TwinFix CannulatedCompression Screw

Leibinger Solutionsfor Hand Surgery

ProceduralGuide

TwinFix

Sterilization, Organization, Storage

29-12020 ProfyleMODULARSterilizingContainer

29-40162 TwinFixImplantModule

29-12007 InstrumentRack

29-12022 RackforImplantModule

29-12024 ProfyleMODULARGenericInstrumenttraywithsiliconeinsert

29-12021 LidforSterilizingContainer

Instrumentation for Percutaneous Approach

07-40250 DrillandScrewGuide

07-40211 SleeveforTargetDevice(07-40210)and

DrillandScrewGuide(07-40250)

07-40215 DrillGuidefor1mmK-Wires

07-40240 CannulatedScrewdriverHandle

07-40230 CannulatedDrill2.4mm,withdepthstop

07-40232 Cannulatedtap

07-40220 CannulatedScrewdriverBlade

07-40280 K-Wire,1.0x160mm(Packageof10)

07-40245 DepthMeasuringGauge

Additional Instrumentation for Open Screw Osteosynthesis

07-40210 TargetDeviceforCompressionScrew

07-40216 ScaphoidTargetBow

07-40270 Self-retainingRetractorwithGuidingSleevesfor KirschnerWires1.0/1.6mmdiam.

Optional

07-40221 Emergencybladeforscrewremoval

3.2 mm TwinFix Cannulated Compression Screws

58-30414 Diam.3.2x14mm

58-30416 Diam.3.2x16mm

58-30418 Diam.3.2x18mm

58-30420 Diam.3.2x20mm

58-30421 Diam.3.2x21mm

58-30422 Diam.3.2x22mm

58-30423 Diam.3.2x23mm

58-30424 Diam.3.2x24mm

58-30425 Diam.3.2x25mm

58-30426 Diam.3.2x26mm

58-30427 Diam.3.2x27mm

58-30428 Diam.3.2x28mm

58-30430 Diam.3.2x30mm

58-30432 Diam.3.2x32mm

58-30434 Diam.3.2x34mm

Indications

Scaphoidfracture

1. Insertion of the K-wire

Intercarpalarthrodesis Fingerjointarthrodesis Correctiveosteotomyofhalluxvalgus

TheK-wireisinsertedusingthedrillandscrewguide.

On the lateral projection, the K-wiremust not penetrate the waist of thescaphoid. It should liewithin the boneatadistanceofapprox.2mmfromthepalmarcortex.

Maximumulnarinclinationofthewristprovidesagoodviewofthescaphoid.

Under image intensifier, the K-wire isappliedinp.a.projectionatthejunctionof the radial/middle third of thescaphoidtubercle.Ensurethatinsertionisasfardorsallyaspossibleontheedgeofthetrapezium.

The wire is then drilled proximallyunderrepeatedimageintensifiercontroltowardsthetipofthescaphoid.

With the hand in 45o supination, theproximal pole of the scaphoid is seenveryclearly.Thetipofthewireisdrilledforward in this position as far as thecortexbutwithoutpenetratingit.Thepositionofthewireisthencheckedagaincarefullyinall4planes.

Treatment of a scaphoid fracture

DrillandScrewGuideSleeve

DrillGuideforK-wireDrillandScrewGuide

Completelyassembled

ThisStep-by-StepProcedurehasbeendevelopedincooperationwithDr.Hans-WernerBouman,ATOSPraxisklinik,Bismarckstrae9-15,D-69115Heidelberg.

2. Checking the position of the Kirschner wire in 4 planes under image intensifier control

a.p.(axialalignmentoftheK-wireinthescaphoid)

lateral(positionrelativetothetrapeziumandtothewaistofthescaphoid)

45opronation(viewoftheheadofthescaphoid)

45osupination(viewofthepoleofthescaphoid)

3. Determining screw length

ReadingthescaletheendoftheK-wiredefinesthelengthofthescrew.

Measuring the length - the measuringsleeveisinsertedovertheK-wire.Ensure that the tip sits firmly on the tubercle and that no soft tissue has become interposed.

Thelengthreadoffthedepthmeasuringgauge is set on the cannulated drill bymeansoftheknurledscrew.

Thedrillguidewithsleeveispositionedfirmlytothetubercle(caution:interposedtissue).Theopeningon the sleeve facestowards the trapezium. The drill is in-sertedintothedrillguideovertheK-wireandisrotateduntilitmeetstheknurlednut.DonotchangetheangulationofthedrillwhiletheK-wireisinsertedintothedrill. Checking the position with theimageintensifierisrecommended.Alternatively, drilling can be continuedunderconstantimageintensifiercontroluntiljustbeforethetipoftheK-wire.

4. Drilling through drill and screw guide

5. Loading the screw 6. Measuring screw length

Check the screwdriver blade is in thelocked position (yellow and blue ringvisible), center the screwdriver bladeand press firmly to remove the screwfromtheimplantmodule.

Optional: checking of the screw lengthon the measuring scale of the implantmodule.

7. Insertion of the screw

Selection of a screw shorter than themeasured length is recommended. Thisguarantees that the head of the screwcan be submerged sufficiently beneaththelevelofthecortexandthetipofthescrewwillnotimpactontheendofthedrillhole in theproximal fragmentandforcethefractureapart.

Caution: for reasons of safety, thescaleshows2mmlessthantheactuallengthofthewire.

The required screw length is read fromthe side of the sleeve on the targetdevice.

All further steps are described underpoints48.

Whenthescrewheadiscompletelysubmergedinthebone(imageintensifiercontrol in45opronation),thescrewdriverisunlocked.Todothis,thesleeveispulledbackwardsothatonlytheyellowringisvisible.Now only the foot thread (gold) can turn. A rotation is usually sufficient to completecompression.

Thescrewdriverislockedwheninsertingthe screw (coupling pushed completelyforward both blue and yellow rings arevisible),sothatthescrewheadandscrewfoot turn simultaneously. When thereamerbelowtheheadreachesthecortex(see illustration), a certain degree ofprecompressionofthefragmentsoccurs.

8. Checking the position of the screw in 4 planes

Open treatment of a scaphoid fracture or pseudarthrosis with the target device

The target bow is introduced betweenthe scaphoid and the styloid process oftheradiuswiththewristdistracted.

The target bow is then pusheddownwards. By rotating the target bowslightly, the edge of the spoon slots inbetweenthescaphoidandthelunateandthejointsurfaceoftheradius.

Thetargetdeviceisnowpressedtogetherfirmly so that the teeth of the sleeveattachmenthooksecurelyintotheradialthirdofthetubercle.Thelateralopeningofthesleevefacestowardsthetrapeziumandmustlieasclosetothisaspossible.

Caution:When measuring with the targetdevice, a safety distance of 4 mm isincluded so that the TwinFix screwcanbesubmergedsufficientlybeneaththelevelofthecortex.

7. Insertion of the screw

For cleaning and sterilization please follow the instructions for use.

Stryker Leibinger GmbH &Co. KGBtzingerStrae37-41D-79111FreiburgGermanyTel.:++49(0)7614512-0Fax:++49(0)7614512-120

Stryker Leibinger Inc.4100EastMilhamAvenueKalamazoo,MI49001USATel.:++1-269-323-7700Fax:++1-269-648-7114

http://www.leibinger.com

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LiteratureNumber90-07542PrintDate08/06Rev.1

Copyright2004Stryker