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Sterile Distal Radius Kit Surgical Technique Image Intensifier Control

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Sterile Distal Radius Kit Surgical Technique Image Intensifier Control For Fragment-Specifi c Fracture Fixation Using the Variable Angle LCP® Two-Column Volar Distal Radius Plate 2.4 With Variable Angle Locking Technology Sterile Distal Radius Kit Surgical Technique Image intensifier control Warning 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 Indications 3 Sterile Kit Variations and Added Instruments 4 Distal Radius Sterile Kit Key Steps 6 Sterile Tube Packaging 7 AO Principles 8 Clinical Cases 9 Surgical Technique Approach 10 Implantation Steps 11 Postoperative Treatment and Implant Removal 21 Product Information 22 MRI Information 28 Bibliography 29 Sterile Distal Radius Kit Surgical Technique DePuy Synthes 1 2 DePuy Synthes Sterile Distal Radius Kit Surgical Technique Indications Variable Angle LCP® Two-Column Volar Distal Radius Plates 2.4 are indicated for the fixation of intra- and extra-articular fractures and osteotomies of the distal radius. Sterile Distal Radius Kit Surgical Technique DePuy Synthes 3 Sterile Kit Variations and Added Instruments Variable Angle LCP® Volar and Dorsal Distal Core sterile kits Radius Plates 2.4. Core sterile kits contain both the implants and instruments to perform one distal radius surgery with a 3-shaft hole Sterile Instruments and Implants for multi-fragment VA-LCP Two-Column Distal Radius Plate 2.4. All implants fracture fixation with variable angle locking technology. are available in both Stainless Steel and Titanium. Extra screws are provided single-packed in sterile packaging. 4 DePuy Synthes Sterile Distal Radius Kit Surgical Technique Sterile Kit Variations and Added Instruments Sterile instrument kits with individually packed sterile plates and screws Instrument kits are part of a modular system with individually packed sterile plates and screws. They contain only the instruments needed to perform one distal radius surgery with the following DePuy Synthes Variable Angle radius plates: VA-LCP Two-Column Distal Radius Plates 2.4 VA-LCP Two-Column Distal Radius Plates, 2.4/2.7, Extra-Long VA-LCP Extra-articular Distal Radius Plates 2.4 VA-LCP Dorsal Distal Radius Plates 2.4 Plates and screws are available single-packed in sterile packaging. Trial implants In addition, sterile trial implants are available separately to determine the correct plate length and width of VA-LCP Two-Column Distal Radius Plates. Implant removal screwdriver The single-use T8 screwdriver is designed to facilitate implant removal without the need for a sterile instrument kit. Note that the screwdriver tip is Note: All implants and instruments of the Sterile non-retaining to facilitate maximum torque transmission. Distal Radius Kit are single use. Do not resterilize. Dispose of all unused items after surgery. Sterile Distal Radius Kit Surgical Technique DePuy Synthes 5 Distal Radius Sterile Kit Key Steps Note: Please refer to the corresponding IFU (www.depuysynthes.com/ifu) and this surgical technique for full usage information. 6 DePuy Synthes Sterile Distal Radius Kit Surgical Technique Sterile Tube Packaging The amount and lengths of screws contained in the Step 3: Distal Radius Single Use Kit has been identifi ed both Circulating Nurse (non-sterile fi eld): scientifi cally to fi t various anatomies and through historical Hold the outer cap and point the inner tube towards sales data. For most cases, the kit will contain screws of the sterile fi eld. suffi cient length. It is recommended to measure each Scrub Nurse (sterile fi eld): hole’s depth to determine the correct screw length based Remove the inner tube by pulling and if necessary slightly on the current recommendation of the literature.3,10 twisting the inner tube back and forth to release it from the outer cap. When twisting the tube, hold on to the Extra screws that are not contained in the kit are tube and not the cap. available individually packed in sterile tubes. sterile fi eld non-sterile fi eld Leading the Way to Sterile Implants Step 4: Open the inner tube by unscrewing the inner cap The Sterile Tube concept consists of a solution that from the inner tube and remove the holder with the screw. uses 2 tubes where one fi ts into the other to allow a streamlined and secure transfer of sterile implants into the sterile fi eld. Follow the following steps to access a sterile screw: Step 1: Tear the pull-strip open to remove the sleeve. sterile fi eld Step 5: Engage the screwdriver in the screw recess and if necessary secure with fi nger. Remove the screw from the holder by tilting it out of the holder/tilting the holder away at the opening. non-sterile fi eld Step 2: Open the outer tube by unscrewing the outer cap from the outer tube. Do not touch the inner tube to maintain sterility. sterile fi eld non-sterile fi eld Sterile Distal Radius Kit Surgical Technique DePuy Synthes 7 AO Principles AO PRINCIPLES In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1,2 In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, 2. 4_Priciples_03.pdf 1 05.07.12 12:08 AnatomicAnatomic reduction reduction StableStable fixation fixation FractureFracture reduction reduction and and fixation fixation to to FractureFracture fixation fixation providingproviding absolute abso- restorerestore anatomical anatomical relationships. relationships. orlute relative or relative stability, stability, as required as by therequired patient, by the the injury, patient, and the the injury, 1 2 personalityand the personality of the fracture. of the fracture. Early,Early, active active mobilization mobilization PreservationPreservation of of blood blood supply supply EarlyEarly and and safe safe mobilization mobilization and and 4 3 PreservationPreservation of of the the blood blood supply supply rehabilitationrehabilitation of ofthe the injured injured part part toto soft soft tissues tissues and and bone bone by by gentle andand the the patient patient as asa whole.a whole. reductiongentle reduction techniques techniques and and carefulcareful handling. handling. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991. 2 Rüedi1. Müller TP, RE ME, Buckley, Allgöwer CG M,Moran. Schneider AO PrinciplesR, Willenegger of Fracture H. Manual Management. of Internal Fixation . 2nd ed.3rd Stuttgart,ed. Berlin, NewHeidelberg, York: Thieme. New York: 2007. Springer-Verlag; 1991. 2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart New York: Thieme; 2007. 8 DePuy Synthes Sterile Distal Radius Kit Surgical Technique 4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique Clinical Cases Case 1 24-year-old male with AO 23C2.1 fracture, fall from scaffold Preoperative, AP view Preoperative, lateral view Postoperative, AP view Postoperative, lateral view Case 2 77-year-old female with AO 23C1 fracture, fall Preoperative, AP view Preoperative, lateral view Postoperative, AP view Postoperative, lateral view Sterile Distal Radius Kit Surgical Technique DePuy Synthes 9 Approach Make a longitudinal incision slightly radial to the fl exor carpi radialis tendon (FCR). Dissect between the FCR and the radial artery, exposing the pronator quadratus. Detach the pronator quadratus from the lateral border of the radius and elevate it toward the ulna. Note: Leave the volar wrist capsule intact to avoid devascularization of the fracture fragments and destabilization of the volar wrist ligaments. 10 DePuy Synthes Sterile Distal Radius Kit Surgical Technique Implantation Steps 1. Select implant Instrument 03.111.120S Trial Implants for VA-LCP Two-Column Distal Radius Plate 2.4, sterile Trial implants Double-sided sterile trial implants may be used to identify the desired plate size prior to opening a distal radius sterile kit. Trial implants with 3 shaft holes are available for VA-LCP Two-Column Volar Distal Radius Plates 2.4. Trial implant choices, for VA-LCP Two-Column Volar Distal Radius Plates 2.4 (narrow, standard, wide head sizes). Trial implants are marked with Left (L) and Right (R) as well as the corresponding plate type (narrow, standard, wide). Select the correct distal radius sterile kit according to the trial implant matching the bone and fracture pattern with respect to side (left and right, facing up) and size (narrow, standard, wide). Precaution: Ensure proper plate selection by verifying the L (left) and R (right) etching on the trial implant. The trial implant’s distal lip is slightly lower on the radial side. Note: Excessive and repetitive bending of the trial implants should be avoided. Trial implants are double-sided (L and R version). Sterile Distal Radius Kit Surgical Technique DePuy Synthes 11 Implantation Steps 2. Reduce fracture and position plate Instrument 292.120 Kirschner Wires Ø 1.25 mm, with trocar tip Reduce the fracture The reduction method will be fracture-specific. Position plate Apply the plate to fit the volar surface. The order of screw insertion and the use of K-wires may vary depending on the fracture pattern and reduction technique. If necessary, use 1.25 mm K-wires inserted through the desired Kirschner-wire hole to temporarily fix the plate distally. The distal K-wire holes of the plate are designed to indicate the nominal screw trajectory angle of the screw hole medial to the respective K-wire hole.
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