surgicaltechnique - synthes.vo.llnwd.netsynthes.vo.llnwd.net/o16/llnwmb8/int mobile/synthes...
TRANSCRIPT
Spring Plates 3.5. Reduction and fixationofsmallbonefragments.
SurgicalTechnique
ThispublicationisnotintendedfordistributionintheUSA.
Spring Plates 3.5 Surgical Technique DePuy Synthes 1
Table of Contents
Introduction
Surgical Technique
Product Information
Bibliography 12
Bibliography 13
SpringPlates3.5/Indications 2
AOPrinciples 3
ClinicalProblemandPreoperativePlanning 4
Implantation 5
Implants 9
Instruments 10
Sets 11
Imageintensifiercontrol
WarningThisdescriptionalonedoesnotprovidesufficientbackgroundfordirectuse ofDePuySynthesproducts.Instructionbyasurgeonexperiencedinhandlingtheseproductsishighlyrecommended.
Processing, Reprocessing, Care and MaintenanceForgeneralguidelines,functioncontrolanddismantlingofmulti-partinstruments,aswellasprocessingguidelinesforimplants,pleasecontactyourlocalsalesrepresentativeorreferto:http://emea.depuysynthes.com/hcp/reprocessing-care-maintenanceForgeneralinformationaboutreprocessing,careandmaintenanceofSynthesreusabledevices,instrumenttraysandcases,aswellasprocessingofSynthesnon-sterileimplants,pleaseconsulttheImportantInformationleaflet(SE_023827)orreferto: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
2 DePuy Synthes Spring Plates 3.5 Surgical Technique
DescriptionInpelvicandacetabularsurgery,itisoftendifficulttoreduceandfixsmallbonefragments.TheSpringPlates3.5arein-tendedtoreduceandstabilizebonefragmentsthataretoosmallforscrews.Theycanbeusedindividuallyorincon-junctionwitha3.5mmreconstructionplate.
Features and Benefits
– Two sharp spikes on the bottom surface Sharpspikesonthebottomsurfacecapturesmall fragments.
– Pre-bent convex plate shape Theinsertionofscrewsintothepreloadedplatereducesandcompressesthefragments.
IndicationsTheSynthes3.5mmSpringPlateisintendedforpelvicandacetabularreconstructivesurgeryandfracturefixationofthedistalfibula.
Spring Plates 3.5 / Indications
Spring Plates 3.5 Surgical Technique DePuy Synthes 3
AO Principles
In1958,theAOformulatedfourbasicprinciples1,2,whichhavebecometheguidelinesforinternalfixation:
Anatomic reductionTheplatewithitsspikes,itspre-bentshapeanditselongatedholesfacilitatesanatomicreduction.
Stable fixationTheplatespikesandthespring-effectprovideanoptimalcompressionmechanismtoholdsmallfragmentsinplace.
Preservation of blood supplyTheconvexplatedesignpreservesthebloodsupplythroughminimalplatetobonecontactandduetoareducednumberofscrews.Furthermore,theplatedesignpermitsindirectre-duction,thusresultinginreducedsoft-tissuestripping.
Early, active mobilizationTheSpringPlate3.5combinedwiththeAOtechnique,pro-videsstablefracturefixationwithminimaldamagetovascu-larsupply.Thishelpsimprovetheenvironmentforboneheal-ing,acceleratingthepatient’sreturntomobilityandfunction.
1 MüllerME,AllgöwerM,SchneiderR,WilleneggerH(1995)ManualofInternalFixation.3rd,expandedandcompletelyreviseded.1991.Berlin,Heidelberg,NewYork:Springer
2RüediTP,BuckleyRE,MoranCG(2007)AOPrinciplesofFractureManagement.2ndexpandeded.2002.Stuttgart,NewYork:Thieme
4 DePuy Synthes Spring Plates 3.5 Surgical Technique
Clinical problemThisimagerepresentsanexampleofaposteriorwallfractureoftheacetabulumwithtwosmallfracturefragmentsforwhichtheSpringPlatewouldberecommended.
Preoperative planningImplantationoftheSpringPlatecanbeperformedusingoneofthefourfollowingsets:
01.100.013 LowProfile3.5PelvicInstrumentSet
181.600 BasicPelvicInstrumentSet
182.415 LCPCompactSmallFragment InstrumentSet
182.456 InstrumentSetLC-DCP
Clinical Problem and Preoperative Planning
Spring Plates 3.5 Surgical Technique DePuy Synthes 5
Implantation
1Temporary fixation
Instruments
292.160 KirschnerWireB1.6mmwithtrocartip
03.100.018 BallSpike
ReduceandfixthefracturefragmentwithKirschnerwiresoranappropriatereductioninstrumentwithpointedballtips,suchasaballspike.
Note:WhileplacingtheKirschnerwires,payattentionthattheywillnotinterferewiththeSpringPlatelater.
2Place Spring Plate
PlaceaSpringPlateofappropriatelengthsothatthespikesengageinthefracturefragment.Checkplateplacementbyholdingtheplateorfracturefragmentwithanappropriatereductioninstrumentwithpointedballtips.
6 DePuy Synthes Spring Plates 3.5 Surgical Technique
Implantation
4Determine screw length
Instrument
319.091or DepthGauge319.010
Usedepthgaugetodeterminethecorrectscrewlength.
3Drill screw hole
Instruments
315.920or Drillbit,B2.5mm324.210or397.342
323.360 Universaldrillguide
Drillaholefora3.5mmcortex,a3.5mmpelviccortexora4.0mmcancellousbonescrewusinga2.5mmdrillbitincombinationwiththeuniversaldrillguide.
Spring Plates 3.5 Surgical Technique DePuy Synthes 7
5Insert screw
Instrument
314.570 Screwdriver,hexagonal,small, B2.5mm,length270mm
Inserta3.5mmcortex,a3.5mmpelviccortexora4.0mmcancellousbonescrewofappropriatelength.The“spring”effectoftheplatemayhelptoachievethedesiredcompres-sionviaspikesonthesmallfracturefragment.
8 DePuy Synthes Spring Plates 3.5 Surgical Technique
6Option: Insert additional Spring Plate
Ifneeded,asecondSpringPlatecanbeplaced.Repeatsteps1to5.
Forfurtherstabilityandadditionalcompressiontothecon-struct,insertareconstructionplateontopoftheSpringPlates.
Note:Thisrepresentsonlyonepossibleconfigurationfortheplacementoftwo2-holespringplatesinaspecificclinicalsituation.
Implantation
Spring Plates 3.5 Surgical Technique DePuy Synthes 9
Implants
3.5 Spring Plates
– onlyavailableinstainlesssteel – forsterileimplantsaddsuffix“S”tothearticlenumber
Art.No. Description
02.100.301 SpringPlate3.5,1hole,length19.5mm
02.100.302 SpringPlate3.5,2holes,length31.5mm
02.100.303 SpringPlate3.5,3holes,length43.5mm
Screws
The3.5SpringPlatecanbeusedwith3.5mmcortexscrews,3.5mmpelviccortexscrewsand4.0mmcancellousbonescrews.
Art.No. Description
204.810– CortexScrewsB3.5mm,self-tapping,204.848 10–48mm(2mmincrements)
204.845– CortexScrewsB3.5mm,self-tapping,204.910 45–110mm(5mmincrements)
204.640– PelvicCortexScrewsB3.5mm,204.750 self-tapping,40–150mm (5mmincrements)
206.010– CancellousBoneScrewsB4.0mm,fully 206.060 threaded,10–60mm
Kirschner wire
292.160 KirschnerWireB1.6mmwithtrocartip
10 DePuy Synthes Spring Plates 3.5 Surgical Technique
Instruments
314.570 Screwdriver,hexagonal,small,B2.5mm, length270mm
315.920or Drillbit,B 2.5mm324.210or397.342
319.091or DepthGauge319.010
323.360 Universaldrillguide
03.100.018 BallSpike
Spring Plates 3.5 Surgical Technique DePuy Synthes 11
Sets
ImplantationoftheSpringPlatecanbeperformedusingoneofthefourfollowingsets:
01.100.013 LowProfile3.5PelvicInstrumentSet
181.600 BasicPelvicInstrumentSet
182.415 LCPCompactSmallFragmentInstrumentSet
182.456 InstrumentSetLC-DCP
12 DePuy Synthes Spring Plates 3.5 Surgical Technique
Bibliography
RichterH,HutsonandZychG(2004)TheUseofSpringPlatesintheInternalFixationofAcetabularFractures. JOrthopTrauma2004.18:179–181.
GouletJ,RouleauJ,MasonDandGoldsteinS.ComminutedFracturesofthePosteriorWalloftheAcetabulum.ABiome-chanicalEvaluationofFixationMethods.JBoneJointSurgAm,Volume76-A(10),October1994,pp1457–1463.
Spring Plates 3.5 Surgical Technique DePuy Synthes 13
MRI Information
Torque, Displacement and Image Artifacts according to ASTM F 2213-06, ASTM F 2052-06e1 and ASTM F2119-07Non-clinicaltestingofworstcasescenarioina3 TMRIsystemdidnotrevealanyrelevanttorqueordisplacement oftheconstructforanexperimentallymeasuredlocalspatialgradientofthemagneticfieldof3.69 T/m.Thelargestimageartifactextendedapproximately169mmfromtheconstructwhenscannedusingtheGradientEcho(GE).Testingwasconductedona3 TMRIsystem.
Radio-Frequency-(RF-)induced heating according to ASTM F2182-11aNon-clinicalelectromagneticandthermaltestingofworstcasescenarioleadtopeaktemperatureriseof9.5 °C withanaveragetemperatureriseof6.6 °C(1.5 T)anda peaktemperatureriseof5.9 °C(3 T)underMRIConditionsusingRF Coils[wholebodyaveragedspecificabsorptionrate(SAR)of2 W/kgfor6minutes(1.5 T)andfor15 minutes (3 T)].
Precautions: Theabovementionedtestreliesonnon-clini-caltesting.TheactualtemperatureriseinthepatientwilldependonavarietyoffactorsbeyondtheSARandtimeofRFapplication.Thus,itisrecommendedtopayparticularattentiontothefollowingpoints: – Itisrecommendedtothoroughlymonitorpatientsunder-goingMRscanningforperceivedtemperatureand/orpainsensations.
– PatientswithimpairedthermoregulationortemperaturesensationshouldbeexcludedfromMRscanningproce-dures.
– GenerallyitisrecommendedtouseaMRsystemwith lowfieldstrengthinthepresenceofconductiveimplants.Theemployedspecificabsorptionrate(SAR)shouldbereducedasfaraspossible.
– Usingtheventilationsystemmayfurthercontributetoreducetemperatureincreaseinthebody.
0123
Synthes GmbHEimattstrasse 34436 OberdorfSwitzerlandTel: +41 61 965 61 11Fax: +41 61 965 66 00www.depuysynthes.com
ThispublicationisnotintendedfordistributionintheUSA.
AllsurgicaltechniquesareavailableasPDFfilesat www.depuysynthes.com/ifu ©
DePuySynthesTraum
a,adivisionofSynthesGmbH
.2015.Allrightsreserved.
036.
00
0.58
1 D
SEM
/TR
M/0
815/
043
8 09
/15