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 fxation for the operative treatment 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 profle 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 fxation during reduction for preliminary also available. All plates can be three-dimensionally con- and defnitive 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 fxations 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 fxation, 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

–– Profle: 3.7 mm –– Screw angulation: up to 30° –– Low profle: 2.7 mm –– Reconstruction Plate with low –– Holes: 3 –20 (straight) –– Screw angulation: up to 25° profle, 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 fle, curved: a radius of 88 mm – Available in two radii (88 mm – Left and right and 108 mm) to ft 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

–– Profle: 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 fxation 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 fﬁxationxation to Fracture fﬁxationxation 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 fxation, correction 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 Profle 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 for in-situ plate contouring: Refer to page 17.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 7 Instruments

Standard

Instruments for screw fixation Screw fxation of the pelvis requires the use of extra-long screws and corresponding instruments. The following instruments are part of the Pelvic Instrument Set:

–– Extra-long 3-fluted calibrated drill bit –– Extra-long taps, calibrated with depth markings –– Extra-long screwdrivers (hexagonal and Stardrive) and screwdriver shafts (hexagonal and Stardrive) –– Extra-long depth gauge

Bending instruments –– The bending pliers should be used as the primary bending instrument. –– A smooth bend is best achieved by the introduction of many small bends. –– Bending irons, designed specifcally for use with the reconstruction plates, are also available.

8 DePuy Synthes Pelvic Implants and Instruments Surgical Technique In-situ bending instruments – In-situ bending instruments allow precise intraoperative adaptation of the pre-bent reconstruction plate to the bone anatomy. – The in-situ bending and twisting handles with different tips (straight, 90°, 120°) allow use in different surgical approaches.

In-situ Bender

In-situ Bending and Twisting Handles

Bending templates Malleable bending templates are available for all reconstruction plate shapes (straight, curved, J-shaped). These can be ﬁ tted to the reduced bone and then a plate is shaped to ﬁ t the template.

The templates can also be used to determine plate lengths.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 9 Instruments

Retractors

A wide range of malleable, blunt, spoon shaped, pelvic, Hohmann and sciatic nerve retractors provide more options to aid the surgeon with the chosen approach.

11 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Radiolucent retractors Radiolucent retractors allow for the passage of x-rays without having to remove the instrumentation in order to visualize the implant underneath. Another advantage of these retractors is their light weight.

In an effort to accommodate the surgeon needs, Synthes has redesigned several retractors in aluminum, thus making them radiolucent.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 11 Instruments

Reduction

Pelvic reduction forceps The pelvic reduction forceps are designed to maximize the potential of the ilioinguinal and Kocher-Langenbeck approaches. The jaws of all the larger forceps are long enough to accommodate the innominate bone, from the iliac crest to the pelvic brim, and can be used without exerting excess pressure on the iliac vessels.

Pelvic reduction forceps are equipped with features to im- prove handling characteristics during reduction maneuvers. –– Pointed-ball tips prevent penetration of bone with a thin cortex. –– Longer spikes with sharper points provide a secure hold on the pelvic surfaces.

Increased selection of forceps, including –– Handles and jaws of different lengths –– Straight and oblique versions

Ball spikes with pointed ball tip The straight ball spikes facilitate reduction of bone fragments. They feature a spike to reduce the risk of the instrument slipping off the bone and a pointed-ball tip to prevent penetration of bone with a thin cortex.

Round and rectangular disks Disks can be used in conjunction with the reduction forceps with pointed ball-tips or the ball spike instruments. In poor quality bone (osteoporotic), they can aid in distributing the applied forces over a larger surface area in effort to prevent iatrogenic or compression fractures.

11 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Pelvic reduction forceps for screws All forceps have been designed for use with 3.5 mm / 4.5 mm screws inserted on opposite sides of a fracture line, which allows the application of considerable reduction forces and manipulation in all three planes.

The large forceps have long handles for the transferal of large forces. The Farabeuf forceps can be either used with screws or as general bone forceps, i.e. to grasp and manipulate the iliac wing. –– Jungbluth large (330 mm), small (250 mm), for B 3.5 mm screws –– Farabeuf medium (250 mm), small (190 mm), for Cortex Screws B 3.5 and 4.5 mm

Reduction forceps with points These standard forceps can be applied directly to the bone’s surface, or be used with shallow drill holes or anchoring rings and hooks.

Medium and large bone hooks The bone hooks are designed to allow the surgeon to mani pulate the bone or bone fragments in order to ensure proper alignment and to achieve an anatomical reduction.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 11 Plate Contouring

1 1 Contour plate

Instruments

03.100.031 Bending Pliers for Reconstruction Plates 3.5

329.290 Bending Pliers for Reconstruction Plates 2.7 and 3.5

For plate contouring, place a plate between the ledge and the groove of the bending pliers. Place the concave surface on the side of pliers with the ledge. Squeeze the handles gradually and bend the plate as appropriate. (1)

For in-plane bending, place a plate into the groove of the 2 bending pliers. Squeeze the handles gradually and bend the plate as appropriate. (2)

Precautions: –– Instruments and screws may have sharp edges or moving joints that may pinch or tear user’s glove or skin. –– Handle devices with care and dispose worn bone cutting instruments in an approved sharps container.

11 DePuy Synthes Pelvic Implants and Instruments Surgical Technique 2 Twist plate

Instruments

03.100.031* Bending Pliers for Reconstruction Plates 3.5

329.080 Bending Iron for Reconstruction Plates 3.5 and 4.5, length 190 mm

329.290** Bending Pliers for Reconstruction Plates 2.7 and 3.5

Hold the plate using the plier grips and twist the plate by using an additional bending iron.

Precaution: Reverse bending or use of the incorrect instrumentation for bending may weaken the plate and lead to premature plate failure (e.g. breakage). Do not bend the plate beyond what is required to match the anatomy. For reconstruction plates with coaxial combi-holes: use threaded pin to avoid screw hole deformation during bending.

Note: The bending pliers (03.100.031)* are intended for use with the Reconstruction Plates 3.5 contained in the Low Profle 3.5 mm Pelvic System. The bending pliers (329.290)** are intended for use with the standard Reconstruction Plates 3.5.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 11 Plate Contouring

In-situ Plate Contouring

In-situ bending instruments adjust the pre-bent, reconstruction plates on the bone to match relevant patient anatomy during a surgical procedure. Using this instruments helps decrease the surgical time by reducing the need for repeated cycles of plate positioning and removal until the plate has been suffciently shaped.

Indications The instruments are intended for use with the following plate systems: –– Reconstruction Plates 3.5 with low profle (straight, curved and J-shaped) –– Reconstruction Plates 3.5 with wide Angle –– DCP Reconstruction Plates 3.5, straight and curved

Contraindications Plates with locking and coaxial combi-holes. In particular: –– Locking Reconstruction Plates 3.5 –– Pubic Symphysis Plates 3.5 –– Spring Plates 3.5 –– Reconstruction Plates 3.5 with coaxial combi-holes –– Other plate sizes than 3.5 mm

Note: Preoperative pre-bending of the reconstruction plates is always required before in-situ plate bending. The in-situ bending instruments are intended for detailed and accurate adaptation of the plates to the local anatomy.

Precautions: –– Do not bend the plate at the level of the holes. –– Reverse bending or use of the incorrect instrumentation for bending may weaken the plate and lead to premature plate failure (e.g. breakage). Do not bend the plate beyond what is required to match the anatomy.

11 DePuy Synthes Pelvic Implants and Instruments Surgical Technique 1 Contour plate: in-situ bending or correction of the bending radius

Instrument

03.100.090 In-situ Bender

Grasp the preliminary fxated plate with the in-situ bender. The nose and counter-bearing mouth of the bender must sit in the notches of the reconstruction plate.

Squeeze the handles and bend the plate as required.

2 Bend or twist plate

Instruments

03.100.091 In-situ Bending and Twisting Handle, straight

03.100.092 In-situ Bending and Twisting Handle, 90°

03.100.093 In-situ Bending and Twisting Handle, 120°

Use two straight In-situ Bending and Twisting Handles. Place the tip of each handle in the plate hole. One handle is used for holding the plate while the second handle is mani pulated to bend or twist the plate accordingly.

Note: The In-situ Bending and Twisting Handle, straight can be combined with the In-situ Bending and Twisting Handle, 90° or 120° where appropriate.

Precaution: Ensure that the tip of the instrument is properly attached to the plate to prevent slippage.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 11 Fracture Fixation

Note: The following cases of fracture fxation represent possible uses of pelvic instruments. Several applications are shown but other applications are possible.

A. Pubic Symphysis Fractures

1 Approach

Use an anterior approach (e.g. Pfannenstiel or Stoppa).

11 DePuy Synthes Pelvic Implants and Instruments Surgical Technique 2 1 Reduce fracture

Instruments

399.980 Reduction Forceps, large, with Points, ratchet lock, length 200 mm

398.750 Pelvic Reduction Forceps, for use with Cortex Screws B 3.5 and 4.5 mm

398.880 Pelvic Reduction Forceps, large, adjustable, speed lock, length 300 mm 2 Achieve reduction of the pubic symphysis by using the large reduction forceps with points. (1)

Alternatively, achieve reduction by inserting two screws an- teriorly and using pelvic reduction forceps (398.750/398.880). (2,3)

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 11 Fracture Fixation

3 Fix plate

Instruments

03.100.032 Ratcheting Handle with AO/ASIF Quick Coupling

03.100.033 Screwdriver Shaft, hexagonal, for Screws B 3.5 mm, length 250 mm

324.214 Drill Bit B 2.8 mm, with Scale, length 200/100 mm, 3-flute, for Quick Coupling

311.310 Tap for Cortex Screws B 3.5 mm, calibrated, length 175 mm Pre-drilling: B 2.5 mm

312.648 LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm

314.090 Holding Sleeve, for Nos. 314.070, 314.550 and 314.570

314.570 Screwdriver, hexagonal, small, B 2.5 mm, length 270 mm for Screws B 3.5 mm

315.920 Drill Bit B 2.5 mm, calibrated, length 230/205 mm, 3-flute, for Quick Coupling

319.091 Depth Gauge for Cortex Screws B 3.5 mm, measuring range up to 150 mm

511.773 Torque Limiter, 1.5 Nm, for AO/ASIF Quick Coupling

Alternative instruments

03.100.045 Screwdriver Shaft Stardrive

314.115 Screwdriver Stardrive 3.5, SD15

22 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Place the Pubic Symphysis Plate 3.5 over the symphysis joint and make a temporary fxation (e.g. with plate holding for- 1 2 ceps).

According to preoperative planning and plate selection (locking/non-locking), use B 3.5 mm cortex screws and/or B 3.5 mm locking screws to fx the plate. If compression is needed between the symphysis joint, use the plate with DCU holes.

Insert the frst cortex screw in the lateral part of DCU hole (eccentric). Insert the second cortex screw eccentrically into the DCU hole of the contralateral side of the pubic symph ysis. (1,2)

Precaution: Check appropriate length and position of screw under image intensifer control. 3

Alternate tensioning of the screws results in compression of the symphysis.

Refer to the DCP and LC-DCP Systems technique guide (036.001.093) for more detailed steps during screw insertion and plate fxation.

Additional locking screws should be inserted according to the LCP Locking Compression Plate technique guide (036.000.019). (3)

Notes: –– The x-ray template 034.000.485 indicates locking screw directions. –– Refer to the DCP and LC-DCP Systems DSEM/TRM/1115/0556 and/or LCP Locking Compression Plate DSEM/TRM/0115/0278 Surgical Techniques for independent lag screw placement and plating. –– Screwdriver Shaft Stardrive (03.100.045) and Screwdriver Stardrive 3.5, SD15 (314.115) are used for B 3.5 mm Stardrive screws.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 22 Fracture Fixation

B. Iliac Fractures

1 Approach

Use an anterior or posterior approach appropriate for the fracture pattern. The following example of an iliac fracture shows a possible fracture treatment using a posterior (Kocher – Langenbeck) approach.

2 Reduce fracture

Instruments

398.740 Pelvic Reduction Forceps, small, length 190 mm, for use with Cortex Screws B 3.5 and 4.5 mm

399.980 Reduction Forceps with Points, ratchet lock, length 200 mm

Confrm anatomical reduction of the anterior aspect of the iliac wing by fnger palpation.

To reduce the iliac bone, use reduction forceps on the iliac crest and the posterior iliac wing.

22 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Alternative technique 1

Instruments

311.310 Tap for Cortex Screws B 3.5 mm, calibrated, length 175 mm Pre-drilling: B 2.5 mm

314.570 Screwdriver, hexagonal, small, B 2.5 mm, length 270 mm for Screws B 3.5 mm

315.920 Drill Bit B 2.5 mm, calibrated, length 230/205 mm, 3-flute, for Quick Coupling

319.091 Depth Gauge for Cortex Screws B 3.5 mm, measuring range up to 150 mm

398.750 Pelvic Reduction Forceps, medium, length 250 mm, for use with Cortex Screws B 3.5 and 4.5 mm 2 398.880 Pelvic Reduction Forceps, large, adjustable, speed lock, length 300 mm

399.980 Reduction Forceps with Points, ratchet lock, length 200 mm

Alternatively, insert two temporary cortex screws on either side of the fracture line and gain compression using pelvic reduction forceps: 398.750 Farabeuf (1) or 398.880, Jungbluth (2).

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 22 Fracture Fixation

3 Fix plate on posterior inferior ilium

Instruments

03.100.032 Ratcheting Handle with AO/ASIF Quick Coupling

03.100.033 Screwdriver Shaft, hexagonal, for Screws B 3.5 mm, length 250 mm

311.310 Tap for Cortex Screws B 3.5 mm, calibrated, length 175 mm Pre-drilling: B 2.5 mm

314.090 Holding Sleeve, for Nos. 314.070, 314.550 and 314.570

314.570 Screwdriver, hexagonal, small, B 2.5 mm, length 270 mm for Screws B 3.5 mm

315.920 Drill Bit B 2.5 mm, calibrated, length 230/205 mm, 3-flute, for Quick Coupling

319.091 Depth Gauge for Cortex Screws B 3.5 mm, measuring range up to 150 mm

399.091 Bone Holding Forceps, self-centering, soft lock, length 191 mm

399.980 Reduction Forceps, large, with Points, ratchet lock, length 200 mm

Alternative instruments

03.100.045 Screwdriver Shaft Stardrive

314.115 Screwdriver Stardrive 3.5, SD15

22 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Insert a screw through the 4-hole low profle pelvic reconstruction plate into the body of the ilium, close to the sciatic 1 2 notch. (1)

Precaution: Check appropriate length and position of screw under image intensifer control.

To reduce the posterior iliac fragment, insert a temporary screw into the posterior superior iliac spine. (2)

Compress the fracture using the bone holding forceps. The forceps is therefore hooked into the most posterior plate hole and the temporary screw on the other side of the fracture line is used as a counter bearing. (3) 3 4 After additional screw fxation through the plate, remove the temporary screw. (4)

Precaution: During fxation close to the greater sciatic notch, control drill bit penetration and screw lengths with two-fnger palpation to prevent damage to the nerve or vessels.

Note: Refer to the DCP and LC-DCP Systems DSEM/TRM/1115/0556 and/or LCP Locking Compression Plate DSEM/TRM/0115/0278 Surgical Technique for independent lag screw placement and plating.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 22 Fracture Fixation

4 Fix plate on iliac crest

Instruments

03.100.018 Ball Spike, straight, with pointed ball tips B 6.5 mm, length 300 mm

03.100.032 Ratcheting Handle with AO/ASIF Quick Coupling

03.100.033 Screwdriver Shaft, hexagonal, for Screws B 3.5 mm, length 250 mm

311.310 Tap for Cortex Screws B 3.5 mm, calibrated, length 175 mm Pre-drilling: B 2.5 mm

314.090 Holding Sleeve, for Nos. 314.070, 314.550 and 314.570

314.570 Screwdriver, hexagonal, small, B 2.5 mm, length 270 mm for Screws B 3.5 mm

315.920 Drill Bit B 2.5 mm, calibrated, length 230/205 mm, 3-flute, for Quick Coupling

319.091 Depth Gauge for Cortex Screws B 3.5 mm, measuring range up to 150 mm

399.980 Reduction Forceps, large, with Points, ratchet lock, length 200 mm

Alternative instruments

03.100.045 Screwdriver Shaft Stardrive

314.115 Screwdriver Stardrive 3.5, SD15

22 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Place a low profle pelvic reconstruction plate posterior to the iliac crest, and fx it with B 3.5 mm cortex screws.

The ball spike with pointed ball tip may also be used to achieve reduction.

Precaution: Check appropriate length and position of screw under image intensifer control.

Note: Refer to the DCP and LC-DCP Systems DSEM/TRM/1115/0556 and/or LCP Locking Compression Plate DSEM/TRM/0115/0278 technique guide for independent lag screw placement and plating.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 22 Fracture Fixation

C. Acetabulum Two Column Fractures

1 Approach

Use an ilioinguinal approach.

22 DePuy Synthes Pelvic Implants and Instruments Surgical Technique 2 1 Reduce fracture in iliac crest

Instruments

03.100.019 Ball Spike, straight, long, with pointed ball tips B 6.5 mm, length 400 mm

294.680 Schanz Screw B 6.0 mm, length 190/50 mm, Stainless Steel

398.740 Pelvic Reduction Forceps, small, length 190 mm, for use with Cortex Screws B 3.5 and 4.5 mm

399.980 Reduction Forceps, large, with Points, 2 ratchet lock, length 200 mm

Insert a Schanz screw into the proximal femur to allow intraoperative manual traction. (1)

Confrm anatomic reduction of the different fracture fragments. Fragments may be temporarily fxated with Kirschner wires. (2)

Different reduction instruments (e.g. ball spike, reduction forceps) may aid in achieving appropriate reduction. (2,3)

Note: For a detailed handling description of the Schanz screws, refer to the corresponding Surgical Technique 3 (DSEM/TRM/0516/0677).

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 22 Fracture Fixation

3 Insert screw in iliac crest

Instruments

03.100.032 Ratcheting Handle with AO/ASIF Quick Coupling

03.100.033 Screwdriver Shaft, hexagonal, for Screws B 3.5 mm, length 250 mm

310.370 Drill Bit B 3.5 mm, length 195/170 mm, 2-flute, for Quick Coupling

311.310 Tap for Cortex Screws B 3.5 mm, calibrated, length 175 mm Pre-drilling: B 2.5 mm

314.090 Holding Sleeve, for Nos. 314.070, 314.550 and 314.570

314.570 Screwdriver, hexagonal, small, B 2.5 mm, length 270 mm for Screws B 3.5 mm

315.920 Drill Bit B 2.5 mm, calibrated, length 230/205 mm, 3-flute, for Quick Coupling

319.091 Depth Gauge for Cortex Screws B 3.5 mm, measuring range up to 150 mm

398.740 Pelvic Reduction Forceps, small, length 190 mm, for use with Cortex Screws B 3.5 and 4.5 mm

399.980 Reduction Forceps, large, with Points, ratchet lock, length 200 mm

Alternative instruments

03.100.045 Screwdriver Shaft Stardrive

314.115 Screwdriver Stardrive 3.5, SD15

33 DePuy Synthes Pelvic Implants and Instruments Surgical Technique According to the DCP and LC-DCP Systems DSEM/TRM/1115/0556 technique guide for independent lag screw placement, insert a B 3.5 mm cortex screw (lag screw) into the iliac crest.

Precaution: Check appropriate length and position of screw under image intensifer control.

Use the pelvic reduction forceps and/or the large reduction forceps with points to maintain reduction.

Precaution: Use oscillating mode while drilling to avoid soft tissue damage and penetration of the anterior or posterior iliac cortex.

4 Insert screw in body of ilium

Instrument

03.100.023 Pelvic Reduction Forceps, with pointed ball tips B 6.5 mm, length 400 mm

Insert a second lag screw into the body of the ilium perpendicular to the fracture line.

Precaution: Check appropriate length and position of screw under image intensifer control.

Use the pelvic reduction forceps to maintain reduction.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 33 Fracture Fixation

5 Reduce posterior column

Instrument

399.980 Reduction Forceps, large, with Points, ratchet lock, length 200 mm

Use the reduction forceps with points to reduce the fragment of the quadrilateral surface. The forceps bridge from the pelvic brim to the quadrilateral surface.

Alternative technique

Instruments

03.100.020 Pelvic Reduction Forceps, with pointed ball tips B 6.5 mm, length 250 mm 1

03.100.022 Pelvic Reduction Forceps, angled, with pointed ball tips B 6.5 mm, length 240 mm

03.100.029 Bone Hook, medium, long, length 330 mm

03.100.120 Spiked Disc, round, hole 6.5 mm

314.291 Collinear Reduction Clamp (Sliding Mechanism)

398.753 Pelvic Arm, for Collinear Reduction Clamp

Alternatively the pelvic reduction forceps with pointed ball tips (straight or angled) can be used to reduce the fracture.

If necessary, spiked discs can be used with all pelvic reduction forceps with ball tips. (1)

33 DePuy Synthes Pelvic Implants and Instruments Surgical Technique The collinear reduction clamp with pelvic arm is useful to reduce the posterior column. (2) 2

The bone hook placed beneath the ischial spine may also be used to reduce the posterior column. (3)

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 33 Fracture Fixation

6 In-situ plate contouring

If preoperative bending is insuffcient after plate positioning, insertion and tightening of the frst screws, the in-situ bending instruments can be used to further adapt the plate to the local anatomy.

Instruments

03.100.090 In-situ Bender

03.100.091 In-situ Bending and Twisting Handle, straight

03.100.092 In-situ Bending and Twisting Handle, 90°

03.100.093 In-situ Bending and Twisting Handle, 120°

If in-situ plate adaptation is required, use the in-situ bender as described on page 17.

33 DePuy Synthes Pelvic Implants and Instruments Surgical Technique If plate needs to be bent or twisted to ft the local anatomy, the in-situ bending and twisting handles should be used as described on page 17.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 33 Fracture Fixation

7 Fix plate on pelvic brim

Instruments

03.100.019 Ball Spike, straight, long, with pointed ball tips B 6.5 mm, length 400 mm

03.100.032 Ratcheting Handle with AO/ASIF Quick Coupling

03.100.033 Screwdriver Shaft, hexagonal, for Screws B 3.5 mm, length 250 mm

311.310 Tap for Cortex Screws B 3.5 mm, calibrated, length 175 mm Pre-drilling: B 2.5 mm

314.090 Holding Sleeve, for Nos. 314.070, 314.550 and 314.570

314.291 Collinear Reduction Clamp (Sliding Mechanism)

314.570 Screwdriver, hexagonal, small, B 2.5 mm, length 270 mm for Screws B 3.5 mm

315.920 Drill Bit B 2.5 mm, calibrated, length 230/205 mm, 3-flute, for Quick Coupling

319.091 Depth Gauge for Cortex Screws B 3.5 mm, measuring range up to 150 mm

398.753 Pelvic Arm, for Collinear Reduction Clamp

Alternative instruments

03.100.045 Screwdriver Shaft Stardrive

314.115 Screwdriver Stardrive 3.5, SD15

33 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Fix a J-plate with B 3.5 mm cortex screws on the pelvic brim according to the DCP and LC-DCP Systems (036.001.093) technique guide. Lawwg screws through the plate help to achieve a stable fxation between the anterior and posterior column.

Precaution: Check appropriate length and position of screw under image intensifer control.

8 Fix plate on pubic rami

Insert additional screws through the plate into the pubic rami to maintain reduction and stable fxation of the anterior column.

Precaution: Check appropriate length and position of screw under image intensifer control.

Note: Refer to the DCP and LC-DCP Systems DSEM/TRM/1115/0556 and/or LCP Locking Compression Plate DSEM/TRM/0115/0278 Surgical Technique for lag screw placement and plating.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 33 Implant Removal

Unlock all screws from the plate, then remove the screws completely from the bone. This prevents simultaneous rota- tion of the plate when unlocking the last locking screw.

For details regarding implant removal refer to the Surgical Technique “Screw Extraction Set” DSEM/TRM/0614/0104.

33 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Plates

Reconstruction Plate 3.5 with low profile, straight* –– Stainless steel

Art. No. Holes Length (mm) 245.023 3 39 245.024 4 52 245.025 5 65 245.026 6 78 245.027 7 91 245.028 8 104 245.029 9 117 245.030 10 130 245.031 11 143 245.032 12 156 245.033 13 169 245.034 14 182 245.035 15 195 245.036 16 208 245.038 18 234 245.039 20 260

Reconstruction Plate 3.5 with low profile, curved (radius 108 mm)* –– Stainless steel

Art. No. Holes Length (mm) 245.876 6 78 245.878 8 104 245.880 10 130 245.882 12 156 245.884 14 182 245.886 16 208

* All implants are available sterile packed. For sterile implants add suffix “S” to article number.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 33 Plates

Reconstruction Plate 3.5 with low profile, curved (radius 88 mm)* –– Stainless steel

Art. No. Holes Length (mm) 245.906 6 78 245.908 8 104 245.910 10 130 245.912 12 156 245.914 14 182 245.916 16 208

Reconstruction J-Plate 3.5 with low profile* –– Stainless steel

Art. No. Direction Holes Length (mm) 245.920 right 10 130 245.922 right 12 156 245.924 right 14 182 245.926 right 16 208 245.930 left 10 130 245.932 left 12 156 245.934 left 14 182 245.936 left 16 208

* All implants are available sterile packed. For sterile implants add suffix “S” to article number.

44 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Symphyseal Plate 3.5 with coaxial combi-holes* –– Stainless steel

Art. No. Holes Length (mm) 02.100.004 4 57 02.100.006 6 78

Symphyseal Plate 3.5 with coaxial combi-holes and 2 DCP* –– Stainless steel

Art. No. Holes Length (mm) 02.100.014 4 57 02.100.016 6 78

Reconstruction J-Plate 3.5 with coaxial combi-holes (radius 88 mm)* –– Stainless steel

Art. No. Direction Holes Length (mm) 02.100.360 right 10 130 02.100.362 right 12 156 02.100.364 right 14 182 02.100.366 right 16 208 02.100.361 left 10 130 02.100.363 left 12 156 02.100.365 left 14 182 02.100.367 left 16 208

* All implants are available sterile packed. For sterile implants add suffix “S” to article number.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 44 Plates

Reconstruction Plate 3.5 with coaxial combi-holes, straight* –– Stainless steel

Art. No. Holes Length (mm) 02.100.103 3 39 02.100.104 4 52 02.100.105 5 65 02.100.106 6 78 02.100.107 7 91 02.100.108 8 104 02.100.109 9 117 02.100.110 10 130 02.100.111 11 143 02.100.112 12 156 02.100.113 13 169 02.100.114 14 182 02.100.115 15 195 02.100.116 16 208 02.100.118 18 234 02.100.120 20 260

* All implants are available sterile packed. For sterile implants add suffix “S” to article number.

44 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Reconstruction Plate 3.5 with wide Angle, straight* –– Stainless steel

Art. No. Holes Length (mm) 02.100.203 3 39 02.100.204 4 52 02.100.205 5 65 02.100.206 6 78 02.100.207 7 91 02.100.208 8 104 02.100.209 9 117 02.100.210 10 130 02.100.211 11 143 02.100.212 12 156 02.100.213 13 169 02.100.214 14 182 02.100.215 15 195 02.100.216 16 208 02.100.218 18 234 02.100.220 20 260

Spring Plate 3.5* –– Stainless steel

Art. No. Holes Length (mm) 02.100.301 1 19.5 02.100.302 2 31.5 02.100.303 3 43.5

* All implants are available sterile packed. For sterile implants add suffix “S” to article number.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 44 Screws

02.200.010 –150 Cortex Screw Stardrive B 3.5 mm, self-tapping, length 10 –150 mm, Stainless Steel*

204.630 –750 Pelvic Cortex Screw B 3.5 mm, self-tapping, head height 2.75 mm, length 30 –150 mm, Stainless Steel*

204.810 – 838 Cortex Screw B 3.5 mm, selftapping, length 10 – 38 mm, Stainless Steel*

213.010 – 095 Locking Screw B 3.5 mm, selftapping, length 10 – 95 mm, Stainless Steel*

02.200.003 Threaded Pin Stardrive B 3.5 mm, Stainless Steel*

Locking Screw Stardrive B 3.5 mm, self-tapping* –– Stainless steel

Art. No. Length (mm) Art. No. Length (mm) 212.101 10 212.116 38 212.102 12 212.117 40 212.103 14 212.119 45 212.104 16 212.121 50 212.105 18 212.123 55 212.106 20 212.124 60 212.107 22 212.125 65 212.108 24 212.126 70 212.109 26 212.127 75 212.110 28 212.128 80 212.111 30 212.129 85 212.112 32 212.130 90 212.113 34 212.131 95 212.115 36

* All implants are available sterile packed. For sterile implants add suffix “S” to article number.

44 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Instruments

03.100.011 Pelvic Retractor, medium, length 268 mm

03.100.012 Pelvic Retractor, large, length 323 mm

03.100.013 Retractor for Sciatic Nerve

03.100.014 Retractor for Sciatic Nerve, long

03.100.015 Retractor, malleable, width 20 mm, length 330 mm

03.100.016 Retractor, malleable, width 30 mm, length 330 mm

03.100.017 Retractor, malleable, width 40 mm, length 330 mm

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 44 Instruments

03.100.107 Radioluscent Pelvic Retractor, blunt, length 274 mm, Aluminium

03.100.108 Radioluscent Hohmann Retractor, width 35 mm, length 275 mm, Aluminium

03.100.109 Radioluscent Hohmann Retractor, width 18 mm, length 240 mm, Aluminium

03.100.110 Radioluscent Hohmann Retractor, width 24 mm, length 267 mm, Aluminium

03.100.111 Radioluscent Pelvic Retractor, medium, length 268 mm, Aluminium

03.100.112 Radioluscent Pelvic Retractor, large, length 323 mm, Aluminium

398.550 Pelvic Retractor, blunt

399.270 Bone Lever, long narrow tip, width 18 mm, length 235 mm

03.100.018 Ball Spike, straight, with pointed ball tips B 6.5 mm, length 300 mm

03.100.019 Ball Spike, straight, long, with pointed ball tips B 6.5 mm, length 400 mm

44 DePuy Synthes Pelvic Implants and Instruments Surgical Technique 03.100.020 Pelvic Reduction Forceps with pointed ball tips B 6.5 mm, length 250 mm

03.100.023 Pelvic Reduction Forceps with pointed ball tips B 6.5 mm, length 400 mm

03.100.021 Pelvic Reduction Forceps, angled, with pointed ball tips B 6.5 mm, length 200 mm

03.100.022 Pelvic Reduction Forceps, angled, with pointed ball tips B 6.5 mm, length 240 mm

03.100.024 Pelvic Reduction Forceps, asymmetric, with pointed ball tips B 6.5 mm

03.100.027 Disc, round, hole B 6.5 mm

03.100.028 Disc, rectangular, hole B 6.5 mm

03.100.120 Spiked Disc, round, hole 6.5 mm

03.100.121 Spiked Disc, rectangular, hole B 6.5 mm

398.740 Pelvic Reduction Forceps, small, length 190 mm, for use with Cortex Screws B 3.5 and 4.5 mm

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 44 Instruments

398.750 Pelvic Reduction Forceps, medium, length 250 mm, for use with Cortex Screws B 3.5 and 4.5 mm

398.880 Pelvic Reduction Forceps, large, adjustable, speed lock, length 300 mm

03.100.025 Pelvic Reduction Forceps, small, for Screws B 3.5 mm, length 250 mm

399.980 Reduction Forceps, large, with Points, ratchet lock, length 200 mm

03.100.029 Bone Hook, medium, long, length 330 mm

03.100.030 Bone Hook, large, long, length 330 mm

398.520 Bone Hook, sharp, medium, length 230 mm

398.530 Bone Hook, sharp, large, length 200 mm

03.100.031 Bending Pliers for Reconstruction Plates 3.5

329.080 Bending Iron for Reconstruction Plates 3.5 and 4.5, length 190 mm

44 DePuy Synthes Pelvic Implants and Instruments Surgical Technique 03.100.090 In-situ Bender

03.100.091 In-situ Bending and Twisting Handle, straight

03.100.092 In-situ Bending and Twisting Handle, 90°

03.100.093 In-situ Bending and Twisting Handle, 120°

03.100.034 Bending Template for Low Proﬁ le 3.5 Reconstruction Plates, straight, 20 holes

03.100.035 Bending Template for Low Proﬁ le 3.5 Reconstruction J-Plates, 16 holes

03.100.036 Bending Template for Low Proﬁ le 3.5 Reconstruction Plates, curved (R88), 16 holes

03.100.037 Bending Template for Low Proﬁ le 3.5 Reconstruction Plates, curved (R108), 16 holes

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 49 Instruments

324.031 Plate Holder with thread B 3.5 mm, long

03.100.040 LCP Drill Sleeve 3.5, short, with thread, for Drill Bits B 2.8 mm

312.648 LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm

315.920 Drill Bit B 2.5 mm, calibrated, length 230/205 mm, 3-flute, for Quick Coupling

324.210 Drill Bit B 2.5 mm, calibrated, length 300 mm, with Quick Coupling, for Percutaneous Insertion

324.214 Drill Bit B 2.8 mm, with Scale, length 200/100 mm, 3-flute, for Quick Coupling

310.288 Drill Bit B 2.8 mm, length 165 mm, for AO/ASIF Quick Coupling

310.370 Drill Bit B 3.5 mm, length 195/170 mm, 2-flute, for Quick Coupling

319.091 Depth Gauge for Cortex Screws B 3.5 mm, measuring range up to 150 mm

311.310 Tap for Cortex Screws B 3.5 mm, calibrated, length 175 mm

311.431 Handle with Quick Coupling

55 DePuy Synthes Pelvic Implants and Instruments Surgical Technique 03.100.032 Ratcheting Handle with AO/ASIF Quick Coupling

319.970 Screw Forceps, self-holding, length 85 mm

314.090 Holding Sleeve, for Nos. 314.070, 314.550 and 314.570

314.570 Screwdriver, hexagonal, small, B 2.5 mm, length 270 mm

03.100.033 Screwdriver Shaft, hexagonal, for Screws B 3.5 mm, length 250 mm

314.115 Screwdriver Stardrive 3.5, SD15

314.116 Screwdriver Shaft Stardrive 3.5, SD15, self-holding, for AO/ASIF Quick Coupling

03.100.045 Screwdriver Shaft Stardrive 3.5, SD15, length 250 mm, for AO/ASIF Quick Coupling

511.773 Torque Limiter, 1.5 Nm, for AO/ASIF Quick Coupling

393.100 Universal Chuck with T-Handle

398.650 Pliers for Screw Removal, length 205 mm

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 55 Optional Implants

DCP 4.5, narrow* –– Stainless steel

Art. No. Holes Length (mm) 224.020 2 39 224.040 4 71

LC-DCP 4.5, narrow* –– Stainless steel

Art. No. Holes Length (mm) 224.520 2 34 224.530 3 52 224.540 4 70

Reconstruction Plate 4.5, straight* X = 2: Stainless steel X = 4: Titanium

Art. No. Holes Length (mm) Art. No. Holes Length (mm) X29.330 3 45 X29.400 10 157 X29.340 4 61 X29.410 11 173 X29.350 5 77 X29.420 12 189 X29.360 6 93 X29.430 13 205 X29.370 7 109 X29.440 14 221 X29.380 8 125 X29.450 15 237 X29.390 9 141 X29.460 16 253

* All implants are available sterile packed. For sterile implants add suffix “S” to article number.

55 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Reconstruction Plate 3.5, straight* X = 2: Stainless steel X = 4: Titanium

Art. No. Holes Length (mm) X45.150 5 58 X45.160 6 70 X45.170 7 82 X45.180 8 94 X45.190 9 106 X45.000 10 118 X45.020 12 142 X45.040 14 166 X45.060 16 190 X45.080 18 214 X45.100 20 238 X45.120 22 262

Pelvic Reconstruction Plate 3.5, curved* X = 2: Stainless steel X = 4: Titanium

Art. No. Holes Length (mm) X45.300 6 70 X45.310 8 94 X45.320 10 118 X45.330 12 142 X45.340 14 166 X45.350 16 190 X45.360 18 214

* All implants are available sterile packed. For sterile implants add suffix “S” to article number.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 55 Optional Screws

Cortex Screws* X = 2: Stainless steel X = 4: Titanium

X04.810 – 930 Cortex Screw B 3.5 mm, self-tapping, length 10 – 130 mm

X14.814 – 940 Cortex Screw B 4.5 mm, self-tapping, length 14 – 140 mm

Cancellous Bone Screws* X = 2: Stainless steel X = 4: Titanium

X06.010 – 060 Cancellous Bone Screw B 4.0 mm, fully threaded, length 10 – 60 mm

X07.010 – 060 Cancellous Bone Screw B 4.0 mm, short thread, length 10 – 60 mm

X16.030 –120 Cancellous Bone Screw B 6.5 mm, thread length 16 mm, length 30 –120 mm

X17.045 –150 Cancellous Bone Screw B 6.5 mm, thread length 32 mm, length 45 –150 mm

X18.020 –110 Cancellous Bone Screw B 6.5 mm, fully threaded, length 20 –110 mm

294.680* Schanz Screw B 6.0 mm, length 190/50 mm, Stainless Steel

X19.980* Washer B 7.0/3.6 mm, for Screws B 2.7 to 4.0 mm

* All implants are available sterile packed. For sterile implants add suffix “S” to article number.

55 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Optional Instruments

398.550 Pelvic Retractor, blunt

398.710 Spiked Disc, for Reduction Forceps

398.712 Disc for Reduction Forceps, rectangular

398.730 Pelvic Reduction Forceps, asymmetric, with pointed ball tips, length 400 mm

398.840 Pelvic Reduction Forceps, angled, small, with pointed ball tips, speed lock, length 190 mm

398.850 Pelvic Reduction Forceps, angled, large, with pointed ball tips, speed lock, length 230 mm

398.860 Pelvic Reduction Forceps, long, with pointed ball tips, speed lock, length 400 mm

398.870 Pelvic Reduction Forceps, long, with three pointed ball tips, speed lock, length 400 mm

398.890 Pelvic Reduction Forceps, with angled pointed ball tips, speed lock, length 250 mm

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 55 Optional Instruments

398.540 Ball Spike, with pointed ball tip, length 300 mm

399.092 Reduction Forceps, large, with Points, soft lock, length 222 mm

399.850 Pelvic Osteotomy Chisel, width 15 mm, length 304/134 mm

399.860 Pelvic Osteotomy Chisel, width 20 mm, length 304/134 mm

329.290 Bending Pliers for Reconstruction Plates 2.7 and 3.5

329.640 Bending Template for Straight Reconstruction Plates 3.5

329.660 Bending Template for Curved Reconstruction Plates 3.5

329.680 Bending Template for Straight Reconstruction Plates 4.5, to be cut

391.968 Shortcut 2.7 to 4.5, without rasp, for Reconstruction Plates 2.7 to 4.5, required in pairs

391.969 Shortcut 2.7 to 4.5, with Rasp, for Reconstruction Plates 2.7 to 4.5, required in pairs

55 DePuy Synthes Pelvic Implants and Instruments Surgical Technique 315.230 Drill Bit B 2.5 mm, length 180/155 mm, 3-flute, for Quick Coupling

315.250 Drill Bit B 2.5 mm, length 110/85 mm, 3-flute, for Quick Coupling

315.930 Drill Bit B 3.2 mm, calibrated, length 230/205 mm, 3-flute, for Quick Coupling

310.300 Drill Bit B 3.2 mm, length 180/165 mm, 2-flute, for Jacobs Chuck

310.320 Drill Bit B 3.2 mm, length 130/115 mm, 2-flute, for Jacobs Chuck

315.290 Drill Bit B 3.2 mm, length 195/170 mm, 3-flute, for Quick Coupling

315.310 Drill Bit B 3.2 mm, length 145/120 mm, 3-flute, for Quick Coupling

315.350 Drill Bit B 3.5 mm, length 110/85 mm, 3-flute, for Quick Coupling

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 55 Optional Instruments

310.450 Drill Bit B 4.5 mm, length 130/115 mm, 2-flute, for Jacobs Chuck

310.480 Drill Bit B 4.5 mm, length 195/170 mm, 2-flute, for Quick Coupling

310.490 Drill Bit B 4.5 mm, length 180/165 mm, 2-flute, for Jacobs Chuck

315.440 Drill Bit B 4.5 mm, length 145/120 mm, 3-flute, for Quick Coupling

315.480 Drill Bit B 4.5 mm, length 195/170 mm, 3-flute, for Quick Coupling

319.090 Depth Gauge for Long Screws B 3.5 mm, measuring range up to 110 mm

311.320 Tap for Cortex Screws B 3.5 mm, length 110/50 mm

311.330 Tap for Cortex Screws B 3.5 mm, length 180/110 mm

55 DePuy Synthes Pelvic Implants and Instruments Surgical Technique 311.460 Tap for Cortex Screws B 4.5 mm, length 125/70 mm

311.480 Tap for Cortex Screws B 4.5 mm, length 180/110 mm

311.470 Tap for Cortex Screws B 4.5 mm, calibrated, length 175 mm

314.030 Screwdriver Shaft, hexagonal, small, B 2.5 mm

314.070 Screwdriver, hexagonal, small, B 2.5 mm, with Groove

314.550 Screwdriver Shaft, hexagonal, small, B 2.5 mm, length 165 mm, for Quick Coupling

314.150 Screwdriver Shaft, hexagonal, large, B 3.5 mm

314.260 Screwdriver, hexagonal, large, B 3.5 mm, with Groove, length 300 mm

314.280 Holding Sleeve, large, for Nos. 314.190, 314.240, 314.260, 314.270 and 314.750

314.560 Screwdriver Shaft, hexagonal, large, B 3.5 mm, length 165 mm, for Quick Coupling

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 55 Other Available Pelvic Instruments and Implants from Synthes

Collinear Reduction Clamp Set The Collinear Reduction Clamp assists in achieving and main- taining fracture reduction in minimally invasive techniques. The system consists of sliding mechanism, attachable arms and reduction attachments according to the clinical needs.

Refer to Surgical Technique DSEM/TRM/0115/0280(1).

Cannulated Percutaneous Guiding System Set The Cannulated Percutaneous Guiding System is a soft tissue protector to assist in pelvic and acetabular reconstructive surgery. It allows for less invasive placement of 3.5 mm cortex or pelvic screws as well as 4.0 cancellous screws. It accepts temporary fxation with Kirschner wires / guide wires up to B 2.8 mm.

Refer to Surgical Technique DSEM/TRM/0714/0126.

66 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Pelvic C-Clamp The Pelvic C-Clamp is an emergency stabilization instrument for unstable injuries and fractures of the pelvic ring. Unstable pelvic ring fractures can be associated with massive loss of blood that can cause terminal shock. The Pelvic C-Clamp allows rapid reduction and stabilization of these unstable pelvic ring fractures, thus assisting the surgeon to gain control of the shock reaction. This neither delays nor hinders subsequent diagnosis and therapy.

Note: The Pelvic C-Clamp is not contained in the pelvic sets. See separate Synthes publication “Pelvic C-Clamp”. Refer to Surgical Technique DSEM/TRM/0815/0486.

Large External Fixator Indications for stabilizing the anterior pelvic ring with a large external fxator are: Unstable fractures in the anterior pelvic ring, or symphysis fractures with or without participa- tion of the posterior pelvic ring. This type of stabilization is also possible in emergencies such as polytrauma, open wounds and, where appropriate, as an alternative to internal osteosynthesis.

The pelvis can be stabilized with an external fxator both at the iliac crest and the supraacetabular region.

The clamps are magnetic resonance conditional. This allows magnetic resonance examinations of patients who have been stabilized with the external fxator.

Refer to Surgical Technique DSEM/TRM/0416/0651.

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 66 Other Available Pelvic Instruments and Implants from Synthes

Sacral Bars The Synthes 6.0 mm Threaded Sacral Bars offer an additional option for stabilization of the posterior pelvic ring.

Two threaded bars are therefore drilled through the posterior iliac crests and by compression of the nuts, bridging and compression of the posterior pelvic ring is achieved.

Note: Two 6.0 mm Threaded Sacral Bar Kits are necessary to build the construct described in the Surgical Technique (01.100.763 Sacral Bar Set, Bar Length 200 mm, sterile or 01.100.766 Sacral Bar Set, Bar Length 260 mm, sterile). Also, bolt cutters capable of cutting a 6.0 mm bar will be necessary to complete the procedure (Rod Cutter 388.720 is available). Refer to Surgical Technique DSEM/TRM/0815/0437.

Spring Plate 3.5 The Synthes Spring Plate 3.5 is intended for reduction and fxation of small bone fragments.

In pelvic and acetabular surgery, it is often diffcult to reduce and fx small bone fragments with screws because the fragments may break into even smaller pieces. Mainly in the joint areas (acetabulum) it is essential that even small fragments are anatomically reduced and help to achieve again a homogenous joint congruency. The 3.5 Spring Plates are intended to reduce and stabilize bone fragments that are too small for screws. They can be used individually or in con-junction with a 3.5 mm reconstruction plate.

Refer to Surgical Technique DSEM/TRM/0815/0438.

66 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Trocar for Cannulated Screws 6.5 and 7.3 mm The trocar for 6.5 mm / 7.3 mm cannulated screws is intended to be used as a drill sleeve for a 2.8 mm guide wire and as a reduction tool, especially in minimally invasive procedures.

In addition to the existing guide handle for Kirschner wires B 2.5 (03.306.009) the new trocar features a pointed tip that provides better traction when used on an irregular bony surface.

The length of the standard trocar for cannulated screws is 300 mm and the long trocar for cannulated screws is 350 mm long. (314.052/314.054)

Curved Pelvic Osteotomy Chisels The Curved Pelvic Osteotomy Chisels are general surgical instruments, designed specifcally for peri-acetabular osteotomies and are available in 15 mm and 20 mm widths with a smooth curve. (03.100.038/03.100.039)

These instruments feature an improved shape (curved in- stead of angled) compared to the existing Pelvic Osteotomy Chisels (399.850 and 399.860).

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 66 Other Available Pelvic Instruments and Implants from Synthes

Curved Chisel Blades The Curved Chisel Blades are primarily used to reshape the femoral neck. The four Chisel Blades are a line extension to the already existing straight Chisel Blades (399.550 – 399.580).

The Curved Chisel Blades feature a curved working end and are used in conjunction with the conventional chisel handle (399.540).

03.100.115 Curved Chisel Blade 5 mm

03.100.116 Curved Chisel Blade 10 mm

03.100.117 Curved Chisel Blade 16 mm

03.100.118 Curved Chisel Blade 25 mm

66 DePuy Synthes Pelvic Implants and Instruments Surgical Technique Periosteal Elevators The Periosteal Elevators are basic surgical instruments and are available in 6 mm and 14 mm width curved blades and 14 mm and 20 mm width straight blades. They are designed to simplify the dissection and atraumatic exposure of the bone. They serve to free the bone surface from soft tissues in order to prepare the fracture surfaces for defnitive fxation. (399.350/399.380)

width length 03.100.041 Periosteal Elevator, curved blade 6 mm 200 mm

03.100.042 Periosteal Elevator, curved blade 14 mm 200 mm

03.100.043 Periosteal Elevator, straight blade 14 mm 200 mm

03.100.044 Periosteal Elevator, straight blade 20 mm 200 mm

399.350 Periosteal Elevator, curved shaft, 14 mm 190/75 mm round edge

399.360 Periosteal Elevator, slightly curved 6 mm 190/90 mm blade, round edge

399.370 Periosteal Elevator, straight shaft, 14 mm 202/80 mm round edge

399.380 Periosteal Elevator, straight shaft, 20 mm 202/80 mm round edge

Pelvic Implants and Instruments Surgical Technique DePuy Synthes 66 MRI Information

Torque, Displacement and Image Artifacts according to ASTM F 2213-06, ASTM F 2052-06e1 and ASTM F 2119-07 Non-clinical testing of worst case scenario in a 3 T MRI system did not reveal any relevant torque or displacement of the construct for an experimentally measured local spatial gradient of the magnetic feld of 3.69 T/m. The largest image artifact extended approximately 169 mm from the construct when scanned using the Gradient Echo (GE). Testing was conducted on a 3 T MRI system.

Radio-Frequency-(RF-)induced heating according to ASTM F 2182-11a Non-clinical electromagnetic and thermal testing of worst case scenario lead to peak temperature rise of 9.5 °C with an average temperature rise of 6.6 °C (1.5 T) and a peak temperature rise of 5.9 °C (3 T) under MRI Conditions using RF Coils (whole body averaged specifc absorption rate [SAR] of 2 W/kg for 6 minutes [1.5 T] and for 15 minutes [3 T]).

Precautions: The above mentioned test relies on non-clinical testing. The actual temperature rise in the patient will depend on a variety of factors beyond the SAR and time of RF application. Thus, it is recommended to pay particular attention to the following points: –– It is recommended to thoroughly monitor patients under going MR scanning for perceived temperature and/or pain sensations. –– Patients with impaired thermoregulation or temperature sensation should be excluded from MR scanning procedures. –– Generally, it is recommended to use a MR system with low feld strength in the presence of conductive implants. The employed specifc absorption rate (SAR) should be reduced as far as possible. –– Using the ventilation system may further contribute to reduce temperature increase in the body.

66 DePuy Synthes Pelvic Implants and Instruments Surgical Technique

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Synthes GmbH Eimattstrasse 3 Not all products are currently available in all markets. 4436 Oberdorf Switzerland This publication is not intended for distribution in the USA. Tel: +41 61 965 61 11 Fax: +41 61 965 66 00 All surgical techniques are available as PDF files at www.depuysynthes.com www.depuysynthes.com/ifu 0123 © DePuy Synthes a division Trauma, of Synthes GmbH. 2016.