The Flower Anatomic Distal Fibula
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1 The Flower Anatomic Distal Fibula PROCEDURE GUIDE
2 The Flower Foot & Ankle Application STRAIGHT LOCKING FIBULA PLATE ANTERIOR LATERAL DISTAL TIBIAL PLATE MEDIAL DISTAL TIBIAL PLATE ANATOMIC DISTAL FIBULA PLATE STRAIGHT LOCKING FIBULA PLATE WITH SYNDESMOTIC SLOT DISTAL TIBIAL A-PLATE INDICATIONS FOR USE: The Flower Ankle Plating Set is intended for use for fixation of the ankle in adults and adolescents (12-21) in whom the growth plates have fused, and particularly in osteopenic bone. Specifically, Distal Medial and Lateral Tibia plates are intended for fixation of osteotomies, fractures, non-unions, and replantations of bones and bone fragments of the diaphyseal and metaphyseal regions of the distal tibia. Distal Tibia A-Plates are intended to buttress partial articular fractures and bone fragments of the distal tibia. Straight and Distal Lateral Fibula Plates are intended for fixation of osteotomies, fractures, non-unions, mal-unions, and replantations of bones and bone fragments of the diaphyseal and metaphyseal regions on the distal fibula. 2 The Flower Anatomic Distal Fibula Procedure Guide
3 The Flower Anatomic Distal Fibula Product Rationale The Flower Anatomic Distal Fibula Plate is a low profile stabilization plate designed to best accommodate biomechanical considerations of the distal fibula. The Flower Anatomic Distal Fibula Plate allows for the use of variable angle locking and compression screws that both sit flush within the plate. The dual slots in the plate are designed to accommodate variable placement of syndesmotic fixation, when required. The plate is also compatible with titanium endo buttons if flexible syndesmotic fixation is desired. The Flower Anatomic Distal Fibula Plate Design Features PLATE RATIONALE SURGICAL BENEFIT Dual syndesmotic slots Allows variable placement of the syndesmotic fixation & recess allowing suture buttons to sit flush Anatomic curvature Ideal anatomic fit distally and along the fibular shaft Anatomic low profile plate (1.8mm at the head) Minimizes plate prominence reducing potential soft tissue irritation Patented Flower locking mechanism features variable angle locking screw holes allowing +/- 15 of freedom Screws sit flush in the locking holes The Flower Anatomic Distal Fibula Procedure Guide 3
4 The Flower Anatomic Distal Fibula Surgical Strategy Step 1 Fracture Reduction using the Flower Lag Technique a. Once the fracture is reduced, use the 3.5mm drill bit (LSK 035) and the 3.5mm end of the drill guide to drill the gliding hole in the near cortex. b. Place the 2.5mm end of the drill guide into the previously drilled gliding hole and use the 2.5mm drill bit (DBK 035) to drill the pilot hole bicortically through the far cortex. Placing the 2.5mm end of the drill guide into the 3.5mm drilled hole will ensure the pilot hole and gliding hole are concentric. c. Screw length can be confirmed using the depth gauge that is part of the Flower Olive Wire Kit (OWK 200). d. With the hook of the depth gauge engaged behind the far cortex of the pilot hole, confirm the depth gauge is fully seated on the near cortex. The depth of the hole can be read off the distal end of the slider. e. Insert the 3.5mm variable angle compression screw using the screw driver from the Flower Olive Wire Kit (OWK 200). a b Step 2 Plate Selection and Provisional Fixation a. A plate trial (FIS 653) is available to determine the appropriate plate length before opening the sterile packaged plate. b. The plate trial may also be used as a bending template if bending is required. c. Select plate size so that a minimum of 3 screws are proximal to the fracture and a minimum of 3 screws are distal to the fracture. d. The plate can be temporarily fixed to the bone using olive wires placed through the screw holes. Step 3 Drill Pilot Holes 2.7mm variable angle locking screws are recommended for the distal portion of the construct a. Starting with the distal locking holes and, using a 2.0mm drill bit (DBK 027), pilot holes are drilled using caution not to violate the opposite cortex in the articular portion of the ankle joint. b. Measure the pilot hole using the Flower Depth Gauge (OWK 200). c. Ensure that the instrument is fully seated into the screw hole before the hook probe is advanced into the pilot hole. d. Pilot hole depth can be read off the distal end of the slider. e. Insert the locking screws into the distal screw holes using the Flower Screw Driver. Note: This is NOT a torque limiting screw driver. Screws are fully inserted once flush with the top of the plate. Do not overtighten. 4 The Flower Anatomic Distal Fibula Procedure Guide
5 The Flower Anatomic Distal Fibula Surgical Strategy Step 4 Insert Proximal Screws a. The pilot holes are created and measured in the same manner as described in Step 3. b. Using the locking end of the drill guide (DBK 035) pilot holes are drilled for 3.5mm locking and compression screws in the proximal shaft. Step 5 Syndesmotic Fixation a. The Flower Anatomic Distal Fibula Plate has two oblong slots for syndesmotic fixation, the slots accommodate a 3.5mm or a 4.0mm screw (4.0mm recommended). b. If desired, the plate is compatible with suture button fixation. c. The recommend level of syndesmosis fixation is 1cm proximal to syndesmosis or about 4cm proximal to ankle joint. d. A 3.0mm drill (DBK 040) is used to drill the pilot hole for 4.0mm screws. Capturing a minimum of 4 cortices is recommended. Note: The syndesmotic screw is not placed under a standard lag technique and is not intended to compress across the syndesmosis. e. During fixation, place the ankle at neutral dorsiflexion and avoid clamping syndesmosis to prevent over tightening. Note: To place screws under power, utilize the quick connect medium (T-15) speed driver shaft found Flower Large Bone K-Wire Kit (FIM 115). Only insert the screw 90% of the total length with the speed driver. The final screw threads must be inserted with the Screw Driver (OWK 200) to prevent overtightening. Do not overtighten, screws are fully inserted once flush with the top of the plate. Step 6 The Final Construct Anatomically contoured and low profile, the Flower Distal Fibula Plate provides five distal locking holes for robust fixation. The syndesmotic slots aid in proper syndesmosis targeting and allow all forms of fixation to sit with the top of the plate. The Flower Anatomic Distal Fibula Procedure Guide 5
6 The Flower Anatomic Distal Fibula Implant Selection VARIABLE ANGLE LOCKING SCREWS Screw Diameters Product Description Lengths 2.7mm 2.7mm Variable Angle Locking Screw 10mm-20mm 3.0mm* 3.0mm Variable Angle Locking Screw 8mm-30mm 3.5mm 3.5mm Variable Angle Locking Screw 10mm-20mm 4 *Additionally available. Not included in the Ankle Fibula IndicationCube. Additional lengths available. VARIABLE ANGLE COMPRESSION SCREW Screw Diameters Product Description Lengths 2.7mm 2.7mm Variable Angle Compression Screw 10mm-18mm 3.5mm 3.5mm Variable Angle Compression Screw 10mm-24mm 4.0mm 4.0mm Variable Angle Compression Screw 10mm-20mm, 40mm-60mm 4 Additional lengths available. ANATOMIC DISTAL FIBULA PLATES Product # Orientation Holes DLF 105 Left 5 DLF 205 Right 5 DLF 107 Left 7 DLF 207 Right The Flower Anatomic Distal Fibula Procedure Guide
7 The Flower Anatomic Distal Fibula Single-Use Instrument Overview ANATOMIC DISTAL FIBULA PLATE TRIAL Anatomic Distal Fibula Plate Trial FIS 653 DRILL BIT KITS DBK 027 DBK 035 DBK 040 LAG SCREW KITS LSK 027 LSK 035 LSK mm Drill Bit with Drill Guide 2.5mm Drill Bit with Drill Guide 3.0mm Drill Bit with Drill Guide 2.7mm Drill Bit with Lag Screw Drill Guide 3.5mm Drill Bit with Lag Screw Drill Guide 4.0mm Drill Bit with Lag Screw Drill Guide LARGE BONE K-WIRE KIT FIM mm K-Wire (4) T15 Medium Speed Driver Shaft, QC MEDIUM OLIVE WIRE KIT OWK 200 T15 Medium Screw Driver Medium Depth Gauge 1.8mm Olive Wires (2) PLATE BENDERS FIM 234 The Flower Anatomic Distal Fibula Procedure Guide Plate Benders 7
8 FlowerCube : Schedule. Treat. Turn. Schedule Case Sooner. (Ready-for-Surgery ) Treat Confidently. (Sterile & Single-Use) Turn OR Faster. (FlowerCube) No cleaning and sterilization FlowerCube is always ready to complete the case No time consuming set drop off Instrument kits are always complete Drill bits are always sharp Reliable sterility FlowerCube is always ready for the next surgery No delay with back to back cases Enough sterile inventory for multiple cases Flower Orthopedics Corporation 100 Witmer Road Suite 280 Horsham, PA T: F: FOCPG-LE-009 RevA 8/15
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