a dedicated system for reconstructive pelvic and ...synthes.vo.llnwd.net/o16/llnwmb8/us...

$: A dedicated System for Reconstructive Pelvic and ...synthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes... · and deﬁnitive stabilization of pelvic and acetabular fractures. The$
A dedicated System for Reconstructive Pelvic and Acetabular Surgery

Pelvic Implants and InstrumentsSurgical Technique

Image intensifier control

MR Information The Low Profile Pelvic System has not been evaluated for safety and compatibility in the MR environment. It has not been tested for heating, migration or image artifact in the MR environment. The safety of the Low Profile Pelvic System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 1

Table of Contents

Introduction Implant Specifications 4

AO Principles 6

Intended Use, Indications and Contraindications 7

Instruments 8• Standard 8• Retractors 10• Reduction 12

Surgical Technique Plate Contouring 14• In-situ Plate Contouring 16

Fracture Fixation 18• A. Pubic Symphysis Fractures 18• B. Iliac Fractures 22• C. Acetabulum Two Column Fractures 28

Implant Removal 38

Product Information Product Overview 39

Also Available 52

Other Available Pelvic Instruments and Implants from DePuy Synthes 55

2 DePuy Synthes Pelvic Implants and Instruments Surgical Technique

Essential equipment for the surgical treatment of pelvic and acetabular fractures

The complex anatomy of the pelvic ring and acetabulum involve complex surgical exposures and demands exact anatomical reduction to achieve positive functional results.

The AO and Synthes took this into consideration in developing the Pelvic Implant and Instrument Sets.

Reconstruction Plate and Screw SetThe pelvic and acetabular low profile implants offer pre-shaped plate designs. Additional trays with locking compression, wide angle (acetabular) and J-plates (pelvic brim) are also available. All plates can be three-dimensionally contoured allowing them to be closely adapted to pelvic bone surfaces. Bending templates allow for easy manual adap tation of the plates.

Pelvic Standard Instrument SetThe Pelvic Instrument Set has a wide range of standard instruments for screw insertion, plate adaptation (bending instruments) and fixation during reduction for preliminary and definitive stabilization of pelvic and acetabular fractures.

The Pelvic Implant and Instrument Sets contain a wide range of implants, reduction instruments, retractors and instruments for screw and plate fixation for the operative treatment of pelvic and acetabular fractures. All implants are available in 316L implant stainless steel.


Pelvic Retractor SetA wide range of retractors (pelvic, Hohmann, sciatic nerve and malleable) within the Pelvic Retractor Set provide more options to aid the surgeon in achieving good visibility within the chosen approach.

Pelvic Reduction Instrument SetThe pelvic reduction forceps and other reduction instruments within the Pelvic Reduction Instrument Set are designed to aid the surgeon with fracture reduction of pelvic injuries.

Introduction


Implant Specifications

Reconstruction PlatesOccasionally, pelvic osteosyntheses can be carried out using screws alone, but in the majority of cases lag screw fixations must be supplemented by one or more plates.

The bone surfaces in the pelvic region have a very complex topography. In order to achieve accurate fixation, the plates should be contoured to the bone surface. Poorly contoured plates can lead to fracture displacement when the screws are fully tightened through the plate.

The design of the reconstruction plates allow for contouring in all three planes.

Uniform cross-sectionImproved contourability

• Profile: 3.7 mm• Screw angulation: up to 30°• Holes: 3 –20 (straight)• Allow the use of cortex screws

and/or pelvic cortex screws 3.5 mm

3.5 mm Reconstruction Plates with low profile

3.5 mm Reconstruction Plates with wide Angle

• Low profile: 2.7 mm• Screw angulation: up to 25°• Holes: 3 –20 (straight),

6 –16 (curved), 10 –16 (J-shaped) • Reconstruction Plate with low

profile, curved:– Available in two radii (88 mm

and 108 mm) to fit the average pelvis of a female or male, respectively

– Allows the use of cortex screws and/or pelvic cortex screws 3.5 mm

• Reconstruction Plate with low profile, J-shaped: hybrid of curved and straight:– One leg of the plate is straight,

while the other leg is bent with a radius of 88 mm

– Left and right– Fits along pelvic brim, from

the pubic rami (curved part of the plate) to the SI joint (straight end of the plate)


Low profile and rounded edgesReduce the risk of soft tissue irritation.

Coaxial combi-holes in locking platesAllow the use of locking screws or cortex screws in the same round conical plate hole.

• Profile: 3.7 mm• Screw angulation:

up to 12° (cortex screws)• Holes: 3–20 (straight),

10–16 (J-shaped)• Features coaxial combi-holes

(this means the plate can be used with standard cortex screws 3.5 as well as with 3.5 locking screws)

• Fits the anatomy of the pubic symphysis

• Coaxial combi-holes accept 3.5 locking screws as well as standard/pelvic cortex screws (3.5)

• Radius of 60 mm• Reinforced midsection of plate • 3 small holes in midsection can

be used to attach sutures • 4 versions:

– 4 coaxial combi-holes – 6 coaxial combi-holes – 2 DCU holes and 2 coaxial

combi-holes*– 2 DCU holes and 4 coaxial

combi-holes*

* DCU: Dynamic Compression Unit

• Reduces and stabilizes small bone fragments that are too small for screws.

• Can be used individually or with a 3.5 mm reconstruction plate.

• Pre-bent convex shape with two sharp spikes on the bottom surface. Reduction is achieved by sinking spikes into small fragments while tightening a screw through one of the screw holes.

• Convex shape for better bone retention. Small fragments are preloaded once a screw is inserted which allows the plate to adapt better to bony, uneven surfaces.

• Allows the use of cortex screws and/or pelvic cortex screws 3.5 mm.

3.5 mm Locking Reconstruction Plate

3.5 mm Pubic Symphysis Plate 3.5 mm Spring Plate


AO Principles

1

4

2

3

4_Priciples_03.pdf 1 05.07.12 12:08

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique

AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, 2.

1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.

2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1, 2

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; 1991.

2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart New York: Thieme; 2007.


Intended Use, Indications and Contraindications

Intended UsePelvic implants are intended for temporary fixation, correction or stabilization of bones in the pelvis.

Indications

Symphysis fractures• Pubic Symphysis Plates

Pelvic brim fractures• Reconstruction Plates

– Straight Plates – Curved Plates (88 mm radius, 108 mm radius) – J-Plates

• 3.5 mm Locking Reconstruction Plate – Straight Plates – J-Plates

• 3.5 mm Wide Angle Reconstruction Plates – Straight Plates

Ilium/Iliac wing fractures • Reconstruction Plates

– Straight Plates – Curved Plates (88 mm radius, 108 mm radius)

• 3.5 mm Locking Reconstruction Plates – Straight Plates

• 3.5 mm Low Profile Reconstruction Plates with wide Angle – Straight Plates

Acetabulum fractures• Reconstruction Plates

– Straight Plates – Curved Plates (88 mm radius, 108 mm radius)

• 3.5 mm Reconstruction Plates with wide Angle – Straight Plates

ContraindicationsNo specific contraindications.Intended use for in-situ plate contouring: Refer to page 16.


Instruments

StandardInstruments for screw fixationScrew fixation of the pelvis requires the use of extra-long screws and corresponding instruments. The following instruments are part of the Pelvic Instrument Set:

• Extra-long 3-fluted calibrated drill bit• Extra-long taps, calibrated with depth markings• Extra-long screwdrivers (hexagonal and StarDriveTM

recess) and screwdriver shafts (hexagonal and StarDrive recess)

• Extra-long depth gauge

Bending instruments• The bending pliers should be used as the primary

bending instrument. • A smooth bend is best achieved by the introduction

of many small bends.• Bending irons, designed specifically for use with

the reconstruction plates, are also available.


In-situ bending instruments• In-situ bending instruments allow precise intraoperative

adaptation of the pre-bent reconstruction plate to the bone anatomy.

• The in-situ bending and twisting handles with different tips (straight, 90°, 120°) allow use in different surgical approaches.

In-situ Bender

In-situ Bending and Twisting Handles

Bending templates

Malleable bending templates are available for all recon-struction plate shapes (straight, curved, J-shaped). These can be fi tted to the reduced bone and then a plate is shaped to fi t the template.

Precaution: Reverse bending or use of the incorrect instrumentation for bending may weaken the plate and lead to premature plate failure (e.g. breakage). Do not bend the plate beyond what is required to match the anatomy.

The templates can also be used to determine plate lengths.


RetractorsA wide range of malleable, blunt, spoon shaped, pelvic, Hohmann and sciatic nerve retractors provide more options to aid the surgeon with the chosen approach.

Instruments


Radiolucent retractorsRadiolucent retractors allow for the passage of x-rays without having to remove the instrumentation in order to visualize the implant underneath. Another advantage of these retractors is their light weight.

In an effort to accommodate the surgeon needs, DePuy Synthes has redesigned several retractors in aluminum, thus making them radiolucent.


Pelvic reduction forcepsThe pelvic reduction forceps are designed to maximize the potential of the ilioinguinal and Kocher-Langenbeck approaches. The jaws of all the larger forceps are long enough to accommodate the innominate bone, from the iliac crest to the pelvic brim, and can be used without exerting excess pressure on the iliac vessels.

Pelvic reduction forceps are equipped with features to improve handling characteristics during reduction maneuvers.• Pointed-ball tips prevent penetration of bone with

a thin cortex.• Longer spikes with sharper points provide a secure

hold on the pelvic surfaces.

Increased selection of forceps, including• Handles and jaws of different lengths• Straight and oblique versions

Ball spikes with pointed ball tipThe straight ball spikes facilitate reduction of bone fragments. They feature a spike to reduce the risk of the instrument slipping off the bone and a pointed-ball tip to prevent penetration of bone with a thin cortex.

Round and rectangular disksDisks can be used in conjunction with the reduction forceps with pointed ball-tips or the ball spike instruments. In poor quality bone (osteoporotic), they can aid in dis-tributing the applied forces over a larger surface area in effort to prevent iatrogenic or compression fractures.

Reduction

Instruments


Pelvic reduction forceps for screwsAll forceps have been designed for use with 3.5 mm/ 4.5 mm screws inserted on opposite sides of a fracture line, which allows the application of considerable reduction forces and manipulation in all three planes.

The large forceps have long handles for the transferal of large forces. The Farabeuf forceps can be either used with screws or as general bone forceps, i.e. to grasp and manipulate the iliac wing. • Jungbluth large (330 mm), small (250 mm),

for B 3.5 mm screws• Farabeuf medium (250 mm), small (190 mm),

for Cortex Screws B 3.5 and 4.5 mm

Reduction forceps with points These standard forceps can be applied directly to the bone’s surface, or be used with shallow drill holes or anchoring rings and hooks.

Medium and large bone hooksThe bone hooks are designed to allow the surgeon to mani pulate the bone or bone fragments in order to ensure proper alignment and to achieve an anatomical reduction.


Plate Contouring

Surgical Technique

1. Contour plate

Instruments

03.100.031 Bending Pliers for 3.5 mm Low Profile Reconstruction Plates

329.08 Bending Iron for 3.5 mm and 4.5 mm Reconstruction Plates

For plate contouring, place a plate between the ledge and the groove of the bending pliers. Place the concave surface on the side of pliers with the ledge. Squeeze the handles gradually and bend the plate as appropriate. (1)

For in-plane bending, place a plate into the groove of the bending pliers. Squeeze the handles gradually and bend the plate as appropriate. (2)

Precautions:• Instruments and screws may have sharp edges

or moving joints that may pinch or tear user’s glove or skin.

• Handle devices with care and dispose worn bone cutting instruments in an approved sharps container.

1

2


2. Twist plate

Instruments

03.100.031* Bending Pliers for 3.5 mm Low Profile Reconstruction Plates

329.08 Bending Iron for 3.5 mm and 4.5 mm Reconstruction Plates

Hold the plate using the plier grips and twist the plate by using an additional bending iron.

Precaution: Reverse bending or use of the incorrect instrumentation for bending may weaken the plate and lead to premature plate failure (e.g. breakage). Do not bend the plate beyond what is required to match the anatomy. For reconstruction plates with coaxial combi-holes: use threaded pin to avoid screw hole deformation during bending.

Note: The bending pliers (03.100.031)* are intended for use with the 3.5 mm Reconstruction Plates contained in the 3.5 mm Low Profile Pelvic System.


Plate Contouring

In-situ Plate ContouringIn-situ bending instruments adjust the pre-bent, reconstruction plates on the bone to match relevant patient anatomy during a surgical procedure. Using these instruments helps decrease the surgical time by reducing the need for repeated cycles of plate positioning and removal until the plate has been sufficiently shaped.

The instruments are intended for use with the following plate systems:• 3.5 mm Reconstruction Plates with low profile

(straight, curved and J-shaped)• 3.5 mm Reconstruction Plates with wide Angle• 3.5 mm DCP Reconstruction Plates, straight and curved

These instruments are not intended for plates with locking and coaxial Combi holes. In particular:• 3.5 mm Locking Reconstruction Plates• 3.5 mm Pubic Symphysis Plates• 3.5 mm Spring Plates• 3.5 mm Reconstruction Plates with coaxial combi-holes• Other plate sizes than 3.5 mm

Note: Preoperative pre-bending of the reconstruction plates is always required before in-situ plate bend-ing. The in-situ bending instruments are intended for detailed and accurate adaptation of the plates to the local anatomy.

Precautions:• Do not bend the plate at the level of the holes.• Reverse bending or use of the incorrect instrumen-

tation for bending may weaken the plate and lead to premature plate failure (e.g. breakage). Do not bend the plate beyond what is required to match the anatomy.


1. Contour plate: in-situ bending or correction of the bending radius

Instrument

03.100.090 In-situ Bending Pliers for use with Pelvic Reconstruction Plates

Grasp the preliminary fixated plate with the in-situ bender. The nose and counter-bearing mouth of the bender must sit in the notches of the reconstruction plate.

Squeeze the handles and bend the plate as required.

2. Bend or twist plate

Instruments

03.100.091 In-situ Bending and Twisting Handle, straight

03.100.092 In-situ Bending and Twisting Handle, 90°


Use two straight In-situ Bending and Twisting Handles.Place the tip of each handle in the plate hole. One handle is used for holding the plate while the second handle is mani pulated to bend or twist the plate accordingly.

Note: The In-situ Bending and Twisting Handle, straight can be combined with the In-situ Bending and Twisting Handle, 90° or 120° where appropriate.

Precaution: Ensure that the tip of the instrument is properly attached to the plate to prevent slippage.


Note: The following cases of fracture fixation repre-sent possible uses of pelvic instruments. Several applications are shown but other applications are possible.

1. Approach

Use an anterior approach (e.g. Pfannenstiel or Stoppa).

A. Pubic Symphysis Fractures

Fracture Fixation


1

2

3

2. Reduce fracture

Instruments

399.98 Reduction Forceps, with Points, Ratchet, 200 mm

398.75 Medium Pelvic Forceps, 250 mm

398.88 Pelvic Reduction Forceps

Achieve reduction of the pubic symphysis by using the large reduction forceps with points. (1)

Alternatively, achieve reduction by inserting two screws anteriorly and using pelvic reduction forceps (398.75/398.88). (2,3)


Fracture Fixation

3. Fix plate

Instruments

03.100.032 Ratcheting Handle with Quick Coupling

03.100.033 3.5 mm Screwdriver Shaft, hexagonal, long

324.214 2.8 mm Percutaneous Drill Bit Quick Coupling, 200 mm, 100 mm Calibration

311.31 Tap for 3.5 mm Cortex Screws, 175 mm/140 mm calibrated

312.648 2.8 mm Threaded Drill Guide

314.09 Holding Sleeve

314.57 Small Hexagonal Screwdriver, long

315.92 2.5 mm three-fluted Drill Bit, QC/230 mm/200 mm Calibration

319.091 Depth Gauge for 3.5 mm Cortex Screws

511.773 Torque Limiting Attachment, 1.5 Nm, Quick Coupling

Alternative instruments

03.100.045 StarDrive Screwdriver Shaft T15, 250 mm, long

314.115 StarDrive Screwdriver T15


1 2

3

Place the 3.5 mm Pubic Symphysis Plate over the symphysis joint and make a temporary fixation (e.g. with plate holding forceps).

According to preoperative planning and plate selection (locking/non-locking), use B 3.5 mm cortex screws and/or B 3.5 mm locking screws to fix the plate. If compression is needed between the symphysis joint, use the plate with DCU holes.

Insert the first cortex screw in the lateral part of DCU hole (eccentric). Insert the second cortex screw eccentrically into the DCU hole of the contralateral side of the pubic symph ysis. (1,2)

Precaution: Check appropriate length and position of screw under image intensifier control.

Alternate tensioning of the screws results in compression of the symphysis.

Additional locking screws should be inserted according to the LCP® Locking Compression Plate surgical technique DSUS/TRM/1016/1165. (3)

Notes:• Refer to the LCP Locking Compression Plate

DSUS/TRM/1016/1165 surgical technique for lag screw placement and plating.

• StarDrive Screwdriver Shaft T15 (03.100.045) and StarDrive Screwdriver T15 (314.115) are used for B 3.5 mm StarDrive screws.


1. Approach

Use an anterior or posterior approach appropriate for the fracture pattern. The following example of an iliac fracture shows a possible fracture treatment using a posterior (Kocher – Langenbeck) approach.

2. Reduce fracture

Instruments

398.74 Small Pelvic Forceps, 200 mm


Confirm anatomical reduction of the anterior aspect of the iliac wing by finger palpation.

To reduce the iliac bone, use reduction forceps on the iliac crest and the posterior iliac wing.

Fracture Fixation

B. Iliac Fractures

1

2


Alternative technique

Instruments

311.31 Tap for 3.5 mm Cortex Screws, 175 mm/140 mm, calibrated


315.92 2.5 mm three-fluted Drill Bill, QC/230 mm/200 mm Calibration


398.75 Medium Pelvic Forceps, 250 mm

398.88 Pelvic Reduction Forceps


Alternatively, insert two temporary cortex screws on either side of the fracture line and gain compression using pelvic reduction forceps: 398.75 Farabeuf (1) or 398.88, Jungbluth (2).


3. Fix plate on posterior inferior ilium

Instruments








399.091 Bone Holding Forceps, soft, Ratchet, F/Plates to 9 mm wide



03.100.045 StarDrive Screwdriver Shaft T15 250 mm, long


Fracture Fixation

1 2

3 4


Insert a screw through the 4-hole low profile pelvic reconstruction plate into the body of the ilium, close to the sciatic notch. (1)


To reduce the posterior iliac fragment, insert a temporary screw into the posterior superior iliac spine. (2)

Compress the fracture using the bone holding forceps. The forceps is therefore hooked into the most posterior plate hole and the temporary screw on the other side of the fracture line is used as a counter bearing. (3)

After additional screw fixation through the plate, remove the temporary screw. (4)

Precaution: During fixation close to the greater sciatic notch, control drill bit penetration and screw lengths with two-finger palpation to prevent damage to the nerve or vessels.

Note: Refer to the LCP Locking Compression Plate DSUS/TRM/1016/1165 surgical technique for lag screw placement and plating.


4. Fix plate on iliac crest

Instruments

03.100.018 Straight Ball Spike, 6.5 mm ball diameter, 320 mm












Fracture Fixation


Place a low profile pelvic reconstruction plate posterior to the iliac crest, and fix it with B 3.5 mm cortex screws.

The ball spike with pointed ball tip may also be used to achieve reduction.




1. Approach

Use an ilioinguinal approach.

C. Acetabulum Two Column Fractures

Fracture Fixation

1

2

3


2. Reduce fracture in iliac crest

Instruments

03.100.019 Straight Ball Spike, long, 6.5 mm Ball Diameter, 420 mm

294.68 6.0 mm Schanz Screw, Spade Point, 190 mm



Insert a Schanz screw into the proximal femur to allow intraoperative manual traction. (1)

Confirm anatomic reduction of the different fracture fragments. Fragments may be temporarily fixated with Kirschner wires. (2)

Different reduction instruments (e.g. ball spike, reduction forceps) may aid in achieving appropriate reduction. (2,3)

Note: For a detailed handling description of the Schanz screws, refer to the corresponding surgical technique for the Large External Fixator – Pelvic Frame (DSUS/TRM/0814/0215).


3. Insert screw in iliac crest

Instruments



310.37 3.5 mm Drill Bit, QC/195 mm











Fracture Fixation


Insert a B 3.5 mm cortex screw (lag screw) into the iliac crest perpendicular to the fracture line.


Use the pelvic reduction forceps and/or the large reduction forceps with points to maintain reduction.

Precaution: Use oscillating mode while drilling to avoid soft tissue damage and penetration of the ante-rior or posterior iliac cortex.

4. Insert screw in body of ilium

Instrument

03.100.023 Reduction Forceps for Low Profile Pelvic System, 400 mm

Insert a second lag screw into the body of the ilium perpendicular to the fracture line.


Use the pelvic reduction forceps to maintain reduction.


5. Reduce posterior column

Instrument


Use the reduction forceps with points to reduce the fragment of the quadrilateral surface. The forceps bridge from the pelvic brim to the quadrilateral surface.

Alternative technique

Instruments

03.100.020 Pelvic Reduction Forceps, straight, with pointed ball tips B 6.5 mm

03.100.022 Pelvic Reduction Forceps, angled, with pointed ball tips B 6.5 mm

03.100.029 Bone Hook, medium, long, length 330 mm

03.100.120 Spiked Round Disk for 6.5 mm Ball

314.291 Sliding Mechanism for Collinear Reduction Clamp

398.753 Pelvic Arm, 225 mm, for Collinear Reduction Clamp

Alternatively the pelvic reduction forceps with pointed ball tips (straight or angled) can be used to reduce the fracture.

If necessary, spiked discs can be used with all pelvic reduction forceps with ball tips. (1)

1

Fracture Fixation


The collinear reduction clamp with pelvic arm is useful to reduce the posterior column. (2)

The bone hook placed beneath the ischial spine may also be used to reduce the posterior column. (3)

Note: For a detailed handling description of the col-linear reduction clamp, refer to the corresponding surgical technique (DSUS/TRM/0417/1437).

2

3


6. In-situ plate contouring

If preoperative bending is insufficient after plate positioning, insertion and tightening of the first screws, the in-situ bending instruments can be used to further adapt the plate to the local anatomy.

Instruments

03.100.090 In-situ Bending Pliers for use with Pelvic Reconstruction Plates

03.100.091 In-situ Bending and Twisting Handle, straight



If in-situ plate adaptation is required, use the in-situ bending instruments as described on page 16.

Fracture Fixation


If plate needs to be bent or twisted to fit the local anatomy, the in-situ bending and twisting handles should be used as described on page 16.


7. Fix plate on pelvic brim

Instruments

03.100.019 Straight Ball Spike, long, 6.5 mm Ball Diameter, 420 mm



311.31 Tap for 3.5 mm Cortex Screws 175 mm/140 mm, calibrated


314.291 Sliding Mechanism for Collinear Reduction Clamp




398.753 Pelvic Arm, 225 mm, for Collinear Reduction Clamp




Fracture Fixation


Fix a J-plate with B 3.5 mm cortex screws on the pelvic brim. Lag screws through the plate help to achieve a stable fixation between the anterior and posterior column.


8. Fix plate on pubic rami

Insert additional screws through the plate into the pubic rami to maintain reduction and stable fixation of the anterior column.




Unlock all screws from the plate, then remove the screws completely from the bone. This prevents simultaneous rotation of the plate when unlocking the last locking screw.

For details regarding implant removal refer to the surgical technique “Screw Removal Set” DSUS/TRM/1016/1197.

Implant Removal


Graphic Case Components690.426 Lid for 3.5 mm Low Profile Pelvic

System Implant Set690.436 Tray for 3.5 mm Low Profile Reconstruction Plates690.437 Tray for 3.5 mm Low Profile Pelvic System Cortex Screws690.438 Screw Rack for 3.5 mm Low Profile Locking Screws690.912 Two Level Graphic Case Base Instruments03.100.034 Bending Template, 20 holes, 260 mm03.100.036 Bending Template for 3.5 mm Low Profile Reconstruction Plate, 88 mm radius, 16 holes03.100.037 Bending Template for 3.5 mm Low Profile Reconstruction Plate, 108 mm radius, 16 holes319.97 Screw Forceps

3.5 mm Low Profile Pelvic System Implant Set (01.100.002)

Product Overview

Product Information

Implants3.5 mm Pelvic Cortex Screws, self-tapping Length (mm) Qty.204.640 40 4204.645 45 4204.650 50 4204.655 55 4204.660 60 4204.665 65 4204.670 70 4204.675 75 2204.680 80 2204.685 85 2204.690 90 2204.695 95 2

Length (mm) Qty.204.700 100 2204.705 105 2204.710 110 2204.715 115 2204.720 120 2204.725 125 2204.730 130 2204.735 135 2204.740 140 2204.745 145 2204.750 150 2

For detailed cleaning and sterilization instructions, please refer to www.depuysynthes.com/hcp/cleaning-sterilization or sterilization instructions, if provided.


Implants continued

3.5 mm Cortex Screws, self-tapping Length (mm) Qty.204.810 10 4204.812 12 4204.814 14 4204.816 16 4204.818 18 4204.820 20 4204.822 22 4204.824 24 4

Length (mm) Qty.204.826 26 4204.828 28 4204.830 30 4204.832 32 4204.834 34 4204.836 36 4204.838 38 4

3.5 mm Locking Screws, self-tapping, with StarDrive recess Length (mm) Qty.212.101 10 4212.102 12 4212.103 14 4212.104 16 4212.105 18 4212.106 20 4212.107 22 4212.108 24 4212.109 26 4212.110 28 4212.111 30 4212.112 32 4212.113 34 4212.115 36 4

Length (mm) Qty.212.116 38 4212.117 40 4212.119 45 2212.121 50 2212.123 55 2212.124 60 2212.125 65 2212.126 70 2212.127 75 2212.128 80 2212.129 85 2212.130 90 2212.131 95 2

219.98 Washer, 7.0 mm, 4 ea.

Product Overview


3.5 mm Low Profile Reconstruction Plates, 2 ea. Holes Length (mm)245.023 3 39245.024 4 52245.025 5 65245.026 6 78245.027 7 91245.028 8 104245.029 9 117245.030 10 130

Holes Length (mm)245.031 11 143245.032 12 156245.033 13 169245.034 14 182245.035 15 195245.036 16 208245.038 18 234245.039 20 260

3.5 mm Low Profile Curved Reconstruction Plates, 2 ea.88 mm 108 mmradius radius Holes Length (mm)245.906 245.876 6 78245.908 245.878 8 104245.910 245.880 10 130245.912 245.882 12 156245.914 245.884 14 182245.916 245.886 16 208

Implants continued

3.5 mm Pubic Symphysis Plates, with coaxial Combi holes,2 ea. Holes Length (mm)02.100.004 4 5702.100.006 6 78

Also Available3.5 mm Pubic Symphysis Plates, with 2 central DCP Holes Holes Length (mm)02.100.014 4 5702.100.016 6 78

3.5 mm Spring Plates* Holes02.100.301 102.100.302 202.100.303 3

* These implants are available nonsterile or sterile-packed. Add “S” to product number for sterile product.


Additional Implant Trays – 3.5 mm Locking Low Profile Reconstruction Plate Tray (01.100.042)Tray690.435 Tray for 3.5 mm Locking Low Profile

Reconstruction Plates Instruments02.200.003 3.5 mm Threaded Plug, StarDrive, 4 ea.03.100.034 Bending Template, 20 holes, 260 mm03.100.040 2.8 mm Threaded Drill Guide, short, 35 mm long, 2 ea.03.100.045 3.5 mm StarDrive Screwdriver Shaft, T15, 250 mm long, 2 ea.310.288 2.8 mm Drill Bit, quick coupling, 165 mm, 2 ea.312.648 2.8 mm Threaded Drill Guide, 2 ea.324.031 Threaded Plate Holder, long324.214 2.8 mm Percutaneous Drill Bit, quick coupling, 200 mm, 100 mm calibration, 2 ea.511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling

Implants3.5 mm Pubic Symphysis Plates, with coaxial Combi holes,2 ea. Holes Length (mm)02.100.004 4 5702.100.006 6 78

3.5 mm Locking Low Profile Reconstruction Plates, 2 ea. Holes Length (mm)02.100.103 3 3902.100.104 4 5202.100.105 5 6502.100.106 6 7802.100.107 7 9102.100.108 8 10402.100.109 9 11702.100.110 10 130

Holes Length (mm)02.100.111 11 14302.100.112 12 15602.100.113 13 16902.100.114 14 18202.100.115 15 19502.100.116 16 20802.100.118 18 23402.100.120 20 260

Product Overview


Also Available3.5 mm Pubic Symphysis Plates, with 2 central DCP holes Holes Length (mm)02.100.014 4 5702.100.016 6 78


Additional Implant Trays – 3.5 mm Wide Angle Low Profile Reconstruction Plate Tray (01.100.022)Tray690.424 Tray for 3.5 mm Low Profile Wide Angle Reconstruction Plates Instruments03.100.034 Bending Template, 20 holes, 260 mm

Wide angle plates feature larger diameter holes in a thicker plate, allowing maximum screw angulation.

Implants3.5 mm Wide Angle Low Profile Reconstruction Plates, 2 ea. Holes Length (mm)02.100.203 3 3902.100.204 4 5202.100.205 5 6502.100.206 6 7802.100.207 7 9102.100.208 8 10402.100.209 9 11702.100.210 10 130

Holes Length (mm)02.100.211 11 14302.100.212 12 15602.100.213 13 16902.100.214 14 18202.100.215 15 19502.100.216 16 20802.100.218 18 23402.100.220 20 260

28°

Product Overview


Additional Implant Trays – 3.5 mm Low Profile Reconstruction J-Plate Tray (01.100.032)Tray690.423 Tray for 3.5 mm Low Profile Recon - struction J-Plates Instruments03.100.035 Bending Template for 3.5 mm Low Profile Reconstruction J-Plates, 16 holes, 2 ea.03.100.036 Bending Template for 3.5 mm Low Profile Curved Reconstruction Plate, 88 mm radius, 16 holes, 2 ea.

Implants3.5 mm Low Profile Reconstruction J-Plates, 88 mm radius, 2 ea.Locking Non-locking Holes Length (mm)02.100.360 245.920 10 130 right02.100.362 245.922 12 156 right02.100.364 245.924 14 182 right02.100.366 245.926 16 208 right

02.100.361 245.930 10 130 left02.100.363 245.932 12 156 left02.100.365 245.934 14 182 left02.100.367 245.936 16 208 left

3.5 mm Low Profile Curved Reconstruction Plates, 88 mmradius, 2 ea. Holes Length (mm)245.906 6 78245.908 8 104


Additional Implant Trays – 3.5 mm Low Profile Pelvic System StarDrive Screw Tray, without Locking Screws (01.100.132)Tray690.439 Tray for 3.5 mm Low Profile Pelvic System StarDrive Cortex Screws Instruments314.116 StarDrive Screwdriver Shaft, T15, quick coupling319.97 Screw Forceps

Implants3.5 mm Cortex Screws, self-tapping, with T15 StarDrive recess Length (mm) Qty.02.200.010 10 402.200.012 12 402.200.014 14 402.200.016 16 402.200.018 18 402.200.020 20 402.200.022 22 402.200.024 24 402.200.026 26 402.200.028 28 402.200.030 30 402.200.032 32 402.200.034 34 402.200.036 36 402.200.038 38 402.200.040 40 402.200.042 42 402.200.044 44 402.200.045 45 402.200.046 46 402.200.048 48 4

Length (mm) Qty.02.200.050 50 402.200.055 55 402.200.060 60 402.200.065 65 402.200.070 70 402.200.075 75 202.200.080 80 202.200.085 85 202.200.090 90 202.200.095 95 202.200.100 100 202.200.105 105 202.200.110 110 202.200.115 115 202.200.120 120 202.200.125 125 202.200.130 130 202.200.135 135 202.200.140 140 202.200.145 145 2 02.200.150 150 2

Product Overview


Additional Implant Trays – 3.5 mm Low Profile Pelvic System Screw Rack for Locking Screws (01.100.122)Screw Rack690.438 Screw Rack for 3.5 mm Low Profile Locking Screws

Implants3.5 mm Locking Screws, self-tapping, with StarDrive recess Length (mm) Qty.212.101 10 4212.102 12 4212.103 14 4212.104 16 4212.105 18 4212.106 20 4212.107 22 4212.108 24 4212.109 26 4212.110 28 4212.111 30 4212.112 32 4212.113 34 4212.115 36 4

Length (mm) Qty.212.116 38 4212.117 40 4212.119 45 2212.121 50 2212.123 55 2212.124 60 2212.125 65 2212.126 70 2212.127 75 2212.128 80 2212.129 85 2212.130 90 2212.131 95 2


Additional Instrument Sets – 3.5 mm Low Profile Pelvic System Instrument Set (01.100.013)Graphic Case Components690.427 Lid for 3.5 mm Low Profile Pelvic System Instruments690.431 Tray for 3.5 mm Low Profile Pelvic System Instruments690.912 Two Level Graphic Case Base

Instruments03.100.031 Bending Pliers for 3.5 mm Reconstruction Plates03.100.032 Ratcheting Handle with quick coupling03.100.033 3.5 mm Screwdriver Shaft, hexagonal, 250 mm length, 2.5 mm width across flats, 2 ea.03.100.045 3.5 mm StarDrive Screwdriver Shaft, T15, 250 mm length310.37 3.5 mm Drill Bit, quick coupling, 195 mm, 2 ea.311.31 Tap for 3.5 mm Cortex Screws, 175 mm, 140 mm, calibrated, 2 ea.314.09 Holding Sleeve314.57 Small Hexagonal Screwdriver, 270 mm length315.92 2.5 mm three-fluted Drill Bit, quick coupling, 230 mm/200 mm calibration, 2 ea.319.091 Depth Gauge324.210 2.5 mm Percutaneous Drill Bit, quick coupling, 300 mm, 200 mm calibration, 2 ea.329.08 Bending Iron, for 3.5 mm and 4.5 mm Reconstruction Plates, 190 mm length, 2 ea. (2 required)

Also Available311.431 Large Handle with quick coupling

Product Overview


Additional Instrument Sets – 3.5 mm Low Profile Pelvic System Retractor Set (01.100.004)Graphic Case Components690.421 Lower Tray for 3.5 mm Low Profile Pelvic Retractors690.422 Lid for 3.5 mm Low Profile Pelvic Retractors690.432 Upper Tray for 3.5 mm Low Profile Pelvic Retractors690.913 Three Level Graphic Case Base

Instruments03.100.011 Spoon Retractor, medium, 268 mm03.100.012 Spoon Retractor, large, 323 mm03.100.013 Sciatic Nerve Retractor03.100.014 Sciatic Nerve Retractor, long

Malleable Retractors03.100.015 20 mm width, 330 mm length03.100.016 30 mm width, 330 mm length03.100.017 40 mm width, 330 mm length

398.55 Blunt Pelvic Retractor, 2 ea.399.27 Hohmann Retractor, 18 mm width, 242 mm length, long narrow tip

Also Available03.100.107 Aluminum Blunt Pelvic Retractor Aluminum Hohmann Retractors03.100.108 35 mm width03.100.109 18 mm width03.100.110 24 mm width

03.100.111 Aluminum Spoon Retractor, medium03.100.112 Aluminum Spoon Retractor, large

Graphic Case Components690.428 Lid for 3.5 mm Low Profile Pelvic System Reduction Instruments690.433 Lower Tray for 3.5 mm Low Profile for Pelvic Reduction Instruments690.434 Upper Tray for 3.5 mm Low Profile for Pelvic Reduction Instruments690.913 Three Level Graphic Case Base

Instruments294.68 6.0 mm Schanz Screw, 190 mm length, spade point, 4 ea.03.100.018 Straight Ball Spike, 6.5 mm ball diameter, 320 mm03.100.019 Straight Ball Spike, long, 6.5 mm ball diameter, 420 mm03.100.020 Straight Reduction Forceps with pointed ball tips, 6.5 mm ball diameter03.100.021 Angled Forceps, small, with pointed ball tips, 6.5 mm ball diameter, 195 mm03.100.022 Angled Forceps, large, with pointed ball tips, 6.5 mm ball diameter03.100.023 Reduction Forceps with pointed ball tips, 6.5 mm ball diameter, 400 mm03.100.024 Asymmetric Reduction Forceps, with pointed ball tips, 6.5 mm diameter03.100.025 Reduction Forceps for 3.5 mm Screws, 250 mm03.100.027 Round Disc, 6.5 mm hole diameter, 2 ea.03.100.028 Rectangular Disc, 6.5 mm hole diameter, 2 ea.03.100.029 Medium Bone Hook, long, 330 mm03.100.030 Large Bone Hook, long, 330 mm393.10 Universal Chuck with T-Handle398.65 Forceps, for broken screw removal398.74 Small Pelvic Forceps, 200 mm398.75 Medium Pelvic Forceps with jaws, for large screws, 250 mm length398.88 Pelvic Reduction Forceps, speed lock, 330 mm length399.98 Reduction Forceps, with Points, Ratchet, 200 mm


Additional Instrument Sets – 3.5 mm Low Profile Pelvic System Reduction Instrument Set (01.100.003)

Product Overview


Also Available03.100.120 Spiked Round Disk03.100.121 Spiked Rectangular Disk398.52 Medium Bone Hook, 230 mm length, for tibia and pelvis398.53 Large Bone Hook, 200 mm


The 3.5 mm Low Profile Pelvic System is modular and canbe customized to match the customer’s needs.

Trays (with Trays implants) (without implants)

01.100.005 60.100.002 4.5 mm Cortex Screws and Instrument Set, with self-tapping screws

01.100.006 60.100.002 4.5 mm Cortex Screws and Instrument Set, with non-self-tapping screws

01.100.012 690.436 Tray for 3.5 mm Low Profile Reconstruction Plates

01.100.022 690.424 Tray for 3.5 mm Low Profile Wide Angle Reconstruction Plates

01.100.032 690.423 Tray for 3.5 mm Low Profile Reconstruction J-Plates

01.100.042 690.435 Tray for 3.5 mm Locking Low Profile Reconstruction Plates

01.100.122 690.438 Screw Rack for 3.5 mm Low Profile Locking Screws

01.100.132 690.439 Tray for 3.5 mm Low Profile Pelvic System StarDrive Cortex Screws (Locking screws sold separately)

Note: These implant trays do not include graphic cases or lids, which must be ordered separately. Each tray occupies one level in a graphic case; the trays can be combined, as required, in one, two or three level graphic cases.

Graphic Cases and Lid690.911 Single Level Graphic Case Base690.912 Two Level Graphic Case Base690.913 Three Level Graphic Case Base690.429 Lid for 3.5 mm Low Profile Pelvic System

Note: For the set contents of these implant trays, see previous pages.

Also Available


Configuration examples

Ordering only the wide angle plate set01.100.022 3.5 mm Wide Angle Low Profile Reconstruction Plate Tray690.911 Single Level Graphic Case Base690.429 Lid for 3.5 mm Low Profile Pelvic System

Ordering the wide angle plate set and J-plate set01.100.022 3.5 mm Wide Angle Low Profile Reconstruction Plate Tray01.100.032 3.5 mm Low Profile Reconstruction J-Plate Tray690.912 Two Level Graphic Case Base690.429 Lid for 3.5 mm Low Profile Pelvic System

Ordering the wide angle plate set, J-plate setand reconstruction plate set01.100.022 3.5 mm Wide Angle Low Profile Reconstruction Plate Tray01.100.032 3.5 mm Low Profile Reconstruction J-Plate Tray01.100.042 3.5 mm Locking Low Profile Reconstruction Plate Tray690.913 Three Level Graphic Case Base690.429 Lid for 3.5 mm Low Profile Pelvic System


Also Available

Instruments03.100.038 Curved Pelvic Osteotome, 15 mm blade width03.100.039 Curved Pelvic Osteotome, 20 mm blade width

Periosteal Elevators03.100.041 6 mm width, curved blade03.100.042 14 mm width, curved blade03.100.043 14 mm width, straight blade03.100.044 20 mm width, straight blade

03.100.107 Aluminum Blunt Pelvic Retractor

Aluminum Hohmann Retractors03.100.108 35 mm width03.100.109 18 mm width03.100.110 24 mm width

03.100.111 Aluminum Spoon Retractor, medium03.100.112 Aluminum Spoon Retractor, large

03.100.120 Spiked Round Disk03.100.121 Spiked Rectangular Disk

03.100.140 Handle, for Cannulated Percutaneous Guiding System03.100.141 2.5 mm Drill Sleeve, for Cannulated Percutaneous Guiding System03.100.142 3.5 mm Drill Sleeve, for Cannulated Percutaneous Guiding System311.431 Large Handle with quick coupling314.052 Trocar for 6.5 mm and 7.3 mm Cannulated Screws, 300 mm314.054 Trocar for 6.5 mm and 7.3 mm Cannulated Screws, long, 350 mm397.341 3.5 mm Cleaning Brush397.342 2.5 mm Drill Bit, Jacobs chuck, 400 mm, 140 mm calibration397.343 3.5 mm Drill Bit, Jacobs chuck, 380 mm398.52 Medium Bone Hook, 230 mm length, for tibia and pelvis398.53 Large Bone Hook, 200 mm length, for femur and pelvis

Trays60.100.002 Tray for 4.5 mm Cortex Screws and Instruments690.916 Full Tray (Blank)690.917 Full Tray Finger Mat

Sets01.100.005 4.5 mm Cortex Screw and Instrument Set with Self-tapping Screws01.100.006 4.5 mm Cortex Screw and Instrument Set

* These implants are available nonsterile or sterile-packed. Add “S” to product number for sterile product.

Implants3.5 mm Pubic Symphysis Plates with DCP Holes Holes Length (mm)02.100.014 4 5702.100.016 6 78

3.5 mm Spring Plates* Holes02.100.301 102.100.302 202.100.303 3


Collinear Reduction Clamp SetThe Collinear Reduction Clamp assists in achieving and maintaining fracture reduction in minimally invasive techniques. The system consists of sliding mechanism, attachable arms and reduction attachments according to the clinical needs.

Refer to surgical technique DSUS/TRM/0417/1437.

Cannulated Percutaneous Guiding System SetThe Cannulated Percutaneous Guiding System is a soft tissue protector to assist in pelvic and acetabular reconstructive surgery. It allows for less invasive placement of 3.5 mm cortex or pelvic screws as well as 4.0 cancellous screws. It accepts temporary fixation with Kirschner wires/guide wires up to B 2.8 mm.


Other Available Pelvic Instruments and Implants from DePuy Synthes


Other Available Pelvic Instruments and Implants from DePuy Synthes

Pelvic C-ClampThe Pelvic C-Clamp is an emergency stabilization instrument for unstable injuries and fractures of the pelvic ring. Unstable pelvic ring fractures can be associated with massive loss of blood that can cause terminal shock. The Pelvic C-Clamp allows rapid reduction and stabilization of these unstable pelvic ring fractures, thus assisting the surgeon to gain control of the shock reaction. This neither delays nor hinders subsequent diagnosis and therapy.


Large External FixatorIndications for stabilizing the anterior pelvic ring with a large external fixator are: Unstable fractures in the anterior pelvic ring, or symphysis fractures with or without participation of the posterior pelvic ring. This type of stabilization is also possible in emergencies such as polytrauma, open wounds and, where appropriate, as an alternative to internal osteosynthesis.

The pelvis can be stabilized with an external fixator both at the iliac crest and the supraacetabular region.

The clamps are magnetic resonance conditional. This allows magnetic resonance examinations of patients who have been stabilized with the external fixator.



Sacral BarsThe DePuySynthes 6.0 mm Threaded Sacral Bars offer an additional option for stabilization of the posterior pelvic ring. Two threaded bars are therefore drilled through the posterior iliac crests and by compression of the nuts, bridging and compression of the posterior pelvic ring is achieved.


3.5 mm Spring PlateThe DePuySynthes 3.5 mm Spring Plate is intended for reduction and fixation of small bone fragments.

In pelvic and acetabular surgery, it is often difficult to reduce and fix small bone fragments with screws because the fragments may break into even smaller pieces. Mainly in the joint areas (acetabulum) it is essential that even small fragments are anatomically reduced and help to achieve again a homogenous joint congruency. The 3.5 mm Spring Plates are intended to reduce and stabilize bone fragments that are too small for screws. They can be used individually or in con-junction with a 3.5 mm reconstruction plate.

Refer to surgical technique 103488055.

© DePuy Synthes 2018. All rights reserved.103488070 10/18 STä

Synthes USA, LLC 1101 Synthes AvenueMonument, CO 80132

Manufactured or distributed by:Synthes USA Products, LLC 1302 Wrights Lane EastWest Chester, PA 19380

To order (USA): 800-523-0322 To order (Canada): 800-946-8999

Note: For recognized manufacturer, refer to the product label.

www.depuysynthes.com

Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed.

Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information.

CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.

Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada.

Not all products may currently be available in all markets.

a dedicated system for reconstructive pelvic and ...synthes.vo.llnwd.net/o16/llnwmb8/us...

Documents