S3Ã¢Â„Â¢ Proximal Humerus Plating System Surgical Technique - Biomet

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Surgical Technique Surgical Technique Step 7: Fracture Debridement • Debride the fracture Step 10: Apply Bone Graft • To facilitate healing, bone graft should be considered Step 8: Fracture Reduction • After debridement, the fracture is reduced by traction and indirect manipulation Tips: remove the Mayo table to facilitate reduction. Step 11: Determine the Proper Plate Position • Select the appropriate side plate (left or right) • Choose the appropriate length (3,4,6,8,11 or 14 hole) • Fix the shaft of the plate using a 3.8 mm cortical screw through the slotted hole Tips: If using prepacked sterile implants, S3 trial templates can be used to confirm the required plate size. Apply the plate 2 cm to 2.5 cm distal to the insertion of the supraspinatus, the anterior border of the plate should be immediately lateral to the bicipital groove. Step 9: Tuberosity Repair • In the case of severe comminution, suturing the rotator cuff together will help reduce the tuberosities After plate positioning a 2.0 mm guide wire will need to be loaded in the wire driver. Step 12: Drill Central Guide Wire • Drill the 2.0 mm guide wire through the central hole on the proximal portion of the plate. Advance slowly and verify its trajectory under fluoroscopy 6 7
Surgical Technique Surgical Technique Step 13: Verify Central Guide Wire Placement • Place the guide wire in the centre of the humeral head • This plate position will reduce the risk of subacromial impingement Step 15: Manually Drill for Subchondral Support Pegs • With the 4.0 mm drill attached to the driver handle, advance the drill, through the drill guide until resistance from subchondral bone is felt • This will ensure that the peg engages subchondral bone for optimal fixation Tips: when drilling for smooth pegs use FDB40L (Drill Bit Fast 4.0 mm Long). When drilling for partially threaded pegs use FDS40 (Drill Bit Fast 4.0 mm Step). Step 14: Drill Cortex Through F.A.S.T. Guide • Using the short 4.0mm drill (FDB40S), drill through the F.A.S.T. Guide and perforate the cortex • This drill has a stop that will only allow it to penetrate the near cortex • If re-drilling is required after F.A.S.T. Guide removal, thread the drill guide (DRGSH) into the desired peg hole and drill on power using DB40S (Drill Bit Short 4.0 mm) Tips: bending the central guide wire and rotating it out of the way will ease the attachment of the drill guide to the plate. Other K-Wire holes can be used to provisionally fix the plate to the bone. Step 16: Verify Drill Depth • Once resistance is felt, fluoro imaging should verify that the tip of the manual drill is close to subchondral bone • Care should be taken not to penetrate subchondral bone Tips: the depth gauges have a bias built in that will reduce the measured depth by 2.5 mm. If peg to subchondral bone contact is desired, add 2.5 mm to the depth gauge. Depths can be Gauged from the manual drill or the sleeveless depth gauge. Both can be read through either the F.A.S.T. Guide or through the drill guide, using the appropriate calibrated scale. 8 9
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Page 3: Surgical Technique Surgical Techniq
Page 7 and 8: Peg and Screw Options S 3 Proximal

S3Ã¢Â„Â¢ Proximal Humerus Plating System Surgical Technique - Biomet

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