COMPACT ANKLE FRACTURE SYSTEM Consolidated ankle fracture solution for surgery centers SURGICAL TECHNIQUE
TABLE OF CONTENTS INTRODUCTION Compact Ankle Fracture System 2 AO Principles 8 Indications 9 Clinical Cases 10 SURGICAL TECHNIQUE Preparation 11 2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate 12 Technique for Distal Fibula Fracture 3.5 mm LCP Hook Plate Technique 20 for Distal Fibula Fracture 4.0 mm Cannulated Screw Technique 26 for Medial Malleolus Fracture PRODUCT INFORMATION Implants 32 Instruments 36 Set List 42 Image intensifier control Compact Ankle Fracture System Surgical Technique DePuy Synthes Select
CONSOLIDATED ANKLE FRACTURE SOLUTION FOR SURGERY CENTERS DePuy Synthes Select offers surgical device systems designed for use in the most common orthopedic and podiatric procedures performed in Ambulatory Surgery Centers (ASCs). The Select compact systems feature the same high-quality DePuy Synthes products used in hospitals, but combined into consolidated sets to help improve efficiency for our ASC customers. The configuration of the Compact Ankle Fracture System contains general instruments, Locking Compression Plates (LCP ) such as fibula plates, 1 /3 tubular plates, hook plate, as well as screws for syndesmotic repair and medial malleolus fractures. The LCP 1 /3 tubular plate is a commonly used implant for a high number of distal fibula fractures that results in a fixedangle construct and obtains fixation in osteoporotic bone. Additionally the LCP distal fibula plates are anatomically contoured and offer multiple screw options in the head of the plate. FLEXIBILITY IN THE OPERATING ROOM Color-coded layout for instrument identification Includes general instruments; all instrumentation is grouped by screw size, making it easier for surgical teams to quickly locate related components Contains precontoured fibula plates, 1 /3 tubular plates, and hook plates enabling surgeons to choose the appropriate option based on the complexity of the fracture Also contains solid and cannulated screws for syndesmotic repair and medial malleolus fractures Plates are designed to accomodate various fracture patterns and the patient s anatomy Locking and conventional screws allow for appropriate bone fixation Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 3
Compact Ankle Fracture System COLOR CODING A comprehensive color coding system highlights groups of instruments and associated screw sizes/types. Drill bits, drill guides, screwdriver shafts as well as the graphic case trays and screw racks are color-coordinated to facilitate pre-, intra-, and post-operative handling of the sets. In addition to the color for each screw size/type a band system distinguishes the drill size for the threaded hole (= one color band) and the gliding hole (= two color bands). The one band/two band principle is also replicated on the drill guides. Color Screw size (mm) Screw type Drill size (mm) Threaded hole = one color band Drill size (mm) Gliding hole = two color bands Shaft size Orange 2.7 Cortex 2.0 2.7 T8 Yellow 3.5/4.0 Cortex/Cancellous 2.5 3.5 2.5 mm Hex Black 3.5 Locking 2.8 T15 Gray 4.0 Cannulated 2.7 2.5 mm Hex 4 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
Compact Ankle Fracture System ORDER OF USE LAYOUT The layout of instruments is focused on order of use to correlate with the surgical steps and therefore assist with the intra-operative sequence. Instruments are arranged by groups (general instruments, 2.7 mm screw instrumentation, etc.). The handling flows from left to right and from top to bottom. E.g. general instruments are typically used first and are therefore placed on the left. Hence, implant specific instruments are located on the right side in order of the surgical steps: Drill bit Drill guide Measuring device Screwdriver TLA 1. REDUCE 2. DRILL Left General instruments Right Implant specific instruments 2, 3, 4 2.7 mm screw instruments 3. MEASURE 1 2, 3, 4 3.0 mm cortex/ 4.0 mm cancellous screw instruments 2, 3, 4 3.5 mm locking screw instruments 4. INSERT SCREW Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 5
Compact Ankle Fracture System IMPLANTS 2.7 MM/3.5 MM LCP LATERAL DISTAL FIBULA PLATE Anatomically contoured distal fibula plates Multiple screw options in the head of plate Locking screws offer a fixed-angle construct and obtain fixation in osteoporotic bone Coaxial screw holes help minimize screw head prominence and create a low profile construct Allows technique of clamp reduction, followed by independent lag screw, and neutralization plate placement in typical spiral fracture patterns For valgus failure fibular fractures with comminution and for bridge plating of comminuted fractures LCP ONE-THIRD TUBULAR PLATE Plate can be contoured to patient anatomy Locking screws offer a fixed-angle construct and obtain fixation in osteoporotic bone Available with 3 10 holes (33 mm 117 mm lengths) and 12 holes (141 mm) Plate contains only locking holes, that accept 3.5 mm locking screws, 3.5 mm cortex screws, and 2.7 mm cortex screws 6 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
Compact Ankle Fracture System Implants 3.5 MM LCP HOOK PLATE Low profile Hooks provide additional point of fixation Locking screws offer a fixed-angle construct and obtain fixation in osteoporotic bone Precontoured shape to provide spring-effect, to aid in reduction Dual hook configuration facilitates placement Nonlocking hole between the hooks allows fracture compression with a lag screw 4.0 MM CANNULATED SCREWS Used with 1.25 mm diameter guide wire Hemispherical head ensures optimal annular contact with washers and Synthes plates when screws are angled Low-profile head reduces possibility of soft tissue irritation Standard 2.5 mm hexagonal drive is compatible with screwdrivers in other commonly used Synthes sets Reverse-cutting flutes assist in screw removal Thread lengths: Short thread ( 1 /3 the screw length) Long thread ( 1 /2 the screw length) Cancellous thread profile uses deep cutting threads with a large pitch to increase resistance to pullout. The large pitch also accelerates screw insertion and removal Self-drilling, self-tapping screw tip facilitates screw insertion by eliminating the need for predrilling and tapping in most cases Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 7
AO PRINCIPLES In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation. 1 They are: Anatomic reduction Fracture reduction and fixation to restore anatomical relationships. Stable fixation Stability by fixation or splintage, as the personality of the fracture and the injury requires. Preservation of blood supply Preservation of the blood supply to soft tissue and bone by careful handling. Early, active mobilization Early, active mobilization of the part and patient. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991. 8 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
INDICATIONS 2.7 mm/3.5 mm LCP Distal Fibula Plate The 2.7 mm/3.5 mm LCP Distal Fibula Plates are indicated for fractures, osteotomies and nonunions of the metaphyseal and diaphyseal region of the distal fibula, especially in osteopenic bone. LCP One-Third Tubular Plates The LCP One-Third Tubular Plates are intended for fixation of fractures, osteotomies and nonunions of the clavicle, scapula, olecranon, humerus, radius, ulna, pelvis, distal tibia, and fibula, particularly in osteopenic bone. 3.5 mm LCP Hook Plate The 3.5 mm LCP Hook Plate is indicated for fractures, osteotomies and nonunions of small bones including the ulna, radius, tibia and fibula, particularly in osteoporotic bone. 4.0 mm Cannulated Screws For fracture fixation of small bones and small bone fragments. Warning: This device is not approved for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic or lumbar spine. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 9
CLINICAL CASES Case 1* 2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate Postoperative lateral Postoperative AP Case 2* LCP One-Third Tubular Plates Postoperative lateral Postoperative AP * Case studies are not necessarily predictive of results in other cases. Results in other cases may vary. 10 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
PREPARATION Required set 01.119.021 ASC Ankle Fracture Set Complete the preoperative radiographic assessment and plan. Determine procedure, type of fixation, screw/plate size and implant locations to ensure proper implant selection and position. Use the appropriate method for surgical incision and exposure of the fracture as needed. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 11
2.7 MM/3.5 MM LCP LATERAL DISTAL FIBULA PLATE TECHNIQUE FOR DISTAL FIBULA FRACTURE The techniques for implanting the lateral distal fibula plate and one-third tubular plate are similar. The following describes implantation of a lateral distal fibula plate. 1 Reduce fibular fracture Instruments 398.41 Reduction Forceps with points 399.99 Reduction Forceps with serrated jaw 292.12 1.25 mm Kirschner Wire, 150 mm 292.16 1.6 mm Kirschner Wire, 150 mm 292.20 2.0 mm Kirschner Wire, 150 mm Expose and clean the fracture site and reduce the fracture. It is critical that fibular length, alignment and rotation are accurately restored. In spiral or oblique fracture patterns, a clamp can be applied for reduction. Provisional reduction can be maintained with pointed reduction forceps or K-wires. 12 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture 1. Reduce fibular fracture continued Alternatively, in some fracture patterns, the plate can be used to assist with and guide the reduction. This may be especially important in comminuted fractures where a bridging technique is used. Technique tip: Application of an external fixator or distractor may facilitate obtaining fibular length, fracture reduction and visualization of the distal tibiofibular joint. Confirm the reduction with image intensification. Temporary reduction can be obtained with clamps, multiple Kirschner wires, or independent lag screws if the fracture pattern allows. K-wires can be placed through the distal end of the plate to assist with temporary maintenance of the reduction and for plate placement. Options for maintaining the reduction depend on the fracture configuration and include: Independent lag screws Lag screws through the plate Locking screws through the plate Locking screws do not provide interfragmentary compression; compression must be achieved with standard lag screws or by using the plate itself to compress the fracture. The fracture must be reduced and compressed before fixation of the LCP distal fibula plate with locking screws in simple fracture configurations. If a bridge plate technique is planned, the implant can be secured proximally and distally using locking screws, if the fibular length, alignment and rotation are correct. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 13
2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture 2 Insert plate Expose the fibula proximally as needed for plate application. In the majority of circumstances, an open approach for plate application will be performed. Occasionally, a submuscular plate insertion will be performed using a minimally invasive technique. The plate can be slid along the lateral fibular shaft and positioned with the distal end of the plate approximately 5 mm from the tip of the fibula. 3 Position plate and fix provisionally Temporarily hold the plate in position using any of the following options. These options also prevent plate rotation while inserting the first locking screw: Standard plate holding forceps K-wires placed through the plate distally and/ or proximally 2.7 mm cortex screw placed in one of the distal holes 3.5 mm cortex screw placed in a Combi hole After plate insertion, check plate placement and alignment using fluoroscopy. Ensure proper reduction before inserting the first locking screw. Once locking screws are inserted, further reduction is not possible without loosening the locking screws. Verify plate placement under image intensification to determine if final screw and plate placement are acceptable. 14 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture 4 Distal screw insertion Determine the combination of screws to be used for fixation. If a combination of locking and cortex screws will be used, cortex screws should be inserted first. Note: To secure the plate to the fibula before locking screw insertion, it is recommended to pull the plate to the bone using a cortex screw. Nonlocking screw insertion fixation with 2.7 mm cortex screws Instruments 03.119.014 2.0 mm Drill Bit, quick coupling, 125 mm, Orange 03.119.015 2.7 mm Drill Bit, quick coupling, 100 mm, Orange 03.119.018 2.7 mm Universal Drill Guide, Orange 03.119.019 StarDrive Screwdriver Shaft, T8, Purple/Orange 311.43 Handle, with quick coupling 319.01 Depth Gauge Use the 2.0 mm drill bit through the 2.7 mm universal drill guide to predrill the bone. Measure for screw length using the depth gauge. Select and insert the appropriate 2.7 mm cortex screw using the StarDrive screwdriver shaft. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 15
2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture 4. Distal screw insertion continued Locking screw insertion fixation with 2.7 mm locking screw If a locking screw will be used as the first screw, be sure the fracture is reduced and the plate is held securely to the bone. This prevents plate rotation as the screw is locked to the plate. Instruments 03.119.014 2.0 mm Drill Bit, quick coupling, 125 mm, Orange 03.119.019 StarDrive Screwdriver Shaft, T8, Purple/Orange 314.468 Holding Sleeve for StarDrive Screwdriver Shaft, T8 311.43 Handle, with quick coupling 313.353 Drill Guide 319.01 Depth Gauge 511.776 Torque Limiting Attachment, 0.8 Nm, quick coupling Insert the 2.0 mm threaded drill guide into a 2.7 mm locking hole until fully seated. Use the 2.0 mm drill bit to drill to the desired depth. Remove the 2.0 mm threaded drill guide. Use the depth gauge to determine screw length. Select and insert the appropriate 2.7 mm locking screw using the StarDrive screwdriver shaft. 16 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture 5 Shaft screw insertion Nonlocking screw insertion fixation with 3.5 mm cortex screws Instruments 311.43 Handle, with quick coupling 314.06 Holding Sleeve 319.01 Depth Gauge 03.119.002 2.5 mm Drill Bit, Yellow 03.119.003 3.5 mm Drill Bit, Yellow 03.119.006 Small Hexagonal Screwdriver Shaft, Yellow/Gray 03.119.009 3.5 mm Universal Drill Guide, Yellow Use the 2.5 mm drill bit through the 3.5 mm universal drill guide to predrill the bone. For the neutral position, press the drill guide down in the nonthreaded hole. To obtain compression, place the drill guide at the end of the nonthreaded hole away from the fracture (do not apply downward pressure on the spring-loaded tip). Measure for screw length using the depth gauge. Select and insert the appropriate 3.5 mm cortex screw using a small hexagonal screwdriver shaft. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 17
2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture 5. Shaft screw insertion continued Locking screw insertion fixation with 3.5 mm locking screw Instruments 03.119.008 StarDrive Screwdriver Shaft, T15, Black 03.119.029 2.8 mm Drill Bit, Black 312.648 2.8 mm Threaded Drill Guide 319.01 Depth Gauge 511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling Insert the 2.8 mm threaded drill guide into a locking hole or Combi hole until fully seated. Use the 2.8 mm drill bit to drill to the desired depth. Remove the drill guide. Use the depth gauge to determine screw length. Select and insert the appropriate 3.5 mm locking screw using the StarDrive screwdriver shaft. 18 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
2.7 mm/3.5 mm LCP Lateral Distal Fibula Plate Technique for Distal Fibula Fracture 6 Confirm reduction and fixation Carefully assess the final reduction and fixation via direct visualization and image intensification. Confirm the stability of the fixation and that there is unrestricted motion at the ankle joint. Using AP and lateral fluoroscopic visualization, confirm reduction and appropriate positioning of the plate and screws. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 19
3.5 MM LCP HOOK PLATE TECHNIQUE FOR DISTAL FIBULA FRACTURE 1 Fracture reduction and primary fixation Instrument 292.16 1.6 mm Kirschner Wire, 150 mm In multifragmentary fractures, care must be taken to avoid excessive stripping of the periosteum as well as devascularization of the fragments. Indirect reduction usually is obtained by longitudinal traction, either on the foot, or of the main distal fragment using a bone hook. If the distal fragment is large enough, insert one or two K-wires to hold the reduction. The correct length, rotation and alignment must be checked under image intensification. 20 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture 2 Position plate Instruments 03.119.014 2.0 mm Drill Bit, quick coupling, 125 mm, Orange 03.119.018 2.7 mm Universal Drill Guide, Orange 292.16 1.6 mm Kirschner Wire 329.04 Bending Iron for 2.7 mm and 3.5 mm Plates 329.05 Bending Iron for 2.7 mm and 3.5 mm Plates Contour the plate to fit the bone using the bending irons. Place the tip of the hooks inside the bone as distally as possible. Optionally predrill two holes for hook placement using the plate as a guide. Be careful not to damage the surgical gloves or the patient s surrounding soft tissues with the sharp hooks. Note: If required, the plate can be bent using bending pliers. Pay attention not to bend the plate over the Combi holes to prevent deformity of the locking portion. The plate hooks must not be bent. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 21
3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture 3 Insert cortex screws Determine the combination of screws to be used for fixation. If a combination of locking and cortex screws will be used, cortex screws should be inserted first. Note: To secure the plate to the fibula before locking screw insertion, it is recommended to pull the plate to the bone using a cortex screw. Instruments 03.119.002 2.5 mm Drill Bit, quick coupling, 110 mm, Yellow 03.119.003 3.5 mm Drill Bit, quick coupling, 110 mm, Yellow 03.119.009 3.5 mm Universal Drill Guide, Yellow 03.119.005 3.5 mm/2.5 mm Insert, Yellow 03.119.006 Small Hexagonal Screwdrive Shaft, Yellow/Grey 311.43 Handle with Quick Coupling 314.06 Holding Sleeve 319.01 Depth Gauge Use the 2.5 mm drill bit through the 3.5 mm universal drill guide to predrill the bone. Measure for screw length using the depth gauge. Select and insert the appropriate 3.5 mm cortex screw using the small hexagonal screwdriver shaft and the handle with quick coupling. Note: In osteopenic bone, a 4.0 mm cancellous screw may also be used in this step. 22 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture 4 Insert screw between hooks (optional) Instruments 03.119.002 2.5mm Drill Bit, quick coupling, 110 mm, Yellow 03.119.003 3.5 mm Drill Bit, quick coupling, 110 mm, Yellow 03.119.009 3.5 mm Universal Drill Guide, Yellow 03.119.005 3.5 mm/2.5 mm Insert, Yellow 03.119.004 Countersink for 3.5 mm Cortex and 4.0 mm cancellous Screws, Yellow 03.119.006 Small Hexagonal Screwdrive Shaft, Yellow/Grey 311.43 Handle with Quick Coupling 314.06 Holding Sleeve 319.01 Depth Gauge Drill a screw hole between the hooks with the 2.5 mm drill bit. Be sure to angle the drill away from the long axis of the plate to avoid colliding with other screws in the plate. Measure for screw length, using the depth gauge. Ensure that the screw will not collide with the reduction Kirschner wires. Insert and tighten a 3.5 mm cortex screw using the small hexagonal screwdriver shaft and the handle with quick coupling. Alternatively, use a 2.7 mm cortex screw in this hole. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 23
3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture 5 Insert locking screws Instruments 03.119.029 2.8 mm Drill Bit, quick coupling, 165 mm, Black 312.648 2.8 mm Threaded Drill Guide 03.119.008 Stardrive Screwdriver Shaft, T15, Black 311.43 Handle with Quick Coupling 319.01 Depth Gauge 511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling Insert the threaded drill guide into the locking portion of an open elongated Combi hole in the plate shaft until fully seated. Use the 2.8 mm drill bit to the desired depth. Remove the drill guide and use the depth gauge to determine the screw length. Insert a 3.5 mm locking screw using the StarDrive screwdriver shaft with torque limiting attachment and the handle with quick coupling. Remove the 1.6 mm Kirschner wires. Note: Always use a torque limiting attachment when using power to insert screws. Alternatively, follow the appropriate steps for inserting a 3.5 mm cortex screw into this hole. 24 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
3.5 mm LCP Hook Plate Technique for Distal Fibula Fracture 6 Confirm reduction and fixation Carefully assess the final reduction and fixation via direct visualization and image intensification. Confirm the stability of the fixation and that there is unrestricted motion at the ankle joint. Using AP and lateral fluoroscopic visualization, confirm reduction and appropriate positioning of the plate and screws. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 25
4.0 MM CANNULATED SCREW TECHNIQUE FOR MEDIAL MALLEOLUS FRACTURE 1 Reduction Instrument 398.41 Reduction Forceps with Points, broad Reduce the fracture anatomically with the use of small pointed reduction forceps, taking care with the soft tissues. Do not strip the periosteum more than necessary. 26 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture 2 Insert guide wires Instruments 03.119.024 2.7 mm/1.25 mm Double Drill Sleeve, Grey 900.722 1.25 mm Threaded Guide Wire Insert the 1.25 mm guide wires through the 2.7 mm/ 1.25 mm double drill sleeve to the appropriate depth. Check placement of the wire under image intensification. Remove the drill sleeve. As decided in preoperative planning, these K-wires should occupy the future position of the lag screws. The direction of the k-wires/screws should be as perpendicular as possible to the fracture plane. 3 Predrill (optional) Instruments 03.119.024 2.7 mm/1.25 mm Double Drill Sleeve, Grey 03.119.025 2.7 mm Cannulated Drill Bit, Grey In dense bone, it may be helpful to use a 2.7 mm cannulated drill bit to penetrate the near cortex prior to screw insertion. Use the 2.7 mm cannulated drill bit with the 2.7 mm/ 1.25 mm double drill sleeve to drill the near cortex only. Use image intensification if necessary. Care must be taken to avoid penetration of the ankle joint. In some cases, especially in cancellous bone, the self-drilling flutes of the 4.0 mm cannulated screw make predrilling unnecessary. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 27
4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture 4 Measure Instrument 319.15 Cannulated Screw Measuring Device The length of the screw shaft must be chosen so that the threaded part of the screw lies fully within the opposite bone fragment, but does not penetrate beyond the denser epiphyseal cancellous bone. Slide the tapered end of the cannulated screw measuring device over the guide wire, down to the bone. Read the scale at the end of the guide wire to determine appropriate screw length. This reading will place the screw 5 mm short of the tip of the guide wire, allowing the threaded portion of the guide wire to remain in the bone during screw insertion. 28 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture 5 Insert screw Instruments 03.119.027 Cannulated 2.5 mm Hexagonal Screwdriver Shaft, Grey 03.119.007 Holding Sleeve for Cannulated 2.5 mm Hexagonal Screwdriver 311.43 Handle with quick coupling Place the appropriate length screw over the guide wire. Use the cannulated hexagonal screwdriver shaft, and holding sleeve to insert the screw. Insert the screw without excessive tightening. The screw should come to rest with its threads completely beyond the fracture line. Remove and discard the guide wire. Notes If using power to insert screws, use of the holding sleeve will reduce the risk of stripping the hex recess To prevent the screw head from sinking into the thin malleolar cortex, the use of a washer is recommended, especially in osteoporotic bone Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 29
4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture 6 Confirm reduction and fixation Carefully assess the final reduction and fixation via direct visualization and image intensification. Confirm the stability of the fixation and that there is unrestricted motion at the ankle joint. Using AP and lateral fluoroscopic visualization, confirm reduction and appropriate positioning of the screws. 30 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
4.0 mm Cannulated Screw Technique for Medial Malleolus Fracture 7 Cleaning cannulations Instruments 319.25 1.35 mm Cleaning Brush 319.38 1.25 mm Cleaning Sylet Note: Cleaning the cannulation in each instrument is imperative for proper function and component life. Instruments should be cleared intraoperatively with the cleaning stylet to prevent accumulation of debris in the cannulation and potential binding of the instruments about the guide wire. Instruments should be cleaned postoperatively with both the stylet and cleaning brush. Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 31
IMPLANTS 2.7 mm Locking Screws, self-tapping 1,3 Threaded, conical head locks securely into the threaded holes in the plate to provide angular stability Locked screws allow unicortical screw fixation and load transfer to the near cortex T8 StarDrive recess 2.7 mm Cortex Screws, self-tapping 1,3 For use in round or Combi holes Used to provide compression or neutral fixation T8 StarDrive recess 3.5 mm Locking Screws, self-tapping 1,3 Threaded, conical head locks securely into the threaded holes in the plate to provide angular stability Locked screws allow unicortical screw fixation and load transfer to the near cortex T15 StarDrive recess 3.5 mm Low-profile Cortex Screws, self-tapping 1,2 For use in round or Combi holes Used to provide compression or neutral fixation 2.5 mm Hex recess 4.0 mm Cancellous Bone Screws 1,2 For use in round or Combi holes Used to provide compression or neutral fixation Fully or partially threaded shaft 2.5 mm Hex recess Screws are available in: 1. 316L stainless steel 2. commercially pure (CP) titanium 3. titanium alloy (Ti-6AI-7Nb) 32 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
Implants 4.0 mm Cannulated Screws, short thread 1,3 Cannulated shaft accepts 1.25 mm diameter guide wires Thread length = 1 /3 screw length 2.5 mm Hex recess Washer, 7.0 mm 1,3 To prevent screw head from sinking into osteoporotic bone Screws are available in: 1. 316L stainless steel 2. commercially pure (CP) titanium 3. titanium alloy (Ti-6AI-7Nb) Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 33
Implants 2.7 mm/3.5 mm LCP Lateral Distal Fibula Plates 2,4 Right and left designs Lengths from 86 mm to 151 mm LCP One-Third Tubular Plates, with collar 1,3 Available with 4 10 holes (45 mm 117 mm lengths) Plate contains only locking holes, that accept 3.5 mm locking screws, 3.5 mm cortex screws, 2.7 mm cortex screws and 4.0 mm cancellous screws Plates are available in:. 1. 316L stainless steel 2. 22Cr-13Ni-5Mn stainless steel 3. commercially pure (CP) titanium 4. titanium alloy (Ti-6AI-7Nb) 34 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
Implants 3.5 mm LCP Hook Plate 1,3 One plate design for right and left 3 Shaft holes Length 62 mm Plates are available in:. 1. 316L stainless steel 2. 22Cr-13Ni-5Mn stainless steel 3. commercially pure (CP) titanium 4. titanium alloy (Ti-6AI-7Nb) Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 35
INSTRUMENTS 03.119.002 2.5 mm Drill Bit, quick coupling, 110 mm, Yellow 03.119.003 3.5 mm Drill Bit, quick coupling, 110 mm, Yellow 03.119.004 Countersink for 3.5 mm Cortex and 4.0 mm Cancellous Screws, Yellow 03.119.005 3.5 mm/2.5 mm Insert, Yellow 03.119.006 Small Hexagonal Screwdriver Shaft, Yellow/Grey 03.119.007 Holding Sleeve for Cannulated 2.5 mm Hexagonal Screwdriver 03.119.008 Stardrive Screwdriver Shaft, T15, Black 36 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
Instruments 03.119.009 3.5 mm Universal Drill Guide, Yellow 03.119.014 2.0 mm Drill Bit, quick coupling, 125 mm, Orange 03.119.015 2.7 mm Drill Bit, quick coupling, 100 mm, Orange 03.119.017 Countersink for 2.7 mm Cortex Screws, Purple/Orange 03.119.018 2.7 mm Universal Drill Guide, Orange 03.119.019 Stardrive Screwdriver Shaft, T8, 105 mm, Purple/Orange 03.119.024 2.7 mm/1.25 mm Double Drill Sleeve, Grey Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 37
Instruments 03.119.025 2.7 mm Cannulated Drill Bit, quick coupling, 160 mm, Grey 03.119.026 Cannulated Countersink for 5.0 mm and 4.0 mm cannulated screws, Grey 03.119.027 Cannulated 2.5 mm Hexagonal Screwdriver Shaft, Grey 03.119.029 2.8 mm Drill Bit, quick coupling, 165 mm, Black 292.12 1.25 mm Kirschner Wire, 150 mm, trochar point 292.16 1.6 mm Kirschner Wire, 150 mm, trochar point 292.20 2.0 mm Kirschner Wire, 150 mm, trochar point 38 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
Instruments 311.43 Handle with quick coupling 312.648 2.8 mm Threaded Drill Guide 313.353 Drill Sleeve for 2.0 mm Drill Bit 314.06 Holding Sleeve 314.468 Holding Sleeve for 314.467 319.01 Depth Gauge for 2.7 mm and 3.5 mm Cortex and 4.0 Cancellous Screws 319.15 Cannulated Screw Measuring Device for 3.5 mm and 4.0 mm screws Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 39
Instruments 319.25 1.35 mm Cleaning Brush 319.38 1.25 mm Cleaning Stylet 319.39 Sharp Hook 319.97 Screw Forceps 324.024 Push-Pull Reduction Device 329.04 Bending Iron for 2.7 mm and 3.5 mm Plates 329.05 Bending Iron for 2.7 mm and 3.5 mm Plates 398.41 Reduction Forceps with Points, broad 40 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
Instruments 399.19 Hohmann Retractor, 8 mm width 399.36 Periosteal Elevator, 6 mm width, round edge, curved blade 399.49 Hohmann Retractor, 15 mm width 399.99 Reduction Forceps with serrated jaw 511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling 511.776 Torque Limiting Attachment, 0.8 Nm, quick coupling 900.722 1.25 mm Threaded Guide Wire, 150 mm Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 41
COMPACT ANKLE FRACTURE INSTRUMENT AND IMPLANT SET ASC (01.119.021) Graphic Case 60.119.020 Compact Ankle Fracture Graphic Case ASC Instruments 03.119.002 2.5 mm Drill Bit, quick coupling, 110 mm, Yellow, 2 ea. 03.119.003 3.5 mm Drill Bit, quick coupling, 110 mm, Yellow, 2 ea. 03.119.004 Countersink for 3.5 mm Cortex and 4.0 mm Cancellous Screws, Yellow 03.119.005 3.5 mm/2.5 mm Insert, Yellow 03.119.006 Small Hexagonal Screwdriver Shaft, Yellow/Grey 03.119.007 Holding Sleeve for Cannulated 2.5 mm Hexagonal Screwdriver 03.119.008 Stardrive Screwdriver Shaft, T15, Black 03.119.009 3.5 mm Universal Drill Guide, Yellow 03.119.014 2.0 mm Drill Bit, quick coupling, 125 mm, Orange, 2 ea. 03.119.015 2.7 mm Drill Bit, quick coupling, 100 mm, Orange, 2 ea. 03.119.017 Countersink for 2.7 mm Cortex Screws, Purple/Orange 03.119.018 2.7 mm Universal Drill Guide, Orange 03.119.019 Stardrive Screwdriver Shaft, T8, 105 mm, Purple/Orange 03.119.024 2.7 mm/1.25 mm Double Drill Sleeve, Grey 03.119.025 2.7 mm Cannulated Drill Bit, quick coupling, 160 mm, Grey, 2 ea. 03.119.026 Cannulated Countersink for 5.0 mm and 4.0 mm Cannulated Screws, Grey 03.119.027 Cannulated 2.5 mm Hexagonal Screwdriver Shaft, Grey 03.119.029 2.8 mm Drill Bit, quick coupling, 165 mm, Black, 2 ea. For detailed cleaning and sterilization instructions, please refer to: www.synthes.com/cleaning-sterilization In Canada, the cleaning and sterilization instructions will be provided with the Loaner shipments. 42 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
Compact Ankle Fracture Instrument and Implant Set ASC (01.119.021) Instruments continued 292.12 1.25 mm Kirschner Wire, 150 mm, trochar point, 10/pkg. 292.16 1.6 mm Kirschner Wire, 150 mm, trochar point, 10/ pkg. 292.20 2.0 mm Kirschner Wire, 150 mm, trochar point, 10/pkg. 311.43 Handle with quick coupling, 2 ea. 312.648 2.8 mm Threaded Drill Guide, 2 ea. 313.353 Drill Sleeve for 2.0 mm Drill Bit, 2 ea. 314.06 Holding Sleeve 314.468 Holding Sleeve for 314.467 319.01 Depth Gauge for 2.7 mm and 3.5 mm Cortex, and 4.0 Cancellous Screws 319.15 Cannulated Screw Measuring Device for 3.5 mm and 4.0 mm screws 319.25 1.35 mm Cleaning Brush 319.38 1.25 mm Cleaning Stylet 319.39 Sharp Hook 319.97 Screw Forceps 324.024 Push-Pull reduction device 329.04 Bending Iron for 2.7 mm and 3.5 mm Plates 329.05 Bending Iron for 2.7 mm and 3.5 mm Plates 398.41 Reduction Forceps with Points, broad 399.19 Hohmann Retractor, 8 mm width, 2 ea. 399.36 Periosteal Elevator, 6 mm width, round edge, curved blade 399.49 Hohmann Retractor, 15 mm width, 2 ea. 399.99 Reduction Forceps with serrated jaw 511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling 511.776 Torque Limiting Attachment, 0.8 Nm, quick coupling 900.722 1.25 mm Threaded Guide Wire, 150 mm, 10 ea. 22Cr-13Ni-5Mn stainless steel. Plates are also available in titanium alloy (Ti-6Al-7Nb). * 316L stainless steel. Plates/screws are also available in Commercially pure (CP) titanium. ** 316L stainless steel. Plates/screws are also available in titanium alloy (Ti-6Al-7Nb). Implants 2.7 mm/3.5 mm LCP Lateral Distal Fibula Plates Stainless steel Holes Length (mm) 02.112.138 4 86 right 02.112.139 4 86 left 02.112.140 5 99 right 02.112.141 5 99 left 02.112.142 6 112 right 02.112.143 6 112 left 02.112.148 9 151 right 02.112.149 9 151 left LCP One-Third Tubular Plates, with collar Stainless steel* Holes Length (mm) 241.341 4 45 241.351 5 57 241.361 6 69 241.371 7 81 241.381 8 93 241.401 10 117 3.5 mm LCP Hook Plate Stainless steel* Holes Length (mm) 02.113.103 3 62 2.7 mm Locking Screws, self-tapping, with T8 StarDrive recess, 5 ea. Length Length Stainless steel** (mm) Stainless steel (mm) 202.210 10 202.222 22 202.212 12 202.224 24 202.214 14 202.226 26 202.216 16 202.228 28 202.218 18 202.230 30 202.220 20 Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 43
Compact Ankle Fracture Instrument and Implant Set ASC (01.119.021) Implants continued 2.7 mm Cortex Screw, self-tapping, with T8 StarDrive recess, 3 ea. Length Length Stainless steel** (mm) Stainless steel** (mm) 202.870 10 202.892 32 202.872 12 202.894 34 202.874 14 202.896 36 202.876 16 202.898 38 202.878 18 202.900 40 202.880 20 202.962 42 202.882 22 202.963 44 202.884 24 202.965 46 202.886 26 202.966 48 202.888 28 202.967 50 202.890 30 3.5 mm Locking Screws, self-tapping, with StarDrive recess, 3 ea. Length Length Stainless steel** (mm) Stainless steel** (mm) 212.101 10 212.107 22 212.102 12 212.108 24 212.103 14 212.109 26 212.104 16 212.110 28 212.105 18 212.111 30 212.106 20 3.5 mm Cortex Screws, with low-profile head, self-tapping, hex drive recess Stainless steel* Length (mm) Qty. 02.206.010 10 6 02.206.012 12 6 02.206.014 14 6 02.206.016 16 6 02.206.018 18 6 02.206.020 20 3 02.206.022 22 3 02.206.024 24 3 02.206.026 26 3 02.206.028 28 3 02.206.030 30 3 02.206.032 32 3 02.206.034 34 3 02.206.036 36 3 02.206.038 38 3 02.206.040 40 3 02.206.042 42 3 02.206.044 44 3 02.206.046 46 3 02.206.048 48 3 02.206.050 50 3 02.206.052 52 3 02.206.054 54 3 02.206.056 56 3 02.206.058 58 3 02.206.060 60 3 * 316L stainless steel. Plates/screws are also available in Commercially pure (CP) titanium. ** 316L stainless steel. Plates/screws are also available in titanium alloy (Ti-6Al-7Nb). 44 DePuy Synthes Select Compact Ankle Fracture System Surgical Technique
Compact Ankle Fracture Instrument and Implant Set ASC (01.119.021) Implants continued 4.0 mm Cancellous Bone Screws, fully threaded, 3 ea. Length Length Stainless steel* (mm) Stainless steel* (mm) 206.010 10 206.018 18 206.012 12 206.020 20 206.014 14 206.022 22 206.016 16 206.024 24 Also available 01.119.022 Titanium Compact Ankle Fracture Instrument and Implant Set 4.0 mm Cancellous Bone Screws, partially threaded, 3 ea. Length Length Stainless steel* (mm) Stainless steel* (mm) 207.030 30 207.050 50 207.035 35 207.055 55 207.040 40 207.060 60 207.045 45 4.0 mm Cannulated Screws, short thread, 3 ea. Length Length Stainless steel** (mm) Stainless steel** (mm) 207.620 20 207.636 36 207.622 22 207.638 38 207.624 24 207.640 40 207.626 26 207.642 42 207.628 28 207.644 44 207.630 30 207.646 46 207.632 32 207.648 48 207.634 34 207.650 50 Washer, 7.0 mm Stainless steel** Qty. 219.98 6 * 316L stainless steel. Plates/screws are also available in Commercially pure (CP) titanium. ** 316L stainless steel. Plates/screws are also available in titanium alloy (Ti-6Al-7Nb). Compact Ankle Fracture System Surgical Technique DePuy Synthes Select 45
Synthes Inc. 1302 Wrights Lane East West Chester, PA 19380 Telephone: (610) 719-5000 To order: (800) 523-0322 www.depuysynthes.com Synthes (Canada) Ltd. 2566 Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) 567-0440 To order: (800) 668-1119 Fax: (905) 567-3185 DePuy Synthes Trauma, a division of DOI 2013. All rights reserved. J12439-A 9/13