MouseExFix. Surgical technique guide. i. Implants i. Systems 1. Surgical material 2. Surgical approach 3. Application 4. Osteotomy 5.

Transcription

1 Surgical technique guide i. Implants i. Systems 1. Surgical material 2. Surgical approach 3. Application 4. Osteotomy 5. Finishing

2 i External fixation System Stabilization of the Femur with an external fixator enabling osteotomies from 0.25 to 3.00 mm. In-vivo adjustment of fixator stiffness is possible. MouseExFix Technology The MouseExFix system is a locked external fixator made of PEEK and TAN which offeres a simple and an adjustable design and comes in a variety of sizes and stiffnesses. We currently offer a standard model for osteotomies from 0.25 to 1.00 mm; a large (L) model for osteotomies up to 2.00 mm and an extra large (XL) model for osteotomies up to 3.00 mm. The MouseExFix Mounting pin is made of TAN and comes in a standard length of mm and is designed with a four flanche. The four flange head on the end of the Mounting pin enables application and removing of the pin. To support the application of the Fixator various Saw guides are available. assembled MouseExFix with adjustable stiffness simple MouseExFix simple MouseExFix L simple MouseExFix XL MouseExFix Mounting pin 0.45 mm

3 i. Systems The MouseExFix system can cover single cut osteotomies up to large bone defects or flexible fixation technology. The fixator available can be used within the diaphysis of the femur. The images on the right demonstrate the various models of MouseExFix applied to the mouse femur. MouseExFix with adjustable stiffness MouseExFIx available in different sizes and stiffnesses

4 1. Surgical material Implants: - 1x MouseExFix simple 100% - 4x MouseExFix Mounting pins 0.45 mm RIS MouseExFix simple 100% RIS MouseExFix Mounting pin 0.45 mm Implant specific instruments: - 1x MouseExFix Saw guide RIS MouseExFix Sawguide 100% 1.00 mm Instruments: - 4x hand drills - 1x Accu Pen 3V RIS Hand drill RIS AccuPen 3V Consumables: - 1x 0.45 mm Drill bit - 1x 0.22 mm Gigly wire saw, 0.50 m - 1x Square box wrench 0.70 mm - 1x Vicryl suture Skin glue (Epiglue) / Vicryl suture x Ethibond Vicryl suture 6-0 RIS Drill Bit 0.45 mm RIS Gigly wire saw 0.22 mm RIS Square box wrench 0.70 mm

5 2. Surgical approach Positioning Mouse in prone position.

6 2. Surgical approach Approach Longitudinal incision along the femur from the hip joint to the knee with scalpel or mini scissors.

7 2. Surgical approach Approach Longitudinal incision of the fascia lata.

8 2. Surgical approach Approach M. vastus lateralis and M. biceps femoris are split and M. tensor fasciae latae is lifted to expose the full length of the femur (preserving the sciatic nerve).

9 2. Surgical approach Approach Circular preparation of the femur along the midway of the diaphysis in the planned area of the osteotomy.

10 3. Application Application of the Gigly wire saw Loop the wire saw around the bone in medio-lateral orientation.

11 3. Application Centering of the first screw hole top MouseExFix Detail: Sectional view of the orientation of the MouseExFix to the centring bit showing top/bottom. Position the 1.00 mm centering bit in the MouseExFix as shown. Make sure the MouseExFix is not mounted upside down by inserting the centering bit into the MouseExFix. If there is no resistance within the first few tenths of a millimeter the orientation of the fixator is correct. Keep the problem of a right orientation of the MouseExFix in mind during the whole application procedure. Position the device on the prepared femur in anterolateral direction by externally rotating the femur. Hold the MouseExFix with a small clamp for it to be parallel to the longitudinal axis of the bone.

12 3. Application Preparation for drilling and screwing By applying the first Mounting pin the alignment of the fixator is determined. Therefore it is important to pay attention to positioning the plate parallel to the femur. Adjust the orientation of the longitudinal axis so that the plate is reclined anterolaterally and parallel to the bone. Retain rotation of the bone until you have inserted the first Mounting pin.

13 1 4. Application Drilling and insertion of the Mounting pin Carefully use the forceps to hold the fixator in position with the MouseExFix acting as drill guide. Insert the drill bit into the second hole (1) distally to the planned fracture gap and check the position of the drill bit (tip pointing into the countersink). While drilling make sure that you drill completely through both cortices. Insert the Mounting pin into the tip of the 0.70 mm square box wrench and carefully insert it into the MouseExFix without loosing the alignment to the first borehole. As soon as the tip is in contact with the bone, start turning. After approximately 5 full turns make sure that the thread at the proximal end of the Mounting pin caches the MouseExFix body. This thread locks the system. Stop turning when the end of the bone thread is close to the top surface of the bone.

14 3. Application Sequence of screw placement Drill the hole for the second screw (2) proximal to the planned osteotomy and insert the screw. The third (3) and the last screw (4) should be placed in the order shown in the illustration.

15 4. Osteotomy Accomplishing the osteotomy If needed, attach the saw guide to the MouseExFix. Create a defined fracture gap by using the Gigly saw (sufficient irrigation! ). To avoid damage of the soft tissue cut the saw wire close to the bone on one side after completing the osteotomy.

16 4. Osteotomy Attached MouseExFix in situ.

17 5. Finishing Wound closure The muscular layer and the fascia lata are closed with Ethibond vicryl suture 6-0.

18 5. Finishing Wound closure Skin suture with Ethibond vicryl suture 6-0.

19 5. Finishing Wound closure To avoid wound biting the suture must not end distal to the lower implant level. To avoid wound biting it is also possible to use skin glue instead of a suture.

20 Hazards and legal restrictions Scientific editor: Illustrations: Design and layout: In collaboration with: Hazards Great care has been taken to maintain the accuracy of the information contained in this publication. However, the publisher, and/or the distributor, and/or the editors, and/or the authors cannot be held responsible for errors or any consequences arising from the use of the information contained in this publication. Contributions published under the name of individual authors are statements and opinions solely of said authors and not of the publisher, and/or the distributor, and/or the RISystem Group. The products, procedures, and therapies described in this work are hazardous and are therefore only to be applied by certified and trained medical professionals in environments specially designed for such procedures. Ronny Bindl, Germany Sandra Wissing, Switzerland Romano Matthys, Switzerland University of Ulm, Institut für Unfallchirurgische Forschung und Biomechanik, Director A. Ignatius, Germany No suggested test or procedure should be carried out unless, in the user s professional judgment, its risk is justified. Whoever applies products, procedures, and therapies shown or described in this work will do this at their own risk. Because of rapid advances in the medical sciences, RISystem recommends that independent verification of diagnosis, therapies, drugs, dosages, and operation methods should be made before any action is taken. Although all advertising material which may be inserted into the work is expected to conform to ethical (medical) standards, inclusion in this publication does not constitute a guarantee or endorsement by the publisher regarding quality or value of such product or of the claims made of it by its manufacturer. RISystem AG Talstrasse 42d 7270 Davos Switzerland info@risystem.com