Stryker Hansson Pin System Bedienungsanleitung

•Slipped Capital Femoral Epiphysis

Operative Technique

Hansson™Pin System

Pediatrics

Contents

Introduction and Rationale 3

Relative Indications & Contraindications 4

Features & Beneﬁts 5

Operative Technique

Patient Positioning 6

Reduction 7

Optional Stabilization Guide Wire Insertion 8

Determining the Incision and Insertion Points 9

Skin Incision and Guide Wire Insertion 10

Drilling and Measurement 11

Instrument-to-Pin Assembly 12

Insertion of the Hansson Pin 13

and Activation of the Hook

Instrument Removal 14

Postoperative Regime 15

Pin Removal 16

Ordering Information

Implants 17

Instruments 18

References 19

Introduction

The Hansson™ Pin system, designed

by Professor Lars Ingvar Hansson at

the University of Lund in Sweden,

was developed based on research

concerning the effects of implants on

the blood supply to the femoral head.

Speciﬁcally developed for the

treatment of slipped capital femoral

epiphysis, the Hansson Pin system has

been designed to minimise surgical

trauma to the patient and offer secure,

stable ﬁxation with reduced risk of

healing complications for all grades

of fracture.

Twenty years of successful clinical

studies have been carried out to

enhance the Hansson™ Pin System

to its current form.

This work is summarized in 6 theses

and more than 70 published articles.

Rationale

The methodology involves a cylindrical

pin inserted in a drill hole which

attaches to the femoral head via a hook,

providing strong, stable ﬁxation

through a simple and precise procedure.

The drill hole and pin run at right

angles to the growth zone and are,

depending on the degree of slipping,

relatively centrally located in the

femoral neck and head.

The pin is 10-20mm longer than the

drillhole toallow continued growth

in the length of the femoral neck.

Slips of up to 60° can be stabilised

byosteosynthesis.

Relative Indications & Contraindications

Slipped Capital

Femoral Epiphysis

Adult Femoral Neck Fractures

The physician’s education, training and

professional judgement must be relied

upon to choose the most appropriate

device and treatment.

Conditions presenting an increased

risk of implant failure include:

•Any active or suspected latent

infection or marked local

inﬂammation in or about the

affected area.

•Compromised vascularity that would

inhibit adequate blood supply to the

fracture or the operative site.

•Bone stock compromised by disease,

infection or prior implantation that

can not provide adequate support

and/or ﬁxation of the devices.

•Material sensitivity, documented

or suspected.

•Obesity. An obese patient can

produce loads on the implant that

can lead to failure of the ﬁxation of

the deviceor to failure of the device

itself.

•Patients having inadequate tissue

coverage over the operative site.

•Implant utilization that would

interfere with anatomical structures

or physiological performance.

•Anymental or neuromuscular

disorder which would create an

unacceptable risk of ﬁxation failure or

complications in postoperative care.

•Othermedical orsurgical conditions

which would preclude the potential

beneﬁt of surgery.

Detailed information is included in the

instructions for use being provided

with each implant.

See package insert for a complete list

ofpotential adverse effects and

contraindications. The surgeon must

discuss all relevant risks, including the

service life of the device and the need

for postoperative protection of the

implant with the child’s parents,

when necessary.

Relative Contraindications

Contraindications

Indications

Due toalackof any supportive

clinical experience, the Hansson Pin

is not recommended for use with

paediatric hip fractures.

Features & Beneﬁts

Preventing diastasis and further

displacement of the epiphysis

The risk of further intraoperative

displacement of the femoral head is

reduced by drilling a channel for the

Hansson Pin with the femoral head

ﬁxed with kirschner wires. The smooth

outer pin allows the surgeon to gently

push the implant through the channel,

reducing the risk of diastasis between

the femoral neck and the head.1

Lasting stable ﬁxation

The hook resists loosening of the

ﬁxation to the femoral head as the

longitudinal growth of the femoral

neck retracts the pin in the channel

thereby stabilizing the femoral head.

Loosening of the implant is potentially

reduced because of resorption and

growth of the femoral neck under

normal conditions.1

Reducing the risk of unequal

bone length

The continued growth of the femoral

neck in cases with Slipped Capital

Femoral Epiphysis is an indication

of undisturbed intra- and postoperative

vascularization, as the nutrition for the

proliferating cells of the growth plate

is provided by the epiphysial vessels.

By preserving the blood supply,

the Hansson Pin System reduces

the risk of unequal bone length.1

Easy extraction

The risk of the pin being trapped in

the bone is reduced as the pin surface

is smooth. The hook is easily

withdrawn back into the body of the

pin, which can then be removed.1

Frontal view Lateral view

Slipped Capital

Femoral Epiphysis

Operative Technique

Step 1 - Patient Positioning

Correct positioning of the patient

on the fracture table is essential for

avoiding problems and complications

during surgery (Fig. 1).

Place the patient in supine position

on the fracture table.

Healthy side: Position the leg on the

healthy side with the hip in ﬂexion

and slight abduction so that the C-arm

can be adjusted intra-operatively for

both the anterior/posterior and the

lateral/medial views. This is necessary to

obtain a true lateral view of the femoral

neck and head (Fig. 2). The purpose of

this view is to avoid the penetration of

the end of the pin through the surface

of the femoral head.

Furthermore, again for avoiding pin

penetration, the surface of the femoral

head must beseen continuously when

moving the C–armfromthe horizontal

position to the vertical position.

Slipped side: Position the hip in full

extension with neutral position

between abduction and adduction.

Fig. 1–Position Patient; C-Arm in A/P View

Fig.2–Position Patient; C-Arm in L/M View

Operative Technique

Step 2 - Reduction

Apply the surgical boot to the foot.

Mild traction is applied for the sole

purpose of maintaining the leg in the

horizontal plane. Additional support

under the thigh may be necessary.

Rotate the foot internally by 30-60°

and ﬁx in position. This is so that the

femoral neck is parallel to the radiation

beam in the lateral view (Fig. 3).

Stable (Chronic) Slips

Eighty to ninety percent of slips are

stable (or chronic).

Stable slips are always pinned in situ.

Any attempt to perform a closed

reduction on a chronic slip may lead

to avascular necrosis.

Gradual bone remodelling has taken

placeas a response to the insidious

slipping of the femur away from

the femoral head. (Fig. 4) This is

the body's natural attempt to adapt

the geometry of the proximal femur

in ordertomaintain a functional hip

joint. The remodelling is therefore

ossiﬁedand reductionis not possible.

The stable slip is pinned with the

intention of preventing further

slippage, as well as preventing the

possibility of acute-on-chronic

traumatic changes, which could be

devastating for the vascularization

of the femoral head.

The surgical treatment of a stable slip

can therefore be planned in advance

but must be considered urgent.

Fig. 3 – Internal Rotation of the Hip

Fig. 4 – Bone Remodelling

30- 60°

Unstable (Acute) Slips

Unstable slips (where the event is

recent, the child cannot weight-bear

and the threat of avascular necrosis

of the femoral head is an immediate

danger) must be pinned without delay

from the moment of the patient's

arrival in the clinic.

This is an emergency situation.

Some chronic remodelling may be

noted on X-ray and again, this ossiﬁed

modiﬁcation of the hip joint cannot be

reduced in surgery.

The acute or unstable portion of the

slip is treated with closed reduction

byinternal rotation and then pinned.

The chronic portion is left as it is.

Step 3 – Stabilization Guide

Wire Insertion

When treating unstable (acute)

slips

aGuide Wire may be used.

Using biplanar ﬂoroscopy, it is inserted

percutaneously in the trochanteric

region into the femoral neck and

head for intraoperative stabilization.

(Fig. 5).

Fig.5

Operative Technique

Step 4 – Determining the Incision

Point and Implant Position

Slipping of the femoral head occurs

in a true posterior direction.

The Hansson Pin must be positioned

in the central part of the femoral head.

To achieve this, the pin must be

inserted anterior-laterally in the

greater trochanter and then directed

posteriorly (Fig. 6).

Aprerequisite for being able to

correctly position the Hansson Pin

is to insert a Ø2.4mm Guide Wire

prior to drilling.

Guide Wire Insertion Point –

Anterior/Posterior View:

Position a Guide Wire on the skin

of the anterior aspect of the thigh.

Verify by anterior/posterior

ﬂuoroscopy that the Guide Wire

is in the correct position in the central

part of the femoral neck and head

(Fig. 7). Mark the position of the

Guide Wire on the anterior surface

of the thigh.

Lateral/Medial View:

Now position the Guide Wire over the

skin onthe lateral aspect of the thigh.

Verify by lateral/medial ﬂuoroscopy that

the Guide Wire has been positioned to

enter posteriorly towards the central

part of the femoral head (Fig. 8)

Mark the position of the Guide Wire

onthe lateral aspect of the thigh.

The intersection of these two lines at

the anterior-lateral aspect of the thigh

at the level of the lesser trochanter

represents the optimal point for

percutaneous insertion of the Guide

Wire (Fig. 9).

Fig. 6 – Final Implant Position to Achieve Fig. 8 – L/M X-Ray of Guide Wire over skin

Fig. 7 – A/P X-Ray of Guide Wire over skin

Fig. 9 – Incision and Guide Wire Insertion Point

Operative Technique

Step 5 – Skin Incision and Guide

Wire Insertion

Make a 20mm incision at the site

where the two lines on the thigh

intersect. The insertion point on the

anterior-lateral face of the proximal

femur is identiﬁed at the level of the

lesser trochanter (Fig. 10).

If harder cortical bone is anticipated

(such as with a child being treated

with chemotherapy), the surgeon may

prefer to pre-drill the cortex with the

optional drill.

Insert the Guide Wire over the Guide

Wire Bush and Drill Sleeve. Using a

power drill, begin insertion from the

anterio-lateral cortex, crossing the

epiphysis and targeting the center of

the femoral head. According to the

severity of the slip, the guide wire will

bein an oblique positionin the

femoral neck.

Use frequent biplanar ﬂuoroscopic

control to verify the alignment of

the GuideWire in both the anterior/

posterior and lateral/medial plane.

This is to ensure that the centre of the

femoral head will be reached.

If the direction of the Guide Wire

appears to deviate from the centre

ofthe femoral head, stop the

procedure, remove the Guide Wire,

and recommence until correct

positioning of the Guide Wire is

obtained (Fig. 11). Advance to within

5mm of the subchondral bone to

anticipate the necessary space for the

hook to be extruded.

Remove the Guide Wire Bush.

Fig. 10 – Skin Incision

Operative Technique

Fig. 11 – Guide Wire Insertion Final Implant Position toAchieve

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