The Flower Anatomic Distal FibulaPROCEDURE GUIDE

www.flowerortho.com

INDICATIONS FOR USE:The Flower Ankle Plating Set is intended for use for fixation of the ankle in adults and adolescents (12-21) in whom the growth plates have fused, andparticularly in osteopenic bone. Specifically,• Distal Medial and Lateral Tibia plates are intended for fixation of osteotomies, fractures, non-unions, and replantations of bones and bone fragmentsof the diaphyseal and metaphyseal regions of the distal tibia.

• Distal Tibia A-Plates are intended to buttress partial articular fractures and bone fragments of the distal tibia.• Straight and Distal Lateral Fibula Plates are intended for fixation of osteotomies, fractures, non-unions, mal-unions, and replantations of bones andbone fragments of the diaphyseal and metaphyseal regions on the distal fibula.

2 The Flower Anatomic Distal Fibula Procedure Guide

The Flower Foot & Ankle Application

ANTERIORLATERAL DISTALTIBIAL PLATE

MEDIAL DISTALTIBIAL PLATE ANATOMIC

DISTAL FIBULAPLATE

STRAIGHTLOCKING FIBULAPLATE WITHSYNDESMOTICSLOT

DISTAL TIBIAL A-PLATE

STRAIGHTLOCKINGFIBULA PLATE

The Flower Anatomic Distal Fibula Plate is a low profilestabilization plate designed to best accommodate biomechanicalconsiderations of the distal fibula.

The Flower Anatomic Distal Fibula Plate allows for the use ofvariable angle locking and compression screws that both sit flushwithin the plate.

The dual slots in the plate are designed to accommodate variableplacement of syndesmotic fixation, when required. The plate isalso compatible with titanium endo buttons if flexiblesyndesmotic fixation is desired.

The Flower Anatomic Distal Fibula Procedure Guide 3

The Flower Anatomic Distal Fibula Plate – Design Features

The Flower Anatomic Distal Fibula – Product Rationale

PLATE RATIONALE SURGICAL BENEFIT

Allows variable placement of the syndesmotic Dual syndesmotic slots fixation & recess allowing suture buttons to sit

flush

Anatomic curvature Ideal anatomic fit distally and along the fibularshaft

Anatomic low profile plate (1.8mm at the head) Minimizes plate prominence reducing potential soft tissue irritation

Patented Flower locking mechanism features variable angle locking screw holes allowing Screws sit flush in the locking holes+/- 15° of freedom

Step 2 – Plate Selection and Provisional Fixation a. A plate trial (FIS 653) is available to determine the appropriate platelength before opening the sterile packaged plate.

b. The plate trial may also be used as a bending template if bending isrequired.

c. Select plate size so that a minimum of 3 screws are proximal to thefracture and a minimum of 3 screws are distal to the fracture.

d. The plate can be temporarily fixed to the bone using olive wires placedthrough the screw holes.

4 The Flower Anatomic Distal Fibula Procedure Guide

The Flower Anatomic Distal Fibula – Surgical Strategy

Step 1 – Fracture Reduction using the Flower Lag Technique a. Once the fracture is reduced, use the 3.5mm drill bit (LSK 035) andthe 3.5mm end of the drill guide to drill the gliding hole in the nearcortex.

b. Place the 2.5mm end of the drill guide into the previously drilledgliding hole and use the 2.5mm drill bit (DBK 035) to drill the pilothole bicortically through the far cortex. Placing the 2.5mm end of thedrill guide into the 3.5mm drilled hole will ensure the pilot hole andgliding hole are concentric.

c. Screw length can be confirmed using the depth gauge that is part ofthe Flower Olive Wire Kit (OWK 200).

d. With the hook of the depth gauge engaged behind the far cortex of thepilot hole, confirm the depth gauge is fully seated on the near cortex.The depth of the hole can be read off the distal end of the slider.

e. Insert the 3.5mm variable angle compression screw using the screwdriver from the Flower Olive Wire Kit (OWK 200).

Step 3 – Drill Pilot Holes2.7mm variable angle locking screws are recommended for thedistal portion of the constructa. Starting with the distal locking holes and, using a 2.0mm drillbit (DBK 027), pilot holes are drilled using caution not to violatethe opposite cortex in the articular portion of the ankle joint.

b. Measure the pilot hole using the Flower Depth Gauge (OWK 200).

c. Ensure that the instrument is fully seated into the screw holebefore the hook probe is advanced into the pilot hole.

d. Pilot hole depth can be read off the distal end of the slider.e. Insert the locking screws into the distal screw holes using theFlower Screw Driver.Note: This is NOT a torque limiting screw driver. Screws arefully inserted once flush with the top of the plate. Do notovertighten.

a

b

The Flower Anatomic Distal Fibula Procedure Guide 5

Step 5 – Syndesmotic Fixationa. The Flower Anatomic Distal Fibula Plate has two oblong slots for syndesmoticfixation, the slots accommodate a 3.5mm or a 4.0mm screw (4.0mmrecommended).

b. If desired, the plate is compatible with suture button fixation.c. The recommend level of syndesmosis fixation is 1cm proximal to syndesmosis orabout 4cm proximal to ankle joint.

d. A 3.0mm drill (DBK 040) is used to drill the pilot hole for 4.0mm screws.Capturing a minimum of 4 cortices is recommended. Note: The syndesmotic screw is not placed under a standard lag technique and isnot intended to compress across the syndesmosis.

e. During fixation, place the ankle at neutral dorsiflexion and avoid clampingsyndesmosis to prevent over tightening.Note: To place screws under power, utilize the quick connect medium (T-15) speed driver shaft found Flower Large Bone K-Wire Kit (FIM 115). Onlyinsert the screw 90% of the total length with the speed driver. The final screwthreads must be inserted with the Screw Driver (OWK 200) to preventovertightening. Do not overtighten, screws are fully inserted once flush with the topof the plate.

The Flower Anatomic Distal Fibula – Surgical Strategy

Step 6 – The Final ConstructAnatomically contoured and low profile, the Flower Distal Fibula Plate providesfive distal locking holes for robust fixation. The syndesmotic slots aid in propersyndesmosis targeting and allow all forms of fixation to sit with the top of theplate.

Step 4 – Insert Proximal Screwsa. The pilot holes are created and measured in the same manner as described inStep 3.

b. Using the “locking end” of the drill guide (DBK 035) pilot holes are drilled for3.5mm locking and compression screws in the proximal shaft.

6 The Flower Anatomic Distal Fibula Procedure Guide

The Flower Anatomic Distal Fibula – Implant Selection

Screw Diameters Product Description Lengths

2.7mm 2.7mm Variable Angle Locking Screw 10mm-20mm

3.0mm* 3.0mm Variable Angle Locking Screw 8mm-30mm

3.5mm 3.5mm Variable Angle Locking Screw 10mm-20mm

*Additionally available. Not included in the Ankle Fibula IndicationCube™.Additional lengths available.

Screw Diameters Product Description Lengths

2.7mm 2.7mm Variable Angle Compression Screw 10mm-18mm

3.5mm 3.5mm Variable Angle Compression Screw 10mm-24mm

4.0mm 4.0mm Variable Angle Compression Screw 10mm-20mm, 40mm-60mm

Additional lengths available.

Product # Orientation Holes

DLF 105 Left 5

DLF 205 Right 5

DLF 107 Left 7

DLF 207 Right 7

VARIABLE ANGLE LOCKING SCREWS

VARIABLE ANGLE COMPRESSION SCREW

ANATOMIC DISTAL FIBULA PLATES

4

4

4

The Flower Anatomic Distal Fibula Procedure Guide 7

The Flower Anatomic Distal Fibula – Single-Use Instrument Overview

ANATOMIC DISTAL FIBULA PLATE TRIAL Part # Contents of KitFIS 653 Anatomic Distal Fibula Plate Trial

DRILL BIT KITS Part # Contents of Kit

DBK 027 2.0mm Drill Bit with Drill GuideDBK 035 2.5mm Drill Bit with Drill Guide DBK 040 3.0mm Drill Bit with Drill Guide

LARGE BONE K-WIRE KIT Part # Contents of Kit

FIM 115 1.4mm K-Wire (4)T15 Medium Speed Driver Shaft, QC

LAG SCREW KITS Part # Contents of KitLSK 027 2.7mm Drill Bit with Lag Screw Drill GuideLSK 035 3.5mm Drill Bit with Lag Screw Drill GuideLSK 040 4.0mm Drill Bit with Lag Screw Drill Guide

MEDIUM OLIVE WIRE KIT Part # Contents of Kit

T15 Medium Screw Driver OWK 200 Medium Depth Gauge

1.8mm Olive Wires (2)

PLATE BENDERS Part # Contents of KitFIM 234 Plate Benders

Flower Orthopedics Corporation100 Witmer Road • Suite 280 • Horsham, PA 19044 • T: 877-778-8587 • F: 215-394-8904

www.flowerortho.com

FlowerCube™: Schedule. Treat. Turn.

Turn OR Faster.(FlowerCube)

Schedule Case Sooner.(Ready-for-Surgery™)

Treat Confidently.(Sterile & Single-Use)

• No cleaning andsterilization

• FlowerCube is alwaysready to complete thecase

• No time consuming setdrop off

• Instrument kits arealways complete

• Drill bits are alwayssharp

• Reliable sterility

• FlowerCube is always readyfor the next surgery

• No delay with back to backcases

• Enough sterile inventory formultiple cases

FOCPG-LE-009 RevA 8/15