Cannulated Angled Blade Plate 3.5 and 4.5, 90.

Transcription

1 Cannulated Angled Blade Plate 3.5 and 4.5, 90. Technique Guide This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.

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3 Table of Contents Introduction Cannulated Angled Blade Plates 3.5 and 4.5, 90 2 Indications 4 Surgical Technique Surgical Technique 5 Implant Removal 12 Cleaning of Instruments 13 Product Information Implants 14 Instruments 15 Image intensifier control Warning This description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling these instruments is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 1

4 Cannulated Angled Blade Plates 3.5 and 4.5, 90 Cannulated Angled Blade Plate 3.5, 90 The cannulated blade allows accurate insertion and exact positioning of the plate Blade geometry and the oblique lag screw provide high rotational stability Available blade lengths: 30, 35, 40 and 45 mm Number of screw holes: 4, 5, 6, 8 or 10 The three round screw holes next to the blade are suitable for cortex screws B 3.5 mm or cancellous bone screws B 4.0 mm LC-DCP holes for cortex screws B 3.5 mm LC-DCP undercuts allow good periosteal blood supply Available in Pure Titanium or Stainless Steel 2 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

5 Cannulated Angled Blade Plate 4.5, 90 The cannulated blade allows accurate insertion and exact positioning of the plate Blade geometry and the oblique lag screw provide high rotational stability Available blade lengths: 30, 40, 50, and 60 mm Number of screw holes: 4, 5, 6, 8, 10, or 12 The three round screw holes next to the blade are suitable for cortex screws B 4.5 mm or cancellous bone screws B 6.5 mm LC-DCP holes for cortex screws B 4.5 mm LC-DCP undercuts allow good periosteal blood supply Available in Pure Titanium or Stainless Steel Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 3

6 Indications The Cannulated Angled Blade Plate 3.5 and 4.5, 90 has the following indications: Humerus 2-part fractures of the proximal humerus Non-unions of the proximal humerus Tibia Metaphyseal fractures of the proximal and distal tibia Metaphseal non-union and malunion Metaphyseal/diaphyseal hinged tibia osteotomies 4 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

7 Surgical Technique A proximal humeral fracture is used to demonstrate the following surgical technique for the Cannulated Angled Blade Plate 3.5 and 4.5, 90. Important: Use the guide wire to determine the blade length intraoperatively. X-ray templates are not required. 1 Patient positioning Position the patient in a beach chair position. 2 Fracture reduction Reduce the fracture under image intensifier control. 3 Approach Use a deltopectoral approach. Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 5

8 Surgical Technique 4 Determine blade entry point and insert guide wire Drill Guide for Cannulated Angled Blade Plate 3.5 or Drill Guide for Cannulated Angled Blade Plate Guide Wire B 2.0 mm with threaded tip with trocar, length 230 mm, Stainless Steel Place the drill guide on the lateral metaphysis of the proximal humerus. Insert the guide wire through the central hole of the drill guide. Place the tip of the guide wire in the subchondral position. Use the image intensifier to check the position of the guide wire. The position of the guide wire indicates the final position of the blade at a 90 angle to the diaphysis. Note: The drill guide does not need to be used to insert the guide wire. Check position with the image intensifier. 6 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

9 5 Determine blade length Instruments Direct Measuring Device for Cannulated Screws B 7.0 mm Remove the drill guide. Slide the direct measuring device onto the guide wire and use the markings to read the blade length. The extent of the fracture will determine the plate shaft length. Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 7

10 Surgical Technique 6 Open blade entry point Instruments Drill Guide for Cannulated Angled Blade Plate 3.5 or Drill Guide for Cannulated Angled Blade Plate Drill Bit B 4.5/2.1 mm, cannulated, calibrated, length 230/210 mm, 3-flute, for Jacobs Chuck Slide the drill guide again onto the guide wire and align with the humeral metaphysis. Use a B 3.5 or 4.5 mm drill bit to drill a hole through the near cortical bone to the left and to the right of the guide wire hole (1;2). Then use a B 2.5 or 3.2 mm drill bit to drill through the near cortical bone through the two oblique holes of the drill guide from distal to proximal (3;4). Remove the drill guide. Slide the cannulated drill bit onto the guide wire and drill through the remaining cortical bone. Note: All cortical bone at the blade entry point must be removed in order to facilitate blade insertion and achieve optimal fit of the plate to the metaphysis. 8 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

11 7 Contour plate Instruments Bending Template for Cannulated Angled Blade Plate 3.5, 4 holes, length 80 mm Bending Template for Cannulated Angled Blade Plate 3.5, 10 holes, length 158 mm or Bending Template for Cannulated Angled Blade Plate 4.5, 5 holes, length 94 mm Bending Template for Cannulated Angled Blade Plate 4.5, 8 holes, length 148 mm Bending Template for Cannulated Angled Blade Plate 4.5, 12 holes, length 220 mm Bending Iron for Plates 2.4 to 3.5, length 145 mm and Bending Iron for Plates 2.4 to 3.5, length 145 mm Place the bending template distally under the blade entry point to adapt it to the bone. Use bending pliers or a bending iron to contour the plate to match the template. Ensure a snug fit of plate shaft and bone. Important: The angle between the guide wire and the humeral metaphysis must identically match the angle between the blade and the plate shaft. Note: Avoid bending the plate back and forth. Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 9

12 Surgical Technique 8 Insert plate Slide the plate onto the guide wire. Press the blade manually through the cortical and the cancellous bone until its final position is reached. Remove and dispose of the guide wire. Dense bone procedure Instruments Inserter/Extractor for Cannulated Angled Blade Plates 3.5 and Slotted Hammer, small, for Cannulated Angled Blade Plates 3.5 and 4.5 Optional Tension Device, articulated, span 20 mm Attach the inserter/extractor as close to the plate angle as possible. Slide the blade onto the guide wire. Press it manually through the opening in the cortical bone. Use slight taps of slotted hammer onto the inserter/extractor to move the plate into its final position and complete the insertion. Note: Use the tension device to achieve additional compression between the proximal fragment of the humeral head and the metaphysis. 10 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

13 9 Attach plate Insert a cortex screw B 3.5 or 4.5 mm or a cancellous bone screw B 4.0 or 6.5 mm as a lag screw obliquely through the hole in the angle of the plate. Increase the drill hole width up to the fracture line to the same size as the outer diameter of the screw thread. This will act as a gliding hole. To achieve compression between the proximal fragment of the humeral head and the metaphysis, seat the lag screw in the far cortical bone distal to the fracture. Insert cortex screws B 3.5 or 4.5 mm or cancellous bone screws B 4.0 or 6.5 mm into the proximal round holes and cortex screws B 3.5 or 4.5 mm into the distal LC-DCP holes to secure the plate in its final position. Ensure the screws are firmly seated in both cortices to achieve stable fixation. Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 11

14 Implant Removal Remove plate Instruments Inserter/Extractor for Cannulated Angled Blade Plates 3.5 and Slotted Hammer, small, for Cannulated Angled Blade Plates 3.5 and 4.5 After removing all screws, attach the inserter/extractor close to the angle between the plate shaft and the blade and extract the plate with slight taps of the slotted hammer. 12 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

15 Cleaning of Instruments Instrument Cleaning Stylet B 2.0 mm, for Cannulated Instruments Carefully clean the instruments to maintain proper function. Clean the cannulation of the drill bit B 4.5/2.1 mm intraoperatively with the cleaning stylet. Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 13

16 Implants Cannulated Angled Blade Plates 3.5* X Cannulated Angled Blade Plate 3.5, 90, 10 holes, blade length 30 mm X Cannulated Angled Blade Plate 3.5, 90, 10 holes, blade length 35 mm X Cannulated Angled Blade Plate 3.5, 90, 10 holes, blade length 40 mm X Cannulated Angled Blade Plate 3.5, 90, 10 holes, blade length 45 mm X Cannulated Angled Blade Plate 3.5, 90, 4 holes, blade length 30 mm X Cannulated Angled Blade Plate 3.5, 90, 4 holes, blade length 35 mm X Cannulated Angled Blade Plate 3.5, 90, 4 holes, blade length 40 mm X Cannulated Angled Blade Plate 3.5, 90, 4 holes, blade length 45 mm X Cannulated Angled Blade Plate 3.5, 90, 5 holes, blade length 30 mm X Cannulated Angled Blade Plate 3.5, 90, 5 holes, blade length 35 mm X Cannulated Angled Blade Plate 3.5, 90, 5 holes, blade length 40 mm X Cannulated Angled Blade Plate 3.5, 90, 5 holes, blade length 45 mm X Cannulated Angled Blade Plate 3.5, 90, 6 holes, blade length 30 mm X Cannulated Angled Blade Plate 3.5, 90, 6 holes, blade length 35 mm X Cannulated Angled Blade Plate 3.5, 90, 6 holes, blade length 40 mm X Cannulated Angled Blade Plate 3.5, 90, 6 holes, blade length 45 mm X Cannulated Angled Blade Plate 3.5, 90, 8 holes, blade length 30 mm X Cannulated Angled Blade Plate 3.5, 90, 8 holes, blade length 35 mm X Cannulated Angled Blade Plate 3.5, 90, 8 holes, blade length 40 mm X Cannulated Angled Blade Plate 3.5, 90, 8 holes, blade length 45 mm Cannulated Angled Blade Plates 4.5* X Cannulated Angled Blade Plate 4.5, 90, 4 holes, blade length 30 mm X Cannulated Angled Blade Plate 4.5, 90, 4 holes, blade length 40 mm X Cannulated Angled Blade Plate 4.5, 90, 5 holes, blade length 30 mm X Cannulated Angled Blade Plate 4.5, 90, 5 holes, blade length 40 mm X Cannulated Angled Blade Plate 4.5, 90, 6 holes, blade length 30 mm X Cannulated Angled Blade Plate 4.5, 90, 6 holes, blade length 40 mm X Cannulated Angled Blade Plate 4.5, 90, 8 holes, blade length 30 mm X Cannulated Angled Blade Plate 4.5, 90, 8 holes, blade length 40 mm X Cannulated Angled Blade Plate 4.5, 90, 8 holes, blade length 50 mm X37.104(s) Cannulated Angled Blade Plate 4.5, 90, 10 holes, blade length 40 mm X Cannulated Angled Blade Plate 4.5, 90, 10 holes, blade length 50 mm X Cannulated Angled Blade Plate 4.5, 90, 10 holes, blade length 60 mm X Cannulated Angled Blade Plate 4.5, 90, 12 holes, blade length 30 mm X Cannulated Angled Blade Plate 4.5, 90, 12 holes, blade length 40 mm X Cannulated Angled Blade Plate 4.5, 90, 12 holes, blade length 50 mm X Cannulated Angled Blade Plate 4.5, 90, 12 holes, blade length 60 mm * X = 2: Stainless Steel X = 4: Pure Titanium All implants are available sterile packed. For sterile implants add suffix "S" to article number. 14 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

17 Instruments General Instruments Drill Guide for Cannulated Angled Blade Plate Drill Guide for Cannulated Angled Blade Plate Guide Wire B 2.0 mm with threaded tip with trocar, length 230 mm, Stainless Steel Direct Measuring Device for Cannulated Screws B 7.0 mm Inserter/Extractor for Cannulated Angled Blade Plates 3.5 and Slotted Hammer, small, for Cannulated Angled Blade Plates 3.5 and Drill Bit B 4.5/2.1 mm, cannulated, calibrated, length 230/210 mm, 3-flute, for Jacobs Chuck Impactor for Cannulated Angled Blade Plate Insert for Impactor No Impactor for Cannulated Angled Blade Plate Insert for Impactor No , single Cleaning Instruments Cleaning Stylet B 2.0 mm, for Cannulated Instruments Bending Irons Bending Iron for Plates 2.4 to 3.5, length 145 mm Bending Iron for Plates 2.4 to 3.5, length 145 mm Bending Templates Bending Template for Cannulated Angled Blade Plate 4.5, 5 holes, length 94 mm Bending Template for Cannulated Angled Blade Plate 4.5, 8 holes, length 148 mm Bending Template for Cannulated Angled Blade Plate 4.5, 12 holes, length 220 mm Bending Template for Cannulated Angled Blade Plate 3.5, 4 holes, length 80 mm Bending Template for Cannulated Angled Blade Plate 3.5, 10 holes, length 158 mm Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 15

18 16 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

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20 Synthes GmbH Eimattstrasse 3 CH-4436 Oberdorf Ö öACQä This publication is not intended for distribution in the USA. All surgical techniques are available as PDF files at Synthes GmbH All rights reserved AC DSEM/TRM/0714/ /2014