Cerclage Passer. For minimally invasiveapplication of cerclage wires.

Handling TechniqueWire application

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Table of Contents

Introduction

Surgical Technique

Product Information

Bibliography 17

Cerclage Passer 2

Indications 4

Clinical Cases 5

Preparation 6

Surgical Steps 7

Implants 14

Instruments 15

Sets 16

Image intensifier control

WarningThis description alone does not provide sufficient background for direct use ofthe instrument set. Instruction by a surgeon experienced in handling theseinstruments is highly recommended.

Reprocessing, Care and Maintenance of Synthes InstrumentsFor general guidelines, function control and dismantling of multi-part instruments,please contact your local sales representative or refer to:www.synthes.com/reprocessing

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Techniques for the treatment ofperiprosthetic fractures and other indi-cations often include the applicationof cerclage wires. The cerclage passerinstrument set contains the additionalinstruments needed for minimally invasive procedures.

Modular set configurationThe cerclage passer can be used for theminimal invasive application of cerclagewires. The modular case concept allowsstorage of the relevant instruments onmodular instrument trays.

Note: Set does not include implants

Overview Cerclage Passer

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Cerclage Passer. For minimally invasive application of cerclage wires.

Available in two sizes (diameter 46 mm and 60 mm)adapted to anatomy.

Allow passage of wire around the bone throughsmall approach.

One size trocar is compatible with both cerclagepasser sizes.

Designed as two separate halves to facilitate sequential insertion through one incision.

Quick Step Surgical Technique

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Cerclage TwisterCerclage Tunneling Device

Prepares the way and facili-tates the passage of thecerclage passer. Available intwo sizes that correspondwith the bending diameterof the cerclage passer.

Easy assembly anddisassembly for cleaning.

Adapts force by scrolling the adjustingsleeve to prevent wire breakage.

For use with 0.8 mm, 1.0 mm, 1.25 mmand 1.5 mm diameter wires.

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Indications

For general orthopaedic trauma surgery involving the application of cerclage wires – Periprosthetic fractures of the femur– Subtrochanteric fractures– Hip and knee prostheses– Additional fixation– Temporary reduction

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Clinical Cases

85 year old male with AO 32-A3.3 fracture

80 year old male with AO 32-A1 fracture

pre-op post-op

pre-op post-op

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Preparation

1Preparation

Set

01.221.000 Instrument Set for minimally invasive Wire Cerclage

Optional set

107.920 Wire Instrument Set in Sterilization Tray

Implants

291.044 – Coil with Cerclage Wire, different 291.130 diameters

Complete a preoperative radiographic assessment and prepare the preoperative plan. Position the patient accordingto the respective fracture requirements on a radiolucent operating table.

2Incision and preparation of the soft tissue tunnel

Instruments

03.221.002 Cerclage Tunneling Device, small, � 46 mm

03.221.004 Cerclage Tunneling Device, large, � 60 mm

Choose the appropriate size Cerclage Tunneling Device forthe field of application and the fracture. Make an incisionand carefully insert the tunneling device over the periosteumfrom ventral and dorsal around the bone. Pay special atten-tion to perforate the fascia on the linea aspera on the dorsalfemur.

Preparation of the tunnel is necessary to facilitate the following insertion of the cerclage passer.

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Surgical Steps

1Insertion of cerclage passer

Instruments

03.221.010 Cerclage Passer, minimally invasive, � 46 mm

03.221.011 Cerclage Passer, minimally invasive, � 60 mm

03.221.003 Trocar, for Cerclage Passer Nos. 03.221.010 and 03.221.011

Put one trocar in each tube of the cerclage passer. This prevents soft tissue from entering the cannulated tubes ofthe cerclage passer. Insert one half of the cerclage passer,then the other by following the prepared soft tissue tunnels.

Note: To prevent damage do not apply too much force whileinserting the cerclage passer. Deformation of the tubes canresult in non-closure of the instrument when connecting thehalves.

The markings on each half (“small”, “large”) can be usedfor orientation. When the forceps are connected together,the markings will appear in the same direction.

Note: When the cerclage passer is in use, pay attention tothe sterile field.

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2

3

2Connection and closure of the cerclage passer

With the cerclage passer in place, connect the flat parts ofthe forceps (1). Slide the notch of one half into the corre-sponding part of the other half (2, 3).

Important: While connecting the the two parts, the tipsmust not meet. Do not attempt to close the forceps as longas the middle of the forceps is not connected properly.

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Surgical Steps

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4

5

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Once the two connecting parts have been brought together,close the forceps until the markings on the two halves arealigned and form a line (4). The tips of the cannulated tubeswill then meet and form a passageway for the wire.

Secure the closed cerclage passer by locking the bracket (5). Remove the trocars.

Technique tip: Open and close the bracket by pressing theends of the handles slightly together. Closed correctly, thebars of the cerclage passer forceps are parallel. The correctlyclosed position of the cerclage passer can be controlled bymoving it up and down or using image intensifier control.

Important: When closing the cerclage passer, be careful notto damage any soft-tissue structures. Where necessary, en-large the approach to verify that no soft-tissue structures arebeing damaged.

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Surgical Steps

3Insertion of cerclage wire

Instrument

391.963 Universal Bending Pliers, length 165 mm

Prepare a cerclage wire in the desired length. The only correct direction for insertion is marked by an arrow.

Push the cerclage wire through the tube of the closed cerclage passer.

The use of pliers (e.g. Universal Bending Pliers) can be usefulfor wire insertion. Insert step by step to prevent a kinkingof the wire. The wire must be out of the opposite part of thecerclage passer.

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4Removal of Cerclage Passer forceps

Unlock the forceps by opening the bracket.

Disconnect the two halves of the cerclage passer forceps andremove one half after the other.

Be sure that the inserted cerclage wire stays around thebone. Hold the opposite end of the wire.

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Surgical Steps

5Tightening and fixation

Instruments

03.221.001 Cerclage Twister

03.607.513 Front Cutter

Insert the cerclage wire through the lower opening of theCerclage Twister, with the bar separating the two ends of thecerclage wire.

The handle has to be positioned in the middle of thethreaded section. Do not set the wire diameter of the Cerclage Twister. The tip of the Cerclage Twister should beclose to the bone. Tighten the Cerclage wire and wind itaround the handle. Take care that the cerclage wire doesnot obstruct the sleeve.

Apply pre-tension by pulling the handle back to the blueknob. Adjust the wire diameter on the corresponding scaleof the Cerclage Twister by sliding the tip of the arrow towards the numbers.

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Turn the Cerclage Twister clockwise until the ratchet clicks2 to 3 times or the desired tension is achieved.

Note: While turning the Cerclage Twister, the whole twisterdevice will turn.

Warning: Be careful to apply less tension in osteoporoticbone.

Using the Front Cutter, cut the cerclage wire near the handleand pull out the Cerclage Twister.

Slide with the Front Cutter along the cerclage wire and cut itnear the bone. Use the front end of the Front Cutter to bendthe twisted end of the cerclage wire to the bone.

Alternative Technique: Slide with the Front Cutter alongthe cerclage wire and bend the twisted end to the bone. Cutthe wire.

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Implants

291.044 Coil with Cerclage Wire � 0.4 mm, length 8 m, Stainless Steel

291.050 Coil with Cerclage Wire � 1.0 mm, length 10 m, Stainless Steel

291.060 Coil with Cerclage Wire � 1.25 mm, length 10 m, Stainless Steel

291.070 Coil with Cerclage Wire � 0.6 mm, length 8 m, Stainless Steel

291.090 Coil with Cerclage Wire � 0.8 mm, length 10 m, Stainless Steel

291.130 Coil with Cerclage Wire � 1.5 mm, length 10 m, Stainless Steel

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Instruments

03.221.010 Cerclage Passer, minimally invasive,� 46 mm

03.221.011 Cerclage Passer, minimally invasive, � 60 mm

03.221.003 Trocar, for Cerclage Passer Nos. 03.221.010 and 03.221.011

03.221.002 Cerclage Tunneling Device � 46 mm

03.221.004 Cerclage Tunneling Device � 60 mm

03.607.513 Front Cutter

03.221.001 Cerclage Twister

391.963 Universal Bending Pliers

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Sets

01.221.000 Instrument Set for minimally invasive Wire Cerclage

68.221.100 Tray for Standard Instruments for minimally invasive Wire and Cable Cerclage

03.221.002 Cerclage Tunneling Device � 46 mm

03.221.010 Cerclage Passer, minimally invasive, � 46 mm

03.221.004 Cerclage Tunneling Device � 60 mm

03.221.011 Cerclage Passer, minimally invasive, � 60 mm

03.221.003 Trocar, for Cerclage Passer

68.221.110 Tray for Additional Instruments for minimally invasive Wire Cerclage

03.221.001 Cerclage Twister

03.607.513 Front Cutter

391.963 Universal Bending Pliers

Additionally available

68.221.120 Labelling Plate for Instrument Set for minimally invasive Cerclage, for Vario Case

68.000.101 Lid for Instrument Tray, size 1/1, (without labelling)

519.400 Cleaning Brush, for Compact Air Drive, Power Drive and Colibri

Vario Case components

689.507 Lid (Stainless Steel), size 1/1, for Vario Case

689.510 Vario Case, Framing, size 1/1, height 88 mm

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Bibliography

Schmidt AH, Kyle RF (2002) Periprosthetic fractures of the femur. Orthop Clin North Am: 143–152

Tong G, Bavonratanavech S (2006) Minimally Invasive PlateOsteosynthesis (MIPO): Concepts and cases presented by theAO East Asia

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