THE FIRST YEARS. News News New Trauma Products from AO Development. News Number

Transcription

1 THE FIRST 50 YEARS News 1 08 News 1 08 New Trum Products from AO Development News Numer News Numer

2 TABLE OF CONTENTS EDITORIAL 1 AO S PEDIATRIC EXPERT GROUP 2 NEW HAND PRODUCTS 5 LCP Volr Column Distl Rdius Plte 2.4 LCP Met-Diphysel Volr Distl Rdius Plte Technicl Know-how in Imge Processing LCP Rottion Correction Plte 2.0 NEW FOOT PRODUCTS 12 Locking Cuoid Plte 2.4 Locking Tlus Plte 2.4 Locking Nviculr Plte 2.4 Expert Hindfoot Arthrodesis Nil (HAN) Modulr Mini Frgment LCP 2.0, 2.4, 2.7 NEW LOWER EXTREMITY PRODUCTS 17 PFNA Asin Size Jpnese Proximl Femorl Nil (Antirottion) Study SureLock R/AFN Arm for Proximl Aiming Device R/AFN Guiding nd Clirtion Unit Dynmic Hip Screw (DHS) Blde Tretment of Unstle Femorl Neck Frctures LCP DHS with Collr Remer Irrigtor Aspirtor (RIA) Remer Hed Locking Clip Irrigtion-Aspirtion Tue LCP Brod Curved 4.5/5.0, holes Cnnulted 4.0 mm Hex Cerclge Cle Buttons COMPUTER ASSISTED SURGERY (CAS) 34 Surgicl Trum Module Axis Reduction nd Alignment Module Posterior Pelvic Ring Fixtion Module NEW VETERINARY PRODUCTS 36 LCP Brod Plte 3.5 Tii Plteu Leveling Osteotomy Plte (TPLO) Biomechnicl Consequences of the TPLO Procedure Smll Frgment Plte Set Mini Frgment Implnt nd Instrument Set NEWS FROM AO PUBLISHING 41 Osteotomies for Posttrumtic Deformities NEW SPINE PRODUCTS 42 ArcoFix Synex II Optionl ugmentle screws NEW CRANIOMAXILLOFACIAL (CMF) PRODUCTS 44 Mndile Externl Fixtor II EXPERTS SYMPOSIA 46 PORTRAIT OF PROF RAMI MOSHEIFF 48 TK PRIZES TK Innovtion Prize 2007 TK Certificte of Merit 2007 NEW UPPER EXTREMITY PRODUCTS 29 PHILOS Sizing Templtes NEW KNEE PRODUCTS 30 TomoFix Medil Distl Femur (MDF) NEW PELVIC PRODUCTS 32 Pelvic Spring Plte for Reduction Cnnulted Percutneous Guiding System Spiked Disks Round nd Rectngulr DUE TO VARYING COUNTRIES LEGAL AND REGULATORY APPROVAL REQUIREMENTS PLEASE CONSULT THE APPROPRIATE LOCAL PRODUCT LABELING FOR APPROVED INTENDED USE OF THE PRODUCTS DECSRIBED IN THIS BROCHURE. ALL DEVICES IN THIS BROSCHURE ARE AOTK APPROVED. FOR LOGISTICAL REASONS, THESE DEVICES MAY NOT BE AVAILABLE IN ALL COUNTRIES WORLDWIDE AT THE DATE OF PUBLICATION.

3 EDITORIAL 1 Der reder This TK News issue will focus on new trum techniques nd informtion round these, plus few selected items from spine nd CMF surgery. In the led rticle of this issue, Jmes Hunter nd Theddy Slongo from the Peditric Expert Group (PAEG) will give you comprehensive overview of the ltest developments for trum nd orthopedic surgery in dolescents. The revivl of elstic niling not only in children hs een driven y the innovtions of the PAEG. Three yers go, the AO Foundtion strted collortion with BrinLAB. In lte 2007, the Technicl Commission pproved the first nvigtion modules for surgicl trum, xis reduction nd lignment, nd posterior pelvic ring fixtion. These modules were developed y the AO s Computer Assisted Surgery Expert Group (CSEG) under the ledership of Prof Christin Krettek from Hnover. With the hindfoot rthrodesis nil, the Expert nil fmily is now complete. In the future, the AO will work on optimizing these products to provide more vriety, such s very smll versions, or nils dpted to regionl ntomicl needs, such s the PFNA Asin size. Furthermore, the instrumenttion nd iming devices such s SureLock will e improved. In the distl rdius, the LCP volr column distl rdius pltes 2.4 set provides the most complete system ville, ddressing ll distl rdius frcture types in single set. In foot surgery, the locking cuoid, tlus nd nviculr pltes complete the locking foot module which will e relunched in the ner future s new set. The column Portrit fetures Rmi Mosheiff from Isrel who hs done tremendous mount of reserch nd development s well s teching on intrmedullry niling. I would like to encourge you to follow his exmple nd to shre your tlents with us. You cn pproch the AO nytime if you hve n ide for the improvement of ptient tretment s he did. Once gin, I would like to stress tht none of the product descriptions in this puliction re sustitute for the AO s OP techniques or the AO teching tools. You cn otin more detiled informtion on these products from the AO or your locl distriuter. If you hve ny comments or questions on the rticles or the new products, plese don t hesitte to contct me. Yours fithfully, Norert P Hs

4 2 AO S PEDIATRIC EXPERT GROUP Jmes Hunter, Theddy Slongo AO S PEDIATRIC EXPERT GROUP Fig 1 CAPOS chisel in use. The Peditric Expert Group (PAEG) ws first convened in Decemer Prior to tht, AO s involvement in peditric frcture cre nd orthopedics hd een firly miniml. Fixtion of peditric frctures hd d reputtion. Implnts for children were few nd fr etween, nd mny were out of dte nd hd not een suject to ny development process. Within AO quite lot of work hd een done within children s documenttion, ut few senior figures in the orgnistion hd continued with significnt children s prctice. The min drivers for the formtion of the PAEG were firstly, tht children s orthopedic nd frcture surgery ws out to develop in response to modern helth cre requirements nd secondly, tht new ides, prticulrly in frcture surgery, were lredy eing promulgted nd required investigtion. Elstic niling of long one frctures hd een descried in the French literture from the 1980 s onwrds nd hd een ccepted through much of centrl Europe y the mid 1990 s. However, despite pulictions in mjor Anglophone journls, there hd een little cceptnce of this technique in either the UK or the US. Fig 1 Fluoroscopic view of CAPOS chisel. Osteotomy of the Proximl Femur Although the AO hd designed osteotomy implnts for the stndrd procedures required in children s orthopedics, they were not fvored y the mjority of peditric orthopedic surgeons. The resons were vried some of the implnts were too ig, they were quite demnding to insert, nd some disliked the concept of hitting chisel towrds the femorl hed of child or infnt. Solutions were forthcoming. The first product produced ws the Toddler osteotomy plte which hd lrge lde ttched to DC plte 3.5. This ws idel for children with cererl plsy (CP), who tend to hve well developed proximl femur with rther grcile shfts. This remins n implnt with very high usge. Next we ddressed the prolem of the implnts eing demnding to use. Our originl pln hd een to crete ngled lde pltes tht could e inserted over guide wire; prolems of strength nd engineering prevented this, ut system for inserting the chisel over guide wire ws developed the cnnulted peditric osteotomy system (CAPOS). With this technique guide wire could e inserted into the idel position, imged, the chisel inserted over the wire nd then the chisel removed nd replced with the pproprite lde plte (Fig 1 ). This ws considerle improvement ut some surgeons were disppointed tht the implnt could not e plced over the guide wire. Ultimtely, the idel osteotomy implnt should e introduced into the proximl femur without hmmering. Hving completed the CAPOS project, essentilly wy of inserting existing implnts, the PAEG immeditely strted work on new genertion of osteotomy implnts to e sed on locking compression pltes (LCP). The result ws the LCP peditric hip plte system (PHP) tht ws completed in This series hs 4 neck shft

5 AO S PEDIATRIC EXPERT GROUP 3 Fig 2 LCP peditric hip plte (PHP) insertion ngled guide wire. ngles (soon to e five) nd replictes the techniques nd clcultions of lde plting without requiring chisel. Surgeons of different genertion less fmilir with clculting osteotomy ngles from the shft cn esily work off the line of the femorl neck (s if they were doing DHS). The ngles currently ville re 100, 110, 120, 150 (130 plte is plnned). The technique is simple; slim guide wire is inserted in the high center position of the femorl neck, followed y two more sustntil guide wires elow it. The osteotomy is performed. The plte is rought to the femur with locked drill guides mintining the ngle. (Fig 2 2) The two min guide wires re sequentilly replced with locking hed screws whilst the two other fixes re mintined. After the plte hs een ttched to the proximl femur the shft is fixed using either cortex or locking hed screws s the sitution demnds. Finlly, screw is put into the proximl frgment tht engges the clcr, enhncing stility to level greter thn the lde plte. The incresed stility ppers to reduce periopertive pin whilst heling occurs relily (Fig 2c). The design of the plte mkes it lower profile resulting in retrievl eing down to ptient choice rther thn mndted y prominence. Erly results hve een most encourging nd the system is ecoming very populr prticulrly mongst surgeons with CP prctice, s in these ptients one cn e very osteoporotic, good indiction for locking compression pltes. A smller version for hip dysplsi surgery in infnts is plnned. Fig 2 Sliding PHP over guide wires. Slipped Upper (Cpitl) Femorl Epiphysis (SUFE) This condition is seen frequently y trum surgeons s well s peditric orthopedic surgeons. Conventionl tretment is to stilize in situ using cnnulted screw, nd the 7.3 mm screw hs proven useful due to its stiff 2.8 mm guide wire. The difficulties of removing these nd other screws hve een circumvented y leving them in. Newer concepts of SUFE hve ffected the developments. The Bern school hs suggested tht much osteorthritis is cused y impingement of metphysel one on the cetulr mrgin, nd the condition tht cuses this pr excellence is SUFE. They suggest tht pinning in situ my only e the est tretment for the mildest forms of SUFE, nd tht moderte slips my require metphysel ump resection, nd more severe cses open replcement of the epiphysis. Both these ltter re typiclly done through hip disloction pproch, nd fixtion with threded K-wires is their stndrd. This is ll reltively controversil even within the PAEG, ut we hve greed tht n implnt tht is esy to retrieve is prerequisite to flexile pproch. Such n implnt is in the lte stges of design. Fig 2c Heled vrus osteotomy with PHP. Femorl Shft Frctures Femorl shft frctures re controversil for numer of resons. Firstly they consume disproportionte mount of resource, oth for helth cre providers nd prents. As result the trditionl tretment, trction, is infrequently used except for the smllest infnts. Secondly children nd dolescents re getting much hevier (it is now not unusul to see 100 kg children in the clinic). Elstic niling of the

6 4 AO S PEDIATRIC EXPERT GROUP femur the stndrd tretment of shft frctures etween ges of 5 or 6 nd lte dolescence my not e roust enough for hevier children nd dolescents, or those with unstle frcture ptterns (Fig 3). Fig 3 Instle femorl shft frcture in 12-yer-old oy; weight 65 kg. The first solution offered y the PAEG is the end cps for elstic nils. These re inserted over the top of the nils fter insertion nd cutting of the nils (Fig 3). They prevent cking out of the nils in frctures tht re unstle either due to configurtion or ptient weight. Biomechnicl studies performed in the AO Center show tht these increse the push-out force six times over tht of conventionlly inserted nils, nd the group hs collected clinicl experience to demonstrte efficcy (Fig 3c). The end cps lso protect the soft tissues from the cut nil ends, nd improve retrievl ecuse the cp fcilittes nil loction nd cretes spce round the nil ends for the extrction pliers. Only one smll extr instrument, the driver for the cps, is required. The second solution is the dolescent femorl nil (Fig. 4). Conventionl ntegrde niling of the femur in this ge group is concern ecuse of the possiility of vsculr necrosis of the femorl hed. This is rre ut devstting. It is thought tht it cn e voided using lterl trochnteric strt point. The dolescent femorl nil voids the lood supply to the proximl femur y fr lterl strting point nd doule curved configurtion. Initil experience in the US hs een very fvourle. Current res of study for the group include fixtion round the growth plte, stilistion of osteogenesis imperfect nd osteotomy of the distl femur. Fig 3 Insertion of end cp over nil. Fig 3c Frcture stilised y TEN nd end cps. Cse provided y Jmes Hunter, Nottinghm, GB Fig 4 Adolescent femorl nil.

7 NEW HAND PRODUCTS 5 Jesse Jupiter, Mrtin Lnger NEW HAND PRODUCTS LCP Volr Column Distl Rdius Plte 2.4 The LCP volr column distl rdius plte (VCP) 2.4 is indicted for fixtion of complex intr- nd extrrticulr frctures, nd especilly for highly comminuted frctures, s well s corrective osteotomies of the distl rdius. The implnt design is sed upon concept y Rikli nd Regzzoni, who identified the structurl columns of the distl rdius nd the need to not only reduce the rticulr components ut lso provide support for oth the rdil nd ulnr sides eqully. The LCP VCP is ntomiclly contoured for the distl rdius nd hs low profile, which implies less overll implnt ulk, minimizing softtissue irrittion. It provides multiple screw options in the hed of the plte (8- nd 9-hole hed configurtions) to etter support the rticulr surfce nd to ddress frcture frgments individully. A 3-screw cluster ddresses the rdil styloid. Four screws support the ulnr column. The plte shft is ville in 3-, 4-, nd 5-hole versions nd ccepts 2.4/2.7 mm cortex or 2.4 mm locking hed screws. The LCP VCP provides the option to use mini drill guides nd stndrd threded drill guides to confirm screw trjectory options. The LCP VCP 2.4 comes in left nd right versions. All pltes re ville in stinless steel nd titnium. Overll, the system consists of 40 different pltes, mking it the most complete set for distl rdius frctures ville. 28-yer-old womn. Fig 1 X-rys preopertive.

8 6 NEW HAND PRODUCTS c d Fig 2 f Step-y-step opertive procedure. e f Fig 3 X-rys postopertive. c d Fig 4 d Full motion recovery. Cse provided y Jesse Jupiter, Boston

9 NEW HAND PRODUCTS 7 LCP Met-Diphysel Volr Distl Rdius Plte The LCP met-diphysel volr distl rdius pltes hve een designed s longer distl rdius pltes, to tret frctures with proximl extension into the diphysel regions of the rdius. The met-diphysel volr distl rdius plte is effectively plte comining the hed of the LCP volr distl rdius plte with similr shft to the LCP 3.5. But the met-diphysel volr distl rdius plte cn e plced more proximl thn the LCP volr distl rdius plte, nd it is significntly stronger. 34-yer-old mle, with open frcture fter motor vehicle ccident. The met-diphysel volr distl rdius plte is precontoured to mtch the volr surfce of the distl rdius. It fetures 25 ngultion equivlent to the norml ntomy of the distl rdius. The plte hed offers 4 threded round holes which ccept 2.4 mm locking hed screws. The pltes re ville with 5, 7, 9, 11, 13, or 15 holes in the shft, rnging from mm. A precontoured rdil ow is included in the shft of the pltes fter 95 mm to mtch the ntomic curve of the rdil shft. Relief cuts re included fter every other hole, eginning fter the 7th hole (fter 95 mm) to ese dditionl contouring needed to mtch the ptient s specific rdil ow. The pltes re ville in left nd right configurtions nd in stinless steel or CP titnium. Fig 1 Preopertive x-rys; primry stiliztion with externl fixtor. Fig 2 Eight months postopertive; full forerm rottion nd 75% grip strength nd wrist motion. Cse provided y Jesse Jupiter, Boston Fig 3 Full motion recovery.

10 8 NEW HAND PRODUCTS PRODUCT RELATED NEWS FROM THE AO DEVELOPMENT INSTITUTE (ADI) Hnsrudi Noser, Dve Little, Ldislv Ngy, Thoms Kup NEWS PRODUCT RELATED FROM NEWS FROM AO THE AO DEVELOPMENT INSTITUTE INSTITUTE (ADI) (ADI) Technicl Know-how in Imge Processing We support your Clinicl Development nd Puliction with our Technicl We support Know-how your Clinicl Imge Development Processing nd Puliction Fig 1 The plcement of homologous lndmrks on the rdius surfce through the holes of mnully ligned templte of met-diphysel volr distl rdius plte prototype. Aout us The Humn Morphology Service Center (HMSC) of the of the AO Development AO Development Institute Institute (ADI) (ADI) mintins mintins dtse dtse of CT scns of CT-scns of cdveric of cdveric humn humn specimens specimens used in used other in projects other projects in the AO in the institutes. AO institutes. Additionlly, Additionlly, dtse the dtse includes virtul includes one virtul models one of models the entire of the skeleton entire which skeleton re the which derived re from derived the CT from scns. the CT This scns. dtse This is dtse registered registered t the relevnt t the Eidgenössischer regultory uthorities Dtenschutz- in Switzerlnd. und A Öffentlichkeitseuftrgter mjor tsk of the HMSC is in to Switzerlnd. offer support in A implnt mjor tsk design of the nd HMSC optimiztion is to offer to the support AO Network in implnt nd design externl nd prtners, optimiztion sed on to its the dtse, AO Network know-how, nd externl nd resources. prtners, sed on its dtse, know-how, nd resources. Services Services Since its foundtion in 2002 the HMSC hs cquired more thn Since thousnd its foundtion one dt in sets, 2002 know-how the HMSC in hs medicl cquired imge more computing, thn thousnd sttisticl one shpe dt sets, nlysis know-how of 3-D one in medicl models. imge Moreover, computing, it hs excellent nd st- nd tisticl softwre shpe resources nlysis (Amir, of 3-D Geomgic, one models. Unigrphics, Moreover, Mtl) it hs to excellent ccomplish its support resources tsk. (Amir, The service Geomgic, offerings Unigrphics, include CT Mtl) scns of to cdveric ccom- softwre plish ones, its imge support processing, tsk. The segmenttion, service offerings reverse include engineering, CT scns of sttisticl cdveric shpe ones, nlysis, imge principl processing, components segmenttion, nlysis reverse (PCA), rpid engineering, prototyping sttisticl nd CMF shpe relted nlysis, imge computing. principl components nlysis (PCA), rpid prototyping nd CMF relted imge computing. Exmple Exmple An exmple of our services is the response to request from the An AO exmple Hnd Expert of our Group services (HAEG) is the which response ws to interested request in from the the shpe AO Hnd vriility Expert of Group the distl (HAEG) rdius which nd ws shft, interested with respect in the to shpe the vriilitdiphysel of the volr distl distl rdius rdius nd shft, plte. with Together respect to with the met-diphysel medicl nd met- volr technicl distl mentor, rdius plte. smple Together of 15 rdii with from medicl the dtse nd technicl ws selected mentor, nd evluted. smple of To 15 identify rdii from the the region dtse of interest ws selected (ROI) nd on the evluted. virtul To specimens, identify the we ligned region of virtul interest templte (ROI) on of the plte virtul prototype specimens, on the we ligned rdii, nd virtul plced lndmrks templte of on plte the one prototype surfces on through the rdii, the nd first plced eight lndmrks distl plte on holes the s one illustrted surfces in through Fig 1. These the first lndmrks 8 distl plte were holes used s to illustrted lign the ones in Fig to 1. ech These other lndmrks y generlized were used to Procrustes lign the fit, ones which to ech minimises other the y sum generlized of the distnces Procrustes etween fit, which homologous minimises lndmrks. the sum of the Then, distnces the ligned etween surfces homologous were lndmrks. scn-converted Then, nd the ligned superposed, surfces resulting were in scn-converted 3-D imge in which nd superposed, the grey vlues resulting of the in voxels 3-D represent imge in which the numer the grey of one vlues model of the intersections voxels represent s illustrted the numer in Fig of one 2. This model 3-D intersections imge crries s sttisticl illustrted informtion Fig 2. for This the 3-D complete imge smple. crries It sttisticl enles informtion us to extrct for the the medin complete surfce smple. nd It to enles visulize us to locl extrct devitions the medin from surfce the medin nd one. to visulize locl devitions from the medin one. Fig 3 shows three surfces of the ligned nd superposed volumes of the rdii:

11 NEW HAND PRODUCTS PRODUCT RELATED NEWS FROM THE AO DEVELOPMENT INSTITUTE (ADI) 9 Fig 2 The different cuts through the superposed superposed rdii give rdii insight give insight into the into shpe the vriility shpe vriility with respect with to the respect region to of the interest region (the of interest plte). The (the red plte). color The represents red color the represents segmenttion the medin used segmenttion for medin surfce used for medin medin genertion. surfce genertion. 1. envelope of ll rdii 2. Fig medin 3 shows intersection three surfces of the ligned nd superposed volumes of 3. the common rdii: intersection The 1. envelope medin ROI of ll is rdii intended to e templte for potentil pre-shped pltes. 2. medin It cn intersection e oserved tht the shpe vriility is very smll round the 3. common lndmrks intersection used for ligning the ones nd tht the vriility increses The medin with region growing of interest distnce (ROI) from is intended them. By to crefully e templte choosing for only potentil the ROI preshped relevnt pltes. for the It implnt, cn e oserved the ligning tht nd the shpe verging vriility of the one is very surfce smll round results the in optiml lndmrks templtes used for for ligning preshped the ones implnts. nd tht The implnt the vriility hs to increses fit well with only to growing the ROI. distnce Vritions from them. outside By crefully of no interest choosing for only the the plte ROI design. relevnt Such for the investigtions implnt, the cn ligning result nd in verging sis for decision-mking of the one surfce to results engineers optiml of implnt templtes mnufcturers. for preshped implnts. The implnt hs to fit well only to the ROI. Vritions outside re of no Interested interest for in the collortion? plte design. Such investigtions cn result in sis for The decision-mking HMSC would to e engineers gld to support of implnt you mnufcturers. in solving your clinicl prolems nd open questions relted to one vriility. With us s prtner you Interested get rid of in time-consuming collortion? segmenttion nd dt mngement nd you The HMSC cn focus would on your e gld core to usiness. support you We in re solving looking your forwrd clinicl to prolems discussing nd your open study questions ide. relted to one vriility. With us s prtner you get rid of time-consuming segmenttion nd dt mngement nd you cn focus on your core usiness. We re looking forwrd to discussing Contct. your study ide. PD Dr. Hnsrudi Noser Project Group Leder AO Contct. Development Institute Clvdelerstrsse PD Dr. Hnsrudi Noser 8 CH-7270 Project Group DvosLeder hnsrudi.noser@ofoundtion.org AO Development Institute +41 Clvdelerstrsse CH-7270 Dvos hnsrudi.noser@ofoundtion.org Fig 3 Fig The 3surfces of the envelope, the medin, The nd surfces the common of the intersection envelope, the surfces medin, nd (from the left common to right) intersection of the ligned surfces nd (from superposed left to volumes right) of of the the ligned rdii of nd the superposed smple. volumes of the rdii of the smple.

12 10 NEW HAND PRODUCTS LCP Rottion Correction Plte 2.0 Frctures of the metcrpls nd proximl phlnges which hel in mlposition cn led to severe impirment of hnd function. In prticulr, rottionl mislignments re prolemtic ecuse of crossing nd scissoring digits whenever full flexion of the fingers to fist is ttempted. Optiml recovery of hnd function includes the meticulous restortion of lignment, length nd rottion of digits nd metcrpls. A creful pproch needs to e chosen in order not to further compromise the soft-tissue sitution which gin requires proper reconstruction. The fixtion hs to e stle enough to fcilitte immedite ctive nd pssive finger exercises. The LCP rottion correction plte 2.0 enles intropertive correction of mlrottion, djustment to the one nd restortion of correct lignment, prevents scissoring of the digits, nd is esily dptle to condylr-ner frctures. 30-yer-old mle, work ccident with uzz-sw. The LCP rottion correction plte 2.0 is ntomiclly precontoured, hs low plte-nd screw profile, rounded edges nd polished surfces which minimize irrittion of soft tissue nd ligments. The plte fetures 2.5 mm slotted hole in the medil lterl direction. This olong hole, positioned trnsverslly to the shft s xis, enles intropertive verifiction of the result of the reduction nd, where required, intropertive correction of the rottionl xis of the one. The optiml posture of the digit cn e set through loosening nd tightening of the cortex screw in the trnsverse hole. The plte is ville in shft lengths of 34 mm (3 comintion holes) or 40 mm (4 holes) which llows frgment-specific tretment of metcrpl frctures nd frctures of the proximl phlnges. Both versions re 1.3 mm thick, nd ville in stinless steel nd CP titnium, s well s sterile nd nonsterile. c d Fig 1 d Preservtion of the short se of the proximl phlnx for the extremly importnt flexion of the metcrpophlngel (MP) joint.

13 NEW HAND PRODUCTS 11 c d e f Fig 2 f Primry tretment of the index fingers phlngel frcture using the compct hnd set 1.5. Afterwrds ngulr stle fixtion t the very smll MP-joint frgment of the middle fingers proximl phlnx, nd precise djustment of rottion with LCP rottion correction plte 2.0. c Fig 3 c Full motion recovery 4 months postopertive. Cse provided y Mrtin Lnger, Münster, DE

14 12 NEW FOOT PRODUCTS Andrew Snds, Les Grujic, Per-Henrik Agren, Jun Gerstner, In Winson, Michel Cstro NEW FOOT PRODUCTS The LCP foot pltes (cuoid, tlus nd nviculr) re intended for use in selective frctures, osteotomies, reconstructive procedures nd revisions of the foot. The pltes hve locking hole for mny sizes of locking hed nd nonlocking hed screws. They re designed for optiml fit in ech ntomic re. Connecting ris etween the plte holes enle esy ending nd contouring of the pltes. The pltes re of oss nd ri design, in which the wekest cross section is cross the connecting ris. When the plte is contoured, it deforms cross the connecting ris nd not cross the osses. This ssures tht the threded locking holes mintin their ility to lock to the screws distorting the internlly-threded holes. The pltes re ville in 316L stinless steel. Locking Cuoid Plte 2.4 The locking cuoid plte hs the sme shpe s the current nonlocking cuoid plte, ut now includes locking holes. The plte is ville in right or left versions. c Fig 1 c Preopertive x-rys. c Fig 2 c Postopertive x-rys. Cse provided y Andrew K Snds, New York, US

15 NEW FOOT PRODUCTS 13 Locking Tlus Plte 2.4 The locking tlus plte 2.4 is 6-hole plte tht cn ccept 2.4 mm locking or 2.7 mm locking hed screws. The plte cn e contoured to fit on either the medil or lterl side of the tlus. If necessry, one or more locking holes cn e cut off to ssure proper fit the tlus. c Fig 1 Preopertive. Fig 2 c Postopertive. Locking Nviculr Plte 2.4 The locking nviculr plte is designed for dorsl ppliction ut cn e used medilly s well. It hs multiple points of fixtion on the min row, which sits proximlly nd the rms, which sit distlly. The plte cn e contoured s needed to fit the nviculr, nd to mke sure the screws do not penetrte the hemisphericl underlying tlonviculr joint. 41-yer-old mle with motor vehicle ccident. Fig 1 Preopertive x-rys. Fig 2 Postopertive x-rys. Cse provided y Thoms Trquinio, Jckson, US

16 14 NEW FOOT PRODUCTS Expert Hindfoot Arthrodesis Nil (HAN) The Expert hindfoot rthrodesis nil (HAN) is indicted to fcilitte tiiotloclcnel rthrodesis to tret severe foot/nkle deformity, rthritis, instility, nd skeletl defects; these include, ut re not limited to neuro-osteorthropthy (Chrcot foot), vsculr necrosis of the tlus, filed joint replcement or filed nkle fusion, distl tiil frcture nonunions, nd osteorthritis, rheumtoid rthritis nd pseudorthrosis, nd tumor resection nd reconstruction. The cnnulted hindfoot rthrodesis nil hs lterl end of 12 which llows n entry point in the center of the lterl column of the clcneus. The nil enles proper hindfoot lignment nd restores 3 5 hindfoot vlgus positioning. The nil design, rotting insertion hndle nd the iming rm enle trgeted medil-to-lterl or lterl-to-medil proximl locking. Distl locking options re with spirl lde in the clcneus for more stility in osteopenic one, with 6.0 mm Strdrive locking hed screw from the clcneus into the cuoid, or with 5.0 mm Strdrive locking hed screw from the tlus into the nviculr or further distl in the medil column. An end cp for screws nd for spirl ldes is ville. As prt of the Expert nil fmily, the HAN uses most of the instrumenttion of the humerl, femorl nd tiil nils, except for n extended length 5.0 mm clirted drill for extr long 6.0 mm locking hed screws. The nils re ville in 10, 12 nd 13 mm dimeters, in 150, 180, nd 240 mm lengths, right nd left designs. 42-yer-old, femle with severe insulin-dependent dietes mellitus (IDDM); Chrcot foot, wheel chir since 1 yer. c Fig 1 c Preopertive x-rys.

17 NEW FOOT PRODUCTS 15 c Fig 2 c Preopertive soft-tissue condition. c Fig 3 c Imge intensifier check postopertive. c Fig 4 c Follow-up 3 months fter surgery; Ptient cn wlk for out 15 minutes, nd stnd on the foot without pin. Cse provided y Hermnn Bil, Berlin, DE

18 16 NEW HAND AND FOOT PRODUCT Modulr Mini Frgment LCP 2.0, 2.4, 2.7 The modulr mini frgment LCP system (in some countries it is clled the LCP compct hnd system) is intended for fixtion of frctures, osteotomies, nonunions, replnttions, nd fusions of smll ones nd smll frgments, prticulrly in osteopenic one. The modulr mini frgment LCP system includes 2.0 mm, 2.4 mm, nd 2.7 mm modules. Severl pltes were dded to the existing set to provide more vriety nd to keep the plte lengths nd numer of holes consistent for ll the different modules. These re the LCP 2.7 with 10, nd 8 holes, nd the LCP 2.7 dption plte with 12 holes. Both versions re ville in stinless steel or CP titnium. Furthermore, 40 mm length, 2.0 mm cortex screw, self-tpping with Strdrive recess (in stinless steel nd CP titnium) hs een dded to the set. Femle, 10 yers, fter one tumor (Ewing's srcom) resection nd llogrft implnttion, fistul to necrotic llogrft. c Fig 1 c Preopertive x-rys. c Hnd without ny function. c Fig 4 c Postopertive. Cse provided y Mrtin Lnger, Münster, DE Fig 2 Resection of necrotic rdius, temporry ExFix nd pllcos spcer. Fig 5 Outcome fter 2.5 months. Fig 3 Microvsculr osteocutneous free fiul flp for reconstruction of rdius nd dorsl skin. Proximl osteosynthesis with two screws nd rthrodesis of wrist wrist with LCP 2.7.

19 NEW LOWER EXTREMITY PRODUCTS 17 Tkeshi Swguchi, Kodi Kojim, Michel Bluth, Michel Suk, Christoph Sommer, Michel Schütz, Toru Sto, Philip Kregor NEW LOWER EXTREMITY PRODUCTS PFNA Asin Size The design of the PFNA ws developed sed on the ntomy of the Cucsin popultion. For the verge Asin ptient, the fit of these implnts is not optiml. Therefore, cdver studies using CT scns were performed to dpt the design of the PFNA to the ntomy of the Jpnese nd other Asin popultion. shorter thinner ngle smller thinner The PFNA Asin size hs etter fit to the smller trochnteric re nd nrrower intrmedullry cnl of the Asin popultion. It fetures lterl flt surfce which mkes insertion esier nd lowers the pressure on the lterl cortex. The end hs een reduced to 5 versus 6 compred to the PFNA. The proximl dimeter hs een reduced to 16.5 mm (versus 17.0 mm). Furthermore, the spirl lde dimeter hs een reduced to 10.3 mm. The PFNA Asin size comes in four different distl dimeters from 9 12 mm, ech in three lengths (170, 200, nd 240 mm*). The long PFNA Asin size (300 nd 340 mm) is ville in two distl dimeters of 9 nd 10 mm. Additionl lengths of mm in 20 mm steps re plnned. The lde is ville in lengths of mm in steps of 5 mm. The nil is mde out of titnium luminium nioium (TAN) nd sterile pckged. In ddition, some selected instruments hve lso een specificlly designed for the smller stture of the popultion nd to the needs of the Asin surgeons. The PFNA Asin size is indicted for pertrochnteric frctures (Müller AO Clssifiction 31-A1 nd 31-A2), intertrochnteric frctures (31-A3), nd high sutrochnteric frctures (32-A1). The long version is indicted for low nd extended sutrochnteric frctures, ipsilterl trochnteric frctures, comintion frctures in the proximl femur, nd pthologicl frctures. * The 240 mm nil comes in two different distl dimeters 9 nd 10 mm only.

20 18 NEW LOWER EXTREMITY PRODUCTS 90-yer-old mle, injured y fll down. Fig 1 Preopertive x-rys. Fig 2 X-rys 2 weeks fter surgery; ptient could stnd nd wlk with one cne. Fig 3 X-rys 6 months postopertive. Cse provided y Toru Sto, Okym, JP 77-yer-old mle. Fig 1 Preopertive x-rys. c Fig 2 c Postopertive x-rys. c Fig 3 c X-rys 3 months postopertive. Cse provided y Tkeshi Swguchi, Toym, JP

21 NEW LOWER EXTREMITY PRODUCTS yer-old femle. Fig 1 Preopertive x-rys. Fig 2 c Postopertive x-rys. c Fig 3 c X-rys 3 months postopertive. c Cse provided y Tkeshi Swguchi, Toym, JP

22 20 NEW LOWER EXTREMITY PRODUCTS PRODUCT RELATED NEWS FROM AO CLINICAL INVESTIGATION AND DOCUMENTATION (AOCID) Sine Goldhhn PRODUCT RELATED NEWS FROM AO CLINICAL INVESTIGATION AND DOCUMENTATION (AOCID) Jpnese Proximl Femorl Nil (Antirottion) Study The AO s First Completely Bilingul Study Fig 1 AO Clinicl Investigtion (AOCID) hs, in coopertion with Jpnese collegues, initited the first multicenter study in orthopedic trum in Jpn. The proximl femorl nil ntirottion Asi (PFNA study) will occupy Jpnese reserchers t 29 hospitls over the next 2 yers. The first ptients were lredy included. When the study is completed, more thn 300 cses of ptients over 65 yers with proximl femorl frctures (more specificlly isolted, unstle, closed trochnteric frctures) will hve een exmined. Among Jpnese ptients ged 65 yers nd older with proximl femorl frctures, the proportion of those ged 90 yers nd older hs incresed over the lst decdes from 3% in 1983 to nerly 20% in One reson for this is the incresing numer of ptients with osteoporosis in the older popultion. Compred to other ethnic groups, Asin people hve the lowest one mss. Study ckground The ide for the study cme from the Asin Trum Working Group (ASWG) ecuse Asin people hve different geometric proportions of the femorl one compred to Europen or Americn popultions. For exmple, studies hve shown tht Asin women hve shorter femorl necks, smller femorl neck ngles, nd more nterior owing of the shft thn white Americns. The new PFNA Asi hs specilly dpted sizes nd geometry to etter suit the locl popultion. It osts flt lterl side, higher ending point of the nil resulting in strighter tip point, smller medil-lterl ending of 5, nd dpted surgicl instruments. Jpnese doctors were the driving force ehind the development of the PFNA Asi nd re pivotl to this study. In ddition to the principl clinicl investigtor, Dr Tkeshi Swguchi, Drs Tdshi Tnk, Ysuhiro Nnri, nd Atsushi Skuri re lso centrl to the study s success. Although originl PFNA hve een in clinicl use since 2005 in Jpn, no dt on the rte of mismtch re ville yet. Therefore, one of the study s gols is to determine whether potentil mismtch exists etween the new PFNA Asi nd Jpnese ptients, nd whether oth Jpnese ptients nd surgeons needs will e met.

23 NEW LOWER EXTREMITY PRODUCTS PRODUCT RELATED NEWS FROM AO CLINICAL INVESTIGATION AND DOCUMENTATION (AOCID) 21 Ojectives of the study The primry ojective of this prospective multicenter cse series is to ssess ny frcture fixtion compliction nd revision rtes during the clinicl use of the proximl femorl nil ntirottion Asi (PFNA Asi) for the tretment of unstle, closed trochnteric frctures, clssified ccording to the Müller AO Clssifiction type 31-A2 or 31-A3. Frcture fixtion complictions include ny one/frcture- or implnt/surgeryrelted event. Fig 2 In ddition to the ssessment of potentil mismtches of femorl medullry cvity nd the PFNA Asi t the femorl gret trochnter (lterl to lde insertion point), the middle medil portion nd distl end of the nil re investigted: soft tissue, wound or generl complictions, prognostic fctors for the occurrence of complictions (eg, one minerl density, dementi), length of hospitl sty, wlking ility, cpcity to return to pre-injury sttus, qulity of life, mortlity, ntomicl restortion (cliniclly nd rdiogrphiclly), length of surgery (skin to skin time) nd opertive hndling of the implnt nd the instrumenttion. The follow-up schedule pplying to this study includes initil hospitliztion, s well s follow-up visits t 6 weeks, 12 weeks, 6 months nd 12 months (these re the defined time intervls). The finl evlution of x-rys nd complictions will e performed y study review ord t the end of the study. Fig 3 First completely ilingul study Every document in the study is written in oth Jpnese nd English. For exmple, every question on ech cse report form is sked in Jpnese nd English. The im of this is to ese the filling out of the cse report forms for Jpnese collegues. Additionlly, for the first time, the OpVerdi dtse hs een completely creted in oth lnguges. This nturlly creted lot of work for the AO s tem of computer specilists due to the different chrcters used in oth lnguges. The key to success for the plnning phse of this study ws the close collortion etween the principle clinicl investigtor (PCI) in Jpn nd the responsile AOCID study mnger, despite distnce of more thn 10,000 kilometres etween them.

24 22 NEW LOWER EXTREMITY PRODUCTS SureLock The current stndrd technique for distl locking of intrmedullry nils is the freehnd technique. This requires n experienced surgeon in order to hit the hole correctly. Even if the procedure is performed quickly, the surgeon is exposed to rdition. During the nil insertion there is lmost no deformtion of the nil in torsion nd vrus-vlgus, ut smll deformtion cn occur in the AP plne. SureLock llows simple, fst nd precise distl locking despite this deformtion, without mking hole in the nterior cortex, in long proximl femorl nils s the PFN, PFNA, nd TFN nd decreses surgeon s exposure to rdition. The OR technique hs three min steps fter the SureLock hs een ssemled nd clirted to the respective nil. First, the C-rm is rotted until it is in the exct sme plne s the nil-iming-rm construct. This is chieved y rotting the C-rm until the dotted line on the lterl side of the iming rm is overlying the medin line on the medil side of the iming rm. This cn e done either y eye or with exct clcultion of the degrees using the scles on the iming rm. Secondly, the iming rm is tilted until it is lined up with the nil. This cn gin e done either y eye or y clculting the millimeters the iming rm needs to e moved. Finlly, drilling through the sleeve ssemly nd insertion of the screws. The technique is esy to lern, simple to use, nd so precise tht even unexperienced surgeons cn hit the distl hole on first ttempt. Furthermore, SureLock enles more working spce for the surgeon since the C-rm does not need to e positioned perpendiculr to nil (drilling not in xis with C-rm).

25 NEW LOWER EXTREMITY PRODUCTS 23 R/AFN Arm for Proximl Aiming Device The retrogrde/ntegrde femorl nil (R/AFN) is cnnulted intrmedullry niling system for the tretment of distl femur nd/ or diphysel frctures of the femur in which retrogrde pproch is indicted. The R/AFN lso enles fixtion of frctures of the femorl shft with n ntegrde pproch through the piriformis foss. A proximl iming device (PAD) enles surgeons to lock the nil distlly nd proximlly completely without fluorescent x-ry. After determintion of the nil length the surgeon must clirte the proximl iming device to the proposed nil. The proximl guide prt leds to the correct loction nd orienttion of the locking holes of the nil. For drilling nd screw plcement, the proximl guide is used in the sme wy s norml iming rm. Compred to the free-hnd technique, the PAD offers simple nd effective solution for proximl locking of short nils. For the short R/AFN ( mm), new proximl iming rm enles distl nd proximl locking. It consists of long iming rm which is mounted onto the R/AFN insertion hndle. The rm fetures drill holes for the proximl interlocking. It lso ccepts two inserts for distl interlocking, one for distl stndrd locking nd one for distl spirl lde locking. An iming sleeve 12.0/8.0 mm with crosshirs, length 188 mm is used to check if the nil locking holes re still in line with the iming rm holes. R/AFN Guiding nd Clirtion Unit The clirtion unit nd the guiding unit llow for proximl interlocking with short R/AFN ( mm length) using the proximl iming device (PAD). Compred to the distl femur nil (DFN) the distnce etween the clirtion pins is smller since the R/AFN proximl interlocking holes re closer together. The guiding unit is mounted onto the rm of the PAD nd used in comintion with the clirtion unit for proximl locking of the short R/AFN.

26 24 NEW LOWER EXTREMITY PRODUCTS Dynmic Hip Screw (DHS) Blde The dynmic hip screw (DHS) lde is indicted for pertrochnteric frctures of type 31-A1 nd 31-A2, intertrochnteric frctures of type 31-A3 (in comintion with the trochnteric stilizing plte), nd femorl neck frctures 31-B ccording to the Müller AO Clssifiction. It is especilly pproprite for use in elderly people with osteopenic/ porotic one. The DHS lde replces the DHS screw. Due to the shpe of the lde nd the locking mechnism there is etter rottionl stility of the femorl hed neck frgment which reduces the risk of cut-out, delyed union nd vrus ngultion in unstle trochnteric frctures. The lde llows for compction of the one which leds to etter nchorge of the implnt in the femorl hed, especilly eneficil in osteoporotic one. In cdver model performed t the AO Reserch Institute (ARI), the superior performnce of the DHS lde regrding cut-out resistnce compred to the DHS screw could e shown (see seprte rticle). The surgicl technique of the DHS lde is very similr to the existing DHS. The only difference is tht the DHS lde is hmmered into position compred to the screw which is turned into position. The rottionl locking of the DHS lde tkes plce fter the lignment of the DHS plte onto the femorl shft to enle rigid construct. The locking tkes plce with specil screwdriver nd 1.5 Nm torque-limiting ttchment. No dditionl ntirottionl screw crnil to the DHS lde is necessry (contrry to the originl DHS screw). Müller AO Clssifiction type 31-A2 frcture in n 83 yer-old femle with severe osteoporosis. The DHS lde is fully comptile with the existing DHS pltes. It is ville from mm in increments of 5 mm in oth stinless steel nd titnium. It is only ville sterile. Cse provided y Christoph Sommer, Chur, CH Fig 1 Preopertive x-rys. Fig 2 X-rys postopertive. Fig 3 X-rys fter 6 months; no clinicl prolems.

27 NEW LOWER EXTREMITY PRODUCTS PRODUCT RELATED NEWS FROM THE AO RESEARCH INSTITUTE (ARI) 25 Krsten Schwieger, Mrkus Windolf PRODUCT RELATED NEWS FROM THE AO RESEARCH INSTITUTE (ARI) Tretment of Unstle Femorl Neck Frctures Is the DHS Blde Superior Alterntive to the Dynmic Hip Screw? Ojective The dynmic hip screw (DHS) is well estlished implnt for tretment of trochnteric nd femorl neck frctures. However, cut-out of the screw s postopertive compliction occurs in 1 6% of ll clinicl cses. The DHS lde hs een developed s n lterntive to the screw to reduce the cut-out rte. This in vitro study compres the DHS lde to the stndrd DHS with regrd to cut-out resistnce of the implnt in n unstle femorl neck frcture model. Fig 1 Unstle femorl neck frcture model with posterior nd medil one wedges removed. Mterils/methods Ten pirs of humn cdveric femor were used. Left nd right ones of every femorl pir were rndomly instrumented with either DHS lde or DHS using 4-hole side pltes. Tip-pex distnce ws stndrdized to 10 mm. After implnttion n unstle type 31-B2 frcture ccording to the Müller AO Clssifiction (Fig 1) ws creted using custom-mde sw guide. Cyclic loding ws performed to the femorl hed pplying lod trjectories s mesured in vivo in totl hip replcement (THR) ptients (Bergmnn et l., 2001). The pssive function of the iliotiil nd ws simulted y cle. Strting t 1500 N the pek lod ws incresed y 500 N every 5000 cycles until cut-out or complete filure of the construct. X-rys were tken t 5000 cycle intervls. A survivl nlysis ws performed sed on the numers of cycles until cut-out, defined s the first visile implnt migrtion s determined from x-rys. Fig 2 Survivl proility of the DHS (red) nd DHS lde (green). Fig 3 Cncellous one structure efore (left) nd fter insertion of the DHS lde (right). Results With the pplied loding regime totl of 100% cut-outs occurred in the DHS group compred to 50% in the DHS lde group. The survivl proility in terms of cut-out resistnce ws significntly higher for the DHS lde (Fig 2) (P =.023). Conclusion Bsed on the dt ville, we conclude tht the DHS lde performs superior compred to the DHS in terms of cut-out resistnce under cyclic loding. This might e due to cncellous one compction round the helicl lde during implnt insertion (Fig 3), which should e investigted in further studies. This in vitro study supports the usge of the DHS lde in order to reduce the cut-out rte in tretment of un stle femorl neck frctures.

28 26 NEW LOWER EXTREMITY PRODUCTS LCP DHS with Collr The LCP DHS with collr is used to tret femorl neck, inter- nd pertrochnteric frctures. The LCP DHS with collr is modifiction of the existing DHS. The collr llows for moderte lterl uttress nd ccommodtes the hed of the ntirottionl screw. Additionl fetures re the LCP holes nd ullet nose t the distl end. The ngle of the collr is 15 nd hs een specificlly designed to mtch the Asin ntomy. The LCP DHS with collr is comptile with the trochnter stiliztion plte nd the locking trochnter stiliztion plte. The surgicl technique of the LCP DHS with collr is the sme s tht of the DHS. The only difference is tht the ntirottionl screw must e inserted through the collr. However, the chnges in geometry of the LCP DHS with collr (collr, LCP hole, undercuts, ullet nose t the distl end of the plte) offer the surgeon the possiility to chieve ngulr stility of the fixtion nd to choose less invsive pproch. Undercuts help to improve the periostel lood supply. The cliniclly well estlished geometry of the rrel (sliding mechnism) hs not een chnged. The sttic test revels slightly higher stiffness for the new LCP DHS with collr plte/screws system compred to the stndrd DHS plte/ screw system. With ll performed dynmic tests the plte is the criticl component of the DHS system nd ist the first to fil. The LCP DHS with collr is currently ville in titnium luminium nioium (TAN) only. The system will strt with sizes 135 (3 5 holes) nd 140 (3 5 holes). Additionl sizes will e dded lter. 80-yer-old femle. Fig 1 d Preopertive x-rys. c X-ry 4 weeks postertive. d Postopertive x-ry. c d Cse provided y Tkefumi Kuroki, Fukuok, JP

29 NEW LOWER EXTREMITY PRODUCTS 27 Remer Irrigtor Aspirtor (RIA) Introduction The RIA is indicted for the tretment of cute frctures of the femur in preprtion for cceptnce of n intrmedullry implnt or prosthesis nd for hrvesting intrmedullry remings for one grfting. The RIA provides irrigtion nd spirtion during reming, which llows for single-pss reming nd hs een shown to reduce intrmedullry pressure. Norml sline irrigtion flows through the drive shft nd remer hed into the medullry cnl. When coupled with dequte suction, the irrigtion mixes with the morselized medullry contents which is then evcuted through the spirtion tue. Remer Hed Locking Clip RIA lso hrvests finely morselized utogenous one nd one mrrow for ny surgicl procedure which requires one grft to fcilitte fusion nd/or fill one defects. These procedures include spinl fusion, joint rthrodesis, totl joint replcement, frcture repir, nonunion, mxillofcil reconstruction, pthology smpling nd tumor removl. Remer Hed Expnding the rnge of options for intrmedullry sizing, the RIA system remer heds re now ville in dditionl dimeters of 11.0, 17.5, 18.0, 18.5, nd 19.0 mm. This will offer n overll rnge from mm in 0.5 mm increments. They re sterile pckged nd intended for single-ptient use. Drive Shft with Locking Clip Locking Clip A locking clip to prevent the RIA tue ssemly from detching from the RIA drive shft during reming hs een dded. The locking clip is ttched to the RIA system fter the drive shft hs een connected to the tue ssemly nd is designed to clip nd remin in plce during reming. The locking clip is sterile pcked nd intended s disposle, single-ptient use item. Irrigtion-Aspirtion Tue Specilly sized irrigtion-spirtion tuing hs een designed to further fcilitte dequte spirtion. A smll plstic clip cn e used to close off the irrigtion until reming egins. Irrigtion-Aspirtion Tue The tues come together in one sterile pckge ut cn esily e seprted from ech other so tht they cn e ttched to the two loctions in the operting room.

30 28 NEW LOWER EXTREMITY PRODUCTS LCP Brod Curved 4.5/5.0, holes For diphysel frctures in tll ptients with n extended comminuted frcture zone the existing line of LCP rod curved pltes 4.5/5.0 from holes re too short. There is lso need for longer pltes due to n incresing numer of periprosthetic frctures. The LCP system with its possiility of ngulr stility ids in tretment of such frctures. The LCP 4.5/5.0 fetures rdius of 1500 mm ccording to the nte curvture of the femorl shft (similr to LISS/LCP DF nd UFN). A ullet nose enles miniml invsive surgery nd undercuts preserve the lood supply. The existing line of LCP rod curved 4.5/5.0 from holes ws extended up to 26 holes (479 mm length). The pltes re ville in stinless steel nd CP titnium. Cnnulted 4.0 mm Hex Cerclge Cle Buttons The cnnulted 4.0 mm hex cerclge uttons re prt of the orthopedic cle system. Cles plced through such uttons cn e used for temporry reduction of spirl frctures nd for dditionl fixtion when screws re not possile, prticulrly in tretment of periprosthetic frctures. Cle uttons help to position the cle over screws nd prevent slippge. Currently, cle uttons exist for noncnnulted screws. The new cnnulted cle uttons fit the recess of 5.0 mm, 6.5 mm nd 7.3 mm cnnulted screws. The cerclge uttons re ville in titnium nd stinless steel.

31 NEW UPPER EXTREMITY PRODUCTS 29 Norert Südkmp NEW UPPER EXTREMITY PRODUCTS PHILOS Sizing Templtes The PHILOS sizing templtes re simple solution for the intropertive selection of implnt size. They re designed for surgeons working with sterile pckged implnts where visul comprison of the implnt to the frcture pttern is impossile without opening the pckge nd to ensure mximum precision in determining the correct implnt size. The templtes re ville in three lengths, equivlent to PHILOS 3-holes, 5-holes, nd long. The outer contours reflect the shpe nd size of the implnts. They cn e wshed nd sterilized. Temporry positioning with 1.6 mm K-wire is possile.

32 30 NEW KNEE PRODUCTS Philipp Loenhoffer NEW KNEE PRODUCTS TomoFix Medil Distl Femur (MDF) The gol of distl femur vrus osteotomy is to shift the mechnicl leg xis from the lterl to the medil comprtment. There re vrious possiilities for surgicl correction of vlgus mllignment. The AO Knee Expert Group (KNEG) fvors closing wedge osteotomy of the distl femur for vlgus correction, ecuse open wedge osteotomy on the lterl side cuses significnt moridity due to tensioning of the iliotiil trct, nd friction over the implnt. The KNEG lso found tht distl femur opening wedge osteotomy did not show the sme heling cpcity s on the tii nd tht one grfting ws necessry to void pseudrthrosis. Biomechnicl testing confirmed superior stility of medil closing wedge techniques s compred to lterl open wedge techniques nd fvorle xil nd torsionl loding chrcteristics of n ngulr stle internl fixtor, the TomoFix medil distl femur (MDF). The TomoFix MDF fetures ntomiclly preshped pltes with ending ngle of 20. If needed during the opertion, this ngle cn e further ent y using the ending press. The plte profile is 4 mm. The TomoFix MDF is ville in left nd right version. The hed of the plte offers four isolted LCP holes for 5.0 mm locking hed screws. The screw xes of these four LCP holes re converged y 2. Through this lignment cut-out of the screws cn e prevented nd the distnce to the crucite ligment is improved. The olt ngultion of 15 in the frontl plne enles use of longer screws nd thus more stle fixtion. Bolt plcement is esy nd sfe due to the ntomiclly dpted shpe. The plte shft fetures four stndrd 4.5/5.0 LCP comintion holes which re shifted throughout the longitudinl xis. The end of the plte hs ullet nose for use of MIO technique. Specific guiding locks for the left nd right pltes help to insert the drill socket in the correct xis onto the plte. The plte is inserted distlly under the vstus medil muscle fter screwing the threded LCP drill guides into the four distl plte holes using the guiding lock. The distl drill holes re oriented in 20 ngle inclintion on the frontl plne to void posterior perfortion of locking hed screws in the distl femur. Biomechnicl studies demonstrte tht interfrgmentry compression hs positive effect on one heling. For this reson lg screw is positioned in the dynmic compression unit directly ove the osteotomy for compression of the osteotomy site.

33 NEW KNEE PRODUCTS 31 The Ptient cn e moilised s erly s dy one fter surgery. Prtil weight ering is recommended for 6 weeks, ctive movement of the knee is encourged. X-ry control fter 6 weeks should demonstrte ony heling. Full weight ering cn e llowed in mny cses fter this time period, if the osteotomy site is still pinful nd one heling is incomplete, weight ering should e delyed for further 3 4 weeks. 27-yer-old mle developed severe lterl joint line pin fter lterl menicectomy. Fig 1 Preopertive x-ry. Fig 2 6 correction ws performed to normlize the mechnicl xis. Fig 3 6 weeks postopertive the ptient ws le to fully weight er, nd hd free rnge of motion. Cse provided y Philipp Loenhoffer, Hnnover, DE

34 32 NEW PELVIC PRODUCTS Tim Pohlemnn, Jeff Mst, Keith Myo NEW PELVIC PRODUCTS Pelvic Spring Plte for Reduction The pelvic spring plte for reduction is intended for use s reduction instrument for pelvic nd cetulr reconstructive surgery. It is primrily n intropertive reduction id nd would generlly not e prt of the finl fixtion construct. The plte is 11 mm wide y 3.3 mm thick nd hs four 2 mm length spikes. It hs 30 preend etween the 2nd nd 3rd hole of the plte. At the topside of the end is threded hole to ccept screws with 2.5 mm hex or T15 Strdrive recess. The plte is ville in stinless steel only. The plte cn e ttched to forceps to reduce or keep smll frgments in plce ginst lrger one frgments in the pelvis, when the smll frgments re too smll to use screw. This is chieved y sinking the two front spikes into the smll frgment nd pulling towrds the lrger frgment efore pushing the rer spikes into the lrger frgment to mintin the reduction. Therefore, the frcture cn e reduced in stges. The plte cn lso e used s n implnt y instlling 3.5 mm cortex or pelvic screw in the 1st or 2nd hole, efore removing the forceps nd then the screw with 2.5 mm hex or T15 Strdrive recess. Cnnulted Percutneous Guiding System The cnnulted percutneous guiding system is drill guide nd softtissue protector to ssist in pelvic nd cetulr reconstructive surgery. The cnnultion ccepts drill sleeves nd 3.5 mm pelvic or cortex screws. A 2.5 mm nd 3.5 mm drill sleeve re prt of the system. Locliztion for screw plcement is estlished y guide wire, normlly with fluoroscopic guidnce. The drill guide is then dvnced over the guide wire with the pproprite drill sleeve in plce. Screw length determintion is drill it sed. The guide wire holds position, simplifying screw insertion, nd provides n re of lternte strting points if needed.

35 NEW PELVIC PRODUCTS 33 Spiked Disks Round nd Rectngulr The rectngulr spiked disk (13 30) for 6.5 mm ll nd the round spiked disk (20 mm) for 6.5 mm ll re intended to ssist in pelvic nd cetulr reconstructive surgery. They re used in conjunction with the reduction forceps. They re identicl to existing round nd rectngulr disks in the low profile pelvic system, ut with spikes dded on the one contct surfce. This will limit slippge s force is pplied oliquely to the disc on corticl surfce such s the qudrilterl surfce.

36 34 COMPUTER ASSISTED SUGERY (CAS) Christin Krettek COMPUTER ASSISTED SURGERY (CAS) Nvigtion Surgicl Trum Module The Surgicl Trum Module for computer-ssisted surgery (CAS) is softwre solution for wide rnge of surgicl trum interventions on computer pltform. CAS mens simultneous nvigtion in multiple 2-D imges cquired y C-rm t the sme time. Thus fluoroscopic nvigtion enhnces the cpility nd disply options of ny regulr fluoroscope without extr rdition. Once cquired, fluoroscopic imges re stored y the Surgicl Trum Module. The relevnt informtion on these imges (eg, position nd orienttion of instruments such s drills or osteotomes) is constntly updted throughout the entire procedure. This process is clled virtul fluoroscopy nd is sed on rel-time trcking of the frctured ones with ttched reference rrys. At the sme time, the Surgicl Trum Module lso precisely displys the position of surgicl instruments reltive to the treted ones, such s drill guide or osteotome. By providing simultneous informtion on multiple fluoro imges CAS improves visuliztion nd minimizes rdition exposure. An intuitive workflow concept guides the surgeon through the CAS procedure whilst compring rel-time informtion of the ntomy nd surgicl instruments to previously creted pln. Another useful function of CAS with the Surgicl Trum Module is the digitl ruler, which cn e pplied for vriety of mesurements, eg, clcultion of the length nd dimeter of n intrmedullry nil, length of screw, femorl neck ntetorsion or simply the lignment of tool in reltion to plnned trjectory. From simple to complex cses the Surgicl Trum Module offers guidnce nd intropertive verifiction of the otined result. This instnt feedck lso mkes this module n effective teching nd trining tool. Since ll steps cn e sved together with dditionl informtion, such s the time needed to complete surgicl tsk, the system is lso n idel qulity tool to document intropertive results.

37 COMPUTER ASSISTED SUGERY (CAS) 35 Axis Reduction nd Alignment Module The Axis Reduction nd Alignment Module supports femorl frcture reduction procedures, nil insertion, one lignment such s torsion (rottion), leg length control, nd implnt positioning. It is pplicle to ll extrrticulr frcture types from 32-A to 32-C ccording to the Müller AO Clssifiction. The module provides relile quntittive informtion to restore the prefrcture sitution with respect to shft xis lignment, rottion, nd leg length, s well s the possiility to restore symmetry to the contrlterl side, if it is uninjured. The plcement of interlocking screws is lso supported without n dditionl C-rm, thus limiting rdition. Designed for the intrmedullry fixtion of femorl shft frctures, this module cn e used for ny kind of reduction of shft or metphysel frctures, unrelted to the fixtion device. Intrrticulr frcture reduction is not supported y the module. Posterior Pelvic Ring Fixtion Module The Posterior Pelvic Ring Fixtion Module guides surgeons through the complex ntomy of the pelvis during screw fixtion of the posterior pelvic ring. An esy-to-use interfce enles intuitive plnning nd insertion of scroillic screws, sed on multiple intropertively otined C-rm imges. The disply simultneously shows the surgicl instruments in ll relevnt views (inlet, outlet, AP nd lterl), nd the surgeon is sfely guided to the desired trget position. This virtul fluoroscopy lso sustntilly reduces rdition time, nd is prticulrly useful for C-type frctures, ccording to the Müller AO Clssifiction.

38 36 NEW VETERINARY PRODUCTS Kenneth A Johnson, Alessndro Pirs, Brin Bele, Rndy J Boudrieu NEW VETERINARY PRODUCTS LCP Brod Plte 3.5 The LCP rod plte 3.5 is indicted for long one frctures in lrge reed dogs. This plte utilizes the stndrd humn LCP with limited contct design, except for few minor chnges. It fetures centrl, stcked comintion hole t one end, which fcilittes tretment of metphysel frctures. The LCP rod plte 3.5 system contins 14 pltes with lengths from 7 22 holes. The holes re stggered. It uses compression screws, 3.5 mm locking hed, 3.5 mm cortex, nd 4.0 mm cncellous one screws offering much greter verstility thn conventionl pltes. The implnt mteril is 316L stinless steel. The pltes will e housed in the smll frgment plte set grphic cse. No dditionl instruments or screws re needed. 5-yer-old mle English Mstiff, rod trffic ccident. Fig 1 Comminuted frcture of the left uln. Fig 2 Reconstruction of rticulr component with screws plced in lg fshion. Shft stilized with ridging plte fixtion using locking hed nd stndrd cortex screws. Cse provided y Michel P Kowleski, North Grfton, MA, US

39 NEW VETERINARY PRODUCTS 37 Tii Plteu Leveling Osteotomy Plte (TPLO) Crnil crucite ligment (CrCL) injuries re one of the most common cnine orthopedic prolems. These injuries frequently re treted using tiil plteu leveling osteotomy (TPLO). The AO Veterinry TPLO system is indicted for osteotomies of the cnine proximl tii. It comines six new pltes with sic instrumenttion set. The 6 pltes re precontoured to mtch the ntomic configurtion of the proximomedil tii with limited contct design. The pltes re ville in left nd right configurtions nd feture locking screw technology. The pltes hve three different sizes; 2.7, 3.5, nd 3.5 rod ccording to the screw dimeter. Until recently, only the TPLO plte 3.5 hd een relesed, ut now ll three plte types re ville. The pltes nd screws re ville in 316L stinless steel. The TPLO pltes utilize either locking hed or compression screws; 2.7 mm nd 3.5 mm locking hed nd 2.7 mm nd 3.5 mm cortex, nd 4.0 mm cncellous one screws. Three-yer-old neutered femle Tos, 60 kg, chronic (6 months) lmeness, pinful stifle. Fig 1 X-rys preopertive. Fig 2 Postopertive x-rys. Fig 3 10-week follow-up shows heled osteotomy. Cse provided y Rndy Boudrieu, North Grfton, US

40 38 NEW VETERINARY PRODUCTS PRODUCT RELATED NEWS FROM AO RESEARCH INSTITUTE (ARI) Mrkus Windolf 1, Kenneth A Johnson 2, Krsten Schwieger 1 PRODUCT RELATED NEWS FROM THE AO RESEARCH INSTITUTE (ARI) Biomechnicl Consequences of the TPLO PROCEDURE Ojective Tii plteu leveling osteotomy (TPLO) is surgicl procedure developed for the tretment of crnil crucite ligment deficient stifles in dogs. TPLO is proposed to decrese crnil tiil thrust y controlled rottion of the tiil plteu. Currently, conventionl nd ngulr stle plte fixtion cn e performed to stilize the cylindricl osteo tomy. This study investigted the iomechnicl consequences of the procedure including the effect of using either conventionl or locking hed screws in the tiil plteu frgment. Mterils/methods Eight pirs of cdveric dog tiie were instrumented with titnium reference pins in order to trck the tiil plteu frgment orienttion y mens of CT imging. Position of the tiil plteu ws determined for the intct one, fter rottion of the frgment, nd fter plte ppliction (Fig 1). Bones were pirwise instrumented y n experienced surgeon with TPLO pltes using either conventionl or locking hed screws in the tiil plteu frgment. All specimens were iomechniclly tested in physiologicl orienttion using cyclic xil compression t 1000 N for cycles. Stiffness t the eginning of the test nd plstic deformtion of the construct t the end of the test were determined in terms of displcement of the mchine ctutor. Results The conventionl screw group reveled significnt lrger trnsltion of the frgment towrds the plte (P =.006) nd greter vrince in frgment rottion s result of plte ppliction (Fig 2). However, mximum devitions of the chieved tiil plteu orienttion from the preopertively plnned orienttion were up to 5 for oth groups. The mount of this rottion correlted significntly with the plstic deformtion of the construct fter testing in the conventionl screw group (R = 0.81, P =.005). Neither plstic deformtion nor construct stiffness were significntly different etween conventionl nd ngulr stle plte fixtion. c Fig 1 c Determintion of tiil plteu orienttion for the intct one (), fter osteotomy nd provisionl fixtion () nd fter plte fixtion (c).

41 NEW VETERINARY PRODUCTS PRODUCT RELATED NEWS FROM AO RESEARCH INSTITUTE (ARI) 39 Conclusion This study demonstrted less vrition of the tiil plteu position due to instrumenttion with n ngulr stle TPLO plte. However, the fixtion type did not ffect the iomechnicl stility of the construct. Within the conventionl group higher iomechnicl stility cn e chieved due to lower degree of rottion which leds to lrger ony contct etween the frgments. Fig 2 Trnsltion nd rottion of the tiil plteu frgment etween provisionl fixtion () nd plte fixtion () for oth groups. Vlues re given s men ± stndrd devition reltive to the coordinte system depicted in Fig 1. 1) AO Reserch Institute, Clvdelerstrsse 8, 7270 Dvos, Switzerlnd 2) The Ohio Stte University, Deprtment of Veterinry Clinicl Sciences, 601 Vernon, Thrp Street, Columus Ohio, US

42 40 NEW VETERINARY PRODUCTS Smll Frgment Plte Set The implnts in the smll frgment plte set re indicted for long one frctures in smll reed dogs nd cts. The smll frgment instrument nd implnt system (2.7, 3.5, 4.0) ws recently introduced. These systems re now ville in single grphic cse which houses the smll frgment DCP set, the smll frgment LC-DCP set, nd the smll frgment LCP set. Mini Frgment Implnt nd Instrument Set The implnts in the mini frgment system re indicted for long one frctures in toy reed dogs nd cts. The mini frgment implnt nd instrument system comines existing 1.5, 2.0, nd 2.4 implnts (DCP, LC-DCP, nd LCP) into n orgnized set. The implnts re mde of 316L stinless steel. The set is designed s compct, orgnized storge system in order to fit into the smller sized utoclves commonly used in veterinry clinics.

43 NEWS FROM AO PUBLISHING 41 Cristin Lusti NEWS FROM AO PUBLISHING Relese in June 2008 Numer of pges: 700 Numer of figures nd illustrtions: 1800 For more informtion nd to order plese visit Tle of contents Principles prt Foreword Introduction 1.1 Posttrumtic deformities 1.2 Generl considertions on indictions, types of osteotomy, nd fixtion methods 1.3 Dignostics nd plnning of deformity correction: formtion of surgicl pln Mnul prt 2.1 Clvicle: introduction nd cse collection 2.2 Humerus, proximl: introduction nd cse collection 2.3 Humerus, distl: introduction nd cse collection 2.4 Elow joint: introduction nd cse collection 2.5 Rdius nd uln, proximl nd shft: introduction nd cse collection 2.6 Rdius nd uln, distl: introduction nd cse collection 2.7 Pelvis: introduction nd cse collection 2.8 Hip joint: introduction nd cse collection 2.9 Femur, proximl: introduction nd cse collection 2.10 Femur, shft: introduction nd cse collection 2.11 Femur, distl: introduction nd cse collection 2.12 Knee joint: introduction nd cse collection 2.13 Tii, proximl: introduction nd cse collection 2.14 Tii, shft: introduction nd cse collection 2.15 Tii, distl: introduction nd cse collection 2.16 Ankle: introduction nd cse collection 2.17 Midfoot nd hindfoot Glossry Osteotomies for Posttrumtic Deformities René K Mrti, Ronld J vn Heerwrden An interntionl group of renowned surgeons present n outstnding hnds-on pproch to perform correction osteotomies in posttrumtic deformities from the clvicle to the foot. Most of the content is sed on cse presenttions nd ech cse provides step-y-step descriptions of cse history, plnning, surgicl pproch, osteotomy, fixtion, rehilittion, nd finlly pitflls nd perls. Hundreds of full-color pictures, precise illustrtions, nd x-rys demonstrte the significnt steps in deformity corrections. Long-term follow-ups demonstrte the efficcy of osteotomies in the tretment of mlunions. In the principles preceding the cse presenttions relevnt theoreticl informtion on posttrumtic deformities nd osteotomies, indictions, opertive techniques, nd fixtion methods, s well s the formtion of surgicl pln is provided. This ook should convince cretive orthopedic nd trum surgeons to consider joint-preserving techniques in the tretment of posttrumtic deformities nd rthritis.

44 42 NEW SPINE PRODUCTS Frnk Kndzior, Roert McGuire NEW SPINE PRODUCTS ArcoFix nd Synex II: the AOSpine Anterior Frcture Solution AOSpine type A frctures of the thorcolumr spine ccount for 66% of ll spine injuries. They often cuse n initil or, if left untreted, susequent kyphotic deformity. Especilly the type A2 nd A3 frctures commonly require fusion. Furthermore, these frctures re symptom of osteoporosis. A very ccurte reconstruction nd strong mechnicl support is crucil for good outcome. With the ArcoFix/Synex II comintion, the AOSpine TK developed stright forwrd instrumenttion for the miniml invsive nterior stilistion of thorcolumr tumors nd frctures. The development of this comined system ws sed on the following requirements: Implnt nd instrument must llow mximum intropertive verstility with regrd to the relignment of the spine (kyphosis correction). Ese of use with short lerning curve. A less invsive procedure. Comptiility with previously developed technology. Respecting the AO philosophy for frcture tretment. ArcoFix ArcoFix siclly consists of three prts. The telescopic prt llows for distrction nd compression nd the two swivelheds tht enle kyphosis or lordosis correction. Thnks to these unique fetures, the system llows the surgeon to first insert, position nd fix the implnt (verterl ody screws) nd then perform the kyphosis correction nd height restortion efore everything is finlly tightened (golden screws) nd secured.

45 NEW SPINE PRODUCTS 43 Synex II After the frcture is reduced nd stilized, the Synex II expndle cge is introduced with the ngled Synex II spreder tip. Once Synex II is in plce it is expnded until the implnt nd the verterl endpltes re in full contct. Synex II is modulr system. Eight different centrl odies cn e comined with 15 different types of endpltes. This helps to rech n idel cross-sectionl lod distriution nd thus to provide very good mechnicl support of the previously chieved correction. The centrl ody of Synex II ws slimmed down compred to the Synex I. This leves more spce to e filled with more one thus promoting fusion. AOSpine TK pprovl: The pprovl of the AOSpine TK for Synex II ws chieved lst My. The pprovl for ArcoFix is in progress nd is expected fter the extensive clinicl tril phse which is lredy underwy, nd is expected to e finished soon. Optionl ugmentle screws For the mny cses of wek or questionle one qulity the system lso offers ugmentle verterl ody screws. These screws re cnulted with dditionl cross-holes. This feture llows cement distriution round the front hlf of the screw. This results in n re ugmenttion providing higher lod resistnce which then leds to significnt reduction of screw cut-outs. Injecting the cement with the optiml viscosity, low enough to run round the screw ut high enough to not lek out, is solutely crucil. Therefore the AOSpine TK lso developed Vertecem, system which ensures tht the cement lwys hs the idel viscosity t the time of ppliction.

46 44 NEW CRANIOMAXILLOFACIAL (CMF) PRODUCTS Scott P Brtlett, Lim K Cheung, Crl-Peter Cornelius, Dniel Buchinder NEW MANDIBLE PRODUCTS Mndile Externl Fixtor II After the relese of the first mndile externl fixtor in July 2004 the feedck from clinicins, often requesting more technicl ese nd verstility, led to the development of the mndile externl fixtor II. Although the mndile externl fixtor II system comes with mny new fetures, it ddresses the sme clinicl indictions s the originl system: Severe open mndiulr frctures Highly comminuted closed frctures Nonunions nd delyed unions (especilly ssocited with infection) Tumor resections Fcil deformity correction Gunshot wounds Pnfcil frctures Burn mintennce Bone grfting defects A strong impetus from surgeons ws the request for n incresed numer of snp-on clmps in the kit. Thus, insted of the originl eight, the new system contins lrger numer of clmps. The set contins self-drilling ntomic Schnz screws with two thred lengths for ech ntomicl region (symphysis, ody, rmus) nd shoulder stop to prevent overinsertion. The shft length of the screws is dpted to the locl skin thickness nd respects the regionl geometry of the mndile (symphysis, ody, rmus). The Schnz screw shft llows for use with rpid driver systems. The 4.0 mm titnium connecting rods re ville in four sizes (full mndile, full mndile with rmus, three-qurter mndile, nd onehlf mndile). Antomiclly preent to the mndiulr shpe the metl rods cover wide ntomic vriety ut cn e contoured to mtch individul ptient needs with the included rod ender. To ensure optiml stility of the frmework construction the connecting rods should e positioned pproximtely one fingerredth wy from the ptient s skin surfce, evenly round the mndiulr circumference, in order to keep the cntilevers long the Schnz screws short. At lest two Schnz screws should e plced on lrge segments: One in close proximity (10 mm) to the frcture or resection line nd nother one preferly nother 10 mm wy from tht.

47 NEW CRANIOMAXILLOFACIAL (CMF) PRODUCTS 45 To llow the surgeon to uild longer modulr frme, new 120 mm cron fier connecting rod hs een included in the set. Extended cron fier rods with lengths of 140, 160, 180, nd 200 mm re ville on request, ut will not fit inside the try of the grphic cse. Instruments specificlly designed for this system re the rtcheting screwdriver hndle, the rpid driver nd the Schnz screw dpter for tightening of the Schnz screws. The new mndile externl fixtor II cn e djusted throughout the whole operting procedure nd is MR sfe. c d e f g h Fig 1 i Stiliztion of the mndile during primry resection of floor-of-the-mouth crcinom with infiltrtion of the sympysel one. The sequence shows the ppliction strting in the ngles, stepwise ssemly, temporry removl of the connecting r for en loc tumor resection nd remounting. i Cse imges courtesy of Crl-Peter Cornelius, München, DE

48 46 EXPERTS SYMPOSIA Norert Hs EXPERTS SYMPOSIA Experts Symposi re specil kind of AO meeting to exchnge clinicl experience with the ltest implnts nd devices. It ws strted in the yer 2000 shortly fter the introduction of the LCP nd menwhile extended to the new intrmedullry nil fmily. In 2007, three Experts Symposi were held. Most of the time ws spent discussing the cses presented y the prticipting surgeons. The shred cses were either difficult ones or clinicl situtions in which prolems occurred using the new techniques. The more difficult, originl or prolemtic these cses were, the more interesting the discussion turned out to e. The nonymous response system (ARS) ws used so tht presenttions were hlted to sk the udience wht they would hve done next in the given sitution. Typiclly, during the course of the symposi it ecme hrder nd hrder to tell the fculty nd prticipnts prt. The very open nd honest exchnge hs mde these events very specil nd extremely eneficil to improve hndling of the new devices. Furthermore, the conclusions drwn from the discussion hve een turned into recommendtions for AO Eduction for future teching in this re. On July 13 14, 2007, the 2nd Experts Symposium on intrmedullry niling took plce in Innsruck, Austri. A totl of 85 surgeons from 23 different countries prticipted. In the proximl femur, repositioning is, nd will remin, the source of most complictions. The spirl lde offers more rottionl stility. For frctures of the femorl shft, the superiority of lterl entry point compred to the trochnter tip ws shown. It ws lso demonstrted tht curved nils re more forgiving thn stright nils. In cses of extreme osteoporosis nd very distl femorl frctures it ws recommended to void niling nd to use locking compression pltes insted. A study on the new tii nil (TNS) showed 13% nonunion rte fter one yer, result which is demonstrly etter thn tht found in the literture, ut which is still too high. The use of TNS for distl shft nd segment frctures leds to significnt improvement. Proximl tii frctures remin complex re nd therefore should only e tckled y experienced surgeons.

49 EXPERTS SYMPOSIA 47 The first ever Experts Symposium in the Asin Pcific region took plce on August 6, 2007 t the Bumrungrd Hospitl, Bngkok, Thilnd. A totl of 45 surgeons from twelve different countries exchnged their clinicl experiences gined using the LCP fmily. Implnt removl ws intensively deted ecuse it is over proportionlly crried out in Asi t the ehest of the ptient for trditionl resons, nd consequently is n re of Asin expertise. In the cse of the proximl humerus, it is repositioning despite ll the dvnces in implnts which is the cuse of most prolems. It ws recommended to more intensively school course prticipnts in repositioning, eg, in the use of tension nd wiring through the holes mde for this purpose in the hed of the Philos plte. The Experts Symposium held in August in Chicgo ws doule premiere: it ws the first one held in the US nd it delt with LCP nd intrmedullry niling t the sme time. In proximl humerus, it ws perceived tht the existing pltes mke it seem too esy to fix these difficult frctures properly. Inexperienced surgeons often underestimte the complexity. Teching is vitl nd should include imging, s poor rdiology leds to poor outcome. An increse of incidence of very distl humerus frctures with decresing frgment size ws oserved (complex elow frctures). For proximl femur frctures, very strong trend towrds intrmedullry niling ws identified compred to the dynmic hip screw (DHS) due to the fster nd esier procedure, less lood loss nd more fun. The lterl femorl nil new entry point enles esier ccess nd less soft-tissue dmge. In the distl tii, plting hs lower compliction rte thn niling if good reduction cn e chieved percutneously. The nterolterl distl tii plte ws perceived dvntgeous ut most surgeons still use the medil pproch. The 3rd AO Experts Symposium on intrmedullry niling will tke plce in July 11th, nd 12th, 2008 in Minz, Germny. The 2nd Asin one will e held on August 2nd in Tokyo nd del with LCP nd intrmedullry niling which is lso the content of the 2nd meeting in North Americ on Jnury 10th, nd 11th, 2009 in Florid.

50 48 PORTRAIT Thoms Rüedi TRIBUTE TO PROF RAMI MOSHEIFF Rmi Mosheiff ws orn in 1957 in Jeruslem nd spent most of his life in tht exciting city. After high school he served from in the Isrel Defence Forces s prtrooper, prmedic nd instructor, nd hs een in the reserves of the medicl corps since then. He grduted in 1985 from the Herew University Medicl School, Jeruslem with thesis on Stress frctures in highly motivted militry recruits prospective study. This focused him from the eginning of his residency on orthopedic trum t the Orthopedic Surgery Deprtment of the Hdssh University Hospitl in Jeruslem. Exctly 20 yers go, nd during his residency he ttended his first AO Principles Course in 1988 in Dvos. In 1991, he received n AO fellowship t the BG Unfllklinik in Ludwigshfen nd 2 yers lter he spent 6 months s reserch fellow t the ARI in Dvos, studying the distrction osteogenesis in the tretment of severe one defects. Dr Mosheiff spent most of 1994 rod gin s fellow in orthopedic trum surgery with 2 months ech t the Mrylnd Shock Trum Center in Bltimore, Hrorview Hospitl in Settle, Hospitl for Specil Surgery in New York City, nd t the Medicl University in Hnover, Germny. At home t the Hdssh University Hospitl he rpidly climed the creer ldder from instructor to ssocite professor for orthopedic surgery nd in 2005 ecme the hed of the Orthopedic Trum Service t the Hdssh Medicl Center. In tht position he unfortuntely gthered n unequlled experience in the mngement of mss csulties from terror ttcks. He shred this expertise with the AO t the Experts Symposi which rought him into contct with the TK System. He is lso n expert in the nvigtion of intrmedullry niling. Rmi cted s Fculty Memer in mny AO Courses t home nd rod. Tody he is responsile for regionl courses nd lrge interntionl events in Sloveni, Turkey, Greece, s well s in Dvos. In 1993, Rmi joined the AO Alumni nd since 2000 he hs een chirmn of the Isreli AOAA chpter. In 2003 he ws elected to represent his country in the Bord of Trustees of the AO Foundtion. Since 1978 Rmi hs received mny wrds nd prizes for outstnding contriutions nd chievements in the field of orthopedic trum. His profound interest in reserch is reflected y twelve considerle reserch grnts which he hs received for his institution in the pst yers. Proly more importnt thn the impressive list of pulictions, honors nd long list of plmres is the fct tht Rmi is most experienced nd engged clinicin nd surgeon, highly respected collegue nd gret friend with wonderful personlity. In the AO Dr Mosheiff represents the next genertion of young, enthusistic nd fithful memers, who hopeful will e le to crry on the feux scrés of the founding fthers into the future.

51 TK PRIZES Norert P Hs TK PRIZES 2007 TK Innovtion Prize 2007 The TK Innovtion Prize is the highest prize wrded y the TK System. In 2007, the TK Executive Bord decided to wrd the prize to two surgeons from Jpn to honor their contriutions nd to stress the successful regionliztion strtegy of the whole TK System which ws implemented 3 yers go. Tkeshi Swguchi, MD ws honored for his numerous contriutions to developments in the tii, s well s dpttions of existing implnts to the Asin ntomy. He is the medicl director of the deprtment for orthopedic nd joint reconstructive surgery t Toym Municipl Hospitl, Jpn. Toru Sto, MD received the prize for his numerous contriutions to developments in intrmedullry niling nd dpttions of existing implnts to the Asin ntomy. He is the chief of orthopedic surgery t the Okym Medicl Center, Jpn. Furthermore, he is one of the clinicl investigtors of the ongoing PFNA study in Jpn. TK Certificte of Merit 2007 Peter Messmer, MD from Bsel, Switzerlnd ws honored with the TK Certificte of Merit for his outstnding contriutions to the development of the co-xil clmp. Hzrds Gret cre hs een tken to mintin the ccurcy of the informtion contined in this work. However, AO nd/or distriutor nd/or the uthors nd/or the editors of this work cnnot e held responsile for errors or ny consequences rising from the use of the informtion contined in this work. Contriutions pulished under the nme of individul uthors re sttements nd opinions solely of sid uthors nd not of AO. The products, procedures nd therpies descried in this work re hzrdous nd re therefore only to e pplied y certified nd trined medicl professionls in environments specilly designed for such procedures. No suggested test or procedure should e crried out unless, in the user s professionl judgment, its risk is justified. Whoever pplies products, procedures nd therpies shown or descried in this work will do this t their own risk. Becuse of rpid dvnces in the medicl sciences, AO recommends tht independent verifiction of dignosis, therpies, drugs, dosges nd opertion methods should e mde efore ny ction is tken. Although ll dvertising mteril which my e inserted into the work is expected to conform to ethicl (medicl) stndrds, inclusion in this work does not constitute gurntee or endorsement of the qulity or vlue of such product or of the clims mde of it y its mnufcturer. Legl restrictions This work ws produced y AOTK nd AO Pulishing, Dvos, Switzerlnd. All rights reserved y AO Pulishing. This work contins works protected y copyright, trdemrk nd other lws. Prohiited re in prticulr ny commercil use s well s ny copying of the work. It is prohiited to mke this work or ny prts thereof ville on ny Intrnet or on the Internet or to crete derivtive works sed on the works contined in this work. Restrictions on use The rightful owner of n uthorized copy of this work my use it for eductionl nd reserch purposes only. Single imges or illustrtions my e copied for reserch or eductionl purposes only. The imges or illustrtions my not e ltered in ny wy nd need to crry the following sttement of origin Copyright y AO Pulishing, Switzerlnd. Some nmes, instruments, tretments, logos, designs etc. referred to in this work re lso protected y ptents nd trdemrks or y other intellectul property protection lws (eg, AO, ASIF, AO/ASIF, TRIANGLE/GLOBE Logo re registered trdemrks) even though specific reference to this fct is not lwys mde in the work. Therefore, the ppernce of nme, instrument etc. without designtion s proprietry is not to e construed s representtion y AO tht it is in the pulic domin.