PF Manual v14 Email

8/8/2019 PF Manual v14 Email

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Surgical technique


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PF Posterior Fixator

The posterior Fixator is a rigid xation for the treatment of fractures and malalignment

of the spine. The device allows easy reduction of the spine in all planes and can be

used as a single or multiple level xator. The device is a rigid xator in which the pe-

dicle screws are independently placed in the vertebra.

Benets

When in place the device is adjustible without any restrictions.

Precise compression / distraction with pedicle screws locked in angle to the construct.

Reposition of fracture deformities is performed with simple reduction instruments in a

controlled and careful mode.

The different reduction planes are all separately locked.


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Surgical technique

Pre operative planning

Prior to the operation the actual cross sectional size of the pedicle should be check-

ed by CT-scan. The rear part of all pedicle screws have a diameter of 6.35mm.

However two different screw diameters are available; 5 and 6mm. The 5mm screws

are usually used in the thoracic spine from T5 downwards. The 6mm screws should

be used whenever possible, typically from T12 downwards including the sacrum.

The device should be placed as close as possible to the level of the lesion, thereby

immobilizing the minimum number of segments.

Patient positioning

The patient is placed prone on a radiolucent operating table in such a way that the

C-arm image-intensier can be placed under the patient. Reduction is facilitated by

initial positioning in hyperextension by external means.

Indications for use:

1. Fractures of the lower thoracic and lumbar spine.

2. Posttraumatic spinal deformity.

3. Vertebral tumors, metastasis, infections and cases with imminent instability.

4. Spondylolisthesis and lumbar scoliosis.

5. Spondylolysis


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Preparation for screw placement. An

awl is used to penetrate the cortex at

the intersection of the dotted lines. The

tap is used to prepare the screw canal

down into the pedicle. Use the tap that

corresponds to the desired screw

diameter.

STEP 1

Use the tap to measure the depth of the canal. Add 15 mm for the protruding part of

the screw. The pedicle screws are inserted, do not turn down the screws all the way,

the nal tightening of the pediclescrews can be done when the blocks are in place.


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STEP 3

The rod and blocks are slid over the screw lengthener on to the pediclescrews. Let

the proximal block slide on rst. The distance between the blocks is regulated

by turning the rod (shortening gives compression - Lengthening gives distraction).

The PF-blocks are assembled on to the spindle bolt outside the patient.

The threaded block is mounted on the hexagonal side of the rod and the

unthreaded block on the opposite side. Make sure that both blocks can rotate fre-ely on the rod (do not overtighten the locking screws in the blocks).

STEP 2


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STEP 4

C

ompression or distraction can be achieved by turning the spindle bolt with the

angled screwdriver. The screwdriver is inserted into the hexagonal hole at either

the cranial or caudal side of the bolt.

By turning the pedicle screws the rod and block assembly can be lowered against

the lamina, achieving a minimum of protrusion.

CAUTION!The length of the pedicle screw in the vertebra has to be monitored withX-ray.

STEP 5


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STEP 6

Reduction handles are mounted over the blocks. The handle is placed over the

block and the plug is inserted into the block as shown below.

STEP 7

With the reduction handles in place the fracture can be reduced. The distance between

A and B should be normalized both anteriorly and posteriorly.

Reduction - Correction


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STEP 8

C

orrection is done as follows: Assemble the reduction clamps on the ends

of the reduction handles. Reduction starts by turning the clamping rod. The

distance A - B should be carefully monitored during the correction procedure.

Caution: Kyphotic deformity often requires a shortening of the device to be able

to achieve sufcient lordosis.

Use the angular screwdriver to compensate for shortening. A ball headedhexagonal screwdriver may be used instead of the angled screwdriver ifthat feels more comfortable.

STEP 9


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With the oblique clamp mounted on the reduction handles. Translatory de-

formity can easily be corrected.

STEP 10

STEP 11

Finally all locking screws are tightened and the implantation is completed.


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Postoperative regime

Early mobilization is advocated, i.e. as soon as the postoperative pain has resol-

ved, which is usually within 3-5 days after injury or surgery. Heavy patients (over

75-80 kg) and patients with major instability should wear a threepoint corset for 2-3months. Extension injuries which can be stabilized by compression and exion com-

pression injuries suitable for management via the tension band principle should not

require any postoperative support.

Patients without neurological decit usually require to be off work for 4-6 months

after which sound union can normally be anticipated. The device may be removed

after 8 months but in most instances leaving it in-situ has no adverse effect.


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ImplantsItem no.

Fixation blocksPF-blocks w/o thread, set of 2 ST250-005

PF-blocks with thread, set of 2 ST250-006

Rods 7 mmSpindle bolt 35 mm ST250-235

Spindle bolt 45 mm ST250-245





Spindle bolt 95 mm* ST250-295



Spindle bolt 125 mm* ST250-325Spindle bolt 150 mm* ST250-350

Pedicle screws 5 mm Pedicle screw 45 mm ST250-545

Pedicle screw 50 mm ST250-550






Pedicle screws 6 mmPedicle screw 45 mm ST250-645Pedicle screw 50 mm ST250-650







Pedicle screws 7 mmPedicle screw 60 mm ST250-760

Pedicle screw 65 mm ST250-765Pedicle screw 70 mm ST250-770



Additional implantsIntermediate block, 10 mm offset* ST250-850

Intermediate block, 13 mm offset ST250-860

*Sizes marked with * are made to order, the delivery

time for these sizes may vary.


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Instruments

Screwdriver handle "Snap on" 20-001

Bit for "Snap-on" screwdriver 20-003

Screwdriver "Multi tip" 20-002Angular screwdriver 50-001

Round bit for Multi tip screwdriver 20-352

Straight bit for Multi tip screwdriver 20-353

Crown bit for Multi tip screwdriver 50-602

Tap 5 mm (for 5mm screws) 40-500

Tap 6 mm (for 6 & 7mm screws) 40-600

Reduction handles, set of 2 90-004

Reduction clamps, set of 2 20-007

Open key 6 mm 50-009Screw lenghtener 50-010

Ring key 50-011

Block releaser 90-002

20-002

20-003

50-001

40-500 / 40-600

90-004

20-007

50-011

50-010

50-009

90-002

120-001

20-352

20-353

50-602

20-001


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Postal adress: Anatomica AB, Stora vgen 25, SE-436 34 Askim, SWEDENTelephone: +46 (0)31-748 89 00, Fax: +46 (0)31-28 72 76E-mail: [email protected], Web: www.anatomicaspine.com

Anatomica design, manufactureand supply Orthopaedic Products tohospitals and distributors all overthe world.

The company was founded in 1981and our head quarter is located inGothenburg, Sweden.

In 1981 an agreement was signedwith Biomet Inc for distribution of

their products. Today Anatomicaalso distributes products from othermanufacturers, mainly from the USAand the European Union.

In 2001 Anatomica aquired thecompany Nordopedic from professorSven Olerud. This gave us the opp-ortunity to develop and manufacturespinal products.

Our Quality and environmental sys-tem is certifed according to the ISO13485 and ISO 14000 standards.

Anatomica stands for Quality, Safety

and a High Level ofService.

Documents

PF Manual v14 Email