课件文稿文件

MediumExternalFixator—BasicModularFrame

SynthesMediumExternalFixator—BasicModularFrame

Synthes

1

2

1

5

3

TechniqueOverview

1

InsertSchanzscrewsintothefirstfragment

2

Buildfirstmodule

ConnectonecombinationclamptoeachSchanzscrewinthefirstfragment.Connehortcarbonfiberrodtotheclamps.Tightennuts.

3

InsertSchanzscrewsintothesecondfragment

4

Buildsecondmodule

ConnectonecombinationclamptoeachSchanzscrewinthesecondfragment.Conne hortcarbonfiberrodtotheclamps.Tightennuts.

5

Connectmodules

Connectthetworodswithonerodandtwocombinationclamps.

6

7

Reducethefracture

6

Usetherodsofthefirstandsecondmodulesas“handles”forreduction.Tightennuts.

7

Increasestiffness

Toincreasestiffnessandrotationalstability,adda

bartotheframeconfiguration.The barshouldspanthelengthoftheframe,connectingthefirstandsecondmodules.

mendedComponentsforBasicFrame

ProductNumber

Item

tyNeeded

494.7xx

4.0mmTitaniumSelf-DrillingSchanzScrew

4

390.031 MediumCombinationClamp, 6

MRsafe

395.7xx 8.0mmCarbon 3

FiberRod

394.991 ProtectiveCap, 4

for4.0mmFixationPins

395.781 ProtectiveCap, 4

for8.0mmCarbonFiberRods

Notes:MRsafemeansthatthedevicewhenusedintheMRenvironmenthasbeendemonstratedtopresentnoadditionalrisktothepatient,butmayaffectthequalityofthediagnosticinformation.

AnMRenvironmentisdescribedasthegeneralenvironmentpresentinthevicinityofanMRscannerand/oranywhereintheprocedureroom,includingthecenteroftheboreoftheMRscanner.

Notes:Schanzscrews(stainlesssteelortitanium)andcarbonfiberrodsaremadefromnonmagneticmaterialsanddonotcreateheatordeflectionintheMRenvironment.

Additionalcomponentsarerequiredforoptionalframeconfigurations.

Stainlesssteelself-drillingSchanzscrewsornon-self-drillingSchanzscrewsmayalsobeused.

MediumExternalFixator—BasicModularFrame

SynthesMediumExternalFixator—BasicModularFrame

Synthes

Whentouse

Themodularframetechnique,usingtheMediumExternalFixator,canbeemployedforthefixationofdiaphyseallongbonefractureswithsofttissueinjury(closedoropen).

Theuseofinterconnectedmodulesallowsoptimizationofthepincementaccordingtothefracturepattern.

Relevantanatomy

Theframeillustratedonthepreviouspageisforthetibia:Schanzscrewsshouldbeinsertedinthesafezone1asillustrated.

SchanzscrewsshouldbecedintheAPneforumstability,asshownintheillustratedframe.Alternatively,theymaybe

Forpediatricpatientsusefluoroscopicimaging,

mostdistalandthemostproximalSchanzscrewsatleast2cmfromthephyses.Whilethephysesare4mm–6mmwide,theyhaveundulatingshapes.Therefore,tobeinthesafezoneandavoidinjurytoagrowthte,allow1cmforitstotalwidth.3

Reductionwiththemodulartechnique

Note:Fracturereductioncanbeadjustedintra-andpostoperativelybyfollowingthreebasicsteps.

1

Loosencombinationclampnutsonconnectingrodclampsonly

2

Userodsashandlestoreducethefracture

3

Retightenallnuts

TibialSafeZones2

220°

60°

70°

40°

140°

50°

100°

20°

140°

90°

30°

Legend

OptimalzonesforSchanzScrewinsertion

40°

120°

Safezonesfor

SchanzScrewinsertion

60°

20°

2

1

1

2

F.BehrensandK.Searls.“ExternalFixationoftheTibia.”JournalofBoneandJointSurgery.1986;68-B.246–254.

A.Fernández.“ExternalFixation.”AOPrinciplesofFractureManagement.

T.RüediandW.Murphy,ed.Dübendorf,Switzerland;AOPublishing.2000.239.Illustrationmodifiedandusedwithpermission.

J.AlonsoandM.Horowitz.“UseoftheAOExternalFixatorinChildren.”

JournalofPediatricOrthopaedics.1987;7.594–600.

Additionalreading

Fernández,A.ModularExternalFixationinEmergencyusingthe

A.O.TubularSystem.Monte,Uruguay;EditorialMarAdentro.1991.

OptionalFrameConfigurations

Themodulartechniquecanbeusedtoconstructframesforanylongbonefracturesortobridgeajoint.

AdditionalstabilitycanbeachievedbyaddingacarbonfiberrodbetweenthemostdistalandthemostproximalSchanzscrew.

Elbowbridge Humerusframe

Framesbuiltwithmulti-pinclampsallowthesameadjustabilityasmodulartechniqueframes.SeetheTibialShaftFrameTechniqueGuideformoreinformation.

Femurframe(small-staturedadult) Double-stackedtibiaframe

SynthesMediumExternalFixator—BasicModularFrame

Synthes

MediumExternalFixatorSetwithSelf-DrillingSchanzScrews

StainlessSteel(01.302.602)orTitanium(01.302.604)

GraphicCase

690.450 GraphicCase,forMediumExternalFixator

Im

293.74

200mm,

Self-DrillingSchanzScre

294.777 4.0mmdiameter,125mm,4ea.

294.778 4.0mmdiameter,150mm,4ea.

294.785 5.0mmdiameter,175mm,4ea.

294.786 5.0mmdiameter,2

Im

293.74 5.0mmSteinmannPinwithCentralThread,200mm,2ea.

TitaniumSelf-DrillingSchanzScrews494.777 4.0mmdiameter,125mm,4ea.

494.778 4.0mmdiameter,150mm,4ea.

494.785 5.0mmdiameter,175mm,4ea.

494.786 5.0mmdiameter,200mm,4ea.

310.19

2.0mmDrillBit,quickcoupling,

100mm,2ea.

310.37

3.5mmDrillBit,quickcoupling,195mm,2ea.

321.158

CombinationWrench,8mmwidthacrossflats

392.955

4.0mm/2.5mmDrillSleeve

392.969

CombinationT-Wrench,8mm

393.101

DriveAdaptorwithquickcoupling,for4.0mmSchanzScrews

393.103

DriveAdaptorwithquickcoupling,for5.0mmSchanzScrews

393.105

SmallUniversalChuckwithT-Handle

394.181

3.5mmTrocar,short

394.182

3.5mmTrocar,long

394.183

2.5mmTrocar

395.911

DrillSleeveHandle

395.912

5.0mm/3.5mmDrillSleeve,short

395.913

5.0mm/3.5mmDrillSleeve,long

395.921

6.0mm/5.0mmThreadedDrillSleeve,short

395.922

4.0mmThreadedDrillSleeve

395.923

6.0mm/5.0mmThreadedDrillSleeve,long

SterilizationParametersforSets(01.302.602and01.302.604)

TheseSynthessetswithalladditionallyavailableitems,asmarkedinthecase,canbesterilizedbythefollowingparameters.Formoreinformation,pleaserefertographiccasepackageinsert.

Method Cycle Temperature ExposureTime

Prevacuum

132°–135°C

8Minutes

(Wrapped)

(270°–275°F)

GravityDis

cement

132°–135°C

22Minutes

(Wrapped)

(270°–275°F)

Instruments(forbothsets)

FixationMaterial(forbothsets)

MediumCombinationClamp,MRsafe,8ea.

DynamizationClipforMediumCombinationClamp,MRsafe,4ea.

MediumMulti-PinClamp,4position,MRsafe,2ea.

RodAtta ent,forMediumMulti-PinClamp,MRsafe,4ea.

MediumOpenAdjustableClamp,

MRsafe,4ea.

MediumMulti-PinClamp,6position,MRsafe,2ea.

8.0mm/11.0mmCombinationClamp,MRsafe,2ea.

394.991 ProtectiveCaps,for4.0mmFixationPins,1pkg.of10

394.993 ProtectiveCaps,for5.0mmFixationPins,1pkg.of10

395.781 ProtectiveCaps,for8.0mm

CarbonFiberRods,4pkgs.of2

8.0mmCarbonFiberRods

395.782

200mm

395.784

220mm

395.786

240mm,2ea.

395.788

280mm,2ea.

395.792

320mm,2ea.

395.796

360mm,2ea.

395.797

400mm

395.779 160mm,2ea.

AlsoAvailableImnts

SchanzScrews

294.43–.48 4.0mm,spadepoint,60mm–150mm

294.52–.57 5.0mm,bluntedtrocarpoint,

100mm–250mm

294.71–.76 4.5mm,bluntedtrocarpoint,

80mm–200mm

Self-DrillingSchanzScrews294.774–.7794.0mm,60mm–175mm

294.782–.7885.0