3.5 mm Cannulated Screw Technique Guide
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1 3.5 mm Cannulated Screw Technique Guide An Integral Part of the SYNTHES Cannulated Screw System Original Instruments and Implants of the Association for the Study of Internal Fixation AO ASIF
2 The 3.5 mm Cannulated Screw Features Cannulated shaft accepts 1.25 mm diameter guide wires (threaded and non-threaded wires available). Hemispherical head ensures optimal annular contact with washers and Synthes plates when screws are angled. Low-profile head reduces possibility of soft tissue irritation. Standard 2.5 mm hexagonal drive is compatible with screwdrivers in other commonly used Synthes sets. Reverse-cutting flutes assist in screw removal. Thread profile designed to provide pullout resistance and insertion efficiency similar to those of the standard 3.5 mm cortex screw mm guide wire 5.0 mm diameter low-profile head with 2.5 mm hex drive Spherical underside 2.5 mm diameter shaft Reverse-cutting flutes Cancellous thread profile Thread lengths Material Partially threaded Fully threaded Implant quality 316L stainless steel
3 Indications For fracture fixation of small bones and small bone fragments, such as: Fractures of the metatarsals Arthrodeses of the carpals and phalanges Osteochondritis dissecans Ligament fixation Fractures of the carpals and metacarpals Fixation of metacarpal and metatarsal osteotomies Radial styloid fractures Warning: This device is not approved for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic, or lumbar spine. 1
4 AO Principles In 1958, the AO ASIF (Association for the Study of Internal Fixation) formulated four basic principles, which have become the guidelines for internal fixation: Anatomic Reduction A guide wire marks the prescribed path for the cannulated screw and secures alignment of the fragments while the screw is being inserted. The cannulated screw is inserted over the wire and tightened to further compress the fragments and hold the reduction. Stable Fixation Cannulated screws provide interfragmentary compression and absolute stability across the fracture. The screws are available in different threads lengths, allowing the surgeon to optimize purchase in the far fragment for maximum compression and stability. Preservation of Blood Supply The use of small diameter guide wires allows precise placement of cannulated screws through small incisions. This technique minimizes disruption of soft tissue and preserves vascular blood flow for bone healing. Early Mobilization Cannulated screws, combined with AO technique, provide stable fracture fixation with minimal trauma to vascular supply. This helps to create an improved environment for bone healing, accelerating the patient s return to previous mobility and function. 2
5 Surgical Technique Technique Tips Cleaning Cannulations Cleaning the cannulation in each instrument is imperative for proper function. Instruments should be cleared intraoperatively with the 1.25 mm Cleaning Stylet to prevent accumulation of debris in the cannulation and potential binding of the instruments with the guide wire. Instruments should be cleaned postoperatively with the stylet and the cleaning brush. Inserting Guide Wires Reduce and hold bone fragments in position with Kirschner wires or forceps prior to placing guide wires. Drilling Because of their hollow cross section and long length, cannulated drill bits are more susceptible to breakage than solid drill bits of the same diameter. Use less axial force, avoid bending, and advance the drill bit slowly to minimize the possibility of breakage. Cannulated drill bits should be inspected after every procedure and replaced if worn or damaged. 1 1 Insert guide wire Insert a 1.25 mm threaded or unthreaded guide wire through the 2.7 mm/1.25 mm Double Drill Sleeve to the appropriate depth. Check placement of wire under image intensification. Remove the drill sleeve. If needed to prevent rotation of the fragment, insert a second guide wire parallel to the first, following the same procedure. 3 2 Countersink (optional) Where necessary, use the Cannulated Countersink to create a recess for the screw head. 3 Measure for screw length Slide the tapered end of the Cannulated Screw Measuring Device over the guide wire. This reading determines appropriate screw length and maximum drilling depth. This will prevent overdrilling of the threaded tip of the guide wire and penetration of the far cortex. Note: Screw length will be approximately 5 mm short of the guide wire tip (the length of the threaded portion of the wire). 3
6 Surgical Technique (continued) 4 4 Set drilling depth To set the drilling depth, insert the 2.7 mm Cannulated Drill Bit into the 2.7 mm insert sleeve of the 3.5 mm/2.7 mm Drill Guide with Stop until the quick-coupling end of the bit rests on the drill guide. Insert the drill bit into the nontapered end of the measuring device, and loosen the knurled nut on the drill guide with stop. Rotate the threaded end of the drill guide with stop until the drill bit length corresponds to the reading obtained for screw length. Tighten the knurled nut. 5 Drill Place the drilling assembly over the guide wire. Drill until the quick-coupling end of the drill bit contacts the drill guide with stop. Note: Avoid directing the drill bit; let it follow the guide wire. Take care to remove the drill bit slowly and to pull back straight while running the drill forward to prevent guide wire pullout. Image intensification may be used to confirm drilling depth. Note: If the fracture pattern necessitates insertion of a fully threaded screw, drill a gliding hole in the near fragment before proceeding. Use the drill guide with stop with the 3.5 mm insert sleeve and the 3.5 mm Cannulated Drill Bit. 5 6 Tap Use the cannulated tap through the 3.5 mm/2.5 mm Double Drill Sleeve to tap the near cortex. Note: In dense metaphyseal bone, it may be necessary to tap over the entire nonthreaded length of the guide wire. 7 Insert Screw Using the Cannulated Hexagonal Screwdriver with the Holding Sleeve, insert the previously selected screw (step 3). Remove and discard the guide wire. 7 Note: In osteoporotic bone, a Washer may be used to prevent the screw head from sinking into the bone. 4
7 3.5 mm Cannulated Screw Instrument and Implant Sets Synthes offers the following 3.5 mm Cannulated Screw Instrument and Implant sets: 3.5 mm Cannulated Screw Instrument and Implant Set [105.03] 3.5 mm/4.0 mm Cannulated Screw Combined Instrument and Implant Set [105.14] Graphic Cases Each set includes a graphic case that houses and organizes all of the set s implants and instruments in order to facilitate surgery, sterilization and inventory control. The graphic case also provides space for some of the most common Also Available instruments and implants. Screw racks are removable to enable separate sterilization of implants, and replacements can be ordered separately or as part of the graphic case. Set Description: Graphic Case: Screw Rack: 3.5 mm Cannulated Screw Instrument and Implant Set [105.03] 3.5 mm/4.0 mm Cannulated Screw (3.5 mm) Combined Instrument and Implant Set [105.14] (4.0 mm) 5
8 Implants 3.5 mm Cannulated Screws, partially threaded mm 50 mm* Washer, 7.0 mm [219.98] To prevent screw head from sinking into osteoporotic bone Also Available 3.5 mm Cannulated Screws, fully threaded mm 50 mm* *2 mm increments 6
9 Instruments 1.25 mm Threaded Guide Wire, 150 mm [292.62] Maintains reduction during drilling. Threaded spade point tip allows easy penetration into the bone and maximum resistance to inadvertent removal. Cannulated Screw Measuring Device [319.15] Provides a direct reading for both screw length and maximum drilling depth. Indicated screw length will place screw at thread-shaft junction of wire, approximately 5 mm short of guide wire tip. 2.7 mm Cannulated Drill Bit [310.67] Quick coupling, 160 mm, 1.35 mm cannulation. 3.5 mm/2.7 mm Drill Guide with Stop [312.85] Used for precise drilling to a predetermined depth. Cannulated Countersink [310.86] Cuts a recess for the screw head. Quick-connects to Handle, with quick coupling [311.43]. 2.7 mm/1.25 mm Double Drill Sleeve [312.35] and 3.5 mm/2.5 mm Double Drill Sleeve [312.28] Protect soft tissue during guide wire placement, drilling and tapping. Cannulated Tap for 3.5 mm Cannulated Screws [311.39] Allows precise tapping in dense bone when necessary. Quick-connects to Handle, with quick coupling [311.43]. Handle, with quick coupling [311.43] 7
10 Instruments (continued) Holding Sleeve [314.08] Cannulated Hexagonal Screwdriver, 2.5 mm hex [314.29] Fully cannulated for insertion of any 3.5 mm Cannulated Screw over the guide wire. Accommodates Holding Sleeve [314.08]. Small Hexagonal Screwdriver Shaft, 2.5 mm hex [314.03] For removal of 3.5 mm Cannulated Screws; connects to Handle, with quick coupling [311.43] mm Cleaning Stylet [319.38] For intraoperative clearing of cannulated instruments mm Cleaning Brush [319.25] For postoperative cleaning of cannulated instruments. Screw Forceps [319.97] 8
11 3.5 mm Cannulated Screw Instrument and Implant Set [105.03] Graphic Case mm Cannulated Screw Instrument and Implant Set Graphic Case (includes removable screw rack) Implants mm Cannulated Screws, partially threaded, 10 mm 50 mm,* 3 ea Washer, 7.0 mm, 6 ea. Instruments mm Threaded Guide Wire, 150 mm (10/pkg.), 2 pkg mm Cannulated Drill Bit, 160 mm, quick coupling, 2 ea Cannulated Countersink Cannulated Tap for 3.5 mm Cannulated Screws Handle, with quick coupling mm/2.5 mm Double Drill Sleeve mm/1.25 mm Double Drill Sleeve mm/2.7 mm Drill Guide with Stop Small Hexagonal Screwdriver Shaft Holding Sleeve Cannulated Hexagonal Screwdriver Cannulated Screw Measuring Device mm Cleaning Brush mm Cleaning Stylet Screw Forceps Also Available mm Cannulated Screws, fully threaded, 10 mm 50 mm* mm Threaded Guide Wire, 150 mm, spade point on both ends mm Non-Threaded Guide Wire, 150 mm, spade point (10/pkg.) mm Cannulated Drill Bit, 160 mm, quick coupling Cannulated Hexagonal Screwdriver Shaft for 3.5 mm and 4.0 mm Cannulated Screws mm Cannulated Screw Instrument and Implant Set Graphic Case Screw Rack Small Battery Drive with 14.4 V Battery Pack Sets: H with Hudson Reduction Drive Unit M with Modified Trinkle Reduction Drive Unit T with Trinkle Reduction Drive Unit *2 mm increments
12 SYNTHES (USA) 1690 Russell Road Paoli, PA Telephone: (610) Fax: (610) To order: (800) SYNTHES (CANADA) LTD Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) Fax: (905) To order: (800) Original Instruments and Implants of the Association for the Study of Internal Fixation AO ASIF 1992 SYNTHES (USA) SYNTHES and ASIF are registered trademarks of SYNTHES (USA) and SYNTHES AG Chur. Printed in U.S.A. GP1191-C 6/04 J2725-C
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