce the joint. Fluoroscopic Images 14 Chapter 2 Surgical Technique

15 12 mm CannuLink Angled Implants 13 mm 14 mm Implant Selection Step 4 Select the implant size (determined from Step 3) and corresponding guide wire. Implant Part Number Implant Size Wire Size IFS A ø2.2mm 0.8mm IFS A ø2.4mm 1.1mm IFS A ø2.9mm 1.6mm ø2.2 mm ø2.4 mm ø2.9 mm Note: Use only the guide wires supplied with the system. Proximal Phalanx Preparation Step 5 Based on the size selected, insert the trocar tip of the corresponding guide wire into the proximal phalanx along its central axis. Verify the correct position of the guide wire with dorsal-plantar and medial-lateral fluoroscopy views. After the wire location has been verified, continue to advance the wire until it reaches the desired depth. Figure 31 Figure 31 Figure 32 CAUTION: Correct trajectory is critical, as incorrect placement of the wire may cause difficulty implanting the device or misalignment of the joint. Note: It is not recommended to utilize temporary guide wire fixation across the MPJ in conjunction with Angled CANNULINK Implants. Guide wires should only be utilized for proper intramedullary placement. Step 6 Based on implant selection, choose the appropriate cannulated drill bit. Color-coded drill bits that correspond with the implant are provided in the system. The 2.2 mm implants correspond with the 1.7mm diameter yellow drill bit, the 2.4mm implants correspond with the 2.0mm diameter green drill bit Figure 32 and the 2.9mm implants correspond with the 2.5mm diameter blue drill bit. Drill over the guide wire until the boss of the bit abuts the cut surface of the proximal phalanx. Figure 33 CAUTION: If the pilot hole is not drilled to the indicated depth, fully implanting the proximal, barbed portion of the implant may be difficult or not possible. Tip: If the bone is very dense and the cannulated drill is unable to drill to the appropriate depth, utilize the solid drill bits instead (the guide wire will need to be removed). Figure 33 Chapter 2 Surgical Technique 15

16 Middle Phalanx Preparation Step 7 Remove the guide wire from the proximal phalanx and insert the trocar tip of the guide wire into the middle phalanx along its central axis. Verify the correct position of the guide wire with dorsal-plantar and medial-lateral fluoroscopy views. Figure 34 After the position has been verified, continue to drive the guide wire distally through both the middle and distal phalanges until it exits the toe. Continue to drive the guide wire distally (by engaging the wire driver s collet on the distal end of the guide wire and pulling) until the laser etched line on the conical tipped end of the wire just contacts the cut surface of the middle phalanx. Figure 35 CAUTION: If excessive guide wire length is exposed from the middle phalanx, the implant will not be able to be inserted over the wire to the appropriate level and therefore unable to fully engage the middle phalanx. Tip: If preserving the DIP joint is desired, do not pass the wire distally out the toe. The wire will need to be removed after the countersinking for the drive feature. Figure 34 Figure 35 Step 8 A countersink is provided to ensure the implant drive feature can be buried below the cut surface of the middle phalanx. Insert the countersink into the handle provided. Figure 36 Place the countersink over the exposed wire and rotate several times so that the countersink shoulder bottoms out on the cut surface of the middle phalanx. Figure 37 Figure 36 Figure Chapter 2 Surgical Technique

17 Figure 38 Step 9 Select the implant that is preloaded onto the driver socket and attach the socket to the handle. Figure 38 Place the implant/handle assembly over the guide wire. Drive the threaded portion of the implant into the middle phalanx by screwing it in place. Continue to drive the threaded portion until the rim of the driver socket is completely within the pocket that was created by the countersink in the middle phalanx. The angled implant is orientation dependent. When the flat of the driver is pointed dorsally, the implant is angled plantar. Drive the screw portion of the implant until the words THIS SIDE UP are in line with the dorsal aspect of the middle phalanx. Figure 39 Remove and dispose the driver socket from the implant leaving the barbed portion of the implant exposed. Figure 40 Dorsal View Figure 39 Figure 40 Figure 41 CAUTION: Do not insert the implant over the wire unless it is retracted to the laser line because the implant will not be able to be inserted over the wire to the appropriate level and therefore unable to fully engage the middle phalanx. If the guide wire was not advanced to the laser etched line in order to preserve the DIP joint, remove the guide wire prior to driving the implant into the middle phalanx. Tip: If the surgeon removes the driver socket from the implant prior to achieving the correct, final orientation of the implant, the surgeon must reload the implant on the driver to spin the implant to the desired location. In order to do so, the angled barbed portion of the implant must point away from the flat surface of the driver with the text THIS SIDE UP. When the correct orientation is achieved, axial pressure will allow the implant drive mechanism to engage in the driver and the implant is reloaded. Step 10 Position the implant in axial alignment with the proximal phalanx drill hole. Insert the barbed portion of the implant into the pre-drilled hole in the proximal phalanx. Apply axial force (firmly compress the joint) until appropriate apposition is achieved between the middle and proximal phalanges. Figure 41 Confirm with fluoroscopy in multiple views. Any overhanging bone at the fusion site should be excised. Tip: The impactor may be used to aid in fully seating the implant in the proximal phalanx. To use the impactor, assemble the impactor into the handle and place it over the wire and onto the distal phalanx. Tap the end of the handle until the middle and proximal phalanx meet. Step 11 Verify the correction and the implant position in multiple views using fluoroscopy. Closure and Post-Operative Care Step 12 Remove the wire and close the surgical site according to surgical preference. Postoperative care regimen should be assigned according to surgeon preference. Chapter 2 Surgical Technique 17

18 Implants and Instruments APPENDIX STANDARD IMPLANTS Description Part # 2.2mm Implant & Driver Assembly 2.4mm Implant & Driver Assembly 2.7mm Implant & Driver Assembly 2.9mm Implant & Driver Assembly IFS IFS N IFS N IFS N OPTIONAL IMPLANTS Description Part # 2.4mm Max Implant & Driver Assembly 2.9mm Max Implant & Driver Assembly 2.2mm Angled Implant & Driver Assembly 2.4mm Angled Implant & Driver Assembly 2.9mm Angled Implant & Driver Assembly IFS IFS IFS A IFS A IFS A EXT IMPLANTS Description Part # 2.4mm 15mm EXT Implant IFS N-15S 2.4 mm 18mm EXT Implant IFS N-18S 2.7 mm 15mm EXT Implant IFS N-15S 2.7mm 18 mm EXT Implant IFS N-18S 2.9mm 16mm EXT Implant IFS N-16S 2.9mm 19mm EXT Implant IFS N-19S 18 CANNULINK Intraossous Fixation System

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20 1023 Cherry Road Memphis, TN Nesbitt Avenue South Bloomington, MN and denote Trademarks and Registered Trademarks of Wright Medical Group N.V., or its affiliates Wright Medical Group N.V. or its affiliates. All Rights Reserved. IFS REV B ECN Apr-2016