Cerclage Passer. For minimally invasive application of ...synthes.vo.llnwd.net/o16/LLNWMB8/INT Mobile/Synthes... · minimal invasive application of cerclage cables. The modular case

Cerclage Passer. For minimally invasiveapplication of cerclage cables.

Handling TechniqueCable application

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Table of Contents

Introduction

Surgical Technique

Product Information

Bibliography 20

Cerclage Passer 2

Indications 4

Clinical Cases 5

Preparation 6

Surgical Steps 7

Implants 15

Instruments 16

Sets 18

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

Cerclage Passer Handling Technique Synthes 1

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2 Synthes Cerclage Passer Handling Technique

Techniques for the treatment ofperiprosthetic fractures and other indi-cations often include the applicationof cerclage cables. 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 cerclagecables. The modular case concept allows storage of the relevant instru-ments on modular instrument trays.

Note: Set does not include implants

Overview Cerclage Passer

Cerclage Passer. For minimally invasiveapplication of cerclage cables.

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

Allow passage of cable 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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Cable Crimper Cerclage Tunneling Device

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

Two levers: For pre-tension andcomplete crimping.

The crimper automatically releases whenthe cable is crimped (no over-crimping orunder-crimping possible).

A ratchet mechanism controls the amountof crimp and deformation.


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Indications

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


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Clinical Cases

78 year old female with AO 32-A1.1 fracture

72 year old female with AO 32-A1.2 fracture

Preoperative Postoperative

Preoperative Postoperative


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1Preparation

Set

01.221.100 Instrument Set for minimally invasive Cable Cerclage

Optional set

188.215 Cable System in Vario Case

Implants

x98.80x.01 Cerclage Cables with Crimp

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

Preparation

2Incision and preparation of soft tissue tunnel

Instruments

03.221.002 Cerclage Tunneling Device, � 46 mm

03.221.004 Cerclage Tunneling Device, � 60 mm

Choose the appropriate size cerclage tunneling device for thefield of application and the fracture. Make an incision andcarefully 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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1Insertion of cerclage passer

Instruments

03.221.010 Cerclage Passer, � 46 mm, minimally invasive

03.221.011 Cerclage Passer, � 60 mm, minimally invasive

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 pre-vents soft tissue from entering the cannulated tubes of thecerclage passer. Insert one half of the cerclage passer, thenthe 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 used fororientation. When the forceps are connected together, themarkings will appear in the same direction.

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

Surgical Steps


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1

2

3

2Connection and closure of cerclage passer

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

Important: While connecting the two parts, the tips mustnot meet. Do not attempt to close the forceps as long as themiddle of the forceps is not connected properly.

Surgical Steps


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4

5

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 cable.


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 cable passing tube

Instrument

03.221.012S Cable Passing Tube, length 400 mm, sterile

Push the cable passing tube through the tube of the closedcerclage passer. The only correct direction for insertion ismarked by an arrow.

Important: It is not possible to pass a pre-assembledcerclage cable without cable passing tube. The crimp at thebeaded end of the cable allows no direct passage throughthe cerclage passer.

The cable passing tube is for single use only and must not bereprocessed or resterilized.

Note: Do not use pliers for cable passing tube insertion dueto tube damages. The cable passing tube must exit theopposite part of the cerclage passer.

Do not open the cerclage passer when the cable passingtube is in use. The ends of the cerclage passer might cut thecable passing tube.

Tip: For better insertion bevel the cable passing tube.

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4Remove cerclage passer forceps

Unlock the forceps by opening the bracket.

Disconnect the two halves of the cerclage passer forceps andremove the half with arrow.

Be sure that the inserted cable passing tube stays around thebone. Hold the opposite end of the cable passing tube byhand.


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Surgical Steps


5Insert cable through cable passing tube

Implants

298.800.01 Cerclage Cable with Crimp � 1.0 mm, Stainless Steel


498.800.01 Cerclage Cable with Crimp � 1.0 mm, Titanium Alloy (TAN)

498.801.01 Cable with Crimp � 1.7 mm, Titanium Alloy (TAN)

Select the cable according to the application and fracture.

Push the end without bead through the cable passing tubewithout the cerclage passer until the cable exits. Remove theother half of the cerclage passer.

Important: If the cerclage cable is used in contact withother implants (e.g. LCP broad curved plate), consider thecorrect combination of metals.

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6Remove cable passing tube

Remove the cable passing tube by pulling it over the endwithout bead. Take care that the inserted cable stays aroundthe bone.


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Cable System. For OrthopaedicTrauma Surgery.

Technique Guide

7Tightening and fixation of cable

For further procedure, please refer to the Cable System technique guide (036.000.371) page 8, step 4A.

Surgical Steps

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Implants



498.800.01 Cerclage Cable with Crimp � 1.0 mm, Titanium Alloy (TAN)

498.801.01 Cable with Crimp � 1.7 mm, Titanium Alloy (TAN)

For additional implants please refer to the Cable Systemtechnique guide (036.000.371), page 32.


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Instruments

03.221.010 Cerclage Passer � 46 mm,minimally invasive

03.221.011 Cerclage Passer � 60 mm,minimally invasive


03.221.002 Cerclage Tunneling Device � 46 mm


03.607.513 Front Cutter

391.201 Cable Tensioner


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391.882 Cable Crimper

391.883 Attachment Bit for Tension Holder

391.884 Tension Holder, for temporary use


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Sets

01.221.100 Instrument Set for minimally invasive Cable Cerclage

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


03.221.010 Cerclage Passer � 46 mm, minimally invasive


03.221.011 Cerclage Passer � 60 mm, minimally invasive


68.221.130 Tray for Additional Instruments for minimally invasive Cable Cerclage

391.201 Cable Tensioner

391.882 Cable Crimper

391.883 Attachment Bit for Tension Holder

391.884 Tension Holder, for temporary use

03.607.513 Front Cutter


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Additionally available in sterile


Additionally available

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

68.000.101 Lid for Modular Tray, size 1/1

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 126 mm


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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

Bibliography

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All technique guides are available as PDF files at www.synthes.com/lit

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Cerclage Passer. For minimally invasive application of ...synthes.vo.llnwd.net/o16/LLNWMB8/INT Mobile/Synthes... · minimal invasive application of cerclage cables. The modular case