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.