2.4 mm and 3.0 mm headless compression screws tgsynthes.vo.llnwd.net/o16/mobile/synthes north...

2.4 mm and 3.0 mm HeadlessCompression Screws. For fixation ofsmall bones and small bone fragments.

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

2.4 mm and 3.0 mm Headless Compression Screw 2

Technique Overview 4

AO Principles 5

Indications 6

Scaphoid Fixation 7

First Metatarsal Osteotomy 14

Screw Removal 20

Implants 21

Instruments 25

Set Lists 28

Image intensifier control

Synthes

2 Synthes 2.4 mm and 3.0 mm Headless Compression Screws Technique Guide

The 2.4 mm Self-drilling, Self-tapping, Cannulated Headless Compression Screw

T8 StarDrive recess 3.1 mm cortical thread (double thread*)

2.0 mm shaft

2.4 mm cancellous thread (single thread*)

Implant quality 316L stainless steel

Titanium alloyTi-6Al-7Nb

Short thread

1.1 mm guide wire

Self-drilling and self-tapping flutes


Long thread

* Threads are of equal lead (i.e. they advance the same distance for each revolution)

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The 3.0 mm Self-drilling, Self-tapping, Cannulated Headless Compression Screw

T8 StarDrive recess

* Threads are of equal lead (i.e. they advance the same distance for each revolution)

3.5 mm cortical thread (double thread*)

2.0 mm shaft

3.0 mm cancellous thread (single thread*)

Implant quality 316L stainless steel

Titanium alloyTi-6Al-7Nb

Short thread

1.1 mm guide wire



Long thread


Technique Overview

1 Insert screw

Thread the head of the headlesscompression screw into the tip of the compression sleeve. Insertthe screw into the bone using thecompression sleeve construct.

2 Compress

The tip of the compression sleeve actsas a conventional lag screw head.When the tip of the compression sleeve contacts the bone, the fracture gap is closed and compressed as with a lag screw.

3 Countersink

Following compression of the fracture,hold the compression sleeve stationaryand use the screwdriver to advance thescrew head into the bone.

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In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation.1 Those principlesas applied to the 2.4 mm and 3.0 mm Headless CompressionScrews are:

Anatomic reductionA guide wire marks the prescribed path for the cannulatedheadless compression screw and secures the alignment of the fragments while the screw is being inserted. The cannulated headless compression screw is inserted over the wire and tightened to further compress the fragmentsand hold the reduction.

Stable fixationRegardless of the size of the fracture gap, cannulated headless compression screws provide interfragmentary compression and absolute stability. Furthermore, the instrumentation allows the surgeon to directly control the amount of compression. The screws are available in different thread lengths, allowing the surgeon to optimizepurchase in the far fragment for maximum compression and stability.

Preservation of blood supplyThe use of small diameter guide wires allows precise placementof the cannulated headless compression screws throughsmall incisions. This technique minimizes disruption of softtissue and preserves vascular blood flow for bone healing.

Early, active mobilizationCannulated headless compression screws, combined withAO technique, provide stable fracture fixation with minimaltrauma to vascular supply. This helps to create an improvedenvironment for bone healing, accelerating the patients return to previous mobility and function.

AO Principles

1. M. E. Mller, M. Allgwer, R. Schneider, and H. Willenegger. AO Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991.


Synthes 2.4 mm Headless Compression Screws are indicatedfor fixation of fractures and nonunions of small bones andsmall bone arthrodeses, including scaphoid fractures; intra-articular fractures of the tarsals, metatarsals, carpals andmetacarpals; bunionectomies and osteotomies; arthrodesesof small joints (e.g. phalanges); fractures of the patella, ulnaand radial styloid.

Synthes 3.0 mm Headless Compression Screws are intendedfor fixation of intra-articular and extra-articular fractures and nonunions of small bones and small bone fragments;arthrodeses of small joints; bunionectomies and osteotomies,including scaphoid and other carpal bones, metacarpals,tarsals, metatarsals, patella, ulnar styloid, capitellum, radialhead and radial styloid.

Indications

Scaphoid nonunion Scaphoid fracture

Carpal fusion DIP fusion

Calcaneal and talar fractures Bunionectomy

Toe fusion Radial styloid fracture

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This surgical technique describes a volar approach procedure.Depending on the type and location of the fracture, a dorsalapproach to the scaphoid may be preferred. The same surgicalsteps apply.

1Insert guide wire

Instruments

292.622, 1.1 mm Guide Wire (threaded or nonthreaded)292.623

312.151 2.0 mm/1.1 mm Double Drill Sleeve

Reduce fragments with a 1.1 mm guide wire and the 2.0 mm/1.1 mm double drill sleeve using image intensification.Insert the wire from distal-radial to proximal-ulnar until thetip is anchored into the far cortex. Ensure the guide wire liesalong the central axis of the scaphoid in the frontal andsagittal planes.

Note: Using a pen-style rather than a pistol-grip drive unitmay facilitate the insertion of the 1.1 mm guide wire. Insertthe guide wire in 10 mm to 15 mm increments to minimizethe possibility of bending the wire.

Scaphoid Fixation


Scaphoid Fixation continued

2Drill trapezium (optional)

Instruments

03.226.003 4.8 mm Cannulated Trapezium Drill

03.226.005 4.8 mm Trapezium Drill Sleeve

311.43 Handle, with quick coupling

If the foot process of the trapezium is prominent, it can be removed with the 4.8 mm cannulated trapezium drill to ensure central placement of the screw.

Slide the trapezium drill through the 4.8 mm trapezium drillsleeve and over the guide wire to the trapezium. Carefullydrill the trapezium by hand to remove interfering bone. Useimage intensification to ensure the trapezium drill does notdamage the scaphoid.

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3Measure screw length

Instrument

03.226.002 Measuring Device

Slide the tapered end of the measuring device over the guidewire to the bone.

The reading on the measuring device at the end of the guidewire indicates the screw length which will place the screw tip at the tip of the guide wire.

To choose the appropriate screw length, subtract approximately2 mm to account for fracture gap compression and the desired countersinking depth.

When selecting the shaft thread length, ensure that all threadsare past the fracture line during the compression stage.

Correctly selected thread lengthShaft thread is past the fracture line during compression.

Incorrect thread lengthShaft thread is in the fracture gap. Compression of the fracture gap is not possible.



4Drill (optional)

Instruments

310.221 2.0 mm Cannulated Drill Bit


The self-drilling flutes of the headless compression screwmake predrilling unnecessary in most cases. Predrilling is recommended in dense bone and in arthrodeses, as the axial force necessary for inserting self-drilling screws couldtemporarily distract the fragments.

Place the 2.0 mm/1.1 mm double drill sleeve with the 2.0 mmcannulated drill bit over the guide wire. Drill, using image intensification if necessary.

Note: To prevent the guide wire from backing out duringdrilling, do not over-drill at the tip of the wire, and removethe drill bit slowly. To ensure the guide wire stays in place, do not use the drill in reverse. Before drilling and after measuring, the wire may be advanced into the distal radius to assure retention after drilling.

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5Pick up screw

Instruments

03.226.000 Compression Sleeve for 3.0 mm HeadlessCompression Screw

03.266.016 Compression Sleeve for 2.4 mm HeadlessCompression Screw

Twist the compression sleeve over the head thread of thescrew to remove it from the screw rack.

Optional instrument

319.97 Screw Forceps

Alternatively, use the screw forceps to pick up the screwfrom the rack and thread it into the compression sleeve.



6Insert screw and compress

Instruments

03.226.000 Compression Sleeve for 3.0 mm Headless Compression Screw

03.226.006 Compression Sleeve Handle


Slide the compression sleeve handle into the back of thecompression sleeve.

Insert the screw over the guide wire and thread it into thebone by turning the compression sleeve.

Tighten the compression sleeve until the fracture gap is closedand compressed.

Warning: Take care not to over-tighten the screw as thethreads may strip. Use a two-finger technique to tighten the screw.

If the thread strips (noticeable through decreased resistancewhile tightening), some of the compression will be lost.When the screw is countersunk, the thread will purchase the bone again, thus reducing the danger of postoperativescrew loosening.

If loss of compression makes screw removal necessary, follow the instructions on page 20.

Note: Use image intensification to check that the entireshaft thread is beyond the fracture line. Otherwise no compression can be achieved.

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7Insert screw head

Instruments


03.226.004 Cannulated StarDrive Screwdriver Shaft, T8, quick coupling



Remove the compression sleeve handle from the compressionsleeve. Slide the cannulated StarDrive screwdriver shaft throughthe compression sleeve into the recess of the screw.

Implant the head thread by turning the screwdriver clockwise.Hold the compression sleeve stable to prevent rotation, whileslightly pressing the compression sleeve on the bone.

Color markingsThe color markings on the screwdriver shaft indicate the position of the screw in the bone:

When the green mark is flush with the top of the compression sleeve, the screw is fully threaded into the compression sleeve and the screwdriver tip is seated in the recess of the screw

When the yellow mark is flush with the top of the compression sleeve, the top of the screw is flush with the bone surface

When the red mark is flush with the top of the compressionsleeve, the screw is 2 mm below the bone surface

Check final screw position with image intensification.

Remove and discard the guide wire.

Hold

Hold


First Metatarsal Osteotomy

The following is a simplified description of the first metatarsalosteotomy (Austin Osteotomy). It is an example to illustrate a use of the headless compression screw in the foot.

1Perform osteotomy

Remove the bunion on the medial side of the first metatarsal,and perform a chevron osteotomy with a saw blade.

2Move distal fragment

Slide the distal fragment in the lateral direction.

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3Insert guide wire

Instruments

292.622, 1.1 mm Guide Wire (threaded or nonthreaded)292.623


While monitoring with the image intensifier, advance the1.1 mm guide wire through the 2.0 mm/1.1 mm double drillsleeve from proximal-dorsal to distal-plantar through the osteotomy, until the thread tip is anchored in the far cortex.

4Measure screw length

Instrument


Slide the tapered end of the measuring device over the guidewire to the bone.

The reading on the measuring device at the end of the guidewire indicates the screw length which will place the screw tipat the tip of the guide wire.

To choose the appropriate screw length, subtract approximately2 mm to account for osteotomy gap compression and thedesired countersinking depth.

When selecting the shaft thread length, ensure that all threadswill be past the osteotomy line during the compression stage.


First Metatarsal Osteotomy continued

5Drill (optional)

Instruments

310.221 2.0 mm Cannulated Drill Bit

312.151 2.0 mm/1.1 Double Drill Sleeve

The self-drilling flutes of the headless compression screwmake predrilling unnecessary in most cases. However,predrilling is recommended in dense bone and in arthrodeses,as the axial force necessary for inserting self-drilling screwscould temporarily distract the fragments.

Place the 2.0 mm/1.1 mm double drill sleeve and the 2.0 mmcannulated drill bit over the guide wire. Drill, using image intensification if necessary.

Note: To prevent the guide wire from backing out duringdrilling, do not over-drill at the tip of the wire, and removethe drill bit slowly. To ensure the guide wire stays in place, do not use the drill in reverse.

6Pick up screw

Instruments



Twist the compression sleeve over the head thread of thescrew to remove it from the screw rack.

Optional instrument


Alternatively, use the screw forceps to pick up the screwfrom the rack and thread it into the compression sleeve.

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7Insert screw and compress

Instruments




Slide the compression sleeve handle into the back of thecompression sleeve.

Insert the screw over the guide wire and thread into thebone by turning the compression sleeve.

Tighten the compression sleeve until the osteotomy is compressed.

Warning: Take care not to over-tighten the screw as thethreads may strip. Use a two-finger technique to tighten the screw.

If the thread strips (noticeable through decreased resistancewhile tightening), some of the compression will be lost.When the screw is countersunk, the thread will purchase the bone again, thus reducing the danger of postoperativescrew loosening.

If loss of compression makes screw removal necessary, followthe instructions on page 20.

Note: Use image intensification to check that the shaft threadis beyond, and not across, the osteotomy site. Otherwise nocompression can be achieved.


First Metatarsal Osteotomy continued

8Insert screw head

Instruments


03.226.004 Cannulated StarDrive Screwdriver Shaft, T8, quick coupling



Remove the compression sleeve handle from the compressionsleeve. Slide the cannulated StarDrive screwdriver shaft throughthe compression sleeve into the recess of the screw.

Implant the head thread by turning the screwdriver clockwise.Hold the compression sleeve stable to prevent rotation, whileslightly pressing the compression sleeve on the bone.

Color markingsThe color markings on the screwdriver shaft indicate the position of the screw in the bone:

When the green mark is flush with the top of the compression sleeve, the screw is fully threaded into the compression sleeve and the screwdriver tip is seated in the recess of the screw

When the yellow mark is flush with the top of the compression sleeve, the top of the screw is flush with thebone surface

When the red mark is flush with the top of the compressionsleeve, the screw is 2 mm below the bone surface

Check final screw position with image intensification.

Remove and discard the guide wire.

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9Remove protruding bone

Remove the projecting bone of the proximal fragment with a saw blade.


Screw Removal

Instruments


03.226.004 Cannulated StarDrive Screwdriver Shaft, T8

03.226.016 Compression Sleeve for 2.4 mm Headless Compresssion Screw


314.467 StarDrive Screwdriver Shaft, T8

To remove the headless compression screw, use a T8 StarDrivescrewdriver shaft.

If the screw threads are stripped, however, use the followingprocedure:

Twist the compression sleeve over the head thread, and insertthe screwdriver through the compression sleeve into theStarDrive recess of the screw. If necessary, expose the StarDriverecess and part of the head thread using a hook, hollowreamer, or curette. Remove the screw by simultaneouslypulling on the compression sleeve and turning the screwdriver counterclockwise.

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2.4 mm Headless Compression Screws, short threadShaft thread (T) approximately 20% of screw length (L)

Stainless Length Thread Steel Titanium (mm) length (mm)02.226.209 04.226.209 9 4 02.226.210 04.226.210 10 4 02.226.211 04.226.211 11 4 02.226.212 04.226.212 12 4 02.226.213 04.226.213 13 4 02.226.214 04.226.214 14 4 02.226.215 04.226.215 15 4 02.226.216 04.226.216 16 4 02.226.217 04.226.217 17 4 02.226.218 04.226.218 18 4 02.226.219 04.226.219 19 4 02.226.220 04.226.220 20 4 02.226.221 04.226.221 21 4 02.226.222 04.226.222 22 4 02.226.223 04.226.223 23 4 02.226.224 04.226.224 24 5 02.226.225 04.226.225 25 5 02.226.226 04.226.226 26 5 02.226.227 04.226.227 27 6 02.226.228 04.226.228 28 6 02.226.229 04.226.229 29 6 02.226.230 04.226.230 30 7 02.226.232 04.226.232 32 7 02.226.234 04.226.234 34 8 02.226.236 04.226.236 36 9 02.226.238 04.226.238 38 9 02.226.240 04.226.240 40 10

L

T2 mm

Implants


Implants continued

2.4 mm Headless Compression Screws, long threadShaft thread (T) approximately 40% of screw length (L)

Stainless Length Thread Steel Titanium (mm) length (mm)02.226.317 04.226.317 17 602.226.318 04.226.318 18 602.226.319 04.226.319 19 702.226.320 04.226.320 20 702.226.321 04.226.321 21 802.226.322 04.226.322 22 802.226.323 04.226.323 23 802.226.324 04.226.324 24 802.226.325 04.226.325 25 802.226.326 04.226.326 26 1002.226.327 04.226.327 27 1002.226.328 04.226.328 28 1002.226.329 04.226.329 29 1002.226.330 04.226.330 30 1202.226.332 04.226.332 32 1202.226.334 04.226.334 34 1402.226.336 04.226.336 36 1402.226.338 04.226.338 38 1602.226.340 04.226.340 40 16

L

T2 mm

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3.0 mm Headless Compression Screws, short threadShaft thread (T) approximately 20% of screw length (L)

Stainless Length Thread Steel Titanium (mm) length (mm)02.226.010 04.226.010 10 402.226.011 04.226.011 11 402.226.012 04.226.012 12 402.226.013 04.226.013 13 402.226.014 04.226.014 14 402.226.015 04.226.015 15 402.226.016 04.226.016 16 402.226.017 04.226.017 17 402.226.018 04.226.018 18 402.226.019 04.226.019 19 402.226.020 04.226.020 20 402.226.021 04.226.021 21 402.226.022 04.226.022 22 402.226.023 04.226.023 23 402.226.024 04.226.024 24 502.226.025 04.226.025 25 502.226.026 04.226.026 26 502.226.027 04.226.027 27 602.226.028 04.226.028 28 602.226.029 04.226.029 29 602.226.030 04.226.030 30 702.226.032 04.226.032 32 702.226.034 04.226.034 34 802.226.036 04.226.036 36 902.226.038 04.226.038 38 902.226.040 04.226.040 40 10

L

T2 mm


3.0 mm Headless Compression Screws, long threadShaft thread (T) approximately 40% of screw length (L)

Stainless Length Thread Steel Titanium (mm) length (mm)

02.226.116 04.226.116 16 502.226.117 04.226.117 17 602.226.118 04.226.118 18 602.226.119 04.226.119 19 702.226.120 04.226.120 20 702.226.121 04.226.121 21 802.226.122 04.226.122 22 802.226.123 04.226.123 23 802.226.124 04.226.124 24 802.226.125 04.226.125 25 802.226.126 04.226.126 26 1002.226.127 04.226.127 27 1002.226.128 04.226.128 28 1002.226.129 04.226.129 29 1002.226.130 04.226.130 30 1202.226.132 04.226.132 32 1202.226.134 04.226.134 34 1402.226.136 04.226.136 36 1402.226.138 04.226.138 38 1602.226.140 04.226.140 40 16

L

T2 mm

Implants continued

Synthes 25

Instruments



03.226.003 4.8 mm Cannulated Trapezium Drill, quick coupling

03.226.004 Cannulated StarDrive Screwdriver Shaft, T8,quick coupling





292.623 1.1 mm Nonthreaded Guide Wire, 150 mm length

310.221 2.0 mm Cannulated Drill Bit, quick coupling,150 mm




319.291 1.25 mm Cleaning Brush

292.622 1.1 mm Threaded Guide Wire, 150 mm length

Instruments continued

Synthes 27


398.408 Freer Elevator

398.409 Scaphoid Elevator

Also Available

03.226.007 2.0 mm Drill Guide with Stop

03.226.008 Measuring Device for Drill Guide with Stop

319.292 1.1 mm Cleaning Stylet

2.4 mm Headless Compression Screw SetsStainless Steel (01.226.042) and Titanium (01.226.044)


Screw Rack60.226.024 Screw Rack for 2.4 mm Headless

Compression Screws (with lid)

Implants in set 01.226.04202.226.209 2.4 mm Headless Compression Screws,

02.226.240 short thread, 9 mm40 mm, 2 ea.

02.226.317 2.4 mm Headless Compression Screws, 02.226.340 long thread, 17 mm40 mm, 2 ea.

Implants in set 01.226.04404.226.209 2.4 mm Titanium Headless Compression 04.226.240 Screws, short thread, 9 mm40 mm, 2 ea.

04.226.317 2.4 mm Titanium Headless Compression 04.226.340 Screws, long thread, 17 mm40 mm, 2 ea.

Also Available60.226.025 Lid for Screw Rack for 2.4 mm Headless

Compression Screw


Compression sleeve fits here

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3.0 mm Headless Compression Screw SetsStainless Steel (01.226.062) and Titanium (01.226.064)

Screw Rack60.226.006 Screw Rack for 3.0 mm Headless

Compression Screws (with lid)

Implants in set 01.226.06202.226.010 3.0 mm Headless Compression Screws, 02.226.040 short thread, 10 mm40 mm, 2 ea.

02.226.116 3.0 mm Headless Compression Screws, 02.226.140 long thread, 16 mm40 mm, 2 ea.

Implants in set 01.226.06404.226.010 3.0 mm Titanium Headless Compression 04.226.040 Screws, short thread, 10 mm40 mm, 2 ea.

04.226.116 3.0 mm Titanium Headless Compression 04.226.140 Screws, long thread, 16 mm40 mm, 2 ea.

Also Available60.226.010 Lid for Screw Rack for 3.0 mm Headless

Compression Screws


2.4 mm and 3.0 mm Headless Compression Screw Instrument Set (01.226.022)

Graphic Case60.226.022 2.4 mm and 3.0 mm Headless Compression

Screw Graphic Case

Instruments03.226.000 Compression Sleeve for 3.0 mm Headless

Compression Screw


03.226.003 4.8 mm Cannulated Trapezium Drill

03.226.004 Cannulated StarDrive Screwdriver Shaft, T8, 2 ea.




292.622 1.1 mm Threaded Guide Wire, 150 mm, 10 ea.

292.623 1.1 mm Nonthreaded Guide Wire, 150 mm,10 ea.

310.221 2.0 mm Cannulated Drill Bit, quick coupling,150 mm, 2 ea.




319.291 1.25 mm Cleaning Brush

319.292 1.1 mm Cleaning Stylet


398.408 Freer Elevator

398.409 Scaphoid Elevator

Also Available03.226.007 2.0 mm Drill Guide with Stop

03.226.008 Measuring Device for Drill Guide with Stop

60.226.006 Screw Rack for 3.0 mm HeadlessCompression Screw (with lid)

60.226.023 2.4 mm and 3.0 mm Headless CompressionScrew Graphic Case Lid

60.226.024 Screw Rack for 2.4 Headless CompressionScrew (with lid)

Note: For additional information, please refer to package insert.

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2.4 mm and 3.0 mm Headless Compression Screw Instrument and Implant SetsStainless Steel (01.226.032) and Titanium (01.226.034)

01.226.032 2.4 mm and 3.0 mm Headless CompressionScrew Instrument and Implant Set

Set consists of:

01.226.042 2.4 mm Headless Compression Screw Implant Set

01.226.062 3.0 mm Headless Compression Screw Implant Set

01.226.022 2.4 mm and 3.0 mm Headless CompressionScrew Instrument Set

01.226.034 2.4 mm and 3.0 mm Headless CompressionScrew Instrument and Titanium Implant Set

Set consists of:

01.226.044 2.4 mm Headless Compression Screw TitaniumImplant Set

01.226.064 3.0 mm Headless Compression Screw TitaniumImplant Set

01.226.022 2.4 mm and 3.0 mm Headless CompressionScrew Instrument Set

Synthes (USA)1302 Wrights Lane EastWest Chester, PA 19380Telephone: (610) 719-5000To order: (800) 523-0322Fax: (610) 251-9056

Synthes (Canada) Ltd.2566 Meadowpine BoulevardMississauga, Ontario L5N 6P9Telephone: (905) 567-0440To order: (800) 668-1119Fax: (905) 567-3185

2006 Synthes, Inc. or its affiliates. All rights reserved. Synthes is a trademark of Synthes, Inc. or its affiliates. Printed in U.S.A. 1/09 J6512-D

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2.4 mm and 3.0 mm headless compression screws tgsynthes.vo.llnwd.net/o16/mobile/synthes north...

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