Clavicle System 2.8

Stability redefined

The APTUS Clavicle system provides surgeons with a versatile and anatomical solution to treat fractures, osteotomies, malunions and non-unions of the clavicle. The system includes solutions for superior and anterior clavicle plating. A flexible suture retrieval and fixation system can be added to the superior lateral plates to address affected CC ligaments. The efficient and user-oriented system is backed up with easy to use instrumentation and innovative features to live up to its attention to stability.

Flaps

Two flaps for screws from anterior to posterior to increase stability.

Plate slot to hold an insert for either a cortical screw or suture fixation.

Dimples

Dimples on plate surface – plate can be easily held in position with pointed forceps.

Drill Guide Blocks

Drill guide blocks for superior lateral plates – rapid and easy insertion of screws in a predefined angle.

TriLock^PLUS

TriLock^PLUS screw holes offer the advantage of compression and angular stable locking in one step.

Fracture Location

Clavicle fractures are common injuries, accounting for up to 10% of all fractures in adults. They often result from direct impact to the shoulder. Shaft fractures are the most frequent clavicle fractures followed by lateral and medial fractures. CC joint injuries are often associated with lateral clavicle fractures.^[1]The Medartis APTUS Clavicle System 2.8 takes this into account, providing a portfolio designed to cover a variety of fracture positions. All plates have an anatomic plate design with a low overall profile height and specific design features, such as CC suture fixation directly through the lateral superior plates.

^[1] Boonard, M., et al., Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis. Eur J Orthop Surg Traumatol, 2018. 28(6): p. 1065-1078."

Midshaft

Lateral third

Lateral to midshaft

Clavicle Superior Midshaft Plates

Highlights

Anatomical fit developed based on CT data
8-hole plates in three bend variations. Straightforward anatomical fit on variously shaped bones with reduced need for plate bending

Features

TriLock

Multidirectional locking, screws can pivot freely by ± 15° in all directions

TriLock^PLUS

TriLockPlus screw holes offer the advantage of locking and compression in one step

HexaDrive

Simplified screw pick-up due to patented self-holding technology

Oblong hole

Oblong hole for minor plate adjustments

Rounded edges

Rounded edges for soft tissue protection

Bendable

Plates can be bent with specific plate bending pliers

Dimensions

Dimensions of the plate

Anterior Midshaft Plates

Highlights

Symmetrical plate design based on CT data
Low plate profile with minimal screw head protrusion, rounded edges and a smooth surface
Chamfered and narrowed plate ends with preangled screw holes

Features

TriLock

Multidirectional locking, screws can pivot freely by ± 15° in all directions

TriLock^PLUS

TriLockPlus screw holes offer the advantage of locking and compression in one step

HexaDrive

Simplified screw pick-up due to patented self-holding technology

Oblong hole

Oblong hole for minor plate adjustments

Rounded edges

Rounded edges for soft tissue protection

Bendable

Plates can be bent with specific plate bending pliers

Dimensions

Dimensions of the plate

Clavicle Superior Lateral Plate

Highlights

Two flaps for screws from anterior to posterior allow for screw placement in two planes and increase the possibilities to address fragments
Multiple screw holes and increased pull-out strength in the lateral area for various fracture patterns
Plate slot to hold an insert offers the possibility to fix a suture through the plate or alternatively to place a cortical screw
The optional drill guide block facilitates rapid and accurate screw insertion at a predefined angle

Features

TriLock

Multidirectional locking, screws can pivot freely by ± 15° in all directions

TriLock^PLUS

TriLockPlus screw holes offer the advantage of locking and compression in one step

HexaDrive

Simplified screw pick-up due to patented self-holding technology

Oblong hole

Oblong hole for minor plate adjustments

Preangled holes

Preangled screw holes facilitate less invasive plate placement and fixation

Rounded edges

Rounded edges for soft tissue protection

Drill guide block

Prevents screw collision and offers fast and precise screw placement

Dimensions

Dimensions of the plate

Bendable

Plates can be bent with specific plate bending pliers

Clavicle Anterior Lateral Plates

Highlights

Chamfered and narrowed plate ends with preangled screw holes
Designed for less invasive plate placement and fixation method
Low plate profile with minimal screw head protrusion, rounded edges and a smooth surface for soft tissue protection

Features

TriLock

Multidirectional locking, screws can pivot freely by ± 15° in all directions

TriLock^PLUS

TriLockPlus screw holes offer the advantage of locking and compression in one step

HexaDrive

Simplified screw pick-up due to patented self-holding technology

Oblong hole

Oblong hole for minor plate adjustments

Rounded edges

Rounded edges for soft tissue protection

Bendable

Plates can be bent with specific plate bending pliers

Clavicle Superior Lateral Shaft Plate

Highlights

Specific anatomical fit offers the possibility to position the plate laterally, but away from the AC joint
Multiple options for screw placement to increase pull-out strength in the lateral area
Narrowed lateral plate end with reduced plate thickness
Preangled screw hole in the medial plate end

Features

TriLock

Multidirectional locking, screws can pivot freely by ± 15° in all directions

TriLock^PLUS

TriLockPlus screw holes offer the advantage of locking and compression in one step

HexaDrive

Simplified screw pick-up due to patented self-holding technology

Oblong hole

Oblong hole for minor plate adjustments

Rounded edges

Rounded edges for soft tissue protection

Preangled holes

Preangled screw holes facilitate less invasive plate placement and fixation

Bendable

Plates can be bent with specific plate bending pliers

Screws

Non-locking
2.8 Cortical Screws,
HexaDrive 7

Locking
2.8 TriLock Screws,
HexaDrive 7

The science behind.

Biomechanical analysis of plating techniques for unstable lateral clavicle fractures with coracoclavicular ligament disruption
Jo, O. I., Almond, M., Rupansinghe, H. S., Ackland, D. C., Ernstbrunner, L., & Ek, E. T.

2023

Journal of Shoulder and Elbow Surgery

Background

Neer type IIB lateral clavicle fractures are inherently unstable fractures with associated disruption of the coracoclavicular (CC) ligaments. Because of the high rate of nonunion and malunion, surgical fixation is recommended; however, no consensus has been reached regarding the optimal fixation method. A new plating technique using a superior lateral locking plate with anteroposterior (AP) locking screws, resulting in orthogonal fixation in the lateral fragment, has been designed to enhance stability and reduce implant failure. The purpose of this study was to biomechanically compare 3 different clavicle plating constructs within a fresh frozen human cadaveric shoulder model.

Methods

Twenty-four fresh frozen cadaveric shoulders were randomized into 3 groups (n = 8 specimens): group 1, lateral locking plate only (Medartis Aptus Superior Lateral Plate); group 2, lateral locking plate with CC stabilization (No. 2 FiberWire); and group 3, lateral locking plate with 2 AP locking screws stabilizing the lateral fragment. All specimens were subject to cyclic loading of 70 N for 500 cycles. Data were analyzed for gap formation after cyclic loading, construct stiffness, and ultimate load to failure, defined by a marked decrease in the load displacement curve.

Results

After 500 cycles, there was no statistically significant difference between the 3 groups in gap formation (P = .179). No specimen (0/24) failed during cyclic loading. Ultimate load to failure was significantly higher in group 3 compared to group 1 (286 N vs. 167 N; P = .022), but not to group 2 (286 N vs. 246 N; P = .604). There were no statistically significant differences in stiffness (group 1: 504 N/mm; group 2: 564 N/mm; group 3: 512 N/mm; P = .712). Peri-implant fracture was the primary mode of failure for all 3 groups, with group 3 demonstrating the lowest rate of peri-implant fractures (group 1: 6/8; group 2: 7/8; group 3: 4/8; P = .243).

Conclusion

Biomechanical evaluation of the clavicle plating techniques showed effective fixation across all specimens at 500 cycles. The lateral locking plate with orthogonal AP locking screw fixation in the lateral fragment demonstrated the greatest ultimate failure load, followed by the lateral locking plate with CC stabilization. This new plating technique showed compatible stiffness and gap formation when compared to conventional lateral locking plates as well as plates with CC fixation. The use of orthogonal screw fixation in the distal fragment may negate against the need for CC stabilization in these types of fractures, thus minimizing surgical dissection around the coracoid and potential complications.
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