Spring Plates 3.5. Reduction and ­fixation­of­small­bone­fragments.

Surgical­Technique

This­publication­is­not­intended­for­distribution­in­the­USA.

Spring Plates 3.5 Surgical Technique DePuy Synthes 1

Table of Contents

Introduction

Surgical Technique

Product Information

Bibliography 12

Bibliography 13

Spring­Plates­3.5­/­Indications­ 2

AO­Principles­ 3

Clinical­Problem­and­Preoperative­Planning­ 4

Implantation­ 5

Implants­ 9

Instruments­ 10

Sets­­ 11

Image­intensifier­control

WarningThis­description­alone­does­not­provide­sufficient­background­for­direct­use­ of­DePuy­Synthes­products.­Instruction­by­a­surgeon­experienced­in­handling­these­products­is­highly­recommended.

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

2 DePuy Synthes Spring Plates 3.5 Surgical Technique

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

Features and Benefits

– Two sharp spikes on the bottom surface Sharp­spikes­on­the­bottom­surface­capture­small fragments.­

– Pre-bent convex plate shape The­insertion­of­screws­into­the­preloaded­plate­reduces­and­compresses­the­fragments.

IndicationsThe­Synthes­3.5­mm­Spring­Plate­is­intended­for­pelvic­and­acetabular­reconstructive­surgery­and­fracture­fixation­of­the­distal­fibula.

Spring Plates 3.5 / Indications

Spring Plates 3.5 Surgical Technique DePuy Synthes 3

AO Principles

In­1958,­the­AO­formulated­four­basic­principles1,­2,­which­have­become­the­guidelines­for­internal­fixation:

Anatomic reductionThe­plate­with­its­spikes,­its­pre-bent­shape­and­its­elongated­holes­facilitates­anatomic­reduction.

Stable fixationThe­plate­spikes­and­the­spring-effect­provide­an­optimal­compression­mechanism­to­hold­small­fragments­in­place.

Preservation of blood supplyThe­convex­plate­design­preserves­the­blood­supply­through­minimal­plate­to­bone­contact­and­due­to­a­reduced­number­of­screws.­Furthermore,­the­plate­design­permits­indirect­re-duction,­thus­resulting­in­reduced­soft-tissue­stripping.

Early, active mobilizationThe­Spring­Plate­3.5­combined­with­the­AO­technique,­pro-vides­stable­fracture­fixation­with­minimal­damage­to­vascu-lar­supply.­This­helps­improve­the­environment­for­bone­heal-ing,­accelerating­the­patient’s­return­to­mobility­and­function.

1 Müller­ME,­Allgöwer­M,­Schneider­R,­Willenegger­H­(1995)­Manual­of­Internal­Fixation.­3rd,­expanded­and­completely­revised­ed.­1991.­Berlin,­Heidelberg,­New­York:­Springer

2­­­­Rüedi­TP,­Buckley­RE,­Moran­CG­(2007)­AO­Principles­of­Fracture­Management.­2nd­expanded­ed.­2002.­Stuttgart,­New­York:­Thieme

4 DePuy Synthes Spring Plates 3.5 Surgical Technique

Clinical problemThis­image­represents­an­example­of­a­posterior­wall­fracture­of­the­acetabulum­with­two­small­fracture­fragments­for­which­the­Spring­Plate­would­be­recommended.

Preoperative planningImplantation­of­the­Spring­Plate­can­be­performed­using­one­of­the­four­following­sets:

01.100.013­ Low­Profile­3.5­Pelvic­Instrument­Set

181.600­ Basic­Pelvic­Instrument­Set

182.415­ LCP­Compact­Small­Fragment­ Instrument­Set

182.456­ Instrument­Set­LC-DCP

Clinical Problem and Preoperative Planning

Spring Plates 3.5 Surgical Technique DePuy Synthes 5

Implantation

1Temporary fixation

Instruments

292.160­ Kirschner­Wire­B­1.6­mm­with­trocar­tip

03.100.018­ Ball­Spike

Reduce­and­fix­the­fracture­fragment­with­Kirschner­wires­or­an­appropriate­reduction­instrument­with­pointed­ball­tips,­such­as­a­ball­spike.

Note:­While­placing­the­Kirschner­wires,­pay­attention­that­they­will­not­interfere­with­the­Spring­Plate­later.

2Place Spring Plate

Place­a­Spring­Plate­of­appropriate­length­so­that­the­spikes­engage­in­the­fracture­fragment.­Check­plate­placement­by­holding­the­plate­or­fracture­fragment­with­an­appropriate­reduction­instrument­with­pointed­ball­tips.

6 DePuy Synthes Spring Plates 3.5 Surgical Technique

Implantation

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.

Spring Plates 3.5 Surgical Technique DePuy Synthes 7

5Insert screw

Instrument

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

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

8 DePuy Synthes Spring Plates 3.5 Surgical Technique

6Option: Insert additional Spring Plate

If­needed,­a­second­Spring­Plate­can­be­placed.­Repeat­steps­1­to­5.

For­further­stability­and­additional­compression­to­the­con-struct,­insert­a­reconstruction­plate­on­top­of­the­Spring­Plates.

Note:­This­represents­only­one­possible­configuration­for­the­placement­of­two­2-hole­spring­plates­in­a­specific­clinical­­situation.

Implantation

Spring Plates 3.5 Surgical Technique DePuy Synthes 9

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

10 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 11

Sets

Implantation­of­the­Spring­Plate­can­be­performed­using­one­of­the­four­following­sets:

01.100.013­ Low­Profile­3.5­Pelvic­Instrument­Set

181.600­ Basic­Pelvic­Instrument­Set

182.415­ LCP­Compact­Small­Fragment­Instrument­Set

182.456­ Instrument­Set­LC-DCP

12 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 13

MRI Information

Torque, Displacement and Image Artifacts according to ASTM F 2213-06, ASTM F 2052-06e1 and ASTM F2119-07Non-clinical­testing­of­worst­case­scenario­in­a­3 T­MRI­­system­did­not­reveal­any­relevant­torque­or­displacement­ of­the­construct­for­an­experimentally­measured­local­spatial­gradient­of­the­magnetic­field­of­3.69 T/m.­The­largest­image­artifact­extended­approximately­169­mm­from­the­construct­when­scanned­using­the­Gradient­Echo­(GE).­Testing­was­conducted­on­a­3 T­MRI­system.

Radio-Frequency-(RF-)induced heating according to ASTM F2182-11aNon-clinical­electromagnetic­and­thermal­testing­of­worst­case­scenario­lead­to­peak­temperature­rise­of­9.5 °C­ with­an­average­temperature­rise­of­6.6 °C­(1.5 T)­and­a­ peak­temperature­rise­of­5.9 °C­(3 T)­under­MRI­Conditions­using­RF Coils­[whole­body­averaged­specific­absorption­rate­(SAR)­of­2 W/kg­for­6­minutes­(1.5 T)­and­for­15 minutes­ (3 T)].

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

– Patients­with­impaired­thermo­regulation­or­temperature­sensation­should­be­excluded­from­MR­scanning­proce-dures.­

– Generally­it­is­recommended­to­use­a­MR­system­with­ low­field­strength­in­the­presence­of­conductive­implants.­The­employed­specific­absorption­rate­(SAR)­should­be­­reduced­as­far­as­possible.­

– Using­the­ventilation­system­may­further­contribute­to­­reduce­temperature­increase­in­the­body.

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