ENDOBUTTON Fixation Device

Transcription

1 ENDOBUTTON Fixation Device Distal Biceps Repair A Shoulder Series Technique Guide As described by: Felix Buddy Savoie, MD PRELIMINARY - NOT FOR DISTRIBUTION

2 As described by: Felix Buddy Savoie, MD Chief of the Tulane Institute for Sports Medicine Lee C. Schlesinger Professor of Orthopaedics at Tulane University Tulane University, New Orleans, LA

3 Distal Biceps Repair PRELIMINARY - NOT FOR DISTRIBUTION Patient Preparation Position the patient supine with the arm outstretched on an arm board. Do not use a tourniquet as it may interfere with biceps mobilization. Technique 1. Make a 5 cm transverse incision in the anterior elbow flexion crease (Figure 1). Incise only the skin to avoid injury to the cephalic vein. Use blunt dissection to find the subcutaneous plane. The subcutaneous plane provides access to the biceps and defines the path down to the bicipital tuberosity of the radius. 2. Flex the elbow 90. Use a blunt army-navy retractor to elevate the skin and enable visualization of the torn distal biceps stump. Place a kockher clamp on the stump and pull it distally while using blunt manual dissection to free the muscle from any surrounding adhesion. If necessary, release the lacertus. 3. Deliver the tendon out through the wound and prepare the end with a whipstitch spanning approximately 2 cm of the tendon length. Begin the stitch in the area of the normal tendon, usually 1 cm proximal to the damaged stump, and work toward the myotendinous junction for at least 2 cm and back to the end of the normal tendon. Resect the damaged portion of the tendon. 4. Double pass the suture limbs from the whipstitch into the Smith & Nephew ENDOBUTTON Fixation Device. Tie the sutures to the ENDOBUTTON device so the knots are on the tendon side of the device. Thread one additional suture into each of the end holes of the ENDOBUTTON device to help facilitate proper placement later (Figure 2). Use blunt dissection to follow the path down to the bicipital tuberosity. Place a blunt Holman retractor on the radial and ulnar side of the tuberosity subperiosteally to expose the area of tendon avulsion. Figure 1 Figure 2 3

4 Figure 3 5. Place the forearm in full supination and drill a Beath pin through the tuberosity and out through the dorsum of the forearm. The starting point is 5 6mm from the ulnar side of the tuberosity. Angle the pin in a slightly distal and slightly radial direction (a guide can be used to aid pin alignment, if desired). Place a clamp on the distal end of the pin to prevent its inadvertent removal (Figure 3). 6. Use the Smith & Nephew ENDOBUTTON Drill Bit to overdrill the Beath pin bicortically through the radius and out through the dorsal skin. Create a unicortical foramen where the tendon will be placed. Measure the biceps tendon and drill the appropriate size cannulated reamer (7 or 8 mm) to the proximal cortex of the radius only. Take care not to breach the far cortex. 7. Thread both sutures from the ENDOBUTTON device through the Beath pin eyelet and pull the pin through the radius and out through the dorsal cortex. Figure 4 4

5 8. Pull the ENDOBUTTON device through the radius and flip the device to the transverse position on the cortex. Pull the tendon into the tuberosity (Figure 4). Use fluoroscopic visualization to verify the proper placement of the device on the outer cortex of the radius (Figure 5). If desired, a unicortical interference screw (7 or 8 mm X 10 mm) can be placed into the radial tuberosity adjacent to the tendon (Figure 6). 9. Irrigate and close the wound. Apply a well padded posterior splint at 90 of flexion and full forearm supination. Figure 5 Figure 6 5

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8 Additional Instruction Prior to performing this technique, consult the Instructions for Use documentation provided with individual components including indications, contraindications, warnings, cautions, and instructions. Ordering Information To order the instruments used in this technique call in the U.S. or contact your authorized Smith & Nephew representative. The following products can be used in the Distal Biceps Repair Technique. REF Description mm X 15" Drill-tip passing pin. Sterile, single use, package of mm ENDOBUTTON drill, sterile, single use ENDOBUTTON fixation device, 4.0 mm X 12 mm ULTRABRAID #2 co-braid suture, 38", sterile, package of Tendon sizing block mm Endoscopic Cannulated Drill mm Endoscopic Cannulated Drill mm Endoscopic Cannulated Drill mm Endoscopic Cannulated Drill mm Endoscopic Cannulated Drill mm Cannulated Drill mm Cannulated Drill mm Cannulated Drill Courtesy of Smith & Nephew, Inc., Endoscopy Division Trademarks of Smith & Nephew, registered U.S. Patent & Trademark Office. Endoscopy Smith & Nephew, Inc. Andover, MA USA Fax U.S. Customer Service 2009 Smith & Nephew, Inc. All rights reserved. 04/ Rev. A