Technique Guide. Adjustable Distal Radius Fixator. Part of the Synthes External Fixation Systems.

Transcription

1 Technique Guide Adjustable Distal Radius Fixator. Part of the Synthes External Fixation Systems.

2 Table of Contents Introduction Adjustable Distal Radius Fixator 2 Indications 3 Surgical Technique Configure Fixator 4 Insert Schanz Screws 6 Apply Fixator 8 Make Adjustments 9 Product Information Instruments 12 Set List 13 Synthes

3 Adjustable Distal Radius Fixator Features One-piece fixator Proximal pin clamp Permits indepen dent mechanical adjustments of the following: Distraction/Compression Dorsal/Palmar Translation Radial/Ulnar Translation Flexion/Extension Distal pin clamp Radiolucent Proximal and distal ball joints permit simplified application Screw post Flexion/extension adjustment screw Radial/ulnar adjustment screw Screw post Dorsal/palmar adjustment screw Pin-locking screws Ball-locking screw Gross-distraction pin and distraction screw Ball-locking screw Pin-locking screws Ball-locking screw Ball-locking screw 2 Synthes Adjustable Distal Radius Fixator

4 Indications For stabilizing fractures of the distal radius. Synthes 3

5 Configure Fixator The adjustable distal radius fixator is packaged for application to the right wrist. If the fixator is to be applied to the left wrist, the following steps are necessary. 1 Reposition proximal pin clamp Instrument Hexagonal Screwdriver Loosen the proximal screw post and remove the post and washer assembly. Pull the pin clamp from the fixator body. Place the pin clamp on the opposite side of the fixator body. Reattach and tighten the screw post and washer assembly. 4 Synthes Adjustable Distal Radius Fixator

6 2 Reposition distal pin clamp Repeat step 1 for the distal pin clamp. Align the pin clamp with the 0 mark before tightening the screw post. Synthes 5

7 Insert Schanz Screws Preparation The adjustable distal radius fixator provides 45 mm of distraction. To ensure sufficient travel, it is important to use gentle manipulation combined with finger-trap traction to obtain gross alignment of the fracture prior to pin insertion. 1 Insert distal Schanz screws Instrument mm Parallel Drill Guide To avoid entrapping the extensor mechanism in extension, flex the second metacarpophalangeal joint to 90. Make a 25 mm longitudinal incision over the radial aspect and dissect the soft tissue. 45 Using the parallel drill guide, insert 4.0 mm/3.0 mm self-drilling Schanz screws* into the second metacarpal. Placement should be in the proximal and distal diaphyseal bone, to the frontal plane. Note: The basic self-drilling Schanz screw insertion technique requires the tip to be embedded in the far cortex to resist cantilever forces. It is not necessary for the tip to penetrate through the far cortex. However, if the surgeon feels it is needed, as in osteopenic bone, the screw may be inserted so that it protrudes slightly through the far cortex. * 4.0 mm or 4.0 mm/2.5 mm self-drilling Schanz screws may also be used. 6 Synthes Adjustable Distal Radius Fixator

8 2 Insert proximal Schanz screws Instrument mm Parallel Drill Guide With the hand in neutral position, place the notch of the parallel drill guide against the metacarpal Schanz screw. Mark the position of the distal Schanz screw at the etch line on the handle. Incise the skin and extend an incision 25 mm proximally from the mark. Bluntly dissect to expose the radius. Using the parallel drill guide, insert the second set of Schanz screws at 45 to the frontal plane. 25 mm Synthes 7

9 Apply Fixator 3 Apply the fixator Instrument Hexagonal Screwdriver Verify that the distal pin clamp is positioned at the 0 mark (see page 5 for instruction). Slide the fixator over the Schanz screws. The Schanz screws should protrude approximately 10 mm above the pin clamps. Lock the Schanz screws to the fixator by tightening the four pin-locking screws, using the hexagonal screwdriver. Note: Use the thumb, index and long fingers on the screwdriver when tightening the locking screws. 4 Align the fixator With the hand in neutral position, ensure that the fixator is parallel to the radius in all planes. Tighten the four ball-locking screws, using the hexagonal screwdriver. Note: Use the thumb, index and long fingers on the screwdriver when tightening the locking screws. 8 Synthes Adjustable Distal Radius Fixator

10 Make Adjustments 1 Distraction (red) Instrument Hexagonal Screwdriver Remove the gross-distraction pin. This engages the distraction gear for mechanically controlled adjustment. Note: The gross-distraction pin cannot be reinserted. Lengthening can now be accomplished by turning the distraction screw. One clockwise rotation = 1.5 mm of shortening One counterclockwise rotation = 1.5 mm of lengthening Note: Avoid excessive distraction across the wrist. This causes tension in the extensor tendons, resulting in clawing of the fingers. Use passive flexion of the fingertips to the palm to determine if there is too much distraction. Synthes 9

11 Make Adjustments continued 2 Radial/ulnar translation (blue) Radial/ulnar alignment can be achieved by turning the radial/ulnar adjustment screw. Clockwise rotation translates fragments medially. Counterclockwise rotation translates fragments laterally. ULNAR RADIAL 3 Palmar/dorsal translation (green) Palmar tilt of the radius can be restored by turning the palmar/dorsal adjustment screw. Clockwise = palmar translation Counterclockwise = dorsal translation PALMAR DORSAL 10 Synthes Adjustable Distal Radius Fixator

12 4 Flexion/extension Instrument Hexagonal Screwdriver Loosen the distal screw post 1/4 turn only. Turn the flexion/extension adjustment screw until the desired position is achieved. Tighten the distal screw post. 5 Verify all locking screws are secure Note: Use the thumb, index and long fingers on the screwdriver when tightening the locking screws. Important: The offset wrench should not be used to tighten the fixator locking screws. Synthes 11

13 Instruments Hexagonal Screwdriver Offset Wrench, 2.5 mm hex Drive Adaptor with quick coupling, for 4.0 mm Schanz Screws mm Parallel Drill Guide 12 Synthes Adjustable Distal Radius Fixator

14 Adjustable Distal Radius Fixator Sets with Self-Drilling Schanz Screws Stainless Steel ( ) or Titanium ( ) Graphic Case Adjustable Distal Radius Fixator Set Graphic Case Instruments Hexagonal Screwdriver Offset Wrench, 2.5 mm hex Drive Adaptor with quick coupling, for 4.0 mm Schanz Screws mm Parallel Drill Guide Fixator Adjustable Distal Radius Fixator Implants in set mm/ 3.0 mm Self-Drilling Schanz Screw, 20 mm thread length, 80 mm, 8 ea. Implants in set mm/ 3.0 mm Titanium Self-Drilling Schanz Screw, 20 mm thread length, 80 mm, 8 ea. Also Available Fixators S Adjustable Distal Radius Fixator, with Self-Drilling Schanz Screws, sterile S Adjustable Distal Radius Fixator, with Titanium Self-Drilling Schanz Screws, sterile Also Available Implants mm/3.0 mm Schanz Screw, 20 mm thread, 80 mm mm/2.5 mm Self-Drilling Schanz Screw, 20 mm thread, 80 mm SHA 4.0 mm/3.0 mm Self-Drilling Schanz Screw, hydroxyapatite coating, sterile mm Self-Drilling Schanz Screw, 20 mm thread, 80 mm SHA 4.0 mm Self-Drilling Schanz Screw, hydroxyapatite coating, sterile mm/ 2.5 mm Titanium Self-Drilling Schanz Screw, 20 mm thread, 80 mm SHA 4.0 mm/ 3.0 mm Titanium Self-Drilling Schanz Screw, hydroxyapatite coating, sterile mm Titanium Self-Drilling Schanz Screw, 20 mm thread, 80 mm For additional information, please refer to package insert. Synthes 13

15 Synthes (USA) 1302 Wrights Lane East West Chester, PA Telephone: (610) To order: (800) Fax: (610) Synthes (Canada) Ltd Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) To order: (800) Fax: (905) Synthes, Inc. or its affiliates. All rights reserved. Synthes is a trademark of Synthes, Inc. or its affiliates. Printed in U.S.A. 6/08 J2885-G