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Pelvic Implants and Instruments. a Dedicated System for Reconstructive Pelvic and Acetabular Surgery

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Pelvic Implants and Instruments. a Dedicated System for Reconstructive Pelvic and Acetabular Surgery Pelvic Implants and Instruments. A dedicated system for reconstructive pelvic and acetabular surgery. Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation. Image intensifier control This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance 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 Plates 39 Screws 44 Instruments 45 Optional Implants 52 Optional Screws 54 Optional Instruments 55 Other Available Pelvic Instruments and Implants from Synthes 60 MRI Information 66 Pelvic Implants and Instruments Surgical Technique DePuy Synthes 1 Pelvic Implants and Instruments. A dedicated system for reconstructive pelvic and acetabular surgery. Essential equipment for the surgical treatment of pelvic fractures The complex anatomy of the pelvic ring and acetabulum The Pelvic Implant and Instrument Sets contain a wide range involve complex surgical exposures and demands exact of implants, reduction instruments, retractors and instru- anatomical reduction to achieve positive functional results. ments for screw and plate fixation for the operative treat- ment of pelvic and acetabular fractures. All implants are The AO and Synthes took this into consideration in develop- available in 316L implant stainless steel, sterile and non ster- ing the Pelvic Implant and Instrument Sets. ile packaged. Reconstruction Plate and Screw Set Pelvic Standard Instrument Set The pelvic and acetabular low profile implants offer pre- The Pelvic Instrument Set has a wide range of standard shaped plate designs. Additional trays with locking compres- instruments for screw insertion, plate adaptation (bending sion, wide angle (acetabular) and J-plates (pelvic brim) are instruments) and fixation during reduction for preliminary also available. All plates can be three-dimensionally con- and definitive stabilization of pelvic and acetabular fractures. toured allowing them to be closely adapted to pelvic bone surfaces. Bending templates allow for easy manual adap- tation of the plates. 2 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Pelvic Retractor Set Pelvic Reduction Instrument Set A wide range of retractors (pelvic, Hohmann, sciatic nerve The pelvic reduction forceps and other reduction instruments and malleable) within the Pelvic Retractor Set provide more within the Pelvic Reduction Instrument Set are designed to options to aid the surgeon in achieving good visibility within aid the surgeon with fracture reduction of pelvic injuries. the chosen approach. Pelvic Implants and Instruments Surgical Technique DePuy Synthes 3 Implant Specifications Reconstruction Plates Uniform cross-section Occasionally, pelvic osteosyntheses can be carried out using Improved contourability 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. Reconstruction Plates 3.5 with wide Angle Reconstruction Plates 3.5 with low profile – Profile: 3.7 mm – Screw angulation: up to 30° – Low profile: 2.7 mm – Reconstruction Plate with low – Holes: 3 –20 (straight) – Screw angulation: up to 25° profile, J-shaped: hybrid of curved – Allow the use of cortex screws – Holes: 3 –20 (straight), and straight: and/or pelvic cortex screws 6 –16 (curved), 10 –16 (J-shaped) – One leg of the plate is straight, 3.5 mm – Reconstruction Plate with low pro- while the other leg is bent with file, curved: a radius of 88 mm – Available in two radii (88 mm – Left and right and 108 mm) to fit the average – Fits along pelvic brim, from pelvis of a female or male, the pubic rami (curved part of the respectively plate) to the SI joint (straight end – Allows the use of cortex screws of the plate) and/or pelvic cortex screws 3.5 mm 4 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Coaxial combi-holes in locking plates Low profile and rounded edges Allow the use of locking screws or cortex screws Reduce the risk of soft tissue irritation. in the same round conical plate hole. Locking Reconstruction Plate 3.5 Pubic Symphysis Plates 3.5 Spring Plate 3.5 – Profile: 3.7 mm – Fits the anatomy of the pubic – Reduces and stabilizes small bone – Screw angulation: s y m p h y s i s fragments that are too small for up to 12° (cortex screws) – Coaxial combi-holes accept screws. – Holes: 3 – 20 (straight), 3.5 locking screws as well as stan- – Can be used individually or with a 10 – 16 (J-shaped) dard/pelvic cortex screws (3.5) 3.5 mm reconstruction plate. – Features coaxial combi-holes (this – Radius of 60 mm – Pre-bent convex shape with two means the plate can be used with – Reinforced midsection of plate sharp spikes on the bottom surface. standard cortex screws 3.5 as well – 3 small holes in midsection can be Reduction is achieved by sinking as with 3.5 locking screws) used to attach sutures spikes into small fragments while – 4 versions: tightening a screw through one of – 4 coaxial combi-holes the screw holes. – 6 coaxial combi-holes – Convex shape for better bone reten- – 2 DCU holes and 2 coaxial tion. Small fragments are preloaded – combi-holes* once a screw is inserted which – 2 DCU holes and 4 coaxial allows the plate to adapt better to – combi-holes* bony, uneven surfaces. – Allows the use of cortex screws * DCU: Dynamic Compression Unit and/or pelvic cortex screws 3.5 mm. Pelvic Implants and Instruments Surgical Technique DePuy Synthes 5 AO Principles AO PRINCIPLES In 1958, the AO formulated four basic principles, which have Inbecome 1958, the guidelinesAO formulated for internal four basic fixation principles,1,2. which have become the guidelines for internal fixation1, 2. 4_Priciples_03.pdf 1 05.07.12 12:08 AnatomicAnatomic reduction Stable fixation FractureFracture reductionreduction andand fifixationxation to Fracture fifixationxation providing providing absolute abso- restoreto restore anatomical anatomical relationships. relationships. orlute relative or relative stability, stability, as required as by the patient,required the by injury,the patient, and the the personality injury, 1 2 ofand the the fracture. personality of the fracture. Early,Early, active mobilization Preservation of of bloodblood supplysupply EarlyEarly andand safe mobilization and and 4 3 Preservation of of the the blood blood supply supply rehabilitationrehabilitation of thethe injuredinjured part part and toto softsoft tissuestissues and and bone bone by by gentle andthe patientthe patient as a whole.as a whole. reductiongentle reduction techniques techniques and careful and handling.careful handling. 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. 1 Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer. 1991. 2 Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007. 4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique 6 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Intended Use, Indications and Contraindications Intended Use Pelvic implants are intended for temporary fixation, correc- tion 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 – Locking Reconstruction Plates 3.5 – Straight Plates – J-Plates – Reconstruction Plates 3.5 with wide Angle – Straight Plates Ilium/Iliac wing fractures – Reconstruction Plates – Straight Plates – Curved Plates (88 mm radius, 108 mm radius) – Locking Reconstruction Plates 3.5 – Straight Plates – Low Profile Reconstruction Plates 3.5 with wide Angle – Straight Plates Acetabulum fractures – Reconstruction Plates – Straight Plates – Curved Plates (88 mm radius, 108 mm radius) – Reconstruction Plates 3.5 with wide Angle – Straight Plates Contraindications No specific contraindications. Indications and contraindications
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