Implants trauma Pilon Locking Plates System

All ITS plates are preformed anatomically as a matter of principle. If adjustment of the plate to the shape of the bone is required, this is possible by carefully bending gently in one direction once. Particular care is required when bending in the region of a plate hole, as deformation of the plate may lead to a failure of the locking mechanism. The plate must not be buckled or bent several times. This is particularly important in the case of titanium implants, to prevent material fatigue and subsequent failure. The method of bending is the conscious responsibility of the operating doctor; I.T.S....

1. Introduction P. 5 Preface P. 6 Screws P. 7 Properties P. 8 Indications & Contraindications P. 8 Time of operation 2. Surgical Technique P. 10 Pre-operative patient preparation P. 10 Access P. 11 Reduction P. 12 Placement of the screws P. 15 Postoperative treatment P. 15 Explantation 3. Information P. 17 Locking P. 17 Dotize® P. 18 Order list P. 20 Reconditioning Manual P. 22 Notes

Preface Pilon Locking Plate is a proven osteosynthesis system for various fractures of the pilon. The special feature of this implant is the free choice of screw placement. The user is able to set any desired screw in any hole, either locking or non-locking screw. The free choice of screw angulation (+/- 15°, see page 17) provides an advantage in fracture treatment, especially in the case of complex fractures.

Cortical Screw, Locking, D=3.5mm, SH Spiral Drill, D=2.7mm, L=IOOmm,AO Connector self-holding sleeve ^^^^^^^HfiMAfl^yUai. 61273-100 Spiral Drill, D=2.7mm, L=l00mm, AO Connector self-holding sleeve 37422-xx-N Cancellous Screw, locking, D=4.2mm, SH 61253-180 Spiral Drill, D=2.5mm, L=l80mm, AO Connector self-holding sleeve

Properties Properties of the implant: • Plate material: Titanium • Material of screws: TiAl6V4 ELI • Easier removal of the implant after the fracture has healed • Improved fatigue strength of the implant • Reduced risk of cold welding • Reduced risk of inflammation and allergy • Multi-directional Locking • Anatomically shaped • 5 resp. 6 distal plate holes for fixation close to joint • Pointed proximal plate end for percutaneous insertion Pilon Plate small: Pilon Plate: • 5 distal plate holes for optimal fixation close to joint • Lengths: 4, 6, 8-hole • Strength: 2.5mm • 6 distal plate holes...

Indications, Contraindications & Time of operation Indications: • Fractures of the tibial pilon of AO classification A3, especially groups C2 and C3 Existing infections in the fracture zone and operation area Common situations that do not allow osteosynthesis With advanced osteoporosis In cases of skin and soft tissue problems that prevent a tension-free skin closure Obesity Lack of patient compliance Time of operation: • Primarily in the first hours after trauma • Secondarily after swelling has subsided. Intermediate fixation by means of a external fixator or by means of extension.

Surgical Technique

Pre-operative patient preparation • General anaesthesia, local anaesthesia or combination can be used • The patient is in the supine position with the leg raised slightly on a pedestal • Application of a tourniquet Access Medial Access: • Skin incision is made via the inner side of the ankle • The incision should be made 1-2cm away from the fracture so that the suture is not directly over the plate. • If necessary, the flexor retinaculum (laciniate ligament) can be severed. • Remove the tendon of the tibialis posterior muscle and the flexor tendons from their compartments and hold aside in the...

Reduction • Temporary fixation of the plate to the pilon using guide wires • Anatomical reduction of the articular block and fracture segments to the plate (varus/valgus, ante-/retroversion)a • Subsequent control under fluoroscopy Optionally, the plate can be stabilized using the ITS. Temporary Plate Holder (58164-150).

Placement of the screws With the spiral drill, D=2.7mm, L=100mm, AO Connector (61273-100), drill through the drill guide, D=2.7/2.0mm (62202) into a proximal plate hole. Determine appropriate length using the depth gauge, solid small fragment screws (59022). Insert the D=3.5mm cortical screw (32351-XX) with the screwdriver, WS 2.5, self-holding sleeve (56252).

Then using the spiral drill, D=2.5mm, L=100mm, AO Connector (61253-100) to drill through the drill guide, D=2.7/2.0mm (62202) into a distal plate hole. Determine appropriate length using the depth gauge, solid small fragment screws (59022). Insert the D=4.2mm locking cancellous screw (37422-XX-N) with the screwdriver, WS 2.5, self-holding sleeve (56252).

The remaining plate holes are then filled, with either locking or non-locking screws. Subsequent control of plate position under fluoroscopy. Pilon Plate Pilon Plate small

Postoperative treatment • Keep leg raised for 2 to 5 days and take decongestant actions • Physical therapy immediately following surgery (no immobilization required) • Partial toe touch weight-bearing - at week 6-8 (depends on wound healing): 10-15kg • Full weight-bearing - after about 3 months (depends on consolidation of the joint) • When a locking screw connection has been used, it is necessary to be aware that a diagnosis of non-union may be very delayed. Explantation If desired by the patient, the implant can be removed. Removal should be performed at the earliest 6 months - 1 1/2 years...

Locking Locking works because: • Screw material (TiAlV) is slightly harder than plate material (Titanium Grade 2) • Screw head forms thread into the plate (no cutting) ± 15° and Locking No pre threading No cold welding No debris You can re-set the screw up to 3 times Dotize® Chemical process - anodization in a strong alkaline solution* Dotize Type II anodization • Layer thickness 2000-10 000nm + Film becomes an interstitial part of the titanium + Different colors - Implant surface remains sensitive to: Chipping Peeling Discoloration - No visible cosmetic effect Dotize® Type - II Anodization Type...