Basic Instruments for Screw Plate Fixation Final
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Transcript of Basic Instruments for Screw Plate Fixation Final
Basic instruments for standard screw- and plate fixation
Bali, Indonesia28-30/05/09
Isabel Van Rie RichardsAOTrauma Education for ORP
Learning outcomes
1. Prepare all basic instruments needed for large fragment screw & plate fixation step by step
2. Explain which instruments are used to apply a lag screw
3. Discuss the different instruments needed to obtain dynamic compression with a plate
Operation steps
1. Fracture reduction
2. Bending / contouring the plate
3. Fracture fixation1. Drill the hole
2. Use the countersink
3. Measure
4. Tap
5. Insert the screw
Pointed forceps (Weber)
• Several sizes available • Available with ratchet
closure or with speed
lock • 1 or 2 instruments
are used
With ratchet
Forceps with serrated jaws
• Also used for temporary
plate fixation• Several sizes available• Available with speed lock• 1 or 2 instruments
are used
Self-centering forceps (Verbrugge)
• Also used for temporary
plate fixation• Available with speed
lock• 1 or 2 instruments
are used• Adjustable to size
of fragment
Self-centeringjaws
Sharp hook (Dentist)
• Reduction of small fragments• Used to clean the fracture gap, screw recess
and the tap & drill bit
Elevators & Hohmann
• Elevators: dissection• Hohmann: retractor• Adapt the instrument size to the fracture site
Femoral distractor
• Opens the fracture site so that reduction of smaller fragments is possible
Rod
Nuts
Sleeves
Operation steps
1. Fracture reduction
2. Bending / contouring the plate
3. Fracture fixation1. Drill the hole
2. Use the countersink
3. Measure
4. Tap
5. Insert the screw
Bendingtools
Bending press
Bending irons
Templates
12
Flexible templates
1 2
Operation steps
1. Fracture reduction
2. Bending / contouring the plate
3. Fracture fixation1. Drill the hole
2. Use the countersink
3. Measure
4. Tap
5. Insert the screw
Drill bit
Tip Flutes
Quick coupling
Drill bit
2-fluted 3-fluted
• Enables drilling at a sharp angle• Less strong
• Strong• Standard use
Table of drill bits & taps
Screw Drill bit
threaded hole
Drill bit gliding hole
Tap
Cortical 4.5 3.2 4.5 4.5
Cancellous 6.5 3.2 (4.5) 6.5
Double drill sleeve
• Protection of soft tissue• The double drill sleeve has several functions
12
3
3
Drill sleeve
• Use of the corresponding size• Use as handle
DCP & LC-DCP sleeves
DCP
LC-DCP
• The undersurface of the sleeve must be the same as the plate.
DCP & LC-DCP sleeves
• Allow dynamic compression on the fracture
eccentricneutral
DCP & LC-DCP sleeves
• The arrow must face towards fracture
• The attachments must fit on the handle
Universal drill sleeve
• Inter-fragmentary compression is obtained by correct use of the spring loaded drill sleeve
• Used for DCP, LC-DCP and LCP plates
Universal drill sleeve
Spring is activatedNeutral position
Spring is not activatedEccentric position
Universal drill sleeve
• Disassemble to clean spring and tube• Do not lose any item
4 elementsA way to keep everything together!
Tension device
• Will allow compression or distraction of the fracture.
Compression Distraction
Tension device – used for compression
• Plate is fixed to bone.• Device is connected to plate.• Tension (compression) will be obtained by using
the socket wrench
Countersink
• To cut the recess of the screw head in the bone.• The size of the tip corresponds with the core
diameter.
Depth gauge
• To measure the length of the hole• Depth gauge must be adapted to screw size • Handle is calibrated with increments of 2mm
Disassemble for maintenance
Tap
• To cut the thread of the screw in the bone.• The grooves allow removal of bone debris.
Tap
• Remove bone debris with a sharp hook, a K-wire or by immersing in saline solution.
Screwdriver
• Must be adapted to the recess.• Can be used with/without holding sleeve.
In which order do we use the following instruments?
2. Countersink – tap - measuring
1. Measuring – countersink - tap
3. Countersink – measuring - tap
Wrong procedure
1. Measuring 2. Countersinking
3. Inserting screw
Correct procedure
1. Countersinking
2. Measuring
3. Tapping
4. Inserting screw
Conclusion
1. The basic steps for plate and screw application are always the same: drilling, countersinking, measuring, tapping and screw insertion.
2. A lag screw is applied by drilling a gliding hole. The size of instruments depend of the size of the implants.
3. Dynamic compression is obtained by using the corresponding drill sleeve.