basic instruments for screw plate fixation final
DESCRIPTION
OrthopediTRANSCRIPT
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Basic instruments for standard screw- and plate fixation
Bali, Indonesia28-30/05/09
Isabel Van Rie RichardsAOTrauma Education for ORP
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Learning outcomes
1. Prepare all basic instruments needed for large fragment screw & plate fixation step by step
2. Explain which instruments are used to apply a lag screw
3. Discuss the different instruments needed to obtain dynamic compression with a plate
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Operation steps
1. Fracture reduction
2. Bending / contouring the plate
3. Fracture fixation1. Drill the hole
2. Use the countersink
3. Measure
4. Tap
5. Insert the screw
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Pointed forceps (Weber)
• Several sizes available • Available with ratchet
closure or with speed
lock • 1 or 2 instruments
are used
With ratchet
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Forceps with serrated jaws
• Also used for temporary
plate fixation• Several sizes available• Available with speed lock• 1 or 2 instruments
are used
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Self-centering forceps (Verbrugge)
• Also used for temporary
plate fixation• Available with speed
lock• 1 or 2 instruments
are used• Adjustable to size
of fragment
Self-centeringjaws
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Sharp hook (Dentist)
• Reduction of small fragments• Used to clean the fracture gap, screw recess
and the tap & drill bit
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Elevators & Hohmann
• Elevators: dissection• Hohmann: retractor• Adapt the instrument size to the fracture site
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Femoral distractor
• Opens the fracture site so that reduction of smaller fragments is possible
Rod
Nuts
Sleeves
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Operation steps
1. Fracture reduction
2. Bending / contouring the plate
3. Fracture fixation1. Drill the hole
2. Use the countersink
3. Measure
4. Tap
5. Insert the screw
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Bendingtools
Bending press
Bending irons
Templates
12
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Flexible templates
1 2
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Operation steps
1. Fracture reduction
2. Bending / contouring the plate
3. Fracture fixation1. Drill the hole
2. Use the countersink
3. Measure
4. Tap
5. Insert the screw
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Drill bit
Tip Flutes
Quick coupling
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Drill bit
2-fluted 3-fluted
• Enables drilling at a sharp angle• Less strong
• Strong• Standard use
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Table of drill bits & taps
Screw Drill bit
threaded hole
Drill bit gliding hole
Tap
Cortical 4.5 3.2 4.5 4.5
Cancellous 6.5 3.2 (4.5) 6.5
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Double drill sleeve
• Protection of soft tissue• The double drill sleeve has several functions
12
3
3
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Drill sleeve
• Use of the corresponding size• Use as handle
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DCP & LC-DCP sleeves
DCP
LC-DCP
• The undersurface of the sleeve must be the same as the plate.
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DCP & LC-DCP sleeves
• Allow dynamic compression on the fracture
eccentricneutral
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DCP & LC-DCP sleeves
• The arrow must face towards fracture
• The attachments must fit on the handle
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Universal drill sleeve
• Inter-fragmentary compression is obtained by correct use of the spring loaded drill sleeve
• Used for DCP, LC-DCP and LCP plates
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Universal drill sleeve
Spring is activatedNeutral position
Spring is not activatedEccentric position
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Universal drill sleeve
• Disassemble to clean spring and tube• Do not lose any item
4 elementsA way to keep everything together!
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Tension device
• Will allow compression or distraction of the fracture.
Compression Distraction
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Tension device – used for compression
• Plate is fixed to bone.• Device is connected to plate.• Tension (compression) will be obtained by using
the socket wrench
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Countersink
• To cut the recess of the screw head in the bone.• The size of the tip corresponds with the core
diameter.
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Depth gauge
• To measure the length of the hole• Depth gauge must be adapted to screw size • Handle is calibrated with increments of 2mm
Disassemble for maintenance
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Tap
• To cut the thread of the screw in the bone.• The grooves allow removal of bone debris.
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Tap
• Remove bone debris with a sharp hook, a K-wire or by immersing in saline solution.
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Screwdriver
• Must be adapted to the recess.• Can be used with/without holding sleeve.
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In which order do we use the following instruments?
2. Countersink – tap - measuring
1. Measuring – countersink - tap
3. Countersink – measuring - tap
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Wrong procedure
1. Measuring 2. Countersinking
3. Inserting screw
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Correct procedure
1. Countersinking
2. Measuring
3. Tapping
4. Inserting screw
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Conclusion
1. The basic steps for plate and screw application are always the same: drilling, countersinking, measuring, tapping and screw insertion.
2. A lag screw is applied by drilling a gliding hole. The size of instruments depend of the size of the implants.
3. Dynamic compression is obtained by using the corresponding drill sleeve.