VARIABLE ANGLE LOCKING HAND SYSTEM for Fragment-Specific Fracture Fixation with Variable Angle Locking and Locking Technology

VARIABLE ANGLE LOCKING HAND SYSTEM For fragment-specific fracture fixation with variable angle locking and locking technology

SURGICAL TECHNIQUE TABLE OF CONTENTS

INTRODUCTION Variable Angle Locking Hand System Overview 2

AO Principles 5

Indications 6

Featured Plates & Technique Highlights 7

Screws in the System 18

Featured Instruments 20

SURGICAL TECHNIQUE Preoperative Planning and Reduction 27

Lag Screw Insertion (Optional) 29

Prepare and Insert Plate 37

Insert Screw 50

Implant Removal 51

PRODUCT INFORMATION Implants 54

Instruments 63

Graphic Cases 70

Set Lists 77

Image intensifier control

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies VARIABLE ANGLE LOCKING HAND SYSTEM OVERVIEW

The DePuy Synthes Variable Angle Locking Hand System consists of plates that are anatomic, procedure-specific, and available in both stainless steel and titanium.

The Variable Angle Locking Hand System offers instrumentation to aid in: x fracture reduction x provisional fixation x plate adaptation x construct creation

Designed for the Surgeon and Patient A dedicated, global surgeon team was integral to the design of this system through extensive consultation and participation in multiple design labs. Surgeon interviews, design and development meetings, and collaboration with key opinion leaders determined the clinical components necessary for the DePuy Synthes Variable Angle Locking Hand System. DePuy Synthes Companies are dedicated to improving patient care.

System Snapshot • Extensive system of anatomically precontoured plates • First to the market with 1.3 mm locking screws for hand plating1 • Forceps that aid in fracture reduction and lag screw application • Forceps that aid in plate fixation • Self-retaining screwdrivers • Plates available in 316L stainless steel and titanium • Color-coded instruments

1DePuy Synthes Companies market analysis of leading orthopaedic companies, conducted May 2015.

2 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Variable Angle Locking Hand System Overview

SYSTEM TECHNOLOGY

Variable Angle Locking Technology 1.5 mm and 2.0 mm plates feature variable angle locking coaxial holes. Four columns of threads in the variable angle locking hole provide four points for threaded locking between the plate and the Variable Angle Locking Screw to create a fixed-angle construct at the desired screw angle. x 1.5 mm variable angle plate holes accept: – 1.5 mm variable angle locking screws – 1.5 mm cortex screws – 1.5 mm locking screws. These screws can only be used on-axis x 2.0 mm variable angle plate holes accept: – 2.0 mm variable angle locking screws – 2.0 mm cortex screws – 2.0 mm locking screws. These screws can only be used on-axis x Variable Angle Locking Screws can be angled anywhere within a 30° cone x 1.5 mm and 2.0 mm cortex screws can be used in the plate positioning slots, if present, for traditional compression and fixation

Locking Technology • 1.3 mm plates feature locking, coaxial holes. Fully threaded locking holes provide threaded locking between the plate and the locking screw to create a fixed-angle construct • 1.3 mm locking plate holes accept: – 1.3 mm locking screws – 1.3 mm cortex screws

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 3 Variable Angle Locking Hand System Overview

SYSTEM FEATURES

FEATURES BENEFITS Extensive range of implant options Accommodates a variety of fractures and patient sizes Anatomically contoured plates Designed with contour to adapt to bony anatomy Plates designed for lateral and direct Accommodates plate placement to help dorsal application avoid tendon insertion points Low-profile, anatomically precontoured Designed to reduce soft tissue irritation plates Recessed screw heads Designed to sit flush with the plate surface Variable Angle Locking Technology Offers screw placement options in a variety of fragment patterns and around the joint Provides fixed angle stability for metaphyseal and osteopenic bone Elongated plate holes Facilitate plate positioning Modular, color-coded system Aids in clear identification of instruments for Operating Room staff and Central Processing Facilitates proper instrumentation usage by size Comprehensive instrumentation Aids surgeon in all aspects of procedure: plate adaption, provisional fixation, and bone preparation Implants offered in both stainless steel Allows options for surgeon preference and and titanium patient need T4 and T6 self-retaining screwdriver Aid in screw handling, measuring, and shafts delivery Hex coupling screwdriver handle Ergonomic connection mechanism in a handle design that disassembles for cleaning Reduction Forceps Aids reduction and lag screw application via forceps Plate Holding Forceps Holds plate intraoperatively

4 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique AO PRINCIPLES AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1, 2 InThose 1958, principles the AO formulatedare: four basic principles, which have become the guidelines for internal fixation1, 2.

4_Priciples_03.pdf 1 05.07.12 12:08

AnatomicAnatomic reductionreduction StableStable fixationfixation FractureFracture reductionreduction and fifixationxation toto FractureFracture fixation fixation providingproviding absoluteabso- restorerestore anatomicalanatomical relationships.relationships. orlute relative or relative stability, stability, as required as by therequired patient, by thethe injury, patient, and the the injury, 1 2 personalityand the personality of the fracture. of the fracture.

Early,Early, activeactive mobilizationmobilization PreservationPreservation of of blood blood supply supply EarlyEarly andand safesafe mobilizationmobilization and 4 3 PreservationPreservation of of the the blood blood supply supply rehabilitationrehabilitation ofof thethe injuredinjured part toto softsoft tissues tissues and and bone bone by by gentle andand thethe patientpatient asas aa whole.whole. reductiongentle reduction techniques techniques and and carefulcareful handling. handling.

1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer; 1991. 2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal 2nd ed. Stuttgart, New York: Thieme; 2007. Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991. 2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007. Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 5

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique INDICATIONS

The DePuy Synthes Variable Angle Locking Hand System is intended for fracture fixation of the hand and other small bones and small bone fragments, in adults and adolescents (12–21 years) particularly in osteopenic bone.

System indications include the following: • Open reduction and internal fixation of fractures, mal-unions, and non-unions • Following excision of benign bone tumors • Replantations and reconstructions • Arthrodeses of joints involving small bones • Osteotomies, including deformity correction such as rotation, lengthening, shortening • Pathological fractures, including impending pathologic fractures

Caution: When using this system to treat skeletally immature patients, physiological status of the physes and individual stature of the patient should be assessed before considering treatment options as damage to the physes may occur, leading to potential growth arrest.

MR SAFETY INFORMATION These devices have not been evaluated for safety and compatibility in the MR environment. The devices have not been tested for heating or migration in the MR environment.

6 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique FEATURED PLATES & TECHNIQUE HIGHLIGHTS

The plates contained in this section are featured implants of the DePuy Synthes Variable Angle Locking Hand System. Refer to the product information section for a complete list of all plate configurations offered as part of this system.

Phalangeal Head Plate Available sizes: Designed with an anatomic contour and hole configuration Left Right to facilitate fixation of fractures of the middle and proximal 1.3 mm 02.130.157 02.130.156 phalangeal head. 04.130.157 04.130.156 x Elongated hole for adjustment of plate position 1.5 mm 02.130.257 02.130.256 x Ulnar or radial plate placement 04.130.257 04.130.256 x Curved plate designed to follow the natural curve of the phalanx 02 = Stainless Steel x Screw configuration in the head is designed to span 04 = Titanium the attachment of the collateral ligament x Available in Right and Left orientations x Designed for periarticular fractures and articular fractures of the distal phalanx Left

Right

Surgical Approach

Ulnar Radial

Right Hand

Right Plate Left Plate

Left Hand

Left Plate Right Plate

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 7 Featured Plates & Technique Highlights

When implanting this plate, the following screw order 1 placement is suggested. x Place a cortex screw in the elongated hole (1), leaving the screw slightly loose. Screw placement is at the midaxial line. Place plate prior to the K-wire so that the cortex screw can be positioned at the midaxial line x Provisionally fix the condyles. Place a K-wire in the center of the condyle, so the wire is located between the two 2 distal holes (2). The K-wire should be placed in the center of the axis of the joint. K-wire placement is relative to 3 the fan-shaped, central collateral ligament. Note that the footprint of the ligament is larger than the center of the axis. Make small adjustments to K-wire placement to avoid intra-articular placement of screws, while still creating a stable construct. Variations in K-wire placement are at surgeon’s discretion, considering periarticular tissue and fracture size. For 1.3 mm plates, use a 0.6 mm K-wire. For 1.5 mm plates, use a 0.8 mm K-wire 4 x Adjust the plate along the bone shaft, as necessary, so that the K-wire abuts the plate. Tighten the cortex screw in the elongated hole x Place a screw in most distal hole (3) x Place screw in most volar hole (4) x Confirm placement and depth of screws under radiographic imaging x Place remaining screws in the head and plate shaft, depending on fracture pattern

Refer to surgical technique section for general plate and screw application techniques where this suggested screw insertion order can be applied.

8 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Featured Plates & Technique Highlights

Phalangeal Base Plate Available sizes: Designed with an anatomic contour and hole configuration 1.3 mm 1.5 mm 2.0 mm to facilitate fixation of fractures at the base of the middle 02.130.154 02.130.254 02.130.354 and proximal phalanx. 04.130.154 04.130.254 04.130.354 x Elongated hole for adjustment of plate position x Lateral or dorsal placement 02 = Stainless Steel x Designed for metaphyseal transverse, oblique, or 04 = Titanium comminuted fractures of the phalanx 1 2 When implanting this plate, the following screw order placement is suggested. x Place cortex screw in elongated hole (1), leaving screw slightly loose. Check alignment and adjust plate as necessary x Tighten screw in the elongated hole x Place a Variable Angle Locking Screw in one of the head holes (2). For 1.3 mm plates, place a locking screw. Confirm screw placement and depth under radiographic imaging x Place remaining screws in the head and plate shaft as needed, depending on fracture pattern

Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 9 Featured Plates & Technique Highlights

Condylar Plate Available sizes: Straight plate with hole configuration designed to 1.5 mm 2.0 mm facilitate fixation of the middle and proximal phalanx, 02.130.255 02.130.355 and the metacarpals. 04.130.255 04.130.355 x Elongated hole for adjustment of plate position x Lateral or dorsal placement 02 = Stainless Steel x Designed for metaphyseal transverse, oblique, or 04 = Titanium comminuted fractures of the phalanx and metacarpals 1 Position the head of the plate on the condyles. 2

When implanting this plate, the following screw order placement is suggested. x Place a cortex screw in the elongated hole (1), leaving screw slightly loose. Check alignment and adjust plate, as necessary x Tighten the screw in the elongated hole. Place a Variable Angle Locking Screw in one of the head holes (2). Confirm screw placement and length using radiographic imaging x Place remaining screws in the head and plate shaft as needed, depending on fracture pattern

Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

11 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Featured Plates & Technique Highlights

First Metacarpal Plate, Dorsal Available sizes: Designed with an anatomic contour and hole configuration 1.5 mm 2.0 mm to facilitate fixation in fractures of the base of the first 02.130.263 02.130.363 02 = Stainless Steel metacarpal. 04.130.263 04.130.363 04 = Titanium x Elongated hole for adjustment of plate position x Dorsal placement on the first metacarpal with the wide 2 end of the plate placed proximally x Three 1.0 mm K-wire holes accept k-wires, 1.0 mm or 3 smaller, for provisional fixation x 4 variable angle screw holes in head designed to facilitate capture of fracture fragments 1 Proximal Distal x 1.5 mm Variable Angle Locking Plate has higher strength than a 2.0 mm non-locking straight plate*

Position plate on the metacarpal. During plate placement, consider the curve in the base of the metacarpal.

Place a K-wire in any of the three K-wire holes, if needed, to hold the plate in place and obtain provisional fixation of the fragments around the joint (1).

When implanting this plate, the following screw order placement is suggested. x Place cortex screw in the elongated hole (2), leaving the screw slightly loose. Adjust plate position, as necessary. Tighten cortex screw in the elongated hole x Place a Variable Angle Locking Screw in the most proximal, metaphyseal head hole (3). The screw in the most proximal head hole is placed first since it is closest to the joint. Confirm screw placement and length under radiographic imaging x Place remaining screws in the head and plate shaft as needed, depending on the fracture pattern

Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

*Benchtop testing may not be indicative of clinical performance. Testing on file at DePuy Synthes Companies. Testing was completed comparing the 1.5 mm First Metacarpal Plate, Dorsal to the DePuy Synthes 2.0 mm non-locking straight plate.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 11 Featured Plates & Technique Highlights

First Metacarpal Plate, Lateral Available size: Designed with a shape and hole configuration to facilitate 1.5 mm Left Right fixation in fractures of the first metacarpal. This plate is 02.130.265 02.130.264 designed to be contoured to fit the dorsal and radial 04.130.265 04.130.264 periarticular surfaces. x Elongated hole for adjustment of plate position. 02 = Stainless Steel Elongated hole is positioned on the shaft 04 = Titanium x Designed for palmar approach to the first metacarpal x Lateral placement on the first metacarpal (radiopalmar) x Plate adaptation is recommended to ensure correct fit 2 2 of plate to the bone (see technique section related to plate contouring) x Available in Left and Right orientations x Y-shape with contourable arms to fit varying anatomy 1 1 and address fracture fragments Left Right x Designed for T- or Y-shaped fractures in the sagittal 2 2 plane and comminuted intra-articular fractures of the base of the first metarcarpal

Placement of the plate is fracture-dependent. When implanting this plate, the following screw order and placement is suggested. x Ensure plate is contoured to fit anatomy, prior to implantation. The more contoured arm of the plate is positioned so that it wraps around the bone palmarly. This contoured arm follows the curve of the shaft of the plate x Place a cortex screw in the elongated hole (1), leaving the screw slightly loose. Adjust plate position, as necessary. Tighten cortex screw in the elongated hole x Place a Variable Angle Locking Screw in the arms of the plate (2). Confirm screw placement and length under radiographic imaging x Place remaining screws in the plate, depending on fracture pattern

Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

11 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Featured Plates & Technique Highlights

Metacarpal Neck Plate Available size: Designed with an anatomic contour and hole configuration 1.5 mm to facilitate fixation of the head and neck of the 02.130.268 02 = Stainless Steel metacarpals. 04.130.268 04 = Titanium x Elongated hole for adjustment of plate position x MC V: ulnar placement 2 x MC II-IV: dorsolateral placement 1 x 1.0 mm K-wire hole accepts K-wires 1.0 mm or smaller, for provisional fixation 3 x 4 diverging screws for secure fixation x Designed for unstable subcapital and comminuted head and neck fractures of the metacarpals

When implanting this plate, the following screw order placement is suggested. x Place a cortex screw in the elongated hole (1), leaving the screw slightly loose. Adjust plate position, as necessary. Tighten cortex screw in the elongated hole x Additionally, a K-wire can be placed in the K-wire hole (2) in the distal portion of the plate to hold the plate in place, as necessary x Place a Variable Angle Locking Screw in the either of the most distal holes of the plate head (3). Avoid wire and screw interference when placing screws in a variable angle hole. If necessary, the K-wire can be bent slightly to facilitate placement of the Variable Angle drill guide into a plate hole in the head of the plate

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 11 Featured Plates & Technique Highlights

x Confirm screw placement and length under radiographic imaging x Place remaining screws in the plate, depending on fracture pattern. Fracture pattern will dictate the order of screw placement

Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

Variable angle screws at nominal angle in head of plate.

Variable angle screws at 15° angulation in head of plate.

11 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Featured Plates & Technique Highlights

Rotation Correction Plate Available sizes: Designed with an anatomic contour and hole 1.5 mm 2.0 mm configuration to facilitate fixation of the metacarpals 02.130.266 02.130.366 02 = Stainless Steel and phalanges. 04.130.266 04.130.366 04 = Titanium x Elongated transverse hole for intraoperative adjustment of the reduction, including correction of the fragment rotation of the bone, if necessary. Elongated hole allows 2.5 mm of travel 1 x Design of the plate head facilitates contouring to the anatomy of the condyles 2 x Designed for fractures and osteotomies of the metacarpals and phalanges

When implanting this plate, the following screw order placement is suggested. x Position the plate with the T-shaped section of the plate near the joint x Insert 2 Variable Angle Locking Screws into the T-shaped section of the plate (1), ensuring that the elongated hole (2) is on the side of the osteotomy away from the joint, near a section of intact bone. Confirm screw placement and length under radiographic imaging x Adjust the position of the bone x Place a cortex screw into the elongated transverse hole (2), leaving the screw loose. Release and tighten the cortex screw while adjusting plate position, as necessary x Check result of repositioning with the wrist at maximum extension. Tighten cortex screw x Place remaining screws distal or proximal to the elongated transverse hole. Confirm screw placement and depth using radiographic imaging

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 11 Featured Plates & Technique Highlights

Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

11 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Featured Plates & Technique Highlights

Fracture Plate Available sizes: Designed for indirect reduction techniques where bridging 1.5 mm 2.0 mm or in-situ reduction is desired. 02.130.267 02.130.367 02 = Stainless Steel x Allows adjustment of rotation and angulation before 04.130.267 04.130.367 04 = Titanium fixed angle construct is applied. Consistent with AO indirect reduction techniques of external fixation1,2 x Two elongated holes for intra-operative correction in 2 2 planes x Dorsal placement x Staggered shaft 1 x Designed for crushed, multifragmented, and/or periarticular fractures of the metacarpals and phalanges

When implanting this plate, the following screw order placement is suggested. x Insert a cortex screw into the head of the plate (1) into the condyle, ensuring that the elongated hole (2) is on the side of the osteotomy away from the joint, near a section of intact bone. Provisional fixation in either adjacent hole may be helpful x Correct the position of the bone. Place a cortex screw in the elongated transverse hole (2) x Continue to adjust the position of the bone, as necessary x Check result of repositioning x Place remaining screws distal or proximal to the elongated transverse hole

Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer; 1991. 2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme; 2007.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 11 SCREWS IN THE SYSTEM

1.3 mm Screws 1.3 mm Locking Screws • Only for on-axis insertion in the locking holes • Threaded, conical head locks securely into the locking hole • Self-retaining,T4 STARDRIVE Recess • Self-tapping tip facilitates insertion

1.3 mm Cortex Screws • Can be used in locking holes to compress the plate to the bone • Self-retaining,T4 STARDRIVE Recess • Self-tapping tip facilitates insertion

1.5 mm Screws 1.5 mm Variable Angle Locking Screws • Threaded, rounded head locks securely into the variable angle locking hole • Purple, color-coded head to easily distinguish as Variable Angle Locking Screw • Self-retaining, T4 STARDRIVE Recess • Blunt self-tapping tip

1.5 mm Cortex Screws • Can be used in the variable angle locking holes to compress the plate to the bone • Self-retaining, T4 STARDRIVE Recess • Self-tapping tip facilitates insertion

Also Available • 1.5 mm Locking Screws only used on-axis – Compatible with 1.5 mm Variable Angle Locking Plates

11 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Screws in the System

2.0 mm Screws 2.0 mm Variable Angle Locking Screws • Threaded, rounded conical head locks securely into the locking hole • Purple, color-coded head to easily distinguish as a Variable Angle Locking Screw • Self-retaining, T6 STARDRIVE Recess • Blunt, self-tapping tip

2.0 mm Cortex Screws • Can be used in the variable angle locking holes to compress the plate to the bone • Self-retaining, T6 STARDRIVE Recess • Self-tapping tip facilitates insertion

Also Available • 2.0 mm Locking Screws only used on-axis – Compatible with 2.0 mm Variable Angle Locking Plates

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 11 FEATURED INSTRUMENTS

Reduction Forceps (03.130.291) This instrument is designed to hold reduced metacarpal and phalangeal bone fragments in place, while allowing insertion of a lag screw through the barrel of the forceps. Colors on the drill sleeves indicate the screw size and color bands indicate the threaded and gliding hole.

Plate Holding Forceps (03.130.280) The Plate Holding Forceps is designed to hold the plate in the desired position against the bone. x The ball on the upper portion of the jaws inserts through the plate hole to the bone, and the lower arm is inserted beneath the soft tissue against the underside of the bone x The forceps can then be closed to the desired tightness to hold the plate, and is designed to remain in place after the handles are released

22 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Featured Instruments

Plate Holder (03.130.130) The Plate Holders are designed to hold the plates. • The arms are squeezed together and inserted into a single plate hole. Once the arms are released, they hold the plate via tension • The arms of the plate holders can also be placed in two adjacent holes

The forceps can also be used to hold the outside edges of the plate. If used to hold the outside of the plate, releasing the arms of the holder will allow the plate to disengage.

Alternative Instrument

03.503.034 Mini Plate Holder, Long

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 22 Featured Instruments

Plate Cutter for 1.3 mm to 2.0 mm Plates (03.130.271) The Plate Cutter for Plates is designed to cut all plates within the Variable Angle Locking Hand System. • A rasp for manual deburring is provided on the plate cutter head, if deburring is needed after cutting

Plate Cutter, In-Line for 1.3 mm Locking, 1.5 mm VA Locking, and 2.0 mm VA Locking Plates (03.130.270) The Plate Cutter, In-Line for Plates is designed to cut plates with straight shafts within the Variable Angle Locking Hand System. • Variable Angle locking and locking plate holes are inserted over the insertion posts to hold the plate in place • A rasp for manual deburring feature is provided on the plate cutter head, if deburring is needed after cutting

22 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Featured Instruments

Bending Pliers (03.130.260, 03.130.261) Bending Pliers facilitate additional contouring of the plates, if necessary.

Bending Pins (03.130.140) Bending Pins facilitate additional contouring of 1.3 mm plates, if necessary.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 22 Featured Instruments

Screwdriver Handle with Hex Coupling (03.130.005) The design of the handle reduces the likelihood of rolling on a flat surface.

The hex coupling provides a one-step, reliable connection when inserting the screwdriver shaft.

The screwdriver handle disassembles into three pieces for cleaning and sterilization. The three parts include the hex coupling with spring, the shaft, and the handle.

STARDRIVETM Screwdriver Shafts (03.130.010, 03.130.020) Self-retaining screwdrivers aid in screw handling, measuring, and delivery. 1.3 mm and 1.5 mm screws feature a T4 STARDRIVE Recess. The tip of the T4 Screwdriver is gold-colored. 2.0 mm screws feature a T6 STARDRIVE Recess.

22 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Featured Instruments

Variable Angle Locking Double Drill Guide with Cone (03.130.220, 03.130.320) The double drill guide with cone is designed for variable angle technique and nominal angle technique.

Variable Angle Nominal Angle (Coaxial)

Variable angle technique using the cone-shaped end. Nominal angle technique using the fixed-angle end marked “coaxial.”

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 22 Featured Instruments

Variable Angle Locking Double Drill Guide— Freehand (03.130.221, 03.130.321) The double drill guide – freehand is designed for variable angle technique and nominal angle technique.

Variable Angle Nominal Angle (Coaxial)

Variable angle technique using the variable Nominal angle technique using the fixed-angle angle end, which allows freehand angulation end marked “coaxial.” of the drill bit.

22 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique PREOPERATIVE PLANNING AND REDUCTION

1 Preparation Complete preoperative radiographic assessment and preoperative planning.

Select the implant according to the fracture pattern and anatomy of the bone.

Note: Ensure the proper plate selection is available, including L (left) or R (right) plates. Left plates are designed for the left hand. Right plates are designed for the right hand. For clarification on right and left Phalangeal Head Plate application, see information on Page 7.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 22 Preoperative Planning and Reduction

2 Reduce Fracture

Instruments

292.06 0.6 mm Kirschner Wire, 70 mm, trocar point, (stainless steel)

292.08/492.08 0.8 mm Kirschner Wire, 70 mm, trocar point (stainless steel or titanium)

292.10/492.10 1.0 mm Kirschner Wire, 150 mm, trocar point (stainless steel or titanium)

292.12/492.12 1.25 mm Kirschner Wire, 150 mm, trocar point (stainless steel or titanium)

Reduction Forceps 319.39.96 Sharp Hook

Reduce fracture under imaging using Kirschner wires or reduction forceps if necessary. The reduction method will depend on patient anatomy and fracture pattern.

Optional Instrument

03.130.291 Reduction Forceps for 1.3 to 2.0 mm Screws/Soft Lock

22 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique LAG SCREW INSERTION (OPTIONAL) Lag Screw Insertion – Reduction Forceps

1 Select a Drill Sleeve and Drill Bit Lag screws may be inserted using the Reduction Forceps (03.130.291). The associated drill sleeves and drill bits use a color-coded stripe system. The colors on the drill sleeves and drill bits correspond to the screw size. A single stripe indicates that the drill sleeve or drill bit is used for a threaded hole; a double stripe indicates that the drill sleeve or drill bit is used for a gliding hole.

Screw Size Color Coding Drill Sleeve Drill Bit for Drill Sleeve Drill Bit for for for Threaded Hole for Gliding Hole Instruments Threaded Hole (One Color Stripe)* Gliding Hole (Two Color Stripes)*

1.3 mm Yellow

1.0 mm 1.0 mm 1.3 mm 1.3 mm 03.130.292 03.130.294

1.5 mm Red

1.1 mm 1.1 mm 1.5 mm 1.5 mm 03.130.293 03.130.295

2.0 mm Blue

1.5 mm 1.5 mm 2.0 mm 2.0 mm 03.130.296 03.130.297

*Drill bits are available with various couplings, including Mini Quick Coupling, K-wire, and J-Latch.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 22 Lag Screw Insertion (Optional) Lag Screw Insertion—Reduction Forceps

2 Assemble Drill Sleeve to Forceps Press the drill sleeve into the barrel of the Reduction Forceps so that the sleeve is fully seated and a click is felt.

3 Attach the Reduction Forceps to the Bone Once in place, close the Reduction Forceps to the desired tightness. The forceps is designed to remain in place after the handles are released.

33 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Lag Screw Insertion (Optional) Lag Screw Insertion—Reduction Forceps

4 Gliding Hole Drill Threaded and Gliding Hole

Threaded Hole

Threaded Hole: Using the drill sleeve, drill the far fragment using a drill bit for the threaded hole.

Gliding Hole: Using the drill sleeve, drill the near cortex, so that the thread of the screw does not obtain purchase.

Drill so that the lag screw is perpendicular to the fracture plane.

An alternative technique is to drill for the gliding hole first and then drill for the threaded hole.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 33 Lag Screw Insertion (Optional) Lag Screw Insertion—Reduction Forceps

5 Countersink (Optional) Remove the Drill Sleeve from the forceps. Attach the Countersink (03.130.215) to the Screwdriver Handle. Countersink, if desired.

6 Measure Insert the Depth Gauge (03.130.250) through the barrel of the forceps, to determine the screw length needed. The Depth Gauge is designed for one-handed use.

33 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Lag Screw Insertion (Optional) Lag Screw Insertion—Reduction Forceps

The black line indicates the screw length.

Optional Technique: Use the scale on the back of the Depth Gauge to measure for screw length.

Note: The depth gauge consists of 2 pieces and is designed to be disassembled for cleaning. Slide the tip of the hook so it is fully inside the black outer body. Press the tab on the back of the sliding hook and remove it from the black outer body.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 33 Lag Screw Insertion (Optional) Lag Screw Insertion—Reduction Forceps

7 Insert Cortex Screw

Instruments

03.130.010 STARDRIVE Screwdriver Shaft, T4, 50 mm, Self-Retaining, Hex Coupling

03.130.020 STARDRIVE Screwdriver Shaft, T6, 50 mm, Self-Retaining, Hex Coupling

03.130.005 Screwdriver Handle with Hex Coupling

Assemble the screwdriver shaft to the Screwdriver Handle.

For 1.3 mm and 1.5 mm screws, use the T4 STARDRIVE screwdriver shaft (03.130.010, with yellow and red bands). The tip of the T4 screwdriver is gold-colored.

For 2.0 mm screws, use the T6 STARDRIVE screwdriver shaft (03.130.020, with blue band).

The screwdriver and screws are designed to be self-retaining. To attach the screw to the screwdriver, position the screwdriver directly in line with the screw with no tilting.

Ensure that the screwdriver tip engages the star-shaped recess in the screw. It may be necessary to rotate the screwdriver up to a quarter turn to fully align the star-shaped screwdriver tip into the screw recess. In addition, a tactile sensation may be noticed when the screwdriver shaft is fully aligned with the screw recess. Apply firm axial pressure downwards to ensure that the screw is fully seated before removing the screw from the implant module. Remove the screw from the implant module in a straight vertical position.

Using the screwdriver, place the screw on the scale of the implant module, to confirm the length of the screw.

Insert the screw through the barrel of the reduction forceps. Note: Prior to sterilization of the Reduction Forceps, Confirm screw placement under radiographic imaging. Soft Lock, add one drop of DePuy Synthes Once the screw has been inserted, remove the forceps Autoclavable Oil (519.97) to instrument joints from the bone. and ratchet mechanisms.

33 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique LAG SCREW INSERTION — DOUBLE DRILL SLEEVE (OPTIONAL)

Instruments

03.130.125 1.3 mm/1.0 mm Double Drill Sleeve, for 1.3 mm Cortex Screws/Yellow

03.130.225 1.5 mm/1.1 mm Double Drill Sleeve for 1.5 mm Cortex Screws/Red

03.130.325 2.0 mm/1.5 mm Double Drill Sleeve for 2.0 mm Cortex Screws/Blue

For 1.3 mm, 1.5 mm, and 2.0 mm cortex screws used as independent lag screws, use a double-ended drill sleeve and corresponding drill bit. Drill bits and drill guides are color-coded. Drill bits are available with several different couplings (see item listing). Etch lines on drill bits are spaced 5 mm apart.

A K-wire may be used through the double drill sleeve.

Screw Size Color Coding Double Drill Sleeve Drill Bit For Drill Bit for for Threaded Hole Gliding Hole Instruments (One Color Stripe)* (Two Color Stripes)*

1.3 mm Yellow 03.130.125 1.0 mm 1.3 mm

1.5 mm Red 03.130.225 1.1 mm 1.5 mm

2.0 mm Blue 03.130.325 1.5 mm 2.0 mm

*Drill bits are available with various couplings, including Mini Quick Coupling, K-wire, and J-Latch.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 33 Lag Screw Insertion — Double Drill Sleeve (Optional)

For 1.0 mm cortex screws used as independent lag screws, use a .76 mm drill bit (green band) or 0.8 mm drill bit (green band) and 1.0 mm drill bit. Insert the screws using the 1.0 mm Cruciform Screwdriver Blade with Spring Holding Sleeve (314.482).

Instruments

316.286 0.76 mm Drill Bit, mini quick coupling with 6 mm stop

316.288 0.76 mm Drill Bit, mini quick coupling with 8 mm stop

316.290 0.76 mm Drill Bit, mini quick coupling with 10 mm stop

316.292 0.76 mm Drill Bit, mini quick coupling with 12 mm stop

316.294 0.76 mm Drill Bit, mini quick coupling with 14 mm stop

03.130.000 0.8 mm Drill Bit, K-wire attachment, for threaded hole, 64 mm

316.494 0.8 mm Drill Bit, Stryker J-Latch, for threaded hole, 56 mm

316.385 0.8 mm Drill Bit, Mini Quick Coupling, for Threaded Hole, 40 mm

314.482 1.0 mm Cruciform Screwdriver Blade with Spring Holding Sleeve, Hex Coupling

33 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique PREPARE AND INSERT PLATE

1 Trim Plate

Instrument

03.130.271 Plate Cutter for 1.3 mm - 2.0 mm Plates

If desired, plate cutters can be used to adjust the length of the plate. The Plate Cutter (03.130.271) is designed to cut all plates within the Variable Angle Locking Hand System.

Important: To prevent sharp edges from causing soft tissue irritation, place the plate top side up on the cutters to ensure any sharp edges will angle towards the underside of the plate.

Trim the plate to the desired length using the cutters, and remove any burr by using the rasp on the side of the cutters.

The Plate Cutter creates a straight cut.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 33 Prepare and Insert Plate

Optional Instrument Cut portion 03.130.270 Plate Cutter, In-line for 1.3 mm Locking, of plate 1.5 mm VA Locking, and 2.0 mm VA Locking Plates

The Plate Cutter, In-Line (03.130.270) is designed to cut plates with straight shafts within the Variable Angle Locking Hand System.

Note: When using the Plate Cutter, In-Line, insert the plate top side up in its respective color coded area on the cutter. This is to ensure that the plate holes are protected during cutting. Insert the plate so that the section of the plate to be implanted is located on the side that is color-coded. Ensure that the plate is correctly inserted on the post.

This cutter is designed to be used to cut straight shafts of plates within the Variable Angle Locking Hand System.

Note: The Plate Cutter is designed with 2 silicone inserts in the jaws to hold the cut segment of the plate after cutting. The Plate Cutter, In-Line, is designed with 1 silicone insert. Remove the silicone insert(s) prior to cleaning and sterilization.

The Plate Cutter, Inline, creates a cut with a rounded profile. Remove any burr by using the rasp on the side of the cutters.

33 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Prepare and Insert Plate

2 Contour Plate (Optional) If necessary, contour the plate to fit the patient’s anatomy.

Instruments

03.130.260 Plate Bending Pliers for 1.3 mm Locking and 1.5 mm and 2.0 mm Variable Angle Locking Plates, Right

03.130.261 Plate Bending Pliers for 1.3 mm Locking and 1.5 mm and 2.0 mm Variable Angle Locking Plates, Left

03.130.140 Plate Bending Pins for 1.3 mm Locking Plates

Bend using adjacent holes in the plate.

Orient the benders so the side etched “UP” is facing up, with the top of the plate also facing up.

Precaution: Avoid reverse bends and sharp bends (sharp bends include a single out-of-plane bend between 2 adjacent holes of >30°). Reverse or sharp bends may weaken the plate and lead to premature plate failure.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 33 Prepare and Insert Plate

The Plate Bending Pins (03.130.140) are designed to be used with the 1.3 mm locking plates.

Bend adjacent holes in the plates.

Precaution: Avoid reverse bends and sharp bends (sharp bends include a single out-of-plane bend between two adjacent holes of >30°). Reverse or sharp bends may weaken the plate and lead to premature plate failure.

44 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Prepare and Insert Plate

3 Position Plate

Instruments

292.06 0.6 mm Kirschner Wire, 70 mm, trocar point (stainless steel)

292.08/ 0.8 mm Kirschner Wire, 70 mm, 492.08 trocar point (stainless steel or titanium)

292.10/ 1.0 mm Kirschner Wire, 150 mm, 492.10 trocar point (stainless steel or titanium)

399.97.96 Reduction Forceps, with points, Ratchet, 130 mm

398.95.96 Termite Forceps, 90 mm

398.41.96 Reduction Forceps, with points, Broad-Ratchet

Position the plate over the reduced fracture using the preferred positioning method. Either K-wires or forceps may be used to hold the plate in place. K-wires can be used in the plate K-wire holes, if present.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 44 Prepare and Insert Plate

Optional Instrument

03.130.280 Plate Holding Forceps, Soft Lock

As an alternative, the Plate Holding Forceps may be used to hold the plate to the bone. Insert the ball portion through a plate hole to the bone. The curved arm wraps around the underside of the bone through the incision.

Close the forceps to the desired tightness to hold the plate. The forceps is designed to remain in place after the handles are released.

Precaution: When using the Plate Holding Forceps, avoid the tendons and avoid applying excessive pressure.

Note: Prior to sterilization of the Plate Holding Forceps, Soft Lock, add one drop of DePuy Synthes Autoclavable Oil (519.97) to instrument joints and ratchet mechanisms.

For more information, refer to the Featured Instrument section.

44 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Prepare and Insert Plate

4 Determine Screw Type Depending on the individual case, cortex screws or Variable Angle Locking/locking Screws may be inserted. Locking or cortex screws can be used in any of the screw holes, with the exception of the nonthreaded elongated hole, if present.

The elongated hole is designed for adjustment of plate position. The elongated hole accepts cortex screws only. Leave the cortex screw slightly loose in the elongated hole while adjusting plate position, as necessary. Tighten the cortex screw once plate placement has been confirmed.

If a combination of locking and cortex screws is planned, a cortex screw should be inserted first to pull the plate to the bone. If a locking screw is inserted first, ensure that the plate is held securely to the bone, to avoid spinning the plate as the screw is locked in place.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 44 Prepare and Insert Plate

5 Drill

Instruments

For 1.3 mm Screws

03.130.100 1.0 mm Drill Bit, K-wire Attachment, for Threaded Hole, 75 mm

03.130.101 1.0 mm Drill Bit, Stryker J-Latch, for Threaded Hole, 61 mm

03.130.102 1.0 mm Drill Bit, Mini Quick Coupling, for Threaded Hole, 61 mm

For 1.5 mm Screws

03.130.200 1.1 mm Drill Bit, K-wire Attachment, for Threaded Hole, 70 mm

03.130.201 1.1 mm Drill Bit, Stryker J-Latch, for Threaded Hole, 65 mm

03.130.202 1.1 mm Drill Bit, Mini Quick Coupling, for Threaded Hole, 56 mm

For 2.0 mm Screws

03.130.300 1.5 mm Drill Bit, K-wire Attachment, for Threaded Hole, 88 mm

03.130.301 1.5 mm Drill Bit, Stryker J-Latch, for threaded Hole, 83 mm

03.130.302 1.5 mm Drill Bit, Mini Quick Coupling, for Threaded Hole, 74 mm

Select a drill bit based on the size of the screw. Drill bits Screw Size Drill Bit Size/Color Code are color-coded to the size of the associated screw. 1.3 mm 1.0 mm - Yellow Note: The fracture pattern will dictate the optimal screw placement. 1.5 mm 1.1 mm - Red Fracture pattern will determine the order of screw insertion. In all cases, make sure the plate is in the correct position and flush with the bone. If placing a plate on the condyle, 2.0 mm 1.5 mm - Blue be cognizant of reducing and restoring the articular surface.

44 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Prepare and Insert Plate

6 Verify the drill bit angle and depth under radiographic Select a Drill Guide and Drilling Technique imaging to ensure the desired angle has been achieved.

Variable Angle Locking Double Drill Guide—with If necessary, drill at a different angle and verify again under Cone (03.130.220, 03.130.320) imaging.

Variable Angle Locking Screws can be inserted using Precaution: Avoid redrilling, especially in 2 different techniques, depending on which end of osteopenic bone. the drill guide is used:

Variable Angle Nominal Angle (Coaxial)

Variable angle technique using the cone-shaped end. Nominal angle technique using the fixed-angle end marked “coaxial.”

Fully insert the variable angle end of the drill guide into Fully insert the coaxial end of the drill guide into the the Variable Angle Locking hole. When drilling, the tip of Variable Angle Locking hole and drill. the drill guide should remain fully seated in the hole

Drill the hole with the drill bit at the desired angle within the cone by positioning the drill bit.

Precaution: When using the variable angle end of the guide, it is important to not angulate more than 15° from the central axis of the screw hole. Over angulation could result in difficulty locking the screw.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 44 Prepare and Insert Plate

Drill for Variable Angle Screws—Freehand Verify the drill bit angle and depth under radiographic imaging to ensure the desired angle has been achieved. Variable Angle Locking Double Drill Guide— Freehand (03.130.221, 03.130.321) If necessary, drill at a different angle and verify again under imaging. Avoid redrilling, especially in osteopenic bone. Variable Angle Locking Screws can be inserted using 2 different techniques, depending on which end of the drill guide is used:

Variable Angle Nominal Angle

Variable angle technique using the variable angle. Nominal angle technique using the fixed-angle end marked “coaxial.”

Fully insert the variable angle end of the drill guide into Fully insert the coaxial end of the drill guide into the the Variable Angle Locking hole. Variable Angle Locking hole and drill.

Drill the hole with the drill bit at the desired angle by positioning the drill guide in the hole.

Precaution: When using the variable angle end of the guide, it is important to not angulate more than 15° from the central axis of the screw hole. Over angulation could result in difficulty locking the screw.

44 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Prepare and Insert Plate

A 1.0 mm Threaded Drill Guide (03.130.120) is available for use with only the 1.3 mm plates.

The drill guide allows drilling in the nominal position in the locking hole.

Use a Double Drill Guide (03.130.125, 03.130.225, or 03.130.325) to drill for cortex screws through the plate.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 44 Prepare and Insert Plate

7 Determine Screw Length Use the Depth Gauge (03.130.250) to determine screw length. Screw length is indicated by the black line.

See pages 32–33 for additional technique information for the Depth Gauge.

44 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Prepare and Insert Plate

8 Insert Screw

Instruments

03.130.010 STARDRIVE Screwdriver Shaft, T4, 50 mm, Self-Retaining, Hex Coupling

03.130.020 STARDRIVE Screwdriver Shaft, T6, 50 mm, Self-Retaining, Hex Coupling

03.130.005 Screwdriver Handle with Hex Coupling

Assemble the screwdriver shaft to the screwdriver handle.

1.3 mm and 1.5 mm Screws are inserted with a T4 STARDRIVE Screwdriver (yellow and red bands). The tip of the screwdriver is gold-colored.

2.0 mm Screws are inserted with a T6 STARDRIVE Screwdriver (blue band).

The screwdriver and screws are designed to be self-retaining. To attach the screw to the screwdriver, position the screwdriver directly in line with the screw, with no tilting.

Ensure that the screwdriver tip engages the star-shaped recess in the screw. It may be necessary to rotate the screwdriver up to a quarter turn to fully align the star-shaped screwdriver tip into the screw recess. In addition, a tactile sensation may be noticed when the screwdriver shaft is fully aligned with the screw recess. Apply firm axial pressure downwards to ensure that the screw is fully seated before removing the screw from the implant module. Remove the screw from the implant module in a straight vertical position.

Using the screwdriver, place the screw on the scale of the implant module, to confirm the length of the screw. Insert screw.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 44 INSERT SCREW

When inserting screws, use a two-finger tightening technique.

For Variable Angle Locking and Locking Screws, confirm screw placement and length under radiographic imaging prior to final tightening.

For Variable Angle Locking and Locking Screws, screw insertion is complete when the screw is flush to the plate.

Confirm screw position and depth under radiographic imaging.

Precaution: Avoid penetrating the articular surface.

Postoperative Treatment Postoperative treatment with locking plates or variable angle locking plates does not differ from conventional internal fixation procedures.

55 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique IMPLANT REMOVAL

If removal of the implant is necessary, the following instructions are suggested.

1 Preoperative Planning To ensure that the appropriate screw removal instruments are obtained, the surgeon should have the following information before implant removal: x Implant type x Time of implantation x Material (steel, titanium) x Recess geometry and dimension of screws x Any visible damage to the implant (eg, broken screw shaft)

2 Clean Recess

Instrument

319.39.96 Sharp Hook

Before removing screws, clean the screw recess. Free the screw recess from ingrown bone and tissue using the sharp hook to ensure the screwdriver can be fully inserted. Check the condition and the geometry of the recess of the exposed screwhead.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 55 Implant Removal

3 Implant Removal

Instruments

314.482 1.0 mm Cruciform Screwdriver Blade with Spring Holding Sleeve, Hex Coupling

03.130.010 STARDRIVE Screwdriver Shaft, T4, 50 mm, Self-Retaining, Hex Coupling

03.130.020 STARDRIVE Screwdriver Shaft, T6, 50 mm, Self-Retaining, Hex Coupling

03.130.005 Screwdriver Handle with Hex Coupling

Optional Set

01.240.001 Screw Removal Set

To remove locking screws, first unlock all screws from the plate; then remove the screws completely from the bone.

The last screw removed should be a nonlocking screw on the shaft. This prevents the plate from spinning when locking screws are removed.

Note: To remove broken screws or screws with a damaged screw recess, please refer to the DePuy Synthes Screw Removal Set Technique Guide (J8569) for removal instructions.

55 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique

SUMMARY TABLE INSTRUMENTS

Screw Size

1.0 mm Cortex 1.3 mm Cortex 1.5 mm Cortex 2.0 mm Cortex

Gliding Hole

Gliding Hole (Two Stripes) 1.0 mm 1.3 mm 1.5 mm 2.0 mm Threaded Hole

Threaded Hole Drill Bit (One Stripe) 0.76 mm 1.0 mm 1.1 mm 1.5 mm

Double Drill Guide for 03.130.125 03.130.225 03.130.325 n/a Drill Guide Cortex Screws (1.3 mm/1.0 mm) (1.5 mm/1.1 mm) (2.0 mm/1.5 mm) For Variable Angle Locking or Cortex Screws through the plate

1.0 mm Cortex 1.3 mm Locking or 1.5 mm Variable Angle 2.0 mm Variable Angle Cortex Screws Locking or Cortex Screws Locking or Cortex Screws

n/a

Drill Bit 1.0 mm 1.1 mm 1.5 mm

Variable Angle Double Drill Guide— 03.130.220 03.130.320 with Cone n/a (1.1 mm) (1.5 mm)

Variable Angle Drill Guide Double Drill Guide— 03.130.221 03.130.321 Freehand (1.1 mm) (1.5 mm)

n/a n/a Threaded Drill Guide 03.130.120

Double Drill n/a Guide for 03.130.125 03.130.225 03.130.325 Cortex Screws (1.3 mm/1.0 mm) (1.5 mm/1.1 mm) (2.0 mm/1.5 mm)

Cruciform Screwdriver 314.482 T4 STARDRIVE - 03.130.010 T6 STARDRIVE - 03.130.020

Depth Gauge 03.130.250

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 55 IMPLANTS

1.3 mm Locking Plates – 316 Stainless Steel and TiCP Titanium Plate Thickness: 0.75 mm Stainless Steel Titanium 02.130.150 04.130.150 1.3 mm Locking Straight Plate, 6 Holes

02.130.151 04.130.151 1.3 mm Locking Straight Plate,12 Holes

02.130.152 04.130.152 1.3 mm Locking T-Plate, 3 Holes Head, 5 Holes Shaft

02.130.153 04.130.153 1.3 mm Locking Y-Plate, 3 Holes Head, 5 Holes Shaft

02.130.154 04.130.154 1.3 mm Locking Phalangeal Base Plate, 2 Holes Head, 5 Holes Shaft

02.130.156 04.130.156 1.3 mm Locking Phalangeal Head Plate, Right

02.130.157 04.130.157 1.3 mm Locking Phalangeal Head Plate, Left

02.130.158 04.130.158 1.3 mm Locking Strut Plate, 8 Holes, Oblique, Right

02.130.159 04.130.159 1.3 mm Locking Strut Plate, 8 Holes, Oblique, Left

02.130.161 04.130.161 1.3 mm Locking Web Plate, 14 Holes

55 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Implants

1.5 mm Variable Angle Locking Plates – 316L Stainless Steel and TiCP Titanium Plate Thickness: 1.0 mm Stainless Steel Titanium 02.130.250 04.130.250 1.5 mm Variable Angle Locking Straight Plate, 6 Holes

02.130.251 04.130.251 1.5 mm Variable Angle Locking Straight Plate, 12 Holes

02.130.252 04.130.252 1.5 mm Variable Angle Locking T-Plate, 3 Holes Head, 7 Holes Shaft

02.130.253 04.130.253 1.5 mm Variable Angle Locking Y-Plate, 3 Holes Head, 7 Holes Shaft

02.130.254 04.130.254 1.5 mm Variable Angle Locking Phalangeal Base Plate, 2 Holes Head, 6 Holes Shaft

02.130.255 04.130.255 1.5 mm Variable Angle Locking Condylar Plate, 2 Holes Head, 6 Holes Shaft

02.130.256 04.130.256 1.5 mm Variable Angle Locking Phalangeal Head Plate, Right

02.130.257 04.130.257 1.5 mm Variable Angle Locking Phalangeal Head Plate, Left

02.130.258 04.130.258 1.5 mm Variable Angle Locking Strut Plate, 8 Holes, Oblique, Right

02.130.259 04.130.259 1.5 mm Variable Angle Locking Strut Plate, 8 Holes, Oblique, Left

02.130.260 04.130.260 1.5 mm Variable Angle Locking Strut Plate, 12 Holes

02.130.261 04.130.261 1.5 mm Variable Angle Locking Web Plate, 14 Holes

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 55 Implants

Stainless Steel Titanium 02.130.262 04.130.262 1.5 mm Variable Angle Locking Box Plate, 4 Holes

02.130.263 04.130.263 1.5 mm Variable Angle Locking First Metacarpal Plate, Dorsal

02.130.264 04.130.264 1.5 mm Variable Angle Locking First Metacarpal Plate, Lateral, Right

02.130.265 04.130.265 1.5 mm Variable Angle Locking First Metacarpal Plate, Lateral, Left

02.130.266 04.130.266 1.5 mm Variable Angle Locking Rotation Correction Plate, 6 Holes

02.130.267 04.130.267 1.5 mm Variable Angle Locking Fracture Plate, 6 Holes

02.130.268 04.130.268 1.5 mm Variable Angle Locking Metacarpal Neck Plate

55 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Implants

2.0 mm Variable Angle Locking Plates, 316L Stainless Steel and TiCP Titanium Place Thickness: 1.3 mm Stainless Steel Titanium 02.130.350 04.130.350 2.0 mm Variable Angle Locking Straight Plate, 6 Holes

02.130.351 04.130.351 2.0 mm Variable Angle Locking Straight Plate, 12 Holes

02.130.352 04.130.352 2.0 mm Variable Angle Locking T-Plate, 3 Holes Head, 7 Holes Shaft

02.130.353 04.130.353 2.0 mm Variable Angle Locking Y-Plate, 3 Holes Head, 7 Holes Shaft

02.130.354 04.130.354 2.0 mm Variable Angle Locking Phalangeal Base Plate, 2 Holes Head, 6 Holes Shaft

02.130.355 04.130.355 2.0 mm Variable Angle Locking Condylar Plate, 2 Holes Head, 6 Holes Shaft

02.130.360 04.130.360 2.0 mm Variable Angle Locking Strut Plate, 12 Holes

02.130.362 04.130.362 2.0 mm Variable Angle Locking Box Plate, 4 Holes

02.130.363 04.130.363 2.0 mm Variable Angle Locking First Metacarpal Plate, Dorsal

02.130.366 04.130.366 2.0 mm Variable Angle Locking Rotation Correction Plate, 6 Holes

02.130.367 04.130.367 2.0 mm Variable Angle Locking Fracture Plate, 6 Holes

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 55 SCREWS

1.0 mm Cortex Screws, Self-Tapping, Cruciform 316L Stainless Steel and TiCP Titanium Stainless Steel Titanium Length (mm) 200.526 400.526 6 200.527 400.527 7 200.528 400.528 8 200.529 400.529 9 200.530 400.530 10 200.531 400.531 11 200.532 400.532 12 200.533 400.533 13 200.534 400.534 14

55 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Screws

1.3 mm Cortex Screws, Self-Tapping, T4 STARDRIVE Recess 316L Stainless Steel and Titanium* Stainless Steel Titanium Length (mm) 02.130.004 04.130.004 4 02.130.005 04.130.005 5 02.130.006 04.130.006 6 02.130.007 04.130.007 7 02.130.008 04.130.008 8 02.130.009 04.130.009 9 02.130.010 04.130.010 10 02.130.011 04.130.011 11 02.130.012 04.130.012 12 02.130.013 04.130.013 13 02.130.014 04.130.014 14 02.130.015 04.130.015 15 02.130.016 04.130.016 16 02.130.018 04.130.018 18

1.3 mm Locking Screws, Self-Tapping, T4 STARDRIVE Recess 316L Stainless Steel and Titanium* Stainless Steel Titanium Length (mm) 02.130.104 04.130.104 4 02.130.105 04.130.105 5 02.130.106 04.130.106 6 02.130.107 04.130.107 7 02.130.108 04.130.108 8 02.130.109 04.130.109 9 02.130.110 04.130.110 10 02.130.111 04.130.111 11 02.130.112 04.130.112 12 02.130.113 04.130.113 13 02.130.114 04.130.114 14 02.130.115 04.130.115 15 02.130.116 04.130.116 16 02.130.118 04.130.118 18

*Ti-6Al-7Nb

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 55 Screws

1.5 mm Cortex Screws, Self-Tapping, T4 STARDRIVE Recess 316L Stainless Steel and Titanium* Stainless Steel Titanium Length (mm) 02.214.104 04.214.104 4 02.214.105 04.214.105 5 02.214.106 04.214.106 6 02.214.107 04.214.107 7 02.214.108 04.214.108 8 02.214.109 04.214.109 9 02.214.110 04.214.110 10 02.214.111 04.214.111 11 02.214.112 04.214.112 12 02.214.113 04.214.113 13 02.214.114 04.214.114 14 02.214.115 04.214.115 15 02.214.116 04.214.116 16 02.214.118 04.214.118 18 02.214.120 04.214.120 20 02.214.122 04.214.122 22 02.214.124 04.214.124 24

*Ti-6Al-7Nb

66 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Screws

1.5 mm Variable Angle Locking Screws, Self-Tapping, T4 STARDRIVE Recess 316L Stainless Steel and Titanium* Stainless Steel Titanium Length (mm) 02.130.204 04.130.204 4 02.130.205 04.130.205 5 02.130.206 04.130.206 6 02.130.207 04.130.207 7 02.130.208 04.130.208 8 02.130.209 04.130.209 9 02.130.210 04.130.210 10 02.130.211 04.130.211 11 02.130.212 04.130.212 12 02.130.213 04.130.213 13 02.130.214 04.130.214 14 02.130.215 04.130.215 15 02.130.216 04.130.216 16 02.130.218 04.130.218 18 02.130.220 04.130.220 20 02.130.222 04.130.222 22 02.130.224 04.130.224 24

*Ti-6Al-7Nb

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 66 Screws

2.0 mm Cortex Screws, Self-Tapping, T6 STARDRIVE Recess 316L Stainless Steel and Titanium* Stainless Steel Titanium Length (mm) 201.356.97 401.356.97 6 201.357.97 401.357.97 7 201.358.97 401.358.97 8 201.359.97 401.359.97 9 201.360.97 401.360.97 10 201.361.97 401.361.97 11 201.362.97 401.362.97 12 201.363.97 401.363.97 13 201.364.97 401.364.97 14 201.365.97 401.365.97 15 201.366.97 401.366.97 16 201.368.97 401.368.97 18 201.370.97 401.370.97 20 201.372.97 401.372.97 22 201.374.97 401.374.97 24

2.0 mm Variable Angle Locking Screws, Self-Tapping, T6 STARDRIVE Recess 316L Stainless Steel and Titanium* Stainless Steel Titanium Length (mm) 02.130.306 04.130.306 6 02.130.307 04.130.307 7 02.130.308 04.130.308 8 02.130.309 04.130.309 9 02.130.310 04.130.310 10 02.130.311 04.130.311 11 02.130.312 04.130.312 12 02.130.313 04.130.313 13 02.130.314 04.130.314 14 02.130.315 04.130.315 15 02.130.316 04.130.316 16 02.130.318 04.130.318 18 02.130.320 04.130.320 20 02.130.322 04.130.322 22 02.130.324 04.130.324 24

*Ti-6Al-7Nb

66 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique INSTRUMENTS

03.130.100 1.0 mm Drill Bit, K-wire Attachment, for Threaded Hole, 75 mm

03.130.102 1.0 mm Drill Bit, Mini Quick Coupling, for Threaded Hole, 61 mm

03.130.110 1.3 mm Drill Bit, K-wire Attachment, for Gliding Hole, 60 mm

03.130.112 1.3 mm Drill Bit, Mini Quick Coupling, for Gliding Hole, 46 mm

03.130.200 1.1 mm Drill Bit, K-wire Attachment, for Threaded Hole, 70 mm

03.130.202 1.1 mm Drill Bit, Mini Quick Coupling, for Threaded Hole, 56 mm

03.130.210 1.5 mm Drill Bit, K-wire Attachment, for Gliding Hole, 62 mm

03.130.212 1.5 mm Drill Bit, Mini Quick Coupling, for Gliding Hole, 48 mm

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 66 Instruments

03.130.300 1.5 mm Drill Bit, K-wire Attachment, for Threaded Hole, 88 mm

03.130.302 1.5 mm Drill Bit, Mini Quick Coupling, for Threaded Hole, 74 mm

03.130.310 2.0 mm Drill Bit, K-wire Attachment, for Gliding Hole, 71 mm

03.130.312 2.0 mm Drill Bit, Mini Quick Coupling, for Gliding Hole, 57 mm

03.130.005 Screwdriver Handle with Hex Coupling

03.130.010 STARDRIVE Screwdriver Shaft, T4, 50 mm, Self-Retaining, Hex Coupling

03.130.020 STARDRIVE Screwdriver Shaft, T6, 50 mm, Self-Retaining, Hex Coupling

66 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Instruments

03.130.120 1.0 mm Threaded Drill Guide, for 1.3 mm Locking Plates

03.130.125 1.3 mm / 1.0 mm Double Drill Sleeve, for 1.3 mm Cortex Screws, Yellow

03.130.130 Plate Holder, for 1.3 mm to 2.0 mm Plates

03.130.140 Plate Bending Pin, for 1.3 mm Locking Plates

03.130.220 1.1 mm Variable Angle Locking Double Drill Guide, With Cone, for 1.5 mm Variable Angle Locking Plates

03.130.221 1.1 mm Variable Angle Locking Double Drill Guide, Freehand, for 1.5 mm Variable Angle Locking Plates

03.130.225 1.5 mm / 1.1 mm Double Drill Sleeve, for 1.5 mm Cortex Screws, Red

03.130.320 1.5 mm Variable Angle Locking Double Drill Guide, With Cone, for 2.0 mm Variable Angle Locking Plates

03.130.321 1.5 mm Variable Angle Locking Double Drill Guide, Freehand, for 2.0 mm Variable Angle Locking Plates

03.130.325 2.0 mm / 1.5 mm Double Drill Sleeve, for 2.0 mm Cortex Screws, Blue

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 66 Instruments

03.130.250 Depth Gauge for 1.3 mm, 1.5 mm, and 2.0 mm Screws

03.130.215 Countersink for 1.3 mm, 1.5 mm, and 2.0 mm Screws

03.130.260 Plate Bending Pliers, for 1.3 mm Locking and 1.5 mm and 2.0 mm Variable Angle Locking Plates, Right

03.130.261 Plate Bending Pliers, for 1.3 mm Locking and 1.5 mm and 2.0 mm Variable Angle Locking Plates, Left

03.130.271 Plate Cutter for 1.3 mm, 1.5 mm, and 2.0 mm Plates

03.130.280 Plate Holding Forceps, Soft Lock

03.130.291 Reduction Forceps for 1.3 mm to 2.0 mm Screws, Soft Lock

66 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Instruments

03.130.292 1.0 mm Drill Sleeve, Yellow, for Reduction Forceps 03.130.291

03.130.294 1.3 mm Drill Sleeve, Yellow, for Reduction Forceps 03.130.291

03.130.293 1.1 mm Drill Sleeve, Red, for Reduction Forceps 03.130.291

03.130.295 1.5 mm Drill Sleeve, Red, for Reduction Forceps 03.130.291

03.130.296 1.5 mm Drill Sleeve, Blue, for Reduction Forceps 03.130.291

03.130.297 2.0 mm Drill Sleeve, Blue, for Reduction Forceps 03.130.291

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 66 Instruments

314.482 1.0 mm Cruciform Screwdriver Blade with Spring Holding Sleeve, Hex Coupling

0.76 mm Drill Bits, mini quick coupling 316.286 with 6 mm stop 316.288 with 8 mm stop 316.290 with 10 mm stop 316.292 with 12 mm stop 316.294 with 14 mm stop

In Stainless Sets 292.06 0.6 mm Kirschner Wire w/Trocar Point 70 mm, 10 each 292.08 0.8 mm Kirschner Wire w/Trocar Point 70 mm, 10 each 292.10 1.0 mm Kirschner Wire w/Trocar Point 150 mm, 10 each 292.12 1.25 mm Kirschner Wire w/Trocar Point 150 mm, 10 each

In Titanium Sets 492.08 0.8 mm Ti Kirschner Wire w/Trocar Point 70 mm, 10 each 492.10 1.0 mm Ti Kirschner Wire w/Trocar Point 150 mm, 10 each 492.12 1.25 mm Ti Kirschner Wire w/Trocar Point 150 mm, 10 each

66 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Instruments

398.41.96 Reduction Forceps with Points, Broad-Ratchet

398.95.96 Termite Forceps, 90 mm

399.97.96 Reduction Forceps with Points, Ratchet, 130 mm

319.39.96 Sharp Hook

399.18.96 Small Hohmann Retractor, 6 mm, Short Narrow Tip, 160 mm

399.19.96 Small Hohmann Retractor, 8 mm Short Narrow Tip, 160 mm

399.481 Periosteal Elevator, 3 mm width, curved blade, round edge

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 66 VARIABLE ANGLE LOCKING HAND SYSTEM GRAPHIC CASES

Graphic Cases* 60.130.000 1/3 Instrument Tray, Standard Instruments, for the Variable Angle Locking Hand System

60.130.001 1/3 Instrument Tray, Cutting and Bending Instruments, for the Variable Angle Locking Hand System

60.130.002 1/3 Instrument Tray, Reduction Instruments, for the Variable Angle Locking Hand System

*Graphic cases shown with instruments, available separately.

For detailed cleaning and sterilization instructions, please refer to www.synthes.com/cleaning-sterilization or sterilization instructions, if provided.

77 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Variable Angle Locking Hand System Graphic Cases

60.130.013 1.3 mm Locking Implant and Instrument Module with 1.0 mm Screws 60.130.213 Compact Set Plate Bin for 1.3 mm Locking Implant and Instrument Module 60.130.313 Standard Set Plate Bin for 1.3 mm Locking Implant and Instrument Module

60.130.013

60.130.213

60.130.313

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 77 Variable Angle Locking Hand System Graphic Cases

60.130.015 1.5 mm Variable Angle Locking Implant and Instrument Module 60.130.215 Compact Set Plate Bin for 1.5 mm Variable Angle Locking Implant and Instrument Module 60.130.315 Standard Set Plate Bin for 1.5 mm Variable Angle Locking Implant and Instrument Module

60.130.015

60.130.215

60.130.315

77 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Variable Angle Locking Hand System Graphic Cases

60.130.020 2.0 mm Variable Angle Locking Implant and Instrument Module 60.130.220 Compact Set Plate Bin for 2.0 mm Variable Angle Locking Implant and Instrument Module 60.130.320 Standard Set Plate Bin for 2.0 mm Variable Angle Locking Implant and Instrument Module

60.130.020

60.130.220

60.130.320

60.130.201 Graphic Case, Full Length, 2-High for Variable Angle Locking Hand System

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 77 ALSO AVAILABLE

60.130.004 K-Wire Insert for Instrument Tray for VA Locking Hand System

60.130.005 Drill Insert Module for Reduction Forceps 03.130.291

60.116.114 1/3 Length Auxiliary Tray

03.130.000 0.8 mm Drill Bit K-wire Attachment, for Threaded Hole, 64 mm

03.130.101 1.0 mm Drill Bit, Stryker J-Latch, for Threaded Hole, 61 mm

03.130.111 1.3 mm Drill Bit, Stryker J-Latch, for Gliding Hole, 55 mm

77 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Also Available

03.130.201 1.1 mm Drill Bit, Stryker J-Latch, for Threaded Hole, 65 mm

03.130.211 1.5 mm Drill Bit, Stryker J-Latch, for Gliding Hole, 57 mm

03.130.301 1.5 mm Drill Bit, Stryker J-Latch, for Threaded Hole, 83 mm

03.130.311 2.0 mm Drill Bit, Stryker J-Latch, for Gliding Hole, 66 mm

03.130.270 Plate Cutter, In-line for 1.3 mm Locking and 1.5 mm and 2.0 mm Variable Angle Locking Plates

03.130.277 Silicone Insert for In-line Plate Cutter 03.130.270

03.130.279 Silicone Insert for Plate Cutter 03.130.271

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 77 Also Available

03.503.034 Mini Plate Holder

316.494 0.8 mm Drill Bit, Stryker J-Latch, for threaded hole, 56 mm

316.385 0.8 mm Drill Bit, Mini Quick Coupling, for Threaded Hole, 47 mm

316.306 0.76 mm Drill Bit, Stryker J-Latch, 6 mm Stop, 44.5 mm 316.308 0.76 mm Drill Bit, Stryker J-Latch, 8 mm Stop, 44.5 mm 316.312 0.76 mm Drill Bit, Stryker J-Latch, 12 mm Stop, 44.5 mm 316.314 0.76 mm Drill Bit, Stryker J-Latch, 14 mm Stop, 44.5 mm

77 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique VA LOCKING HAND INSTRUMENT AND IMPLANT SET—STANDARD­­­­ STAINLESS STEEL (01.131.100) AND TITANIUM (01.131.101) VA LOCKING HAND INSTRUMENT AND IMPLANT SET—COMPACT­­­­ STAINLESS STEEL (01.130.225) AND TITANIUM (01.130.235)

Graphic Cases 60.130.000 1/3 Instrument Tray, Standard Instruments, for the Variable Angle Locking Hand System

60.130.001 1/3 Instrument Tray, Cutting and Bending Instruments, for the Variable Angle Locking Hand System

60.130.002 1/3 Instrument Tray, Reduction Instruments, for the Variable Angle Locking Hand System

Screw Length Markers Item Length Item Length Number (mm) Number (mm) 304.104 4 60.116.313 13 304.105 5 60.116.314 14 60.116.306 6 60.116.315 15 60.116.307 7 60.116.316 16 60.116.308 8 60.116.318 18 60.116.309 9 60.116.320 20 60.116.310 10 60.116.322 22 60.116.311 11 60.116.324 24 60.116.312 12

Item Number For detailed cleaning and sterilization instructions, please refer to 60.116.451 Blank www.synthes.com/cleaning-sterilization or sterilization instructions, if provided.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 77 VA Locking Hand Instrument and Implant Set—Standard­­­­ Stainless Steel (01.131.100) and Titanium (01.131.101)

Standard Sets 01.131.100 VA Locking Hand Instrument and Implant Set­­­­—Standard 01.131.101 VA Titanium Locking Hand Instrument and Implant Set­­­­—Standard

Instrument and Implant Modules Included: 60.130.013 1.3 mm 60.130.015 1.5 mm 60.130.020 2.0 mm

Implant Bins Included: 60.130.313 1.3 mm 60.130.315 1.5 mm 60.130.320 2.0 mm

77 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique VA Locking Hand Instrument and Implant Set—Compact­­­­ Stainless Steel (01.130.225) and Titanium (01.130.235)

Compact Sets 01.130.225 VA Locking Hand Instrument and Implant Set­­­­—Compact 01.130.235 VA Titanium Locking Hand Instrument and Implant Set­­­­—Compact

Instrument and Implant Modules Included: 60.130.013 1.3 mm 60.130.015 1.5 mm 60.130.020 2.0 mm

Implant Bins Included: 60.130.213 1.3 mm 60.130.215 1.5 mm 60.130.220 2.0 mm

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 77 VA Locking Hand Instrument and Implant Set—Standard­­­­ Stainless Steel (01.131.100) and Titanium (01.131.101) VA Locking Hand Instrument and Implant Set—Compact­­­­ Stainless Steel (01.130.225) and Titanium (01.130.235)

Instruments 03.130.225 1.5 mm / 1.1 mm Double Drill Sleeve, 03.130.100 1.0 mm Drill Bit, K-wire Attachment, for 1.5 mm Cortex Screws, Red for Threaded Hole, 75 mm 03.130.321 1.5 mm Variable Angle Locking Double 03.130.102 1.0 mm Drill Bit, Mini Quick Coupling, Drill Guide, Freehand, for 2.0 mm for Threaded Hole, 61 mm Variable Angle Locking Plates 03.130.110 1.3 mm Drill Bit, K-wire Attachment, 03.130.325 2.0 mm / 1.5 mm Double Drill Sleeve, for Gliding Hole, 60 mm for 2.0 mm Cortex Screws, Blue 03.130.112 1.3 mm Drill Bit, Mini Quick Coupling, 03.130.250 Depth Gauge for 1.3 mm, 1.5 mm, for Gliding Hole, 46 mm and 2.0 mm Screws 03.130.200 1.1 mm Drill Bit, K-wire Attachment, 03.130.215 Countersink for 1.3 mm, 1.5 mm, for Threaded Hole, 70 mm and 2.0 mm Screws 03.130.202 1.1 mm Drill Bit, Mini Quick Coupling, 03.130.260 Plate Bending Pliers, for 1.3 mm for Threaded Hole, 56 mm Locking and 1.5 mm and 2.0 mm 03.130.210 1.5 mm Drill Bit, K-wire Attachment, Variable Angle Locking Plates, Right for Gliding Hole, 62 mm 03.130.261 Plate Bending Pliers, for 1.3 mm 03.130.212 1.5 mm Drill Bit, Mini Quick Coupling, Locking and 1.5 mm and 2.0 mm for Gliding Hole, 48 mm Variable Angle Locking Plates, Left 03.130.300 1.5 mm Drill Bit, K-wire Attachment, 03.130.271 Plate Cutter for 1.3 mm, 1.5 mm, for Threaded Hole, 88 mm and 2.0 mm Plates 03.130.302 1.5 mm Drill Bit, Mini Quick Coupling, 03.130.280 Plate Holding Forceps, Soft Lock for Threaded Hole, 74 mm 03.130.291 Reduction Forceps for 1.3 mm to 03.130.310 2.0 mm Drill Bit, K-wire Attachment, 2.0 mm Screws, Soft Lock for Gliding Hole, 71 mm 03.130.292 1.0 mm Drill Sleeve, Yellow, for 03.130.312 2.0 mm Drill Bit, Mini Quick Coupling, Reduction Forceps 03.130.291 for Gliding Hole, 57 mm 03.130.294 1.3 mm Drill Sleeve, Yellow, for 03.130.005 Screwdriver Handle with Hex Coupling Reduction Forceps 03.130.291 03.130.010 STARDRIVE Screwdriver Shaft, T4, 50 mm, 03.130.293 1.1 mm Drill Sleeve, Red, for Self-Retaining, Hex Coupling, 2 each Reduction Forceps 03.130.291 03.130.020 STARDRIVE Screwdriver Shaft, T6, 50 mm, 03.130.295 1.5 mm Drill Sleeve, Red, for Self-Retaining, Hex Coupling, 2 each Reduction Forceps 03.130.291 03.130.120 1.0 mm Threaded Drill Guide, for 03.130.296 1.5 mm Drill Sleeve, Blue, for 1.3 mm Locking Plates Reduction Forceps 03.130.291 03.130.125 1.3 mm / 1.0 mm Double Drill Sleeve, 03.130.297 2.0 mm Drill Sleeve, Blue, for for 1.3 mm Cortex Screws, Yellow Reduction Forceps 03.130.291 03.130.130 Plate Holder, for 1.3 mm to 314.482 1.0 mm Cruciform Screwdriver Blade 2.0 mm Plates with Spring Holding Sleeve, 03.130.140 Plate Bending Pin, for 1.3 mm Locking Hex Coupling Plates, 2 each 03.130.221 1.1 mm Variable Angle Locking Double Drill Guide, Freehand, for 1.5 mm Variable Angle Locking Plates

88 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique VA Locking Hand Instrument and Implant Set—Standard­­­­ Stainless Steel (01.131.100) and Titanium (01.131.101) VA Locking Hand Instrument and Implant Set—Compact­­­­ Stainless Steel (01.130.225) and Titanium (01.130.235)

0.76 mm Drill Bits, mini quick coupling 316.286 with 6 mm stop 316.288 with 8 mm stop 316.290 with 10 mm stop 316.292 with 12 mm stop 316.294 with 14 mm stop

319.39.96 Sharp Hook 398.41.96 Reduction Forceps with Points, Broad-Ratchet 398.95.96 Termite Forceps, 90 mm 399.97.96 Reduction Forceps with Points, Ratchet, 130 mm 399.18.96 Small Hohmann Retractor, 6 mm, Short Narrow Tip, 160 mm 399.19.96 Small Hohmann Retractor, 8 mm Short Narrow Tip, 160 mm 399.481 Periosteal Elevator, 3 mm width, curved blade, round edge

In Stainless Steel Sets 292.06 0.6 mm Kirschner Wire w/Trocar Point 70 mm, 10 each 292.08 0.8 mm Kirschner Wire w/Trocar Point 70 mm, 10 each 292.10 1.0 mm Kirschner Wire w/Trocar Point 150 mm, 10 each 292.12 1.25 mm Kirschner Wire w/Trocar Point 150 mm, 10 each

In Titanium Sets 492.08 0.8 mm Ti Kirschner Wire w/Trocar Point 70 mm, 10 each 492.10 1.0 mm Ti Kirschner Wire w/Trocar Point 150 mm, 10 each 492.12 1.25 mm Ti Kirschner Wire w/Trocar Point 150 mm, 10 each

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 88 VA Locking Hand Instrument and Implant Set—Standard­­­­ Stainless Steel (01.131.100) and Titanium (01.131.101) VA Locking Hand Instrument and Implant Set—Compact­­­­ Stainless Steel (01.130.225) and Titanium (01.130.235)

Implants 1.3 mm Locking Plates – 316 Stainless Steel or 1.5 mm Variable Angle Locking Plates – TiCP Titanium 316L Stainless Steel or TiCP Titanium Stainless Stainless Steel Titanium Steel Titanium 02.130.150 04.130.150 1.3 mm Locking Straight 02.130.250 04.130.250 1.5 mm Variable Angle Locking Plate, 6 Holes* Straight Plate, 6 Holes*

02.130.151 04.130.151 1.3 mm Locking Straight 02.130.251 04.130.251 1.5 mm Variable Angle Locking Plate,12 Holes Straight Plate, 12 Holes

02.130.152 04.130.152 1.3 mm Locking T-Plate, 02.130.252 04.130.252 1.5 mm Variable Angle Locking 3 Holes Head, 5 Holes Shaft T-Plate, 3 Holes Head, 7 Holes Shaft 02.130.153 04.130.153 1.3 mm Locking Y-Plate, 3 Holes Head, 5 Holes Shaft 02.130.253 04.130.253 1.5 mm Variable Angle Locking Y-Plate, 3 Holes Head, 02.130.154 04.130.154 1.3 mm Locking 7 Holes Shaft Phalangeal Base Plate, 2 Holes Head, 5 Holes Shaft 02.130.254 04.130.254 1.5 mm Variable Angle Locking Phalangeal Base Plate, 02.130.156 04.130.156 1.3 mm Locking Phalangeal 2 Holes Head, 6 Holes Shaft Head Plate, Right 02.130.255 04.130.255 1.5 mm Variable Angle Locking 02.130.157 04.130.157 1.3 mm Locking Phalangeal Condylar Plate, 2 Holes Head, Head Plate, Left 6 Holes Shaft 02.130.158 04.130.158 1.3 mm Locking Strut Plate, 02.130.256 04.130.256 1.5 mm Variable Angle Locking 8 Holes, Oblique, Right Phalangeal Head Plate, Right 02.130.159 04.130.159 1.3 mm Locking Strut Plate, 02.130.257 04.130.257 1.5 mm Variable Angle Locking 8 Holes, Oblique, Left Phalangeal Head Plate, Left 02.130.161 04.130.161 1.3 mm Locking Web Plate, 02.130.258 04.130.258 1.5 mm Variable Angle Locking 14 Holes* Strut Plate, 8 Holes, Oblique, Right

02.130.259 04.130.259 1.5 mm Variable Angle Locking Strut Plate, 8 Holes, Oblique, Left

02.130.260 04.130.260 1.5 mm Variable Angle Locking Strut Plate, 12 Holes

02.130.261 04.130.261 1.5 mm Variable Angle Locking Web Plate, 14 Holes*

*Not included in Compact Sets.

88 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique VA Locking Hand Instrument and Implant Set—Standard­­­­ Stainless Steel (01.131.100) and Titanium (01.131.101) VA Locking Hand Instrument and Implant Set—Compact­­­­ Stainless Steel (01.130.225) and Titanium (01.130.235)

1.5 mm Variable Angle Locking Plates – 2.0 mm Variable Angle Locking Plates, 316L 316L Stainless Steel or TiCP Titanium (continued) Stainless Steel or TiCP Titanium Stainless Stainless Steel Titanium Steel Titanium 02.130.263 04.130.263 1.5 mm Variable Angle Locking 02.130.350 04.130.350 2.0 mm Variable Angle Locking First Metacarpal Plate, Dorsal Straight Plate, 6 Holes*

02.130.264 04.130.264 1.5 mm Variable Angle Locking 02.130.351 04.130.351 2.0 mm Variable Angle First Metacarpal Plate, Locking Straight Plate, Lateral, Right* 12 Holes

02.130.265 04.130.265 1.5 mm Variable Angle Locking 02.130.352 04.130.352 2.0 mm Variable Angle First Metacarpal Plate, Locking T-Plate, Lateral, Left* 3 Holes Head, 7 Holes Shaft

02.130.266 04.130.266 1.5 mm Variable Angle Locking 02.130.353 04.130.353 2.0 mm Variable Angle Rotation Correction Plate, Locking Y-Plate, 6 Holes* 3 Holes Head, 7 Holes Shaft

02.130.268 04.130.268 1.5 mm Variable Angle Locking 02.130.354 04.130.354 2.0 mm Variable Angle Metacarpal Neck Plate Locking Phalangeal Base Plate, 2 Holes Head, 6 Holes Shaft

02.130.355 04.130.355 2.0 mm Variable Angle Locking Condylar Plate, 2 Holes Head, 6 Holes Shaft

02.130.360 04.130.360 2.0 mm Variable Angle Locking Strut Plate, 12 Holes

02.130.363 04.130.363 2.0 mm Variable Angle Locking First Metacarpal Plate, Dorsal

02.130.366 04.130.366 2.0 mm Variable Angle Locking Rotation Correction Plate, 6 Holes*

*Not included in Compact Sets.

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 88 VA Locking Hand Instrument and Implant Set—Standard­­­­ Stainless Steel (01.131.100) and Titanium (01.131.101) VA Locking Hand Instrument and Implant Set—Compact­­­­ Stainless Steel (01.130.225) and Titanium (01.130.235)

1.0 mm Cortex Screws, Self-Tapping, Cruciform, 2 each 1.3 mm Locking Screws, Self-Tapping, T4 STARDRIVE Recess, 316L Stainless Steel or TiCP Titanium 4 each 316L Stainless Steel or Titanium* Stainless Steel Titanium Length (mm) 200.526 400.526 6 Stainless Steel Titanium Length (mm) 200.527 400.527 7 02.130.104 04.130.104 4 200.528 400.528 8 02.130.105 04.130.105 5 200.529 400.529 9 02.130.106 04.130.106 6 200.530 400.530 10 02.130.107 04.130.107 7 200.531 400.531 11 02.130.108 04.130.108 8 200.532 400.532 12 02.130.109 04.130.109 9 200.533 400.533 13 02.130.110 04.130.110 10 200.534 400.534 14 02.130.111 04.130.111 11 02.130.112 04.130.112 12 1.3 mm Cortex Screws, Self-Tapping, T4 STARDRIVE Recess, 02.130.113 04.130.113 13 4 each 02.130.114 04.130.114 14 316L Stainless Steel or Titanium* 02.130.115 04.130.115 15 Stainless Steel Titanium Length (mm) 02.130.116 04.130.116 16 02.130.004 04.130.004 4 02.130.118 04.130.118 18 02.130.005 04.130.005 5 02.130.006 04.130.006 6 1.5 mm Cortex Screws, Self-Tapping, T4 STARDRIVE Recess, 316L Stainless Steel or Titanium* 02.130.007 04.130.007 7 02.130.008 04.130.008 8 Stainless Steel Titanium Length (mm) Qty 02.130.009 04.130.009 9 02.214.104 04.214.104 4 2 02.130.010 04.130.010 10 02.214.105 04.214.105 5 2 02.130.011 04.130.011 11 02.214.106 04.214.106 6 4 02.130.012 04.130.012 12 02.214.107 04.214.107 7 4 02.130.013 04.130.013 13 02.214.108 04.214.108 8 6 02.130.014 04.130.014 14 02.214.109 04.214.109 9 6 02.130.015 04.130.015 15 02.214.110 04.214.110 10 6 02.130.016 04.130.016 16 02.214.111 04.214.111 11 6 02.130.018 04.130.018 18 02.214.112 04.214.112 12 6 02.214.113 04.214.113 13 6 02.214.114 04.214.114 14 6 02.214.115 04.214.115 15 4 02.214.116 04.214.116 16 4 02.214.118 04.214.118 18 4 02.214.120 04.214.120 20 4 02.214.122 04.214.122 22 4 02.214.124 04.214.124 24 4 *Ti-6Al-7Nb

88 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique VA Locking Hand Instrument and Implant Set—Standard­­­­ Stainless Steel (01.131.100) and Titanium (01.131.101) VA Locking Hand Instrument and Implant Set—Compact­­­­ Stainless Steel (01.130.225) and Titanium (01.130.235)

1.5 mm Variable Angle Locking Screws, Self-Tapping, 2.0 mm Cortex Screws, Self-Tapping, T6 STARDRIVE Recess T4 STARDRIVE Recess 316L Stainless Steel or Titanium* 316L Stainless Steel or Titanium* Stainless Steel Titanium Length (mm) Qty Stainless Steel Titanium Length (mm) Qty 201.356.97 401.356.97 6 4 02.130.204 04.130.204 4 2 201.357.97 401.357.97 7 4 02.130.205 04.130.205 5 2 201.358.97 401.358.97 8 4 02.130.206 04.130.206 6 4 201.359.97 401.359.97 9 4 02.130.207 04.130.207 7 4 201.360.97 401.360.97 10 6 02.130.208 04.130.208 8 6 201.361.97 401.361.97 11 6 02.130.209 04.130.209 9 6 201.362.97 401.362.97 12 6 02.130.210 04.130.210 10 6 201.363.97 401.363.97 13 6 02.130.211 04.130.211 11 6 201.364.97 401.364.97 14 6 02.130.212 04.130.212 12 6 201.365.97 401.365.97 15 6 02.130.213 04.130.213 13 6 201.366.97 401.366.97 16 4 02.130.214 04.130.214 14 6 201.368.97 401.368.97 18 4 02.130.215 04.130.215 15 4 201.370.97 401.370.97 20 4 02.130.216 04.130.216 16 4 201.372.97 401.372.97 22 4 02.130.218 04.130.218 18 4 201.374.97 401.374.97 24 4 02.130.220 04.130.220 20 4 02.130.222 04.130.222 22 4 2.0 mm Variable Angle Locking Screws, Self-Tapping, 02.130.224 04.130.224 24 4 T6 STARDRIVE Recess 316L Stainless Steel and Titanium* Stainless Steel Titanium Length (mm) Qty 02.130.306 04.130.306 6 4 02.130.307 04.130.307 7 4 02.130.308 04.130.308 8 4 02.130.309 04.130.309 9 4 02.130.310 04.130.310 10 6 02.130.311 04.130.311 11 6 02.130.312 04.130.312 12 6 02.130.313 04.130.313 13 6 02.130.314 04.130.314 14 6 02.130.315 04.130.315 15 6 02.130.316 04.130.316 16 4 02.130.318 04.130.318 18 4 02.130.320 04.130.320 20 4 02.130.322 04.130.322 22 4 02.130.324 04.130.324 24 4

*Ti-6Al-7Nb

Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 88 ALSO AVAILABLE SETS

Sets 01.131.013 1.3 mm Locking Hand Instrument and Implant Module Set—Standard 01.131.113 1.3 mm Titanium Locking Hand Instrument and Implant Module Set—Standard

01.131.015 1.5 mm VA Locking Hand Instrument and Implant Module Set—Standard 01.131.115 1.5 mm Titanium VA Locking Hand Instrument and Implant Module Set—Standard 01.131.020 2.0 mm VA Locking Hand Instrument and Implant Module Set—Standard 01.131.120 2.0 mm Titanium VA Locking Hand Instrument and Implant Module Set—Standard

01.130.015 1.5 mm VA Locking Hand Instrument and Implant Module Set—Compact 01.130.115 1.5 mm Ti VA Locking Hand Instrument and Implant Module Set—Compact 01.130.013 1.3 mm Locking and 1.0 mm Instrument and Implant Module Set—Compact 01.130.113 1.3 mm Ti Locking and 1.0 mm Instrument and Implant Module Set—Compact 01.130.020 2.0 mm VA Locking Hand Instrument and Implant Module Set—Compact­­ 01.130.120 2.0 mm Ti VA Locking Hand Instrument and Implant Module Set—Compact

01.130.210 1/3 Instrument Tray/Standard, for VA Locking Hand System Set 01.130.211 1/3 Instrument Tray/Cutting and Bending, for VA Locking Hand System Set 01.130.212 1/3 Instrument Tray/Reduction, for VA Locking Hand System Set

88 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Limited Warranty and Disclaimer: DePuy Synthes Trauma products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed. WARNING: In the USA, this product has labeling limitations. See package insert for complete information. CAUTION: Federal Law restricts these devices to sale by or on the order of a physician. CAUTION:Some devices listed in this technique guide may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada.

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