Revised 5/01/05Copyright © 2005 Creative Medical DesignsTM, Inc.

This updated manual supercedes all previously produced surgical technique manuals. NOTE

Rental or Purchase options are available.

Surgical Videos are also available online at: www.rayhack.com

ULNAR SHORTENINGPrecision Oblique

RAYHACK® OSTEOTOMY SYSTEMS

STAINLESS STEELor

TITANIUM PLATE

PRECISION OBLIQUE ULNAR SHORTENING OSTEOTOMYSURGICAL PROTOCOL

STEP 1

STEP 2

STEP 3

STEP 4

STEP 5

STEP 6

STEP 7

STEP 8

STEP 9

STEP 10

STEP 11

STEP 12 WARNING

STEP 13

SUMMARY

®

®

CTable of

ONTENTS

DISCLAIMER

REFERENCES

RAYHACK®OSTEOTOMY

SYSTEMS

FIG. 1

The three counter sunk holes area lways placed proxima lly

Ulnar subcutaneous borderThe dista l end of the saw guide should beapproximate ly 2 .0 cm from the end of the ulna

ulnar styloid

1STEPPlacement of the Ulnar Saw Guide

*Saw Guide U.S. Patents # 5 ,042 ,9835 ,176 ,685

The saw guide* mustbe placed on the subcutaneous border of the ulna.

Dorsal place -ment is not re commended

RE M E M B E R

CA U T I O N

NOTE

Hall®, Microaire® or Linvatec® sagittal saws

(consult www.rayhack.com/instrumentation.htm)

The saw guide* mustbe placed on the subcutaneousborder of the ulna.

Dorsal or volar placement is not recommended

FIG. 2

2 .5 mm drill bit

Stra ight drill guide

2STEPPositioning of the StraightDrill Guide

Some surgeons will ro utine-ly add 2 mm to their measure-ment to assure that the far cortex is fully captured by thescrew.

Be sure that the saw guideremains centered on the ulna.

not pro videdwith the rental sets.

N O T E

C A U T I O N

N O T E

N O T E

FIG. 2

2 .5 mm drill bit

Stra ight drill guide

2STEPPositioning of the StraightDrill Guide

Some surgeons will ro utine-ly add 2 mm to their measure-ment to assure that the far cortex is fully captured by thescrew.

Be sure that the saw guideremains centered on the ulna.

not pro videdwith the rental sets.

N O T E

C A U T I O N

N O T E

N O T E

CAUTION

NOTE

3STEP Width of the Ulnar Osteotomy andAnticipated Linear Short ening

FIG. 3A

FIG. 3B

Never pass the sawblade’s first marked line:

beyond the topsur face of the saw guide. If the ulnais excessively large, pass this sawblade line with utmost care.

4

FIG. 4

STEP Performing the ObliqueUlnar Shortening Osteotomy

CAUTION

CAUTION

“ULNAR MAX DEPTH”

In removing theulnar saw guid e there may be agreat deal of tension on thescrews. This is partly increase dby the conforming of thestraight saw guide to the convexsurface of the ulna. Be sure tocarefully apply the screwdriverto avoid stripping of the 2.5 mm hexagonal slot in thescrew head, and providecounter pressure to the rad ialforearm when removing thescrew.

If the s crew head socketbecomes “str ipped” and thesaw guide cannot be remo ved itmay be necessary to carefullyremove the screw head withMidas Rex instrumentation(Creative Medical Designs, Inc.does not provide this instumentation).

CAUTION

4

CAUTION2 1/4" inch

The osteotomy is most easily per-formed by flexing the elbow 110 °with the forearm held ve r t i c a l l ywhile aiming the saw blade at a45° angle toward the ceiling. Oncethe amount of bone to be remove dis determined, the appropriate slotsto be used are chosen according toStep 3 on the previous page. Fo rosteotomies greater than 7.4 mm,please see Step 10 .

It is imperative for the distalosteotomy cut to be made first,then the pr oximal. Failure to follow this order may result innon-parallel bone cuts.

It is important to protectall soft tissues from the cutting area.Periosteum must be stripped cir-cumferentially at the osteotomy siteo n l y. It is important to irrigate withsterile slush to cool the bone d u r-ing the cutting procedures in orderto minimize bone necrosis.NO T E Only use a HALL,or MICROAIRE sagittal saw with the specialized saw bladep r ovided in the RAY H AC K® OS T E OTO M YSY S T E M S' TR AY.

(See dimensions.) This saw blade iscontained in a non sterile package.Use of an inappropriate saw blademay damage the saw guide andmay result in inaccurate osteotomycuts.

N ever pass the saw guideb eyond the marked line. Failure top ay strict attention to this detail,m ay result in soft tissue and boned a m a g e .Once both osteotomy cuts aremade, all screws are removed andplaced in the appropriately num-bered temporary holding slots inthe tray.

N!"#: Consult www.rayhack.com/in-strumentation.htm for detailed saw descriptions.

NOTE: Only use a HALL®, MiCROAIRE® or LINVATEC® sagittal saw with thespecialized saw blade

Use of an inappropriate saw blade may damage the saw guide and may result in inaccurate osteotomy cuts.

It is imperative for the distalosteotomy cut to be made first, then the proximal. Failure to fol-low this order may result in non-parallel bone cuts.

®

The ulnar plateis available in stainless steelor titanium. Unless specificedotherwise the stainless steelplate will be pro vided.

5STEPUlnar Bone Plate Fixation

The e longated hole isa lways placed dista lly.

Passthroughplatebenderslots

#1#2

FIG. 5

NOTE

NOTE

NOTE

TM

®

The ulnar plateis available in stainless steelor titanium. Unless specificedotherwise the stainless steelplate will be pro vided.

5STEPUlnar Bone Plate Fixation

The e longated hole isa lways placed dista lly.

Passthroughplatebenderslots

#1#2

FIG. 5

NOTE

NOTE

NOTE

The ulnar plate is available in stainless steel or titanium. Unless specified otherwise the stainless steel plate will be provided .

6STEP Application of the Compression -Distraction Device and Compression of the Osteotomy

Observe the osteotomy for proper anterior-posterior angula tion while tightening the compression

screws in a clockwise direction. If dissatisfied, back up the adjusting screws counterclockwise and repeat the procedure.

If the osteotomy appears to be separating on the opposite cortex (interosseous surface), loosen the adjusting screws

in the compression-dis traction device and try loosening cortical screw #4 in the slotted hole and recompress the osteotomy.

If this still results in separation of the osteotomy, consider prebending the plate an add itiona l sma ll amount .

adjusting compressionscrew

temporary screws4.0 mm longer

hole #3

hole #4

FIG. 6* Compression-Distraction DeviceU.S. Patent # 4 ,929 ,247

NOTE The hexagona l screw holein the compression screws maybecome worn with extended use. If excessively worn this screw shouldbe replaced. A set of replacementscrews is supplied in the renta l se tshould this occur intra-operat ive ly.Unless needed, please do notremove these replacement screwsfrom the tray.

CAUTION

NOTE: Make sure that the scre w#4 at the distal end of the elongated slot of the plate isslightly loose and is free tomove proximally along the slot.

7STEPDrilling the 22 Degre eInterfragmentary Lag Screw Hole

(A) 2 .7 mm drill bit (B) 2 .0 mm drill bit (C) 2 .7 mm tap

2 .7 / 2 .0 mm drillsleeve

angled drill guide

FIG. 7

If the surgeon feels that the inter f ragmentary screw will not “capture” enough cor tical bone on thetapped (far) side of the hole when theangled drill guide is used, (for examplein a very narrow ulna) or that it doesnot fa ll within the desired site of theosteotomy, a d rillingtechnique may be substituted.

NOTE

IMPORTANT

f ree hand

8STEPOblique 2.7 mm Interfragmentary Lag Screw Application

interfragmentaryscrew

2 .5 mm drill bit

hand he ld drillguide

®

FIG. 8A

FIG. 8B

CAUTION

N O T E

N O T E

9STEP

DISCARD THE TEMPORARY

FIXATION SCREWS

Final Fixationof the Osteotomy

replace origina l bone screws

the 2 .7 mminterfragmentary screwhead does not projectabove the plate whendrilled at a 22 degreeangle .

#3

#4

CAUTION

CAUTION NOTE:

FIG. 9

NOTE

®

It is recommended that any surg eoncontemplating such an osteotomycontact Creative Medical Designs,Inc. with any questions or concern sprior to the pro cedure.

Clinical experience hasshown that the amount of boneshortening will be very close (within 1 mm) of the calculated linear shortening (hypotenuse).

10STEP Osteotomies in excess of 7.4 mm

PL E A S E N O T E

FIG. 10

to

10STEP

DETAILS

Osteotomies in excess of 7.4 mm

A P P LY

D R I L L

S H I F T

D R I L L

C U T

D R I L L

DRILL

SCREWS3 2

A

B

C

S H I F T

10STEP

DETAILS

Osteotomies in excess of 7.4 mm

R E M O V E

P I C K

R E M O V E

A P P LY

N O T E :

C O M P R E S S

S H I F T

D

E

FG

S H I F T

11STEP IntraoperativeX-Rays

12STEP

protected until fracture healinghas occurre d.

No activity against resistance is permitted until bone healinghas occurre d.

contraindicated.WARNING

Surgeons Please Note

gis ted.

DELAYED UNION

Post Operative Care -

:

14

13STEP Care and Cleaningof the Instru ments

Return of Instruments for Rental Users

CAUTION :

Enclose the “ RETURNED GOODSSTERILIZATION FORM” w ith theinstruments and place a copy inthe packing slip envelope andapply to the outside of theexpress package.

Please return the equipment byFederal Express or other next daycarrier immediately follow i n gs u r g e r y. Please have your office per-sonnel check with your surgicalservice or hospital shipping and

receiving department to ensure thatthis important function has beenproperly performed.

Thank yo u .

DISCARD

DISCARD

The used saw blade may be manually placed in the saw guide slots in order to remove any bone debris. Visually inspectthese slots to make sure that theses l o ts are completely clean by looking down the slot at a lightsurface. Clean any bone debrisfrom the other instruments .Sterilize the tray and instru -ments.

It is important toclean and thoroughly dry allinstruments before replacing inthe tray. A ny rust spots that mayappear may be lightly buffed usingS c o tc h - B r i t e™. The tray cover is locked into posi-tion by pushing down on the but-ton located on the cover and push-ing this toward the top of the tray.

the used saw blade in an appropriate biohaza r d o u sc o n t a i n e r.

the temporary screwsused to fix the compression-distraction device through holes #3 and #4.

Scotch-Brite is a registered trademarkof the 3M Corporation.NOTE: If the adjusting screws are

removed from the compre ssiondevice during cleaning be sure torealign the components pro perlywith screw re insertion.

ULTRASONIC cleaning isadvised to remove anyremaining bone debris.Sterilize the tray and instruments.

Return of Instruments for Rental UsersEnclose the “ RETURNED GOODSSTERILIZATION FORM” w ith theinstruments and place a copy inthe packing slip envelope andapply to the outside of theexpress package.

Please return the equipment byFederal Express or other next daycarrier immediately follow i n gs u r g e r y. Please have your office per-sonnel check with your surgicalservice or hospital shipping and

receiving department to ensure thatthis important function has beenproperly performed.

Thank yo u .

CREATIVE MEDICAL DESIGNS, INC.13914 Shady Shores Drive • Tampa, FL 33613 Phone (813) 875-9999 Fax (813) 961-5 5 4 3

Web Site - www.rayhack.com E-Mail - cmd@rayhack.com

1 2 3

54

7A 7B

8A 8B

6

7C

9

ULNAR SHORTENING SUMMARYRAYHACK®

Fits ten saws. For specifi cs consult www.rayhack.com/instrumentation.htm

CREATIVE MEDICAL DESIGNS, INC.

Rental or Purchase options are available.