Trofix® Trochanteric Fixation Plate - zimmer2.eu

Take a Grip on Trochanteric Refixation 

Trofix ® 

Trochanteric 

Fixation Plate 

Surgical Technique

Disclaimer 

This document 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. 

Information contained in this document was gathered and compiled by medical experts and qualified Zimmer personnel. The information 

contained herein is accurate to the best knowledge of Zimmer and of those experts and personnel involved in its compilation. However, 

Zimmer does not assume any liability for the accuracy, completeness or quality of the information in this document, and Zimmer is not 

liable for any losses, tangible or intangible, that may be caused by the use of this information.

Trofix Trochanteric Fixation Plate – Surgical Technique 

Trofix Trochanteric 

Fixation Plate 

Table of Contents 

Introduction 4 

Indications 6 

Sample Cases 7 

Surgical Technique 8 

1. Preoperative Planning 

2. Incision 

3. Mobilization of the Trochanteric Fragment(s) 9 

4. Plate Positioning and Reduction 9 

5. Plate Fixation 11 

6. Additional Fixation (Optional) 12 

Postoperative Care 13 

Implants 14 

Graphic Case 16 

Instruments 17 

Planning Aid 19


Introduction 

Trofix is a versatile plate 

solution for the treatment of 

trochanteric fracture(s). 

An innovative plate contour allows for 

multiple fixation options (e.g. screws, 

screw-cerclage systems) improving 

stabilization for different type of trochanteric 

fracture(s). 

The plate profile covers the whole 

trochanteric area reducing the possibility 

of fragment redisplacement. 

Four different plate sizes to suit different bone shapes 

Exclusive plate contour to increase 

compression in the trochanteric area


Multiple options for screw placement 

and the angular freedom of the lateral 

and proximal screws enable the plate 

to be combined with an intramedullary 

system. 

Notches along the plate and the additional 

cerclage screw facilitate the 

positioning of cerclage systems to improve 

plate fixation. 

Premium material: titanium (grade 1).* 

Trofix is offered in a sterile package. 

It is the ideal solution for several indications 

(e.g. as an emergency plate 

for trochanteric refixation during hip 

arthroplasty). 

* Materials: Trofix plate is made of C.P. titanium, 

Protasul ® -Ti, ISO 5832-2, ASTM F67; screws 

are made of titanium alloy TiALNb, Protasul ® -100; 

ISO 5832-11, ASTM F1295; the cerclage screw is 

made of titanium alloy TiALV, Protasul ® -64; 

ISO 5832-3, ASTM F136 

45° 

30° 

Polyaxial screw placements 

and screw types 

Trofix in combination 

with a cerclage system 

∅ 4.5 mm 

cortical screws 

∅ 4.0 mm 

cancellous screws 

∅ 3.5 mm 

cortical screws


Indications 

• Trochanteric pseudarthrosis after 

osteotomy or fracture 

• Trochanteric osteotomies (primary fixation) 

• Multifragmentary trochanteric 

fractures 

• Per-/subtrochanteric fractures with 

trochanteric fragments. In this 

case the plate must be combined 

with an intramedullary system. 

• Periprosthetic fractures with trochanter 

tear off. In this case the plate is combined 

with a stem implant. 

• Pathological fractures/metastases in 

the proximal area of the Femur (fixation 

or augmentation of the trochanter)


Sample Cases 

Pertrochanteric Fracture 

in Combination with Hip 

Arthroplasty 

Pseudarthrosis after 

Subtrochanteric Fracture 

Preoperative 

Preoperative 

Postoperative 

Postoperative


Surgical Technique 

To achieve a good outcome, trochanteric 

fixation surgery is based on five equally 

important steps. 

1. Preoperative Planning 

Preoperative planning with adequate X rays 

and X ray templates (REF 06.0136x.000) is 

strongly recommended. 

This allows determination of the dimensions 

of plate length, head size and 

the appropriate position of screws, par-ticularly 

in presence of a hip prosthesis 

to prevent any interference with the 

hip stem. 

The surgical procedure is defined at this 

stage. 

2. Incision 

A long lateral approach is recommended. 

The length and orientation of the 

incision is determined by the preoperative 

planning. 

Note: the length of the incision should 

include the additional length needed 

for the application of the tension device. 

Preoperative planning with X ray and 

X ray template 

Incision 

10 cm 

5 cm 

0 cm 

5 cm 

10 cm 

15 cm 

20 cm 

Cancellous Screws 

fully threaded short thread 

Cortical Screws 

self-tapping 

Cerclage 

Screw 

span 20 mm 

Magnification 

1.15:1 

Trofix ® Trochanteric Fixation Plate 140 

0cm 1cm 2cm 3cm 4cm 5cm 6cm 7cm 8cm 9cm 

∅ 3.5 

∅ 4.5 

∅ 4 

∅ 4 

20 30 40 50 60 

20 30 40 50 60 

14 20 30 40 46 

10 20 30 40 50 

20 

10 

14 

10 

10 

14 

10 

60 

14 20 30 40 46 

Size 140 

REF Number 02.02270.140 

This reference number must correspond to that of the prosthesis to be implanted. 

© All rights reserved, Zimmer GmbH, CH-8404 Winterthur, Switzerland 

5/2006, Lit.No. 06.01361.000-WL 

46 

46 

50 

50 

50 

50 

Cortical Screw ∅ 4.5 

for articulated tension 

device 

5 cm 10 cm 

15cm 

7 611814 814665 

span 20 mm


3. Mobilization of the 

Trochanteric Fragment(s) 

Mobilize the trochanteric fragment(s) 

together with the abductor muscle 

tendon unit. 

The trochanteric fragment(s) with the 

abductor muscle tendon should be 

released from all the adhering scar tissue 

between the capsula and acetabular 

rim. 

Reduce the freed trochanteric fragment 

to the appropriate anatomic position 

under an image intensifier. 

Avoid damage of the fragment and 

tendon unit. 

Note: the reduction of the trochanteric 

fragment can be facilitated by using a 

cerclage wire placed through the muscle 

above the trochanter tip, to pull the 

fragment down into its original position. 

Debride the areas of bony contact prior 

to reducing the fracture. 

4. Plate Positioning and 

Reduction 

The hooks of the implant should be 

placed over the proximal edge of the 

trochanteric fragment. 

Atraumatic splitting of the tendon and 

muscle fibers longitudinally with scissors 

facilitates the insertion of the hooks. 

Note: avoid the gluteus superior nerve. 

Once the hooks are positioned over 

the top of the fragment(s), reduce the 

fracture. 

Note: do not bend the hooks in order to 

avoid damages on the plate. 

Splitting of the muscle fiber 

Reduction of trochanteric 

fragment(s) with cerclage wire 

Plate positioning 

around the trochanteric 

fragment(s)

10 


For the final reduction, the use of the 

tension device (REF 100.90.060) is recommended. 

It allows the fragment(s) to 

be pulled down against the muscle contraction 

and provides temporary fixation 

to the plate. 

Note: care should be taken during the 

use of the tension device. Maintain 

the tension device in the middle of the 

green zone (250 N) to avoid plate 

deformation due to excessive compression. 

Alternatively, if the metal insert device 

(REF 75.00.37) is used for reduction, a 

verbrugge clamp (REF 00-4816-028-00) 

should be used to hold the plate in 

place around the femur shaft. 

Check (with an image intensifier) the 

reduction and the plate position. 

Note: if the fracture gap is still too wide 

after applying compression, fill the gap 

with bone graft. The opening in the 

head of the plate facilitates this procedure. 

Fracture reductions using 

the tension device 

Alternative fracture 

reduction with an impactor 

and a verbrugge clamp 

Use bone graft to fill the fracture 

gap (if required)


5. Plate Fixation 

Secure the plate both distally and 

proximally. 

5a. Shaft Fixation 

Two types of screws are available for 

shaft fixation. 

4.5 mm titanium screws are used in 

the absence of prosthesis in the central 

holes of the plate. In presence of a 

stem they also may be placed unicortically. 

3.5 mm bicortical titanium screws are 

used in presence of prosthesis, placed 

in the lateral holes at the plate edge. 

Screws should avoid contact with the 

hip stem. The direction of the drill 

hole should match the one defined in 

the preoperative plan. Tapping is mandatory. 

Note: ensure that existing intramedullary 

systems and their fixation and/or 

anchorage elements are not affected or 

damage by screw insertions. Damages 

of hip prosthesis (including holes or 

damaged surfaces) can reduce the life 

expectation of the hip prosthesis drastically. 

Care should be given when inserting 

the titanium screws in a hard or dense 

bone to avoid the breakage of the 

screws. 

25° 

Avoid contact with the stem by using 

the angular freedom of the screw 

Shaft fixation in absence 

of hip stem 

15° 

15° 30° 

Shaft fixation in presence 

of hip stem 

11

12 


5b. Proximal Fixation 

Both proximal screws are essential to 

achieve a good fixation of the plate. 

4.0 mm cancellous screws are used 

in the proximal area to improve interfragmentary 

compression. 45° of 

screw angulation is allowed in the 

distal-proximal direction and 20° in 

the ventro-dorsal direction. 

Remove the tension device when stable 

fixation of the plate is achieved. 

6. Additional Fixation (Optional) 

A cerclage system can be used if it is 

necessary to improve the fixation. 

Notches at the edge of the plate secure 

the contact between the cerclage system 

and the plate. 

Cerclages should be positioned around 

the trochanter fragments and/or the 

shaft as shown. 

An additional cerclage screw 

(REF 02.02280.011) can be used to 

secure the proximal cerclage in 

position. This screw is inserted in the 

hole centered in the plate distal 

curve. 

Note: do not create tension in the 

cerclage around it, because the cerclage 

screw is not designed to withstand high 

tension forces. 

45° 

Proximal fixation 

of the plate 

20° 

Positioning of a cerclage 

system to increase fixation 

stability


Postoperative Care 

Abduction position of the leg for two 

weeks. 

No adduction and active abduction 

for six weeks. 

No active flexion > 60° for six weeks. 

A wedge-shaped pillow is recommended 

for sitting. 

Ambulation with crutches is allowed 

after the first postoperative day. 

The amount of weight bearing relies 

on the outcome of the reduction and 

trochanteric fixation. It should be 

decided by the surgeon for each case. 

1

1 


Implants 

Cancellous screw, short thread 

Protasul ® -100 

Trofix ® Trochanteric Fixation Plate, 

short length 

Protasul ® -Ti 

sterile-packed 

STERILE R 

Size REF 

small head 02.02270.140 

large head 02.02270.150 

Quantity* L mm ∅ mm REF 

2 20 4.0 02.03135.020 

2 22 4.0 02.03135.022 

2 24 4.0 02.03135.024 

2 26 4.0 02.03135.026 

2 28 4.0 02.03135.028 

2 30 4.0 02.03135.030 

2 32 4.0 02.03135.032 

2 34 4.0 02.03135.034 

2 36 4.0 02.03135.036 

2 38 4.0 02.03135.038 

2 40 4.0 02.03135.040 

2 42 4.0 02.03135.042 

2 44 4.0 02.03135.044 

2 46 4.0 02.03135.046 

2 48 4.0 02.03135.048 

2 50 4.0 02.03135.050 

2 55 4.0 02.03135.055 

2 60 4.0 02.03135.060 

Cancellous screw, fully threaded 


∅ 1.9 mm ∅ 4.0 mm ∅ 2.4 mm ∅ 6.0 mm 

∅ 1.9 mm ∅ 4.0 mm ∅ 6.0 mm 

1.75 mm 

l 

* Indicate the quantity in the graphic case 

L 

2.5 mm 

1.75 mm 


2 20 4.0 02.03137.020 

2 22 4.0 02.03137.022 

2 24 4.0 02.03137.024 

2 26 4.0 02.03137.026 

2 28 4.0 02.03137.028 

2 30 4.0 02.03137.030 

2 32 4.0 02.03137.032 

2 34 4.0 02.03137.034 

2 36 4.0 02.03137.036 

2 38 4.0 02.03137.038 

2 40 4.0 02.03137.040 

2 42 4.0 02.03137.042 

2 44 4.0 02.03137.044 

2 46 4.0 02.03137.046 

2 48 4.0 02.03137.048 

2 50 4.0 02.03137.050 

2 55 4.0 02.03137.055 

2 60 4.0 02.03137.060 

L 

2.5 mm 

Trofix ® Trochanteric Fixation Plate, 

long length 

Protasul ® -Ti 


STERILE R 

Size REF 

small head 02.02270.235 

large head 02.02270.245 

Cortical screw 


∅ 2.4 mm ∅ 3.5 mm ∅ 6.0 mm 

1.25 mm 

L 

2.5 mm 


2 10 3.5 02.03131.010 

2 12 3.5 02.03131.012 

2 14 3.5 02.03131.014 

2 16 3.5 02.03131.016 

2 18 3.5 02.03131.018 

2 20 3.5 02.03131.020 

2 22 3.5 02.03131.022 

2 24 3.5 02.03131.024 

2 26 3.5 02.03131.026 

2 28 3.5 02.03131.028 

2 30 3.5 02.03131.030 

2 32 3.5 02.03131.032 

2 34 3.5 02.03131.034 

2 36 3.5 02.03131.036 

2 38 3.5 02.03131.038 

2 40 3.5 02.03131.040 

2 45 3.5 02.03131.045 

2 50 3.5 02.03131.050


Cortical screw 


∅ 

3.0 mm ∅ 

4.5 mm ∅ 

8 mm 

1.75 mm 


2 14 4.5 02.03141.014 

2 16 4.5 02.03141.016 

2 18 4.5 02.03141.018 

2 20 4.5 02.03141.020 

2 22 4.5 02.03141.022 

2 24 4.5 02.03141.024 

2 26 4.5 02.03141.026 

2 28 4.5 02.03141.028 

2 30 4.5 02.03141.030 

2 32 4.5 02.03141.032 

2 34 4.5 02.03141.034 

2 36 4.5 02.03141.036 

2 38 4.5 02.03141.038 

2 40 4.5 02.03141.040 

2 42 4.5 02.03141.042 

2 44 4.5 02.03141.044 

2 46 4.5 02.03141.046 


L 

3.5 mm 

Additional Implant 

Cerclage screw 



STERILE R 

REF 

02.02280.011 

1

1 


Graphic Case 

Trofix ® graphic case 

REF 

complete ZS02.00025.300 

empty ZS02.00025.310 

Trofix ® graphic case module 

for instruments 


for screw instruments 


for screw rack 

Trofix ® graphic case, lid 

REF 

02.00025.303 

REF 

02.00025.304 

REF 

02.00025.305 

REF 

02.00025.301 

Trofix ® graphic case, base (Inox) 

REF 

02.00025.302


Instruments 

Bone-holding forceps verbrugge 

Quantity* REF 

1 00-4816-028-00 

Drill guide ∅ 3.2 mm for neutral 

compression position 

Quantity* ∅ drill mm ∅ screws REF 

1 3.2 4.5 100.40.145 

Depth gauge, L max 110 mm; 

for screws 4.5–6.5 mm 


1 110 4.5/6.5 100.90.030 

▲ 

Jointed socket wrench 

L ▲ 

Quantity* mm L mm REF 

1 11 200 100.90.090 


Double drill guide 

Quantity* A ∅ drill mm B ∅ tap mm REF 

1 2.5 3.5/4 100.40.035 

Self-holding screw forceps 

Quantity* REF 

1 100.90.005 

Articulated tension device span 20 mm 

Quantity* REF 

1 100.90.060 

Handle 

A B A B 

Quantity* REF 

1 100.90.200 

Double drill guide 

Quantity* A ∅ drill mm B ∅ tap mm REF 

1 3.2 4.5 100.40.045 

Depth gauge, L max 110 mm; 

for screws 3.5–4 mm 


1 110 3.5/4 100.90.025 

Combination wrench hexagonal 

Quantity* mm L mm REF 

1 11 140 100.90.080 

T-handle, with quick coupling 

Quantity* REF 

1 100.90.210 

1

1 


▲ ▲ 

Two-fluted drill bit ∅ 2.5 mm 

Quantity L mm l mm REF 

2 110 84 103.25.110 

1 180 154 103.25.180 

▲ ▲ 

I 

I 

L ▲ 

▲ 

L ▲ 

▲ 

Tap ∅ 4 mm for cancellous screws, 

with quick coupling 


1 110 60 106.40.110 

Hexagonal screwdriver small for screws 

∅ 2.7, 3.5 and 4 mm 

Quantity mm L mm REF 

1 2.5 200 109.01.020 

Hexagonal screwdriver for screws 

∅ 4.5, 6.5 and 7 mm 


1 3.5 245 109.02.030 

▲ ▲ 

Two-fluted drill bit ∅ 3.2 mm 


1 145 119 103.32.145 

▲ ▲ 

I 

Tap ∅ 4.5 mm for cortical screws, 



1 125 70 106.45.125 

Hexagonal screwdriver shaft 



1 2.5 100 109.01.025 

Metal insert/extract device 

I 

L ▲ 

▲ 

L ▲ 

▲ 

Quantity REF 

1 75.00.37 

▲ ▲ 

I 

Tap ∅ 3.5 mm for cortical screws, 



2 110 50 106.35.110 

Holding sleeve 

L ▲ 

▲ 

Quantity REF 

1 109.01.060 

Hexagonal screwdriver shaft 



1 3.5 100 109.01.035


Planning Aid 

10 cm 

5 cm 

0 cm 

5 cm 

10 cm 

15 cm 

20 cm 




self-tapping 

Cerclage 

Screw 

span 20 mm 

Magnification 

1.15:1 



∅ 3.5 

∅ 4.5 

∅ 4 

∅ 4 

20 30 40 50 60 

20 30 40 50 60 

14 20 30 40 46 

10 20 30 40 50 

20 

10 

14 

10 

10 

14 

10 

60 

14 20 30 40 46 

Size 140 

REF Number 02.02270.140 



5/2006, Lit.No. 06.01361.000-WL 

10cm 

5 cm 

0 cm 

5 cm 

10cm 

15cm 

20cm 

25cm 

30cm 




self-tapping 

Cerclage 

Screw 

span 20 mm 

Magnification 

1.15:1 




5/2006, Lit.No. 06.01363.000-WL 

46 

46 

50 

50 

50 

50 



device 

5 cm 10 cm 

15cm 

7 611814 814665 


∅ 3.5 

∅ 4.5 

∅ 4 

∅ 4 

20 30 40 50 60 

20 30 40 50 60 

14 20 30 40 46 

10 20 30 40 50 

20 

10 

14 

10 

10 

14 

10 

10 

14 

10 

10 

14 

10 

60 

14 20 30 40 46 

Size 235 

REF Number 02.02270.235 

46 

46 

46 

46 

50 

50 

50 

50 

50 

50 

50 

50 



device 

5 cm 10 cm 

15cm 

7 611814 814672 

span 20 mm 

span 20 mm 

X ray template for 

short plate/small head 

REF 

06.01361.000 


long plate/small head 

REF 

06.01363.000 

10 cm 

5 cm 

0 cm 

5 cm 

10 cm 

15 cm 

20 cm 




self-tapping 

Cerclage 

Screw 

span 20 mm 

Magnification 

1.15:1 



∅ 3.5 

∅ 4.5 

∅ 4 

∅ 4 

20 30 40 50 60 

20 30 40 50 60 

14 20 30 40 46 

10 20 30 40 50 

20 

10 

14 

10 

10 

14 

10 

60 

14 20 30 40 46 

Size 150 

REF Number 02.02270.150 



5/2006, Lit.No. 06.01362.000-WL 

10cm 

5 cm 

0 cm 

5 cm 

10cm 

15cm 

20cm 

25cm 

30cm 




self-tapping 

Cerclage 

Screw 

span 20 mm 

Magnification 

1.15:1 




5/2006, Lit.No. 06.01364.000-WL 

46 

46 

50 

50 

50 

50 



device 

5 cm 10 cm 

15cm 

7 611814 814696 


∅ 3.5 

∅ 4.5 

∅ 4 

∅ 4 

20 30 40 50 60 

20 30 40 50 60 

14 20 30 40 46 

10 20 30 40 50 

20 

10 

14 

10 

10 

14 

10 

10 

14 

10 

10 

14 

10 

60 

14 20 30 40 46 

Size 245 

REF Number 02.02270.245 

46 

46 

46 

46 

50 

50 

50 

50 

50 

50 

50 

50 



device 

5 cm 10 cm 

15cm 

7 611814 814689 

span 20 mm 

span 20 mm 


short plate/large head 

REF 

06.01362.000 


long plate/large head 

REF 

06.01364.000 

1

Contact your Zimmer representative or visit us at www.zimmer.com 

Lit. No. 06.01334.022 – Ed. 03/2007 WL/ZHUB 

+H4406013340221/$070301C07X 

© 2007 by Zimmer GmbH Printed in Switzerland Subject to change without notice

Trofix® Trochanteric Fixation Plate - zimmer2.eu

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