VariAx® Distal Fibula Locking Plate System Foot & Ankle Operative Technique • Distal Fibula Fracture Repair • Polyaxial Locking Technology • Low Profile Design • VariAx 2 One Third Tubular Platin

VariAx Distal Fibula Locking Plate System Contributing Surgeon Bradley R. Merk, MD Associate Professor of Orthopaedic Surgery Director of Orthopaedic Trauma Feinberg School of Medicine Northwestern University Chicago, USA John Early, MD Clinical Professor of Orthopaedic Surgery, University of Texas South Western Medical Centre, Dallas, USA This publication sets forth detailed recommended procedures for using Stryker devices and instruments. It offers guidance that you should heed, but, as with any such technical guide, each surgeon must consider the particular needs of each patient and make appropriate...

VariAx Distal Fibula Indications / Contraindications 4 VariAx Distal Fibula Introduction 5 VariAx 2 One Third Tubular Indications / Contraindications Operative Technique Lateral Plate Positioning Posterior Lateral Plate Placement Preparation for Screw Insertion Screw Insertion Final Steps Optional: Independent Lag Screw Technique Optional: Syndesmotic Screw Fixation Technique

Indications & Contraindications VariAx Distal Fibula Locking Plate System Indications The VariAx Distal Lateral Plate is intended for use in internal fixation of the distal fibula. The VariAx Fibula Straight Plates are intended for use in internal fixation of the distal fibula. Contraindications The physician’s education, training and professional judgement must be relied upon to choose the most appropriate device and treatment. Conditions presenting an increased risk of failure include: • ny active or suspected latent A infection or marked local inflammation in or about the affected area • ompromised...

Introduction VariAx • e VariAx Distal Fibula Locking Th Plate System represents a new generation of implant technology The reconstruction and fixation of distal fibular fractures may now be enhanced by means of the SmartLock polyaxial locking mechanism. This feature allows a surgeon to insert locking or non-locking screws at variable angles with respect to the plate, so that they may be targeted to address the location and geometry of a given fracture • olyaxial Locking Technology P When a locking screw is used, the thread in the head of the screw is designed to re-shape the titanium used in...

Indications & Contraindications VariAx 2 One Third Tubular Plating System Indications The Stryker VariAx 2 One-Third Tubular Plating System is intended for internal fixation of fractures of the clavicle, scapula, olecranon, humerus, radius, ulna, distal fibula, small bones in the ankle, fore, mid-and hind-foot in adult patients. Indications include the following: • Osteotomies and non-unions • Fixation of fractures • ormal bone density N and osteopenic bone • The Stryker VariAx 2 One Third Tubular Plating System has not been evaluated for safety and compatibility in the MR environment. It has...

Overview Plate Options Distal Lateral Fibula Plate Straight Fibula Plate Range: 3 Holes – 12 Holes Length: 77 – 185mm Profile Shaft: 2.0mm Distal End: 1.3mm VariAx 2 One Third Tubular Plating System Range: 2 Holes – 16 Holes Length: 28.5 – 204mm Profile: 2.0mm Range: 2 Holes – 16 Holes Length: 23 – 191mm Profile: 1.7mm Screw Options Locking Screws Diameter: 3.5mm Length: 10 – 70mm Non-Locking Screws

Operative Technique The Operative Technique listed below is designed to provide a general overview on the instruments and procedure required to implant a plate in the distal fibula. This operative technique will focus on the placement and fixation of the Straight Fibula plate and Distal Lateral Fibula Plate. The VariAx 2 One Third Tubular Plating system uses the same techniques and instrumentation. Planning and Preparation Clear identification and classification of the fracture site should first be established pre-operatively using the appropriate methods and visualization. A lateral incision...

Operative Technique Lateral Plate Positioning Having achieved reduction, the plate is selected and applied to the direct lateral surface of the distal fibula. The position should be adjusted to optimize fit and to allow for optimal screw fixation as per the fracture pattern and the pre-operative plan. Fluoroscopy can be utilized as needed to confirm position. The plate can then be stabilized by the insertion of K-Wires to ensure anatomical alignment (proximally and distally). Posterior Lateral Plate Placement The VariAx straight fibula plate and the VariAx 2 one third tubular plate may be applied...

Operative Technique Preparation for Screw Insertion • • A drill guide must first be placed into a corresponding plate screw hole (in a plate), prior to predrilling a pilot hole. • The Drill Guide for Circular Locking Holes (45-80001) must be used in all VariAx Distal Fibula Plate holes. Use the end of the drill guide indicated with yellow color-coded lines to pre-drill for VariAx Distal Fibula plating procedures. Yellow color-coding is associated with 3.5mm VariAx Foot and Ankle screws. The other end of the drill guide is indicated with black colorcoded lines, and is designed for use with VariAx...

Operative Technique Use the drill to create a pilot hole through the drill guide. The 2.6mm Twist Drill (45-35010) is color-coded yellow to match the color associated with the 3.5mm drill guide (double yellow). Although the locking and non-locking screws found in the VariAx Foot and Ankle system are self-tapping, when encountering hard bone a tap may be required. For 3.5mm screws the appropriate tap is accordingly colorcoded yellow (45-35005). Measure the depth of the predrilled hole using the Depth Gauge (45-35002). Always measure the depth of the pre-drilled hole by inserting the depth gauge...

Operative Technique Assemble the appropriate Screwdriver Blade (with AO fitting) with the Screwdriver Handle, Revolving / Rigid, AO (45-85000). The yellow color-coded Screwdriver Blade, AO, T10 (45-35015) or Self Retaining Screwdriver Blade, AO, T10(703667) can be used to insert 3.5mm screws. Begin by pushing the AO quickconnect sleeve towards the body of the Screwdriver Handle, insert the screwdriver blade into the AO quickconnect coupling, and then release the sleeve. The screwdriver handle contains a switch which allows the metal and plastic segments of the handle to either independently rotate,...