pf manual v14 email
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NordOpedic AB
Surgical technique
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PF Posterior Fixator
The posterior Fixator is a rigid xation for the treatment of fractures and malalignment
of the spine. The device allows easy reduction of the spine in all planes and can be
used as a single or multiple level xator. The device is a rigid xator in which the pe-
dicle screws are independently placed in the vertebra.
Benets
When in place the device is adjustible without any restrictions.
Precise compression / distraction with pedicle screws locked in angle to the construct.
Reposition of fracture deformities is performed with simple reduction instruments in a
controlled and careful mode.
The different reduction planes are all separately locked.
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Surgical technique
Pre operative planning
Prior to the operation the actual cross sectional size of the pedicle should be check-
ed by CT-scan. The rear part of all pedicle screws have a diameter of 6.35mm.
However two different screw diameters are available; 5 and 6mm. The 5mm screws
are usually used in the thoracic spine from T5 downwards. The 6mm screws should
be used whenever possible, typically from T12 downwards including the sacrum.
The device should be placed as close as possible to the level of the lesion, thereby
immobilizing the minimum number of segments.
Patient positioning
The patient is placed prone on a radiolucent operating table in such a way that the
C-arm image-intensier can be placed under the patient. Reduction is facilitated by
initial positioning in hyperextension by external means.
Indications for use:
1. Fractures of the lower thoracic and lumbar spine.
2. Posttraumatic spinal deformity.
3. Vertebral tumors, metastasis, infections and cases with imminent instability.
4. Spondylolisthesis and lumbar scoliosis.
5. Spondylolysis
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Preparation for screw placement. An
awl is used to penetrate the cortex at
the intersection of the dotted lines. The
tap is used to prepare the screw canal
down into the pedicle. Use the tap that
corresponds to the desired screw
diameter.
STEP 1
Use the tap to measure the depth of the canal. Add 15 mm for the protruding part of
the screw. The pedicle screws are inserted, do not turn down the screws all the way,
the nal tightening of the pediclescrews can be done when the blocks are in place.
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STEP 3
The rod and blocks are slid over the screw lengthener on to the pediclescrews. Let
the proximal block slide on rst. The distance between the blocks is regulated
by turning the rod (shortening gives compression - Lengthening gives distraction).
The PF-blocks are assembled on to the spindle bolt outside the patient.
The threaded block is mounted on the hexagonal side of the rod and the
unthreaded block on the opposite side. Make sure that both blocks can rotate fre-ely on the rod (do not overtighten the locking screws in the blocks).
STEP 2
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STEP 4
C
ompression or distraction can be achieved by turning the spindle bolt with the
angled screwdriver. The screwdriver is inserted into the hexagonal hole at either
the cranial or caudal side of the bolt.
By turning the pedicle screws the rod and block assembly can be lowered against
the lamina, achieving a minimum of protrusion.
CAUTION!The length of the pedicle screw in the vertebra has to be monitored withX-ray.
STEP 5
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STEP 6
Reduction handles are mounted over the blocks. The handle is placed over the
block and the plug is inserted into the block as shown below.
STEP 7
With the reduction handles in place the fracture can be reduced. The distance between
A and B should be normalized both anteriorly and posteriorly.
Reduction - Correction
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STEP 8
C
orrection is done as follows: Assemble the reduction clamps on the ends
of the reduction handles. Reduction starts by turning the clamping rod. The
distance A - B should be carefully monitored during the correction procedure.
Caution: Kyphotic deformity often requires a shortening of the device to be able
to achieve sufcient lordosis.
Use the angular screwdriver to compensate for shortening. A ball headedhexagonal screwdriver may be used instead of the angled screwdriver ifthat feels more comfortable.
STEP 9
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With the oblique clamp mounted on the reduction handles. Translatory de-
formity can easily be corrected.
STEP 10
STEP 11
Finally all locking screws are tightened and the implantation is completed.
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Postoperative regime
Early mobilization is advocated, i.e. as soon as the postoperative pain has resol-
ved, which is usually within 3-5 days after injury or surgery. Heavy patients (over
75-80 kg) and patients with major instability should wear a threepoint corset for 2-3months. Extension injuries which can be stabilized by compression and exion com-
pression injuries suitable for management via the tension band principle should not
require any postoperative support.
Patients without neurological decit usually require to be off work for 4-6 months
after which sound union can normally be anticipated. The device may be removed
after 8 months but in most instances leaving it in-situ has no adverse effect.
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ImplantsItem no.
Fixation blocksPF-blocks w/o thread, set of 2 ST250-005
PF-blocks with thread, set of 2 ST250-006
Rods 7 mmSpindle bolt 35 mm ST250-235
Spindle bolt 45 mm ST250-245
Spindle bolt 55 mm ST250-255
Spindle bolt 65 mm ST250-265
Spindle bolt 75 mm ST250-275
Spindle bolt 85 mm ST250-285
Spindle bolt 95 mm* ST250-295
Spindle bolt 105 mm* ST250-305
Spindle bolt 115 mm* ST250-315
Spindle bolt 125 mm* ST250-325Spindle bolt 150 mm* ST250-350
Pedicle screws 5 mm Pedicle screw 45 mm ST250-545
Pedicle screw 50 mm ST250-550
Pedicle screw 55 mm ST250-555
Pedicle screw 60 mm ST250-560
Pedicle screw 65 mm ST250-565
Pedicle screw 70 mm ST250-570
Pedicle screw 75 mm ST250-575
Pedicle screws 6 mmPedicle screw 45 mm ST250-645Pedicle screw 50 mm ST250-650
Pedicle screw 55 mm ST250-655
Pedicle screw 60 mm ST250-660
Pedicle screw 65 mm ST250-665
Pedicle screw 70 mm ST250-670
Pedicle screw 75 mm ST250-675
Pedicle screw 80 mm ST250-680
Pedicle screws 7 mmPedicle screw 60 mm ST250-760
Pedicle screw 65 mm ST250-765Pedicle screw 70 mm ST250-770
Pedicle screw 75 mm ST250-775
Pedicle screw 80 mm ST250-780
Additional implantsIntermediate block, 10 mm offset* ST250-850
Intermediate block, 13 mm offset ST250-860
*Sizes marked with * are made to order, the delivery
time for these sizes may vary.
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Instruments
Screwdriver handle "Snap on" 20-001
Bit for "Snap-on" screwdriver 20-003
Screwdriver "Multi tip" 20-002Angular screwdriver 50-001
Round bit for Multi tip screwdriver 20-352
Straight bit for Multi tip screwdriver 20-353
Crown bit for Multi tip screwdriver 50-602
Tap 5 mm (for 5mm screws) 40-500
Tap 6 mm (for 6 & 7mm screws) 40-600
Reduction handles, set of 2 90-004
Reduction clamps, set of 2 20-007
Open key 6 mm 50-009Screw lenghtener 50-010
Ring key 50-011
Block releaser 90-002
20-002
20-003
50-001
40-500 / 40-600
90-004
20-007
50-011
50-010
50-009
90-002
120-001
20-352
20-353
50-602
20-001
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Notes:
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Postal adress: Anatomica AB, Stora vgen 25, SE-436 34 Askim, SWEDENTelephone: +46 (0)31-748 89 00, Fax: +46 (0)31-28 72 76E-mail: [email protected], Web: www.anatomicaspine.com
Anatomica design, manufactureand supply Orthopaedic Products tohospitals and distributors all overthe world.
The company was founded in 1981and our head quarter is located inGothenburg, Sweden.
In 1981 an agreement was signedwith Biomet Inc for distribution of
their products. Today Anatomicaalso distributes products from othermanufacturers, mainly from the USAand the European Union.
In 2001 Anatomica aquired thecompany Nordopedic from professorSven Olerud. This gave us the opp-ortunity to develop and manufacturespinal products.
Our Quality and environmental sys-tem is certifed according to the ISO13485 and ISO 14000 standards.
Anatomica stands for Quality, Safety
and a High Level ofService.