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Hand Surgery
Flower Plate
Four Corner Fusion
What matters most is patient benefit: a shorter immobilization
time (reduced by up to four weeks), significantly less wrist
arthrodesis and correspondingly less muscle loss. All these
are good reasons to decide in favor of the Flower Plate from
KLS Martin. For us, these reasons were decisive in developing
the Flower Plate for the Four Corner Fusion. The first and only
anatomical multidirectional locking plate implant, specially
designed for the treatment of the Four Corner Fusion,
facilitates the operation, reduces x-ray control and shortens
rehabilitation time.
I n n o vat i o n : e a s y, f a s t a n d p a t i e n t - f r i e n d l y
Flower Plate –
reduces rehabilitation time
The standard procedure for the Four Corner Fusion, which uses Kirschner
wires, means substantial restrictions for patients because it involves hand
immobilization for several weeks by means of a cast, especially if one considers
the high level of activity enjoyed by many people today.
In light of the increased demands among affected patients, a procedure
allowing early mobilization and fast recovery of normal hand function was
clearly required.
This is why we designed a plate that – owing to its delicate design –
prevents impingement on the dorsal edge of the radius. In addition, the
anatomical form of the plate, together with the possibility of inserting seven
multidirectional, locking screws, allows optimal and stable fixation.
3
D e s i g n : d e l i c a t e a n d m u l t i d i r e c t i o n a l - l o c k i n g
Form, advantage
and benefits
The Flower Plate is an innovative implant specially designed, in form and
function, to facilitate carpal bone fusion (“four corner fusion”). In close
collaboration with noted hand surgeons, we have created a delicate plate
that, thanks to multidirectional locking screw fixation, enables stable
fusion of the carpal bone without any impingement on the radius.
The form and function of every detail of this plate offers you an advantage
that pays off.
4
Plate design
Fig. 1:1 scale
3.8 mm
Advantage
Benefit
■■ Delicate design
■■ Prevents impingement
■■ Small size
■■ Allows insertion beyond
■■ Low plate profile
■■ Very good adaptation
■■ Free combination of
■■ Intraoperative flexibility
Ø 11.55 mm
on the dorsal edge of the radius
bone surface level
to the carpal bone
Screw design
2.0 mm
2.3 mm
multidirectional, locking
Cross Drive screws and
standard Cross Drive screws
■■ 7 multidirectional-locking
holes
2.0 mm
2.3 mm
■■ High variability
■■ Very high stability
■■ Almost optimal fixation
■■ Angulation of +/- 20°
■■ Early mobilization
■■ Prefixation by means
■■ Exact positioning of the plate
Surgical technique
of non-locking screws
■■ Easy plate adaptation to the
carpal bone
Instruments
■■ Self-centering burr
■■ Easy handling
■■ Straightforward arrangement
■■ Reliability
5
S U R G I C A L TE C H N I Q U E : c l e a r, u n c o m p l i c a t e d a n d w e l l - s t r u c t u r e d
Step by step
to optimal fixation
Indications
Posttraumatic arthrosis with pain
and loss of function due to:
■■ posttraumatic or degenerative carpal bone
arthrosis
■■ instability (SLAC, SNAC)
■■ failed partial arthrodesis (with K-wires)
■■ complex fractures in the intercarpal region
6
Placing options
FCF fusion
STT fusion
SLC fusion
CMC fusion
Notice
Preoperative planning
The technique includes removal of the scaphoid
and arthrodesis of the lunatum, the capitatum,
the hamatum and the triquetrum. In this procedure, special attention should be paid to exact
repositioning of the capitate and lunate bones
in order to ensure correct alignment of the carpus
and subsequent osseous consolidation.
Preoperative planning is carried out
by an A/P and a lateral x-ray view.
SC fusion
Patient positioning
The patient is placed on the back with
upper arm exsanguination, with hand table.
7
S U R G I C A L TE C H N I Q U E : c l e a r, u n c o m p l i c a t e d a n d w e l l - s t r u c t u r e d
Step 1:
Step 2:
Step 3:
A skin incision approx. 6 cm long
is made on the dorsal wrist.
Exposure of the extensor
retinaculum.
After removing the retinaculum,
the 3rd extensor tendon compartment
is opened radially and ulnarly.
Additionally, the 2nd and 4th extensor
tendon compartments are exposed.
Surgical documentation: Prof. Krimmer, Ravensburg (Germany)
8
Step 4:
Step 5:
Step 6:
The 2 extensor tendon compartment is held off radially and the
4th compartment ulnarly. The dorsal
interosseous nerve is exposed and
a long segment resected.
The scaphoid is exposed and
removed.
The four bones to be fused –
the lunate, capitate, hamate,
and triquetrum – are exposed.
nd
The tendons are also held off radially
and ulnarly. The wrist capsule is
opened transversely in the direction
of the dorsal ligaments. Preferably,
with the flap by Bishop and Berger.
This is usually done piecewise,
taking special care to leave the
palmar ligaments fully intact.
Using a small Luer, for example,
the cartilage is carefully removed
from the various joint surfaces until
reaching the cancellous structures.
This ensures optimal fusion of the
carpal bones.
9
S U R G I C A L TE C H N I Q U E : c l e a r, u n c o m p l i c a t e d a n d w e l l - s t r u c t u r e d
Step 7:
Step 8:
Notice:
Once the lunate, capitate, hamate
and triquetral bones have been
exposed, the malpositioned carpal
bones are reduced (correcting e.g.
bone rotation due to wrist instability).
If this turns out to be difficult, the
joystick technique can be used for
repositioning.
Following repositioning, provisional
transfixation of the carpal bones is
performed under X-ray control, using
a 1.6-mm Kirschner wire.
Erection of the lunate bone is particularly important. Provisional palmar
fixation of the carpal bones to be
fused reduces displacement when
subsequently working with the burr.
This facilitates the preparation process and provides more burr resistance, thus enabling the creation of
a uniform, circular implant bed for
the plate.
Suggested fixation:
Radius – lunate – capitate
Alternative:
Fixate capitate and lunate
percutaneously from distal.
10
Step 9:
Step 10:
Step 11:
The self-centering burr (26-130-13-07)
is placed above the four bones to be
fused. If necessary, the 1.5-mm bit can
be used to create a small center-mark
(max. 2 mm) in order to facilitate
correct placement of the burr.
The dorsal bone surface is milled
with the burr (26-130-13-07) until
the edge of the burr is level with the
dorsal bone surface. This allows
plate insertion below bone surface
level.
The intermediate joint spaces of the
four bones are filled with spongiosa at
the base of the prepared implant bed.
Thereafter, the implant (26-130-07-09)
is inserted and aligned so that the
screws can be placed in the best
possible position.
When doing this, note that the plate
should be positioned slightly distally
in order to minimize the risk of dorsal
impingement against the edge of the
radius when extending the wrist.
When performing this step, take care
that sufficient bone substance remains in place on the lunate so it can
be fixed with screws later.
Notice:
For this working step, you need:
Optimal screw placement means:
two screws in the lunate bone, one
screw in the triquetral bone, two
screws in the capitate bone, and
one screw in the hamate bone.
Notice:
The cancellous bone material used
for filling the spaces can be taken
from the removed scaphoid, the distal
radius or the iliac crest.
For this working step, you need:
The standard length is usually
10–16 mm.
Flower Plate
Flower Plate burr
11
S U R G I C A L TE C H N I Q U E : c l e a r, u n c o m p l i c a t e d a n d w e l l - s t r u c t u r e d
Step 12:
Step 13:
Step 14:
To prefix the plate, two non-locking
screws are initially inserted. For the
2.3-mm screw, a hole is predrilled
monocortically using the 1.8-mm
bit (26-153-18-07).
Following insertion of the two nonlocking screws, a x-ray and functional
plate check is carried out.
If the result of the check is satisfactory, locking screws are inserted
into the remaining plate holes.
Then the K-wire can be removed.
In this process, the non-locking
screws can be replaced with locking
screws if required.
The depth gauge (26-145-05-07)
is then used to determine the screw
length needed.
For this working step, you need:
Depth
gauge
12
Core-hole
drill bit
with dental
attachment
If necessary, the open center of the
plate can be easily filled with more
spongiosa.
Step 15:
Step 16:
Follow-up treatment
Following wound irrigation and
cleaning, the capsular and ligamental
structures are carefully restored.
Following skin closure, a final X-ray
is taken.
A splint is worn postoperatively for
4 weeks. After 2 weeks, physical
therapy can be started with the splint
in place.
Finally, the patient is fitted with a
forearm splint allowing active finger
movement.
Regular X-rays are taken to verify
proper bone fusion progress before
resuming normal activities.
13
P R O D U C T R ANGE : s t a n d a r d s e t s a n d o p t i o n s
Implants and
storage modules
Flower Plate
26-130-07-09
Screws
2.0 mm
2.3 mm
2.0 mm
2.3 mm
5
unit(s)
= 1.2 mm
1
unit(s)
Screw length
measuring clip
Length
25-650-03-04
red
  7 mm
Item no.
  6 mm
25-672-07-09
25-672-09-09
25-672-11-09
25-672-13-09
25-672-15-09
25-672-17-09
20 mm
14
25-672-19-09
25-773-08-09
25-772-10-09
25-773-10-09
25-772-12-09
25-773-12-09
25-772-14-09
25-773-14-09
25-772-16-09
25-773-16-09
25-772-18-09
25-773-18-09
25-772-20-09
25-773-20-09
25-673-17-09
18 mm
19 mm
25-772-08-09
25-673-15-09
16 mm
17 mm
25-773-06-09
25-673-13-09
14 mm
15 mm
25-772-06-09
25-673-11-09
12 mm
13 mm
Item no.
25-673-09-09
10 mm
11 mm
Item no.
25-673-07-09
  8 mm
  9 mm
25-650-04-04
black
Item no.
25-673-19-09
Icon explanations
Titanium
1
unit(s)
Packaging unit(s)
Cross-drive
Total thread
Plate profile
Multidirectional and locking
= 2.0 mm
= 2.3 mm
Storage modules: Flower Plate system
Set no. 26-140-70-04
Item no.
Implants
25-772-06 – 20-09
Set includes 5 Cross Drive locking screws, Ø 2.0 mm each length
25-773-06 – 20-09
Set includes 5 Cross Drive locking screws, Ø 2.3 mm each length
25-672-07 – 19-09
Set includes 5 Cross Drive screws, Ø 2.0 mm each length
25-673-07 – 19-09
Set includes 5 Cross Drive screws, Ø 2.3 mm each length
25-130-07-09
2 Flower Plates
Item no.
Instruments
25-650-03-04
Screw length measuring clip, red
25-402-99-07
2 handles, only
25-484-97-07
Cross Drive attachments, 2.0 / 2.3 mm
26-145-05-07
Depth gauge, 2.0 / 2.3 mm
26-153-16-07
Twist drill, 1.5 mm, dental attachment
26-153-18-07
Twist drill, 1.8 mm, dental attachment, short thread
26-130-13-07
Flower Plate burr, Ø 13 mm
Item no.
Storage
55-927-12-04
LPS screw storage
55-927-13-04
Flower Plate instrument storage
55-964-71-04
Flower Plate insert for burr
15
P R O D U C T R ANGE : s t a n d a r d s e t s a n d o p t i o n s
Standard instruments
and options
Standard instruments
½
½
½
½
Handle,
only
Cross Drive
attachments
Depth gauge
Core-hole drill with
dental attachment
Flower Plate
burr
25-402-99-07
10 cm/4“
25-484-97-07
26-145-05-07
26-153-16-07
Ø 1.5 mm
26-130-13-07
Ø 13 mm
1
unit(s)
14 cm / 5½“
1
unit(s)
1
unit(s)
1
unit(s)
26-153-18-07
Ø 1.8 mm
1
unit(s)
16
½
1
unit(s)
Icon explanations
Steel
for screws Ø 2.0 mm
for screws Ø 2.3 mm
Core-hole drill (for screws Ø 2.0 mm)
Core-hole drill (for screws Ø 2.3 mm)
Optional instruments
½
Guide wire
K-wire
dispenser
26-451-00-07
12 cm / 5“,
Ø 1.2 mm,
55-732-12-01
18.5 cm / 7¼“
10
unit(s)
1
unit(s)
17
S e r v ic e : i n f o r m a t i o n m a t e r i a l a n d c a t a l o g s
Should any more questions remain …
… just contact us!
Apart from our range of products specially tailored to the requirements
posed by traumatological and reconstructive interventions in hand surgery,
we also offer you a wide selection of different systems for use in classical
traumatology.
Please do not hesitate to order our Special Catalog for the Upper
and Lower Extremities, which is available in printed and digital form (CD).
To facilitate the ordering process for you, we have created a special
Order Form that is available on request at any time.
Of course, you can reach us personally at your convenience,
either by e-mail – [email protected] –
or telephone (customer hotline): +49-7461-706-109.
18
Special Catalog
for the Upper and
Lower Extremities
Printed version
90-851-48-06
CD version
90-851-38-06
19
KLS Martin Group
Karl Leibinger GmbH & Co. KG
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Tel. +49 74 63 838-0
[email protected]
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Tel. +33 3 89 21 66 01
[email protected]
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Jacksonville, Fl 32246 . USA
Tel. +1 904 641 77 46
[email protected]
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Miami, Fl 33186 . USA
Tel. +1 877 969 45 45
[email protected]
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79224 Umkirch . Germany
Tel. +49 76 65 98 02-0
[email protected]
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Tel. +39 039 605 67 31
[email protected]
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Tel. +86 21 2898 6611
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Tel. +7 (499) 792-76-19
[email protected]
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Tel. +49 74 61 16 58 80
[email protected]
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[email protected]
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