Indications

All skeletally mature patients with:

• Midshaft clavicle fractures Type 2A2, 2B1, 2B2 according to the Robinson Classification

• Midshaft clavicle fractures Type 15 A, 15B, 15C according to the OTA classification.

Relative contraindications:

• Non-union or mal-union repair

• Local infection or inflammation

Contra-Indications

• Material sensitivity

• Inadequate local tissue coverage

• Any mental or neuromuscular disorder, which would create an unacceptable risk of fixation

failure or complications in postoperative care.

• Other medical or surgical conditions, which would preclude the potential benefit of surgery.

Detailed procedure

1. Prophylactic antibiotics are given: cephalosporine, e.g. KEFZOL®. (Sterile natriumcefazoline), 2 g i.v.

2. The patient is positioned in beach chair position on a radiolucent table or table which allows for removal of the shoulder/flank part on the ipsilateral side. (in case the table only allows for removal of the shoulder part it may cause inability to properly use the fluoroscopy in two directions which may lead to opening the skin over the fracture to reduce the fracture and advance the Anser Clavicle Pin)

3. Identification and marking of the anatomic landmarks. Clavicle, AC joint, scapular spine, posterior conoid tubercle, acromion.

4. Positioning of the fluoroscopy.

5. Determine and mark the entry position and exact location for skin incision: Palpate the trapezoid muscle and posterior side of the distal clavicle at the location of the posterior conoid tubercle. The skin incision should be made at the level of the AC joint progressing medially in order to create enough room for the approach of the Anser Clavicle pin.

6. Desinfection and sterile draping.

7. Make a 2-3cm incision of the skin and subcutis at the previously determined position. Make the incision of the subcute aiming medially towards the posterior conoid tubercle. Do not open the AC joint. Palpate the posterior conoid tubercle and the fascia of the trapezoid muscle.

8. Open the fascia to have direct access to the posterior conoid tubercle.

9. Place small rasparatorium or a small Hohmann retractor caudal of the posterior conoid tubercle to identify the caudal border and direction of the medullar canal of the lateral fragment.

10. Use the 4mm spiral drill with tissue-protector to open the cortex into the medullary canal of the lateral fracture element. Make sure the opening is done in the middle or slightly under the equator of the posterior conoid tubercle. Start perpendicular to the primary cortex and slowly angle the drill in the direction of the medullary canal.

11. Remove the drill but keep the tissue-protector in place in order to adequately maintain position and direction at the entrypoint.

12. Drive the flexible Anser Clavicle Pin into the lateral fracture element.
13. Check position of the Anser Clavicle Pin using fluoroscopy in two planes.

14. Advance the Anser Clavicle Pin until the fracture site.

15. Reposition the fracture elements and align them percutaneously using the reduction clamps and reduction manoeuvres. If not possible make an accessory 2-3 cm incision over the fracture site.

WARNING: Do not use the Anser Clavicle Pin as a lever or “joystick” during reduction. It may deform or break.

16. Slowly drive the Anser Clavicle Pin into medial bone fragment in an oscillating fashion to prevent damage to the soft tissues around the fracture site.

17. Check the position of the Anser Clavicle Pin by using fluoroscopy in two planes.

18. If closed reduction fails make a small incision over the fracture site and slowly drive the Anser Clavicle Pin into medial bone fragment under visual control. (Tip: identify both sides of the fracture and manipulate the Anser Clavicle Pin against the cranial cortex of the medial

fragment using the small rasparatorium)

19. Manually drive the cClavicle Pin towards the SC joint using the manual base pindriver until good grip is acquired.

Pre-caution: While inserting the medial fixation make sure to keep pushing the pin forward in order to avoid destruction of the self-tapped thread.

20. Check the position of the base pin by using fluoroscopy in two planes.

21. Prepare the lateral fragment for the Anser Lateral Fixation Device using the Anser Tap. This ensures that a functional thread is created that facilitates proper placement of the Anser Lateral Fixation Device. (Sometimes a bit of pressure needs to be asserted in order to start the tap since it approaches at an angle)

Pre-caution: While tapping make sure to keep pushing the Anser Tap forward in order to avoid destruction of the tapped thread.

22. Insert the Anser Lateral Fixation Device over the Anser Clavicle Pin using the Anser Lateral Fixation Device Inserter. Ascertain the Anser Lateral Fixation Device has positioned itself in one of the indentations of the Anser Clavicle Pin. (If this is not the case it is not possible to place the Anser End Cap; Clean and/or manipulate either the Anser Clavicle

Pin or Anser Lateral Fixation Device to position the Anser Lateral Fixation Device in one of the indentations on the Anser Clavicle pin).A black engraved marker on the Anser Lateral Fixation Device Inserter indicates where the distal end of the Anser End Cap will be located in relation to the Anser Lateral Fixation Device. The marker may be used to identify the part of Anser End Cap that is extracortical.

 

 

 

 

 

23. Check the reposition of the fracture elements and when ascertained of the correct position place the Anser endcap.

24. Advance the Anser endcap until a click is felt and/or heard. (When the Anser lateral fixation device is placed relatively deep into the lateral cortex, the Anser endcap inserter may be blocked by the cortex. When this is the case advance the Anser endcap as much as possible and then simply push the Anser endcap in position using forceps)

 

Warning: The Anser endcap should be placed smoothly over the Anser lateral fixation device. If this does not happen there may be debris interfering or the Anser lateral fixation device has NOT positioned itself in one of the indentations of the Anser Clavicle Pin. Clean and/or manipulate either the Anser Clavicle Pin or Anser lateral fixation device to position the Anser lateral fixation device in one of the indentations on the Anser Clavicle pin. Do not push with force. This may deform or damage the Anser lateral fixation device.

25. Placing the Anser endcap secures the repositioned fracture elements and the appropriate length. To prevent friction and loss of reduction the lateral fixation and Anser encap can freely rotate along the Answer Clavicle Pin.

26. Cut the Anser Clavicle Pin just above the endcap using the Anser Clavicle Pin cutter.

27. Wash out the surgical field and close the wound(s).

28. Obtain images of the Anser Clavicle Pin in two directions.

Anser Clavicle Pin removal

Detailed procedure

1. The patient is positioned in beach chair position.

2. Prophylactic antibiotics are given: cephalosporine, e.g. KEFZOL®. (Sterile natriumcefazoline), 2 g i.v.

3. Identification and marking of the anatomic landmarks and scar.

4. Desinfection and sterile draping.

5. Excise the scar and incise the subcute.

6. Identify the Anser endcap and remove using pliers or forceps.

7. Use the Anser lateral fixation inserter to remove the Anser lateral fixation device.

8. Use pliers or a pindriver to remove the Anser Clavicle Pin.

9. Wash out the surgical field and close the wound.

WRONG

CORRECT

Surgical Technique
Research & Resources

Results of Research

Implant Brochure

Patient Information

CE Approval

FDA Approval

Patents

Patient Experiences

© 2019 Anser Implants | All Rights Reserved | Privacy | Terms of Use