Zimmer Biomet A.L.P.S. User manual

A.L.P.S.®Hand Fracture System
Surgical Technique

2 | A.L.P.S. Hand Fracture System

1 | A.L.P.S. Hand Fracture System
A.L.P.S. Hand Fracture System.................................................................................... 3
F.A.S.T. Guide Inserts & Multi-Directional Screws........................................................ 5
Locking, Non-Locking, & Multi-Directional Screw Options .......................................... 7
Surgeon Design Team................................................................................................. 8
Introduction ............................................................................................................... 9
1.5 mm Locking Plates.............................................................................................. 10
1.5 mm Plate Specifications ...................................................................................... 11
2.5 mm Locking Plates.............................................................................................. 12
2.5 mm Plate Specifications...................................................................................... 13
Plate Options............................................................................................................ 14
Instruments.............................................................................................................. 16
Surgical Technique ................................................................................................... 18
Multi-Directional Screw Insertion.............................................................................. 24
Ordering Information ............................................................................................... 25
Indications and Contraindications............................................................................. 28
Table of Contents

2 | A.L.P.S. Hand Fracture System

3 | A.L.P.S. Hand Fracture System
For metacarpal and phalangeal procedures that
often involve complex fractures and minimal tissue
coverage, the Hand Fracture System provides both
strength and low-profile advantages. Having one
of the thinnest profiles available and contourable
to align with the fingers, these plates may be used
to treat even the most challenging cases.
Coronal
Straight Plate T Plate Y Plate Web Plate T/Y Plate
Axial Sagittal
Low Profile, Locked Plating, Anatomically Contoured
A.L.P.S. Hand Fracture System
• Low profle plates are designed to help
minimize discomfort and soft tissue irritation
• Contoured plates mimic the anatomy of
the fingers
• Plates are available in six plate styles, to suit
fracture complexity
• Flexible Plating Technology delivers in-situ
contourability
• Cobalt chrome screws for strong stable fixation

4 | A.L.P.S. Hand Fracture System

5 | A.L.P.S. Hand Fracture System
To facilitate surgical procedures even further,
the Hand Fracture System Plates come
pre-loaded with Fixed Angle Screw Targeting
F.A.S.T. Guide inserts.
F.A.S.T. Guide®Inserts, Multi-Directional Screws
F.A.S.T. Guide Inserts
• Facilitate accurate drilling
• Pre-loaded and disposable
• Save time in the O.R.:
No intraoperative assembly is required
• Color coded F.A.S.T. Guide inserts
make identification easy:
Silver = 1.5 mm, Gold = 2.5 mm
Multi-Directional Screws
• Cobalt Chrome screws create a strong
mechanical lock
• 1.5 mm and 2.5 mm screws provide
angular stability in a locked construct

6 | A.L.P.S. Hand Fracture System

7 | A.L.P.S. Hand Fracture System
20°
Particularly helpful in challenging fracture cases,
the multiple screw options allow plates and screws
to be placed as close to the bone surface as possible.
Versatility in Construct
Locking, Non-Locking and
Multi-Directional Screw Options
• Choose locking, non-locking, or
multi-directional screws according to need
• All options available in each locking hole
• Locking screws establish a fixed angle
construct for strong fixation or when optimal
screw purchase is required
• Locking Multi-Directional Screws allow
for angulation from fixed angle axis
• 1.5 mm Non-locking and 2.5 mm locking screws
with washers can be utilized with slotted holes
to create axial compression at the fracture site

Surgeon Design Team
Lloyd P. Champagne, M.D.
Arizona Center for Hand Surgery
Phoenix, Arizona
Brian J. Hartigan, M.D. (Deceased)
Northwestern School of Medicine
Chicago, Illinois
Matthew M. Tomaino, M.D., M.B.A.
Tomaino Orthopaedic Care
Rochester, New York

9 | A.L.P.S. Hand Fracture System
Introduction
The A.L.P.S. Hand Fracture System represents the
nextgenerationinanatomicplatedesign.Itcombines
the benefits of low profile titanium plate metallurgy
with the advantages of multiplanar locked screw
technology. These features allow the formation of a
three dimensional matrix of fixed and variable angle
screws to create a true subchondral scaold that can
provide f ixation for fractures including osteoporotic
bone.
The A.L.P.S. Hand Fracture System features TiMAX®
low profile, anatomically contoured implants. In
hand surgery where soft tissue coverage is at risk,
these low profile plates are designed to minimize
discomfort and soft tissue irritation matching the
anatomy of the phalanx and metacarpal, while still
maintaining adequate strength.
The System features F.A.S.T. Guide inserts and
Flexible Plating Technology to facilitate surgical
procedures and save time in the operating room.
F.A.S.T. Guide inserts allow for accurate drilling
and placement of screws. F.A.S.T. Guide inserts
are preloaded and do not require intraoperative
assembly, designed to save time in the OR.
Additionally, the A.L.P.S. Hand Fracture System
allows the use of locking, variable angle, and
standard screws. This hybrid fixation concept allows
the surgeon to stabilize the fracture either by the
use of lag screw techniques through the plate, or
by compression plating techniques. Locking screws
serve to provide stability to comminuted, unstable
metaphyseal fractures or in osteopenic bone.
Intended Use:
This system is intended for stabilization and fixation
of small bone fragments in fresh fractures, revision
procedures, joint fusion and reconstructions of
small bones of the hand, foot, wrist, ankle, humerus,
scapula, finger, toe, pelvis and craniomaxillofacial
skeleton, particularly in osteopenic bone.

10 | A.L.P.S. Hand Fracture System
1.5 mm Locking Plates
TiMAX material
Compression Holes oer
.75 mm of compression
per hole
F.A.S.T. Guide inserts
protect locking thread
during bending
Shaped to go around
tendon insertion Allows longitudinal
fractures to be
addressed obliquely
Compression Holes
Pre-contoured Plate
Pre-loaded
F.A.S.T. Guide inserts

11 | A.L.P.S. Hand Fracture System
1.5 mm Plate Specifications
Plate Styles: Straight T Y Web T/ Y Small T
Plate Width: 4.3 mm 20.4 mm 13.8 mm 12.8 mm 14.1 mm 13.5 mm
Plate Thickness: 1.1 mm 1.1 mm 1.1 mm 1.1 mm 1.1 mm 1.0 mm
Lengths: 61.7 mm 56.3 mm 49.6 mm 46.0 mm 39.3 mm 25.9 mm
1.5 mm Locking Cortical Screw
• CoCr screws for strength
• Self tapping tip minimizes the need for
pre-tapping and eases screw insertion
• Locking screw head designed to minimize
screw back-out and construct pullout
• Square drive
• Available in lengths of 8 – 24 mm
• Doubles as a multi-directional locking screw
1.5 mm Non-Locking Cortical Screw
• Self tapping tip minimizes the need for
pre-tapping and eases screw insertion
• TiMAX material
• Square drive
• Available in lengths of 8 – 24 mm
1.3 mm Non-Locking Cortical Screw
• Stand alone screw
• CoCr Screw for strength
• Self tapping tip minimizes the need for
pre-tapping and eases screw insertion
• Cruciate Head design
• Available in lengths of 8 – 24 mm
1.5 mm Small T Plate
• Specialty plate designed for mid-phalanx fractures
•
Bridges shortened between nodes on the spine to allow
more screws to be inserted in the smaller anatomy
• Arms can be contoured in all 3 planes
(axial, coronal and sagittal)
• Spine can be contoured axially by skipping
one node between bending irons
• Cutter must be used to shorten the spine
• Plate holder can only be used on the arms
and not the spine

12 | A.L.P.S. Hand Fracture System
2.5 mm Locking Plates
Flexible Arms
Stronger Spines
(compared to
1.5 mm plate)
Threaded holes can accept
locking, non-locking, and
multi-directional screws
TiMAX material
TiMAX material
Pre-loaded
F.A.S.T. Guide inserts
Pre-contoured Plate
Compression Holes oer
1 mm of compression per hole

13 | A.L.P.S. Hand Fracture System
2.5 mm Plate Specifications
Plate Styles: Straight T Y Web T/ Y
Plate Width: 6.8 mm 27.6 mm 19.5 mm 17.4 mm 19.5 mm
Plate Thickness: 1.65 mm 1.65 mm 1.65 mm 1.65 mm 1.65 mm
Lengths: 90.2 mm 73.8 mm 71.8 mm 79.8 mm 55.5 mm
2.5 mm Locking Cortical Screw
• Large core diameter and shallow thread pitch
for bending and shear strength
• Self tapping tip minimizes the need for pre-tapping
and eases screw insertion
• Locking screw head designed to minimize screw
back-out and construct pullout
• When paired with the 2.5 mm Compression
Washer, it can be used as a compression screw
in the 2.5 mm plate compression holes
• Square drive
• Available in lengths of 8 – 28 mm
2.5 mm Non-Locking Cortical Screw
• Self tapping tip minimizes the need for pre-tapping
and eases screw insertion
• Square drive
• Available in lengths of 8 – 28 mm
2.5 mm Multi-Directional Locking
Cortical Screw (MDTP)
• CoCr Screws create new thread path in the plate
• Locking screw head designed to minimize screw
back-out and construct pullout
• Narrow shaft of MDTP is comparable to bending
stiness of 2.5 mm locking screws
• Square drive
• Available in lengths of 10 – 28 mm
NOTE: With enough force it is possible to drive the 2.5 mm
MDTPs through the plate. Stop advancing the screw when
the head of screw is flush with the surface of the plate.
2.5 mm Compression Washer
• Converts only the 2.5 mm Locking Cortical Screw
into a compression screw
• Designed to be used in the compression holes
in the 2.5 mm plates

14 | A.L.P.S. Hand Fracture System
Plate Options
T
Straight
The A.L.P.S. Hand Fracture System plates were designed to be modified to meet the needs of the patient and the
fracture. The plates can be shortened, cut, or shaped to create an almost infinite array of plate constructs. The
plates can be shortened by using the benders or cut using the plate cutters. When shortening with the benders, it is
recommended that you straddle the bridge to be removed with the benders and simply bend toward the bottom of
the plate until it releases. This is the preferred shortening method since it will make the broken edge of the plate face
toward the bone, keeping it hidden from the soft tissues. This simple chart demonstrates some of the plate shapes
that can be created from the basic 5 shapes.

15 | A.L.P.S. Hand Fracture System
T/Y
Web
Y

16 | A.L.P.S. Hand Fracture System
Instruments
1.0 mm/1.3 mm Soft Tissue Guide
1.5 mm Plate Holder 1.3 mm/1.5 mm Bone Depth Gauge
2.0 mm/2.5 mm Bone Depth Gauge
2.5 mm Plate Benders
2.5 mm Plate Holder
1.5 mm Plate Benders
1.1 mm/1.5 mm Soft Tissue Guide
Screw Pickup
(shown with 1.3 mm Cruciate Driver)
2.0 mm/2.5 mm Soft Tissue Guide
The A.L.P.S. Hand Fracture System instrumentation provides the hand surgeon with the tools needed to perform
a hand fracture procedure. To help reduce confusion when selecting the correct instrument, the modules have
been color coded so that the bronze instruments are used with 1.3 mm screws, silver instruments are used with
1.5 mm plates and screws, and gold instruments are used with 2.5 mm plates and screws. Similar color coding is
extended to the F.A.S.T. Guide inserts on the plates, creating a simple and convenient identification system. General
instrumentation is also included in the set, allowing for a comprehensive instrumentation system that will facilitate
an ecient surgical procedure.

17 | A.L.P.S. Hand Fracture System
Cutting Pliers
Mini Quick Connect Handles (2)
2.5 mm Countersink 1.5 mm Countersink 2.5 mm Drill Bit 2.0 mm Drill Bit 1.5 mm Drill Bit 1.1 mm Drill Bit 1.3 mm Drill Bit 2.5 mm MDTP Driver 2.5 mm Driver 1.5 mm Driver 1.3 mm Driver 1.0 mm Drill Bit
K-wire Reduction Clamp
(use with K-wires that are .045 inches or smaller)
Small Reduction Clamps
Retractors (2)
Elevator

18 | A.L.P.S. Hand Fracture System
Surgical Technique
1. Assess the fracture
fluoroscopically
Assess the fracture based on preoperative
radiographs and/or intraoperative fluoroscopy.
• Assessment needs to consider fracture,
comminution, bone loss, and geometry
• Fixation may require simply interfragmentary
screw fixation, use of plate and screws,
compression at the fracture site, and/or
supplementation with bone graft
• In the absence of malrotation or shortening,
simple plate application with locking technology
provides rigidity
• In the presence of clinically relevant
displacement (rotation, shortening, angulation)
anatomic reduction should precede plate
application or be provided via in-situ adjustment
of the fracture prior to final plate fixation
2. Make an incision
• While dorsal surgical approaches to metacarpal
fractures and both dorsal and lateral approaches
to phalangeal fractures are feasible, the decision
regarding where to make an incision and its
length are subject to surgeon preference