Surgical Technique. Cannulated Angled Blade Plate 3.5 and 4.5, 90

Transcription

1 Surgical Technique Cannulated Angled Blade Plate 3.5 and 4.5, 90

2

3 Cannulated Angled Blade Plate 3.5 and 4.5, 90 Table of contents Indications/Contraindications 2 Implants 3 Surgical technique 5 Implant removal 8 Cleaning of instruments 8 Image intensifier control Warning This description is not sufficient for immediate application of the instrumentation. Instruction by a surgeon experienced in handling this instrumentation is highly recommended. Synthes 1

4 Cannulated Angled Blade Plate 3.5 and 4.5, 90 Indications/Contraindications Indications Humerus fractures of the surgical neck 3-part fractures of the proximal humerus non-unions of the proximal humerus Tibia metaphyseal fractures of the proximal and distal tibia non-unions of the proximal and distal tibia metaphyseal/diaphyseal hinged tibia osteotomies Foot arthrodeses of the ankle Contraindications fractures and osteotomies of the proximal and distal femur in adults 2

5 Cannulated Angled Blade Plate 3.5 and 4.5, 90 Implants Cannulated Angled Blade Plate 3.5, 90 the cannulated blade allows accurate insertion and exact positioning of the plate blade geometry and oblique lag screw provide for a high rotational stability blade lengths: 30, 35, 40 and 45 mm number of screw holes: 4, 5, 6, 8 or 10 the three round holes next to the blade are suitable for Cortex Screws 3.5 mm or Cancellous Bone Screws 4.0 mm LC-DCP holes for Cortex Screws 3.5 mm LC-DCP undercuts allow good periosteal blood supply available in Pure Titanium ( ) or Stainless Steel ( ) Guide Wire 2.0 mm with Threaded Tip length 230 mm ( ) To determine blade length and for exact positioning of blade and plate shaft. Cortex Screws 3.5 mm, self-tapping Pure Titanium ( ), Stainless Steel ( ) Cortex Screws 3.5 mm Pure Titanium ( ), Stainless Steel ( ) Cancellous Bone Screws 4.0 mm Pure Titanium ( ), Stainless Steel ( ) Synthes 3

6 Cannulated Angled Blade Plate 4.5, 90 the cannulated blade allows accurate insertion and exact positioning of the plate blade geometry and oblique lag screw provide for a high rotational stability blade lengths: 30, 40, 50, and 60 mm number of screw holes: 4, 5, 6, 8, 10, or 12 the three round holes next to the blade are suitable for Cortex Screws 4.5 mm or Cancellous Bone Screws 6.5 mm LC-DCP holes for Cortex Screws 4.5 mm LC-DCP undercuts allow good periosteal blood supply available in Pure Titanium ( ) or Stainless Steel ( ) Guide Wire 2.0 mm with Threaded Tip length 230 mm ( ) To determine blade length and for exact positioning of blade and plate shaft. Cortex Screws 4.5 mm, self-tapping Pure Titanium ( ), Stainless Steel ( ) Cortex Screws 4.5 mm Pure Titanium ( ), Stainless Steel ( ) Cancellous Bone Screws 6.5 mm Pure Titanium ( ), Stainless Steel ( ) 4

7 Cannulated Angled Blade Plate 3.5 and 4.5, 90 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. Since the blade length is determined intraoperatively using the guide wire, the use of X-ray templates is not required. 1 Patient positioning The patient is positioned in a beach chair position. 2 Fracture reduction Reduce the fracture under image intensifier control. 3 Approach The approach is deltopectoral. 4 Determine blade entry point and insert guide wire Place the Drill Guide ( or ) on the lateral metaphysis of the proximal humerus and insert the Guide Wire 2.0 mm ( ) through the central hole 2.0 mm of the drill guide using the Compact Air Drive with Quick Coupling for Kirschner Wires ( ). The tip of the guide wire is placed in subchondral position. Check the position of the guide wire with the image intensifier. The position of the guide wire indicates the final position of the blade in a 90 angle in relation to the diaphysis. Note: The guide wire may also be inserted without using the drill guide. Check position with the image intensifier. Synthes 5

8 5 Determine blade length Remove the drill guide, slide the Direct Measuring Device for Cannulated Screws 7.0 mm ( ) onto the guide wire and read the blade length from the markings of the measuring device. The length of the plate shaft is chosen according to the extent of the fracture Open blade entry point Slide the drill guide again onto the guide wire and align with the humeral metaphysis. Using a drill bit 3.5 or 4.5 mm, drill a hole through the near cortical bone to the left and to the right of the guide wire hole (1 and 2). Using a drill bit 2.5 or 3.2 mm, drill through the near cortical bone through the two oblique holes of the drill guide from distal to proximal (3 and 4). Remove the drill guide. Slide the cannulated Drill Bit 4.5/2.1 mm ( ) onto the guide wire and drill through the remaining cortical bone Note: In order to facilitate the insertion of the blade and to achieve an optimal fit of the plate limb to the metaphysis, the cortical bone at the blade entry point has to be removed completely. 7 Contour plate Adapt the aluminium Bending Template ( /918/919 or /908/912) to the bone by placing it distally under the blade entry point. Use bending pliers or a bending iron to contour the plate to match the bending template, ensuring a snug fit of plate shaft and bone. 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. 6

9 Cannulated Angled Blade Plate 3.5 and 4.5, 90 Surgical technique 8 Insert plate Slide the angled blade plate onto the guide wire and 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 Attach the Inserter/Extractor ( ) as close to the plate angle as possible. Slide the blade onto the guide wire and press it manually through the opening in the cortical bone. Complete the insertion by slight taps with the Slotted Hammer ( ) onto the inserter/extractor until the plate is in its final position. Note: Additional compression between the proximal fragment of the humeral head and the metaphysis can be achieved using the Tension Device ( ). 9 Attach plate As a lag screw, insert a cortex screw 3.5 or 4.5 mm or a cancellous bone screw 4.0 or 6.5 mm 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, the lag screw has to be seated in the far cortical bone distal to the fracture. The angled blade plate is secured in its final position by inserting cortex screws 3.5 or 4.5 mm or cancellous bone screws 4.0 or 6.5 mm into the proximal round holes and cortex screws 3.5 or 4.5 mm into the distal LC-DCP holes. The screws are firmly seated in both cortices to achieve stable fixation. Synthes 7

10 Cannulated Angled Blade Plate 3.5 and 4.5, 90 Implant removal Cleaning of instruments Remove plate After removing all screws attach the Inserter/Extractor ( ) close to the angle between the plate shaft and the blade and extract the plate by slightly tapping with the Slotted Hammer ( ). Cleaning of instruments Proper functioning of the instruments can be maintained by careful cleaning. Intraoperatively, the cannulation of the Drill Bit 4.5/2.1 mm ( ) is cleaned with the Cleaning Stylet 2.0 mm ( ). Postoperatively, the instruments are cleaned with the cleaning stylet 2.0 mm and the Cleaning Brush 2.1 mm ( ). 8

11

12 Synthes GmbH Eimattstrasse 3, CH-4436 Oberdorf Presented by: SE_ AA Synthes 2006 Printed in Switzerland Subject to modifications.