pelvic and acetabular plating - stryker · pelvic and acetabular plating. ... acetabular and pelvic...

$: PELVIC AND ACETABULAR PLATING - Stryker · PELVIC AND ACETABULAR PLATING. ... acetabular and pelvic fracture treatment principles of perfect reduction and stable fixation and also$
PELVIC AND ACETABULAR PLATING

RATIONALE

2

The newly developed Matta Pelvic Set is designed for the most common indications in surgical treatment ofpelvic and acetabular fractures. The extremely complexanatomy of the pelvic bone, particulary the acetabularregion, requires perfect anatomical reduction if good functional and durable results are to be achieved.

The shape, material properties, plate malleability and holespacing of the plates take into account the currentdemands from clinical physicians for sufficient fatiguestrength, optimized transfer of loading forces, and a standardized operative technique with broad applicability.

All implants are made of Stainless Steel (316 LVM).

IMPLANT RATIONALEThe Matta Pelvic Set consists of five different platedesigns. The plates are differentiated by design, stiffnessand function.

MPS PLATESStraight and curved pelvic plates with a hole spacing of16mm are available. Curved plates are designed to matcheither the male (R108) or the female (R88) pelvic brimrespectively. These plates are rather stiff and are preferredfor the pelvic brim and when a more rigid implant is necessary.

MPS FLEX PLATEThese plates have reduced hole spacing (12mm) and aremade of annealed stainless steel, resulting in less stiffness.They are easily contoured and preferred when a stiffimplant is not required (e.g. posterior wall fractures, ilium fixation etc.)

MPS SYMPHYSIS PLATEWith 3.2mm thickness and increased width through the midsection, together with an anatomically curved radius of 75mm, this plate normally obviates the need for axial contouring. This new plate is available in either a four or six hole option.

SCREWSAll the Matta Pelvic System screws have a hexagonalhead with a spherical underside and conform fully to the requirements set by standards. Screw fixation of thepelvis often requires the use of extra-long screws. In addition to the standard screw range, the system includes3.5mm cortical screws up to 110mm, 4.5mm corticalscrews up to 120mm and 6.5mm cancellous screws up to 130mm.

All the cortical screws within the range are self-tapping.Three cutting flutes on the tip of each screw allows cleanercutting and help to reduce “compacting” of the bonechips at the tip of the screw. Due to specially designedcutting grooves, they also offer an enhanced insertion torque.

Depending on the screw selection, the screw heads canbe countersunk almost completely into the specificallydesigned plate holes.

MATERIAL COMPOSITIONASTM F138 & F139/ ISO 5832-1 material standards providerigid specification, which define the chemical composition,microstructural characteristics and mechanical properties of implant quality Stainless Steel. These standards ensure that Stainless Steel 316LVM even if provided by differentsuppliers, is consistent and compatible. The material used for all plates and screws in this system complies with these standards.

3

CLINICAL DESIGN SURGEON

The System is designed with the kind collaboration of the following Clinician:Joel M. Matta, M.D.

Good Samaritan Hospital, Los Angeles, California

with thanks to the late Prof. Emile Letournel

In 1983 the Osteo company of Selzach, Switzerland produced the first commercially available acetabular and pelvic fixation set at the request of, and under the guidance of Prof. Letournel. In 1996 Osteo was purchased by Stryker Corporation and later the name Stryker Trauma was adopted. Prof. Letournel initially chaired the first course, Fractures of the Acetabulum and Pelvis in Paris in 1984 and at his invitation I joined the faculty. Today Stryker Trauma continues to sponsor this course under the chairmanship of myself and others.

Letournel thereby established the now well-accepted acetabular and pelvic fracture treatment principles of perfect reduction and stable fixation and also brought to acceptance the importance of specialized instrumentation and implants to achieve this end.In 1998 I was asked to be a consultant for Stryker Trauma for their educational program and for revising and updating the acetabular and pelvic set. My past involvement with the Paris courses as a faculty member and later Chairman as well as my preference for theLetournel designed Osteo plates made accepting this offer logical.

As per Letournel‘s original specifications the curved plates areavailable in two radii: 108mm to match the curvature of the malepelvic brim and 88mm to match the female. The main complaintthat was heard regarding the plates was that they were too stiffand the holes were too far apart. The curved plates are nowslightly less stiff and the hole interval is reduced to 16mm from18mm. A new plate called the MPS Flex plate has also beenadded with a 12mm hole spacing and flexibility similar to a reconplate. Both plates are 2.5mm thick and the stiffness is controlledby hardening or annealing. The thin profile limits soft tissue intrusion and also facilitates improved screw angulation.

Though the flexible MPS Flex plate has shown to be adequate formany fixations, it is my opinion that a number of surgeons chooseit too frequently and, to the detriment of fixation. It may seemconvenient that when this plate is applied incompletely contoured,tightening the screws completes the contouring. What this meansin effect is that the bone is controlling the contour of the platerather than the plate controlling the contour of the fractured bone.

I prefer the standard curved and straight plates for the majority of fixations including posterior wall fractures. I reserve use of theMPS Flex plate for fractures that require the closer hole spacing orextreme contouring.

The current set includes the clamps and reduction aids that I consider most valuable. This brochure and our education courseswill help the surgeon learn their application. In many ways theinstruments and their use is more important than the plates thatare chosen, just as reduction is usually a more important problemthan fixation. An important reduction instrument that is notincluded is the orthopedic extension table. The most effectivetable to date is the Tasserit table, previously called the Judet table.

It is inevitable that surgeons that use this set will wish at times for a slightly different plate that is not in the box, or a clamp ofanother design. Surgeons who address these fractures frequently(as I do) will probably keep an additional box of items that areoccasionally useful. To make a set however that is affordable andwidely useful, the contents must be carefully chosen. It is expectedthat the set will evolve as surgeons contribute their comments.

Judet and Letournel concluded early on the most important factorin a successful operation was a perfect pre-operative understandingof the X-rays and fracture pattern. The same is true today. The surgeon’s knowledge, skill and dedication remain the primarydeterminants of the patient`s outcome, and the design of this set seeks to facilitate this.

Joel M. Matta, M.D.

4

INTRODUCTION

4

CASES AND TRAYSThe Matta Pelvic System consists of four differentcases with a variety of dedicated, removable inserts. The two plate racks, the screw rack and the trayinserts for the basic instruments, offer optimum modularity for storage and sterilization. The pre-formed inserts for the basic instruments allow for easy access to the instruments which are arranged in a logical order.

PLATES AND SCREWSIn addition to the extra long 3.5mm and 4.5mm self-tappingcortical screw range, the Matta Pelvic Set (“MPS”) includesa selected range of partially threaded 6.5mm cancellousscrews. These offer the option of performing a strong independent interfragmentary Lag–Screw fixation withoutthe need for an additional screw set.The ”all in one“ implant case contains a wide range ofpelvic and acetabular plates together with a dedicatedSymphysis plate.

DRILLS AND TAPSContained within the basic instrument set are all the relevant drill bits and taps corresponding to eachscrew diameter. A titanium oxide coating on the drillbits and taps for the 3.5mm screws enhances not onlythe cutting efficiency but the longevity and improvedvisual identity of each instrument. While all of the cortical screws in the set are self-tapping, the inclusionof taps offers clinicians the option of pre-tapping indense cortical bone.

5

FEATURES AND BENEFITS

5

The new Pelvic System design is based on input from Dr. Joel M. Matta, M.D., Los Angeles, O.R. and sterilization staff, data from literature, and both practical and biomechanical testing results of the system.

FEATURES BENEFITS

Stainless Steel cold worked • Excellent plate malleability for optimum adaptation

and annealed plates to the pelvic surfaces

Straight and curved plate options • Increased indication coverage all in one set

Rounded plate ends • Reduced potential for soft tissue irritation

Dedicated Symphysis Pubis plate • Strong with anatomical fit

3.5/4.5 screw hole option • Flexibility of 3.5mm or 4.5mm screws

Low screw head profile in plate hole • Reduced potential for soft tissue irritation

Self-tapping cortical screws • Quick, simple, and more efficient

Increased screw angulation with 3.5mm screws • Optimized for posterior wall fixation

4 options for Reduction pins • Flexibility of choice of 5mm or 6mm diameter in

150mm or 180mm length

Equal hole spacing on plate • Operative flexibility for screw and plate placement

Advanced plate bender • Easy and smooth three dimensional bending of plates

Malleable bending templates • Allows plate bending away from the operative field

Spiked Disk • Can be used in combination with reduction forceps and

ball spike for increased bone contact

Elastosil® or Canevasit Handles • Surgeon preference

Screwdriver Holding Sleeve • Efficiency in pick-up insertion/removal via

“No-touch” technique

Reduction Instruments • Specialist forceps and optimized clamp design,

small unique reduction forceps for 3.5mm screws

Sciatic Nerve Retractors • 2 sizes available for optimal soft tissue retraction

Modular case design • Maximum flexibility for sterilization method in either outer

base or in sterilization container

Dedicated basic instrument case • All instruments for 3 screw sizes in one set

1

INDICATIONS

The Matta Pelvic System is indicated for fractures of the:

•Pelvic Ring

•Acetabulum

•Sacrum

•Ilium

•Sacroiliac joint dislocations

•Symphysis Pubis disruption

•Revision surgery of pseudoarthroses, non-unions and mal-unions

•Osteotomies

•Arthrodeses

Since traumatology products often must be used in emergencysituations in order to treat patients with acute injuries, the following contraindications may be of a relative or absolutenature, and must be taken into account by the attending surgeon:

•Any active or suspected latent infection in or about the affected area.

•Any mental or neuromuscular disorder which would create an unacceptable risk of fixation failure or complications inpostoperative care.

•Metal sensitivity, documented or suspected.

•Obesity. An overweight or obese patient can produce loads on the implant which can lead to failure of the fixation of thedevice or to failure of the device itself.

•Any time implant utilization would interfere with anatomicalstructures or physiological performance.

•Other medical or surgical conditions which would preclude the potential benefit of surgery.

6

MPS FLEX PLATE (ANNEALED)Posterior wall, Ilium and iliac crest.

MPS STRAIGHT PLATEPelvic Ring, internal and external aspect of theilium, Posterior wall.

MPS SYMPHYSIS PLATESymphysis Pubis.

MPS CURVED R88 PLATEPelvic Ring (female), iliac crest, Posterior wall.

MPS CURVED R108 PLATEPelvic Ring (male), iliac crest,Posterior wall.

7

SCREW FIXATION

DRILL GUIDESUse the Double Drill Guide REF 702417 and the 4.5mm Drill (Double Drill Guide REF 702418 and Drill 3.5mm forscrews 3.5mm) to overdrill the near cortex. Insert the opposite side of the relevant drill guide into the pre-drilled holefor precise axial alignment and use the corresponding drill for the corehole of the screw. This procedure will preventthe loss of reduction and fixation during screw insertion.

The 3.5mm self-tapping cortical screws are the recommendedscrews for plate fixation and are best adapted to the pelvic bone. 4.5mm cortical screws are often too large and their voluminousheads create a slight prominence above the plates, which maylead to soft tissue irritation in certain applications.

Often independent (isolated) interfragmentaryLag–Screws are used in conjunction withpelvic and acetabular fixation.The screw thread takes no purchase in thenear fragment because the screw has a shaft with no thread, and/or the drill hole in the near fragment is equal to the outsidediameter of the screw. The cortex in the nearfragment has to be overdrilled, therefore, to create a ”gliding“ hole. Overdrilling the cortex in this manner allows the screw thread to take purchase only in the bone of the opposite fragment.

Possible Lag–Screw using 4.5mm cortical or 6.5mm cancellous screws:

a) From the crest of the anterior border (Screw 1) in the thickness of the iliac wing.It is always possible to insert ascrew from the antero-inferioriliac spine, passing 1 or 2cmabove the acetabulum (length100–120mm) (Screw 2)

b) Along the axis of the anterior column (Screw 3).This screw isvery useful to secure a transversefracture or an anterior column,through an extended ilio–femoralapproach. The screw should startfrom the posterior aspect of theiliac wing pillar, approx.3-4cmabove the acetabulum.

c) In the thickness of the iliacwing, but from posterior toanterior, starting from the posterior part of the iliac wingor the posterior–superior iliacspine to reduce a sacroiliacjoint fracture dislocation(screws 4 and 5)

d) Along the axis of the posterior column (screw 6)

For all these Lag–Screws, it is essential to drill intermittently, step by step, and change the direction of the drill if you feelpenetration of a cortex. Remain in the correct axis andadvance the drill as far as possible.

INDEPENDENT INTERFRAGMENTARYCOMPRESSION

Therefore, these screws should only be used exceptionally to fix a plate, i.e. when a smaller screw does not get sufficient purchase.Furthermore, the plate holes are designed to accept introductionof 3.5mm screws inserted at extreme angles, up to 35 degrees in all directions. This capability is essential as it must be possibleto avoid penetrating the hip joint or to be able to drive a screwobliquely in the area of the iliac bone, avoiding a previouslyinserted isolated screw.

8

EXAMPLES OF TYPICAL OSTEOSYNTHESES

SYMPHYSIS PUBIS DISRUPTION

TRANSVERSE PLUS POSTERIOR WALL FRACTURE

Fixation of a pure disruption of theSymphysis Pubis using a dedicated MPS Symphysis 4 hole plate. Two screws of 40mm to 45mm into eachpubic bone provide a solid support.

Operated through the Kocher-Langenbeck approach.•Two 3.5mm independent Lag–Screws

maintain the transverse fracture.

•Two independent screws maintain theposterior wall fragments.

•One MPS Flex 8 hole plate (annealed)or an MPS Curved 6 hole plate spans the posterior fragments and fixes thetransverse fracture at the same time.

9


ILIUM FRACTURE

ANTERIOR COLUMN FRACTURE

•One 6.5mm partially threaded cancellous screw inserted from theanterio-inferior iliac spine, passing 1cm to 2cm above the acetabulum.

•One 3.5mm independent Lag-Screw in the iliac crest starting from the anterior branch.

•One MPS Straight 4 hole plate screwedover the fracture line in the area of thepelvic brim.

Fixation of a fracture of the anterior column by ilio-inguinal approach. •An independent Lag-Screw first

maintains the reduction, then a MPS Curved 10 hole plate was shapedto adapt itself optimally to the pelvicbrim going from the pubic spine to the vicinity of the sacroiliac joint, a minimum of two screws beyond the fracture line. The central screws are parallel to the quadrilateral surface.

10


SACRUM FRACTURE

BOTH COLUMN FRACTURE

•Longitudinal posterior approach.

•Fixation of a sacrum fracture by placing two 6.5mm cancellousscrews (preferably 16mm thread)through the lateral iliac wing andadvancing these screws into the S1 vertebral body.

Both column fracture operated throughthe ilio-inguinal approach.•One independent Lag-Screw fixes

the reduction of a separated posteriorfragment of the pelvic brim, just in frontof the sacroiliac joint.

•One MPS Flex 6 hole plate (annealed)placed on the upper aspect of the wingover the posterior fracture line.

•One long MPS Curved 10-hole platealong the pelvic brim (R108mm or88mm depending upon the case) fixesthe anterior column.

•Two 3.5mm independent Lag-Screwsrunning from the upper aspect of the true pelvis fix the reduction of theposterior column.

•Two 3.5mm independent Lag-Screws in the iliac crest fix the reduction of the wing fracture lines.

11


PURE POSTERIOR WALL FRACTURE

POSTERIOR VERTICAL ILIUM FRACTURE

Typical fixation of a fracture of the posterior wall.•Two 3.5mm independent Lag-Screws

initially fix the fragments with thedesired anatomical reduction.

•One MPS Curved R108 6-hole plateor alternatively an MPS Flex 8-holeplate (annealed) spans the fragmentsalong its axis (Neutralization plate).

Anterior component of a Malgaine fracture.•Two 3.5mm independent Lag-Screws

in the crest fix the reduction of thewing fragment.

•One 6.5mm independent cancellous Lag–Screw starting from the posteriorpart of the iliac wing fixes the reductionof the separated anterior fragment.

•One MPS Flex 6-hole plate (annealed)screwed onto the external aspect of theiliac wing.

12

REDUCTION INSTRUMENTS

The Matta Pelvic System forceps and other reduction instrumentsare designed for use with the irregular, large and flat bony surfaces of the pelvic region. The angles and length of the jaws accommodate the innominate bone from the crest to thepelvic brim and cope with the various surgical approaches.Reduction of acetabular fractures are best performed on the orthopedic extension table allowing distal and lateral traction.

REDUCTION FORCEPSWITH POINTSThese forceps can be applieddirectly to the bone`s surface orused with shallow drill holes.

FARABOEF FORCEPSThe versatile Faraboef clamps can be used to grasp and manipulate the iliac wing or as reduction forceps with provisional screws of either3.5mm or 4.5mm diameter.

13

REDUCTION INSTRUMENTS

REPOSITIONING FORCEPS,TYPE MATTAThe two oblique forceps, type Mattaare designed such that the handlesangle away from the critical soft tissue structures and out of line of sight. The sharp points provide a secure hold on the pelvic surfaceswhile the balls prevent penetration of bone with a thin cortex.

REDUCTION FORCEPS,2x1 JAWSThis long forceps with threepointed ball tips allows reductionof perpendicular fractures. Thelong handles provide increasedleverage for difficult reductions.These forceps are also availablein a 1x1 Jaws version.

REDUCTION FORCEPS

These two forceps have beendesigned to be used with either3.5mm or 4.5mm screws (3.5mmversion available in left or rightoption). The screws inserted onopposite sides of the fractureallow considerable reductionforces and manipulation in allthree planes.

SCIATIC NERVERETRACTORTwo sizes available for optimalsoft tissue retraction.

ASYMMETRICALVERBRUGGE FORCEPSSometimes, for easier reduction,only one screw is inserted onwhich one jaw of the Verbruggeforceps is applied. The other jaw then takes direct hold onanother part of the bony surface. Example: The angle of the greatersciatic notch.

STRAIGHT BALL SPIKEThis reduction instrument is usedas a pusher with pointed ball tipto reduce bone fragments. To distribute the reduction forcesover an increased area, theSpiked Disc can be clipped ontothe ball tip.

14

ORDERING INFORMATION - PLATES

4 Recommended set item

MPS STRAIGHT PLATE

Stainless Plate HolesSteel LengthREF mm

425702 26.5 2425703 42.5 3 4425704 58.5 4 4425705 74.5 5425706 90.5 6 4425707 106.5 7425708 122.5 8 4425709 138.5 9425710 154.5 10 4425711 170.5 11425712 186.5 12 4425713 202.5 13425714 218.5 14 4425715 234.5 15425716 250.5 16 4425718 282.5 18425720 314.5 20

MPS FLEX PLATE (ANNEALED)


425754 46.5 4 4425755 58.5 5425756 70.5 6 4425757 82.5 7425758 94.5 8 4

425759 106.5 9425760 118.5 10 4425761 130.5 11425762 142.5 12 4425763 154.5 13425764 166.5 14 4425765 178.5 15425766 190.5 16 4425767 202.5 17425768 214.5 18 4425770 238.5 20425772 262.5 22

MPS CURVED R108 PLATE


425604 58.5 4 4425605 74.5 5 4425606 90.5 6 4425607 106.5 7425608 122.5 8 4425609 138.5 9425610 154.5 10 4425611 170.5 11425612 186.5 12 4425613 202.5 13425614 218.5 14 4425615 234.5 15425616 250.5 16 4425618 282.5 18425620 314.5 20

MPS CURVED R88 PLATE


425654 58.5 4 4425655 74.5 5 4

425656 90.5 6 4425657 106.5 7425658 122.5 8 4425659 138.5 9425660 154.5 10 4425661 170.5 11425662 186.5 12 4425663 202.5 13425664 218.5 14 4425665 234.5 15425666 250.5 16 4425668 282.5 18425670 314.5 20

MPS SYMPHYSIS PLATE, RADIUS 75


425794 60.5 4 4425796 92.5 6 4

15

ORDERING INFORMATION - SCREWS

3.5MM CORTICAL SCREW, SELF TAPPING

Stainless Steel ScrewREF Length mm

338610 10338612 12 4

338614 14 4

338616 16 4

338618 18 4

338620 20 4

338622 22 4

338624 24 4

338626 26 4

338628 28 4

338630 30 4

338632 32 4

338634 34 4

338636 36 4

338638 38 4

338640 40 4

338645 45 4

338650 50 4

338655 55 4

338660 60 4

338665 65 4

338670 70 4

338675 75 4

338680 80 4

338685 85 4

338690 90 4

338695 95 4

338700 100 4

338705 105 4

338710 110 4

WASHER

Stainless Diameter Thickness TitaniumSteel mm mm REFREF

390016 13.0 4 1.5 N/A390019 9.0 4 1.0 N/A

4.5MM CORTICAL SCREW, SELF TAPPING

Stainless Steel PlateREF Length mm

340614 14 4340616 16 4340618 18 4340620 20 4340622 22 4340624 24 4340626 26 4340628 28 4340630 30 4340632 32 4340634 34 4340636 36 4340638 38 4340640 40 4340642 42 4340644 44 4340646 46 4340648 48 4340650 50 4340652 52 4340654 54 4340656 56 4340658 58 4340660 60 4340665 65 4340670 70 4340675 75 4340680 80 4340685 85 4340690 90 4340695 95 4340700 100 4340705 105 4340710 110 4340715 115 4340720 120 4

6.5MM CANCELLOUS SCREW, 16MM THREAD


341050 50 4341055 55 4341060 60 4341065 65 4341070 70 4341075 75 4341080 80 4341085 85 4341090 90 4341095 95 4341100 100 4341105 105 4341110 110 4341115 115 4341120 120 4341125 125 4341130 130 4

6.5MM CANCELLOUS SCREW, 32MM THREAD


342050 50 4342055 55 4342060 60 4342065 65 4342070 70 4342075 75 4342080 80 4342085 85 4342090 90 4342095 95 4342100 100 4342105 105 4342110 110 4342115 115 4342120 120 4342125 125 4342130 130 4


16

ORDERING INFORMATION - INSTRUMENTS


Reference Description

700351 4 Calibrated Drill Bit ø2.5mm x 180mm, with AO Fitting


700353 4 Drill Bit ø3.5mm x 180mm, with AO Fitting



700354 4 Drill Bit ø4.5mm x 180mm, with AO Fitting

702804 4 Tap ø3.5mm x 180mm, with AO Fitting702806 4 Tap ø4.5mm x 180mm, with AO Fitting702807 4 Tap ø6.5mm x 180mm, with AO Fitting

702811 4 Countersink ø6.0mm x 100mm, with AO Fitting702812 4 Countersink ø8.0mm x 100mm, with AO Fitting

702845 4 Screwdriver Hex 2.5mm, L280mm702846 4 Screwdriver Hex 3.5mm, L300mm

702851 4 Screwdriver Hex 2.5mm, L165mm, with AO Fitting

702853 4 Screwdriver Hex 3.5mm, L165mm, with AO Fitting

702861 4 Screwdriver Holding Sleeve for Screws ø3.5mm

702862 4 Screwdriver Holding Sleeve for Screws ø4.5/6.5mm

702417 4 Double Drill Guide ø3.2/4.5mm702418 4 Double Drill Guide ø2.5/3.5mm

702872 4 Depth Gauge 0-110mm, for Screws ø2.7/3.5/4.0mm

702873 4 Depth Gauge 0-150mm, for Screws ø4.5/6.5mm

702847 4 Straight Ball Spike

702912 4 Straight Ball Spike with AO Fitting

702923 4 Spiked Disk

702427 4 T-Handle small with AO Quick Coupling

702848 4 Small Teardrop-Handle with AO Quick Coupling702849 4 Large Teardrop-Handle with AO Quick Coupling

702915 4 Small Sciatic Nerve Retractor702916 4 Large Sciatic Nerve Retractor

390083 4 Reduction Pin ø5.0mm L150mm with AO fitting390084 4 Reduction Pin ø5.0mm L180mm with AO fitting

900106 4 Screw Forceps


710312 4 Template MPS Flex plate, 8 Holes710313 4 Template MPS Flex plate, 18 Holes710315 4 Template MPS Straight plate, 8 Holes710316 4 Template MPS Straight plate, 18 Holes710318 4 Template MPS Curved R108 plate, 8 Holes710319 4 Template MPS Curved R108 plate, 18 Holes710321 4 Template MPS Curved R88 plate, 8 Holes710322 4 Template MPS Curved R88 plate, 18 Holes

702902 4 Bending Iron for Pelvic plates

702903 4 Bending Pliers

702921 4 Small Repositioning Forceps, type Matta702922 4 Large Repositioning Forceps, type Matta

702924 4 Repositioning Forceps for Screws ø4.5mm702925 4 Repositioning Forceps for Screws ø3.5mm, Right702947 4 Repositioning Forceps for Screws ø3.5mm, Left

702926 4 Small Reduction Forceps with Points L130mm702927 4 Large Reduction Forceps with Points L200mm

702928 4 Faraboef Forceps L190mm702929 4 Faraboef Forceps L250mm

702930 4 Repositioning Forceps, 2x1 Jaws702948 4 Repositioning Forceps, 1x1 Jaws

702932 4 Repositioning Forceps with Serrated JawsL140mm

700641 4 Modified Verbrugge Forceps

700647 4 Curved Chisel

Optional Instruments390086 Reduction Pin ø6.0mm x 150mm with AO Fitting390087 Reduction Pin ø6.0mm x 180mm with AO Fitting700367 Large T-Handle with AO Quick Coupling702842 Screwdriver Hex. 2.5mm, L280,

with Elastosil® Handle702843 Screwdriver Hex. 3.5mm, L300,

with Elastosil® Handle702911 Straight Ball Spike L300mm,

with Elastosil® Handle702428 Elastosil® Handle Small with AO Coupling702429 Elastosil® Handle Large with AO Coupling710311 Template MPS Flex plate, 5 Holes710314 Template MPS Straight plate, 5 Holes710317 Template MPS Curved R108 plate, 5 Holes710320 Template MPS Curved R88 plate, 5 Holes

17

ORDERING INFORMATION - CASES & TRAYS


901557 4 Plastic Base (Implant Case, Plates)901557 4 Plastic Base (Implant Case, Screws)


901681 4 Plastic Lid (Implant Case, Plates)


901682 4 Tray Insert (Implant Case, Plates)


901683 4 Plate Rack with Lid # 1 (R88 and Straight)


901684 4 Plate Rack with Lid # 2 (R108, Flex, and Symphysis)


901685 4 Plastic Lid (Implant Case, Screws)


901686 4 Screw Rack with Lids (Implant Case, Screws)


901618 4 Plastic Base (Basic Instruments)


901687 4 Plastic Lid (Basic Instruments)


901688 4 Upper Tray Insert (Basic Instruments)


901689 4 Lower Tray Insert (Basic Instruments)


901690 4 Plastic Base (Reduction Instruments)



901691 4 Plastic Lid (Reduction Instruments)

18

R.Niklaus / 5.12.2001

R.Niklaus / 5.12.2001

PLATE BENDING

R.Niklaus / 5.12.2001

It is necessary to correctly shape the plate in such a way as to perfectly apply it to the reduced contour of the pelvis or the acetabulum. The fitting of the plate on the bony surface should be as perfect as possible so the insertion of screws will not cause thefragments to change position (Figures 1 & 2).

It’s an important fact that the plate must be bent, as far as possible in the spacesbetween the holes so as to alter them as little as possible (Figure 6). It is a wellknown fact that rectangular plates do not bend in a regular fashion but rather at the level of their holes (Figure 7). Thus Sherman type plates with equal holespacing and narrowing between the holes are best adapted to such shaping andallow for a perfect adaptation to the pelvic contours.

For a plate to apply perfectly on a bone, it must be possible to shape it in all directions:

• bend it along it’s main axis (Figure 3a, 3b)

• bend it along it’s main axis (twist), to give it an helicoidal shape (Figure 4a, 4b)

• finally bend it “on the flat” to adapt to the curves of the iliac crest or the upper aspect of the pelvic brim, or to make it possible to span a fragment of the posterior wall or posterosuperior wall along it’s major axis (Figure 5a, 5b)

Figure 5b

Figure 1–Correct Figure 2–Incorrect

Figure 7

Figure 6

R.Niklaus / 6.12.2001

Figure 3a Figure 4a

R.Niklaus / 6.12.2001

Figure 5a

Figure 3b Figure 4b

CorrectPrecise fit of theplate. No danger of displacement ofthe fragments duringscrew insertion.

IncorrectWhen tightening the screws, the fragment will be drawn towardsthe plate.

In certain instances it is desirable to contour the plate to a slight mismatch with the bone. Subsequent insertion and tighteningof the screws causes the plate to manipulate the bone, therefore aiding in obtaining or maintaining the reduction.

OTHER STRYKER PLATING SYSTEMS

19

A wide selection of plates,each featuring K-wire holes — for improved primary stabilization;rounded plate ends — to facilitate the option of subcutaneous plateinsertion; uniform hole spacing with bi-directional holes offeringincreased screw angulation; as well as the unique outer plate contouring — are all features ofthe implant set. A comprehensivescrew range is enhanced not only by a new self-cutting design but by the inclusion of a small range of 2.7mm screws for independent

interfragmentary screw fixation obviating the need for an additional screw set.A full range of instrumentation is complimented by the unique rangeof reduction clamps and forceps.These non-standardized instrumentsoffer the clinician new possibilitiesin their approach to small bone fracture reduction and fixation.

FEATURING:Modular Case design2.7mm cortical screws - self tapping3.5mm cortical screws - self tapping4.0mm cancellous screws - Partial thread4.0mm cancellous screws - Full threadDrill, Taps, Countersink - AO couplings3 diameters of K-wiresModular and Fixed Angle Drill GuidesCompression plateReconstruction plate1/3rd Tubular plateCloverleaf plateT-plateOblique T-plateCalcaneal plateElastosil® HandlesBall Spike and Dental PickCombined Periosteal and Freer ElevatorHohmann RetractorsBending Irons and TemplatesOptional Bending PliersForceps

This system offers Clinicians multiple options for the most common treatments of small bone fractures.

A new selection of seven plates,each featuring K-wire and reductionholes — for improved primary stabilization; rounded plate ends — to facilitate the option of subcutaneous plate insertion; uniform hole spacing with bi-directional holes offeringincreased screw angulation; as well as the unique outer plate contouring — are all features of the implant set.

A comprehensive screw range isenhanced by a self-cutting design.A full range of instrumentation iscomplemented by the unique rangeof reduction clamps and forceps.These non-standardized instrumentsoffer the clinician new possibilitiesin their approach to large–bone fracture reduction and fixation.

FEATURING:Modular Case design4.5mm cortical screws - self tapping6.5mm cancellous screws -16mm thread6.5mm cancellous screws -32mm thread6.5mm cancellous screws -Full threadDrill, Taps, Countersink - AO couplings2 Diameters of K-wiresModular and Fixed Angle Drill GuidesCompression plate- BroadCompression plate - Narrow T-plate T-Buttress plate L-Buttress plate Reconstruction plateElastosil® Handles on all fixed handle instrumentsDental Pick and Ball SpikeCombined Periosteal and Freer Elevator Hohmann Retractors Bending Irons and TemplatesOptional Table Plate Bender PliersForceps

This System offers Clinicians multiple options for the most commontreatments of long–bone fractures.

SMALL FRAGMENT SET

This system offers multiple options for the most common treatments of small–bone fractures. A selection of seven plates is available, each featuring K-wire and reduction holes designed toassist with primary stabilization and rounded plate ends which offer the option of subcutaneousplate insertion. The screws have a new self-cutting design and also include a small range of 2.7mm screws for independent interfragmentary screw fixation. The unique instruments offer new possibilities to assist in the approach to small–bone fracture reduction and fixation.

MPS SYMPHYSIS PLATE

With 3.2mm thickness and an increased width through the midsection, this plate obviates theneed for contouring and cutting. The plate has rounded ends with no sharp edges and has a curved radius of 75mm designed for a better anatomic fit. The plate accepts either 3.5mm or 4.5mm screws which have a low profile when seated in the plate. This new design is availablein either a four or six–hole option in Stainless Steel.

DUPONT

The anatomically pre-contoured design of the Dupont plates makes them optimal for the treatment of distal humeral fractures including supracondylar and intra-articular. This design eliminates the needs for manual bending of ordinary plates intraoperatively, and minimizes theextensive dissection, which is necessary using standard plates.

BASIC FRAGMENT SET

This system offers multiple options for the most common treatments of long–bone fractures. The plates each feature K-wire and reduction holes designed to assist with primary stabilizationand a unique outer plate contouring which offers biomechanical advantages over other systems. A full range of instrumentation is complimented by the unique range of reduction clamps and forceps.

MATTA PELVIC SYSTEM

Designed by Joel M. Matta, M.D. the Matta Pelvic System, with four modular trays, features the latest innovations in Pelvic implants and instrumentation. The system includes a dedicatedSymphysis Pubis plate, differentiated curved radius plates designed to respect both male andfemale anatomies, and as a more malleable MPS Flex plate. The instruments can be easily han-dled and maneuvered around the anatomy without any restriction in visualization. Additional reduction forceps, like the 3.5mm Jungbluth, are unique and epitomize the innovation and practicality of this system.

CALCANEAL PLATE

This flat plate design allows contouring to either the left or right calcaneus. The low–profile1.2mm plate thickness can reduce potential peroneal tendon irritation and facilitate easier clo-sure. The plate also offers K-wire and reduction holes for improved provisional stabilization andreduction validation and is available in three standard sizes in either Stainless Steel or Titanium.

hhoowwoosstt..ccoomm

Stryker® is a registered trademark of Stryker Corporation. Elastosil® is not a registered trademark of Howmedica Osteonics Corp.©Howmedica Osteonics 2001, 2002 Lit. No. LLMMPPSSTTBB 5M 11/02 MC/OI Printed in U.S.A.

pelvic and acetabular plating - stryker · pelvic and acetabular plating. ... acetabular and pelvic...

Documents