1
Zimmer
Distal Radius
Plating System
®
Surgical Technique
2
Zimmer® Distal Radius Plating System Surgical Technique
Introduction
The Zimmer® Distal Radius Plating System is a versatile system
carefully designed to meet the needs of both patients and
surgeons. Using Zimmer’s anatomical database, the plate
contour conforms to a broad range of patient anatomy and the
screw trajectories target the most common fragment and fracture
patterns, all while limiting the construct interference with soft
tissues.
Zimmer has designed the Distal Radius Plating System for
ease of use and polyaxial screw placement. The system offers
comprehensive instrumentation to ensure efficient, repeatable,
and reliable outcomes across a variety of patient populations.
Standard Volar Plate Placement
Nominal Screw Trajectory
Left & Right Cobra Hohmanns
Weitlaner Retractor
Polyaxial and Locking
Drill Guide
Zimmer® Distal Radius Plating System Surgical Technique
3
Zimmer Distal Radius Plating System
Plate Families
Dorsal and
Radial Styloid
Plates
Wide Volar
Plates
Standard Volar
Plates
Features
Plate Contour
The contour was optimized using Zimmer’s proprietary ZiBRA™
Anatomical Modeling System to ensure appropriate fit for a broad
patient population.
Minimal Screw Head Prominence
These low-profile, periarticular plates are anatomically contoured
to reduce soft-tissue irritation by minimizing screw head
prominence even when the screws are used off-axis.
Locking Mechanism
Polyaxial screw locking is achieved when the threads on the screw
head deform to the threads in the hole of the plate. This allows a
total of three attempts at polyaxial locking within each screw hole.
Note: Each locking screw/peg may be redirected once into
a plate hole within a surgery without adversely affecting
the locking performance of that screw/peg. If further
redirection is needed, a new locking screw/peg should be
used.
Narrow Volar
Plates
Extra Articular
Plates
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Zimmer® Distal Radius Plating System Surgical Technique
Screw Features
Screw Options
• 2.4mm Locking Screws
• 2.4mm Cortical Screws
• 1.8mm Locking Pegs
Ease of Use
All screws have been streamlined to use one drill bit and one
depth gauge, simplifying the instrumentation for ease of use. The
drill bit is etched to measure for screw length, saving time and
reducing the number of steps to complete the procedure.
Flexibility
The locking screws and pegs in this system can be angled up to
15 degrees off-center or follow a fixed-angled trajectory with a
standard locking drill guide or a drill guide block.
Variable Angle Trajectory
Color Coded
The cortical screws are color anodized blue for easy identification
in the operating room.
Zimmer® Distal Radius Plating System Surgical Technique
Instrumentation
Simplified
The set includes specialized instrumentation geared to make the
use of the system easier.
Comprehensive Offering
Cobra Hohmanns
Wider Cobra Hohmann retractors allow improved fracture site
exposure and visualization.
Weitlaner Retractors
Retractors specific for distal radius cases; deep teeth with a
wide spread to improve exposure.
Polyaxial Drill Guide
Simple design to target hole and place drill bit within cone of
polyaxiality.
Olive Wires
Shorter Olive Wires to stay out of the way of the drill while
temporarily holding the plate in place.
5
6
Zimmer® Distal Radius Plating System Surgical Technique
Surgical Approach
Volar Approach
Patient Positioning
Position the patient supine and place the forearm on a radiolucent
hand table. (Fig. 1)
Fig. 1
Surgical Approach
Patient Positioning
1. Incision
Make a longitudinal incision slightly radial to the flexor carpi
radialis tendon (FCR). (Fig. 2)
2. Superficial Dissection
Retract the FCR tendon toward the ulna while protecting the
median nerve.
Dissect through the floor of the FCR sheath, protecting the
radial artery radially, exposing the pronator quadratus (PQ).
(Fig. 3)
3. Deep Dissection
Release the PQ radially to ulnarly by sharply incising over the
watershed line and proximally on the lateral edge of the radius.
4. Expose the Radius
Fig. 2
Incision Trace
Elevate the PQ to expose the volar surface of the radius. (Fig. 4)
The origin of the flexor pollicis longus (FPL) muscle can be partially released if needed for added exposure.
Carefully release the brachioradialis.
Fig. 3
Fig. 4
Expose pronator quadratus
Expose the radius
Zimmer® Distal Radius Plating System Surgical Technique
7
Fracture Reduction and
Temporary Fixation
1.25mm K-wires can be used to obtain and maintain accurate
fracture reduction when applying the distal radius plate.
Before Plating:
• Reduce fracture.
• Insert K-wires to hold the reduction. (Fig. 5)
• If needed, K-wires can be inserted parallel to the subchondral
bone to reconstruct the articular surface. (Fig. 5)
• Ensure that K-wires are placed in locations which will not
impede proper plate placement and fixation.
Note: K-wires and drill bits are single use only.
Fig. 5
Hold reduction with K-wires
Step 1: Select Appropriate Plate
Provisionals are available to help in selecting the appropriate
plate size. (Fig. 6) The outer edge of the provisional indicates the
Standard plate width. The inner distal oblong holes indicate the
Narrow plate width.
If using the drill guide block to target distally, attach the Drill
Guide Block to the plate by turning the thumb screw that
connects to the distal most shaft hole in the plate. (Fig. 7) Drill
Guide Blocks are not available for the Dorsal or Extra Articular
plates.
Fig. 6
Provisional plate sizing
Fig. 7
Volar Plate with Drill Guide Block attached with Retention Screw
Instruments
Left Drill Guide Block
00-2366-099-50
00-2366-099-52
00-2366-099-54
Drill Guide Block
Retention Screw
00-2366-099-01
Right Drill Guide Block
00-2366-099-51
00-2366-099-53
00-2366-099-55
8
Zimmer® Distal Radius Plating System Surgical Technique
Step 2: Plate Position
The plate should be positioned on the distal radius proximal to
the Watershed line.
If placed properly, 1.25mm K-wires inserted into the two distal
K-wire holes will not violate the joint. (Fig. 8)
Note: The two distal K-wire holes match the trajectory of
their adjacent screw holes. The K-wire holes are offset
slightly more distal to ensure that the nominal trajectory
of the screws will not be in the joint if the K-wires show
proper placement under flouroscopy.
Fig. 8
Check distal K-wire placement
Note: If bending is required, the locking guides should not
be used as bending irons.
Step 3: Provisionally Fix Plate to Bone
Place a 2.4mm Cortical Screw into the oblong plate shaft hole to
provisionally hold the plate to the bone. (Fig. 9a)
• Drill with a 1.8mm Drill Bit through 1.8mm side of the Combination Drill Guide.
• Measure depth. Select appropriate 2.4mm cortical screw.
• Insert screw using T8 Driver Shaft and AO Type Collet Handle
assembly.
Fig. 9a
Provisionally fix plate to bone with cortical screw placement
An olive wire can be also inserted into any plate hole to
provisionally hold the plate to the bone. (Fig. 9b)
Fig. 9b
Olive wire can also be used to provisionally fix plate to bone
Instruments
Calibrated Drill Bit, AO,
1.8mm Diameter
00-2366-030-18
Smooth Drill Guide
for use with 1.8mm
Diameter Drill
00-2366-022-18
Depth Gauge
10-30mm Length
00-2366-090-00
AO Collet Handle with Spin Cap
00-2366-015-00
T8 Driver Shaft, AO Quick Connect
00-2366-010-00
Zimmer® Distal Radius Plating System Surgical Technique
9
Step 4: Check Distal K-wire Placement
Check 1.25mm K-wire to verify that the screw trajectory will not
violate the joint. (Fig. 10)
Step 5: Optional Distal Cortical Screw
Placement
Insert 2.4mm Cortical Screws into the distal holes using the
instructions in Step 3 as needed to lag the plate and bone
together and/or to assist in fracture reduction. (Fig. 11)
Fig. 10
Lateral view check of Distal K-wire placement
Fig. 11
Optional Distal Cortical Screw placement
Instruments
Calibrated Drill Bit, AO,
1.8mm Diameter
00-2366-030-18
Smooth Drill Guide
for use with 1.8mm
Diameter Drill
00-2366-022-18
Depth Gauge
10-30mm Length
00-2366-090-00
AO Collet Handle with Spin Cap
00-2366-015-00
T8 Driver Shaft, AO Quick Connect
00-2366-010-00
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Zimmer® Distal Radius Plating System Surgical Technique
Step 6: Insert 2.4mm Locking
Screws Distally
Option 1: Fixed angled screw insertion without Drill Guide Block
(Fig. 12a)
• Thread the 1.8mm Locking Drill Guide into selected hole.
• Drill with 1.8mm Drill Bit.
• Measure depth. Select appropriate screw.
• Insert screw using T8 Driver Shaft and AO Type Collet Handle
assembly.
Fig. 12a
Fixed angle screw placement without Drill Guide Block
Option 2: Polyaxial locking screw insertion (Fig. 12b)
• Thread Polyaxial Drill Guide into selected hole.
• Drill with 1.8mm Drill Bit.
• Measure depth. Select appropriate screw.
• Insert screw using T8 Driver Shaft and AO Type Collet Handle
assembly.
NOTE: Polyaxial Drill Guide will limit the drill angle to 15°
off center.
Option 3: Fixed angle screw insertion through the Drill Guide Block
(Fig. 12c)
Fig. 12b
Polyaxial locking screw placement
• Insert 1.8mm side of 1.8mm/2.4mm Combination Drill Guide
through selected hole.
• Drill with 1.8mm Drill Bit.
• Measure depth. Select appropriate screw.
• Insert screw using T8 Driver Shaft and AO Type Collet Handle
assembly.
Fig. 12c
Fixed angle screw placement through the drill block
Instruments
Calibrated Drill Bit, AO,
1.8mm Diameter
00-2366-030-18
Locking Drill Guide for use
with 1.8mm Diameter Drill
00-2366-20-18
Polyaxial Drill Guide
for use with 1.8mm
Diameter Drill
00-2366-040-00
Smooth Drill Guide
for use with 1.8mm
Diameter Drill
00-2366-022-18
Depth Gauge
10-30mm Length
00-2366-090-00
AO Collet Handle with Spin Cap
00-2366-015-00
T8 Driver Shaft, AO Quick Connect
00-2366-010-00
Zimmer® Distal Radius Plating System Surgical Technique
11
Step 7: Insert Remaining Proximal Screws
Repeat procedure from Step 3 or Step 6 to insert 2.4mm Cortical
Screws or 2.4mm Locking Screws in desired proximal holes.
(Fig. 13)
Step 8: Final Check and Closure
Check screw position using flouroscopy and ensure final
tightening before closure.
Note: To ensure screws are not in the joint, the forearm can
be elevated 10 degrees in the Anterior to Posterior view
and 20 degrees in the Lateral to Medial view.
Fig. 13
Positioning of Volar Plate Construct
Instruments
Calibrated Drill Bit, AO,
1.8mm Diameter
00-2366-030-18
Locking Drill Guide for use
with 1.8mm Diameter Drill
00-2366-20-18
Polyaxial Drill Guide
for use with 1.8mm
Diameter Drill
00-2366-040-00
Smooth Drill Guide
for use with 1.8mm
Diameter Drill
00-2366-022-18
Depth Gauge
10-30mm Length
00-2366-090-00
AO Collet Handle with Spin Cap
00-2366-015-00
T8 Driver Shaft, AO Quick Connect
00-2366-010-00
Zimmer® Distal Radius Plating System Surgical Technique
12
Dorsal Approach Patient Positioning
Flex the elbow slightly and internally rotate the arm at the
shoulder. Pronation of the forearm should be avoided. (Fig. 14)
Surgical Approach
1. Incision
• Make a longitudinal incision slightly ulnar to Lister’s tubercle.
2. Dissection
• Carry the dissection through the third dorsal extensor
compartment.
Fig. 14
• Retract the extensor pollicus longus (EPL) radially.
Dorsal approach patient positioning
• Protect the radial sensory nerve.
3. Expose the Radius
• Elevate and retract radially the first and second dorsal extensor
compartments.
• Elevate and retract ulnarly the fourth dorsal extensor
compartment.
To attach the Dorsal Plates, Step 3 and Step 6 from the volar plate
technique should be followed to place 2.4mm Cortical Screws and
2.4mm Locking Screws. (Fig. 15)
Fig. 15
The Dorsal Plates should only be drilled at the fixed angle
trajectory to avoid screw head prominence.
Ulnar Column Plate
Positioning of Dorsal Plates
Radial Column Plate
Radial Styloid Plate
Instruments
Smooth Drill Guide
for use with 1.8mm
Diameter Drill
00-2366-022-18
Calibrated Drill Bit, AO,
1.8mm Diameter
00-2366-030-18
Locking Drill Guide for use
with 1.8mm Diameter Drill
00-2366-20-18
Depth Gauge
10-30mm Length
00-2366-090-00
AO Collet Handle with Spin Cap
00-2366-015-00
T8 Driver Shaft, AO Quick Connect
00-2366-010-00
Zimmer® Distal Radius Plating System Surgical Technique
13
Implant Removal
To remove 2.4mm Locking Screws and/or 1.8mm Locking Pegs,
use the T8 Driver Shaft and AO Type Collet Handle assembly
to unlock all screws/pegs from the plate and then remove the
screws/pegs completely. (Fig. 17)
A small osteotome or elevator may be needed to separate the
plate from the bone.
Fig. 17
Implant removal
Instruments
AO Collet Handle with Spin Cap
00-2366-015-00
T8 Driver Shaft, AO Quick Connect
00-2366-010-00
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Zimmer® Distal Radius Plating System Surgical Technique
Plates
Item Number
00-2328-050-03
00-2328-050-05
00-2328-052-03
00-2328-052-05
00-2328-052-08
00-2328-052-10
00-2328-052-13
00-2328-054-05
00-2328-070-05
00-2328-072-06
00-2328-074-05
00-2328-060-03
00-2328-062-03
00-2328-051-03
00-2328-051-05
00-2328-053-03
00-2328-053-05
00-2328-053-08
00-2328-053-10
00-2328-053-13
00-2328-055-05
00-2328-071-05
00-2328-073-06
00-2328-075-05
00-2328-061-03
00-2328-063-03
Locking Screws
Description
Left Narrow 3 Hole Volar Plate
Left Narrow 5 Hole Volar Plate
Left Standard 3 Hole Volar Plate
Left Standard 5 Hole Volar Plate
Left Standard 8 Hole Volar Plate
Left Standard 10 Hole Volar Plate
Left Standard 13 Hole Volar Plate
Left Wide 5 Hole Volar Plate
Left Radial Styloid Plate
Left Dorsal Radial Column Plate
Left Dorsal Ulnar Column Plate
Left Narrow Extra Articular 3 Hole Plate
Left Standard Extra Articular 3 Hole Plate
Right Narrow 3 Hole Volar Plate
Right Narrow 5 Hole Volar Plate
Right Standard 3 Hole Volar Plate
Right Standard 5 Hole Volar Plate
Right Standard 8 Hole Volar Plate
Right Standard 10 Hole Volar Plate
Right Standard 13 Hole Volar Plate
Right Wide 5 Hole Volar Plate
Right Radial Styloid Plate
Right Dorsal Radial Column Plate
Right Dorsal Ulnar Column Plate
Right Narrow Extra Articular 3 Hole Plate
Right Standard Extra Articular 3 Hole Plate
Cortical Screws
Item Number
00-2329-010-25
00-2329-011-25
00-2329-012-25
00-2329-013-25
00-2329-014-25
00-2329-015-25
00-2329-016-25
00-2329-018-25
00-2329-020-25
00-2329-022-25
00-2329-024-25
00-2329-026-25
00-2329-028-25
00-2329-030-25
Description
Cortical Screw 2.4mm Diameter 10mm Length
Cortical Screw 2.4mm Diameter 11mm Length
Cortical Screw 2.4mm Diameter 12mm Length
Cortical Screw 2.4mm Diameter 13mm Length
Cortical Screw 2.4mm Diameter 14mm Length
Cortical Screw 2.4mm Diameter 15mm Length
Cortical Screw 2.4mm Diameter 16mm Length
Cortical Screw 2.4mm Diameter 18mm Length
Cortical Screw 2.4mm Diameter 20mm Length
Cortical Screw 2.4mm Diameter 22mm Length
Cortical Screw 2.4mm Diameter 24mm Length
Cortical Screw 2.4mm Diameter 26mm Length
Cortical Screw 2.4mm Diameter 28mm Length
Cortical Screw 2.4mm Diameter 30mm Length
Item Number
00-2329-010-24
00-2329-011-24
00-2329-012-24
00-2329-013-24
00-2329-014-24
00-2329-015-24
00-2329-016-24
00-2329-018-24
00-2329-020-24
00-2329-022-24
00-2329-024-24
00-2329-026-24
00-2329-028-24
00-2329-030-24
Description
Locking Screw 2.4mm Diameter 10mm Length
Locking Screw 2.4mm Diameter 11mm Length
Locking Screw 2.4mm Diameter 12mm Length
Locking Screw 2.4mm Diameter 13mm Length
Locking Screw 2.4mm Diameter 14mm Length
Locking Screw 2.4mm Diameter 15mm Length
Locking Screw 2.4mm Diameter 16mm Length
Locking Screw 2.4mm Diameter 18mm Length
Locking Screw 2.4mm Diameter 20mm Length
Locking Screw 2.4mm Diameter 22mm Length
Locking Screw 2.4mm Diameter 24mm Length
Locking Screw 2.4mm Diameter 26mm Length
Locking Screw 2.4mm Diameter 28mm Length
Locking Screw 2.4mm Diameter 30mm Length
Locking Pegs
Item Number
00-2329-010-18
00-2329-012-18
00-2329-014-18
00-2329-016-18
00-2329-018-18
00-2329-020-18
00-2329-022-18
00-2329-024-18
00-2329-026-18
00-2329-028-18
00-2329-030-18
Description
Locking Peg 1.8mm Diameter 10mm Length
Locking Peg 1.8mm Diameter 12mm Length
Locking Peg 1.8mm Diameter 14mm Length
Locking Peg 1.8mm Diameter 16mm Length
Locking Peg 1.8mm Diameter 18mm Length
Locking Peg 1.8mm Diameter 20mm Length
Locking Peg 1.8mm Diameter 22mm Length
Locking Peg 1.8mm Diameter 24mm Length
Locking Peg 1.8mm Diameter 26mm Length
Locking Peg 1.8mm Diameter 28mm Length
Locking Peg 1.8mm Diameter 30mm Length
Zimmer® Distal Radius Plating System Surgical Technique
Instruments
Item Number
00-2366-010-00
00-2366-015-00
00-2366-090-00
00-2366-030-18
00-2366-030-24
00-2366-050-24
00-2366-020-18
00-2366-022-18
00-2366-030-00
00-2366-040-00
00-2366-099-01
00-2366-099-50
00-2366-099-52
00-2366-099-54
00-2366-099-51
00-2366-099-53
00-2366-099-55
00-4819-002-00
00-4819-003-00
00-4814-006-01
00-4817-001-00
00-2366-070-00
00-3045-001-00
00-4816-010-00
00-2366-060-10
00-2366-060-20
00-5900-099-00
00-2366-075-00
00-2366-075-10
00-2366-075-30
Description
T8 Driver Shaft, AO Quick Connect
AO Collet Handle with Spin Cap
Depth Gauge 10-30mm Length
Calibrated Drill Bit, AO, 1.8mm Diameter
Calibrated Drill Bit, AO, 2.4mm Diameter
Calibrated Tap, AO, 2.4mm Diameter
Locking Drill Guide for use with 1.8mm Diameter Drill
Smooth Drill Guide for use with 1.8mm Diameter Drill
Combination Drill Guide for use with 1.8mm/2.4mm Diameter Drill
Polyaxial Drill Guide for use with 1.8mm Diameter Drill
Drill Guide Block Retention Screw
Left Narrow Drill Guide Block
Left Standard Drill Guide Block
Left Wide Drill Guide Block
Right Narrow Drill Guide Block
Right Standard Drill Guide Block
Right Wide Drill Guide Block
Left Bending Iron
Right Bending Iron
Elevator
Sharp Hook
Weitlaner Retractor Small
Weitlaner Retractor, Sharp Prong
Reduction clamps
Left Offset Hohmann Retractor
Right Offset Hohmann Retractor
Standard Case Lid
Standard Case Base
Standard Case Tray w/ Volar Plate Caddy
Standard Screw Caddy
15
This Surgical Technique is not approved for distribution in the United States.
This documentation is intended exclusively for physicians and is not intended for laypersons.
Information on the products and procedures contained in this document is of a general nature
and does not represent and does not constitute medical advice or recommendations. Because
this information does not purport to constitute any diagnostic or therapeutic statement with
regard to any individual medical case, each patient must be examined and advised individually,
and this document does not replace the need for such examination and/or advice in whole or
in part. Please refer to the package inserts for important product information, including, but not
limited to, contraindications, warnings, precautions, and adverse effects.
Contact your Zimmer representative or visit us at www.zimmer.com
97-2328-002-00 Rev. 1 MC121982 6-26-14 © 2014 Zimmer, Inc.