Pinless Fixator - Royal Children's Hospital · The Pinless Fixator allows immediate stabilization and reduction of tibial ... ALDO M. BERGONZI Importaciones Asunción Tel. +595 21

Original Instruments and Implants of theAssociation for the Study of Internal Fixation –AO/ASIF

Pinless Fixator

Immediate conversionto intramedullary nailing with

Pinless Fixator in place

External Fixationwithout

Invading theMedullary Canal

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Pinless Fixator

The Pinless Fixator allows immediate stabilization and reduction of tibialfractures associated with a critical local or general situation. It does nottransfix the bone and therefore avoids contamination of the medullary canal.

The clips of the Pinless Fixator are compatiblewith the standard AO/ASIF tubular systemcomponents.

Asymmetric, designed especially foroblique placement in the mid-shaft ofthe tibia, without damaging the lateralmuscle compartment.

Large, for transverse placement on theproximal tibia and in areas of softtissue swelling.

Small, for transverse placement in thedistal tibia and the proximal tibia ofsmall patients.

Pinless Fixation – an outstanding system

AsymmetricLarge

Forked tip foranterior tibial crest

The Pinless Clips are available in 3 sizes toaccommodate anatomic variations:

Small

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Intact medullary canal

The Pinless Fixator stabilizes the fracture withoutinvading the medullary canal. In contrast toconventional external fixation the pinless clipspenetrate only the outer cortex to a maximumdepth of 3 mm, thereby eliminating the risk ofinfection entering the medullary canal over thepin tract.

Immediate conversion to nailing possible

Due to the intact medullary canal the Pinless Fixator permitsimmediate conversion to nailing as soon as the local orgeneral situation allows. While staying in place during theoperation it maintains reduction and length during insertionof the nail.

Fast application

The Pinless Fixator can be applied quickly in the operatingtheatre or emergency room. The number of instruments iskept to an absolute minimum: a handle and a combinationwrench.

3 mm

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Pinless Fixator

The Pinless Fixator is a clinically-proven treatment alterna-tive to conventional external fixation. It can be used quicklyand safely in emergency situations, when the definitivetreatment approach cannot be immediately determined dueto soft tissue concerns or when operative time is limited.It is designed for nonweight-bearing, interim stabilizationof:• Tibial fractures with severe soft tissue injury• Tibial fractures in polytrauma patients• Internally fixed tibial fractures requiring additional

stabilization• Intra-operative reduction/distraction during intramedullary

nailing.• Lower limb traction.

Indications

Tibial shaft fracture of apolytrauma patient withsevere cranio-cerebraltrauma.

Initial stabilization withPinless Fixator.

Change to intramedullarynailing after 5 days.

Intra-operative X-raycontrol.

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55-year-old patient withclosed tibial fracture withsevere soft tissue damage.

Displaced malleolar fracture type B.

Calcaneus traction of 4 kg until internal fixation is possible.

Correction with PinlessFixator.

Removal of Pinless Fixatorafter 6 weeks.

Primary stabilization withintramedullary nailing –Subsequent valgus falseposition.

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Pinless Fixator

For maximum frame stability,always select the smallest avail-able clip that will accommodatethe anatomy.

Always use a minimum of 4 clips (2 ineach main fragment). Place the clipsfreely according to the soft tissuesituation, but under consideration ofthe safe corridor.

The application of the Pinless Fixatorcan be divided into three main steps:

1. Application of the Clips

2. Assembling the Frame

3. Reduction and Fixation

b.Snap the handle pair onto the clip asshown. Tighten the knurled knob tosecure the handle to the clip.

1. Applicationof the Clips

a.Select the first symmetric clip.

Open the hinge nut with theCombination Wrench No. 321.16.

c.Make two generous skin incisions atthe desired locations for the trocartips. Orient the incisions in theexpected plane of correction so thatthe fracture may be manipulatedeasier after frame assembly. Be carefulwhen applying the clip: excessiveanterior positioning may cause thetrocar to slip on the anteromedialcortical surface of the tibia.Pass the trocar tips through theincisions, and place the tips onto thebone.

Surgical Technique

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d.Lightly squeeze the handle together,and “rock” the clip along the axis, ina 45° arc. This rocking motion “drills”the tips into the cortex. Continuerocking until the tips are well seatedin the cortical bone.This rocking motion is critical, as thepull-out resistance of the clip nearlydoubles when the clips are rocked.

Note: If the tips slip, open the clipand reposition the tips.

e.Once the clip is secured in the bone,the Handle with Ratchet Lock may beengaged to relieve hand pressure andfree the surgeon to continue with theprocedure (see fig. on the far right).If the Handle without Ratchet Lock isused, maintain grip on the handle andfully tighten the hinge nut, firstmanually, then with the CombinationWrench (see fig. on the near right).Pull up on the handles to test fixation.

f.Detach the handles from the clip byopening them slightly to relievetension, then turn the knurled knobcounterclockwise. Remove the handlepair. Until the frame is assembled, theclips may “flop” as shown.

45°

1200

1000

800

600

400

200

0 0 2 4 6 8 10 12 14 16 18 20

Pull-out Force vs.Number of Rocking Motions

Number of Rocking Motions

Pull-

ou

t Fo

rce

(N)

Small ClipLarge Clip

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Pinless Fixator

2. Assembling the Framea.Loosely place the fixation posts. Each fixation post rotates360°, which permits fracture reduction after frameassembly. Align the fixation posts so they will accommodatea single, straight bar, and finger-tighten the post nuts inthis position.

g.Place the additional clips on the bone in the same manner.Put at least two clips on each fragment, spreading themapart from each other to increase stability.

Place the clips according to the safe corridor known fromconventional external fixation (see AO/ASIF Manual ofInternal Fixation, pages 376/377).

Use the asymmetric clips in the diaphyseal area to avoidpenetration of the anterior tibialis, gastrocnemius, andsoleus muscles. It is important to place the single tip first.Incise the skin transversely and retract the soft tissue so thatthe posteromedial crest can be directly palpated andvisualized. Slide the tip between the gastrocnemius andbone, and place it just posterior to the posteromedial crest.Close the clip so that the forked tip passes through ananterior incision and sits on the anterior crest. Compressthe handles and firmly tighten the hinge nut.

Note: It is not advisable to “rock” the asymmetric clip, butit may be necessary to “wiggle” it slightly to ensurefixation.

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b.Assemble one clamp onto each fixation post, aligning allthe rod vices. Fixation posts and clamps should only befinger-tightened to allow for fracture reduction.Insert a Carbon Fibre Rod or Stainless Steel Tube11.0 mm dia. through the clamps.

3. Reduction and Fixation

Perform initial reduction of the fracture.The fixation posts and clamps can be loosened for easierfracture reduction. Do not loosen the hinge nut. Looseningthe nut will cause the clip to open.Perform final reduction and firmly tighten all nuts with theCombination Wrench 11 mm.

Use only one bar on all clips. The use of a second bar on allclips can cause malalignment and/or clip slippage.

Note: If you intend to change to nailing later on, take intoaccount the entry point of the nail, when positioning thetube or carbon fibre rod.

WarningThis description is not sufficient for immediateapplication of the instrumentation. Instruction by asurgeon experienced in handling this instrumentationis highly recommended.

Subject to alteration.

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Pinless Fixator

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Manufacturer:STRATEC MedicalEimattstrasse 3 CH-4436 Oberdorf

EU authorized representative:SYNTHES GmbH & Co. KGIm Kirchenhürstle 4–6 D-79224 Umkirch

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