EXTERNAL FIXATION SYSTEM
2 3 1 4 5 1. DJD II Body 2. Humeral Guide 3. Pin Insertion Guides 4. Hoffmann II Compact Instruments 5. Hoffmann II Compact Components and Apex Pins 2
Overview The DJD II is a Dynamic Elbow Joint Distractor which extends the range of the Hoffmann II Compact System to treat posttraumatic elbow stiffness as well as some acute elbow trauma cases. Plus, it provides the same advantages as the Hoffmann II Compact System in terms of ease of use, versatility and patient comfort. The two principal goals of the DJD II are to allow active or passive motion of the elbow and to protect the elbow articular surfaces and the collateral ligaments. Motion is allowed by a hinge which replicates the elbow axis of rotation, while an integrated distraction mechanism prevents the articular surfaces from damaging each other. The DJD II may be used in either a monolateral or bilateral configuration. This allows a great deal of flexibility in use and indications. Whatever the indications, the DJD II allows mobilization of the elbow providing for earlier rehabilitation, facilitating the patient s daily tasks and increasing his/her comfort. 3
Indications / Contraindications Indications Trauma indications When protection of the articular surfaces is required: Coronoid fracture with or without fixation; Olecranon fracture with tenuous fixation; Distal humerus articular fractures; Unstable ulnohumeral joint after acute collateral ligament disruption; Combination of instability with any of the above fractures (complex instability). Reconstruction indications As an adjunct for individuals undergoing release of stiff elbow. This is most common in the post-traumatic condition, but occasionally is used with inflammatory stiffness. The use of distraction is generally indicated in these circumstances: There has been a significant amount of dissection suggesting that maintaining the intraoperative motion will be difficult. If the pathology has modified the joint contour requiring refashioning of the joint surface, with or without an interposition membrane. When an interposition procedure is performed. If the collateral ligament has been reconstructed or repaired in association with the release. Contraindications Inexperience with the use of external fixation devices is considered a relative contraindication. Application of the DJD II is technically demanding and requires accurate placement of the skeletal pins. If uncertainty exists with regard to the anatomic location of the neurovascular structures due to post-traumatic destruction of the joint, the DJD II should be used only with extreme caution. The pins, under these circumstances, may be inserted under direct vision. Local sepsis is a relative contraindication to the application of the DJD II. The presence of some internal fracture fixation devices in the distal humerus or proximal ulna. Pre-emptive medical condition, e.g. severe osteoporosis. 4
Features & Benefits Simplified frame construction (only 1 major component) Most compact elbow external fixator Integrated hinge to replicate the elbow s natural axis of rotation Integrated joint distraction mechanism Unilateral or bilateral frame configurations Highly versatile system Independent pin placement reduces the potential of neurovascular injury Compatible with Hoffmann II Compact couplings Compatible with Apex pins Enters in the concept of a unique external fixation family Limited risk of elbow joint infection due to removable reference pin after frame positioning Simple, user friendly instrumentation 5
DJD II Body Humeral Rod Hinge The DJD II body has been specifically designed to provide strength, reduce bulkiness and weight and simplify use. The DJD II body is composed of two 5mm diameter stainless steel rods linked together by a hinge which includes an integrated distraction mechanism to distract the elbow joint. These elements cannot be disassembled from each other, which contributes to the simplicity of the system. The DJD II body s ulnar and humeral rods are compatible with the Hoffmann II Compact couplings. The complex anatomy of the elbow makes independent pin placement a crucial advantage in reducing the potential of neurovascular injury. The DJD II body bored hinge allows the positioning of the DJD II body over the 3mm Apex reference pin which has to be previously inserted into the axis of rotation of the elbow (see operative technique). Therefore, the DJD II body hinge is designed to replicate the anatomical axis of rotation and allows natural mobilization of the elbow. The removal of the reference pin at the end of the surgery limits potential risk of elbow joint infection. N.B.: In case of bilateral frame configuration, the 3mm Apex reference pin is replaced by a 3mm smooth transfixing pin, over which the DJD II bodies are applied to both lateral and medial sides. Once the frames are secured, the smooth transfixing pin which replicates the elbow axis of rotation for both of the frames is removed, thus reducing the risk of joint infection. Distraction Screw The DJD II body distraction mechanism allows distraction up to 10mm (typically 2-3mm distraction is sufficient to accomplish the goals of the procedure) without any additional components. Ulnar Rod Graduated millimeter scale allows precise distraction The DJD II body distraction mechanism includes a graduated scale to allow controlled distraction. Its 5mm square head screw is identical to the 5mm square head screws of the Hoffmann II Compact couplings allowing the use of the same wrench. 6
Pin-to-Rod Coupling Independent pin placement is a key factor to successful elbow surgery where complex anatomy dictates the pin insertion areas. The Hoffmann II Compact pin-to-rod coupling has been specifically designed to provide the freedom of single pin placement with ease of use. Designed to accept 3 & 4mm Apex pins and 5mm rods Integrated spring loaded snap-fit mechanism allows easy assembly and temporary fixation during adjustment procedures Lateral entries with a click effect of the pin / rod Radially serrated tooth design provides excellent locking and rotational stability Easy access top locking via a 5mm square head screw Rod-to-Rod Coupling The Hoffmann II Compact rod-to-rod coupling connects two 5mm rods to each other. Thus, a 5mm rod can be placed between the proximal humeral rod and the distal ulnar rod of the DJD II by using two Hoffmann II Compact rod-to-rod couplings. Such a frame may be used to lock the joint in order to minimise elbow joint movement during the first 24 hours after the surgery (see operative technique). Designed to accept 5mm rods Integrated spring loaded snap-fit mechanism allows easy assembly and temporary fixation during adjustment procedures Lateral entries with a click effect of the rods Radially serrated tooth design provides excellent locking and rotational stability Easy access top locking via a 5mm square head screw 7
DJD II Frames Reference Guide A. Unilateral frame (Lateral) B. Bilateral frame C. Unilateral frame (Medial) A B C DJD II body 1 2 1 (Cat No 5195-0-010) Pin-to-rod coupling 4 8 4 (Cat No 4940-1-020) Apex pins 4 8 4 8
Components Case 1: Heterotopic bone formation after neurotrauma causing complete ankylosis of the joint. 19 year old man Pre-operative X-ray Post-operative Post-operative Frame removal Range of Motion (ROM): 0 X-ray frame at 6 weeks Case 2: Post-traumatic stiffness after supracondylar fracture. ROM: 135 45 year old man Pre-operative X-ray Post-operative Post-operative Frame removal ROM: 60 X-ray frame at 6 weeks ROM: 120 Case 3: Fascia lata arthroplasty. Rheumatoid arthritis: right elbow joint ankylosis since 14 years. 52 year old woman Pre-operative X-ray Post-operative Post-operative Frame removal at 6 weeks ROM: 0 X-ray frame ROM: 85 9
Components Cat. No Description DJD II component 5195-0-010 DJD II body Hoffmann II couplings 4940-1-010 Hoffmann II Compact rod-to-rod coupling 4940-1-020 Hoffmann II Compact pin-to-rod coupling Recommended Hoffmann II Compact rod 5049-5-250 Stainless Steel connecting rod 5mm x 250mm 5049-5-525 Carbon connecting rod 5mm x 250mm Recommended Apex 3 & 4mm pins Self Drilling/Self Tapping 5038-5-080 Pin diameter 3mm, length 80mm, thread length 20mm 5038-2-110 Pin diameter 3mm, length 110mm, thread length 25mm 5023-2-090 Pin diameter 4mm, length 90mm, thread length 20mm 5023-3-120 Pin diameter 4mm, length 120mm, thread length 30mm 5023-5-150 Pin diameter 4mm, length 150mm, thread length 40mm Blunt 5036-2-080 Pin diameter 3mm, length 80mm, thread length 20mm 5036-2-110 Pin diameter 3mm, length 110mm, thread length 25mm 5027-2-090 Pin diameter 4mm, length 90mm, thread length 20mm 5027-3-120 Pin diameter 4mm, length 120mm, thread length 30mm 5027-4-150 Pin diameter 4mm, length 150mm, thread length 40mm Smooth transfixing pin (bilateral frame construction) 5045-5-200 Smooth transfixing diameter 3mm, length 200mm 10
Instruments Cat. No Description DJD II specific instruments 5195-1-010 Humeral guide 5195-1-020 3mm pin insertion guide 5195-1-030 4mm pin insertion guide Hoffmann II Compact standard instruments 4940-9-030 5mm wrench / 3 & 4mm pin driver 5150-9-005 5mm spanner wrench 4940-9-010 Stabilization / reduction wrench 4920-9-020 Thumbwheel Tray 5195-9-100 Storage and sterilization case Stryker, Hoffmann, Hoffmann II, Apex, Monotube, Triax, Compact and Tenxor are trademarks of Stryker Corporation. Hoffmann II Swiss Patent Application: 01-709/94-3. Other Patents Pending. * Patents: EU 385,929; 374,093; Canada 1,193,506; U.S. 5,160,335 and 5,207,676. ** Swiss Patent Application: 02-709/94-3. Other Patents Pending. *** Patents: EU 230,856; Swiss CH 671,150; U.S. 4,978,350. Data on file at Stryker Howmedica Osteonics USA. 11
onotube Unilateral frame system designed to handle a wide variety of fractures and limb-lengthening applications. This simple, colour-coded system offers both dynamic and carbon tubes for individualised performance and economy. True simplicity, versatility, and economy. Modular frames which allow for true independent pin placement. Completely compatible with Original Hoffmann components, this new system improves flexibility and ease-of-use, while enhancing frame economics through minimal componentry. It s external fixation with a snap. Compact EXTERNAL FIXATION SYSTEM TRIAX E X T E R N A L F I X A T I O N S Y S T E M ** Designed to complement the anatomy of the distal radius by allowing independent movement of its clamps in multiple planes. Standard unilateral or bi-lateral bridging frames for intra-articular fractures and peri-articular non-bridging frames for extraarticular fractures. Fully compatible with the Hoffmann II System, based on a spring-loaded snap-fit mechanism that improves flexibility and ease-of-use. * The DJD II is a Dynamic Elbow Joint Distractor. Fully compatible with the Hoffmann II Compact System, it is designed to treat posttraumatic elbow stiffness as well as acute elbow trauma cases. The Tenxor System is a hybrid system providing advanced technology and ease of application. Fully compatible with Hoffmann II and Monotube Triax, based on a spring-loaded, snap-fit mechanism that improves flexibility and ease of use. *** Every Fixator incorporates the high quality pin-to-bone interface provided by Apex Pins. The Apex Pin cuts more sharply with less torque, friction and heat upon insertion improving purchase while minimising the risk of pin tract problems. Available in self-drilling and blunt tip designs, only from Stryker Howmedica Osteonics! MANUFACTURER: Manufacturing location 5 chemin des Aulx CH-1228 Plan-les-Ouates Geneva, Switzerland Tel: 00 41 22 884 0111 Fax:00 41 22 884 0199 Cat. No: 5075-3-500 2001 Stryker Corporation. All rights reserved. 0701