Embed Size (px)
Citation preview
Operative Technique
2.0mm & 3.0mm
Asnis MicroCannulated Screw System
2
This Operative Technique sets forth detailed recommended procedures for using Stryker Osteosynthesis devices and instruments. It offers guidance that should be followed, but, as with any technical guide, each surgeon must consider the particular needs of each patient and make appropriate adjustments as required.
Note: The bone screws referenced in this Operative Technique are not approved for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic or lumbar spine.
1. Introduction 3
2. Features & Benefits 4
3. Examples of Applications & Relative Contraindications 5
5. Operative Technique
5.1 Asnis Micro General Considerations 6
5.2 Austin/Chevron Osteotomy 10
5.3 Extraction 15
6. Ordering Information 16
Table of Contents
3
Cannulated Screws have a long, proven clinical history in Orthopaedic surgery. Along with the arthroscope and image intensifier, cannulated screws have been a major facilitator of minimally invasive surgery. Extensive surgical exposure of bone fragments and intensive soft tissue stripping have been changed to a minimally invasive percutaneous procedure.
The Asnis Micro 2.0mm and 3.0mm cannulated titanium screws dedicated for foot and hand surgery offer an effective solution for trauma and reconstructive indications. The Asnis Micro System is designed to facilitate surgical procedures by simplifying screw placement, insertion and removal.
Small screw diameters, with low profile screw heads and the advanced cutting characteristics of the Asnis Micro Cannulated Screws are combined to meet the surgeons' needs in their daily practice.
These important features make the Asnis Micro the system of choice.
Introduction
4
2.0mm and 3.0mm Diameters developed to meet the special needs of foot and hand surgeons
Low Profile Screw Heads specially designed for reduced potential of soft tissue irritation
Type III Anodization implants with Colour Coding for better distinction in the O.R.
Equal Shaft and Core Diameters developed for minimization of stress risers
Reverse Cutting Flutes to facilitate implant removal
Self Cutting Screw Design with an efficient cutting tip to improve insertion properties
Features and Benefits
5
Relative Contraindications
Examples of Applications
Note:For additional information please refer to the Instructions For Use (IFU), Ref.-No. 90-01971 delivered with each implant and IFU, Ref.-No. 90-01972 delivered with each instrument.
• FracturesofthePhalanges,Metatarsals, Tarsals and Ankle
• FracturesofthePhalanges,Metacarpals, Carpals and Distal Radius
• FracturesofthePatella• CorrectiveOsteotomiesoftheFore-,
Mid- and Hind Foot and the Hand• ArthrodesesintheFore-,Mid-and
Hind Foot• LigamentFixation
The physician’s education, training and professional judgement must be relied upon to choose the most appropriate device and treatment option.
The Asnis Micro 2.0mm and 3.0mm Cannulated Screws are designed for fixation of fracture fragments, intra-articular fractures and fixation of osteotomy sites in the hand and foot.
• Compromisedvascularitythatwould inhibit adequate blood supply to the fracture on the operative site
• Anyactiveorsuspectlatentinfection or marked local inflammation in or about the affected area
• Materialsensitivitydocumentedor suspected
• Patientshavinginadequatetissuecoverage over the operative site
• Bonestockcompromisedbydiseases, infection or prior implantation that can not provide adequate support and/or fixation
• Implantutilizationthatwouldinterfere with anatomical structures or physiological performance
• Anoverweightorobesepatientcan produce loads on the implant which can lead to failure of the fixation or to failure of the device itself
• Anymentalorneuromusculardisorder which could create an unacceptable risk of fixation failure or complications in postoperative care
• Other medical or surgical conditions which would preclude the potential benefit of the surgery.
Applications & Contraindications
6
Guide Wire Insertion
Insert the K-Wire using the Double Drill Guide at the entry point of the final screw placement to the appropriate depth.
Note:In case of dense cortical or pediatric bone, puncture the proximal cortex before inserting the K-Wire, by using the solid drill bit manually or by power according to the screw diameter chosen.
Countersinking of the Screw Head (Optional Step)
Where soft tissue coverage is minimal, the option for countersinking the screw head for further recess of the low profile screw head may be used.
Assemble the Elastosil® Handle with the Cannulated Countersink by pushing the sleeve toward the tip, inserting the Countersink Head and releasing the sleeve.
Note:Countersinking should be applied before screw length measurement since it influences the measurement of the overall screw length.
Washers
In osteoporotic bone or where the cortex is thin, Washers may be placed under the screw head in order to spread the load over a bigger area. After countersinking Washers cannot be used.
Apply the Countersink over the K-Wire and prepare the bone for countersinking by turning the instrument clockwise.
To disassemble the Cannulated Countersink push the sleeve forward and remove the tip.
Operative Technique
Asnis Micro General Considerations
7
All screw measurements need to be taken prior to drilling and/ or tapping over the K-Wire.
If countersinking is required, measurement of the screw length must be performed after using the countersink.
Please note:After using any cannulated instrument over a K-Wire, make certain that the K-Wire did not shift or dislocate.
After screw insertion always confirm proper screw length by using an image intensifier or through direct visual verification.
Measurement of the Screw Length
In order to achieve the correct screw length measurement, ensure the final position of the K-Wire by using an image intensifier, or visually verify K-wire placement, prior to measurement.
Note:The following can influence the result of your screw length measurement:• Ifthemeasuringgaugeisnotplaced
perpendicular to the bone surface, the measurement can be influenced by up to 1−2mm
• Duringscrewinsertionintoboneof poor quality, the screw head may sink into the bone, which can result in an unanticipated countersinking of approximately 1−2mm
Due to the factors listed above, and to avoid penetration or damage of the articular surface, it is recommended to subtract a minimum of 1−2mm from the screw measurement, or as appropriate.
Slide the Direct Measuring Gauge over the K-Wire and position it in direct contact with the bone.
The Direct Measurement Gauge measures directly to the tip of the K-Wire, thus ensuring that the final screw position corresponds with the initial tip position of the K-Wire.
The end of the K-Wire, when placed against the Direct Measurement Gauge, allows for a direct reading of the complete screw length to be used. This measurement includes the screw head.
Subtract appropriately for any anticipated fracture reduction or inter-fragmentary reduction due to compression of the screw during insertion.
Also note, when Washers are used, the height of the implanted washer (0.5mm for the 2.0mm Asnis Micro Washer or 0.7mm for 3.0mm Asnis Micro Washer) needs to be considered for the overall screw length.
Operative Technique
Asnis Micro General Considerations
8
Screw Insertion Set Up
Assemble the Cannulated Screwdriver onto the Elastosil® Handle as described for the Cannulated Countersink on page 6.
Take the Holding Sleeve and slide it over the Cannulated Screwdriver until it engages.
Pull the sleeve toward the handle so that the tip of the screwdriver is visible.
Place the screwdriver into the chosen screw, push the sleeve forward and take the screw securely out of the rack.
Optionally screws may also be taken from the screw rack by using the Screw Foreceps.
Pre-Drilling (Optional Step)
In case of hard cortical or pediatric bone, pre-drilling can be used. Insert theCannulatedDrillBitaccordingto the screw diameter into a power or manual cannulated drill. Slide it over the K-Wire and overdrill the K-Wire to its tip by using the Double Drill Guide.
Optionally the Solid Drill may be used without the use of a K-Wire.
Note:In order to avoid damaging the K-Wire use low speed or a manual drill.
Operative Technique
Asnis Micro General Considerations
9
Screw Insertion
To prepare for insertion place the screw over the K-Wire onto the bone and draw the Holding Sleeve towards the handle, so that the screw head is visible.
Insert the screw over the K-Wire by turning the screwdriver clockwise.
After final insertion remove the screwdriver from the screw and verify the K-Wire and screw position with the image intensifier.
After the positions have been verified remove and discard the K-Wire.
To remove the Holding Sleeve compress the bushing. The entire Holding Sleeve can now be removed from the Screw Driver.
Operative Technique
Asnis Micro General Considerations
10
Bone Preparation
Make a dorsal medial skin incision crossing the first Metatarsal Phalangeal Joint. Retract the soft tissues carefully, being certain to protect the neuro vascular bundle in the skin flap.
Perform a lateral release if necessary through the same incision. This would include the release of the adductor tendon and the fibular sesamoidal ligament.
Note:Beawareofthesuperficialbranchofthe deep peroneal nerve.
Resect the medial eminence, with protection of the sagittal groove.
Perform a t-shaped incision of the capsule thus exposing the joint.
Austin / Chevron Osteotomy
Operative Technique
11
Osteotomy
Perform a V-shaped osteotomy at the head-neck level at an angle of 60°, with the apex at the K-Wire.
Translate the capital fragment laterally.
60°
Note:The head will follow the direction which is predetermined by the K-Wire placement.
Insert the K-Wire in the center of the metatarsal head depending on the required osteotomy.
Operative Technique
Austin / Chevron Osteotomy
12
Note:Countersinking should be applied before screw length measurement since it influences the measurement of the overall screw length.
Washers
In osteoporotic bone or where the cortex is thin, Washers may be placed under the screw head in order to spread the load over a bigger area.
After countersinking Washers cannot be used.
Guide Wire Insertion
Place the K-Wire for the screw in the appropriate position aiming at the center of the metatarsal head.Insert the K-Wire through the metatarsal head until the tip is visible and then retract it slightly so that the tip is below the level of articular cartilage.
Assemble the Cannulated Countersink by pushing the sleeve toward the tip, inserting the Cannulated Countersink and releasing the sleeve.
Countersink of the Screw Head (Optional Step)
Where soft tissue coverage is minimal, countersinking may be considered.
Apply the Countersink over the K-Wire and prepare the bone for countersinking by turning the instrument clockwise
Note:In case of dense cortical bone, puncture the cortex before inserting the K-Wire, by using the drill bit manually or by power according to the screw diameter chosen.
Austin / Chevron Osteotomy
Operative Technique
13
Measurement of the Screw Length
All screw measurements need to be taken prior to drilling and/ or tapping over the K-Wire.
If countersinking is required, measurement of the screw length must be performed after using the countersink.
Please note:After using any cannulated instrument over a K-Wire, make certain that the K-Wire did not shift or dislocate.
After screw insertion always confirm proper screw length by using an image intensifier or through direct visual verification.
In order to achieve the correct screw length measurement, ensure the final position of the K-Wire by using an image intensifier, or visually verify K-wire placement, prior to measurement.
Note:The following can influence the result of your screw length measurement:• Ifthemeasuringgaugeisnotplaced
perpendicular to the bone surface, the measurement can be influenced by up to 1−2mm
• Duringscrewinsertionintoboneof poor quality, the screw head may sink into the bone, which can result in an unanticipated countersinking of approximately 1−2mm
Due to the factors listed above, and to avoid penetration or damage of the articular surface, it is recommended to subtract a minimum of 1−2mm from the screw measurement, or as appropriate.
Slide the Direct Measuring Gauge over the K-Wire and position it in direct contact with the bone.
The Direct Measurement Gauge measures directly to the tip of the K-Wire, thus ensuring that the final screw position corresponds with the initial tip position of the K-Wire.
The end of the K-Wire, when placed against the Direct Measurement Gauge, allows for a direct reading of the complete screw length to be used. This measurement includes the screw head.
Subtract appropriately for any anticipated fracture reduction or inter-fragmentary reduction due to compression of the screw during insertion.
Also note, when Washers are used, the height of the implanted washer (0.5mm for the 2.0mm Asnis Micro Washer or 0.7mm for 3.0mm Asnis Micro Washer) needs to be considered for the overall screw length.
Operative Technique
Austin / Chevron Osteotomy
14
Operative Technique
Pre-Drilling (Optional Step)
In case of hard cortical bone, pre-drilling can be used.Insert the cannulated drill bit according to the screw diameter into a power or manual cannulated drill. Slide it over the K-Wire and overdrill the K-Wire to its tip by using the Double Drill Guide.
Optionally the Solid Drill may be used without the use of a K-Wire.
Note:In order to avoid damaging the K-Wire use low speed or a manual drill.
Screw Insertion Set Up
Assemble the Cannulated Screwdriver onto the Elastosil® Handle as described for the Cannulated Countersink on page 6.
Take the Holding Sleeve and slide it over the Cannulated Screwdriver until it engages.
Pull the sleeve towards the handle so that the tip of the screwdriver is visible.
Place the screwdriver into the chosen screw, push the sleeve forward and take the screw securely out of the rack.
Austin / Chevron Osteotomy
15
Holding Sleeve Support
In case of difficult screw extraction due to bone quality, the Holding Sleeve in combination with the Solid Screwdriver can be used as a support for lifting and turning the screw.
Screw Insertion
To prepare for insertion, place the screw over the K-Wire onto the bone and draw the Holding Sleeve towards the handle so that the screw head is visible.
Insert the screw over the K-Wire by turning the instrument clockwise.
After final insertion remove the screwdriver from the screw and verify the K-Wire and screw position with the image intensifier.
After the positions have been verified remove and discard the K-Wire.
Resect the remaining head and neck prominence in a parallel plane to the medial border of the foot.
Operative Technique
Austin / Chevron Osteotomy
Extraction
16
40-30110
40-30112
40-30114
40-30116
40-30118
40-30218
40-30120
40-30220
40-30122
40-30222
40-30124
40-30224
40-30126
40-30226
40-30128
40-30228
40-30230
40-30232
40-30234
40-30236
40-30238
40-30240
40-30108
40-30109
40-30111
40-30113
40-30214
40-30115
40-30215
40-30216
40-30117
40-30217
40-30119
40-30219
40-30121
40-30221
40-30123
40-30223
40-30125
40-30225
40-30127
40-30227
40-30129
40-30229
40-30130
40-30132
40-30134
40-30136
40-30138
40-30140
10mm
12mm
14mm
16mm
18mm
18mm
20mm
20mm
22mm
22mm
24mm
24mm
26mm
26mm
28mm
28mm
30mm
32mm
34mm
36mm
38mm
40mm
8mm
9mm
11mm
13mm
14mm
15mm
15mm
16mm
17mm
17mm
19mm
19mm
21mm
21mm
23mm
23mm
25mm
25mm
27mm
27mm
29mm
29mm
30mm
32mm
34mm
36mm
38mm
40mm
3.0mm Asnis Micro Cannulated Screws
REF Total Thread Recommended Length Length Set Item
40-20110
40-20112
40-20114
40-20116
40-20118
40-20218
40-20120
40-20220
40-20122
40-20222
40-20124
40-20224
40-20226
40-20228
40-20230
40-20108
40-20109
40-20111
40-20113
40-20115
40-20117
40-20217
40-20119
40-20219
40-20126
40-20128
40-20130
10mm
12mm
14mm
16mm
18mm
18mm
20mm
20mm
22mm
22mm
24mm
24mm
26mm
28mm
30mm
8mm
9mm
11mm
13mm
15mm
17mm
17mm
19mm
19mm
26mm
28mm
30mm
2.0mm Asnis Micro Cannulated Screws
4mm
5mm
6mm
7mm
5mm
8mm
5mm
9mm
5mm
10mm
6mm
10mm
12mm
12mm
14mm
4mm
4mm
5mm
6mm
6mm
5mm
8mm
5mm
9mm
6mm
6mm
6mm
4mm
4mm
4mm
4mm
5mm
8mm
5mm
9mm
5mm
10mm
6mm
10mm
6mm
12mm
6mm
12mm
14mm
14mm
16mm
16mm
18mm
18mm
4mm
4mm
4mm
4mm
6mm
4mm
7mm
7mm
4mm
8mm
5mm
9mm
5mm
9mm
5mm
10mm
6mm
10mm
6mm
12mm
6mm
12mm
6mm
6mm
7mm
7mm
8mm
8mm
REF
40-20900
2.0mm Asnis Micro Washer
REF
40-30900
3.0mm Asnis Micro Washer
Ordering Information – Implants Unsterile
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
REF Total Thread Recommended Length Length Set Item
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
Recommended Set Item
17
REF Total Thread Length Length
40-20110S
40-20112S
40-20114S
40-20116S
40-20118S
40-20218S
40-20120S
40-20220S
40-20122S
40-20222S
40-20124S
40-20224S
40-20226S
40-20228S
40-20230S
40-20108S
40-20109S
40-20111S
40-20113S
40-20115S
40-20117S
40-20217S
40-20119S
40-20219S
40-20126S
40-20128S
40-20130S
10mm
12mm
14mm
16mm
18mm
18mm
20mm
20mm
22mm
22mm
24mm
24mm
26mm
28mm
30mm
8mm
9mm
11mm
13mm
15mm
17mm
17mm
19mm
19mm
26mm
28mm
30mm
2.0mm Asnis Micro Cannulated Screws, Sterile
4mm
5mm
6mm
7mm
5mm
8mm
5mm
9mm
5mm
10mm
6mm
10mm
12mm
12mm
14mm
4mm
4mm
5mm
6mm
6mm
5mm
8mm
5mm
9mm
6mm
6mm
6mm
REF Total Thread Length Length
40-30110S
40-30112S
40-30114S
40-30116S
40-30118S
40-30218S
40-30120S
40-30220S
40-30122S
40-30222S
40-30124S
40-30224S
40-30126S
40-30226S
40-30128S
40-30228S
40-30230S
40-30232S
40-30234S
40-30236S
40-30238S
40-30240S
40-30108S
40-30109S
40-30111S
40-30113S
40-30214S
40-30115S
40-30215S
40-30216S
40-30117S
40-30217S
40-30119S
40-30219S
40-30121S
40-30221S
40-30123S
40-30223S
40-30125S
40-30225S
40-30127S
40-30227S
40-30129S
40-30229S
40-30130S
40-30132S
40-30134S
40-30136S
40-30138S
40-30140S
10mm
12mm
14mm
16mm
18mm
18mm
20mm
20mm
22mm
22mm
24mm
24mm
26mm
26mm
28mm
28mm
30mm
32mm
34mm
36mm
38mm
40mm
8mm
9mm
11mm
13mm
14mm
15mm
15mm
16mm
17mm
17mm
19mm
19mm
21mm
21mm
23mm
23mm
25mm
25mm
27mm
27mm
29mm
29mm
30mm
32mm
34mm
36mm
38mm
40mm
3.0mm Asnis Micro Cannulated Screws, Sterile
4mm
4mm
4mm
4mm
5mm
8mm
5mm
9mm
5mm
10mm
6mm
10mm
6mm
12mm
6mm
12mm
14mm
14mm
16mm
16mm
18mm
18mm
4mm
4mm
4mm
4mm
6mm
4mm
7mm
7mm
4mm
8mm
5mm
9mm
5mm
9mm
5mm
10mm
6mm
10mm
6mm
12mm
6mm
12mm
6mm
6mm
7mm
7mm
8mm
8mm
REF
40-20900S
2.0mm Asnis Micro Washer, Sterile
REF
40-30900S
3.0mm Asnis Micro Washer, Sterile
Recommended Set Item
Ordering Information – Implants Sterile
18
45-20001
45-20001S
45-20004
45-20004S
45-20005S
45-20011
45-20011S
45-20006S
45-20007S
45-20008
45-20009
45-20014
45-20015
45-20015S
45-30001
45-30001S
45-30004
45-30004S
45-30005S
45-30011
45-30011S
45-30006S
45-30007S
45-30008
45-30009
45-30014
45-30015
45-30015S
Cannulated Screwdriver 2.0 mm, AO Coupling
Cannulated Screwdriver 2.0mm, AO Coupling, Sterile
Solid Screwdriver, 2.0mm, AO Coupling
Solid Screwdriver 2.0mm, AO Coupling, Sterile
Cannulated Drill 1.7mm, AO Coupling, Single Use, Sterile
Solid Drill 1.7mm, AO Coupling
Solid Drill 1.7mm, AO Coupling, Sterile
Cannulated Tap 2.0 mm, AO Coupling, Single Use, Sterile
Cannulated Countersink 2.8mm, AO Coupling, Single Use, Sterile
Holding Sleeve for 2.0mm Screws
Double Drill Guide 0.8/1.7mm
Cleaning Stylet 0.8mm
K-Wire 0.8 mm x 100 mm, Single Use
K-Wire 0.8 mm x 100 mm, Single Use, Sterile
Cannulated Screwdriver 3.0 mm, AO Coupling
Cannulated Screwdriver 3.0mm, AO Coupling, Sterile
Solid Screwdriver 3.0mm, AO Coupling
Solid Screwdriver 3.0mm, AO Coupling, Sterile
Cannulated Drill 2.1mm, AO Coupling, Single Use, Sterile
Solid Drill 2.1mm, AO Coupling
Solid Drill 2.1mm, AO Coupling, Sterile
Cannulated Tap 3.0 mm, AO Coupling, Single Use, Sterile
Cannulated Countersink 3.8mm, AO Coupling, Single Use, Sterile
Holding Sleeve for 3.0 mm Screws
Double Drill Guide 1.2/2.1mm
Cleaning Stylet 1.2mm
K-Wire 1.2 mm x 100 mm, Single Use
K-Wire 1.2 mm x 100 mm, Single Use, Sterile
REF Description
2.0mm Asnis Micro Instruments
3.0mm Asnis Micro Instruments
Ordering Information – Instruments
19
45-90010
45-90200
900106
29-32400
29-32000
29-35000
29-35200
45-80000
29-32010
Asnis Micro, Direct Measuring Gauge 0.8/1.2 mm
Asnis Micro Elastosil® Handle, Cannulated, AO Coupling
Screw Forceps
Instrument Tray for Asnis Micro 2.0 and 3.0 System
Screw Rack for Asnis Micro 2.0mm/3.0mm Screws (including Lid)
Container „Stryker Foot Solutions“ (3 Levels without Lid)
Lid for Asnis Micro 2.0 and 3.0 System (Container Lid)
Spring for 2.0mm and 3.0mm Holding Sleeve
Lid for Asnis Micro Screw Rack
REF Description
Asnis Micro Generic Instruments
Spare Parts
Ordering Information – Instruments
Biologics
Surgical Products
Neuro & ENT
Trauma, Extremities & Deformities
Biologics
Surgical Products
Neuro & ENT
Trauma, Extremities & Deformities
Stryker Leibinger GmbH & Co. KGBötzingerStrasse39-41D-79111 FreiburgGermany
www.osteosynthesis.stryker.com
The information presented in this brochure is intended to demonstrate a Stryker product. Always refer to the package insert, product label and/or user instructions before using any Stryker product. Surgeons must always rely on their own clinical judgment when deciding which products and techniques to use with their patients. Products may not be available in all markets. Product availability is subject to the regulatory or medical practices that govern individual markets. Please contact your Stryker representative if you have questions about the availability of Stryker products in your area.
Stryker Corporation or its subsidiary owns the registered trademark: Stryker Stryker Corporation or its subsidiary owns, uses or has applied for the following trademarks: Asnis Micro Wacker-Chemie GmbH owns the following trademark: Elastosil
Literature Number : 90-17001LOT C2608
Copyright © 2008 Stryker
