AcUMEDr ScAPHOID TARGETING GUIDE
ScAPHOID TARGETING GUIDE Since 1988 Acumed has been designing solutions to the demanding situations facing orthopedic surgeons, hospitals and their patients. Our strategy has been to know the indication, design a solution to fit, and deliver quality products and instruments. For over three years the scaphoid targeting guide has been successfully used for percutaneous placement of a guide wire through the central axis of non-displaced scaphoid fractures. The guide has been designed to eliminate the guesswork associated with placing a guide wire freehand and helps reduce valuable operating time. The Scaphoid Targeting Guide facilitates percutaneous guide wire placement for non-displaced fractures of the scaphoid. The guide assists in placing the guide wire down the central axis of the scaphoid, providing precise placement of Acumed s Acutrak or Acutrak 2 screw. The clamping feature of the guide holds the patients hand firmly in position while moving from anterior-posterior views to lateral views for imaging. Additionally the guide offers features, seen under fluoroscopy, that help align the guide with the proper scaphoid positioning. They include, the central hole, which can be seen over the CMC joint, just distal to the scaphoid and the locking bolt, which aligns with the proximal pole of the scaphoid.
Wire placement holes in the disk offer nine different angles to customize placement of the guide wire. The guide also provides distal/proximal and radial/ulnar adjustments helping to align the wire without having to remove the guide. The center hole on the targeting disk allows visibility, using imaging, for placement over the CMC joint. This placement helps align the guide wire with the central axis of the scaphoid. Color-coded targeting disks are available in three different sizes. They include.035,.045 and.054. These wire sizes facilitate the use of Acutrak 2 Standard, Mini and Micro screws as well as the traditional Acutrak Standard, Mini and 4/5 screws. Distal/Proximal Adjustment Wheel Radial/Ulnar Adjustment Wheel Locking Posts Locking Arm Right/Left Hand Positioning Wrist Rest Locking Bolt Guide Wire Disks
SURGICAL TECHNIQUE SCAPHOID TARGETING GUIDE Step 1: Start the procedure by marking the thumb CMC joint with a surgical marker on the volar side of the hand. This can be done using fluoroscopy prior to placing the hand in the guide. A second option is to mark the distal tubercle of the scaphoid and then approximately 1 cm to the distal pole of the scaphoid is the thumb CMC joint. Make a second mark indicating the CMC joint. Place the supinated hand on the guide base. Step 2: Place the guide on the posts with the DISTAL marking distal on the hand. Target the CMC mark (made with the marker) in the center of the hole in the guide. Clamp the hand down firmly, in the guide, using the locking arms. This is the provisional placement of the guide for targeting the scaphoid. Note: The square adjustment block of the guide, with the adjustment knobs, should be centered before inserting the guide disk. A B Step 3: Determine the correct size guide wire disk to be used (.035 inch,.045 inch and.054 inch). Place the disk in the center of the guide with the locking bolt in the marked right or left hand position. Note:.035 - Fusia Disk.045 - Blue Disk.054 - Grey Disk Step 4: A fluoroscopy shot is then taken in the AP view. The center hole (A) on the targeting disk should be on the thumb CMC joint. Adjust the center circle, with the adjustment distal/proximal or medial/lateral wheels, to center the disk over the joint. Note: To check rotation, locate the locking bolt (B) hole using fluoroscopy (the left/ right screw). A line drawn from the center of that screw (proximal to the scaphoid) to the center hole (distal to the scaphoid) marks the rotation and aim of the wire.
By Mitchell B. Rotman, MD Step 5: Insert the guide wire in the center of the nine guide wire holes in the disk. Place the wire through the skin to the distal pole of the scaphoid and check placement by fluoroscopy. If the guide wire is not placed in the center of the distal pole, use the adjustment knob to shift the guide medial/ lateral until the wire is centered. If the angle of the wire does not match the anatomy of the patient, remove the wire and place it in the guide wire holes medial or lateral to the center hole. Step 6: The hand is then moved to a true lateral position (The lateral fluoroscopy view is important. The pisiform in a true lateral view is located between the scaphoid tubercle and the capitate). Check positioning and if needed adjust the guide wire with the distal/ proximal adjustment wheel. If the angle of the wire needs adjustment, remove it and place it distal or proximal to the current position. Step 7: Once the lateral view is correct and the guide wire is aligned with the central axis of the scaphoid go back and check the AP view one more time. If this is correct advance the wire through the scaphoid. Check final AP and lateral wire positioning under imaging. Step 8: Once the guide wire is centered in the scaphoid, remove the guide by first removing the wire disk, then unlock the locking arms and remove the guide. Screw placement can be done volar or dorsal. Measure the scaphoid length, advance the guide wire and insert the proper size Acutrak screw (4-5mm shorter than the scaphoid). Note: If the screw is placed dorsally flex the wrist and advance the guide wire through the dorsal side of the wrist. Measure using the standard two-wire technique and place the proper length Acutrak screw.
ORDERING INFORMATION Scaphoid Targeting Guide Set 30-0050 Scaphoid Targeting Guide Assembly 30-0001 Thumb Screw 30-0016 Guide Wire Disk.035 inch 30-0017-S Guide Wire Disk.045 inch 30-0018-S Guide Wire Disk.054 inch 30-0019-S.035 x 6 Guide Wire Stainless Steel Single Trocar WS-0906ST.045 x 6 Guide Wire Stainless Steel Single Trocar WS-1106ST.045 x 6 Guide Wire Stainless Steel Double Trocar WS-1106DT.054 x 7 Guide Wire Stainless Steel Single Trocar WS-1407ST AcUMEDr 5885 NW Cornelius Pass Road Hillsboro, OR 97124 (888) 627-9957 www.acumed.net Distributed by: ACT00-06-A Effective: 11/2008