Академический Документы
Профессиональный Документы
Культура Документы
INDEX
Introduction
Indications
Operative Technique
Slipped Capital Femoral Epiphysis
Introduction
3 Incision
4 Guide-Wire Insertion
10
10
7 Pin Insertion
11
Case Report
12
14
2 Incision
14
14
4 Distal Drilling
15
5 Proximal Drilling
15
16
16
17
17
Case Report
18
Pin Removal
19
Ordering Information
20
References
1 Slipped Capital Femoral Epipysis
21
21 & 22
INTRODUCTION
References
1. Hannson L.I. (1982): Osteosynthesis with the Hook-Pin in Slipped Capital
Femoral Epiphysis. Acta Orthop. Scand. 53: 87-96
2. Stromqvist B., Hansson L.I. (1984): Femoral head vitality in femoral neck
fracture after Hook-Pin Internal Fixation. Clin. Orthop. 191: 105-109
3. Stromqvist B., Hansson L.I., Nilsson L.T., and Thorngren K.G. (1987):
Hook-Pin Fixation in femoral neck fractures. A two year follow-up study of 300
cases. Clin. Orthop. 218: 58-62
4. Ceder L., Stromqvist B., Hansson L.I. (1987): Effects of strategy changes in the
treatment of femoral neck fractures during a 17 year period. Clin. Orthop.
218: 53-57
5. Bray T.J., Smith-Hoeffer B., Hooper A., Timmerman L. (1988): The displaced
femoral fracture. Clin. Orthop. 230: 127-140
6. Comprehensive Care of Hip Fractures. Bauer G.C.H., Hansson L.I., Lidgren L.,
Stromqvist B., Thorngren K.G., Scientific Exhibit. A.A.O.S. - Las Vegas 1985.
INDICATIONS
PEDIATRIC:
Slipped Capital
Femoral Epiphysis
ADULT:
Transcervical and
Subcapital Neck
Fractures
Basal Neck
Fractures
SLIPPED CAPITAL
FEMORAL EPIPHYSIS
INTRACAPSULAR
FEMORAL NECK
FRACTURE
site.
post
dist
OPERATIVE TECHNIQUE
SLIPPED CAPITAL
FEMORAL EPIPHYSIS
OPERATIVE TECHNIQUE
SLIPPED CAPITAL FEMORAL EPIPHYSIS
STRONG, STABLE FIXATION
THROUGH A SIMPLE AND
PRECISE PROCEDURE
30-60
Lateral view
OPERATIVE TECHNIQUE
SLIPPED CAPITAL FEMORAL EPIPHYSIS
3 Incision
A 10-20 mm longitudinal subtrochanteric
incision is made and the fascia lata is divided
in the direction of the fibres.
4 Guide-Wire Insertion
The guide wire is inserted through the fascia.
In the AP-view the tip of the guide wire should
be level with the lesser trochanter. In the
lateral view it should be central in relation to
the femoral head and neck. Once the
alignment of the guide wire is satisfactory, it is
advanced to the subchondral bone of the
femoral head.
NOTE
To prevent unintended guide-wire
advancement and penetration in the
surrounding tissue, frequently check
the position of the guide-wire under
image intensification.
OPERATIVE TECHNIQUE
SLIPPED CAPITAL FEMORAL EPIPHYSIS
Inner
Introducer
Outer
Introducer
NOTE
It is important to make sure that the inner
pin is in correct position in the window of
the outer pin prior to insertion.
10
OPERATIVE TECHNIQUE
SLIPPED CAPITAL FEMORAL EPIPHYSIS
7 Pin insertion
A pin of the selected length is introduced in
the drill hole, ensuring that the guide-line on
the outer introducer is pointing superiorly.
When the pin is seen to be in position, the
hook is activated by turning the introducer
handle clockwise as far as it will go. The
introducer assembly and the stabilisation
guide-wire are then removed and the wound is
closed.
NOTE
Bilateral Slipping
In view of the high rate of bilateral slipping,
operation of the contralateral hip is
recommended in cases of slipped capital
femoral epiphysis.1
11
CASE REPORT
SLIPPED CAPITAL FEMORAL EPIPHYSIS
X-RAY CASES
Fig.2
Both sides have been operated in the same
anaesthesia to avoid the high risk of later slipping
also on the unaffected side.
Fig.1
A 15 year old boy with left-sided
Slipped Capital Femoral Epiphysis,
treated with a Hansson Pin
Fig. 4
The physes are closed and the Hansson Pin seem
retracted into the bone. The positioning of the
hook is the same in the femoral head, showing
the elongation of the femoral neck.
Fig.3
View at 3 years, showing attained
size of the femoral neck
12
OPERATIVE TECHNIQUE
FEMORAL NECK
FRACTURES
13
OPERATIVE TECHNIQUE
FEMORAL NECK FRACTURES
STRONG, STABLE FIXATION
THROUGH A SIMPLE AND
PRECISE PROCEDURE
2 Incision
A 10-20mm incision is made and the fascia lata
is divided in the direction of the fibres.
NOTE
To prevent unintended guide-wire
advancement and penetration in the
surrounding tissue, frequently check
the position of the guide-wire under
image intensification.
14
OPERATIVE TECHNIQUE
FEMORAL NECK FRACTURES
4 Distal Drilling
The short cannulated drill is inserted over the
end of the guide-wire. The protective measuring
sleeve is advanced to the lateral cortex and
drilling is carried out, using image intensification
to ensure that the drill follows the line of the
guide-wire accurately and does not cut through
the calcar. It is also important to ensure that the
guide-wire does not penetrate the pelvis. When
the drill is fully advanced in the femoral head,
the required length of pin is read off the scale
on the drill protruding from the sleeve. The
protective measuring sleeve and the guide-wire
are then removed.
NOTE
Make sure that the protective
measuring sleeve is in contact
with the bone.
Direct reading
of the length
5 Proximal Drilling
The next stage is to drill a hole for the proximal
pin as close as possible to the posterior cortex of
the femoral neck. This is achieved by selecting
the drill guide which gives the widest possible
separation of the pins without cutting through
the posterior cortex. The incision is extended 20
to 30mm.
A check can be made, before drilling, to ensure
the correct drill guide has been selected. The
selected drill guide is then pushed over the distal
drill and rotated, in order that the new channel is
situated posteriorly to the distal drill. The sharp
tip of the guide is pushed into the cortex to aid
stability.
15
OPERATIVE TECHNIQUE
FEMORAL NECK FRACTURES
6 Proximal Drilling
Ensuring that the sharp tip of the drill guide is
firmly located against the femoral cortex, the
long solid drill is used to prepare the second
hole, using image intensification in both AP and
lateral views to ensure that the drill does not cut
through the calcar. The hole is drilled up and
into the subchondral bone of the head. The
lateral view alone indicates whether the drill is
advanced sufficiently in the femoral head. The
length of pin required is again read off the scale
on the drill protruding from the drill guide. The
drill and drill guide are then removed.
NOTE
It is important to clean the channel by
running the drill in forward motion as the
drill is removed.
Inner
Introducer
Outer
Introducer
NOTE
It is important to make sure that the inner
pin is in correct position in the window of
the outer pin prior to insertion.
Hansson
Pin
16
OPERATIVE TECHNIQUE
FEMORAL NECK FRACTURES
Guide Line
A-P View
NOTE
Before turning the handle, make sure that the
guide wire has been removed.
M-L View
Post-Operative Care
Full weight-bearing may be allowed from the
first post-operative day as tolerated by the
patient, except in young patients with
displaced fractures: these can be prescribed
a six-week period of nonweight-bearing.
17
CASE REPORT
FEMORAL NECK FRACTURE
X-RAY CASES
Fig.1
Fig.2
Fig.3
Garden IV
Fig.4
Fig.5
hook-pins
hook-pins
18
PIN REMOVAL
A 10-20mm skin incision is made for pin removal.
The end of the pin can be identified manually or
using image intensification. The fibrous tissue
which often surrounds the end of the pin is
incised.
The outer introducer is placed over the extractor
and the extractor is screwed clockwise. Engage the
lugs of the outer introducer into the pin. Continue
to turn the extractor. This withdraws the hook back
into the body of the pin, which can then be
removed.
Occasionally, it may happen that the hook is
removed on its own, leaving behind the body of
the pin. In that case, the body of the pin can be
removed by using the inner introducer.
19
Pin
Length
mm
394070S
394075S
394080S
394085S
394090S
394095S
394100S
394105S
394110S
394115S
394120S
394125S
394130S
394135S
394140S
70mm
75mm
80mm
85mm
90mm
95mm
100mm
105mm
110mm
115mm
120mm
125mm
130mm
135mm
140mm
Special Order
Titanium
Ref
694070S
694075S
694080S
694085S
694090S
694095S
694100S
694105S
694110S
694115S
694120S
694125S
694130S
694135S
694140S
INSTRUMENTS
Ref.No.
Description
704501
704522
704510
704537
704538
704539
704511
Guide-wire Bush
704515
Outer Introducer
704516
Inner Introducer
704517
Introducer Handle
704518
Extractor
704505S
901703
6.7mm x 246mm
20
REFERENCES
Slipped Capital Femoral Epipysis
Clinical Studies:
1.
Osteosynthesis with the Hook-Pin in Slipped Capital Femoral Epiphysis. Hansson L.I. (1982):
Acta Orthop. Scand. 53: 87-96
2.
Epidemiology of Slipped Capital Femoral Epiphysis in Southern Sweden. Hgglund G., Hansson L.I., and Ordeberg G. (1984):
Clinic. Orthop. 191: 82-94
3.
Slipped Capital Femoral Epiphysis in Southern Sweden. Long-term Results after Femoral neck Osteotomy. Hgglund G., Hansson L.I., Ordeberg G., and
Sandstrm S. (1986):
Clinic. Orthop. 210: 152-159
4.
Vitality of the Slipped Capital Femoral Epiphysis. Preoperative evaluation by tetracycline labeling.
Hgglund G., Hansson L.I., and Ordeberg G. (1985):
Acta Orthop. Scand. 56: 215-217
5.
Familial Slipped Capital Femoral Epiphysis. Hgglund G., Hansson L.I., and Sandstrm S. (1986):
Acta Orthop. Scand. 57: 510-512
6.
Slipped Capital Femoral Epiphysis in Southern Sweden. Long-term Results after Nailing/Pinning. Hgglund G., Hansson L.I., and Sandstrm S. (1987):
Clinic. Orthop. 217: 190-200
7.
Bone Growth after Fixing Slipped Femoral Epiphyses: Brief Report. Hgglund G., Bylander B., Hansson L.I., Selvik G. (1988):
J Bone Joint Surg (Br) 70: 845-46
8.
Remodelling After Pinning for Slipped Capital Femoral Epiphysis. Jones J.R., Paterson D.C., Hillier T.M., Foster B.K. (1990):
J Bone Joint Surg (Br) 72: 568-73
Thesis:
1.
2.
REFERENCES
Femoral Neck Fractures
Clinical Studies:
1.
Vitality of the femoral head after femoral neck fracture evaluated by tetracycline labelling.
Strmqvist B, Ceder L, Hansson LI, Thorngren KG
Arch Orthop Trauma Surg 99:1-6, 1981
2.
3.
Scintimetric evaluation of nailed femoral neck fractures with special reference to type of osteosynthesis.
Strmquist B, Hansson LI, Palmer J
Acta Orthop Scand 1983 Jun:54(3):340-7
4.
Femoral head vitality after intracapsular hip fracture, 490 cases studied by intravital tetracycline labelling and Tc-MDP radionuclide imaging.
Strmqvist B
Acta Orthop Scand Suppl 200:1-71,1983
5.
6.
7.
Femoral head vitality in femoral neck fracture after hook-pin internal fixation.
Strmquist B, Hansson LI
Clin Orthop 1984 Dec:(191):105-9
8.
9.
21
REFERENCES
Femoral Neck Fractures (cont.)
10. Hip fracture in rheumatoid arthritis.
Strmqvist B
Acta Orthop Scand 1984 Dec:55(6):624-8
11. External and biopsy determination of peroperative Tc-99m MDP femoral-head labbeling in fracture of the femoral neck.
Strmqvist B, Brismar J, Hansson LI
J Nucl Med 1984 Aug:25(8):854-8
12. Hook-pin fixation in femoral neck fractures. A two-year follow-up study of 300 cases.
Strmqvist B, Hansson LI, Nilsson LT
Clin Orthop 218:58-62, 1987
13. Effects of strategy changes in the treatment of femoral neck fractures during a 17-year period.
Ceder L, Strmqvist B, Hansson LI
Clin Orthop 1987 218:53-7
14. Prognostic precision in postoperative, 99Tc-MDP scintimetry after femoral neck fracture.
Strmqvist B, Hansson LI, Nilsson LT
Acta Orthop Scand 1987 58:494-8
15. Displacement in femoral neck fractures. A numerical analysis of 200 fractures.
Eliasson P, Hansson LI, Krrholm J
Acta Orthop Scand 1988 Aug:59(4):361-426.
16. Treatment of hip fractures in rheumatoid arthritis.
Strmqvist B, Kelly I, Lidgren L
Clin Orthop 1988 Mar:(228):75-8
17. Fixation of fractures of the femoral neck using screws or hook-pins. Radionuclide study and short-term results.
Strmqvist B, Hansson LI, Ross H
Rev Chir Orthop 1988:74(7):609-13
18. Intracapsular pressures in undisplaced fractures of the femoral neck.
Strmquist B, Nilsson LT, Egund N
J Bone Joint Surg:Br: 1988 Mar:70(2):192-4
19. Function after hook-pin fixation of femoral neck fractures. Prospective 2-year follow-up of 191 cases.
Nilsson LT, Strmqvist B, Thorngren KG
Acta Orthop Scand 1989 Oct:60(5):573-8
20. Stability of femoral neck fractures. A postoperative roentgen stereophotogrammetric analysis.
Ragnarsson JI, Hansson LI, Krrholm J
Acta Orthop Scand 1989 Jun:60(3):283-735.
21. Internal fixation of femoral neck fractures in Parkinsons disease. 32 patients followed for 2 years.
Londos E., Nilsson L.T., Strmqvist B.
Acta Orthop Scand 1989; 60(6):682-685
22. Stability of femoral neck fracture. Roentgen stereophotogrammetry of 29 hook-pinned fractures.
Ragnarsson JI, Krrholm J
Acta Orthop Scand 1991; 62(3):201-207.
23. Femoral neck fracture fixation with hook-pins. 2 years results and learning curve in 626 prospective cases.
Strmqvist B., Nilsson L.T., Thorngren K.G.
Acta Orthop Scand 1992; 63(3):282-287
24. Bone mineral content and fixation strength of femoral neck fractures. A cadaver study.
Sjstedt A., Zetterberg C.,Hansson T., Hult E., Elkstrm L.
Acta Orthop Scand 1994; 65(2):161-165
25. Factors Influencing Postoperative Movement in Displaced Femoral Neck Fractures: Evaluation by Conventional Radiography and Stereography.
Ragnarsson J.I., Krrholm J.
Journal of Orthopaedic Trauma 1992; N2: 152-158.
26. Function of the hip after femoral neck fractures treated by fixation or secondary total hip replacement.
Nilsson LT, Franzen H, Strmqvist B, Wiklund I
Int Orthop 1991:(15):315-18
27. The effect of Implant design and bone density on maximum torque and holding power for femoral neck fracture devices.
Eriksson F., Mattsson P., Larsson S.
Annales Chirurgiae et Gynaecologiae 2000; 89: 119-123
28. Treatment of femoral neck fracture with Hansson Pins. A biomechanical study.
Uta S., Inoue Y., Kaneko K., Mogami A., Tobe M., Maeda M., Iwase H., Obayashi O.
Japan Clinical Biomechanics 2000; 21:377-383
29. Quality of life is better after osteosynthesis than after hemioarthroplasty in femoral neck fractures.
Nilsson LT, Jaalovara P, Franzen H, Virkkunen H, Strmqvist B
Submitted.
Thesis:
1.
2.
3.
Femoral neck fracture stability. Evaluation with roentgen stereophotogrammetric analysis, magnetic resonance imaging, scintimetry, radiography and
histopatology.
Jon Ragnarsson, 1991.
22
PIN SYSTEM
The OMEGA PLUS Compression Hip Screw System integrates innovative features
such as sideplate made of superstrong alloy material and improved
instrumentation. OMEGA PLUS Plates and Lag Screws are available in Sterile
or Non-Sterile packaging for customer preference and convenience.
This new generation of Cannulated Screws has been designed to optimise surgical
outcomes while simplifying procedures. The ASNIS III System offers the surgeon a
complete choice of implants, material and packaging combined with a new userfriendly instrumentation.
PIN SYSTEM
This innovative device has been developed for Femoral Neck Fracture and Slipped
Capital Femoral Epiphysis treatments. The Hansson Pin System is a simple and
precise instrumentation combined with a unique implant. This unthreaded pin
with a spreading hook allows a strong and stable fixation through a simple and
short procedure, thus preserving the blood supply and the bone integrity.
DISTRIBUTION:
Stryker Trauma
Selzach AG
Bohnackerweg 1
2545 Selzach
Switzerland
REF NO: THAN0103/022000E
2002 Stryker Corporation. All rights reserved.
0302