H 3 LRF

Hoffmann LRF ®
Circular External
Fixation
Operative technique
Hoffmann LRF Circular External Fixation | Operative technique
Hoffmann LRF
Circular External Fixation
Contents
This publication sets forth detailed recommended

1. Indications and contraindications . . . . . . . . . . . . 3 procedures for using Stryker devices and instruments.
2. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 It offers guidance that you should heed, but, as

with any such technical guide, each surgeon must
3. Key components . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 consider the particular needs of each patient and make
Rings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 appropriate adjustments when and as required.
Ring types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 A workshop training is recommended prior to
Foot arches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 performing your first surgery. All non-sterile devices
Rocker shoes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 must be cleaned and sterilized before use. Follow the
Wire bolt, wire bolt adaptor . . . . . . . . . . . . . . . . . 11 instructions provided in our cleaning and sterilization
Apex pin adaptor, apex pin bolt . . . . . . . . . . . . . . . 12 guide (L24002000).
Connecting nut . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Multi-component instruments must be disassembled
Telescopic struts . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 for cleaning. Please refer to the corresponding
Threaded rods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 assembly/disassembly instructions. Please remember
Hinge couplings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 that the compatibility of different product systems
have not been tested unless specified otherwise in the
Static struts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
product labeling.
4. Key instruments . . . . . . . . . . . . . . . . . . . . . . . . . . 23 See package insert (Instruction for Use) (V15013,
Fixation components wrenches . . . . . . . . . . . . . . . 23 V15034, V15011) for a complete list of potential adverse
Wire tensioner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 effects, contraindications, warnings and precautions.
Recommended tension levels . . . . . . . . . . . . . . . . 25 The surgeon must discuss all relevant risks including
Wire tensioner disassembly . . . . . . . . . . . . . . . . . . 25 the finite lifetime of the device with the patient when
necessary.
5. Operative technique . . . . . . . . . . . . . . . . . . . . . . 26
Sleeve system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
6. Frame examples . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Static foot & ankle frame . . . . . . . . . . . . . . . . . . . . 32
Note:
Tibial shaft frame . . . . . . . . . . . . . . . . . . . . . . . . . . 34 For a complete overview of the entire Hoffmann
Proximal tibial (plateau) frame . . . . . . . . . . . . . . . . 36 LRF System, it is recommended that the user also
Distal tibial frame . . . . . . . . . . . . . . . . . . . . . . . . . . 38 references the Hoffmann LRF Gradual Correction
Distal radius frame . . . . . . . . . . . . . . . . . . . . . . . . . 40 operative technique (H-ST-2), Hoffmann LRF
bone transport operative technique (H-ST-31),
the Hoffmann LRF Hexapod operative technique
(H-ST-34) the Patient Guide for External Fixation
(H-PG-1), the Hoffmann LRF Hexapod Hole Offset
Guide (H-ADI-1), and the Hoffmann LRF Web
Application user manual (H-IFU-2).
2
Operative technique | Hoffmann LRF Circular External Fixation
Indications & contraindications
Indications for use Intended use

The Hoffmann LRF System is indicated in pediatric The Hoffmann LRF (Limb Reconstruction Frame)
patients and adults for the treatment and fixation of: System is intended for fixation of fractures, joint
contractures, fusions, limb lengthening, deformity
• Open and closed fractures
correction, bone and soft tissue reconstruction in
• P
ost-traumatic joint contracture which has resulted pediatric patients and adults.
in loss of range of motion
• F
ractures and disease which generally may result Contraindications
in joint contractures or loss of range of motion and
fractures requiring distraction Since external fixation devices are often used in
emergency situations to treat patients with acute
• Pseudoarthrosis or non-union of long bones injuries, there are no absolute contraindications for
• L
imb lengthening by epiphyseal, diaphyseal, use. The surgeon’s education, training and professional
or metaphyseal distraction judgment must be relied upon to choose the most
appropriate device and treatment for each individual
• Correction of bony or soft tissue deformity patient. Whenever possible, the device chosen should be
• Correction of segmental bony or soft tissue defects of a type indicated for the fracture being treated and/or
for the procedure being utilized.
• Joint arthrodesis
Conditions presenting an increased risk of failure
• M
anagement of communicated intra-articular include:
fractures of the distal radius
1. I nsufficient quantity or quality of bone which
• Bone transport would inhibit appropriate fixation of the device.
The Hoffmann LRF System is indicated in adults for: 2. C
ompromised vascularity that would inhibit
• Osteotomy adequate blood supply to the fracture or
operative site.
• R
evision procedure where other treatments or
devices have been unsuccessful 3. Previous history of infections.
• Bone reconstruction procedures 4. A
ny neuromuscular deficit which could interfere
with the patient’s ability to limit weight bearing.
• Fusions and replantations of the foot
5. A
ny neuromuscular deficit which places an
• Charcot foot reconstruction unusually heavy load on the device during the
• Lisfranc dislocations healing period.
6. Malignancy in the fracture area.
7. M
ental, physical or neurological conditions which
may impair the patient’s ability to cooperate with
the postoperative regimen.
3
Indications & contraindications
Precautions Warnings
Information for patient. Surgeons must instruct the Single use devices cannot be reused, as they are
patients to report any unusual changes of the operated not designed to perform as intended after the first
site to their physician. Surgeon should immediately usage. Changes in mechanical, physical or chemical
evaluate the patient if a change at the fracture site characteristics introduced under conditions of repeated
has been detected. The surgeon should evaluate the use, cleaning and re-sterilization may compromise
possibility of subsequent clinical failure, and discuss the integrity of the design and/or materials leading to
with the patient the need for reduced activity levels, diminished safety, performance and/or compliance with
and / or possible revision surgery in order to aid relevant specifications. Please refer to the device label
fracture healing. to identify single or multiple use and/or cleaning and
re-sterilization release.
The surgeon should discuss all physical and
psychological limitations inherent in the use of external
fracture fixation appliances with the patient. Particular
attention should be given to premature weight bearing,
activity levels and the necessity for periodic medical
follow-up.
The surgeon must warn patients of surgical risks,
and make them aware of possible adverse effects.
The patient should be warned that the device cannot
and does not replicate a normal healthy bone, that the
device can break or become damaged as a result of
strenuous activity or trauma.
The Hoffmann LRF System is MR Unsafe
4
Introduction
The typical LRF construct features

two or more rings bridged by
three to four telescopic struts with
multiplanar, ball jointed fixation
bolts. Once applied, the LRF can be
unlocked for gross frame adjustment
and fracture reduction. The LRF
can be finely adjusted to aid in limb
alignment and definitively locked to
hold compression and reduction.
If deemed appropriate, the LRF
Telescopic Struts can provide up
to 5mm of controlled dynamization.
Compatibility
The Hoffmann LRF is mechanically
compatible with Hoffmann II,
Hoffmann II MRI and Hoffmann 3
Modular Fixation.
5
Key
components
6
Key components
Rings
• vailable in aluminum and
A
radiolucent carbon fiber reinforced
polymer
• ull, open, segment, and short
F
and long foot ring options
Use connection bolt (4933-1-702) with M6

nut (4933-1-701) to connect open ring to ring
segment
Note:
Indicates suggested placement
location when four struts are
used in construct
Indicates suggested placement
location when three struts are
used in construct
7
Key components
Ring types
Diameter Diameter
Full ring (Aluminum) Full ring (Carbon)
Ø80mm Ø80mm
Ø100mm Ø100mm
Ø120mm Ø120mm
Ø140mm Ø140mm
Ø155mm Ø155mm
Ø180mm Ø180mm
Ø210mm Ø210mm
Ø240mm
Ø270mm
Diameter Diameter
Open ring (Aluminum) Open ring (Carbon)
Ø100mm Ø100mm
Ø120mm Ø120mm
Ø140mm Ø140mm
Ø155mm Ø155mm
Ø180mm Ø180mm
Ø210mm Ø210mm
Ø240mm
Diameter Diameter
Ring segment (Aluminum) Ring segment (Carbon)
Ø100mm Ø100mm
Ø120mm Ø120mm
Ø140mm Ø140mm
Ø155mm Ø155mm
Ø180mm Ø180mm
Ø210mm Ø210mm
Ø240mm
Diameter Diameter
Foot ring, long (Aluminum) Foot ring, long (Carbon)
Ø100mm Ø100mm
Ø120mm Ø120mm
Ø140mm Ø140mm
Ø155mm Ø155mm
Ø180mm Ø180mm
Ø210mm Ø210mm
Diameter Diameter
Foot ring, short (Aluminum) Foot ring, short (Carbon)
Ø100mm Ø100mm
Ø120mm Ø120mm
Ø140mm Ø140mm
Caution: Ø155mm Ø155mm
To maintain intended performance, Ø180mm Ø180mm
carbon fiber rings should not be re-sterilized Ø210mm Ø210mm
beyond (50) autoclave cycles.
8
Key components
Foot arches
• Radiolucent carbon fiber
reinforced polymer
• ully assembled design with built-
F
in hinged connection bolts allow
for angular adjustment
• rovides weight-bearing support
P
when linked to tibial ring
• vailable in 100, 120,
A
140, 155, 180 and 210mm
diameters
oot arches are attached
F
to rings using the M8
connection nuts
(4933-1-010).
To ensure easy application,
assemble foot arches on
rings prior to tensioning
wires.
I f both rocker shoes and
foot arches are used, take
caution not to occupy the
holes required for rocker
shoe attachment
Caution:
To maintain intended
performance, carbon fiber foot
arches should not be re-sterilized
beyond (50) autoclave cycles.
9
Key components
Rocker shoes
• I ndependent shoe design allows
side-specific height adjustment to
compensate for angled distal foot ring
• nterior and posterior shoe ends
A
feature a 15º slope
• readed rubber sole helps improve
T
traction during ambulation
• Available in 6 sizes
• Dedicated posterior Rocker
Shoe mounting holes
Note: Caution: Note:
Rocker shoes are not offered Use caution when walking on wet Rocker shoes are
sterile and must be applied or slippery surfaces. attached to rings using
post-operatively. the M6 connection nuts
(4933-1-701)
Max Clearance = 23mm

(incl. Washer Red 7mm)
Rocker shoe sizing
Left foot rings Dia (mm) Long rocker shoe size
100 Small rocker shoe
120 long (4934-8-100)
140 Medium rocker shoe

155 long (4934-8-140)
180 Large rocker shoe

210 long (4934-8-180)
Short foot rings Dia (mm) Short rocker shoe size

Note: 100 Small rocker shoe
I f rocker shoes are indicated, do not 120 long (4934-7-100)
occupy dedicated mounting holes
140 Medium rocker shoe
with other frame components.
155 long (4934-7-140)
n open end of the foot ring, rocker
O
shoes mount on inner row of holes. 180 Large rocker shoe
210 long (4934-7-180)
10
Key components
Wire bolt
• uilt-in grooved stainless
B
steel washer
• annulated wire bolt head reduces
C
overall component weight and
accepts counter-torque wire bolt
Wrench for one-handed tightening
• Accepts 1.5, 1.8, & 2.0mm wires
• Available in short, medium
and long sizes
• hamfer on wire bolt head
C
indicates slot location
Note:
se only medium and long wire
U
bolts when inserted directly into
carbon fiber rings.
Wire bolt adaptor

• U
sed in conjunction with wire bolts
to capture obliquely inserted wires
or wires placed above or below ring
surface
•A
vailable in long and short versions
Note:
ire bolts and wire bolt adaptors
W
are attached to rings using the M8
connecting nuts (4933-1-010).
Utilize counter-torque
instrumentation to minimize
wire bending during final
tightening.
11
Key components
Apex pin adaptor Spring-loaded clamp allows

snapfit retention of pins
• Available in long and short versions
Interdigitating counter-torque
• ne-piece design compatible
O
serrations mechanically lock
with 3/4/5/6mm apex pins
desired pin placement
• djustable for multiplanar
A
fixation options
Built-in hex nut provides
counter-torque wrench access
for tightening assistance
Built-in retention clip allows for

provisional snapfit connection to
rings without nuts
Apex pin bolt

• One-piece design compatible
with 3/4/5/6mm apex pins
• Designed to connect apex pins
directly parallel to ring
Caution:
Apex pin adaptors and apex
pin bolts should only be
provisionally tightened around
the soft tissue protection sleeve
with thumbwheel. If spanner
wrenches are used, the sleeve
may deform if over tightened.
Note:
Apex pin adaptors and apex pin
bolts are attached to rings using
the M8 connecting nuts
(4933-1-010).
12
Key components
Connecting nut (M8)

• uilt-in washer provides more
B
surface area to contact ring
• ong connecting nut available for
L
wrench access when components
are placed side by side on rings
13
Key components
Telescopic struts Counter-torque Long 177-277mm

surface
12º 12º
Ball joint
Medium 138-201mm
Short 119-161mm
Extra short
100-125mm
Quick release
Counter-torque Thread end of strut

surface
Tube end of strut
ote:
N
Telescopic struts are attached to
Dynamization wheel rings using the short M8 connecting
nuts (4933-1-010) only.
Ball joint
Telescopic strut cleaning

• Completely unscrew colored safety nut
• Flush quick release mechanism with water
• fter cleaning, lubricate the threads of the colored safety nut
A
and screw the colored safety nut back up to the groove
14
Key components
Telescopic struts: fracture reduction

Once mounted, the LRF can be unlocked and used as a fracture
reduction tool. Once proper gross alignment is achieved, fine
tuning can ensue followed by final locking. In addition to the
quick release mechanisms, all ball joints must be unlocked to
achieve full range of motion.
Before After
15
Key components
Telescopic struts: gross length adjustment

The length of the telescopic strut can be easily adjusted to fit between 2 rings
when building the frame. Gross length adjustment may also be useful during
fracture reduction.
3. A
djust strut to
desired length
2. U
nlock quick release mechanism
by aligning the pin in the unlocked 4. O
nce proper length is achieved, lock
position quick release mechanism by aligning pin
with locked padlock symbol
1. U
nthread the safety nut down to
the line (groove) 5. H
and tighten the colored safety nut
ote:
N
In addition to unlocking the quick
release mechanisms, unlocking the
ball joints may ease gross length
adjustment.
aution:
C
Flat surfaces on quick release Finger
mechanisms are for finger grip grip only
adjustments only. Using a wrench
to swivel quick release mechanism
may damage the strut.
16
Key components
Telescopic struts: fine

tuning length adjustments
The length of the telescopic struts Note:
can be fine-tuned once the frame he clinician must ensure that
T
is assembled. This feature allows compression of the device using
the clinician to apply distraction or the fine tuning mechanism does not
compression to the construct at any destabilize the fracture pattern.
time during the course of the treatment.
2. T
ighten ball joint on
threaded end of strut
Threaded end of Strut
1. L
ock quick release
mechanism by aligning the
pin in the locked padlock
position
4. W
rench (4933-9-207) fits on pin Tube end of strut
to adjust length
+ Distraction
– Compression
Each full turn distracts
or compresses by 2mm Fine tuning length adjustment
3. L
oosen ball joint at tube end
5. Tighten ball joint tube end
of strut
Caution:
nly loosen square drive enough
O
to make adjustments. Forcing the
square drive too loose may damage
strut.
17
Key components
12º 12º
Telescopic struts: ball
joint adjustments
The ball joints at both ends of the
telescopic strut make it possible to
connect rings that are not parallel or
are of different diameters. They also
can help with reducing bone fractures.
Ball joints allow for 12o

of freedom from neutral
1. T
he ball joints are unlocked at
both ends of strut by loosening
the square drive with the yellow
5mm wrench driver (4940-9-030)
or the 5mm spanner wrench
(4933-9-205)

Using M8 nuts, each strut
is connected to the rings
Prior to frame assembly,

the clinician has the
option to realign the ball
joint to straight position 2. Frame
can be manipulated
using the thumbwheel to reduce fracture or adjust
for telescopic struts alignment
(4933-9-208), yellow
teardrop 5mm wrench
(4940-9-030), and 4933-
9-202 ratchet wrench
for counter-torque
as shown.
3. Once
frame is satisfactorily
adjusted, ball joints at both ends
of strut are locked by tightening
the 5mm square drive
18
Key components
Telescopic struts: dynamization

Dynamization may be initiated post- Each line on the strut corresponds to one
operatively during early stages of bone additional millimeter of dynamization.
healing and after early callus formation While using dynamization, patients
as assessed radiographically. Struts can should exercise extra caution when
be gradually dynamized as determined engaging in extraneous physical
by the clinician. Dynamization is activities. A maximum of 5mm of
achieved by turning the dynamization dynamization may be achieved with
wheel on the telescopic strut using these struts.
wrench (4933-9-207).
Closed wheel Open wheel

Maximum dynamization
is 5mm. Each line
indicates 1mm of
dynamization
Scale 1mm
Dynamization
wheel
Use open end on telescopic strut wrench (4933-9-207)

on wheel (not on pin) to adjust dynamization
19
Key components
Threaded rods
The Hoffmann LRF System includes threaded rods in the following sizes*:
6mm x 30mm
6mm x 60mm
6mm x 80mm
6mm x 100mm
6mm x 120mm
6mm x 150mm
6mm x 200mm
6mm x 250mm
6mm x 300mm
6mm x 350mm
6mm x 400mm
LRF threaded rods are attached to

rings using the ring/threaded rod
connecting M6 nut 4933-1-701.
Proximal tibial (plateau)
Tibial shaft
frame
*O
ptional rod cutter (5057-6-300)
not included in set.
20
Key components
Hinge couplings
•T
he LRF hinge couplings can be
connected to threaded rods to
create a wide range of simple
hinged assemblies
•P
re-assembled hinge coupling can be
locked for static frame applications
•C
onstrained, offering motion
in a single plane
Frame example: hinge coupling used
to reinforce foot and ankle frame by
connecting foot arch to tibial ring
Caution:
I t is recommended that hinge
couplings are reinforced with M6
connecting nuts when attaching M6 connecting nuts
to threaded rods.
Note:
inge couplings are attached
H
to rings using ring connection
bolt (4933-1-702).
Note:
hen building a static connection
W
between tibial ring and foot arch,
confirm that self-locking nuts on
hinge couplings are locked tight.
21
Key components
Static struts
The Hoffmann LRF System includes
static struts that can be used to stack
rings. The static struts are available in
the following sizes:
Extra short 20mm

Short 30mm
Medium 40mm
Long 60mm
Static struts are connected

to rings using connection
bolt (4933-1-702)
Ø8mm static struts designed to

accommodate Hoffmann II and
Hoffmann 3 couplings for additional
fixation options
22
Key instruments
Fixation components
wrenches
Wire bolt wrench (4933-9-201)

with built-in counter-torque for
tightening wire bolts
Designed to protect the

surgeon’s hand from the wire
Thumbwheel for ratchet wrench

(4933-9-203) for provisional tightening.
Can be used in conjunction with
ratchet wrench.
Ratchet wrench (4933-9-202)

for quick bolt tightening.
Flip over for loosening or tightening.
Note:
atchet and wire bolt wrench may
R
be used in a one-handed procedure.
23
Key instruments
Wire tensioner
Wire tensioner (4933-9-100) Wrench (5150-9-125) Wire tensioner nose, short (4933-9-110)
with modular counter-torque to connect wire tensioner or wire tensioner nose, long (4933-9-111)
nose for tightening assistance nose to wire tensioner
Before introducing wire into tensioner,

ensure that gold indicator is on open
padlock side (counterclockwise
turn of black handle)
Turn black handle clockwise to

tension wire to the desired level. There
are three rings on the shaft of the black
handle corresponding to 50kg, 90kg,
and 130kg. When the ring submerges
into the barrel, the wire has been
tensioned to the corresponding level.
Once appropriate tension level is
achieved, connecting nut is tightened
with the appropriate wrench.
Once wire-bolt is definitively tightened

on wire, the tensioner is removed
off the wire by rotating the black
handle counterclockwise until the
gold indicator is in the open padlock
position.
Note:
o not trim excess wire until
D
tensioning is complete. If the
tensioner does not bite the wire
during tensioning, repeat the
procedure: Turn black tensioner
handle counterclockwise until gold
indicator is in the open padlock
position. Proceed with clockwise
turns to engage wire until
tensioned to desired level.
24
Key instruments
Recommended tension levels
50kg Tension 90kg Tension 130kg Tension
•W
ire bolt offset adaptor, short •W
ire bolt, short (4933-1-001)
(4933-1-005) used with wire bolt
•W
ire bolt, medium (4933-1-002)
short (4933-1-001)
•W
ire bolt offset adaptor, long
(4933-1-005) used with wire bolt •W
ire bolt, long (4933-1-003)
•W
ires used on foot rings
short (4933-1-001)
Wire tensioner disassembly / assembly & lubrication
Align yellow indicator with Using wrench (5150-9-125) remove Using wrench (5150-9-125) remove
unlocked padlock symbol wire tensioner nose wire tensioner wheel
After removing the inner cylinder from Align pin and groove to reintroduce the Using wrench (5150-9-125)
the tensioner barrel, apply lubrication inner cylinder to the tensioner barrel attach wire tensioner wheel
to moving parts. Lubrication should be
performed before sterilization at least
after every 5 surgeries
25
Operative
technique
26
Operative technique
Sleeve system
1. W
hen templating apex pin placement
off of rings, identify proper hole and
introduce apex pin bolt.
Note:
pex pin bolts and apex pin
A
adaptors are attached to rings
with M8 connecting nuts.
2. S
elect the sleeve assembly that
corresponds to the diameter apex pin
being inserted and introduce into the
apex pin bolt.
Caution:
The sleeve assemblies include sizes
to accommodate 3, 4, 5, and 6mm
apex pins.
Do not over-tighten pin bolt around
sleeve assembly as this may deform
the soft tissue sleeve. Utilize
thumbwheels to provisionally
capture sleeve assembly in pin bolt.
3. I mpact trocar to create dimple

in cortical wall. If self-drilling
apex pins are used, the trocar is
removed and the appropriately
sized apex pin inserted through
the soft tissue sleeve.
4. W
hen using blunt apex pins,
pre-drilling is necessary. After
impacting and removing trocar,
introduce drill sleeve into soft tissue
sleeve in preparation for drilling.
27
Operative technique
Sleeve system
5. D
rill to desired depth and remove
drill and drill sleeve from the soft
tissue sleeve.
6. I nsert apex pin through soft tissue

sleeve and advance to the desired
position.
7. O
nce proper apex pin placement is
achieved, loosen connection nut on
apex pin bolt and remove the soft
tissue sleeve.
28
Operative technique
Sleeve system
8. Utilize counter-torque
instrumentation to minimize pin bolt
rotation during final tightening.
29
0860-2016 gamma3_long_nail_optech -proof 6
30
Frame
examples
31
Frame examples
Static foot & ankle frame

example
It is recommended to insert a minimum Warning:
of 3 points of fixation per circular o ensure sufficient construct
T fixation should be considered
ring and a minimum of 4 points of stability, it is recommended that (i.e. obese patients or patients
fixation per foot ring. If only wires the tibial ring and foot arch are that are ambulatory in the early
are used on a fixation block then 4 reinforced with supplemental postoperative phase). Construct
wires are recommended. A minimum fixation. Shown: distal tibial ring design and weight bearing
of 4 struts is recommended for this and foot arch bridged with hinged protocols are always to
application. couplings and threaded rod. In the surgeon’s discretion.
certain incidences, supplemental
Caution:
Confirm all nuts and connections are
tightened upon completion of frame. Confirm
all quick release mechanisms and ball joints
on struts are in locked position.
The wires should be curled or cut short to
prevent skin injury.
32
Frame examples
Static foot & ankle frame

components 11. L.
A.
15. 12.
E.
G. 13.
F. B.
2. 12.
J. C.
D.
1. 4.
14.
K. 3. I.
9.
M. 16. 10.
O.
N.
H. 8.
6. 7.
5.
17.
Components used
1. 2 x Full ring 7. 6 x Apex half pin 13. 4 x Static strut

2. 1 x Foot ring, long 8. 6 x End cap 14. 1 x Apex pin adaptor, long
3. 10 x Wire bolt 9. 3 x Apex pin bolt, Ø3-6 15. 2 x Hinge coupling
4. 2 x Apex pin adaptor, short 10. 27 x M8 connecting nut 16. 2 x M6 connecting nut
5. 4 x Telescopic strut 11. 1 x Foot arch 17. 1 x Threaded rod
6. 5 x Wire with olive 12. 8 x Connecting bolt
Instruments used
A. Wire tensioner F. Ratchet wrench K. Spanner wrench 7/10mm

B. Wire tensioner nose, long G. Thumbwheel for ratchet wrench L. Wrench (red)
C. Wire cutting and bending pliers H. Drill brace or universal chuck M. Soft tissue sleeve
D. Wire bolt wrench I. Split wire sleeve N. Drill sleeve
E. Telescopic strut wrench J. Pin driver O. Trocar
33
Frame examples
Tibial shaft frame example

It is recommended to insert a minimum of three fixation points per ring.
Fixation points may be a combination of wires and/or pins. Fixation should
be placed in a divergent fashion for increased stability. If only wires are used on a
fixation block then 4 wires are recommended.
Caution:
onfirm all nuts and connections
C
are tightened upon completion of
frame. Confirm all quick release
mechanisms and ball joints on
struts are in locked position.
34
Frame examples
Tibial shaft frame components
3. 13.
G. 12. I.
F. 7. 8.
E.
H. 2.
D.
14.
B. 1.
6.
4. 5.
C.
A.
11.
10.
9.
Components used
1. 1 x Full ring 7. 2 x M6 connecting nut 13. 1 x Post, long

2. 1 x Open ring 8. 2 x Ring connecting bolt 14. 15 x M8 connecting nut
3. 1 x Ring segment 9. 4 x Telescopic strut
4. 1 x Apex pin bolt, Ø3-6 10. 6 x Apex pin
5. 3 x Apex pin adaptor, short 11. 6 x End cap
6. 1 x Apex pin adaptor, long 12. 2 x Hoffmann 3 coupling
Instruments used
A. Drill brace or universal chuck F. Ratchet wrench

B. Soft tissue sleeve G. Thumbwheel for ratchet wrench
C. Drill sleeve H. Pin driver
D. Trocar I. Telescopic strut wrench
E. Spanner wrench 7/10mm
35
Frame examples
Proximal tibial (plateau)

frame example
It is recommended to insert a minimum
of three fixation points per ring.
Fixation points may be a combination
of wires and/or pins. Fixation should
be placed in a divergent fashion for
increased stability. If only wires are
used on a fixation block then 4 wires
are recommended.
Caution:
C
The wires should be curled or cut
short to prevent skin injury.
36
Frame examples
Proximal tibial frame

components
L.
3. A.
E.
G.
7. 8.
F. B.
2.
J. C.
D.
1.
K. 6. I.
5.
4. 12.
M.
O.
N.
H.
11. 13.
10.
9.
Components used
1. 1 x Full ring 6. 1 x Apex pin adaptor, long 11. 3 x Apex half pin
2. 1 x Open ring 7. 2 x M6 connecting nut 12. 16 x M8 connecting nut
3. 1 x Ring segment 8. 2 x Connecting bolt 13. 3 x End cap
4. 6 x Wire bolt 9. 3 x Telescopic strut
5. 2 x Apex pin adaptor, short 10. 3 x Wire with olive
Instruments used

B. Wire tensioner nose, short G. Thumbwheel for ratchet wrench L. Wrench (red)
37
Frame examples
Distal tibial frame example

of three fixation points per ring.
Fixation points may be a combination of
wires and/or pins. Fixation should
be placed in a divergent fashion for
increased stability. If only wires are
used on a fixation block then 4 wires are
recommended.
Caution:
onfirm all nuts and connections are
C
tightened upon completion of frame.
Confirm all quick release mechanisms
and ball joints on struts are in locked
position.
he wires should be curled or cut short
T
to prevent skin injury.
38
Frame examples
Distal tibial frame

components
L.
3. A.
E.
G.
7. 8.
F. B.
2.
J. C.
D.
1.
K. 6. I.
5.
4. 12.
M.
O.
N.
H.
11. 13.
10.
9.
Components used
1. 1 x Full ring 6. 1 x Apex pin adaptor, long 11. 3 x Apex half pin
2. 1 x Open ring 7. 2 x M6 connecting nut 12. 17 x M8 connecting nut
3. 1 x Ring segment 8. 2 x Connecting bolt 13. 3 x End cap
4. 6 x Wire bolt 9. 3 x Telescopic strut
5. 1 x Apex pin adaptor, short 10. 3 x Wire with olive
Instruments used

B. Wire tensioner nose, short G. Thumbwheel for ratchet wrench L. Wrench (red)
39
Frame examples
Distal radius frame

example
of two to three fixation points per ring.
Fixation points may be a combination
of wires and/or pins. Fixation should
be placed in the radius in a divergent
fashion for increased stability.
Caution:
C
40
Frame examples
Distal radius frame

components
C. D.
E.
B.
A.
I.
G.
1.
2. 7. 3.
H.
F.
5. 6.
4.
Components used
1. 2 x Full ring 5. 5 x Apex pin

2. 1 x Apex pin bolt, short 6. 5 x End cap
3. 4 x Apex pin adaptor 7. 11 x M8 connecting nut
4. 3 x Telescopic strut
Instruments used
A. Spanner wrench 7/10mm F. Drill brace or universal chuck

B. Ratchet wrench G. Soft tissue sleeve
C. Thumbwheel for ratchet wrench H. Drill sleeve
D. Telescopic strut wrench I. Trocar
E. Pin driver
41
Notes:
42
Notes:
43
Trauma & Extremities

This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or her own professional Manufacturer:
clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense
medical advice and recommends that surgeons be trained in the use of any particular product Stryker GmbH
before using it in surgery. Bohnackerweg 1
The information presented is intended to demonstrate a Stryker product. A surgeon must always refer to the package insert, product 2545 Selzach
label and/or instructions for use, including the instructions for Cleaning and Sterilization (if applicable), before using any Stryker Switzerland
product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices
in individual markets. Please contact your Stryker representative if you have questions about the availability of Stryker products stryker.com
in your area.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or
service marks: Apex, Hoffmann, Stryker. All other trademarks are trademarks of their respective owners or holders.
Content ID: H-ST-1_Rev. 2, 06-2016
Copyright © 2016 Stryker

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Hoffmann LRF ®

This publication sets forth detailed recommended

2. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 It offers guidance that you should heed, but, as

Indications & contraindications

Indications for use Intended use

Indications & contraindications

The Hoffmann LRF System is MR Unsafe

The typical LRF construct features

Use connection bolt (4933-1-702) with M6

Max Clearance = 23mm

140 Medium rocker shoe

180 Large rocker shoe

Short foot rings Dia (mm) Short rocker shoe size

Wire bolt adaptor

Apex pin adaptor Spring-loaded clamp allows

Built-in retention clip allows for

Apex pin bolt

Connecting nut (M8)

Telescopic struts Counter-torque Long 177-277mm

Counter-torque Thread end of strut

Tube end of strut

Telescopic strut cleaning

Telescopic struts: fracture reduction

Telescopic struts: gross length adjustment

Telescopic struts: fine 

Threaded end of Strut

Ball joints allow for 12o

Prior to frame assembly,

Telescopic struts: dynamization

Closed wheel Open wheel

Use open end on telescopic strut wrench (4933-9-207)

LRF threaded rods are attached to

Proximal tibial (plateau)

Extra short 20mm

Static struts are connected

Ø8mm static struts designed to

Wire bolt wrench (4933-9-201)

Designed to protect the

Thumbwheel for ratchet wrench

Ratchet wrench (4933-9-202)

Before introducing wire into tensioner,

Turn black handle clockwise to

Once wire-bolt is definitively tightened

Recommended tension levels

50kg Tension 90kg Tension 130kg Tension

Wire tensioner disassembly / assembly & lubrication

3. I mpact trocar to create dimple

6. I nsert apex pin through soft tissue

Hoffmann LRF Circular External Fixation | Operative technique

Operative technique | Hoffmann LRF Circular External Fixation

Hoffmann LRF Circular External Fixation | Operative technique

Static foot & ankle frame

Operative technique | Hoffmann LRF Circular External Fixation

Static foot & ankle frame

1. 2 x Full ring 7. 6 x Apex half pin 13. 4 x Static strut

A. Wire tensioner F. Ratchet wrench K. Spanner wrench 7/10mm

Hoffmann LRF Circular External Fixation | Operative technique

Telescopic struts: fine

3. I mpact trocar to create dimple

6. I nsert apex pin through soft tissue