Spring Plates 3.5. Reduction and ­fixation­of­small­bone­fragments.

Surgical­Technique

This­publication­is­not­intended­for­distribution­in­the­USA.

Instruments­and­implantsapproved­by­the­AO­Foundation.

Image­intensifier­control

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Processing, Reprocessing, Care and MaintenanceFor­general­guidelines,­function­control­and­dismantling­of­­multi-part­instruments,­as­well­as­processing­guidelines­for­­implants,­please­contact­your­local­sales­representative­or­refer­to:http://emea.depuysynthes.com/hcp/reprocessing-care-maintenanceFor­general­information­about­reprocessing,­care­and­maintenance­of­Synthes­reusable­devices,­instrument­trays­and­cases,­as­well­as­processing­of­Synthes­non-sterile­implants,­please­consult­the­Important­Information­leaflet­(SE_023827)­or­refer­to:­ http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

Spring Plates 3.5 Surgical Technique DePuy Synthes 1

Table of Contents

Introduction Spring­Plates­3.5­ 2

AO­Principles­ 3

Intended­Use,­Indications,­Contraindications­ 4

Surgical Technique Clinical­Problem­and­Preoperative­Planning­ 5

Implantation­ 6

Implant­Removal­ 10

Product Information Implants­ 11

Instruments­ 12

Sets­ 13

Bibliography 14

MRI Information 15

2 DePuy Synthes Spring Plates 3.5 Surgical Technique

DescriptionIn­pelvic­and­acetabular­surgery,­it­is­often­difficult­to­reduce­and­fix­small­bone­fragments.­The­Spring­Plates­3.5­are­in-tended­to­reduce­and­stabilize­bone­fragments­that­are­too­small­for­screws.­They­can­be­used­individually­or­in­con-junction­with­a­3.5­mm­reconstruction­plate.­

Features

– Two sharp spikes on the bottom surface Sharp­spikes­on­the­bottom­surface­capture­small­ fragments.­

– Pre-bent convex plate shape The­insertion­of­screws­into­the­preloaded­plate­reduces­and­compresses­the­fragments.

Spring Plates 3.5

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AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, 2.

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.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

Spring Plates 3.5 Surgical Technique DePuy Synthes 3

AO Principles

1­­Müller­ME,­Allgöwer­M,­Schneider­R,­Willenegger­H.­Manual­of­Internal­Fixation.­ 3rd­ed.­Berlin,­Heidelberg,­New­York:­Springer.­1991.­

2­­Rüedi­TP,­Buckley­RE,­Moran­CG.­AO­Principles­of­Fracture­Management.­2nd­ed.­Stuttgart,­New­York:­Thieme.­2007.

Stable fixationFracture­fixation­providing­absolute­or­relative­stability,­as­required­by­the­­patient,­the­injury,­and­the­personality­of­the­fracture.

Anatomic reductionFracture­reduction­and­fixation­ to­restore­anatomical­relationships.

Early, active mobilizationEarly­and­safe­mobilization­and­ rehabilitation­of­the­injured­part­and­the­patient­as­a­whole.

Preservation of blood supplyPreservation­of­the­blood­supply­ to­soft­tissues­and­bone­by­gentle­ reduction­techniques­and­careful­handling.

In­1958,­the­AO­formulated­four­basic­principles,­which­have­become­the­guidelines­for­internal­fixation1,2.

4 DePuy Synthes Spring Plates 3.5 Surgical Technique

Intended usePelvic­implants­are­intended­for­temporary­fixation,­correc-tion­or­stabilization­of­bones­in­the­pelvis.

Indications The­Synthes­3.5­mm­Spring­Plate­is­intended­for­pelvic­and­acetabular­reconstructive­surgery.

Contraindications No­specific­contraindications.

Intended Use, Indications, Contraindications

Spring Plates 3.5 Surgical Technique DePuy Synthes 5

Clinical problemThis­image­represents­an­example­of­a­posterior­wall­fracture­of­the­acetabulum­with­two­small­fracture­fragments­for­which­the­Spring­Plate­would­be­recommended.

Preoperative planningImplantation­of­the­Spring­Plate­can­be­performed­using­one­of­the­four­following­sets:

01.100.013­ Low­Profile­3.5­Pelvic­Instrument­Set

181.600­ Basic­Pelvic­Instrument­Set

182.415­ LCP­Compact­Small­Fragment­ Instrument­Set

182.456­ Instrument­Set­LC-DCP

Precautions: – Instruments­and­screws­may­have­sharp­edges­or­moving­joints­that­may­pinch­or­tear­user's­glove­or­skin.

– Handle­devices­with­care­and­dispose­worn­bone­cutting­instruments­in­an­approved­sharps­container.

Clinical Problem and Preoperative Planning

6 DePuy Synthes Spring Plates 3.5 Surgical Technique

Implantation

1Temporary fixation

Instruments

292.160­ Kirschner­Wire­B­1.6­mm­with­trocar­tip

03.100.018­ Ball­Spike

Reduce­and­fix­the­fracture­fragment­with­Kirschner­wires­or­an­appropriate­reduction­instrument­with­pointed­ball­tips,­such­as­a­ball­spike.

Precaution:­While­placing­the­Kirschner­wires,­pay­attention­that­they­will­not­interfere­with­the­Spring­Plate­later.

2Place Spring Plate

Place­a­Spring­Plate­of­appropriate­length­so­that­the­spikes­engage­in­the­fracture­fragment.­Check­plate­placement­by­holding­the­plate­or­fracture­fragment­with­an­appropriate­reduction­instrument­with­pointed­ball­tips.

Spring Plates 3.5 Surgical Technique DePuy Synthes 7

4Determine screw length

Instrument

319.091­or­­ Depth­Gauge319.010­

Use­depth­gauge­to­determine­the­correct­screw­length.

3Drill screw hole

Instruments

315.920­or­ Drill­bit,­B­2.5­mm324.210­or397.342

323.360­ Universal­drill­guide

Drill­a­hole­for­a­3.5­mm­cortex,­a­3.5­mm­pelvic­cortex­or­a­4.0­mm­cancellous­bone­screw­using­a­2.5­mm­drill­bit­in­combination­with­the­universal­drill­guide.

8 DePuy Synthes Spring Plates 3.5 Surgical Technique

5Insert screw

Instrument

314.570­ Screwdriver,­hexagonal,­small,­ B­2.5­mm,­length­270­mm

Insert­a­3.5­mm­cortex,­a­3.5­mm­pelvic­cortex­or­a­4.0­mm­cancellous­bone­screw­of­appropriate­length.­The­“spring”­effect­of­the­plate­may­help­to­achieve­the­desired­compres-sion­via­spikes­on­the­small­fracture­fragment.

Precaution:­Check­appropriate­length­and­position­of­screw­under­image­intensifier­control.

Implantation

Spring Plates 3.5 Surgical Technique DePuy Synthes 9

6Option: Insert additional Spring Plate

If­needed,­a­second­Spring­Plate­can­be­placed.­Repeat­steps­1­to­5.

For­further­stability­and­additional­compression­to­the­con-struct,­insert­a­reconstruction­plate­on­top­of­the­Spring­Plates.

Note:­This­represents­only­one­possible­configuration­for­the­placement­of­two­2-hole­spring­plates­in­a­specific­clinical­­situation.

11 DePuy Synthes Spring Plates 3.5 Surgical Technique

Unlock­all­screws­from­the­plate,­then­remove­the­screws­completely­from­the­bone.­This­prevents­simultaneous­rota-tion­of­the­plate­when­unlocking­the­last­locking­screw.

For­details­regarding­implant­removal,­refer­to­the­Surgical­Technique­”Screw­Extraction­Set“­DSEM/TRM/0614/0104.

Implant Removal

Spring Plates 3.5 Surgical Technique DePuy Synthes 11

Implants

3.5 Spring Plates

– only­available­in­stainless­steel – for­sterile­implants­add­suffix­“S”­to­the­article­number

Art.­No.­ Description

02.100.301­ Spring­Plate­3.5,­1­hole,­length­19.5­mm

02.100.302­ Spring­Plate­3.5,­2­holes,­length­31.5­mm

02.100.303­ Spring­Plate­3.5,­3­holes,­length­43.5­mm

Screws

The­3.5­Spring­Plate­can­be­used­with­3.5­mm­cortex­screws,­3.5­mm­pelvic­cortex­screws­and­4.0­mm­cancellous­bone­screws.

Art.­No.­ Description

204.810­–­ Cortex­Screws­B­3.5­mm,­self-tapping,204.848­ 10­–­48­mm­(2­mm­increments)

204.845­–­ Cortex­Screws­B­3.5­mm,­self-tapping,204.910­ 45­–110­mm­(5­mm­increments)­

204.640­–­ Pelvic­Cortex­Screws­B­3.5­mm,204.750­ self-tapping,­40­–150­mm­ ­ (5­mm­increments)

206.010­–­ Cancellous­Bone­Screws­B­4.0­mm,­fully 206.060­ threaded,­10­–­60­mm

Kirschner wire

292.160­ Kirschner­Wire­B­1.6­mm­with­trocar­tip

12 DePuy Synthes Spring Plates 3.5 Surgical Technique

Instruments

314.570­ Screwdriver,­hexagonal,­small,­B­2.5­mm,­ length­270­mm

315.920­or­ Drill­bit,­B 2.5­mm324.210­or397.342

319.091­or­­ Depth­Gauge319.010

323.360­ Universal­drill­guide

03.100.018­ Ball­Spike

Spring Plates 3.5 Surgical Technique DePuy Synthes 13

Sets

Implantation­of­the­Spring­Plate­can­be­performed­using­one­of­the­four­following­sets:

01.100.013­ Low­Profile­3.5­Pelvic­Instrument­Set

181.600­ Basic­Pelvic­Instrument­Set

182.415­ LCP­Compact­Small­Fragment­Instrument­Set

182.456­ Instrument­Set­LC-DCP

14 DePuy Synthes Spring Plates 3.5 Surgical Technique

Bibliography

Richter­H,­Hutson­and­Zych­G­(2004)­The­Use­of­Spring­Plates­in­the­Internal­Fixation­of­Acetabular­Fractures.­ J­Orthop­Trauma­2004.­18:179­–181.

Goulet­J,­Rouleau­J,­Mason­D­and­Goldstein­S.­ComminutedFractures­of­the­Posterior­Wall­of­the­Acetabulum.­A­Biome-chanical­Evaluation­of­Fixation­Methods.­J­Bone­Joint­Surg­Am,­Volume­76­-­A(10),­October­1994,­pp­1457–1463.

Spring Plates 3.5 Surgical Technique DePuy Synthes 15

MRI Information

Torque, Displacement and Image Artifacts according to ASTM F 2213-06, ASTM F 2052-06e1 and ASTM F 2119-07Non-clinical­testing­of­worst­case­scenario­in­a­3 T­MRI­ system­did­not­reveal­any­relevant­torque­or­displacement­ of­the­construct­for­an­experimentally­measured­local­spatial­gradient­of­the­magnetic­field­of­3.69 T/m.­The­largest­image­­artifact­extended­approximately­169 mm­from­the­construct­when­scanned­using­the­Gradient­Echo­(GE).­Testing­was­­conducted­on­a­3 T­MRI­system.

Radio-Frequency-(RF-)induced heating according to ASTM F 2182-11aNon-clinical­electromagnetic­and­thermal­testing­of­worst­ case­scenario­lead­to­peak­temperature­rise­of­9.5 °C­ with­an­average­temperature­rise­of­6.6 °C­(1.5 T)­and­a­ peak­temperature­rise­of­5.9 °C­(3 T)­under­MRI­Conditions­­using­RF­Coils­(whole­body­averaged­specific­absorption­rate­[SAR]­of­2 W/kg­for­6 minutes­[1.5 T]­and­for­15 minutes­ [3 T]).

Precautions:­The­above­mentioned­test­relies­on­non-clini­- cal­testing.­The­actual­temperature­rise­in­the­patient­will­­depend­on­a­variety­of­factors­beyond­the­SAR­and­time­of­ RF­application.­Thus,­it­is­recommended­to­pay­particular­­attention­to­the­following­points: – It­is­recommended­to­thoroughly­monitor­patients­under-going­MR­scanning­for­perceived­temperature­and/or­pain­sensations.

– Patients­with­impaired­thermoregulation­or­temperature­­sensation­should­be­excluded­from­MR­scanning­proce­- dures.

– Generally,­it­is­recommended­to­use­a­MR­system­with­ low­field­strength­in­the­presence­of­conductive­implants.­ The­employed­specific­absorption­rate­(SAR)­should­be­ reduced­as­far­as­possible.

– Using­the­ventilation­system­may­further­contribute­to­ reduce­temperature­increase­in­the­body.

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