Locking Radial Plate Systemfor Radial Reconstruction andfor Radial and Ulnar Shortening

FAROS Recon

Our core competence is hand surgery, a field where we can offer youmuch more than just standard treatment solutions for, say, distal radial fractures. Many of our products are intended to help you toachieve outstanding results in difficult, non-everyday situations aswell. Products such as our ulnar head prosthesis (UHP) or the FlowerPlate for mediocarpal partial arthrodesis (4-corner fusion) are excellentexamples of this.

Our objective is to simplify hand surgery interventions through intelli-gent system solutions, helping you to achieve the best possible results inthe interest of the patient. Working in close cooperation with well-knownauthors and their teams, we have translated new ideas into innovativeproducts that are consistently being developed further in an ongoing process. The result is a wide range of high-quality systems that impresswith their clever design along with easy and safe handling.

And what’s more, we have never lost sight of the economic perspectiveand service needs of our customers.

We consider ourselves as a true partner – to be relied upon for routinetasks and special challenges alike.

3

INNOVAT ION: s imple , fa s t and use r- f r i end ly

Table of Contents –FAROS Recon

System presentation Pages: 4 – 5

Form, advantage, benefit

FAROS C surgical technique Pages: 6 – 11

For radial displacement osteotomy

URS mini surgical technique Pages: 12 – 17

For radial and ulnar shortening

The product range Pages: 18 – 29

Standard sets and options

4

DES IGN: FAROS Recon

FAROS radial correction plates are innovative implants specially designed, in form as well as technique, for correcting the distal radius. Based on closecollaboration with renowned hand surgeons, a plate system has been createdthat covers almost all of the treatment options available for radial corrections.

Form, advantage and benefit

5

T-Drive screw head

Advantages Benefits

■ All screws of the system feature a T-Drive socket of identical size

■ Self-retaining

■ Excellent force transmission

■ Easy handling

■ Safe screw implantation

■ Reduced socket rounding risk

Standard and locking screws

■ Ø 2.7-mm and 3.5-mm standard screws

■ Ø 2.7-mm and 3.5-mm multidirectional locking screws

■ A small, self-explanatory selection of screws provides for safe bone stabilization in almost any situation

FAROS C

URS mini

■ Plate design specially matched to radial correction needs

■ Different holes to allow both standard screws and multidirec-tional locking screws to be used

■ Secure repositioning and fixation of the distal fragment

■ Highly stable system for correct bone position throughout the healing process

■ Atraumatic plate design

■ Round holes allowing the use of multidirectional locking screws

■ Premounted drill guides and saw guides

■ Less soft tissue irritation

■ Extremely stable implant, despite its small size

■ Easy handling of the system thanks to exact orthogonal drilling and a parallel osteotomy creating smoothly cut surfaces

Dotize®: type II anodization■ Increased strength,

compared with titanium alloy

■ Smooth surface

■ Enables the use of plates with a relatively low profile

■ Inhibits tissue adhesion and bone in-growth

■ Supports easy removal of the metal implant

■ Reduces rate of metalosis

Fati

gue

Str

engt

h

TI6AI4Vnon anodized

TI6AI4Vanodized type II

10721239(N) 1600

1400

1200

1000

800

600

400

200

0

6

SURGICAL TECHNIQUE : FAROS C

FAROS C – Step by step to optimal fixation

Indications

Palmar corrective osteotomy of malunited radial fractures of

■ types A2/A3 acc. to AO classification

■ type A 3.2 acc. to AO classification

Preoperative planning

Preoperative planning of corrective osteotomies requires X-raystaken in the A/P and sagittal planes.

The sagittal X-rays are used to draw sketches of the plannedosteotomy (see next page).

7

Fig. 1:The dorsal tilt of the radial joint surface (here: 22°)is determined by way of a lateral X-ray. The result is then compared with the palmar inclination (here: 10°) of the non-injured side to define thedesired joint position. The correction angle (here: 32°) is equivalent to the sum total of bothangles (dorsal tilt plus intended palmar inclination).

Advantageously, the osteotomy angle (here: 16°) isidentical with the bisector of the correction angle.

Fig. 2:Proximally, the distally fixed plate stands off fromthe shaft of the radius at the same angle as deter-mined for the malposition. This ensures that, following osteotomy, the shaft of the plate adaptssnugly to the shaft of the radius as soon as the desired joint position is reached when opening the osteotomy.

Correction in the sagittal planeActual situation: -22° Target: +10°➛ Correction angle: 32°➛ Bisector: 16°

22°

16°

10°10°

16°

16°

dorsal palmardorsal palmar

Osteotomy

32°

32°

10°

Intended joint position

Osteotomy

8

SURGICAL TECHNIQUE : FAROS C

Surgical technique: Dr. Prommersberger (M.D., P.D.), Bad Neustadt (Germany)

Fig. 3: Ulnar inclination correction:Actual situation: +16° Target: +25°➛ Correction angle: 9.0°➛ Bisector: 4.5°

To determine the correction and osteotomy angles for ulnar inclination,a sketch is drawn as well. The AP X-ray of the non-injured side providesthe reference value for the intendedulnar inclination (here: 25°). The correction angle (here: 9°) is thencalculated as the difference betweenthe targeted ulnar inclination and theflattened ulnar inclination (here: 16°)of the injured side. Conveniently again in this case, the osteotomyangle (here: 4.5°) corresponds to the bisector of the correction angle.

Fig. 5: X-ray example of a shortened and dorsally tilted radius. The erosion ofthe lunate caused by the traumaticulnar impaction syndrome is clearlyvisible.

Fig. 4: The required ulnar height of the bone block depends on ulnar feed.

16°

25°

4.5°4.5°4.5°

9°

3.5 mm

3.5 mm16°

25°

3.5 mm

9

Fig. 7: After preparation the first extensor tendon compartment is opened.

Fig. 8: After opening the third extensor tendon compartment, the extensorpollicis longus tendon is lifted.

Fig.6: Radiopalmar approach:A Y-shaped skin incision approx. 7 cmlong is made on the distal radius.

10

SURGICAL TECHNIQUE : FAROS C

This step requires:

Universaldepth gauge

T-Drive screwdriver

Drill bit, 2.0 mm

Fig. 9: The brachioradial muscle is partiallydetached at the point of insertion.Thereafter, the quadrate pronatormuscle is pushed off the radiustowards ulnar together with the longflexor muscle of the thumb and theradial artery.

To provide a smooth contact surfacefor the plate, it is usually necessary to ablate the palmar edge of the firstextensor tendon compartment.

Fig. 11: Once all distal screws have been placed, the planned osteotomy is marked out and the plate removed.

The osteotomy site is located proxi-mally to the distal, locking screwholes, in the bisector of the plannedcorrection angle in both planes.

The osteotomy is performed as sketched, using an oscillating saw.

Fig. 10: A radial plate of correct size is selected. To facilitate plate positio-ning, the drill-bit centering sleeve (26-276-03-07) can be mounted in advance to serve as a joystick.

The plate is now attached to the radius. Using the centering sleeve,the holes for the 2.7-mm locking screws (26-502-xx-09) are drilled with the 2.0-mm bit (26-937-20-07).Each screw is inserted with the screwdriver before drilling the nexthole.

Centering sleeve, 2.0 mm

11

This step requires:

Fig. 13: The bone chip is inserted into theosteotomy gap. A 3.5-mm lag screwcan be used to fix it securely in place.

Notice:To harvest the bicortical bone chipfrom the iliac crest, for example, thelarge iliac crest mill (23-190-06-07)can be used.

Fig. 14: After irrigating and cleaning thewound, the capsule and the ligamentstructures are carefully restored. A final X-ray is then taken.

Finally, the patient is provided with asterile dressing and a dorsal forearmplaster splint.

Fig. 12: Upon completion of the osteotomy, the plate is again fitted to the radiusdistally. Subsequently, the osteotomygap is widened to cause the plateshaft to attach to the shaft of the radius. If necessary, plate-holding forceps can be used for provisionalfixation of the plate in the proximalregion.

The length of the osteotomy gap isnow correctly adjusted under X-raycontrol and the plate fixed in place in the proximal region using 3.5-mmscrews.

Universaldepth gauge

2.0-mm drill bit

Centering sleeve, 2.0 mm

2.5-mm drill bit

3.5-mm gliding hole bit

12

SURGICAL TECHNIQUE : URS m in i

URS mini – Step by step to optimal fixation

Indications

■ Ulnar impaction syndrome

■ Radial impaction syndrome

Notice:

When shortening the radius, the plate is preferably inserted byusing a radiopalmar (alternatively: dorsal) approach. The osteo-tomy is performed orthogonally to the plate. As no lag screw isrequired in this case, the 6-hole plate version (26-163-06-09) is sufficient. No saw guide is used in this procedure.

13

Preoperative planning

Preoperative planning is carried out by X-rays taken in the A/Pand lateral beam paths.

Positioning

The patient is placed on the back with the upper arm exsanguinated.The arm is placed on a hand table, with the forearm in full supinationposition.

14

SURGICAL TECHNIQUE : URS m in i

Fig. 1: X-ray example of an ulnar impactionsyndrome.

Fig. 3: The incision is then continued betweenthe flexor and extensor musclesthrough the intermuscular septum.This is followed by exposure of theulna, with the quadrate pronatormuscle being carefully pushed off thebone in the distal section of the ulna.

Fig. 2: Ulnopalmar approach:A skin incision approx. 8 cm long is made over the distal ulna.

Such ulnopalmar access provides for secure soft-tissue coverage of the plate.

Surgical technique: Prof. Krimmer, Ravensburg (Germany)

15

Fig. 5: Using the premounted drill sleeves,the holes for the 2.7-mm screws are now drilled with the 2.0-mm bit(26-937-20-07).

Note that the two distal holes as well as the elongated proximal holes are to be filled with standard screws (26-901-xx-09).

Fig. 6: After the holes have been drilled, the sleeves are removed with the screwdriver. This is followed by lengthmeasurement using the universaldepth gauge (26-945-60-07).

Thereafter, the screws are inserted inthe sequence shown above, startingmonocortically.

Fig. 4: Once the ulna has been completelyexposed, the shortening plate is put in place along the inner edge on thepalmar side, approx. 3 cm away proximally from the distal end.

Notice:If the plate does not rest flatly on thebone in this area, precise adaptationto the ulnar surface will be necessaryin order to prevent plate tilting afterthe osteotomy.Plate adaptation is done with the bending pliers (25-229-25-07).

1 3 4 2

This step requires:

Universaldepth gauge

Bending pliers 2.0-mm drill bit

16

SURGICAL TECHNIQUE : URS m in i

This step requires:

2.0-mm drill bit

Compression forceps

Fig. 7: Depending on the width of the inten-ded osteotomy, the appropriate sawguide (3 mm, 4 mm or 6 mm) is selected and placed underneath theplate as shown above. As this requireslifting the plate slightly, it may benecessary to loosen the screws a little.

Notice:The fixing grooves of the saw guideare placed in the 3rd distal hole and on the distal edge of the central elongated hole.

To assure stable fixation of the sawguide during the sawing process, the screws must be retightened.

max

. 15

mm

max.0,5 mm

ca. 40 mm

Fig. 9: Upon removing the parallel, cortico-cancellous bone chip, the 3rd distal,2.7-mm locking screw (26-502-xx-09)is inserted as well and screwed in place bicortically together with theother distal screws.

Thereafter, the osteotomy gap is closed by pulling the plate with theURS mini compression forceps (26-166-10-07).

To assure complete closure of theosteotomy gap, ulnar duction of thewrist may be necessary in addition.

Fig. 8: The saw guide enables you to performa parallel osteotomy directly below the4th distal hole.

To make sure that the finely toothedsaw blade can oscillate freely withinthe guide slots, it should be dimen-sioned as follows:

■ Thickness: max. 0.5 mm■ Width: max. 15 mm■ Length: approx. 40 mm

Upon completion of the osteotomy, the screws are loosened a little againto remove the saw guide.

17

This step requires:

Fig. 11: The remaining elongated hole abovethe osteotomy is filled with a 2.7-mmstandard screw for additional stability,using the lag screw technique. The required hole is created with the2.0-mm drill bit (26-937-20-07) andthe 2.7-mm drill bit (26-937-27-07).

Fig. 12: After irrigating and cleaning thewound, the capsule and the ligamentstructures are carefully restored. A final X-ray is then taken.

Finally, the patient is provided with asterile dressing and a dorsal forearmplaster splint.

Fig. 10: To fix the osteotomy closure, the twoproximal screws are now tightened in their elongated holes. Then the central proximal hole is drilled with the 2.0-mm bit (26-937-20-07) and filled with a 2.7-mm locking screw (26-502-xx-09).

Universal depth gauge

2.0-mm drill bit

Universal depth gauge

2.0-mm drill bit

2.7-mm drill bit

T-Drive screw-driver

L R

RL Screw position in plate

Screw position in plate

18

PRODUCT RANGE : s tandard s e t s and opt ions

FAROS Recon implantsFAROS C radial plates

Palmar radial platesThe bold-type item numbers are recommended for inclusion in set.

26-172-10-09

right side

length 78 mm

= 2.5 mm

26-172-11-09

left side

length 78 mm

= 2.5 mm

26-173-10-09

right side

length 90 mm

= 2.5 mm

26-173-11-09

left side

length 90 mm

= 2.5 mm

1⁄1 1⁄1 1⁄1 1⁄1

Dotize® unit(s)1

Dotize® unit(s)1

Dotize® unit(s)1

Dotize® unit(s)1

R Screw position in plate

L

with tab26-171-11-09

left side

length 78 mm

= 2.5 mm

19

with tab26-171-10-09

right side

length 78 mm

= 2.5 mm

Icon explanations

Titanium, Dotize®

Items/pack

Multidirectionallocking holes

Plate profile = 2.5 mm

unit(s)1

Dotize®

1⁄1 1⁄1

Dotize® unit(s)1

Dotize® unit(s)1

20

PRODUCT RANGE : s tandard s e t s and opt ions

FAROS Recon implants URS mini Ulnar and radial shortening plates

URS mini plate, 7-hole26-163-07-09

length 79 mm

= 1.9 / 3.2 mm

URS mini plate, 6-hole26-163-06-09

length 71 mm

= 1.9 / 3.2 mm

1⁄11⁄1

Palmar platesThe bold-type item numbersare recommended for inclusion in set.

Dotize® unit(s)1

Dotize® unit(s)1

21

1⁄1

for drill bitmax. Ø 2.0 mm

Screws Ø 2.7 mm

Icon explanations

Titanium, Dotize®

Items/pack

Multidirectionallocking holes

Plate profile

unit(s)1

Dotize®

max. Ø 2.0 mm

22

PRODUCT RANGE : s c re w s

FAROS Recon implants Screws

Length Item No. Item No.8 mm

10 mm12 mm 26-502-12-09 26-504-12-0914 mm 26-502-14-09 26-504-14-0916 mm 26-502-16-09 26-504-16-0918 mm 26-502-18-09 26-504-18-0920 mm 26-502-20-09 26-504-20-0922 mm 26-502-22-09 26-504-22-0924 mm 26-502-24-09 26-504-24-0926 mm 26-502-26-09 26-504-26-0928 mm 26-502-28-09 26-504-28-0930 mm 26-502-30-09 26-504-30-0932 mm 26-502-32-09 26-504-32-0934 mm 26-502-34-09 26-504-34-0936 mm 26-502-36-09 26-504-36-0938 mm 26-502-38-09 26-504-38-0940 mm 26-502-40-09 26-504-40-09

Screws Multidirectional, locking cortical screws,

Ø 2.7 mm

Multidirectional, locking cortical screws,

Ø 3.5 mm

unit(s)1

set2

set2

set4

set4

set4

set4

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

The bold-type item numbersare recommended for inclusion in set.

Icon explanations

Items/set

Items/pack

Titanium

T-Drive, non-cannulated

Multidirectionallocking holes

Ø 2.7 mm

Ø 3.5 mm

set1

unit(s)1

Length Item No. Item No.8 mm 26-901-08-09 26-903-08-09

10 mm 26-901-10-09 26-903-10-0912 mm 26-901-12-09 26-903-12-0914 mm 26-901-14-09 26-903-14-0916 mm 26-901-16-09 26-903-16-0918 mm 26-901-18-09 26-903-18-0920 mm 26-901-20-09 26-903-20-0922 mm 26-901-22-09 26-903-22-0924 mm 26-901-24-09 26-903-24-0926 mm 26-901-26-09 26-903-26-0928 mm 26-901-28-09 26-903-28-0930 mm 26-901-30-09 26-903-30-0932 mm 26-901-32-09 26-903-32-0934 mm 26-901-34-09 26-903-34-0936 mm 26-901-36-09 26-903-36-0938 mm 26-901-38-09 26-903-38-0940 mm 26-901-40-09 26-903-40-09

Screws Standard cortical screws,

Ø 2.7 mm

Standard cortical screws,

Ø 3.5 mm

unit(s)1

set4

set2

set2

set4

set4

set4

set4

set4

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

set2

The bold-type item numbersare recommended for inclusion in set.

23

24

PRODUCT RANGE : s torage module and s e t l i s t

Suggested set Instruments

The selection of instruments described below represents a basic set needed for the implantation of FAROS C as well as URS mini plates.

Additional instruments are specifically required in each case. These are listed on the right and shown on page 28 for FAROS C.

The instruments and saw guides additionally required for URSmini plates are depicted on page 29.

FAROS instrument set

55-910-76-07 FAROS storage module, complete

26-931-27-07 Forefoot and hindfoot soft-tissue sleeve, 2.7 mm

26-931-35-07 Forefoot and hindfoot soft-tissue sleeve, 3.5 mm

26-937-20-07 Twist drill, Ø 2.0 mm

26-937-25-07 Twist drill, Ø 2.5 mm

26-945-60-07 FAROS universal depth gauge, 60 mm

26-950-11-07 AO handle with silicone insert, black

26-952-00-07 T-Drive bit, T8, non-cannulated / AO attachment/coupling

25-229-25-07 Bending pliers for locking (fixed-angle) plates

Additionally required for FAROS C

26-937-35-07 Gliding hole drill, 3.5 mm

26-185-35-07 FAROS centering sleeve for 3.5-mm drill bits

26-276-03-07 FAROS centering sleeve for 2-mm drill bits

Additionally required for URS mini

26-166-03-07 Saw guide for parallel cut, 3 mm

26-166-04-07 Saw guide for parallel cut, 4 mm

26-166-06-07 Saw guide for parallel cut, 6 mm

26-166-10-07 URS mini compression forceps

26-937-27-07 Gliding hole drill, 2.7 mm

25

Icon explanations

Items/set

Items/pack

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set2

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

set1

unit(s)1

26

PRODUCT RANGE : FAROS bas i c s e t

Instrument set FAROS

1⁄2 1⁄2

Soft-tissue sleeve

26-931-27-07

15 cm/6"

Ø 2.7 mm

Soft-tissue sleeve

26-931-35-07

15 cm/6"

Ø 3.5 mm

1⁄2

Bending pliers for locking plates25-229-25-07

17 cm / 6 6⁄8"

unit(s)1

unit(s)1

unit(s)1

27

Icon explanations

Steel

Items/pack

Silicone

T-Drive, cannulated

T-Drive, non-cannulated

Ø 2.7 mm

Ø 3.5 mm

unit(s)1

Sic

110 mm

80 mm

115 mm

85 mm

1⁄2 1⁄2 1⁄2 1⁄2 1⁄2

Core hole drill

26-937-20-07

Ø 2.0 mm

Core hole drill

26-937-25-07

Ø 2.5 mm

Universal depth gauge

26-945-60-07

18 cm / 7"

Silicone handle

26-950-11-07

11.5 cm / 4 4⁄8"

Screwdriver bit

26-952-00-07

unit(s)1

unit(s)1

unit(s)1

unit(s)1

unit(s)1 Sic

28

PRODUCT RANGE : FAROS bas i c s e t

Additionally required instruments FAROS Recon

Centering sleeve

26-185-35-07

Ø 3.5 mm

1⁄2

Drill bit

26-937-35-07

11.5 cm / 4 4⁄8"

Ø 3.5 mm

1⁄2

FAROS CThe bold-type item numbers are recommended for inclusion in set.

unit(s)1

unit(s)1

1⁄2

Centering sleeve for drill bits, non-cannulated26-276-03-07

Ø 2.0 mm

unit(s)1

Gliding hole drill

26-937-27-07

Ø 2.7 mm

29

Saw guide for parallel cut26-166-03-07

Distance: 3 mm

Saw guide for parallel cut26-166-04-07

Distance: 4 mm

Saw guide for parallel cut26-166-06-07

Distance: 6 mm

Compressionforceps26-166-10-07

17 cm / 6 6⁄8"

URS miniThe bold-type item numbers are recommended for inclusion in set.

Icon explanations

Steel

Items/pack

T-Drive, cannulated

T-Drive, non-cannulated

Ø 2.3 mm

Ø 3.5 mm

unit(s)1

max. 15 m

m

max.0,5 mm

110 mm

80 mm

1⁄21⁄2 1⁄2 1⁄2 1⁄2

unit(s)1

unit(s)1

unit(s)1

unit(s)1

unit(s)1

30

Should any more questions remain … … just contact us!

Apart from our range of products specially tailored to the requirements posed by traumatological and reconstructive interventions in hand surgery, we also offer you a wide selection of different systems for use in classical traumatology.

Please do not hesitate to order our Special Catalog for the Upper and Lower Extremities, which is available in printed and digital form (CD). To facilitate the ordering process for you, we have created a special Order Form that is available on request at any time.

Of course, you can reach us personally at your convenience, either by e-mail – sandra.braunbart@klsmartin.com – or telephone (customer hotline): +49-7461-706-109.

SERV ICE : in for mat ion mater ia l and cata log s

31

FAROS Recon references

Prommersberger K.-J., Lanz U. Die Korrekturosteotomie der fehlverheilten distalen Radiusfrakturvom ExtensionstypOperative Orthopädie und Traumatologie 1998;10:77-89

Prommersberger K.-J., Moossavi S., Lanz U. Ergebnisse der Korrekturosteotomie fehlverheilter Extensionsfrakturen der Speiche an typischer StelleHandchir. Mikrochir. Plast. Chir. 1999;31:234-240

Prommersberger K.-J., van Schoonhoven J.Korrektureingriffe nach distaler RadiusfrakturUnfallchirurg 2007; 110:617-630

Prommersberger K.-J., van Schoonhoven J.Fehlverheilte Extensionsfraktur des distalen RadiusUnfallchirurg 2007; 110:631-636

Prommersberger K.-J., van Schoonhoven J.Störungen des distalen Radioulnargelenkes nach distaler RadiusfrakturUnfallchirurg 2008; 111:6173-186

Prommersberger K.-J., Lanz U.B.Corrective osteotomy of the distal radius through a volar approachTechniques of Hand and Upper Extremity Surgery 2004; 8:70-77

Prommersberger K.-J., van Schoonhoven J., Lanz U.B.Outcome after corrective osteotomy for malunited fractures of the distal end of the radiusJ Hand Surg (Br.) 2002; 27: 55-60

Prommersberger K.-J., van Schoonhoven J., Laubach S., Lanz U. Corrective Osteotomy for Malunited, Palmarly DisplacedFractures of the Distal RadiusEur J Trauma 2001; 27:16-24

Prommersberger K.-J., Fernandez D.L.Nonunion of Distal Radius FracturesClinical Orthopaedics and Related Research 2004;419:51-56

FAROS C videoDVD90-167-31-04

URS videoDVD90-738-39-04

Product Overview TraumatologyPrinted version90-851-16-04

12.13 . 90-601-02-06 . Printed in Germany · Copyright by Gebrüder Martin GmbH & Co. KG · Alle Rechte vorbehalten · Technische Änderungen vorbehaltenWe reserve the right to make alterations · Cambios técnicos reservados · Sous réserve de modifications techniques · Ci riserviamo il diritto di modifiche tecniche

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