The AO ASIF Small External Fixator WristSpanning Frame Technique Guide.pdf

AO ASIF Small External FixatorWrist Spanning Frame Radius frontal volar rim The AO ASIF Small External Fixator TECHNIQUE GUIDE Original Instruments and Implants of the Association for the Study of Internal Fixation AO ASIF The AO ASIF Small External Fixator TECHNIQUE GUIDE Wrist Spanning Frame SYNTHES USA 1690 Russell Road Paoli PA 19301 1262 Telephone 610 647 9700 Fax 610 251 9056 To Order 800 523 0322 SYNTHES CANADA LTD 2566 Meadowpine Boulevard Mississauga Ontario L5N 6P9 Telephone 905 567 0440 Fax 905 567 3185 To order 800 668 1119 SYNTHES USA 2004SYNTHES and ASIF are registered trademarks of SYNTHES USA and SYNTHES AG Chur Printed in U S A 1 04 J4880 A Graphic Case 690 378Graphic Case for Small External Fixator Implants 292 161 6 mm Kirschner Wire 150 mm trocar point 10 pkg 1 pkg 292 202 0 mm Kirschner Wire 150 mm trocar point 10 pkg 1 pkg 292 752 5 mm Kirschner Wire with Thread trocar point 15 mm thread length 10 pkg 1 pkg Stainless SteelTitaniumSelf Drilling Schanz Screws 294 769494 7694 0 mm 2 5 mm 20 mm thread length 80 mm 2 ea 294 771494 7714 0 mm 3 0 mm 20 mm thread length 80 mm 4 ea 294 775494 7754 0 mm 20 mm thread length 80 mm 2 ea 294 776494 7764 0 mm 30 mm thread length 100 mm 2 ea 294 777494 7774 0 mm 40 mm thread length 125 mm 2 ea Instruments 395 35Combination Wrench 7 mm width across flats 395 36Socket Wrench 7 mm width across flats 395 38Simple T Handle 395 911Drill Sleeve Handle 395 9224 0 mm Threaded Drill Sleeve 392 955 4 0 mm 2 5 mm Drill Sleeve 394 183 2 5 mm Trocar Fixation Material 390 041 Small Combination Clamp MR Safe 12 ea 394 991 Protective Caps for 4 0 mm Fixation Pins yellow 10 pkg 1 pkg 392 24Protective Caps for 2 5 mm Kirschner Wires light blue 10 pkg 1 pkg 395 60 4 0 mm Carbon Fiber Rod 60 mm 2 ea 395 61 4 0 mm Carbon Fiber Rods 80 mm 140 mm 395 64 20 mm increments 4 ea 395 65 4 0 mm Carbon Fiber Rods 160 mm 200 mm 395 67 20 mm increments 2 ea Small External Fixator Sets with stainless steel Self Drilling Schanz Screws 115 755 with Titanium Self Drilling Schanz Screws 115 750 AO ASIF Small External FixatorWrist Spanning Frame SMALL EXTERNAL FIXATORWrist Spanning Frame Basic Principles and Application Technique Although the exact frame construct chosen is dictated by the soft tissue injury and fracture pattern basic technique principles apply to all AO ASIF Small External Fixator frames Fracture reduction can be accomplished manually with longitudinal traction percuta neous fixation or open reduction and internal fixation prior to the application of an external fixator Fracture reduction is also possible after the frame has been assembled using the modular technique which allows complete freedom of pin placement When using the modular technique the small external fixator frame can be applied as a wrist spanning frame or a nonspanning frame The fracture location and complexity determine which frame application is appropriate Spanning Frames Bridge or span the wrist joint and are the most common application for wrist fixators Indications Intra articular distal radius fractures Extra articular distal radius fractures Adjunct to percutaneous Kirschner wires 23 A Extra articular fracture Ulna radius intact Nonspanning Frames Do not span the joint Indications Simple intra articular distal radius fractures Extra articular distal radius fractures with a relatively large distal fragment Corrective distal radius osteotomies due to malunion Reproduced from M ller AO Classification of Fractures Long Bones Edition 2001 01 1 ISBN 3 905363 03 8 with permission of AO Publishing Copyright 2001 AO Publishing Switzerland AO Fracture Classifications Radius simple and impacted 2 Radius multifragmentary 3 23 B Partial articular fracture Radius sagittalRadius frontal dorsal rim 23 C Complete articular fracture of radius Articular simple metaphyseal simple Articular simple metaphyseal multifragmentary Articular multifragmentary Graphic Case for Small External Fixator 690 378 shown with additionally available Mini External Fixator and K wire Modules 3 13 21 2 1 When to use The Small External Fixator System is intended to be used in the construction of an external fixation frame for the treatment of hand wrist and foot fractures including Unstable intra and extra articular fractures of the distal radius Open comminuted or bilateral fractures of the wrist hand or foot Fractures in combination with extensive soft tissue injury bone loss vascular or neural involvement Fracture dislocations of the wrist hand or foot Failed closed reduction with casting resulting in secondary deformity Preliminary fixation before or in conjunction with open reduction and internal fixation Extensor retinaculum Compartment 6 Extensor carpi ulnaris Compartment 5 Extensor digiti minimi Compartment 4 Extensor digitorum and extensor indicis Compartment 1 Extensor pollicis brevis Abductor pollicis longus Compartment 2 Extensor carpi radialis brevis Extensor carpi radialis longus Compartment 3 Extensor pollicis longus Compartment 1 Extensor pollicis brevis Abductor pollicis longus Compartment 2 Extensor carpi radialis brevis Extensor carpi radialis longus Compartment 3 Extensor pollicis longus Compartment 4 Extensor digitorum and extensor indicis Compartment 5 Extensor digiti minimi Compartment 6 Extensor carpi ulnaris Dorsal view Dorsal view Relevant anatomy for Schanz screw or Kirschner wire placement Retinaculum Superficial branch of the Radial nerve Radial artery Also Available 310 192 0 mm Drill Bit quick coupling 100 mm 310 202 0 mm Drill Bit Jacob s chuck 85 mm 394 08Mini Lengthening Apparatus 160 mm 394 071Mini Lengthening Apparatus 110 mm 391 82Wire Bending Pliers 160 mm length 392 00Bending Iron 395 51Open Compressor 394 06Small Distractor 395 9314 0 mm Threaded Drill Sleeve 69 mm long 392 9564 0 2 5 mm Drill Sleeve 78 mm long 394 1842 5 mm Trocar 88 mm long 394 99Protective Caps for 4 0 mm Connecting Bars and Carbon Fiber Rods black 10 pkg 115 985Mini External Fixator Instrument and Implant Set 105 105Kirschner Wire Implant Module Set Sterilization Parameters for Sets 115 750 115 755 These Synthes sets with all additionally available items as marked in the case or modules can be sterilized by the following parameters For more information please see graphic case package insert MethodCycleTemperatureExposure Time SteamGravity 132 135 C22 Minutes Displacement 270 275 F Wrapped SteamPrevacuum132 135 C8 Minutes Wrapped 270 275 F AO ASIF Small External FixatorWrist Spanning Frame Radius frontal volar rim The AO ASIF Small External Fixator TECHNIQUE GUIDE Original Instruments and Implants of the Association for the Study of Internal Fixation AO ASIF The AO ASIF Small External Fixator TECHNIQUE GUIDE Wrist Spanning Frame SYNTHES USA 1690 Russell Road Paoli PA 19301 1262 Telephone 610 647 9700 Fax 610 251 9056 To Order 800 523 0322 SYNTHES CANADA LTD 2566 Meadowpine Boulevard Mississauga Ontario L5N 6P9 Telephone 905 567 0440 Fax 905 567 3185 To order 800 668 1119 SYNTHES USA 2004SYNTHES and ASIF are registered trademarks of SYNTHES USA and SYNTHES AG Chur Printed in U S A 1 04 J4880 A Graphic Case 690 378Graphic Case for Small External Fixator Implants 292 161 6 mm Kirschner Wire 150 mm trocar point 10 pkg 1 pkg 292 202 0 mm Kirschner Wire 150 mm trocar point 10 pkg 1 pkg 292 752 5 mm Kirschner Wire with Thread trocar point 15 mm thread length 10 pkg 1 pkg Stainless SteelTitaniumSelf Drilling Schanz Screws 294 769494 7694 0 mm 2 5 mm 20 mm thread length 80 mm 2 ea 294 771494 7714 0 mm 3 0 mm 20 mm thread length 80 mm 4 ea 294 775494 7754 0 mm 20 mm thread length 80 mm 2 ea 294 776494 7764 0 mm 30 mm thread length 100 mm 2 ea 294 777494 7774 0 mm 40 mm thread length 125 mm 2 ea Instruments 395 35Combination Wrench 7 mm width across flats 395 36Socket Wrench 7 mm width across flats 395 38Simple T Handle 395 911Drill Sleeve Handle 395 9224 0 mm Threaded Drill Sleeve 392 955 4 0 mm 2 5 mm Drill Sleeve 394 183 2 5 mm Trocar Fixation Material 390 041 Small Combination Clamp MR Safe 12 ea 394 991 Protective Caps for 4 0 mm Fixation Pins yellow 10 pkg 1 pkg 392 24Protective Caps for 2 5 mm Kirschner Wires light blue 10 pkg 1 pkg 395 60 4 0 mm Carbon Fiber Rod 60 mm 2 ea 395 61 4 0 mm Carbon Fiber Rods 80 mm 140 mm 395 64 20 mm increments 4 ea 395 65 4 0 mm Carbon Fiber Rods 160 mm 200 mm 395 67 20 mm increments 2 ea Small External Fixator Sets with stainless steel Self Drilling Schanz Screws 115 755 with Titanium Self Drilling Schanz Screws 115 750 AO ASIF Small External FixatorWrist Spanning Frame SMALL EXTERNAL FIXATORWrist Spanning Frame Basic Principles and Application Technique Although the exact frame construct chosen is dictated by the soft tissue injury and fracture pattern basic technique principles apply to all AO ASIF Small External Fixator frames Fracture reduction can be accomplished manually with longitudinal traction percuta neous fixation or open reduction and internal fixation prior to the application of an external fixator Fracture reduction is also possible after the frame has been assembled using the modular technique which allows complete freedom of pin placement When using the modular technique the small external fixator frame can be applied as a wrist spanning frame or a nonspanning frame The fracture location and complexity determine which frame application is appropriate Spanning Frames Bridge or span the wrist joint and are the most common application for wrist fixators Indications Intra articular distal radius fractures Extra articular distal radius fractures Adjunct to percutaneous Kirschner wires 23 A Extra articular fracture Ulna radius intact Nonspanning Frames Do not span the joint Indications Simple intra articular distal radius fractures Extra articular distal radius fractures with a relatively large distal fragment Corrective distal radius osteotomies due to malunion Reproduced from M ller AO Classification of Fractures Long Bones Edition 2001 01 1 ISBN 3 905363 03 8 with permission of AO Publishing Copyright 2001 AO Publishing Switzerland AO Fracture Classifications Radius simple and impacted 2 Radius multifragmentary 3 23 B Partial articular fracture Radius sagittalRadius frontal dorsal rim 23 C Complete articular fracture of radius Articular simple metaphyseal simple Articular simple metaphyseal multifragmentary Articular multifragmentary Graphic Case for Small External Fixator 690 378 shown with additionally available Mini External Fixator and K wire Modules 3 13 21 2 1 When to use The Small External Fixator System is intended to be used in the construction of an external fixation frame for the treatment of hand wrist and foot fractures including Unstable intra and extra articular fractures of the distal radius Open comminuted or bilateral fractures of the wrist hand or foot Fractures in combination with extensive soft tissue injury bone loss vascular or neural involvement Fracture dislocations of the wrist hand or foot Failed closed reduction with casting resulting in secondary deformity Preliminary fixation before or in conjunction with open reduction and internal fixation Extensor retinaculum Compartment 6 Extensor carpi ulnaris Compartment 5 Extensor digiti minimi Compartment 4 Extensor digitorum and extensor indicis Compartment 1 Extensor pollicis brevis Abductor pollicis longus Compartment 2 Extensor carpi radialis brevis Extensor carpi radialis longus Compartment 3 Extensor pollicis longus Compartment 1 Extensor pollicis brevis Abductor pollicis longus Compartment 2 Extensor carpi radialis brevis Extensor carpi radialis longus Compartment 3 Extensor pollicis longus Compartment 4 Extensor digitorum and extensor indicis Compartment 5 Extensor digiti minimi Compartment 6 Extensor carpi ulnaris Dorsal view Dorsal view Relevant anatomy for Schanz screw or Kirschner wire placement Retinaculum Superficial branch of the Radial nerve Radial artery Also Available 310 192 0 mm Drill Bit quick coupling 100 mm 310 202 0 mm Drill Bit Jacob s chuck 85 mm 394 08Mini Lengthening Apparatus 160 mm 394 071Mini Lengthening Apparatus 110 mm 391 82Wire Bending Pliers 160 mm length 392 00Bending Iron 395 51Open Compressor 394 06Small Distractor 395 9314 0 mm Threaded Drill Sleeve 69 mm long 392 9564 0 2 5 mm Drill Sleeve 78 mm long 394 1842 5 mm Trocar 88 mm long 394 99Protective Caps for 4 0 mm Connecting Bars and Carbon Fiber Rods black 10 pkg 115 985Mini External Fixator Instrument and Implant Set 105 105Kirschner Wire Implant Module Set Sterilization Parameters for Sets 115 750 115 755 These Synthes sets with all additionally available items as marked in the case or modules can be sterilized by the following parameters For more information please see graphic case package insert MethodCycleTemperatureExposure Time SteamGravity 132 135 C22 Minutes Displacement 270 275 F Wrapped SteamPrevacuum132 135 C8 Minutes Wrapped 270 275 F Self Drilling Schanz Screws 4 0 mm 2 5 mm Self Drilling Schanz Screw 4 0 mm 3 0 mm Self Drilling Schanz Screw 4 0 mm Self Drilling Schanz Screw Increase stiffness Use Schanz screws in place of 2 5 mm K wires and or Add a bar to increase stiffness and to prevent rotation The fourth bar should span the length of the frame connecting the first and second modules 6 40 60 Technique Overview When constructing a Small External Fixator frame choices for pins include 2 5 mm Kirschner wires with thread 4 0 mm 2 5 mm self drilling Schanz screws 4 0 mm 3 0 mm self drilling Schanz screws 4 0 mm self drilling Schanz screws Schanz screws provide more frame stiffness than 2 5 mm Kirschner wires If using 2 5 mm Kirschner wires in either the metacarpal or the radius K wires should converge at 40 60 in the sagittal plane This improves fixation by lengthening the bone pin interface If using Schanz screws they should be perpen dicular to the long axis of the metacarpal and the radius Both K wires and Schanz screws should also be placed at 40 60 in the frontal plane not lateral Pin placement at 40 60 in the frontal plane prevents thumb impingement allowing full mobi lization of the thumb avoids soft tissue interference and makes visualization of the fracture and the wrist joint possible during x ray Build first module Connect one MR Safe Small Combination Clamp to each pin in the metacarpal Connect the clamps with a short 4 0 mm carbon fiber rod 2 Insert metacarpal pins To avoid entrapping the extensor mechanism in extension flex the second metacarpopha langeal joint to 90 Make a small incision at the site of planned pin insertion Bluntly dissect the soft tissues and push the drill sleeve to the bone Insert the pins through the drill sleeve The K wires and Schanz screws should be placed proximally and distally in the diaphy seal bone of the second metacarpal 1 Required set Synthes Small External Fixator Set 115 755 or 115 750 Optional Frame ConfigurationsWrist Spanning Frame Insert pins in the radius Make a small incision at the site of planned pin insertion Bluntly dissect the soft tissues and push the drill sleeve to the bone Insert the pins through the drill sleeve Take care to avoid the superficial branch of the radial nerve Notes In hard bone consider predrilling for the Schanz screws with a 2 0 mm drill bit for accuracy and ease of insertion For best stability pin spacing should be maximized and the distal pin should be as close to the fracture as possible 3 Build second module Connect one MR Safe Small Combination Clamp to each pin in the radius Connect the clamps with a 4 0 mm carbon fiber rod Reduce the fracture using partial frames as handles to aid in reduction 4 Connect modules Connect the modules with a third rod and two MR Safe Small Combination Clamps Perform final fracture reduction if required and tighten the nuts securely Flexion and or ulnar deviation may be required to obtain anatomic reduction 5 Single stack frame configuration Double stack frame configuration Double stack frame configuration with fifth Schanz Screw or 2 5 mm K wire 4 0 mm Carbon Fiber Rods 2 5 mm Kirschner Wire with Thread Protective Caps for 2 5 mm Kirschner Wires light blue for 4 0 mm Fixation Pins yellow Small Combination Clamp MR Safe Connects rods to rods rods to Schanz screws or rod to 2 5 mm Kirschner wires Item References Jacob Roland P and Ralph Hertel The Small AO External Fixator A Versatile Device Injury 1994 Vol 25 Suppl 4 S D28 S D34 Jenkins N H D G Jones S R Johnson W J Mintowt Czyz External Fixation of Colles Fractures The Journal of Bone and Joint Surgery Vol 69 B No 2 March 1987 207 211 Jupiter Jesse B and Diego L Fernandez Complications Following Distal Radius Fractures The Journal of Bone and Joint Surgery American 83 1244 1265 2001 McQueen Margaret M and P J Mackenney Bridging and Non bridging External Fixation of Distal Radius Fractures Orthopaedocs Today January February 1999 8 Werber K D F Raeder R B Brauer and S Weiss External Fixation of Distal Radius Fractures Four Compared with Five Pins A Randomized Prospective Study The Journal of Bone and Joint Surgery American 85 660 666 2003 Recommended components Double stack frame configuration Modular Z frame configuration Modular Z frame configuration with fourth bar Fifth Schanz Screw Self Drilling Schanz Screws 4 0 mm 2 5 mm Self Drilling Schanz Screw 4 0 mm 3 0 mm Self Drilling Schanz Screw 4 0 mm Self Drilling Schanz Screw Increase stiffness Use Schanz screws in place of 2 5 mm K wires and or Add a bar to increase stiffness and to prevent rotation The fourth bar should span the length of the frame connecting the first and second modules 6 40 60 Technique Overview When constructing a Small External Fixator frame choices for pins include 2 5 mm Kirschner wires with thread 4 0 mm 2 5 mm self drilling Schanz screws 4 0 mm 3 0 mm self drilling Schanz screws 4 0 mm self drilling Schanz screws Schanz screws provide more frame stiffness than 2 5 mm Kirschner wires If using 2 5 mm Kirschner wires in either the metacarpal or the radius K wires should converge at 40 60 in the sagittal plane This imp