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Instruments and implantsapproved by the AO Foundation.

Surgical Technique

Schanz Screws and Steinmann Pins

Image intensifier control

This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended.

Processing, Reprocessing, Care and MaintenanceFor general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to:http://emea.depuysynthes.com/hcp/reprocessing-care-maintenanceFor general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

Schanz Screws and Steinmann Pins Surgical Technique DePuy Synthes 1

Table of Contents

Introduction SELDRILL Schanz Screw 2

Self-tapping Schanz Screw 3

Hydroxyapatite-Coated Schanz Screw 4

Steinmann Pin 5

AO Principles 6

Intended Use, Indications and Contraindications 7

Surgical Technique Preoperative planning for all Schanz Screws and Steinmann Pins 8

Setting the Schanz Screws and Steinmann Pins 12

SELDRILL Schanz Screw 12

Self-tapping Schanz Screw 16

Steinmann Pins 21

Product Information The SELDRILL Schanz Screws 24

Schanz Screw (Self Tapping) 25

Hydroxyapatite-Coated Schanz Screws 26

Steinmann Pins 28

Bibliography 30

MRI Information 31

2 DePuy Synthes Schanz Screws and Steinmann Pins Surgical Technique

SELDRILL Schanz Screw

The SELDRILL Schanz Screw has been spe-cifically designed to optimise the bone/pin interface to reduce the occurrence of pin-tract related complications in external fixa-tion.

The unique design of the SELDRILL Schanz Screw reduces heat generation and inser-tion torque while improving pullout resis-tance in cortical and can cellous bone.

Radial preload

Core diameter increase of screw in the near cortex resulting in:

– enhanced anchorage in bone – sealing of intramedullary canal against

contamination – less bone resorption due to minimi-

sation of micromotion in screw-bone interface

Self-drilling and self-tapping

– Quick insertion – Precise geometry of bone thread – No need to search for pre-drilled pilot

hole

Materials

– Commercially pure titanium – Implant quality stainless steel

Standard vs self-drilling Schanz Screws1 (Axial insertion force 35N)

Standard 5.0 mm Schanz Screw (predrilled then inserted at 60 rpm)

5.0mm SELDRILL Schanz Screw (inserted at 400rpm)

Radial preload2–4

Microradiographs – after inserting smooth pins for 6 weeks

40

30

20

10

0Temperature increase (°C)

Insertion torque (Nm×10–1)

Cortical pullout (N×102)

Cancellous pullout (N×102)

Without radial preload: extensive bone resorption

With radial preload: minimal bone resorption

Precise geometry of bone thread

A

B

C

D

E


A Efficient drill bit and tap

– One-step insertion – Precise pilot hole and threads – Reduced heat generation – Decreased insertion torque

B Short, 2% core taper provides optimal radial preload

– Reduces micromotion and pin-tract infections

C Symmetrical thread profile

– Improved pullout strength in diaphyseal and metaphyseal bone

– Improved anchorage in cancellous bone due to increased thread length

D Smooth thread/shaft transition area

– Reduced stress riser

E Standard shaft diameters

– Compatible with Synthes external fixators

Self-tapping Schanz Screw

– With trocar tip – Diameters of 4.0 mm, 4.5 mm, 5.0 mm and 6.0 mm – Lengths of 60 mm, 80 mm, 100 mm, 125/130 mm,

150/160 mm 190/200 mm and 250 mm – Available in Stainless Steel or Titanium alloy (TAN) – Sterile and nonsterile-packaged


Hydroxyapatite Schanz Screw

– Threads are coated with hydroxyapatite (HA) to enhance fixation at the pin-bone interface and reduce the inci-dence of pin loosening

– Self-drilling or self-tapping versions – Diameters of 4.0 mm, 4.5 mm, 5.0 mm and 6.0 mm – Sterile-packaged

Hydroxyapatite-Coated Schanz Screw


Steinmann Pin with trocar tip – Available in Stainless Steel or Titanium alloy (TAN) – Diameters of 3.0 mm/3.5 mm/4.0 mm/4.5 mm and

5.0 mm – Lengths of 125 mm/ 150 mm /175 mm/ 200 mm/ – For some diameters length of 225 mm/250 mm/275 mm/

300 mm – Sterile and nonsterile-packaged

Steinmann Pin with middle thread and trocar tip – Available in Stainless Steel – Diameters of 4.5 mm and 5.0 mm – Lengths of 150 mm, 175 mm, 200 mm, 225 mm, 250 mm,

275 mm, 300 mm

Steinmann Pin with middle thread and trocar tip – Available in Titanium alloy (TAV) – Diameter of 5.0 mm – Lengths of 200 mm, 250 mm

Steinmann Pin with drill tip – Available in Stainless Steel – Diameters of 4.5 mm and 5.0 mm – Lengths of 125 mm, 150 mm, 175 mm, 200 mm, 225 mm,

250 mm, 275 mm, 300 mm – Sterile and nonsterile-packaged

Steinmann Pin

1

4

2

3

4_Priciples_03.pdf 1 05.07.12 12:08

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique

AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, 2.

1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.

2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.


AO Principles

Stable fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1,2.

1 Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer. 1991.

2 Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.


Intended UseSynthes SELDRILL, Self-tapping, Hydroxyapatite-coated Schanz Screws and Steinmann Pins are intended for use with an external fixation system.

IndicationsSynthes SELDRILL, Self-tapping, Hydroxyapatite-coated Schanz Screws and Steinmann Pins are indicated for use with an external fixation system.

ContraindicationsNo specific contraindications.

Warnings: – Synthes hydroxyapatite (HA) coated Schanz Screws are

only available sterile packed. Do not attempt to re-sterilize.

– Synthes SELDRILL, Self-tapping, Hydroxyapatite-coated Schanz Screws and Steinmann Pins are not approved for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic, or lumbar spine.

Intended Use, Indications and Contraindications

60°

60°

90°

60°


Preoperative planning for all Schanz Screws and Steinmann Pins

All External Fixators must be affixed within the recom-mended zones described below.

The construction may not hinder the approach for a primary wound debridement or for a secondary operation. Skin transplants, sequestrectomies, bone grafting or a later osteosynthesis must be performable without restriction.

Surgical approach to the tibia

The soft tissue zone through which Schanz Screws can be inserted without damaging important structures (vessels, nerves, muscles and tendons) is anteromedial to the tibia. The angles of this safe zone vary.

If the lateral surface of the distal third of the tibia is avoided, damage to the anterior tibial artery can be avoided.

If the ventral zone of the distal tibia is avoided, interference with the tendons can also be avoided. In addition, this mini-mizes the probability of potential pin channel infection.

Zones for pin placement in tibia

Save zone


Surgical approach to the femur

A lateral approach to the femur within a 30° angle is recom-mended. A medial approach is also possible from a distal direction.


Surgical approach to the pelvis

There are two recommended options for pin placement of the external fixation assembly in the pelvis.

Supraacetabular pin placement Given the pronounced bone structure, the more technically difficult supraacetabular pin placement is preferred over that of the iliac crest. Proceeding from the superior anterior crest, the site of entry is approximately 4–6 cm in a caudal direc-tion, and 3–4 cm in a medial direction. When the patient is in a supine position, the alignment for drilling the screws is angled approximately 20° in a cranial direction and 30° in-ward.

Iliac crest pin placement

Precaution: To keep from damaging the femoral cutaneous nerve, avoid insertion up to 15 mm in a dorsal direction from the superior anterior iliac spine.

The orientation of the os ilium can be determined by palpa-tion with a finger or an additional instrument. The screws are then inserted delicately between the two laminae of the os ilium.

Preoperative planning for all Schanz Screws and Steinmann Pins


Approach to the humerus

Distally, a dorsal approach to the humerus is appropriate.

Precautions: When dealing with the humerus, primary con-sideration should be given to the radial and axillary nerves. Distally, a dorsal approach to the humerus is appropriate. Proximally, it is recommendable to introduce the Schanz Screws from a ventrolateral direction, caudal to the path of the axillary nerve.


The following steps will be explained with reference to a B 5.0 mm self-drilling, self-tapping (SELDRILL) Schanz Screw, and a B 5.0 mm Schanz Screw inserted in the diaphyseal re-gion of the tibia.

Precaution: Select the appropriate Schanz Screw (self- tapping, SELDRILL, Hydroxyapatite) or Steinmann pin for the patient’s bony anatomy.


The SELDRILL is a self-drilling, self-tapping Schanz Screw. The optimized radial preloading helps minimize the rate of pin infections.

Note: When the new adaptors for Schanz Screws are used, the SELDRILL Schanz Screws as well as all other self-drilling and all Steinmann pins do not have to be clamped in the drill chuck. The adapters are compatible with the universal chuck and AO/ASIF Quick Coupling.

Note: The thread of the SELDRILL Schanz Screws does not result in irritation of the soft tissue.

Setting the Schanz Screws and Steinmann Pins



1Set the drill sleeves on the bone

Required instruments

395.911 Handle for Drill Sleeve

395.921 Drill Sleeve 6.0/5.0 short, with thread

395.912 Drill Sleeve 5.0/3.5, short

394.181 Trocar B 3.5 mm, short

Insert the drill sleeve assembly through a stab incision and set it directly on the bone surface. Then remove the trocar B 3.5 mm and the drill sleeve 5.0/3.5.

Precautions: – Instruments and screws may have sharp edges or moving

joints that may pinch or tear user’s glove or skin. – Handle devices with care and dispose worn bone cutting

instruments in an approved sharps container.



2Insert SELDRILL Schanz Screws


X94.782–788* SELDRILL Schanz Screws B 5.0 mm



393.103 Adapter for SELDRILL Schanz Screws B 5.0 mm

type-dependent Drill with attachment for AO/ASIF Quick Coupling

Insert the SELDRILL Schanz Screw in the B 5.0 mm adapter, and use the drill to screw it through the drill sleeve 6.0/5.0 until the drill tip is anchored in the distant cortical bone.

If it is difficult to determine whether the screw has entered the opposite side of the cortical bone, it is recommendable to check the screw’s penetration depth and position with the image intensifier.

After screwing in the SELDRILL Schanz Screw, remove the drill sleeve and the drill with the adapter.

Precautions: – The SELDRILL Schanz Screw has been developed to mini-

mize heat development. Nevertheless, slow insertion and additional cooling (for example with a Ringer solution) are recommended.

– The tip of the SELDRILL Schanz Screw should be embed-ded in the far cortex to effectively resist cantilever forces and to provide sufficient stability.

Note: Less experienced users are advised to use a hand drill when placing the SELDRILL Schanz Screw in the far cortex.

* X=2 Stainless Steel X=4 Titanium (TiCP)

The SELDRILL Schanz Screw should be embedded in the far cortex:


Alternative technique:


X94.782–788* SELDRILL Schanz Screws B 5.0 mm


395.921 Drill Sleeve 6.0/5.0, short, with thread



393.103 Adapter for SELDRILL Schanz Screws B 5.0 mm

393.100 Universal Chuck with T-Handle


Insert the SELDRILL Schanz Screw B 5.0 mm in the adapter, and use the drill to screw it through the drill sleeve 6.0/5.0 into the near cortical bone.

Remove the drill and replace it with the universal drill chuck with the T-handle (393.100). The screw can now be deli-cately screwed manually into the middle of the distant cortical bone. It is not necessary to completely penetrate the distant cortical bone since anchoring the thread in the near cortical bone and sinking the drill tip in the distant cortical bone effectively absorbs bending force.

Remove the drill sleeve and the universal chuck with T-handle.

Precaution: Only when bones are osteoporotic does the SELDRILL Schanz Screw have to be screwed a bit further into the distant cortical bone, and it may even slightly penetrate through it since this can increase anchoring stability.

Note: A SELDRILL Schanz Screw can be turned back without loosening as the thread is not conical.

Use in the metaphyseal region

The individual surgical steps are the same as when the screws are used in the shaft area.

* X=2 Stainless Steel X=4 Titanium (TiCP)


Instead of self-drilling Schanz Screws (SELDRILL), self-tapping screws can also be used. In contrast to the SELDRILL Schanz Screws, self-tapping screws must be predrilled.

1Set the drill sleeve assembly on the bone






Insert the drill sleeve assembly through a stab incision and set it directly on the bone surface and remove the trocar B 3.5 mm.


Self-tapping Schanz Screw


2Predrilling


310.370 Drill Bit B 3.5 mm, length 195/170 mm, 2-flute, for Quick Coupling


Drill through both sides of the cortical bone with the B 3.5 mm drill bit, then remove the drill sleeve 5.0/3.5.



3Insert the self-tapping Schanz Screw


X94.520–570* Self-Tapping Schanz Screw




The Schanz Screw can now be screwed in through the drill sleeve 6.0/5.0. The tip must be anchored in the distant corti-cal bone to effectively absorb bending force.

Precaution: The tip of the Self-tapping Schanz Screw should be embed-ded in the far cortex to effectively resist cantilever forces and to provide sufficient stability.

* X=2 Stainless Steel X=4 Titanium Alloy (TAN)


Alternative technique using the length gauge

Alternately, the length of the required Schanz Screw can also be precisely checked using the length gauge.




393.780 Depth Gauge for Schanz Screws


After predrilling as described in step 2 on page 17, the length gauge is guided through the drill sleeve 6.0/5.0 and hooked in the distant cortical bone.

Then move the retaining disk to the height of the drill sleeve and lock it with the locking screw.

Remove the length gauge, and insert the tip of the Schanz Screw into the recess of the retaining disk. Slide the universal chuck over the smooth shaft of the Schanz Screw to the height of the tip of the length gauge, and tighten the chuck on the Schanz Screw. Determining the length in this manner will ensure that the screw will be firmly anchored in the distant cortical bone.

The Schanz Screw can now be screwed in through the drill sleeve 6.0/5.0 until the drill chuck stops on the drill sleeve.

Note: If the Schanz Screw is screwed in beyond this point, it will strip the thread due to the resistance of the drill sleeve.


Precautions: – Implant sites should be meticulously cared to avoid pin-

tract infection. Schanz Screws and Steinmann pins may be surrounded with antiseptic coated foam sponges in an effort to avoid infection. An implant-site care procedure should be reviewed with the patient.

– To minimize the risk of pin track infection the following points should be observed:a. Placement of Schanz Screws and Steinmann pins taking

anatomy into consideration (ligaments, nerves, arter-ies).

b. Slow insertion and/or cooling, particularly in dense, hard bone to avoid heat necrosis.

c. Release of skin tension at soft tissue entry point of implant.



The following steps will be explained with reference to a symmetrical compression (generally required for arthrodesis and osteotomies) that is best generated using a bilateral frame construction with Steinmann pins.

Steinmann Pins


Steinmann Pins

Knee arthrodesis

Ankle arthrodesis

Bilateral frames for arthrodesis


X93.500– Steinmann Pin B 5.0 mm with trocar tipX93.590*

394.800– Carbon Fibre Rod B 11.0 mm394.870

390.008 Clamp, clip-on, self-holding

321.160 Combination Wrench B 11.0 mm

393.420 Protective Cap, for Schanz Screws and Steinmann Pins B 5.0 mm

393.760 Compressor, open


The large external fixator enables effective compression by pretensioning the Steinmann pins in relation to each other. Maximum stability is attained by first untightening the rele-vant clamp nuts, then generating the desired compression using the open compressor, and then retightening the nuts.



Bilateral frames for Osteotomies


X93.500– Steinmann Pin B 5 mm with trocar tipX93.590*

394.800– Carbon Fibre Rod B 11.0 mm394.870

390.008 Clamp, clip-on, self-holding

321.160 Combination Wrench B 11.0 mm

393.420 Protective Cap, for Schanz Screws and Steinmann Pins B 5.0 mm

393.760 Compressor, open


In the case of osteotomies of the proximal and distal tibia, inner fixation is generally preferred if there are no associated soft- tissue problems.

Compression osteotomies with a bilateral frame construction are supportive of the metaphysis of rapid bone healing.


Proximal tibia osteotomy

Distal tibia osteotomy

4.0/2.5 mm*, 4.0/3.0mm*

4.0 mm

5.0 mm

6.0 mm

4.0/2.5 mm*, 4.0/3.0 mm*

4.0 mm

5.0 mm

6.0 mm


Total Thread Item no.Item no. Diameter length length StainlessTitanium (mm) (mm) (mm) steel

494.769 4.0/2.5* 80 20 294.769

494.771 4.0/3.0* 80 20 294.771

494.772 4.0/3.0* 100 20 294.772

494.774 4.0 60 20 294.774

494.775 4.0 80 20 294.775

494.776 4.0 100 30 294.776

494.777 4.0 125 40 294.777

494.778 4.0 150 40 294.778

494.779 4.0 175 40 294.779

494.782 5.0 100 30 294.782

494.783 5.0 125 40 294.783

494.784 5.0 150 60 294.784

494.785 5.0 175 60 294.785

494.786 5.0 200 80 294.786

494.788 5.0 250 80 294.788

494.792 6.0 100 30 294.792

494.793 6.0 125 40 294.793

494.794 6.0 150 60 294.794

494.795 6.0 175 60 294.795

494.796 6.0 200 80 294.796

494.798 6.0 250 80 294.798

* Shaft/thread diameter. Shaft and thread diameters are the same for all other sizes listed. All SELLDRILL Schanz Screws are available non-sterile or sterile packed. Add suffix ”S“ to article number to order sterile product.

Product Information

The SELDRILL Schanz Screws

Pure titanium SELDRILL Schanz Screws

Stainless steel SELDRILL Schanz Screws


Schanz Screw (Self Tapping)

B (mm) Length (mm)

X94.300 4.0/3.0* 80/20

X94.430 4.0 60/25

X94.440 4.0 80/25

X94.445 4.0/2.5* 80/20

X94.450 4.0 100/25

X94.460 4.0 125/25

X94.520 5.0 100/50

X94.530 5.0 125/50

X94.540 5.0 150/50

X94.550 5.0 175/50

X94.560 5.0 200/50

X94.570 5.0 250/50

X94.650 6.0 100/50

X94.660 6.0 130/50

X94.670 6.0 160/50

X94.680 6.0 190/50

* Shaft/thread diameter Shaft and thread diameters are the same for all other sizes.

X=2 Stainless SteelX=4 Titanium Alloy (TAN)

All Schanz Screws Self-tapping are available non-sterile or sterile packed. Add suffix “S” to article number to order sterile product.

494.784SHA

294.784SHA


Product Information

Self-Drilling Schanz Screws, HA coating, Pure Titanium, sterile

B (mm) Length (mm)

494.784SHA 5.0 150

494.785SHA 5.0 175

494.786SHA 5.0 200

Self-Drilling Schanz Screws, HA coating, Stainless Steel, sterile

B (mm) Length (mm)

294.776SHA 4.0 100

294.777SHA 4.0 125

294.778SHA 4.0 150

294.779SHA 4.0 175

294.782SHA 5.0 100

294.783SHA 5.0 125

294.784SHA 5.0 150

294.785SHA 5.0 175

294.786SHA 5.0 200

294.788SHA 5.0 250

294.796SHA 6.0 200

Warning: Synthes Hydroxyapatite (HA) coated Schanz Screws are only available sterile packed. Do not attempt to re-sterilize.

Hydroxyapatite-Coated Schanz Screws

294.54SHA


Schanz Screws, HA coating, Stainless Steel,sterile

B (mm) Length (mm)

294.450SHA 4.0 100

294.460SHA 4.0 120

294.520SHA 5.0 100

294.530SHA 5.0 125

294.540SHA 5.0 150

294.550SHA 5.0 170

294.560SHA 5.0 200

294.570SHA 5.0 250

294.670SHA 6.0 160

294.680SHA 6.0 190

294.730SHA 4.5 125

294.740SHA 4.5 150

294.750SHA 4.5 175

294.760SHA 4.5 200

Warning: Synthes Hydroxyapatite (HA) coated Schanz Screws are only available sterile packed. Do not attempt to re-sterilize.


Product Information

Steinmann Pin with trocar tip Stainless Steel or Titanium Alloy (TAN)

B (mm) Length (mm)

X93.350 3.5 125

X93.360 3.5 150

X93.400 4.0 150

X93.410 4.0 175

X93.420 4.0 200

X93.440 4.5 125

X93.450 4.5 150

X93.460 4.5 175

X93.470 4.5 200

X93.480 4.5 250

X93.490 4.5 225

X93.500 5.0 150

X93.510 5.0 175

X93.520 5.0 200

X93.530 5.0 250

X93.540 5.0 300

X93.580 5.0 225

X93.590 5.0 275

X=2 Stainless SteelX=4 Titanium Alloy (TAN)

Steinmann Pin with middle thread (Stainless Steel)

B (mm) Length (mm)

293.640 5.0 150

293.680 4.5 175

293.690 5.0 175

293.730 4.5 200

293.740 5.0 200

293.790 5.0 225

293.840 5.0 250

293.890 5.0 275

293.940 5.0 300

Steinmann Pins


Steinmann Pin with ”middle“ thread (TAV)

B (mm) Length (mm)

493.740 5.0 200

493.840 5.0 250

Steinmann Pin with drill tip (Stainless Steel)

B (mm) Length (mm)

293.130 4.5 150

293.140 4.5 175

293.150 4.5 200

293.220 5.0 125

293.230 5.0 150

293.240 5.0 175

293.250 5.0 200

293.260 5.0 225

293.270 5.0 250

293.280 5.0 275

293.290 5.0 300

All Steinmann pins are available nonsterile or sterile packed. Add suffix ”S“ to article number to order sterile product.

For product information about fixation components for External Fixator (Clamps, Rods ,Adapters, Caps, Drill sleeves) please refer to the corresponding surgical technique:DSEM/TRM/0416/0651: Large and Medium External FixatorDSEM/TRM/0416/0652: Quadrilateral surface PelvicDSEM/TRM/0416/0653: Small External FixatorDSEM/TRM/0516/0675: Large Distractor TibiaDSEM/TRM/0516/0676 : External Distal Radius FixatorDSEM/TRM/0115/0292: Elbow Hinge FixatorDSEM/TRM/0714/0108: Mefisto External FixatorDSEM/TRM/0717/0113: Segment Transport Mefisto External FixatorDSEM/TRM/0717/0114: Hybrid Ring fixatorDSEM/TRM/0717/0136: The Distraction Osteogenesis Ring System


Bennek J (2000) The use of upper limb external fixation in paediatric trauma. Injury, Int J Care Injured 31, 21–26.

Gausepohl T, Koebke J, Pennig D, Hobrecker S, Mader K (2000) The anatomical base of unilateral external fixation in the upper limb. Injury, Int J Care Injured 31, 11–20.

Miner T, Carroll KL (2000) Outcomes of External Fixation of Pediatric Femoral Shaft Fractures. Journal of Pediatric Orthopaedics, 20:405-410.

Rüedi TP, Murphy WM (2000) AO Principles of Fracture Management. Thieme, Stuttgart, New York.

Ruland WO (2000) Is there a place for external fixation in humeral shaft fractures? Injury. Int. J. Care Injured 31, 27–34.

Kapukaya A, Subasi M, Necmioglu S, Arslan H, Kesemenli lC, Yildirim K (1998) Treatment of closed femoral diaphyseal fractures with external fixators in children. Arch Orthop Trauma Surg, 117: 387–389.

Hull JB, Bell MJ (1997) Modern Trends for External Fixation of Fractures in Children: A critical Review. Journal of Pediatric Orthopaedics, 6:103–109.

Gregory P, Pevny T, Teague D (1996) Early Complications with External Fixation of Pediatric Femoral Shaft Fractures. Journal of Orthopaedic Trauma, Vol 10, No 3, 191–198.

Buckley SL (1995) Technique of External Fixation of grossly unstable or open tibial shaft fractures in children. Operative Techniques in Orthopaedics, Vol 5, No 2 (April): 157-163.

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Aronson J, Tursky EA (1992) External Fixation of Femur Fractures in Children. Journal of Pediatric Orthopaedics, 12: 157–163.

Gregory RJH, Cubison TCS, Pinder IM, Smith SR (1992) External Fixation of lower limb fractures in children. The Journal of Trauma, Vol 33, No 5, pp 691–693.

Heim D, Regazzoni P, Perren S (1992) Der Fixateur externe bei offenen Frakturen: Gegenwärtiger Stand seiner Anwend-ung. Injury, No 23, suppl. 2.

Regazzoni P (1989) Das Ilizarov-Konzept mit einem modu-laren Rohrfixateursystem. Operative Orthopädie und Trauma-tologie, No 21, 90–93.

Rüter A, Brutscher R (1988) Die Behandlung ausgedehnter Knochen defekte am Unterschenkel durch die Verschiebungs - osteotomie nach Ilizarov. Der Chirurg, 59, 357–359.

Alonso JE, Horowitz M (1987) Use of the AO/ASIF External Fixator in Children. Journal of Pediatric Orthopaedics, 7: 594–600

Schavan R. (1994) Mechanische Testung von Schanzschen Schrauben. Diplomarbeit, Aachen, Deutschland 1–92.

Biliouris T. L., Schneider E., Rahn B. A., Gasser B., Perren S. M. (1989) The Effect of Radial Preload on the Im-plant- Bone Interface: A Cadaveric Study. J Orthop Trauma 3(4):323–332.

Biliouris T. L., Bresina S. J., Rahn B. A., Perren S. M. (1990) Untersuchung des Effekts unterschiedlicher radialer Kom-pression bei der Insertion von Schanzschen Schrauben. Acta Med Austriaca Suppl 17(40): 34.

Biliouris T. L., Gasser B., Schneider E., Perren S. M. (1990) Die Auswirkung einer radialen Vorlast auf den Knochen bei Ver-wendung von Fixateur externe Nägel. Acta Med Austriaca Suppl 17(40): 27–28.

Bibliography


MRI Information

Non-clinical testing has been performed to assess Torque, Displacement and Image Artifacts according to ASTM F 2213-06, ASTM F 2052-06e1 and ASTM F 2119-07 and Radio-Frequency-(RF-)induced heating according to ASTM F 2182-11a.

These tests have not been done on the individual implants but on the entire external fixator construct.

Please refer to the surgical technique of the corresponding External Fixator system.

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