SURGICAL TECHNIQUE GUIDE PROTEAN. radial head plate. As described by: Jorge L. Orbay, M.D. Miami Hand & Upper Extremity Institute Miami, Florida
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1 SURGICAL TECHNIQUE GUIDE PROTEAN radial head plate As described by: Jorge L. Orbay, M.D. Miami Hand & Upper Extremity Institute Miami, Florida
2 PROTEAN radial head plate Indications for Use The PROTEAN Radial Head Plate Module consists of titanium alloy plates (right and left), screws, and specialized instrumentation. The screws are available in both locking and non-locking configurations and are provided in lengths from 12mm 40mm, with increments of 2mm. Please refer to the PROTEAN Radial Head Plate Module Instructions for Use to review the warnings, precautions and contraindications for this system.
3 ELBOW LANDMARKS 1 Position the forearm in neutral rotation. With the elbow flexed 90, palpate and mark the lateral epicondyle. Make an 8 10cm line through the marked point to perform a lateral approach to the elbow through the indicated tissue plane (Kaplan or Kocher). EXPOSURE 2 Open the joint and gain access to the radial head. Pronate the forearm and limit distal dissection to protect the posterior interosseous branch of the radial nerve. NOTE: The posterior interosseous branch of the radial nerve is located 4cm distal to the radiocapitellar joint. CAUTION: Limit periosteal stripping to reduce the incidence of avascular necrosis.
4 3 INITIAL FRACTURE REDUCTION Reduce the fracture. 4 ASSESS PLATE FIT With the forearm in neutral rotation, maintain radial head reduction and place the plate in the center of the safe zone to assess fit.
5 SAFE ZONE 5 The nonarticulating portion is the safe zone for the application of implants to the radial head. It consistently encompasses a 90 degree angle localized by palpation of the radial styloid and Lister s tubercle or approximately perpendicular to the plane of the metacarpals. ASSESS PLATE FIT 6 Proximal Rim 5mm The proximal end of the plate should be 4-5mm distal to the articular margin (proximal rim) of the radial head.
6 7 PLATE CONTOURING Contour the plate as needed using the PROTEAN Bending Pliers. Proper contouring should allow the plate to sit flush on the bone. CAUTION: Excessive contouring may weaken or cause the plate to break. PRT-BND-PLR PROTEAN Bending Pliers 8 PLATE ALIGNMENT To ensure proper axial alignment of the plate, align the laser etched mark on the head of the plate parallel to the proximal rim of the radial head.
7 DISTAL PLATE FIXATION 9 Using the Drill Guide, drill through the center of the gliding hole using the 2.0mm drill bit. NOTE: Laser etching on the drill can be used to estimate screw length. DRLL-SSC Drill, 2.0mm x 40mm TPDG-SSD-20 Tissue Protector/Drill Guide, Single Sided, 2.0mm SECURE PLATE TO DISTAL FRAGMENT 10 Using the depth gauge, measure hole depth and then insert the appropriate length 2.7mm non-locking screw to secure the plate to the distal fragment. The Depth Gauge has a dual scale to reflect measurements either through the pre-loaded drill guides (top scale) or without pre-loaded drill guides (bottom scale). NOTE: The orientation of the hook on the depth gauge probe corresponds to the flat portion on the depth gauge handle. DPGA-UNV-030 Depth Gauge, Universal, 30mm TPNL-27XXX-TS Threaded Peg, Non-Locking, 2.7mm x XXmm
8 11 LOADING K-WIRE AIMING GUIDES Using the Driver and Handle, insert an AIMing Guide into the most proximal preloaded drill guide (PDG) on the plate. Insert a second AIMing Guide at the most appropriate location to maintain proper reduction. HNDL-SQC-FXD Handle, Small QC, Fixed PDG-AIM-015 AIMing Guides, 1.5mm DRVR-AOS-S20 Driver, Peg, Torque Limiting 12 PROVISIONAL FIXATION Secure the proximal fragment(s) to the plate using two 1.5mm K-Wires through the AIMing Guide. Additional K-wires may be used to secure remaining fragments. KWIR-STD K-Wire, 1.5mm x 127mm
9 REDUCTION CONFIRMATION 13 Confirm reduction and proper K-wire placement 2mm distal to the subchondral plate using fluoroscopy. If additional bending is necessary, use the PROTEAN Bending Pliers for in situ contouring. Repeat previous step for provisional fixation. PILOT HOLE PREPARATION 14 Using the 2.0mm Drill, drill through the available PDGs and measure hole depth. CAUTION: Be careful not to drill into the proximal radio ulnar joint (PRUJ).
10 15 PROXIMAL FRAGMENT FIXATION Remove the pre-loaded drill guide using the peg driver. Insert the appropriate length screw. Repeat for the remaining proximal holes not containing K-Wires. NOTE: Locking and non-locking screws may be used. TPNL-27XXX-TS Threaded Peg, Non-Locking, 2.7mm x XXmm TPFL-23XXX-TS Threaded Peg, Fluted, Locking, 2.3mm x XXmm 16 FINAL PROXIMAL FRAGMENT FIXATION Remove the K-wire and AIMing Guide from the most proximal hole. Drill and measure hole depth. Remove the pre-loaded drill guide and insert an appropriate length 2.3 mm locking screw. Remove the remaining K-Wires and AIMing Guides. Drill and measure hole depths. Remove the preloaded drill guides and insert appropriate length 2.3 mm locking screws.
11 FINAL DISTAL FRAGMENT FIXATION 17 Using a Drill Guide, drill through the distal shaft holes and approximate hole depth using the measurement marks on the drill. Hole depth can also be measured using the Depth Gauge. DRILL GUIDE OPTIONS: TPDG-THD-DG20 Thread-in Drill Guide, 2.0mm TPDG-SSD-20 Tissue Protector/Drill Guide, Single-Sided, 2.0mm INSERT SCREW & CONFIRM PLACEMENT 18 Insert the appropriate length screw (locking or nonlocking) Note: Additional screws can be used adjacent to the plate if necessary for additional fragment reduction.
12 19 FINAL RADIOGRAPHS Confirm proper reduction, screw length and placement using fluoroscopy. CAUTION: Confirm no screws violate the proximal radial-ulnar joint space by pronating and supinating the forearm to ensure there is no crepitus. CAUTION: Confirm that all screws have been fully tightened prior to wound closure. Close the wound in your normal fashion. NOTES
13 Radial Head Plate System (Catalog # PRT-SYS) INSTRUMENT TRAY (Standard Configuration) Loc # Catalog # Description 1 PRT-RHP- LT PROTEAN Radial Head Plate, Left 2 PRT-RHP- RT PROTEAN Radial Head Plate, Right 3 KWIR-STD K-Wire, 1.5mm x 127mm 4 DRLL-SSC Drill, Solid Side Cutting, 2.0mm x 40mm 5 DRVR-AOS-S20 Driver, Peg, Torque Limiting 6 TPNL TS Threaded Peg, Non-Locking, 2.7mm x 10mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 12mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 14mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 16mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 18mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 20mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 22mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 24mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 26mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 28mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 30mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 32mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 36mm, Ti TPNL TS Threaded Peg, Non-Locking, 2.7mm x 40mm, Ti 7 TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 10mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 12mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 14mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 16mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 18mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 20mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 22mm, Ti
14 Loc # Catalog # Description TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 20mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 22mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 24mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 26mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 28mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 30mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 32mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 36mm, Ti TPFL TS Threaded Peg, Fluted, Locking, 2.3mm x 40mm, Ti 8 WBTN-2750-T Washer, Button, Inside Ø2.7mm, Outside Ø5.0mm, Ti 9 PDG-AIM-015 AIMing Guides, 1.5mm 10 TPDG-THD-DG20 Thread-in Drill Guide, 2.0mm 11 DPGA-UNV-030 Depth Gauge, Universal, 30mm 12 HNDL-SQC-FXD Handle, Small QC, Fixed 13 PRT-BND-PLR PROTEAN Bending Pliers 14 TPDG-SSD-20 Tissue Protector / Drill Guide, Single Sided, 2.0mm 15 FRCP-BHM-RTC Forceps, Bone Holding Medium, Ratcheting Miscellaneous 16 PRT-MOD PROTEAN Module NOTES
15 RADIAL HEAD PLATE QUICK REFERENCE CHART PROTEAN Radial Head Plate, Left PROTEAN Radial Head Plate, Right AIMing Guide, 1.5mm 1.5mm x 127mm K-Wire PROTEAN Bending Pliers Drill, Solid Side Cutting, 2.0mm x 40mm Driver, Peg, Torque Limiting
16 RADIAL HEAD PLATE QUICK REFERENCE CHART (Cont) Depth Gauge, Universal, 30mm Threaded Peg, Fluted Locking, 2.3mm x xxmm, Ti Threaded Peg, Non-Locking, 2.7mm x xxmm, Ti Tissue Protector/Drill Guide, Single Sided, 2.0mm Forceps, Bone Holding Medium, Ratcheting
17 NOTES
18 NOTES
19 NOTES
20 PROTEAN radial head plate REDUCT TM headless compression screw MKT RAB MKT RAD May 2015 October SW 87th Avenue, Miami, Florida Tele: SW 87th Avenue, Miami, Florida Tele: Skeletal Dynamics, LLC 2015 Skeletal Dynamics, LLC Designed and Manufactured in the USA Designed and Manufactured in the USA Emergo Europe, Molenstraat 15, 2513 BH The Hague, The Netherlands
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