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As described by:
Jorge L. Orbay, M.D.
Miami Hand Institute
Miami, Florida.
SURGICAL TECHNIQUE GUIDE
System Overview
The ALIGN™ Radial Head System is designed to restore the kinematics of the native radial head.
Through the use of a proprietary alignment instrumentation, the Head Alignment Tool is designed to position the prosthetic head perpendicular to the axis of forearm rotation.
When properly positioned, the revolutionary Radial Head locking mechanism allows you to securely affix the prosthetic head to the stem.
Optimized Titanium Alloy Stem Geometry • Long Stem designed for 3 point fixation
• Plasma coated to assist in biological fixation
• Distal flutes for rotational stability
Adjustable CoCr Head with Locking Screw• Versatility of a bipolar for optimal implant positioning
• Stability of a monoblock for solid fixation
• Self locking wedge ramp threads
DESIGN FEATURES
• Side Loading
• Hybrid Head Design
• Unique Alignment Instrumentation
The proximal and distal radioulnar joints are the two condyles of a single forearm joint that has one axis of rotation.
The axis of forearm rotation courses from the fovea of the ulna to the center of the radial head, which is oriented perpendicular to this axis.
The Head Alignment Tool defines the axis of forearm rotation to position the prosthetic radial head perpendicular to this axis. Italso provides the necessary counter-torque when tightening the Locking Screw.
This helps to restore the kinematics of the native radial head.
EXPOSURE
HEAD SIZING
1
2
Make an incision over the lateral aspect of the elbow; gain access to the radial head through your preferred muscle interval
Remove the radial head fragments; assemble and measure them using the Radial Head Sizing Tray
Note: If between radial head sizes, select the smaller.
FOREARM AXIS GUIDE
TRIAL HEAD SELECTION 3
4
Select the Trial Head that corresponds to the native head
Note: For elliptically shaped radial heads, select the trial head that matches the minimum diameter of the native head
Flex the wrist; then make a stab incision over the fovea of the ulna
Insert the Forearm Axis Guide through the stab incision until it seats flush onto the distal ulna
Drill a 1.5mm K-Wire into the fovea, in the direction of the radial head
Note: Fluoroscopic imaging should be used to verify proper K-Wire placement.
5
6
SECURING FOREARM AXIS JIG
ATTACH BONE FORCEPS
Bend the K-Wire where it exits the Forearm Axis Jig, which will secure it to the ulna
Note: Do not tighten the Forearm Axis Jig at this point to allow for adjustments
Secure the Bone Holding Forceps to the Rail, then clamp it just distal to the fracture line
7
8RESECTION
ADJUSTING GUIDE ASSEMBLY
Now tighten the knob on the Forearm Axis Jig to secure the assembly in place
Note: The Forearm Axis Guide assembly serves as a handle to control the radius during the radial neck resection.
Lift the radius with the Axis Guide assembly, then resect the radial neck fragment
Note: The minimum resection length is 16mm and the maximum resection length is 24mm
CAUTION: Protect the radial nerve when preparing the medullary canal.
9
10
CANAL PREPARATION
NECK PLANING
Broach the medullary canal starting with the smallest Rasp and progressing larger until cortical bone is encountered
Insert each of the Rasps up to the etched depth mark
Note: Make note of the final Rasp size used, then select the corresponding Planer and Trial Stem
Prepare the resected end of the radius using the Planer
11
12
TRIAL NECK SIZING
TRIAL STEM SELECTION
With the forearm pronated and elbow flexed, select the radial neck length using the Neck Sizing Gauges
Note: If between two lengths, always select the shortest sizing option.
Select the Trial Stem that corresponds to the final Rasp/Planer used and insert it into the prepared canal
13
14
TRIAL HEAD & NECK ASSEMBLY
TRIAL CONSTRUCT ASSEMBLY
Assemble the Trial Head and Neck by threading the two components together
Note: The Trial Neck corresponds to the Neck Sizing Gauge used
Thread the handle of the Neck Sizing Gauge into the Trial Head, then side load it onto the Trial Stem Note: The Trial Neck should snap into the Trial Stem when correctly assembled.
15
16
TRIAL VALIDATION
FLUOROSCOPIC CONFIRMATION
Reduce the joint and assess the sizing of the trial components. Manipulate the elbow through its full range of motion to ensure that the joint has not been over-stuffed
Note: Fluoroscopic imaging should be used to verify the proper fit of the trial components
Confirm a proper fit using fluoroscopy, then remove the trial components
17
18
PROSTHETIC STEM INSERTION
PROSTHETIC HEAD LOADING
Insert the Radial Stem implant using the Stem Impactor until the collar seats flush against the radius
Side load the Radial Head implant onto the Radial Stem, then rotate it until the threads for the Locking Screw are positioned laterally
Note: Each Radial Head implant is packaged with its respective Locking Screw.
19
20
Locking Screw INSERTION
HEAD ALIGNMENT TOOL
Loosen the knob on the Forearm Axis Jig and remove the Bone Holding Forceps, then slide the rail distally
Load the Locking Screw onto the Driver then threadit loosely into the Radial Head
Note: The Head Alignment Tool can be used to control the position of the Radial Head
With the Head Alignment Tool connected to the Radial Head, slide the rail into the handle until secured, then re-tighten the knob on the Forearm Axis Jig
Stabilize the Radial Head by holding the Head Alignment Tool, then tighten the Locking Screw using the Universal Driver Handle
Note: This will help to align the prosthetic head to the axis of forearm rotationwhile providing the necessary counter-torque when tightening the Locking Screw
21
22
IMPLANT LOCKING
IMPLANT VALIDATION
A B
Continue stabilizing the Radial Head using the Head Alignment Tool, then final tighten the Locking Screw using the Torque Indicating T-Handle Driver
Additional torque can be gained using the Universal Driver Handle
Note: The Torque Indicating T-Handle ensures that the minimum required torque has been achived.
Remove the Forearm Axis Guide assembly and K-wire
Manipulate the elbow through its full range of motion to confirm final implant alignment
A. Supination
B. Pronation
23
24
FLUOROSCOPIC CONFIRMATION
WOUND CLOSURE
A B
Confirm implant alignment one final time using fluoroscopic imaging
A. Supination
B. Pronation
Repair soft tissues as needed, then close the incision
ALIGN - Radial Head System - Cat.# ALN-RHA-SYS
(Locking Screw Included)
ALN-RHI-180 ∅ 18mm, CoCr
ALN-RHI-200 ∅ 20mm, CoCr
ALN-RHI-220 ∅ 22mm, CoCr
ALN-RHI-240 ∅ 24mm, CoCr
ALN-RHI-260 ∅ 26mm, CoCr
ALN-RHT-180 ALIGN Trial, Radial Head, 18mm
ALN-RHT-200 ALIGN Trial, Radial Head, 20mm
ALN-RHT-220 ALIGN Trial, Radial Head, 22mm
ALN-RHT-240 ALIGN Trial, Radial Head, 24mm
ALN-RHT-260 ALIGN Trial, Radial Head, 26mm
B
A
C
Catalog Number Radial Heads
Catalog Number Radial Stems
Catalog Number Trial Heads
A B C
ALN-RST-0700 7mm x 0mm, Ti 29mm
ALN-RST-0702 7mm x 2mm, Ti 29mm
ALN-RST-0704 7mm x 4mm, Ti 29mm
ALN-RST-0706 7mm x 6mm, Ti 29mm
ALN-RST-0708 7mm x 8mm, Ti 29mm
ALN-RST-0800 8mm x 0mm, Ti 31mm
ALN-RST-0802 8mm x 2mm, Ti 31mm
ALN-RST-0804 8mm x 4mm, Ti 31mm
ALN-RST-0806 8mm x 6mm, Ti 31mm
ALN-RST-0808 8mm x 8mm, Ti 31mm
ALN-RST-0900 9mm x 0mm, Ti 33mm
ALN-RST-0902 9mm x 2mm, Ti 33mm
ALN-RST-0904 9mm x 4mm, Ti 33mm
ALN-RST-0906 9mm x 6mm, Ti 33mm
ALN-RST-0908 9mm x 8mm, Ti 33mm
ALN-RST-1000 10mm x 0mm, Ti 36mm
ALN-RST-1002 10mm x 2mm, Ti 36mm
ALN-RST-1004 10mm x 4mm, Ti 36mm
ALN-RST-1006 10mm x 6mm, Ti 36mm
ALN-RST-1008 10mm x 8mm, Ti 36mm
ALN-RST-1100 11mm x 0mm, Ti 38mm
ALN-RST-1102 11mm x 2mm, Ti 38mm
ALN-RST-1104 11mm x 4mm, Ti 38mm
ALN-RST-1106 11mm x 6mm, Ti 38mm
ALN-RST-1108 11mm x 8mm, Ti 38mm
ALIGN - Radial Head System - Cat.# ALN-RHA-SYS
ALN-RHI-180 ∅ 18mm, CoCr
ALN-RHI-200 ∅ 20mm, CoCr
ALN-RHI-220 ∅ 22mm, CoCr
ALN-RHI-240 ∅ 24mm, CoCr
ALN-RHI-260 ∅ 26mm, CoCr
ALN-RHT-180 ALIGN Trial, Radial Head, 18mm
ALN-RHT-200 ALIGN Trial, Radial Head, 20mm
ALN-RHT-220 ALIGN Trial, Radial Head, 22mm
ALN-RHT-240 ALIGN Trial, Radial Head, 24mm
ALN-RHT-260 ALIGN Trial, Radial Head, 26mm
ALN-RNT-000 ALIGN Trial, Radial Neck, 0.0mm
ALN-RNT-020 ALIGN Trial, Radial Neck, 2.0mm
ALN-RNT-040 ALIGN Trial, Radial Neck, 4.0mm
ALN-RNT-060 ALIGN Trial, Radial Neck, 6.0mm
ALN-RNT-080 ALIGN Trial, Radial Neck, 8.0mm
KWIR-STD-15127 K-Wire, Standard Tip, 1.5mm x 127mm, SS
DRVR-UQC-T20 Driver, Universal QC, T-20
HNDL-UQC-FXD Handle, Universal QC, Fixed
ALN-RHA-TRAY ALIGN Sterilization Tray System
ALN-STT-070 ALIGN Trial, Radial Stem, 7.0mm
ALN-STT-080 ALIGN Trial, Radial Stem, 8.0mm
ALN-STT-090 ALIGN Trial, Radial Stem, 9.0mm
ALN-STT-100 ALIGN Trial, Radial Stem, 10.0mm
ALN-STT-110 ALIGN Trial, Radial Stem, 11.0mm
ALN-RHG-PFA ALIGN, Percutaneous Forearm Axis Jig
ALN-RHG-CRL ALIGN, Captive Rail
ALN-RHG-BHF ALIGN, Bone Holding Foreceps
ALN-RHG-HAT ALIGN, Head Alignment Tool
ALN-RRA-070 ALIGN, Radial Rasp, Stem 7.0mm
ALN-RRA-080 ALIGN, Radial Rasp, Stem 8.0mm
ALN-RRA-090 ALIGN, Radial Rasp, Stem 9.0mm
ALN-RRA-100 ALIGN, Radial Rasp, Stem 10.0mm
ALN-RRA-110 ALIGN, Radial Rasp, Stem 11.0mm
ALN-RPL-070 ALIGN, Radial Planer, Stem 7.0mm
ALN-RPL-080 ALIGN, Radial Planer, Stem 8.0mm
ALN-RPL-090 ALIGN, Radial Planer, Stem 9.0mm
ALN-RPL-100 ALIGN, Radial Planer, Stem 10.0mm
ALN-RPL-110 ALIGN, Radial Planer, Stem 11.0mm
ALN-RHS-SZR ALIGN, Radial Head Sizer
ALN-NGI-000 ALIGN, Neck Gauge & Head Inserter, 0mm
ALN-NGI-020 ALIGN, Neck Gauge & Head Inserter, 2mm
ALN-NGI-040 ALIGN, Neck Gauge & Head Inserter, 4mm
ALN-NGI-060 ALIGN, Neck Gauge & Head Inserter, 6mm
ALN-NGI-080 ALIGN, Neck Gauge & Head Inserter, 8mm
ALN-RST-IMP ALIGN, Impactor, Radial Stem
ALN-RHA-TQH ALIGN, Torque Handle
Catalog Number Trial Necks
Catalog Number Trial Stems
Catalog Number System Instrumentation
Catalog Number General Instrumentation
Catalog Number Sterlization Tray
IndIcatIons General contraIndIcatIons
WarnInGs, PrecautIons and PotentIal adverse effects
The ALIGN™ Radial Head System and accessories are designed specifically for:• Replacement of the radial head for degenerative or post- traumatic disabilities presenting pain, crepitation, and decreased motion at the radio-humeral and/or proximal radio-ulnar joint with: - Joint destruction and/or subluxation - Resistance to conservative treatment• Primary replacement after fracture of the radial head• Symptomatic sequelae after radial head resection• Revisions following failed radial head arthroplasty• The system is intended for press fit use
Warnings• The Head Alignment Tool must be used during the procedure to correctly align the prosthetic head and to provide the necessary counter-torque when tightening the Locking Screw.• The Locking Screw packaged with the Radial Head must be installed and fully tightened to fix the radial head to the Radial Stem. If the Locking Screw is not attached and/or fully secured, the Radial Head may loosen and/or disconnect from the Radial Stem, causing soft tissue irritation and/ or the device failure. • Improper selection, placement, positioning, alignment or fixation of the implanted components may result in unusual stress conditions which may lead to subsequent reduction in the service life of the prosthetic components.• Malalignment of the components or inaccurate implantation can lead to excessive wear and/or failure of the prosthesis or anatomical structures. • The information in this document should be shared with the patient. • The patient should be informed about the importance to follow the post operative rehabilitation to fully understand the possible limitations in normal activities of daily living. The patient must be warned that failure to follow postoperative care instructions may cause the prosthesis or treatment to fail.• Potential ALIGN Radial Head System construct failures such as stress fractures of the bones, loosening of the construct and/ or fixation, delayed fusion, non-fusion, or incomplete healing may occur as a result of non compliance to post operative rehabilitation, excessive wrist activities or construct overloading. • DO NOT reuse any of the ALIGN Radial Head System components. Reuse may compromise the structural integrity of the construct and/or lead to failure which may result in patient injury. • The Torque Handle included in the system requires calibration. DO NOT use if the calibration is overdue. Use of a Torque Handle out of calibration could result in device loosening or failure.
Precautions• The Radial Head with Locking Screw and Radial Stems are supplied sterile using gamma radiation sterilization. DO NOT use if sterile barrier is damaged or if the USE BY date has expired. Any implantable components used with an expired USE BY date will void the product warranty. • The implantable components are for single use only; DO NOT reuse, reprocess or re-sterilize. Reuse, reprocessing or resterilization of the implantable components may: - Compromise the structural integrity of the construct - Lead to failure resulting in patient injury - Create a risk of contamination of the device causing patient infection or cross contamination - Lead to the transmission of infectious disease(s) from one patient to another • Protect the implants against scratching or nicking as such stress concentration may lead to prosthesis failure.• Before using the ALIGN Radial Head System, inspect all prosthesis and instruments for wear, disfiguration and physical damage. If evidence of wear, disfiguration or physical damage is found, DO NOT use and contact your local Skeletal Dynamics representative or the Skeletal Dynamics Customer Care Department.• DO NOT permanently implant the Skeletal Dynamics K-Wires; they are intended to be used for provisional fixation of the ALIGN Radial Head System instrumentation.• The ALIGN Radial Head System has not been evaluated for safety and compatibility in the MR environment; nor has it been tested for heating or migration in the MR environment. • To maintain traceability of the system, record the Lot number for each of the implanted system components.
The ALIGN Radial Head System should not be used if any of the following are present: active or latent infection, sepsis, insufficient quantity or quality of bone and/or soft tissue, material sensitivity, or patients who are unwilling or incapable of following post operative care instructions.
Potential Adverse Events:The following potential risks or discomforts have been associated with radial head arthroplasty: Disassociation, loosening or migration of the prosthesis, infection, erosion of the capitellum, material sensitivity reaction, nerve injuries, undesirable shortening or lengthening of limb, stiffness of the elbow and/or forearm, dislocation and subluxation due to improper positioning, fretting and crevice corrosion can occur at interfaces between the components, wear and deformation of the articular surfaces, intraoperative and postoperative bone fracture and/or postoperative pain and infection.
NOTES:
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© 2011 Skeletal Dynamics, LLC
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