WRIST-01030001 Distal Radius System 2.5 Step by Step PDF
WRIST-01030001 Distal Radius System 2.5 Step by Step PDF
WRIST-01030001 Distal Radius System 2.5 Step by Step PDF
Distal
Radius System
2.5
APTUS®
Wrist
2 | Distal Radius System 2.5
Contents
3 Introduction
3 Product Materials
3 Indications
3 Contraindications
3 Color Coding
3 Possible Combination of Plates and Screws
3 Symbols
4 Treatment Concept
5 Instrument Application
5 General Instrument Application
5 Plate Holding and Positioning
5 Plate Bending
8 Cutting
9 Drilling
11 Assigning the Screw Length
12 Screw Pick-Up
13 Specific Instrument Application
13 Drill Guide Blocks
15 Instrument for Restoration of the Volar Tilt
16 Surgical Techniques
16 General Surgical Techniques
16 Lag Screws
17 Distal Two-Row Screw Allocation
18 Specific Surgical Techniques
18 Hook Plates
19 TriLock Lunate Facet Plates
20 TriLock Distal Radius Rim Plates
21 XL Plates with TriLockPLUS
22 TriLock Locking Technology
22 Correct Application of the TriLock Locking Technology
23 Correct Locking (± 15°) of the TriLock Screws in the Plate
24 Appendix
24 Implants and Instruments
Medartis, APTUS, MODUS, TriLock, HexaDrive and SpeedTip are registered trademarks of Medartis AG / Medartis Holding AG, 4057 Basel, Switzerland
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Distal Radius System 2.5 | 3
Introduction
Product Materials Color Coding
All APTUS implants are made of pure titanium (ASTM F67, System Size Color Code
ISO 5832-2) or titanium alloy (ASTM F136, ISO 5832-3). APTUS 2.5 purple
All of the titanium materials used are biocompatible, APTUS 1.5 green
corrosion-resistant and non-toxic in a biological environment.
K-wires are made of stainless steel (ASTM F 138); Plates and Screws
instruments are made of stainless steel, PEEK, aluminum Special implant plates and screws have their own color:
or titanium. Implant plates gold Fixation plates
Implant plates blue TriLock plates (locking)
Implant screws gold Cortical screws (fixation)
Indications Implant screws blue TriLock screws (locking)
Implant screws silver TriLock Express screws (locking)
APTUS Radius
Implant screws green SpeedTip screws (self-drilling)
• Intra- and extra-articular fractures
Treatment Concept
The table below lists the most common surgical wrist indications which can be treated with the Distal Radius System 2.5 implants.
Plate Type
* * * * * *
Fracture Type
A1
A2
A3
B1.1
B1.2
B1.3
B2
B3
C1
C2
C3
Diaphyseal-metaphyseal
fracture
Correction osteotomy
Primary recommendation The above-mentioned information is a recommendation only. The operating surgeon is solely responsible for the choice of the suitable
implant for the specific case.
Recommendation
Possible * Soft tissue protecting plate position along the watershed line to be respected, according to Soong et al.
(Soong et al.; Volar locking plate implant prominence and flexor tendon rupture; J Bone Joint Surg Am. 2011; 93: 328 – 335)
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Distal Radius System 2.5 | 5
Instrument Application
General Instrument Application
A-2750
2.5 Plate Holding and Positioning Instrument
Plate Bending
If required, the TriLock volar fracture plates, the volar frame
plates, the dorsal radius plates, the small fragment plates,
the lunate facet plates and the distal ulna plates can be bent
with the plate bending pliers (A-2047). The plate bending
pliers have two different pins to protect the locking holes of
flat and curved plates during the bending process.
A-2047
2.0 – 2.8 Plate Bending Pliers, with Pins
The labeled side of the plate must always face upwards when
inserting the plate into the bending pliers.
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6 | Distal Radius System 2.5
Notice
When bending a curved plate (distal ulna plates), the letters
«C – CURVED PLATE THIS SIDE UP» must be legible from
above. This ensures that the plate holes are not damaged.
Notice
While bending, the plate must always be held at two adjacent
holes to prevent contour deformation of the intermediate
plate hole.
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Distal Radius System 2.5 | 7
Caution
Do not bend the plate by more than 30°. Bending the plate
further may deform the plate holes and may cause the plate
to break postoperatively.
Caution
Repeatedly bending the plate in opposite directions may
cause the plate to break postoperatively.
Always use the provided plate bending pliers to avoid
damaging the plate holes. Damaged plate holes prevent
correct and secure seating of the screw in the plate and
increase the risk of system failure.
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8 | Distal Radius System 2.5
Cutting
If required, the plate cutting pliers (A-2046) can be used to
cut the TriLock small fragment plates, the volar frame plates,
the dorsal radius plates as well as K-wires up to a diameter of
1.8 mm.
A-2046
1.2 – 2.8 Plate Cutting Pliers
Recommendation
To facilitate the insertion of the plate, support the cutting
pliers slightly with your middle finger.
You can visually check the desired cutting line through the
cutting window in the head of the pliers (see figure). Always
leave enough material on the rest of the plate to keep the
adjacent hole intact.
Notice
Always cut the plate holes individually. If two plate holes
need to be cut off, two cutting procedures are necessary.
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Distal Radius System 2.5 | 9
Drilling
Color-coded twist drills are available for every APTUS system
size. All twist drills are color-coded via a ring system. A-3713
A-3733
There are two different types of twist drills for the system
size 2.5: The core hole drills are characterized by one colored A-3711
ring, the gliding hole drills (for lag screw technique) are
characterized by two colored rings.
A-3721
A-3731
A-2721
2.5 Drill Guide for Lag Screws
A-2726
2.5 Drill Sleeve, Self-Holding
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10 | Distal Radius System 2.5
After positioning the plate, insert the drill guide and the twist
drill into the screw hole. In the APTUS system, the drill is
guided by the drill shaft and not the drill flute.
You can read the required screw length at the scale of the
drill guide (A-2722) or the self-holding drill sleeve (A-2726)
in connection with the black markings on the drill shaft of
twist drills (A-3713, A-3723 or A-3733).
Notice
The double-ended drill guide for lag screws (A-2721) is used
only to perform the classic lag screw technique according to
AO / ASIF.
Caution
For TriLock plates ensure that the plate holes are pre-drilled
with a pivoting angle of no more than ± 15°. For this purpose,
the drill guides show a limit stop of ± 15°. A pre-drilled
pivoting angle of > 15° no longer allows the TriLock screws to
correctly lock in the plate.
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Distal Radius System 2.5 | 11
To assign the screw length, place the distal end of the slider
onto the implant plate or directly onto the bone.
When using the lag screw technique, place the distal end of
the slider directly onto the bone.
The ideal screw length for the assigned drill hole can be read
on the scale of the depth gauge.
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12 | Distal Radius System 2.5
Screw Pick-Up
The screwdrivers (A-2310, A-2710) and the screwdriver blade A-2710
2.5 Screwdriver, HD7, Self-Holding
(A-2013) feature the patented HexaDrive self-holding system.
A-2013
2.5 / 2.8 Screwdriver Blade, HD7, AO
A-2073
Cannulated Handle with Quick Connector, AO
A-2310
1.2 / 1.5 Screwdriver, HD4, Self-Holding
Notice
The screw will not hold without axial pressure!
Vertically extract the screw from the compartment. The screw
is held securely by the blade. If self-retention between
screwdriver and screw cannot be achieved despite being
picked up correctly, usually the screw has already been
picked up before. This may lead to a permanent deformation
of the self-retaining area of the HexaDrive inside the screw
head. In this case, a new screw has to be used.
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Distal Radius System 2.5 | 13
The drill guides (A-2722 or A-2726), the depth gauge Drill Guide Block Plates
(A-2730) as well as two K-wires with a diameter of up to
A-2727.01 A-4750.101 / 103
1.6 mm can be used together with the drill guide block. You
can drill, measure and insert the screws through the holes of A-2727.02 A-4750.102 / 104
the attached drill guide block. A-2727.03 A-4750.105 / 107
A-2727.04 A-4750.106 / 108
A-2727.05 A-4750.109 / 111
A-2727.06 A-4750.110 / 112
A-2727.13 A-4750.123 / 125
A-2727.14 A-4750.124 / 126
A-2723.01 A-4750.61 / 63
A-2723.02 A-4750.62 / 64
A-2727.23 A-4750.145
A-2727.24 A-4750.146
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14 | Distal Radius System 2.5
Gap
almost
closed
The marking on the drill guide block and the marking on the
rotating element will form a single line. Markings form
a single line
After all screws have been fixed in the distal area of the
plate, the drill guide block can be removed in reverse
sequence.
Gap open
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Distal Radius System 2.5 | 15
Recommendation
For ideal results, place at least three blue TriLock screws into 22°
the most distal row and two blue TriLock screws into the
second distal row.
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16 | Distal Radius System 2.5
Surgical Techniques
General Surgical Techniques
Lag Screws
1. Drilling the gliding hole
Drill the gliding hole (∅ 2.6 mm) using the twist drill with two
purple rings in combination with the correspondingly marked
end of the drill guide (A-2721, two purple bars). Drill at a
right angle to the fracture line.
Recommendation
Do not drill further than to the fracture line.
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Distal Radius System 2.5 | 17
Recommendation
Use the handle (A-2073) instead of a power tool.
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18 | Distal Radius System 2.5
A-4200.40 A-4200.41
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Distal Radius System 2.5 | 19
Caution
Do not insert K-wires into the suture holes.
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20 | Distal Radius System 2.5
Caution
The flaps can be bent once. Bending of the flaps in opposite
directions may cause the plate to break postoperatively.
A B
Drill, assign the screw length and insert the screw (see
chapter «Drilling» and «Assigning the Screw Length»). Start
with the cortical screw in the oblong hole. Repeat these steps
with the remaining plate holes.
Recommendation
The drill guide blocks (A-2727.23, A-2727.24) can be used
along with the distal radius rim plates (A-4750.145,
A-4750.146) for fast and precise positioning of the screws
(see chapter «Drill Guide Blocks»).
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Distal Radius System 2.5 | 21
Caution
Correct compression in the following steps is only achieved if
the drill guide is inserted in a 90° angle into the XL plate.
Caution
TriLockPLUS holes can also be used as conventional TriLock
holes allowing for multidirectional (± 15°) and angular stable
locking with TriLock screws or for the insertion of cortical
screws. For conventional drilling, use the respective side of
the 2.5 drill guide (A-2026, A-2722, A-2726), see also
chapter «Drilling».
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22 | Distal Radius System 2.5
Rotational Angle α
Insertion
Phase Release Locking
A B C
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Distal Radius System 2.5 | 23
However, if there is still a noticeable protrusion (Fig. 2 and 4), Do not overtighten the screw, otherwise the locking function
the screw head has not completely entered the plate and cannot be guaranteed anymore.
Figure 1 Figure 2
Figure 3 Figure 4
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24 | Distal Radius System 2.5
Appendix
Implants and Instruments
For detailed ordering information, please refer to the APTUS Ordering Catalog, also available at www.medartis.com
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WRIST-01030001_v9 / © 2018-03, Medartis AG, Switzerland. All technical data subject to alteration.
M A N U FA C T U R E R & H E A D Q U A R T E R S
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judgement when deciding whether to use a particular product when treating a particular patient. Medartis is not giving any medical advice. The devices may not be
available in all countries due to registration and / or medical practices. For further questions, please contact your Medartis representative (www.medartis.com). This
information contains CE-marked products.
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