Plates Screws s ru e m u e H u tela iq Ple n b-stalegna l Tech ica rg u S

Transcription

1 Plates Screws Surgical Technique s Angle-stable Plate Huerus

2 %

3 %%s % Angle-stable Plate Huerus Surgical Technique s Surgical Technique Angle-stable Plate Huerus

4

5 Content % a Introduction Materials Description Indications/ contra-indications Processing (sterilization & cleaning) 3 a Surgical Technique Anesthesia and positioning Surgical approach Fracture repositioning and retention a Tray a Screws a Case Studies s Surgical Technique Angle-stable Plate Huerus

6 4 Introduction a a a a With the angle-stable proxial huerus plate, you have chosen a sophisticated and universal iplant syste. Prior to the application, carefully read the surgical technique and the instruction for use! Materials For the anufacture of angle-stable plate systes aterials are used which have been proven to be successful in edical technology for decades. The anatoical plates are ade of pure titaniu (ISO Grade 4). The bone screws are ade of a titaniu alloy (ISO TiAl6V4). All aterials used are nationally or internationally standardized. They are characterized by biocopatibility and great safety against allergic reactions. Description As a rule, no shaping required Anatoically contoured plate Exact fitting of the plate not necessary with angle-stable treatent Flat plate design rounded at the edges Avoids soft-tissue irritation Short, cranial end to the plate and countersunk screw heads in the plate Ipingeent will be prevented Angle-stability in the cranial area and in the plate shaft No loosening of screws in relation to the plate Due to extensive load transfer in the screw/bone interface increased strength of the overall assebly; thus secondary repositioning losses are iniized Optial load take-up through cranially inclined screws with diverging alignent Iproved hold in case of reduced bone quality (osteoporosis) Exercise-stability attained enables early functional follow-up treatent Spherical thread in the plate hole and on the screw head Angle-stable connection between screws and plate Plate holes with spherical thread also allow the use of conventional screws (whose head bottos are also spherically shaped) In the plate hole conventional screws can be angled up to 15 in every direction Special holes ø1.9 for Kirschner-wires ø1.8 For teporary fixation of the fractures with Kirschner-wires For the fixation with suture Colour coding for plates and screws Blue (angle-stable), Gold (standard) Clearly arranged, copact set % %

7 a Indications / contra-indications Indications Dislocated and unstable 8 2, 3 and 4 fragent fractures 8 Reconstructable head fractures (AO 11 A1-C3) 8 Pathological fractures Pseudarthroses Osteotoies 5 Contra-indications General contra-indications of an operative intervention Noticeable, not reconstructable huerus head fracture; as a rule, with a non-fixable cap fragent Fractures in childhood and adolescence Presence of a necrosis of the huerus head a Processing (sterilization & cleaning) Together with the instruents, the iplants are supplied non-sterile in one copact set. Before every use, instruents as well as iplants ust be processed. Reference is here ade to the instructions for use. s Surgical Technique Angle-stable Plate Huerus

8 Surgical Technique 6 a a a Anesthesia and positioning 8 The surgery is perfored under general anesthesia. The patient is positioned in the beach-chair position. This facilitates x-ray scanning in apical and axial direction. Surgical approach 8 Recoended is the deltospectoral or the transdeltoid access. Fracture repositioning and retention 8 Indirect repositioning in abduction position of the ar N NOTE: Repositioning is to be done as gently as possible to avoid additional iatrogenic daages of perfusion. 8 Teporary fixation of the fragents with Kirschner-wires ø1.8 possible N NOTE: Care ust here be taken that the wires will not obstruct the subsequent iplantation of the plate. 8 Checking the repositioning result with the under x-ray control N NOTE: The repositioning should be copletely perfored before screwing the plate. 8 However, the spherical design of the plate holes also allows the use of conventional screws with which a (not angle-stable) copression screw osteosynthesis will be possible. % %

9 a 8 Positioning of the plate on the lateral huerus head and shaft 8 Fixation with a Kirschner-wire ø1.8 through one of the holes ø1.9 located in the proxial part of the plate 7 N NOTE: If possible, the wire should be in the rotary center of the huerus head. N SAFETY NOTE: The Kirschner-wire is not re-usable. Please dispose the used Kirschner-wires absolutely. 8 Central placeent of the 3.5 cortical screw in the long hole 8 If necessary, fine adjustent of the plate position after untightening of the screw in the long hole N SAFETY NOTE: To prevent ipingeent, the plate ust not protrude cranially over the greater tubercle. The two cranial screws are cranially inclined at an angle of 20 which allows a fixation of the fragents even with a lower seated plate. s Surgical Technique Angle-stable Plate Huerus

10 8 Surgical Technique a 8 Screwing the drill guide in 8 Set the drill guide on a hole at the cranial end of the plate and align according to the drill direction. Turn counterclockwise until cracking can be heard or felt. Then, turn clockwise until the drill bush is fixed. 8 Pre-drilling under iage converter control N NOTE: Subchondral placeent of the screws offers the best screw hold and thus helps to prevent secondary dislocations. N SAFETY NOTE: It should not be drilled through to prevent penetration of the screws due to secondary sintering of the cap. 8 Reoval of the drill guide 8 Deterining the screw length with the depth gauge 8 For the iplantation of the angle-stable 4.0 cancellous screws (blue) a tap is enclosed as these screws are not self-tapping 8 Inserting and tightening the corresponding screw with the appropriate torque liiter until a first click is hearable N NOTE: Due to the spherical for of the thread on the screw head and in the plate hole, the screw can be locked in the plate with approx. ¼ of a turn. 8 Fitting the other plate holes in the above described anner 8 Fixing the plate shaft with screws % %

11 a N NOTE: The plate shaft can also be fixed with angle-stable screws as well as conventional screws. In a cobined application of angle-stable and conventional screws a conventional screw should be used first to adduct the plate to the bone. Otherwise, there is a risk of daage. Always use the appendant drill guide and appropriate torque liiter for the preparation, placeent and adduction of the angle-stable screws. 9 8 If necessary, a fixation of the tubercles is possible with suture at the sall plate holes ø1.9 8 Reviewing the osteosynthesis result by x-ray in both planes 8 Wound closure a Postoperative Note It is principally within the discretion of the surgeon and the patient whether the plate can be left in the body after the fracture has healed. s Surgical Technique Angle-stable Plate Huerus

12 10 % %

13 Tray a a SET OF ANGLE-STABLE PLATE HUMERUS s IC ARTICLE QUANTITY ART.-NO. Tray for coplete set Angle-stable Plate Huerus, epty 1 IC Screw rack with lid for coplete set Angle-stable Plate Huerus, epty 1 IC Twist drill for quick coupling, ø2.5, L IU Twist drill for quick coupling, ø2.5, L IU Tap for cancellous screw IU Hexagon screwdriver with handle 2.5 width A/F 1 IU Depth gauge for sall screws 1 IS Double drill guide 3.5/ 2.5, drill ø3.5 1 IU Screw holding forceps 1 IU Drill guide for angle-stable plates, ø2.5, short 1 IU Drill guide for angle-stable plates, ø2.5, long 1 IU Kirschner-wire with trocar point ø1.8, L NK INSTRUMENTS Optional: Torque liiter, width A/F 2.5/ 2.9 N 1 IU T I T A N I U M ARTICLE QUANTITY ART.-NO. Angle-stable Plate Huerus, 4 3 hole 1 PW Angle-stable Plate Huerus, 4 4 hole 1 PW Angle-stable Plate Huerus, 4 5 hole 1 PW Angle-stable Plate Huerus, 4 6 hole 1 PW IMPLANTS s Surgical Technique Angle-stable Plate Huerus

14 Screws a 12 a ANGLE-STABLE CORTICAL SCREWS 3.5 (self-tapping) T I T A N I U M LENGTH QUANTITY ART.-NO SK SK SK SK SK SK SK SK SK SK SK SK SK SK SK SK SK ANGLE-STABLE CANCELLOUS SCREWS T I T A N I U M LENGTH QUANTITY ART.-NO SP SP SP SP SP SP SP SP SP SP SP SP SP SP SP % %

15 a CORTICAL SCREWS 3.5 (self-tapping) T I T A N I U M LENGTH QUANTITY ART.-NO SK SK SK SK SK SK SK SK SK SK s Surgical Technique Angle-stable Plate Huerus

16 Case Studies 14 a VARIOUS FRACTURES OF THE HUMERAL HEAD Status before surgery Status after surgery % %

17 a VARIOUS FRACTURES OF THE HUMERAL HEAD 15 Status before surgery Status after surgery s Surgical Technique Angle-stable Plate Huerus

18 16 a Notes

19 Subject to technical changes, errors and isprints. WM / 0807 Layout, typesetting and illustrations: design graphic - Wolfra Passlack Lorenzweg Berlin Gerany Fon Fax custoer.service@aap.de

20 s Lorenzweg Berlin Gerany Fon Fax custoer.service@aap.de WM /