zimmer distal radius plating system...zimmer® distal radius plating system surgical technique 7...

1

Zimmer® Distal Radius

Plating System

Surgical Technique

2 Zimmer® Distal Radius Plating System Surgical Technique

Introduction

The Zimmer® Distal Radius Plating System is a versatile system carefully designed to meet the needs of both patients and surgeons. Using Zimmer’s anatomical database, the plate contour conforms to a broad range of patient anatomy and the screw trajectories target the most common fragment and fracture patterns, all while limiting the construct interference with soft tissues.

Zimmer has designed the Distal Radius Plating System for ease of use and polyaxial screw placement. The system offers comprehensive instrumentation to ensure efficient, repeatable, and reliable outcomes across a variety of patient populations.

Standard Volar Plate Placement

Nominal Screw Trajectory

Left & Right Cobra Hohmanns Weitlaner Retractor Polyaxial and Locking Drill Guide

3Zimmer® Distal Radius Plating System Surgical Technique

Zimmer Distal Radius Plating SystemPlate Families

FeaturesPlate Contour

The contour was optimized using Zimmer’s proprietary ZiBRA™ Anatomical Modeling System to ensure appropriate fit for a broad patient population.

Minimal Screw Head Prominence

These low-profile, periarticular plates are anatomically contoured to reduce soft-tissue irritation by minimizing screw head prominence even when the screws are used off-axis.

Locking Mechanism

Polyaxial screw locking is achieved when the threads on the screw head deform to the threads in the hole of the plate. This allows a total of three attempts at polyaxial locking within each screw hole.

Note: Each locking screw/peg may be redirected once into a plate hole within a surgery without adversely affecting the locking performance of that screw/peg. If further redirection is needed, a new locking screw/peg should be used.

Wide Volar Plates

Dorsal and Radial Styloid

Plates

Standard Volar Plates

Narrow Volar Plates

Extra Articular Plates


Screw FeaturesScrew Options

• 2.4mm Locking Screws

• 2.4mm Cortical Screws

• 1.8mm Locking Pegs

Ease of Use

All screws have been streamlined to use one drill bit and one depth gauge, simplifying the instrumentation for ease of use. The drill bit is etched to measure for screw length, saving time and reducing the number of steps to complete the procedure.

Flexibility

The locking screws and pegs in this system can be angled up to 15 degrees off-center or follow a fixed-angled trajectory with a standard locking drill guide or a drill guide block.

Color Coded

The cortical screws are color anodized blue for easy identification in the operating room.

Variable Angle Trajectory


Instrumentation

Simplified

The set includes specialized instrumentation geared to make the use of the system easier.

Comprehensive Offering

Cobra Hohmanns

Wider Cobra Hohmann retractors allow improved fracture site exposure and visualization.

Weitlaner Retractors

Retractors specific for distal radius cases; deep teeth with a wide spread to improve exposure.

Polyaxial Drill Guide

Simple design to target hole and place drill bit within cone of polyaxiality.

Olive Wires

Shorter Olive Wires to stay out of the way of the drill while temporarily holding the plate in place.


Surgical ApproachVolar Approach

Patient Positioning

Position the patient supine and place the forearm on a radiolucent hand table. (Fig. 1)

Surgical Approach

1. Incision

Make a longitudinal incision slightly radial to the flexor carpi radialis tendon (FCR). (Fig. 2)

2. Superficial Dissection

Retract the FCR tendon toward the ulna while protecting the median nerve.

Dissect through the floor of the FCR sheath, protecting the radial artery radially, exposing the pronator quadratus (PQ). (Fig. 3)

3. Deep Dissection

Release the PQ radially to ulnarly by sharply incising over the watershed line and proximally on the lateral edge of the radius.

4. Expose the Radius

Elevate the PQ to expose the volar surface of the radius. (Fig. 4)

The origin of the flexor pollicis longus (FPL) muscle can be par-tially released if needed for added exposure.

Carefully release the brachioradialis.

Fig. 1 Patient Positioning

Fig. 2 Incision Trace

Fig. 3 Expose pronator quadratus

Fig. 4 Expose the radius


Fracture Reduction and Temporary Fixation1.25mm K-wires can be used to obtain and maintain accurate fracture reduction when applying the distal radius plate.

Before Plating:

• Reduce fracture.

• Insert K-wires to hold the reduction. (Fig. 5)

• If needed, K-wires can be inserted parallel to the subchondral bone to reconstruct the articular surface. (Fig. 5)

• Ensure that K-wires are placed in locations which will not impede proper plate placement and fixation.

Note: K-wires and drill bits are single use only.

Step 1: Select Appropriate PlateProvisionals are available to help in selecting the appropriate plate size. (Fig. 6) The outer edge of the provisional indicates the Standard plate width. The inner distal oblong holes indicate the Narrow plate width.

If using the drill guide block to target distally, attach the Drill Guide Block to the plate by turning the thumb screw that connects to the distal most shaft hole in the plate. (Fig. 7) Drill Guide Blocks are not available for the Dorsal or Extra Articular plates.

Fig. 7 Volar Plate with Drill Guide Block attached with Retention Screw

Instruments

Left Drill Guide Block 00-2366-099-50 00-2366-099-52 00-2366-099-54

Right Drill Guide Block 00-2366-099-51 00-2366-099-53 00-2366-099-55

Drill Guide Block Retention Screw00-2366-099-01

Fig. 5 Hold reduction with K-wires

Fig. 6 Provisional plate sizing


Step 2: Plate Position

The plate should be positioned on the distal radius proximal to the Watershed line.

If placed properly, 1.25mm K-wires inserted into the two distal K-wire holes will not violate the joint. (Fig. 8)

Note: The two distal K-wire holes match the trajectory of their adjacent screw holes. The K-wire holes are offset slightly more distal to ensure that the nominal trajectory of the screws will not be in the joint if the K-wires show proper placement under flouroscopy.

Note: If bending is required, the locking guides should not be used as bending irons.

Step 3: Provisionally Fix Plate to BonePlace a 2.4mm Cortical Screw into the oblong plate shaft hole to provisionally hold the plate to the bone. (Fig. 9a)

• Drill with a 1.8mm Drill Bit through 1.8mm side of the Combination Drill Guide.

• Measure depth. Select appropriate 2.4mm cortical screw.

• Insert screw using T8 Driver Shaft and AO Type Collet Handle assembly.

An olive wire can be also inserted into any plate hole to provisionally hold the plate to the bone. (Fig. 9b)

Fig. 9b Olive wire can also be used to provisionally fix plate to bone

Fig. 9a Provisionally fix plate to bone with cortical screw placement

Instruments

Calibrated Drill Bit, AO, 1.8mm Diameter00-2366-030-18

Depth Gauge 10-30mm Length 00-2366-090-00

AO Collet Handle with Spin Cap 00-2366-015-00

T8 Driver Shaft, AO Quick Connect00-2366-010-00

Smooth Drill Guide for use with 1.8mm

Diameter Drill00-2366-022-18

Fig. 8 Check distal K-wire placement


Step 4: Check Distal K-wire PlacementCheck 1.25mm K-wire to verify that the screw trajectory will not violate the joint. (Fig. 10)

Step 5: Optional Distal Cortical Screw PlacementInsert 2.4mm Cortical Screws into the distal holes using the instructions in Step 3 as needed to lag the plate and bone together and/or to assist in fracture reduction. (Fig. 11)

Fig. 11 Optional Distal Cortical Screw placement




T8 Driver Shaft, AO Quick Connect00-2366-010-00



Fig. 10 Lateral view check of Distal K-wire placement

Instruments


Instruments

Step 6: Insert 2.4mm Locking Screws DistallyOption 1: Fixed angled screw insertion without Drill Guide Block (Fig. 12a)

• Thread the 1.8mm Locking Drill Guide into selected hole.

• Drill with 1.8mm Drill Bit.

• Measure depth. Select appropriate screw.


Option 2: Polyaxial locking screw insertion (Fig. 12b)

• Thread Polyaxial Drill Guide into selected hole.




NOTE: Polyaxial Drill Guide will limit the drill angle to 15° off center.

Option 3: Fixed angle screw insertion through the Drill Guide Block (Fig. 12c)

• Insert 1.8mm side of 1.8mm/2.4mm Combination Drill Guide through selected hole.




Fig. 12b Polyaxial locking screw placement

Fig. 12a Fixed angle screw placement without Drill Guide Block

Fig. 12c Fixed angle screw placement through the drill block

Locking Drill Guide for use with 1.8mm Diameter Drill

00-2366-20-18



Polyaxial Drill Guide for use with 1.8mm



T8 Driver Shaft, AO Quick Connect 00-2366-010-00




Step 7: Insert Remaining Proximal ScrewsRepeat procedure from Step 3 or Step 6 to insert 2.4mm Cortical Screws or 2.4mm Locking Screws in desired proximal holes. (Fig. 13)

Step 8: Final Check and ClosureCheck screw position using flouroscopy and ensure final tightening before closure.

Note: To ensure screws are not in the joint, the forearm can be elevated 10 degrees in the Anterior to Posterior view and 20 degrees in the Lateral to Medial view.

Instruments

Fig. 13 Positioning of Volar Plate Construct


00-2366-20-18



Polyaxial Drill Guide for use with 1.8mm







Dorsal Approach Patient PositioningFlex the elbow slightly and internally rotate the arm at the shoulder. Pronation of the forearm should be avoided. (Fig. 14)

Surgical Approach1. Incision

• Make a longitudinal incision slightly ulnar to Lister’s tubercle.

2. Dissection

• Carry the dissection through the third dorsal extensor compartment.

• Retract the extensor pollicus longus (EPL) radially.

• Protect the radial sensory nerve.

3. Expose the Radius

• Elevate and retract radially the first and second dorsal extensor compartments.

• Elevate and retract ulnarly the fourth dorsal extensor compartment.

To attach the Dorsal Plates, Step 3 and Step 6 from the volar plate technique should be followed to place 2.4mm Cortical Screws and 2.4mm Locking Screws. (Fig. 15)

The Dorsal Plates should only be drilled at the fixed angle trajectory to avoid screw head prominence.

Fig. 15 Positioning of Dorsal Plates

Fig. 14 Dorsal approach patient positioning

Ulnar Column Plate Radial Column Plate Radial Styloid Plate

Instruments


00-2366-20-18








Instruments

Implant RemovalTo remove 2.4mm Locking Screws and/or 1.8mm Locking Pegs, use the T8 Driver Shaft and AO Type Collet Handle assembly to unlock all screws/pegs from the plate and then remove the screws/pegs completely. (Fig. 17)

A small osteotome or elevator may be needed to separate the plate from the bone.

Fig. 17 Implant removal




Item Number Description00-2328-050-03 Left Narrow 3 Hole Volar Plate00-2328-050-05 Left Narrow 5 Hole Volar Plate00-2328-052-03 Left Standard 3 Hole Volar Plate00-2328-052-05 Left Standard 5 Hole Volar Plate00-2328-052-08 Left Standard 8 Hole Volar Plate00-2328-052-10 Left Standard 10 Hole Volar Plate00-2328-052-13 Left Standard 13 Hole Volar Plate 00-2328-054-05 Left Wide 5 Hole Volar Plate00-2328-070-05 Left Radial Styloid Plate 00-2328-072-06 Left Dorsal Radial Column Plate 00-2328-074-05 Left Dorsal Ulnar Column Plate 00-2328-060-03 Left Narrow Extra Articular 3 Hole Plate00-2328-062-03 Left Standard Extra Articular 3 Hole Plate 00-2328-051-03 Right Narrow 3 Hole Volar Plate00-2328-051-05 Right Narrow 5 Hole Volar Plate00-2328-053-03 Right Standard 3 Hole Volar Plate00-2328-053-05 Right Standard 5 Hole Volar Plate00-2328-053-08 Right Standard 8 Hole Volar Plate00-2328-053-10 Right Standard 10 Hole Volar Plate00-2328-053-13 Right Standard 13 Hole Volar Plate 00-2328-055-05 Right Wide 5 Hole Volar Plate00-2328-071-05 Right Radial Styloid Plate 00-2328-073-06 Right Dorsal Radial Column Plate 00-2328-075-05 Right Dorsal Ulnar Column Plate 00-2328-061-03 Right Narrow Extra Articular 3 Hole Plate00-2328-063-03 Right Standard Extra Articular 3 Hole Plate

Plates

Item Number Description00-2329-010-25 Cortical Screw 2.4mm Diameter 10mm Length 00-2329-011-25 Cortical Screw 2.4mm Diameter 11mm Length 00-2329-012-25 Cortical Screw 2.4mm Diameter 12mm Length 00-2329-013-25 Cortical Screw 2.4mm Diameter 13mm Length 00-2329-014-25 Cortical Screw 2.4mm Diameter 14mm Length 00-2329-015-25 Cortical Screw 2.4mm Diameter 15mm Length 00-2329-016-25 Cortical Screw 2.4mm Diameter 16mm Length 00-2329-018-25 Cortical Screw 2.4mm Diameter 18mm Length 00-2329-020-25 Cortical Screw 2.4mm Diameter 20mm Length 00-2329-022-25 Cortical Screw 2.4mm Diameter 22mm Length 00-2329-024-25 Cortical Screw 2.4mm Diameter 24mm Length 00-2329-026-25 Cortical Screw 2.4mm Diameter 26mm Length 00-2329-028-25 Cortical Screw 2.4mm Diameter 28mm Length 00-2329-030-25 Cortical Screw 2.4mm Diameter 30mm Length

Locking Screws

Item Number Description00-2329-010-24 Locking Screw 2.4mm Diameter 10mm Length 00-2329-011-24 Locking Screw 2.4mm Diameter 11mm Length00-2329-012-24 Locking Screw 2.4mm Diameter 12mm Length 00-2329-013-24 Locking Screw 2.4mm Diameter 13mm Length00-2329-014-24 Locking Screw 2.4mm Diameter 14mm Length 00-2329-015-24 Locking Screw 2.4mm Diameter 15mm Length00-2329-016-24 Locking Screw 2.4mm Diameter 16mm Length 00-2329-018-24 Locking Screw 2.4mm Diameter 18mm Length00-2329-020-24 Locking Screw 2.4mm Diameter 20mm Length 00-2329-022-24 Locking Screw 2.4mm Diameter 22mm Length00-2329-024-24 Locking Screw 2.4mm Diameter 24mm Length 00-2329-026-24 Locking Screw 2.4mm Diameter 26mm Length00-2329-028-24 Locking Screw 2.4mm Diameter 28mm Length 00-2329-030-24 Locking Screw 2.4mm Diameter 30mm Length

Cortical Screws

Item Number Description00-2329-010-18 Locking Peg 1.8mm Diameter 10mm Length 00-2329-012-18 Locking Peg 1.8mm Diameter 12mm Length 00-2329-014-18 Locking Peg 1.8mm Diameter 14mm Length 00-2329-016-18 Locking Peg 1.8mm Diameter 16mm Length 00-2329-018-18 Locking Peg 1.8mm Diameter 18mm Length 00-2329-020-18 Locking Peg 1.8mm Diameter 20mm Length 00-2329-022-18 Locking Peg 1.8mm Diameter 22mm Length 00-2329-024-18 Locking Peg 1.8mm Diameter 24mm Length 00-2329-026-18 Locking Peg 1.8mm Diameter 26mm Length 00-2329-028-18 Locking Peg 1.8mm Diameter 28mm Length 00-2329-030-18 Locking Peg 1.8mm Diameter 30mm Length

Locking Pegs


Item Number Description00-2329-010-24 Locking Screw 2.4mm Diameter 10mm Length 00-2329-011-24 Locking Screw 2.4mm Diameter 11mm Length00-2329-012-24 Locking Screw 2.4mm Diameter 12mm Length 00-2329-013-24 Locking Screw 2.4mm Diameter 13mm Length00-2329-014-24 Locking Screw 2.4mm Diameter 14mm Length 00-2329-015-24 Locking Screw 2.4mm Diameter 15mm Length00-2329-016-24 Locking Screw 2.4mm Diameter 16mm Length 00-2329-018-24 Locking Screw 2.4mm Diameter 18mm Length00-2329-020-24 Locking Screw 2.4mm Diameter 20mm Length 00-2329-022-24 Locking Screw 2.4mm Diameter 22mm Length00-2329-024-24 Locking Screw 2.4mm Diameter 24mm Length 00-2329-026-24 Locking Screw 2.4mm Diameter 26mm Length00-2329-028-24 Locking Screw 2.4mm Diameter 28mm Length 00-2329-030-24 Locking Screw 2.4mm Diameter 30mm Length

Item Number Description00-2366-010-00 T8 Driver Shaft, AO Quick Connect 00-2366-015-00 AO Collet Handle with Spin Cap00-2366-090-00 Depth Gauge 10-30mm Length 00-2366-030-18 Calibrated Drill Bit, AO, 1.8mm Diameter 00-2366-030-24 Calibrated Drill Bit, AO, 2.4mm Diameter 00-2366-050-24 Calibrated Tap, AO, 2.4mm Diameter 00-2366-020-18 Locking Drill Guide for use with 1.8mm Diameter Drill 00-2366-022-18 Smooth Drill Guide for use with 1.8mm Diameter Drill 00-2366-030-00 Combination Drill Guide for use with 1.8mm/2.4mm Diameter Drill 00-2366-040-00 Polyaxial Drill Guide for use with 1.8mm Diameter Drill 00-2366-099-01 Drill Guide Block Retention Screw00-2366-099-50 Left Narrow Drill Guide Block 00-2366-099-52 Left Standard Drill Guide Block 00-2366-099-54 Left Wide Drill Guide Block 00-2366-099-51 Right Narrow Drill Guide Block 00-2366-099-53 Right Standard Drill Guide Block 00-2366-099-55 Right Wide Drill Guide Block 00-4819-002-00 Left Bending Iron 00-4819-003-00 Right Bending Iron 00-4814-006-01 Elevator00-4817-001-00 Sharp Hook00-2366-070-00 Weitlaner Retractor Small 00-3045-001-00 Weitlaner Retractor, Sharp Prong 00-4816-010-00 Reduction clamps00-2366-060-10 Left Offset Hohmann Retractor00-2366-060-20 Right Offset Hohmann Retractor00-5900-099-00 Standard Case Lid00-2366-075-00 Standard Case Base00-2366-075-10 Standard Case Tray w/ Volar Plate Caddy00-2366-075-30 Standard Screw Caddy

Instruments

97-2328-002-00 Rev. 1 MC121982 6-26-14 © 2014 Zimmer, Inc.

Contact your Zimmer representative or visit us at www.zimmer.com

This documentation is intended exclusively for physicians and is not intended for laypersons.Information on the products and procedures contained in this document is of a general nature and does not represent and does not constitute medical advice or recommendations. Because this information does not purport to constitute any diagnostic or therapeutic statement with regard to any individual medical case, each patient must be examined and advised individually, and this document does not replace the need for such examination and/or advice in whole or in part. Please refer to the package inserts for important product information, including, but not limited to, contraindications, warnings, precautions, and adverse effects.

This Surgical Technique is not approved for distribution in the United States.

zimmer distal radius plating system...zimmer® distal radius plating system surgical technique 7...

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