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CLAmP AND rOD INTErNAL fIXATION (CrIf) SYSTEmModular implant system for orthopaedic conditions

SurgICAL TEChNIquE

INTErNAL fIXATION INTErNAL fIXATION (CrIf) SYSTEm(CrIf) SYSTEmModular implant system for

SurgICAL TEChNIquE

Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet

INTrODuCTION

SurgICAL TEChNIquE

PrODuCT INfOrmATION

TAbLE Of CONTENTS

Clamp and rod Internal fixation System (CrIf) 2

Indications 2

AO Principles 4

Clinical Cases 5

Preparation 8

Lag Screw Placement (optional) 9

rod Preparation 9

Load Clamps on rod 11

Place Construct 12

Implants 14

Instruments 16

recommended Sets 19

Set Lists 20

2 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique

The DePuy Synthes Clamp and rod Internal fixation (CrIf) System is a modular implant system for veterinary use only and is composed of three components: clamps, rods, and screws. The rods can be cut to length and contoured in any plane.

Standard screws fi x the rod to bone via special clamps. Together, these form a unique internal construct that provides great versatility to the surgeon.

Features and Benefi ts• Three sizes available: mini, small, and medium• utilizes standard cortical and cancellous screws• Can be used with open or minimally invasive techniques• Versatile system requires less inventory• rods can be cut to length• rods can be contoured in multiple planes for

optimal anatomic fi t• Clamps can be positioned anywhere on the rod• Clamps can be rotated to either side of the rod to allow

optimal screw placement

CLAmP AND rOD INTErNAL fIXATION SYSTEm

reference: 1. Zahn K, frei r, Wunderle D, et al. mechanical properties of 18 different AO bone plates and the clamp-rod internal fi xation system tested on a gap model construct. Vet Comp Orthop Traumatol. 2008;21(3):185-94.

mini Small medium

Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 3

ImPLANT fEATurES

Rods• made of implant-quality medical grade stainless steel • Available in three diameters:

– mini (2.0 mm diameter)– Small (3.0 mm diameter)– medium (5.0 mm diameter)

• Offered in a variety of lengths• may be cut to length

Standard Clamps• Affi x to rod using standard screws• Slide axially to any point along length of rod• Screws can be placed through clamps on either

side of the rod• Screws can be angled up to 5º

End Clamps• Affi x to rod end using standard screws• grip end of rod and prevent axial slippage• Screws can be placed through clamps on either

side of the rod• Screws can be angled up to 5°• Distinguished by notch

Screws• Clamps accept standard DePuy Synthes screws• Either self-tapping or non-self-tapping screws can be used• use appropriate screws for each clamp size:

– mini (2.0 mm cortex)– Small (2.7 mm cortex)– medium (3.5 mm cortex/4.0 mm cancellous)

standard clamp

notch in end clamp

end clamp

mini—2.0 mm

Small—3.0 mm

medium—5.0 mm

Shown actual size


In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation.1 They are:

Anatomic Reductionfracture reduction and fixation to restore anatomical relationships.

Stable FixationStability by fixation or splintage, as the personality of the fracture and the injury requires.

Preservation of Blood SupplyPreservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques.

Early, Safe MobilizationEarly, safe mobilization of the part and patient.

The Clamp rod Internal fixation (CrIf) System is intended for canine and feline long-bone repair.

reference: 1. Johnson AL, houlton JEf, Vannini r. AO Principles of Fracture Management in the Dog and Cat. Davos Platz: AO Publishing. 2005.

AO PrINCIPLES

INDICATIONS


CLINICAL CASES

Patient treated with the Small CRIF SystemA 9-lb., eleven-month-old female cat presented with a comminuted fracture of the left femur.

Patient was treated with the Small CrIf System (3.0 mm rod, small clamps, and 2.7 mm cortex screws).

references: 1. Clinical cases courtesy of Clinic of Veterinary Surgery, Ludwig-maximilians—university of munich germany; Dr. ulrike matis, Dr. Klaus Zahn.2. Zahn K, matis u. The clamp rod internal fixator—application and results in 120 small animal fracture patients. Vet Comp Orthop Traumatol. 2004; 17(3):110–120.

Preoperative cranio-caudal Preoperative lateral

8-month follow-up cranio-caudal

8-month follow-up lateral

Postoperative cranio-caudal Postoperative lateral


Clinical Cases

Patient treated with the Medium CRIF SystemA 14-lb., five-year-old male dog presented with a Y-fracture of the left distal humerus.

Patient was treated with a 4.5 mm intercondylar cortical lag screw and the medium CrIf System (5.0 mm rod, medium clamps, and 3.5 mm cortex screws).

Patient treated with the Small CRIF SystemAn 11-lb., four-year-old female cat presented with a non-union of the right tibia 10 weeks after initial repair of a grade 3 open fracture with a Type II external fixator.

The fibula was shortened and the fracture debrided. Cancellous bone was used to fill the gap and the Small CrIf System was implanted (3.0 mm rod, small clamps, and 2.7 mm cortex screws).

Postoperative cranio-caudal

Postoperative lateral



Preoperative lateral



6-week follow-up cranio-caudal

6-week follow-up lateralPreoperative lateral

Preoperative cranio-caudal



Clinical Cases


Implant removal at 4-month follow-up cranio-caudal


Implant removal at 4-month follow-up lateral

Preoperative lateral




Patient treated with the Mini CRIF SystemAn 8.4-lb., eight-month-old female cat presented with a comminuted shaft fracture of the right femur.

Patient was treated with a 2.0 mm lag screw in the main fracture segment and a double mini CrIf System (2.0 mm rod, mini clamps, 2.0 mm cortex screws). removal of CrIf System resulted in remineralization of bone.

references: 1. Clinical cases courtesy of Clinic of Veterinary Surgery, Ludwig-maximilians—university of munich germany; Dr. ulrike matis, Dr. Klaus Zahn.2. Zahn K, matis u. The clamp rod internal fixator—application and results in 120 small animal fracture patients. Vet Comp Orthop Traumatol. 2004; 17(3):110–120.


SurgICAL TEChNIquE

1PreparationDetermine which CrIf System is most appropriate based on patient size, weight, bone, fracture pattern, and activity.

Ensure adequate soft tissue coverage where system is to be implanted. Implant profile is slightly larger than corresponding plate system.

Determine the length of the rod and number of clamps required, anticipating where each screw will be fixed to fragments.

Important: It is strongly suggested that at least three clamps and screws are placed in each main bone fragment, especially in soft bone.

CRIF System Product Reference Table

*See page 14 for detailed information

VC2000.01 mini Clamp VC3000.01 Small Clamp VC5000.01 medium Clamp

VC2000.02 mini End Clamp VC3000.02 Small End Clamp VC5000.02 medium End Clamp

Vr201.030– 2.0 mm rods Vr301.045– 3.0 mm rods Vr501.060– 5.0 mm rods Vr201.090 Vr301.120 Vr501.240

VS201.0XX– 2.0 mm Cortex Screws* VS204.0XX– 2.7 mm Cortex Screws* VS301.0XX– 3.5 mm Cortex Screws* VS202.0XX VS205.0XX VS302.0XX VS403.0XX– 4.0 mm Cancellous VS404.0XX Screws*

392.00 bending Irons 312.561 rod bender, for 3.0 mm 312.561 rod bender, for 3.0 mm (2 required) and 5.0 mm rods and 5.0 mm rods

392.970 rod holding forceps, 392.971 rod holding forceps, 392.972 rod holding forceps, for 2.0 mm rods for 3.0 mm rods for 5.0 mm rods

392.973 Clamp Spreader, 392.974 Clamp Spreader, 392.974 Clamp Spreader, for mini Clamps for Small and for Small and medium Clamps medium Clamps

Mini Small Medium


2Lag screw placement (optional)After reduction, one or more lag screws may be inserted for fracture compression before placement of the CrIf construct. Leave the periosteum intact whenever possible, to preserve the blood supply to the bone fragments.

Surgical Technique

3Rod preparation

Instrument

388.868 Template, for rods

using the rod template, determine required contour of rod.

Note: When clamps are planned for placement near acute bends, the clamps must be placed on the rod prior to rod contouring.


Surgical Technique

rod preparation

Instrument

312.561 rod bender, for 3.0 mm and 5.0 mm rodsor392.00 bending Iron (2 required)

Optional instruments

329.24 bending Pliers

329.241 Anvil for 3.0 mm–5.0 mm rods, for use with 329.24

329.30 Plate bending Press

388.911 bending Irons, for 5.0 mm rods, left

388.922 bending Irons, for 5.0 mm rods, right

Contour the rod using appropriate instrument as noted in the CrIf System reference Table on page 8, or any of the optional instruments listed.

If rod requires cutting, ensure signifi cant burrs are removed from cut ends prior to implantation.

To improve torsional stability, the contour of the rod should match the shape of the bone as closely as possible.

The etched line on the rod is a helpful reference for contouring in multi-planes.


4Load clamps on rod

Instruments

392.973– Clamp Spreaders392.974

392.970– rod holding forceps392.972

It is important to know the number of clamps to be used at this time, since adding clamps later is diffi cult and time-consuming.

Standard technique is to fi rst load all clamps on the contoured rod before placement in the operative site. Alternatively, clamps can be loaded during rod positioning, but this is challenging and should be avoided.

first, load one standard clamp in the clamp spreader. Place this clamp on the rod. Next, load the remaining standard clamps. Clamps can be loaded from both directions. Once all the standard clamps have been loaded on the rod, add the end clamps to the clamp and rod construct.

Tip: If desired, before loading, slightly compress the fl anges of end clamps with rod holding forceps so they will grip the rod. This will prevent the standard clamps from sliding off of the rod and aid in construct handling.

Surgical Technique


Surgical Technique

5Place construct

Instruments

319.01, Depth gauges*319.11

323.201, Drill guides*323.26, 323.36

392.970– rod holding forceps392.972

using the rod holding forceps, place the clamp and rod construct in the operative site. Orient each clamp to provide optimal screw purchase in the various bone fragments.

beginning at either end clamp, use the appropriate drill guide or soft tissue protection sleeve to drill the appropriate screw hole.

measure with the depth gauge, tap (if using non-self-tapping screws) and then insert an appropriate size screw.

*found in recommended Sets (see page 19)


The screw must be fully tightened in order for the clamp to securely grasp the rod. repeat for all remaining clamps.

Important: It is strongly suggested that at least three clamps and screws are placed in each main bone fragment, especially in soft bone.

Surgical Technique


ImPLANTS

2.0 mm Cortex ScrewsVS201.006– 6 mm–40 mm lengthsVS201.040

2.0 mm Cortex Screws, self-tappingVS202.006– 6 mm–40 mm lengthsVS202.040





4.0 mm Cancellous Screws, fully threadedVS403.010– 10 mm–70 mm lengthsVS403.070

4.0 mm Cancellous Screws, partially threadedVS404.010– 10 mm–70 mm lengthsVS404.070


ClampsVC2000.01 mini Clamp, VC2000.02 mini End Clamp,

– for use with 2.0 mm screws and rods

VC3000.01 Small Clamp, VC3000.02 Small End Clamp,

– for use with 2.7 mm screws and 3.0 mm rods

VC5000.01 medium Clamp, VC5000.02 medium End Clamp,

– for use with 3.5 mm screws and 5.0 mm rods

2.0 mm RodsVr201.030– 30 mm–90 mm lengthsVr201.090

3.0 mm RodsVr301.045– 45 mm–120 mm lengthsVr301.120

5.0 mm RodsVr501.060– 60 mm– 240 mm lengthsVr501.240

Implants

notch in end clamp

notch in end clamp

notch in end clamp


INSTrumENTS

312.561 rod bender, for 3.0 mm and 5.0 mm rods– used to contour rod– Accommodates both small and

medium rods

388.868 Template, for rods – malleable rod easily contours to the bone– reduces time required to properly contour rods– reusable for many cases

329.24 bending Pliers

329.30 Plate-bending Press329.30 Plate-bending Press

329.241 Anvil for 3.0 mm–5.0 mm rods, for use with 329.24


Instruments

392.00 bending Iron (2 required)– used to contour mini rods– used in pairs for optimal function

388.911 bending Iron for 5.0 mm rod, left

388.922 bending Iron for 5.0 mm rod, right

rod holding forceps392.970 for 2.0 mm rod, mini392.971 for 3.0 mm rod, small392.972 for 5.0 mm rod, medium – grips rod during contouring,

clamp loading, and screw insertion

392.970

392.971

392.972


Instruments

Clamp Spreaders392.973 for mini Clamps392.974 for Small and medium Clamps – Provides secure handling and easier

loading of clamps

388.72 rod Cutter – for rods up to 6.0 mm

391.990 Plate and rod Cutter – for rods up to 3.0 mm

Also Available

392.973

392.974


rECOmmENDED SETS

Recommended sets for 2.0 mm cortex screws103.522 mini fragment Standard Instrument Set103.527 mini fragment Standard Implant Set

Recommended sets for 2.7 mm, 3.5 mm and 4.0 mm screws103.501 Small fragment Standard Instrument Set103.518 Small fragment Standard Screw Set

103.527

103.518

103.501

103.521


CLAmP rOD INTErNAL fIXATOr (CrIf) ImPLANT SET (103.001)

Graphic Case690.516 Clamp and rod Internal fixation (CrIf)

Implant graphic CaseImplantsrods, 2 ea. Size Diameter (mm) Length (mm)Vr201.030 mini 2.0 30Vr201.045 mini 2.0 45Vr201.090 mini 2.0 90

Vr301.045 Small 3.0 45Vr301.090 Small 3.0 90Vr301.120 Small 3.0 120

Vr501.060 medium 5.0 60Vr501.075 medium 5.0 75Vr501.090 medium 5.0 90Vr501.105 medium 5.0 105Vr501.120 medium 5.0 120Vr501.150 medium 5.0 150Vr501.180 medium 5.0 180Vr501.210 medium 5.0 210Vr501.240 medium 5.0 240

Standard Clamps, 10 ea.

Size Screw (mm) rod (mm)VC2000.01 mini 2.0 2.0VC3000.01 Small 2.7 3.0VC5000.01 medium 3.5 5.0

End Clamps, 4 ea.

Size Screw (mm) rod (mm)VC2000.02 mini 2.0 2.0VC3000.02 Small 2.7 3.0VC5000.02 medium 3.5 5.0

388.868 Template, for 3.5 mm rods, 2 ea.

for detailed cleaning and sterilization instructions, please refer to: www.synthes.com/cleaning-sterilization In Canada, the cleaning and sterilization instructions will be provided with the Loaner shipments.


CLAmP rOD INTErNAL fIXATOr (CrIf) INSTrumENT SET (103.002)

Graphic Case690.517 Clamp rod Internal fixation (CrIf)

Instrument graphic Case

Instruments312.561 rod bender, for 3.0 mm and 5.0 mm rods392.00 bending Iron, for 1.25 mm, 1.6 mm and

2.0 mm Kirschner Wires, 2 ea.392.970 rod holding forceps, for 2.0 mm

rod–mini392.971 rod holding forceps, for 3.0 mm

rod–small392.972 rod holding forceps, for 5.0 mm

rod–medium392.973 Clamp Spreader, for mini Clamps392.974 Clamp Spreader, for Small and

medium Clamps

Also Available388.72 rod Cutter391.990 Plate and rod Cutter

DePuy Synthes Vet1302 Wrights Lane EastWest Chester, PA 19380 Telephone: (610) 719-5000 To order: (800) 523-0322

www.synthesvet.com

Limited Warranty and Disclaimer: DePuy Synthes Vet 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.

WARNING: In the USA, this product has labeling limitations. See package insert for complete information.

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

Not all products are currently available in all markets.

© DePuy Synthes Vet, a division of DOI 2013. All rights reserved.J7322-C 1/14 DV

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