HoffmannII TenXor Hybrid Operative Technique - Stryker

Hoffmann II Lower Extremity
Ring System
Operative Technique
Thin Wire Fracture Fixation Systems
for the Lower Extremity
• Foot and Ankle
• Hoffmann II
• Hybrid Systems
• Monotube Triax

Hoffmann II Hybrid
External Fixation System
8 7b
4
3
2
1
6
5
1. Ring
2. Ring Clamp
3. Wire Post
4. Pin Post
5. Ring to Monotube Triax Tube Clamp, Ø20mm
(Blue) Ring to Monotube Triax Tube Clamp,
Ø25mm (Red)
6. Wires and Apex Half-Pins
7. (a) Hoffmann II and
(b) Triax Components for Diaphyseal Fixation
with Apex Pins
8. Instruments
9. Foot Ring and Threaded Post with Nut
9
7a

Overview
The Hoffmann II Hybrid External
Fixator and the Hoffmann II Foot Ring
are two external fixation systems that
are to be used in conjunction with
the Hoffmann II External Fixation
Systems. All of these systems feature
advanced, patented (5,752,954) “snap
fit” technology which provides ease
and speed
of application, versatility and patient
comfort.
What is a Hybrid Frame?
A hybrid frame is a combination of wires
and half-pins in a frame construct. It combines
the principles of circular ring and
modular or unilateral frame fixation to better
neutralize the forces acting upon the fracture
site.
Hybrid external fixation has become more
and more popular in the treatment of periarticular
fractures of the tibia. This type of
frame configuration may be used to stabilize
metaphyseal fractures, especially in osteoporotic
bone (poor quality bone stock) or
severely comminuted injuries where regular
half-pins may loosen because of repetitive
loading.
Indications
• Bone fracture fixation
• Osteotomy
• Arthrodesis
• Correction of deformity
• Revision procedure where other treatments
or devices have been unsuccessful
• Bone reconstruction procedures
• Fusions and replantations of the foot
More Specifically:
• Severe multifragmentary tibial plateau
and pilon fractures with severe soft tissue
injury
• Distal femoral fractures with soft tissue
damage
• Peri-articular fractures where neither
internal fixation nor regular half pins can
be used
• Crush injuries of the foot where multiple
bones are fragmented and severe soft tissue
damage is present
• Charcot foot, Charcot ankle, and LisFranc
dislocations
What is a circular wire frame?
A circular wire frame incorporates multiple
rings joined together to form a rigid construct
in which thin wire fixation can be
utilized. Tension is applied to the wires to
provide compression and stabilization over
boney sites.
Circular frame fixation has become an
effective treatment in the foot, ankle, and
tibia where soft tissue damage and poor
bone quality are present.
3

Anatomical Considerations for Wire Insertion
Proximal Tibia
Figure 1
1. Tibia
2. Tibial tuberosity
3. Fibula
4. Proximal tibio-fibular joint
5. Patellar tendon
6. Tibial collateral ligament of the knee
7. Tibialis anterior
8. Extensor digitorum longus
9. Gracilis
10. Sartorius
11. Semitendinosus
12. Popliteus
13. Soleus
14. Gastrocnemius (lateral head)
15. Gastrocnemius (medial head)
16. Popliteal vessels
17. Long saphenous vein
18. Short saphenous vein
19. Common peroneal nerve
20. Tibial nerve
When inserting wires (Fig 1) it is important
to ensure that the path they take will avoid
tendons and neurovascular bundles.
The head of the fibula is an important landmark,
but as the peroneal nerve passes distal
and posterior to it care should be taken to
avoid transfixation of the nerve bundle.
The wires should be placed at least 14mm
below the joint line to avoid capsular penetration.
It may be desirable to pass a wire
through the head of the fibula or just anteriorly.
Greater care should be taken with wires
placed near the neck of the fibula as this is
where the branching of the peroneal nerve
takes place.
Transfixation of the patellar tendon by the
anterolateral to posteromedial wire must
be avoided as this will cause pain and
restricted motion. The cross wire is inserted
just anterior to the anterior-lateral compartment
muscles, it should not violate the joint
space, or the gastrocnemius muscle. Care
should be taken not to place this too
anteriorly as this can cause damage to the
hamstring attachment. Transfixation of the
muscle leads to discomfort and restricted
mobility. Should it be necessary to transfix
the muscle, the muscle should be stretched
prior to insertion of the wire.
4

Proximal Tibial Fractures
WIRE INSERTION AREA
LIMIT OF CORTICAL
SCREW FIXATION
Figure 2
Figure 3
The metaphyseal area indicated consists of
thin walled cortical bone not suitable for
half-pin fixation (Fig 2). Apex half pins
are designed for fixation into dense strong
subchondral bone. In this area tensioned
wires are easy to apply, allowing for maximum
wire crossing angles and stable
constructs.
Multiplanar wires create a construct capable
of buttressing against varus/valgus and
flexion/extension deforming forces.
In the diaphysis the use of Apex half pins
is known to give good long-term fixation
with low rates of loosening and pin tract
infection.
In cases of fractures of the tibia with intraarticular
involvement, minor displacement
or short oblique fractures of the diaphyseo
metaphyseal junction, the frame can be
applied with two to four wires proximally
and two or three Apex pins in the
mid-shaft. Additional pins can be placed
independently on the ring for greater
stability, particularly to enhance resistance
to flexion/extension instability, (Fig 3).
In more complex fractures using wires with
olives will allow for the fixation of fracture
fragments.
The Hoffmann II Hybrid Fixator provides
optimal fracture fixation by combining
tensioned wire fixation in the metaphysis
with pin fixation in the diaphysis.
5

Proximal Tibial Fractures
Figure 4 Figure 5
Operative Procedure
1. Pre-operative planning is used to assess
the orientation of the fracture lines and
the extent of the articular surface depression.
Important landmarks are marked on
the skin. CT scans can be helpful.
2. Temporary reduction if appropriate is
carried out. Major fracture fragments are
secured using Stryker Asnis III cannulated
screws. Bone grafting, if required, can be
performed at this time.
Wire Insertion
4. With all external fixation devices it is
important to ensure that the path the
wires and pins take avoids risk of injury
to major blood vessels, tendons and
neurovascular elements.
The order in which wires are placed is
left to the surgeon’s discretion (Fig 5).
Generally three wires are placed in the
proximal tibia.
3. The appropriate sized ring is chosen
allowing for an even clearance of approximately
2 finger widths around the limb
(Fig 4).
The ring is placed with the open area to
the back to allow for knee flexion.
6

Figure 6
SMALL STOPS
ALIGNMENT MARK
Figure 8
Figure 7
5. Using the split wire sleeve guide to hold
the wire and referencing the head of the
fibula the first wire is placed parallel to
the joint surface and just anterior to, or
through the fibular head. The common
peroneal nerve should be avoided during
wire insertion. The first wire exits the
tibia anteromedially avoiding the patellar
tendon. Plain wires or wires with olive can
be used with the split wire sleeve guide
(Fig 6).
6. At this point the ring can be connected to
the wire by using a pair of ring clamps
and wire posts. The wire post is pushed
into the ring clamp, the two small steel
stops on the post must line up with
the alignment mark on the ring clamp
before insertion (Fig 7 & 8). Turn the
post by one quarter turn left or right to
orientate the wire holder direction in the
field of the ring. The assemblies (one pair
of ring clamps and wire posts) can now
be ‘clicked’ onto the ring on the inner or
outer ring surface. Placing the assemblies
on the outer ring surface allows a greater
wire mobility and easier access for
tensioning.
7

Proximal Tibial Fractures
9a
9b
Figure 9
Figure 10
25MM
Figure 11
7. The ring can now be presented to the
wire and the wire ‘clicked’ into the wire
posts (Fig 9, 9a).
If the wire needs adjusting it can be
removed from the post by pushing the
inner clamping plate towards the 7mm
screw and ‘un-clicking’ the wire (Fig 9b).
8. The second wire is placed anterolateral to
posteromedial and 40 to 60 degrees from
the first wire. Again the wire is placed
parallel to the joint surface; it should not
violate the joint space, or the gastrocnemius
muscle.
9. A second pair of ring clamps and wire
posts are ‘clicked’ onto the ring and wire.
10. The third wire is placed medial-lateral
between the first two wires. The position
of the wires can be checked on an image
intensifier and all three wires should form
a small triangle at the center (Fig 10).
11. The final pair of wire posts and ring
clamps are ‘clicked’ into place.
Figure 12
12. The ring clamp/wire post assembly can
be adjusted along the length of the ring.
Each wire post can be adjusted vertically
up to a maximum of 25mm (Fig 11).
This helps to eliminate any bowing of
the wires. Once this stage is completed
the ring clamps can be locked into place
using the 13mm wrench to tighten the
13mm nut (Fig 12). Make sure to stabilize
the ring/construct while tightening so
that reduction and alignment are maintained.
Alternatively all three wires can
be placed prior to attachment to the ring.
Convergence/divergence of wires can be
compensated for by adjusting the height
of the wire post proximally or distally.
8

Wire Tensioning
Stabilization Wrench
Figure 13
70mm Minimum
Figure 14
13. Wire tensioning should not be
performed until all the wires are in a
satisfactory position.
The ring clamp must be locked onto the
ring. Once the ring clamps have been
locked, any adjustment of the wire post
is impossible.
Make sure that the wire post is parallel to
the wire. Any twisting can create a stress
riser, particularly during tensioning (Fig
14 inset).
Before tensioning the wire, it must be
locked in place into one of the wire posts
using the stabilization wrench and the
7mm wrench (Fig 13). The tension will
then be performed on the wire section
which remains unlocked.
When using a wire with an olive, the
side with the olive must be locked first.
Smooth k-wires can be locked at either
end.
Olive k-wires are marked with a series
of dashes on the side where the olive
stop is present.
The tensioning instrument requires a
minimum of 70mm of wire (Fig 14).
9

Wire Tensioning
100kg
50kg
Figure 15
C
B
A
Figure 16
14. Fully open the wire tensioner and feed
the wire through the centre of the instrument
until the instrument makes contact
with the wire post. Turn the T-handle
clockwise until the desired mark is
reached: (Fig 15)
- first mark (50kg tension) for 1.5mm
wires
- second mark (100kg tension) for
2.0mm wires
The wire is now fully tensioned.
Before removing the tensioner, use the
stabilization wrench & T-wrench to
tighten the 7mm screw to lock the wire
in place. Do not use the tensioner to
apply counter force.
For the Hoffmann II Hybrid System,
the best procedure to obtain the optimal
balance of tension between all wires and
therefore the highest stiffness of the set
up is (Fig 16):
Tension to final tension the wire situated
farthest from the ring first (A).
Tension to final tension the middle wire
second (B).
Tension to final tension the wire situated
nearest to the ring (C).
This is then repeated on the other wires.
10

Diaphyseal Half Pin Placement
Hoffmann II
1
2
3
90°
4
5
1
4
Monotube Triax
Figure 17 Figure 18
15. To complete the frame, two or three Apex
half pins (5mm diameter preferably) are
placed in the middle third of
the tibia to provide support for the ring.
Half pins are placed just anterior and
medial to the tibial crest in an anterior or
anteromedial to posterior/posterolateral
direction (Fig 17).
Place the first half pin free hand in the
desired location and fully engage in both
cortices.
16. Use the Hoffmann II multipin clamp
as a guide to place the second half pin.
Place the pins in number 1 and number
5 positions or number 1 and 4 position
with the Monotube Triax clamp
(Fig 18).
17. A third pin may be placed using the same
procedure in position 3 if required.
11

Connecting using Hoffmann II
Proximal Tibial Fractures
SMALL STOPS
Figure 19 Figure 20
Figure 21 Figure 22
18. Hoffmann II rod-to-rod couplings are
‘clicked’ directly on to the wire posts.
Care should be taken to avoid placing
the couplings on the two small stops
(Fig 19).
These couplings allow connection to the
diaphyseal Hoffmann II frame (Fig 20).
19. Additional support can be achieved by
using a short Hoffmann II connecting
rod with a ring clamp (Fig 21).
For additional stability pin posts and
ring clamps can be used for anterior
independent pin placement (Fig 22).
12

Reduction
Figure 23
Figure 24
20. Final reduction can be made using the
ring and rods as ‘handles’ to manipulate
and reposition the fragments to reduce
the fracture. The reduction must be
maintained manually until the rod-to-rod
components are tightened. A final x-ray
should be taken to confirm the reduction
(Fig 23).
22. Once the frame is complete the wires
can be cut back to approximately 35mm
from the posts and bent away from the
7mm screws using the cutting and
bending pliers (Fig 24).
21. Once the desired frame and reduction
are achieved, all the Hoffmann II components
can be finally locked into place
using the 7mm wrenches.
13

Distal Tibial/Ankle Fractures
A B C
4. Extensor Digitorum Longus
5. Extensor Hallucis Longus
6. Peroneus Longus
1. Tibia
2. Fibula
3. Tibialis Anterior
D
7. Peroneus Brevis
8. Peroneus Tertius
Figure 25a
9. Tibialis Posterior
10. Flexor Digitorum Longus
11. Flexor Hallucis Index
12. Triceps Surae (Achilles Tendon)
13. Anterior Tibia Vessels & Deep Peroneal
Nerve
14. Posterior Tibial Vessels & Tibial Nerve
15. Peroneal Vessels
16. Long Saphenous Vein
17. Short Saphenous Vein
The Hoffmann II Hybrid System may be used to treat distal
tibial fractures. The construction of the Hoffmann II Hybrid
frame is identical to the proximal tibial fracture technique.
Figure 25b
However, the anatomy of this portion of the limb should
be taken into consideration for the placement of the wires
(Fig 25a). Figure 25b is a representation of a typical frame
constructed when utilizing the wire placement illustrated by
Figure 25a.
Major fracture fragments may require supplementary internal
fixation for additional stability. For further details please refer
to the relevant Stryker Trauma internal fixation system
guides.
Anatomic Considerations
1. The posterior tibial artery and vein and the tibial nerve
remain posterior to the tibia, traversing medially as they
approach the ankle joint.
2. The anterior tibial artery and vein, and the deep peroneal
nerve, are on the lateral surface of the tibia in proximal
Zone D. They lie on the anterior surface of the tibia in
distal Zone D.
3. The saphenous nerve and greater saphenous vein are
on medial side of the tibia throughout Zone D.
Example of the Distal Tibial Frame Construction
4. The superficial peroneal nerve has divided into its
terminal branches in this zone.
14

Proximal Tibial Fractures using the Monotube Triax
Figure 26 Figure 27
Figure 28 Figure 29
The Monotube Triax frame allows for postoperative
adjustment of the frame,
with integrated dynamization and
distraction-compression features. If these
features are not needed, a Monotube Triax
carbon tube may be used.
The construction of the Hoffmann II Hybrid
ring and wires assembly is identical to the
proximal tibial technique described previously
(Fig 26). Ensure that there is
sufficient clearance between the ring and
the soft tissues to allow ring to tube clamp
placement.
Please follow the step by step technique for
the Monotube Triax diaphyseal frame:
- select the relevant Hoffmann II Hybrid ring
to tube clamp (blue or red)
- ‘click’ the Hoffmann II Hybrid ring to
tube clamp onto the ring on the inner
or outer ring surface (Fig 27)
- fix the Monotube Triax multipin clamp to
the tibial diaphysis using 2 or 3 Apex pins
- place the Monotube Triax tube into
the Hoffmann II Hybrid ring to tube clamp
and the Monotube Triax
multipin clamp (Fig 28)
- position the Monotube Triax tube
relative to the bone; this is possible due
to the versatility of the Hoffmann II Hybrid
ring to tube clamp and the Monotube Triax
fixator
- achieve final reduction using the Hoffmann
II Hybrid ring and the Monotube Triax
reduction handle
- tighten the 7mm screws on the Hoffmann
II Hybrid ring to tube clamp and on the
Monotube Triax clamp to lock the frame
(Fig 29)
15

Anatomical Considerations for Wire Insertion, Mid Foot
Metatarsals
1. Cuneiform Bones
2. Cuboid
3. M. Extensor Digitorum Brevis
4. Styloid Process
5. M. Abductor Digiti Quinti
6. A. V.N. Medial/Lateral Plantar
7. M. Flexor Digitorum Brevis
8. M. Abductor Hallucis
Figure 31a
Phalanges
Metatarsals
Figure 30
Foot Applications
The Hoffmann II Foot Ring System may be
used to treat a variety of foot and ankle indications
including, but not limited to, fracture
fixation and reconstruction procedures.
The frame construct utilizes components and
instrumentation from the Hoffmann II Foot
and Ankle Ring System, the Hoffmann II and
Monotube Triax External Fixation Systems
and the Hoffmann II Hybrid System. The
principles of thin wire placement should be
observed when inserting, placing, and tensioning
wires and half-pins in the foot.
In addition, the anatomy of the foot should
be considered for the placement of both
wires and half pins (Figs. 30-32). Figure 35
is a representation of a typical frame
constructed utilizing the wire placement
illustrated by Figure 31b & 32.
Major fragments may require supplemental
internal fixation for additional stability. For
further details refer to the relevant Stryker
Trauma internal fixation system guides.
Phalanges
Figure 32
Figure 31b
16

Wire Insertion – Metatarsals
1. First wire should be placed obliquely
and dorsally through the base of the first,
second, and third metatarsals
2. A second wire is placed from the lateral
side, obliquely and dorsally from the fifth
and fourth
3. If additional stabilization is needed, a half
pin may be placed in the first metatarsal
4. A third wire is placed in the calcaneus
oblique and medially, positioned at the
height of the inferior aspect of the
calcaneal tuberosity, midway along the
calcaneal process
5. A fourth wire may be placed ~5cm from
the anterior process, medial to lateral in
the calcaneus for greater stability.
6. Transfixing pins or half pins may also
be placed with or instead of k-wires for
stabilization
Choosing an appropriate ring size:
Note: Use as small of a ring as possible for
the most stable construct, while allowing
for edema and dressings. Generally, 2-3 cm
should be behind the heel and around the
foot and tibia.
Connecting the wires to the rings:
1. At this point a wire can be connected to
the ring using a pair of ring clamps and
wire posts. The wire post is pushed into
the ring clamp, the two small steel stops
must line up with the alignment mark
on the ring clamp before insertion (Fig 7,
page 7). Turn the post by one quarter turn
to orient the wire post in the direction of
the field of the ring. Wire posts can be
oriented above or below the rings.
2. The ring clamps may be adjusted to
their appropriate position along the ring
3. Each wire post may be adjusted to a
maximum of 25mm. +/-20 degrees of
angulation is possible to meet the wire
and eliminated “bowing” of the wires.
4. When the desired placement is achieved,
the 13mm nut of the Ring Clamp may be
tightened so that reduction and alignment
can be maintained.
Wire Tensioning
1. Wire tensioning should not be performed
until all wires are in a satisfactory position
and all ring clamps locked. The wire post
opposite where tension will be applied
must also be locked to the wire using the
7mm wrench.
2. A minimum of 70 mm of wire is required
to utilize the wire tensioning instrument
100kg
properly.
Place a fully
opened tensioner
over
50kg
the wire until
the instrument
makes
Figure 33
contact with the wire post. Turn the T-
handle clockwise until the desired tension
is reached (Figure 33).
3. Before removing the tensioner, use the
stabilization wrench and 7mm wrench
to tighten the screw to lock the wire into
place. Repeat this procedure on all corresponding
wires on all rings.
4. Additional stabilization may be gained by
using Hoffmann II rod to rod couplings
and rods or by connecting to the shaft
portion of the wire post.
Connecting ring to ring:
1. A ring may be connected using a pair of
ring clamps and a desired length of carbon
fiber rod. The clamps are “clicked” on the
rings and a rod is passed through the
proximal ring and into the distal ring’s
clamp.
Note: it is best if rings are parallel and
in line with the other.
2. Ring clamps can be fixed at this time by
tightening the 13mm nut.
3. Three points of fixation (Delta-style
frames) are recommended to provide
greater stability between rings. To connect
a foot ring to carbon ring, have the closed
position of the 5/8 ring to the posterior
side of the tibia to allow connection to the
posterior aspect of the foot ring.
Figure 34
Tension Bridge:
To decrease the amount of deflection
that may occur at the distal portion of the
FootRing, a bridge may be constructed as
shown:
Figure 35
17

Frames
1 2 3
4
5
6
18

7 8
FRAME COMPONENTS
1 2 3 4 5 6 7 8
Carbon Ring 1 1 1 1 1 1 1 1
Wires 3 2 3 3 3 2 5 5
Wire Post 6 4 6 6 6 4 10 10
Pin Post - - - 1 - 1 - -
Ring Clamp 6 6 6 7 6 5 16 10
Hoffmann II Rod to Rod 8 4 4 5 6 - 2 2
Hoffmann II Pin to Rod 6 5 3 1 - - - -
Hoffmann II Multipin Clamp - - - 1 2 - - -
Hoffmann II Post - - - 2 3 - - -
Ring to Monotube Triax
Blue Tube Clamp - - - - - 1 - 6
Triax Blue Dynamic - - - - - 1 - 3
Half Apex Pins 6 3 3 3 3 3 - -
Transfixing Apex Pins - 1 - - - - - -
Hoffmann II Rods 6 5 3 3 3 - 4 1
Monotube Blue Pin Clamp - - - - - 1 - -
Foot Ring 1 1
Threaded Post 2 2
19

General Recommendations
• Wires are extremely sharp and should be
handled with care. Eye protection when
using wires is recommended.
• Wires should be placed to allow the
maximum possible angle between the
two outermost wires without damaging
important soft tissue structures.
• Ensure that all components are fully open
(unscrewed) before frame assembly.
• Positioning the ring above (below) the
wires when treating a proximal (distal)
fracture is possible but it makes the
attachment of the Hoffmann II
couplings to the posts more difficult.
• Place the wire and pin posts so that the
7mm screw is accessible.
• Wires may be removed from the wire
post by depressing the tongue and
‘unclicking’ the wires.
• To gain extra height on the ring, the ring
clamp can be inverted (nut on top).
• Tighten the ring clamps completely
before tensioning the wires. The clamp
will not slide on the ring and the wire
post will not move up or down.
• When tightening the 13mm nut on the
ring clamp, use the ring to apply counter
force.
• Minimum wire length required for
tensioning is 70mm
• Tighten the 7mm square head screw of
the wire post until slight deformation
of the wire is visible.
• Keep the wire tensioner parallel to the
wire when tensioning.
• DO NOT use the wire tensioner to apply
counter force. When tightening the 7mm
screws use the stabilization wrench.
• DO NOT ‘click’ the Hoffmann II
couplings on the 2 small stops of the
wire post.
Proximal intra-articular
tibia fracture (A-P view)
Final frame (A-P view) M-L view Final frame (M-L view)
The Hoffmann II Hybrid Fixator System is compatible with the Hoffmann II Fixator System and the Monotube Triax
Fixator System, please see the relevant brochures for details.
The Hoffmann II Hybrid Fixator System is compatible with all 4mm, 5mm and 6mm Apex pins, please see the Apex
Inventory Card for details.
20

Products & Instruments
Cat. No.
Description
4936-0-015 Open Ring 150mm
4936-0-018 Open Ring 180mm
4936-0-021 Open Ring 210mm
4936-0-115 Foot Ring 150mm
4936-0-118 Foot Ring 180mm
4936-0-121 Foot Ring 210mm
4936-2-010 Ring Clamp
4936-2-040 Wire Post
4936-2-050 Short Wire Post
4936-2-030 Pin Post
4920-2-181 8mm Thread Post w/Nut
4936-2-920 Ring to Monotube Triax Tube Clamp Ø20mm (Blue)
4936-2-925 Ring to Monotube Triax Tube Clamp Ø25mm (Red)
Wires
Diameter
Length
5101-1-450 1.5mm 450mm
5101-2-450 2.0mm 450mm
Wires with Olive
Diameter
Length
4936-1-320 1.5mm 450mm
4936-1-340 2.0mm 450mm
Hoffmann II Hybrid Instruments
4936-9-010 Wire Tensioner
4936-9-020 Cutting and Bending Pliers
4936-9-035 13mm Quick Capture Spanner Wrench
4936-9-040 Split Wire Guide
4936-9-050 Stabilization Wrench
4936-9-060 7mm T Wrench
4936-9-070 7mm Cardan Wrench
5054-8-009 7mm Spanner Wrench
4936-9-905 Hybrid System Storage Tray
4936-9-920 Foot Ring System Storage Tray
21

Notes
22

Hoffmann ® II Lower Extremity Ring System
Operative Technique
Monotube TRIAX
External Fixation System
Unilateral frame system designed to handle a wide variety of fractures and limb-lengthening
applications. This simple, color-coded system offers both dynamic and carbon tubes for
individualized performance and economy. True simplicity, versatility, and economy.
Hoffmann II
External Fixation System
Modular frames which allow for true independent pin placement. Completely compatible
with Original Hoffmann components, this new system improves flexibility and ease-of-use,
while enhancing frame economics through minimal componentry. It’s external fixation with
a “snap.”
Hoffmann II Compact
External Fixation System
Designed to complement the anatomy of the distal radius by allowing independent movement
of its clamps in multiple planes. Standard unilateral or bi-lateral bridging frames for
intra-articular fractures and peri-articular non-bridging frames for extra-articular fractures.
Fully compatible with Hoffmann II system, based on a spring-loaded snap-fit mechanism that
improves flexibility and ease-of-use.
Hoffmann II Micro
External Fixation System
The Hoffmann II Hybrid system is a system providing advanced technology and ease of application.
Fully compatible with Hoffmann II System and Monotube Triax system, based on a
spring-loaded, snap-fit mechanism that improves flexibility and ease of use.
Apex
Pin Fixation
Every Fixator incorporates the high quality pin-to-bone interface provided by Apex Pins.
The Apex Pin cuts more sharply with less torque, friction and heat upon insertion improving
purchase while minimizing the risk of pin tract problems.† Available in self-drilling and blunt
tip designs, only from Stryker!
REFERENCES
1. Kenwright J, Richardson JB, Cunningham JL, White SH, Goodship AE, Adams MA, Magnussen PA, Newman JH. Axial
movement and tibial fractures. J Bone Joint Surgery 1991:73b.
2. Hart MB, Wu JJ, Chao EYS, Kelly PJ. External skeletal fixation of canine tibial osteotomies. Compression compared
with no compression. J Bone Joint Surgery 1985; 67 A:598.
The information presented in this brochure is intended to demonstrate the breadth of Stryker product offerings. Always
refer to the package insert, product label and/or user instructions before using any Stryker product. Surgeons must always
rely on their own clinical judgment when deciding which treatments and procedures to use with patients. Products may not
be available in all markets. Product availability is subject to the regulatory or medical practices that govern individual markets.
Please contact your Stryker representative if you have questions about the availability of Stryker products in your area.
Literature Number: LH2HST Rev. 2
GC/GS 1.5M 06/10
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