INDEX Indications Patient Position Surgical Technique - Step 1 Approach - Step 2 Plate Contouring - Step 3 Fracture Reduction - Step 4 Distal Plate Fixation - Step 5 Confirm Proper Reconstruction - Step 6 Implant Removal Warning This publication describes the recommended procedures for using Double Engine devices and instruments. It offers guidance that you should pay attention to. But as with any such technical guide, the guide alone does not provide sufficient background for direct use of the instrument set, each surgeon should also consider the particular needs of each patient and make appropriate adjustments when required. Instruction by experienced surgeon is still highly recommended. All non-sterile devices must be cleaned and sterilized before use. Multi-component instruments must be disassembled for cleaning. Please follow the instructions provided in our Reprocessing, Care and Maintenance Guide (RCMG-2012). Please refer to 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. Caution The implants are designed for temporary fixation of fractured bone fragments until the bone heals. Therefore, if bone does not heal or bone consolidation is delayed or not sufficient, the system may break. Post-operative care under the guidance of the surgeon is also very important and it must be done to ensure the promotion of bone consolidation.
Surgical Technique Indications Indications for this implant are fractures of the distal ulna resulting in unstable radioulnar joint, fractures of the ulna head where the articular surface is displaced, rotated, or tilted, and comminuted extraarticular fractures of the ulnar neck. Patient Position The distal ulna should be placed in a supine position holding the forearm in neutral rotation and allowing a direct approach to the distal ulna. STEP 1 APPROACH The access to the ulna is made through a straight longitudinal incision between the tendons of the extensor carpi ulnaris and flexor carpi ulnaris over the distal ulna. STEP 2 PLATE CONTOURING 111182400 Universal Bending Pliers Contour the plates if necessary with the bending pliers. STEP 3 FRACTURE REDUCTION 111182200 Reduction Forceps with Points 111182300 Reduction Forceps, curved As a reference, situate and secure the hooks of the plate on the tip of the ulnar styloid. It might be useful to stabilize the fracture with the help of reduction forceps STEP 4 PLATE FIXATION 4.1 Drill the desired hole 111301000 Drill Bit, φ1.5, length 110mm 111301100 Drill Sleeve with Scale, φ1.5 Attach the drill sleeve to the desired hole and predrill through the drill sleeve with the 1.5mm drill bit.
4.2 Measure the screw length 4.3 Insert the locking screw STEP 5 CONFIRM PROPER RECONSTRUCTION STEP 6 IMPLANT REMOVAL 111304000 Depth Gauge for 1.5/2.0 Locking Screws Then remove the drill sleeve and measure the screw length with help of the depth gauge. 111305600 Screwdriver, Stardrive, T6 Insert the appropriate 2.0 locking screw with the screwdriver T6 until seated. Use the image intensifier to check the correct reconstruction of the joint, screw position and length from AP, lateral and multiple oblique views. 111305600 Screwdriver, Stardrive, T6 Unlock all screws from the plate before removing all locking screws from the bone. If locking and cortical screws where used, the last screw to be removed should be a non-locking screw in the shaft to prevent the rotation of the plate while removing the locking screws. 4.4 Final tigthen Optional 111304200 Handle for Torque Indicating Screwdriver, T6, 0.4Nm 111301500 Screwdriver Shaft, Stardrive, T6 For final tightening use the Torque Indicating Screwdriver, T6, 0.4Nm. 110221100 Double Drill Guide, φ1.5/φ2.0 111301200 Countersink for φ2.0 Screws 111301400 Tap for Cortex Screws φ2.0 111301500 Screwdriver Shaft, Stardrive, T6 110224000 T-Handle with Quick Coupling The plate offers various options for screw insertion in the distal part permitting to stabilize a wide range of fractures. If length adjustment is needed, one or two 2.0 locking screws should be place into the ulna head in order to securely fix the implant. Place then a 2.0mm cortex screw in the oblong hole to get the correct reduction length. Depending on the bone quality, a combination of cortex and locking screws can be used in the nearby holes to get and optimal fracture stabilization.
Distal Ulnar Locking Plate Instruments 111290000 111301000 Drill Bit, φ1.5, length 110mm 111301100 Drill Sleeve with Scale, φ1.5 111301200 Countersink for φ2.0 Screws 110221100 Double Drill Guide, φ1.5/φ2.0 111301400 Tap for Cortex Screws φ2.0 111301500 Screwdriver Shaft, Stardrive, T6 111301700 Case, HA2.0 111301800 111301900 Tray for Plate φ2.0 111304000 Depth Gauge for 1.5/2.0 Locking Screws 111304200 Handle for Torque Indicating Screwdriver, T6, 0.4Nm 111304400 Holding Forceps for Plates 111304500 Holding Forceps for Screws 111182200 Reduction Forceps with Points 111182300 Reduction Forceps, curved Case Cover, HA2.0
111304800 Bending/Cutting Pliers 111305600 Screwdriver, Stardrive, T6 110224100 Sharp Hook 111182400 Universal Bending Pliers 110223400 Handle with Quick Coupling, straight 110223200 Periosteal Elevator, 3mm 110224000 T-Handle with Quick Coupling 110223100 Periosteal Elevator, 5mm 111430100 Mini Locking Instrument Case 110223700 Bone Lever, 6.5mm 110223800 Bone Lever, 8.5mm 110223900 Bone Lever, 15.5mm