Ascension® Silicone MCP

3/8/06 9:30 AM
Page 2
Ascension Silicone MCP
®
surgical technique
®
surgical technique
Ascension Silicone MCP
SMCP_SrgTchWW-C_Cover
ASCENSION ORTHOPEDICS, INC.
8700 CAMERON ROAD, SUITE 100
AUSTIN, TEXAS, USA 78754
512.836.5001 512.836.6933 fax
CUSTOMER SERVICE: 877.370.5001 (toll-free in U.S.)
[email protected]
www.ascensionortho.com
Caution: U.S. federal law restricts this device
to sale by or on the order of a physician.
© 2006
LC-04-507-001 rev C
WW
WW
Introduction
FIGURE 1A –
Ascension® Silicone MCP
This manual describes the sequence of techniques
and instruments used to implant the Ascension®
Silicone MCP (FIGURE 1A ). Successful use of this
prosthesis depends on proper patient selection,
surgical technique, and post-operative therapy.
Step One:
Joint Exposure
For multiple joint involvement:
A curving transverse incision across the dorsum
of the MCPs is recommended (FIGURE 2 ).
Ascension
Silicone MCP
Standard AP, lateral and oblique x-rays should be
used to template the size of the prosthesis likely to
be required at surgery.
SIZE
CATALOG NUMBER
10
SMCP-500-10
20
SMCP-500-20
30
SMCP-500-30
40
SMCP-500-40
50
SMCP-500-50
Cut the extensor hood on the radial side of the
central tendon or through its center if no dislocation/
subluxation of the tendon is present. Dissect the
extensor tendon free from the joint capsule radially
and ulnarly. This may not be possible in advanced
disease. Split the capsule longitudinally and dissect it
to expose the joint, preserving the capsule as much
as possible for later repair. The dissection should be
continued so that the dorsal base of the proximal
phalanx and the metacarpal head with the collateral
ligament origins are visible.
FIGURE 3: METACARPAL PUNCTURE
Step Two:
FIGURE 4: CANAL ALIGNMENT
Use the starter awl to make the initial puncture of
the metacarpal head (FIGURE 3 ). This puncture
should be placed volar to the dorsal surface of the
metacarpal head a distance 1/3 the sagittal height
of the head (FIGURE 4 ) and centered across the
width of the head. The resulting puncture should
be aligned with the long axis of the metacarpal
medullary canal.
Ascension Silicone MCP
Step Three:
Establishing Metacarpal
Medullary Canal Alignment
Attach the alignment guide to the alignment awl,
insert the alignment awl into the puncture (FIGURE 5 ),
and advance it 1/2 to 2/3 the length of the metacarpal
(FIGURE 6 ). The alignment guide should be parallel to
the dorsal surface of the metacarpal and in line with
the long axis of the bone.
®
FIGURE 1B:
ASCENSION ® SILICONE MCP
TRIAL SET
Opening the Metacarpal
Medullary Canal
FIGURE 5:
ALIGNMENT AWL
INSERTION
FIGURE 6: ALIGNMENT
AWL ADVANCE
surgical technique
®
Ascension Silicone MCP
surgical technique
2
Ascension® Silicone MCP arthroplasty is appropriate
for patients with osteo, post-traumatic and
rheumatoid arthritis. In patients with rheumatoid
arthritis, soft tissue imbalance may be more severe,
and the surgeon must determine that correction of
volar subluxation deformities and ulnar deviation
deformities can be achieved with standard MCP
reconstruction techniques. In patients with severe
intercarpal supination and radial deviation of the
wrist, ulnar deviation of the digits may not be
correctable with soft tissue surgery and in these
instances, it is recommended that corrective wrist
surgery be performed first at a separate setting.
Incision for single joint
involvement
Make a longitudinal incision over the dorsum of
the metacarpophalangeal (MCP) joint (FIGURE 2 ).
®
Pre-Operative
Assessment
Incision for multiple joint
involvement
For single joint involvement:
If questions arise, please contact Ascension
Orthopedics at 877-370-5001 (toll-free in U.S.) or
e-mail [email protected].
The Ascension® Silicone MCP is a single-component
metacarpophalangeal silicone spacer consisting of
proximal and distal intramedullary stems and a central
flexible hinge. It is provided sterile and available in
five sizes. Guided osteotomies are made first to the
metacarpal head and then the proximal phalanx base.
The medullary canals are then progressively broached
to the desired size. The phalanx is broached first
because it generally determines the sizing of the
implant. Trial implants (FIGURE 1B ) are then inserted,
and the joint is reduced. Once the trial reduction is
satisfactory, the trial implants are removed, and the
final implants are inserted.
FIGURE 2: INCISIONS
Surgical Technique
3
Introduction
FIGURE 1A –
Ascension® Silicone MCP
This manual describes the sequence of techniques
and instruments used to implant the Ascension®
Silicone MCP (FIGURE 1A ). Successful use of this
prosthesis depends on proper patient selection,
surgical technique, and post-operative therapy.
Step One:
Joint Exposure
For multiple joint involvement:
A curving transverse incision across the dorsum
of the MCPs is recommended (FIGURE 2 ).
Ascension
Silicone MCP
Standard AP, lateral and oblique x-rays should be
used to template the size of the prosthesis likely to
be required at surgery.
SIZE
CATALOG NUMBER
10
SMCP-500-10
20
SMCP-500-20
30
SMCP-500-30
40
SMCP-500-40
50
SMCP-500-50
Cut the extensor hood on the radial side of the
central tendon or through its center if no dislocation/
subluxation of the tendon is present. Dissect the
extensor tendon free from the joint capsule radially
and ulnarly. This may not be possible in advanced
disease. Split the capsule longitudinally and dissect it
to expose the joint, preserving the capsule as much
as possible for later repair. The dissection should be
continued so that the dorsal base of the proximal
phalanx and the metacarpal head with the collateral
ligament origins are visible.
FIGURE 3: METACARPAL PUNCTURE
Step Two:
FIGURE 4: CANAL ALIGNMENT
Use the starter awl to make the initial puncture of
the metacarpal head (FIGURE 3 ). This puncture
should be placed volar to the dorsal surface of the
metacarpal head a distance 1/3 the sagittal height
of the head (FIGURE 4 ) and centered across the
width of the head. The resulting puncture should
be aligned with the long axis of the metacarpal
medullary canal.
Ascension Silicone MCP
Step Three:
Establishing Metacarpal
Medullary Canal Alignment
Attach the alignment guide to the alignment awl,
insert the alignment awl into the puncture (FIGURE 5 ),
and advance it 1/2 to 2/3 the length of the metacarpal
(FIGURE 6 ). The alignment guide should be parallel to
the dorsal surface of the metacarpal and in line with
the long axis of the bone.
®
FIGURE 1B:
ASCENSION ® SILICONE MCP
TRIAL SET
Opening the Metacarpal
Medullary Canal
FIGURE 5:
ALIGNMENT AWL
INSERTION
FIGURE 6: ALIGNMENT
AWL ADVANCE
surgical technique
®
Ascension Silicone MCP
surgical technique
2
Ascension® Silicone MCP arthroplasty is appropriate
for patients with osteo, post-traumatic and
rheumatoid arthritis. In patients with rheumatoid
arthritis, soft tissue imbalance may be more severe,
and the surgeon must determine that correction of
volar subluxation deformities and ulnar deviation
deformities can be achieved with standard MCP
reconstruction techniques. In patients with severe
intercarpal supination and radial deviation of the
wrist, ulnar deviation of the digits may not be
correctable with soft tissue surgery and in these
instances, it is recommended that corrective wrist
surgery be performed first at a separate setting.
Incision for single joint
involvement
Make a longitudinal incision over the dorsum of
the metacarpophalangeal (MCP) joint (FIGURE 2 ).
®
Pre-Operative
Assessment
Incision for multiple joint
involvement
For single joint involvement:
If questions arise, please contact Ascension
Orthopedics at 877-370-5001 (toll-free in U.S.) or
e-mail [email protected].
The Ascension® Silicone MCP is a single-component
metacarpophalangeal silicone spacer consisting of
proximal and distal intramedullary stems and a central
flexible hinge. It is provided sterile and available in
five sizes. Guided osteotomies are made first to the
metacarpal head and then the proximal phalanx base.
The medullary canals are then progressively broached
to the desired size. The phalanx is broached first
because it generally determines the sizing of the
implant. Trial implants (FIGURE 1B ) are then inserted,
and the joint is reduced. Once the trial reduction is
satisfactory, the trial implants are removed, and the
final implants are inserted.
FIGURE 2: INCISIONS
Surgical Technique
3
Step Four:
FIGURE 7: CUT TILT
Step Seven:
Phalangeal Osteotomy
Attach the distal osteotomy guide on the alignment
awl and reinsert the awl along the previously
established medullary axis. Advance the guide until
the cutting plane is positioned 0.5 to 1.0 mm distal
to the dorsal edge of the proximal phalanx. The
distal guide provides a 5° distally tilt from vertical
(FIGURE 14 ). Rotational alignment of osteotomy
guide is achieved when the volar surface of the guide
is parallel to the dorsal surface of the phalanx.
Collateral ligament integrity should be retained as far
as possible. A conservative osteotomy at least 1.5mm
distal to the dorsal attachment of the collateral
ligaments should be made and then altered later
if necessary. This allows for joint space adjustment
during the fitting of the trial implants (Step 10).
FIGURE 9:
COMPLETING THE
OSTEOTOMY
With the proximal osteotomy guide held steady,
make the cut by passing the saw blade through the
slot of the guide (FIGURE 8 ). Because of the presence
of the alignment awl, only a partial (dorsal) osteotomy
can be performed. Remove the alignment awl and
complete the osteotomy by following the plane
established by the guided cut (FIGURE 9 ).
surgical technique
®
Ascension Silicone MCP
Opening the Phalangeal
Medullary Canal
4
FIGURE 10: PROXIMAL
PHALANX PUNCTURE
CAUTION:
During puncture, the joint must be flexed to
avoid damage by impingement to the dorsal edge
of the metacarpal osteotomy (FIGURE 11 ).
FIGURE 15:
GUIDED OSTEOTOMY
FIGURE 14:
CUT TILT
With the distal osteotomy guide held steady, make
the cut by passing the saw blade through the slot
of the guide (FIGURE 15 ). Because of the presence of
the alignment awl, only a partial (dorsal) osteotomy
can be performed. Remove the alignment awl and
complete the osteotomy by following the plane
established by the guided cut (FIGURE 16 ).
Step Five:
With the joint flexed, use the starter awl to make
the initial puncture of the proximal phalanx base
(FIGURE 10 ). This puncture should be placed volar
to the dorsal surface of the proximal phalanx a
distance 1/3 the sagittal height of the proximal
phalangeal base (FIGURE 11 ) and centered across
the width of the base. The resulting puncture should
be aligned with the long axis of the proximal
phalangeal’s medullary canal.
Collateral ligament integrity should be retained as
far as possible. A conservative osteotomy should be
made and then altered later if necessary. This allows
for joint space adjustment during the fitting of the
trial implants (Step 10). A conservative osteotomy
generally removes only the joint articular surface.
FIGURE 13:
FLEXED FOR
ALIGNMENT
AWL ADVANCE
FIGURE 11:
CANAL ALIGNMENT
Step Eight:
Phalangeal Medullary Canal
Broaching
The phalangeal opening is initially expanded and
shaped with the starter awl. Then, insert the size 10
distal broach (FIGURE 17 ). Use of a side-cutting burr
may be necessary to assist in proper insertion of the
broaches. Rotational alignment of the broach is
achieved when the dorsal surface of the broach is
parallel to the dorsal surface of the phalangeal bone.
The alignment guide mounted on the broach should be
parallel to the dorsal surface of the phalanx and in line
with the long axis of the bone. Continue broaching
FIGURE 16: COMPLETING
THE OSTEOTOMY
®
Special Thin Blade Requirements:
It is strongly recommended that a small,
thin oscillating saw blade be used
(7mm x 29.5mm x 0.4mm).
With the joint flexed, insert the alignment awl in
the puncture and advance it 1/2 to 2/3 the length
of the phalanx (FIGURES 12, 13 ). The alignment
guide should be parallel to the dorsal surface of the
phalanx and in line with the long axis of the bone.
Ascension Silicone MCP
Attach the proximal osteotomy guide on the
alignment awl and reinsert the awl along the previously
established medullary axis. Advance the guide until
the cutting plane is positioned 1.5 to 2.0 mm distal
to the dorsal attachments of the collateral ligaments.
Rotational alignment of the guide is achieved when
the volar surface of the guide is parallel to the dorsal
surface of the metacarpal bone. The proximal guide
provides a 27.5° distal tilt from vertical (FIGURE 7 ).
Establishing Phalangeal
Medullary Canal Alignment
surgical technique
Metacarpal Osteotomy
FIGURE 12:
ALIGNMENT AWL
INSERTION
Step Six:
FIGURE 8:
GUIDED
OSTEOTOMY
5
Step Four:
FIGURE 7: CUT TILT
Step Seven:
Phalangeal Osteotomy
Attach the distal osteotomy guide on the alignment
awl and reinsert the awl along the previously
established medullary axis. Advance the guide until
the cutting plane is positioned 0.5 to 1.0 mm distal
to the dorsal edge of the proximal phalanx. The
distal guide provides a 5° distally tilt from vertical
(FIGURE 14 ). Rotational alignment of osteotomy
guide is achieved when the volar surface of the guide
is parallel to the dorsal surface of the phalanx.
Collateral ligament integrity should be retained as far
as possible. A conservative osteotomy at least 1.5mm
distal to the dorsal attachment of the collateral
ligaments should be made and then altered later
if necessary. This allows for joint space adjustment
during the fitting of the trial implants (Step 10).
FIGURE 9:
COMPLETING THE
OSTEOTOMY
With the proximal osteotomy guide held steady,
make the cut by passing the saw blade through the
slot of the guide (FIGURE 8 ). Because of the presence
of the alignment awl, only a partial (dorsal) osteotomy
can be performed. Remove the alignment awl and
complete the osteotomy by following the plane
established by the guided cut (FIGURE 9 ).
surgical technique
®
Ascension Silicone MCP
Opening the Phalangeal
Medullary Canal
4
FIGURE 10: PROXIMAL
PHALANX PUNCTURE
CAUTION:
During puncture, the joint must be flexed to
avoid damage by impingement to the dorsal edge
of the metacarpal osteotomy (FIGURE 11 ).
FIGURE 15:
GUIDED OSTEOTOMY
FIGURE 14:
CUT TILT
With the distal osteotomy guide held steady, make
the cut by passing the saw blade through the slot
of the guide (FIGURE 15 ). Because of the presence of
the alignment awl, only a partial (dorsal) osteotomy
can be performed. Remove the alignment awl and
complete the osteotomy by following the plane
established by the guided cut (FIGURE 16 ).
Step Five:
With the joint flexed, use the starter awl to make
the initial puncture of the proximal phalanx base
(FIGURE 10 ). This puncture should be placed volar
to the dorsal surface of the proximal phalanx a
distance 1/3 the sagittal height of the proximal
phalangeal base (FIGURE 11 ) and centered across
the width of the base. The resulting puncture should
be aligned with the long axis of the proximal
phalangeal’s medullary canal.
Collateral ligament integrity should be retained as
far as possible. A conservative osteotomy should be
made and then altered later if necessary. This allows
for joint space adjustment during the fitting of the
trial implants (Step 10). A conservative osteotomy
generally removes only the joint articular surface.
FIGURE 13:
FLEXED FOR
ALIGNMENT
AWL ADVANCE
FIGURE 11:
CANAL ALIGNMENT
Step Eight:
Phalangeal Medullary Canal
Broaching
The phalangeal opening is initially expanded and
shaped with the starter awl. Then, insert the size 10
distal broach (FIGURE 17 ). Use of a side-cutting burr
may be necessary to assist in proper insertion of the
broaches. Rotational alignment of the broach is
achieved when the dorsal surface of the broach is
parallel to the dorsal surface of the phalangeal bone.
The alignment guide mounted on the broach should be
parallel to the dorsal surface of the phalanx and in line
with the long axis of the bone. Continue broaching
FIGURE 16: COMPLETING
THE OSTEOTOMY
®
Special Thin Blade Requirements:
It is strongly recommended that a small,
thin oscillating saw blade be used
(7mm x 29.5mm x 0.4mm).
With the joint flexed, insert the alignment awl in
the puncture and advance it 1/2 to 2/3 the length
of the phalanx (FIGURES 12, 13 ). The alignment
guide should be parallel to the dorsal surface of the
phalanx and in line with the long axis of the bone.
Ascension Silicone MCP
Attach the proximal osteotomy guide on the
alignment awl and reinsert the awl along the previously
established medullary axis. Advance the guide until
the cutting plane is positioned 1.5 to 2.0 mm distal
to the dorsal attachments of the collateral ligaments.
Rotational alignment of the guide is achieved when
the volar surface of the guide is parallel to the dorsal
surface of the metacarpal bone. The proximal guide
provides a 27.5° distal tilt from vertical (FIGURE 7 ).
Establishing Phalangeal
Medullary Canal Alignment
surgical technique
Metacarpal Osteotomy
FIGURE 12:
ALIGNMENT AWL
INSERTION
Step Six:
FIGURE 8:
GUIDED
OSTEOTOMY
5
Step Nine:
Metacarpal Medullary Canal
Broaching
The metacarpal opening is initially expanded and
shaped with the starter awl. Then, insert the size 10
proximal broach (FIGURE 19 ). Rotational alignment
of the broach is achieved when the dorsal surface of
the broach is parallel to the dorsal surface of the
metacarpal bone. The alignment guide mounted on
the broach should be parallel to the dorsal surface of
the metacarpal and in line with the long axis of the
bone. Continue broaching until the seating plane
of the broach is 1mm deeper than the osteotomy
(FIGURE 20 ). Repeat the broaching process with
the next larger size broach until the same size as
the largest distal broach is used.
FIGURE 17:
DISTAL BROACH
INSERTION
FIGURE 19: PROXIMAL BROACH INSERTION
Step Ten:
surgical technique
®
Ascension Silicone MCP
Trial Insertion and Reduction
6
The color-coded silicone trials produce the same fit
as the final component. With the joint flexed, insert
the appropriate size trial implant, distal stem first
(FIGURE 21), until the collars seat against the bones.
Reduce the joint and assess stability, joint laxity, and
range of motion. Full extension of the joint should
be possible.
To improve extension or relieve tension, increase the
depth of the osteotomies to increase the joint space.
Generally the metacarpal osteotomy should be adjusted
first. Mount the osteotomy guide on the appropriate
broach and reinsert in the canal to make an adjustment
cut. Remove bone in small increments to avoid joint
laxity or instability. Reinsert the trial. Reduce the joint
and assess stability, joint laxity, and range of motion.
After a satisfactory reduction, use a pick-up to
remove the trial.
FIGURE 20:
PROXIMAL
BROACH
ALIGNMENT
FIGURE 22: PROXIMAL
STEM INSERTION
Implantation, Final Reduction
and Soft Tissue Closure
With the joint flexed, insert the final implant, distal
stem first, until the collars seat against the bones
(FIGURE 22 ). Reduce the joint and recheck stability,
joint axial alignment, and range of motion (ROM).
Full digit extension should be possible. Check intrinsic
tightness and release as necessary. As in all MCP
surgery, the goal is to centralize the extensor
mechanism and imbricate it radially to prevent ulnar
deviation of the digits. In addition, the soft tissue
envelope should be “tightened”. Attempt a capsular
repair, if possible, to provide support and to prevent
volar subluxation/dislocation. The collateral ligaments
may be repaired as necessary. Release the intrinsic
tendons following implant reduction as appropriate,
and transfer according to the surgeon’s preference
(rarely needed). The extensor tendon must be
centralized and snug which can usually be
accomplished by “pants over vest” imbrication of
the radial hood. It may be necessary to incise the
hood on both sides of the central tendon, then repair
the ulnar hood to the radial hood followed by suture
of the central tendon to the middle of the repaired
hood to achieve a proper correction of severe ulnar
dislocation (of the central tendon). Occasionally, the
central tendon can be advanced and sutured into
the dorsal base of the phalanx to increase stability
of the implant against volar subluxation. At the
conclusion of closure and application of the dressing,
take x-rays to confirm the correct implant position.
Post-Operative
Care
FIGURE 21: DISTAL STEM
INSERTION
Place the hand in a bulky dressing. If possible, maintain the wrist at 10-15° of dorsiflexion and slight
ulnar deviation. MCPs should be held in full
extension and PIPs in slight flexion (5-10°). If Swanneck deformities were present pre-operatively, the PIPs
should be placed in the maximum flexion possible.
Use a palmar plaster splint to maintain this position,
with the final wrap over the entire hand leaving the
distal tips of the digits exposed during the first two
days to help with edema control. Encourage active
range of motion (AROM) of the shoulder and elbow.
Accepted practices for post-operative care and
rehabilitation exercises for silicone MCP arthroplasty
should be followed. In osteoarthritic and posttraumatic cases, early motion may be prescribed.
For rheumatoid arthritis cases, late motion initiation
may be appropriate.
®
The size of the phalangeal medullary canal is
generally the limiting factor in implant size
determination. Use clinical judgment and the
x-ray templates to assess implant sizing.
Step Eleven:
Ascension Silicone MCP
FIGURE 18:
DISTAL BROACH
ALIGNMENT
surgical technique
until the seating plane of the broach is flush to 1mm
deeper than the osteotomy (FIGURE 18 ). During
broaching, assess fit and movement resistance. If a
larger size is needed, repeat the broaching process
with the next larger size broach until the largest size
possible can be fully inserted.
7
Step Nine:
Metacarpal Medullary Canal
Broaching
The metacarpal opening is initially expanded and
shaped with the starter awl. Then, insert the size 10
proximal broach (FIGURE 19 ). Rotational alignment
of the broach is achieved when the dorsal surface of
the broach is parallel to the dorsal surface of the
metacarpal bone. The alignment guide mounted on
the broach should be parallel to the dorsal surface of
the metacarpal and in line with the long axis of the
bone. Continue broaching until the seating plane
of the broach is 1mm deeper than the osteotomy
(FIGURE 20 ). Repeat the broaching process with
the next larger size broach until the same size as
the largest distal broach is used.
FIGURE 17:
DISTAL BROACH
INSERTION
FIGURE 19: PROXIMAL BROACH INSERTION
Step Ten:
surgical technique
®
Ascension Silicone MCP
Trial Insertion and Reduction
6
The color-coded silicone trials produce the same fit
as the final component. With the joint flexed, insert
the appropriate size trial implant, distal stem first
(FIGURE 21), until the collars seat against the bones.
Reduce the joint and assess stability, joint laxity, and
range of motion. Full extension of the joint should
be possible.
To improve extension or relieve tension, increase the
depth of the osteotomies to increase the joint space.
Generally the metacarpal osteotomy should be adjusted
first. Mount the osteotomy guide on the appropriate
broach and reinsert in the canal to make an adjustment
cut. Remove bone in small increments to avoid joint
laxity or instability. Reinsert the trial. Reduce the joint
and assess stability, joint laxity, and range of motion.
After a satisfactory reduction, use a pick-up to
remove the trial.
FIGURE 20:
PROXIMAL
BROACH
ALIGNMENT
FIGURE 22: PROXIMAL
STEM INSERTION
Implantation, Final Reduction
and Soft Tissue Closure
With the joint flexed, insert the final implant, distal
stem first, until the collars seat against the bones
(FIGURE 22 ). Reduce the joint and recheck stability,
joint axial alignment, and range of motion (ROM).
Full digit extension should be possible. Check intrinsic
tightness and release as necessary. As in all MCP
surgery, the goal is to centralize the extensor
mechanism and imbricate it radially to prevent ulnar
deviation of the digits. In addition, the soft tissue
envelope should be “tightened”. Attempt a capsular
repair, if possible, to provide support and to prevent
volar subluxation/dislocation. The collateral ligaments
may be repaired as necessary. Release the intrinsic
tendons following implant reduction as appropriate,
and transfer according to the surgeon’s preference
(rarely needed). The extensor tendon must be
centralized and snug which can usually be
accomplished by “pants over vest” imbrication of
the radial hood. It may be necessary to incise the
hood on both sides of the central tendon, then repair
the ulnar hood to the radial hood followed by suture
of the central tendon to the middle of the repaired
hood to achieve a proper correction of severe ulnar
dislocation (of the central tendon). Occasionally, the
central tendon can be advanced and sutured into
the dorsal base of the phalanx to increase stability
of the implant against volar subluxation. At the
conclusion of closure and application of the dressing,
take x-rays to confirm the correct implant position.
Post-Operative
Care
FIGURE 21: DISTAL STEM
INSERTION
Place the hand in a bulky dressing. If possible, maintain the wrist at 10-15° of dorsiflexion and slight
ulnar deviation. MCPs should be held in full
extension and PIPs in slight flexion (5-10°). If Swanneck deformities were present pre-operatively, the PIPs
should be placed in the maximum flexion possible.
Use a palmar plaster splint to maintain this position,
with the final wrap over the entire hand leaving the
distal tips of the digits exposed during the first two
days to help with edema control. Encourage active
range of motion (AROM) of the shoulder and elbow.
Accepted practices for post-operative care and
rehabilitation exercises for silicone MCP arthroplasty
should be followed. In osteoarthritic and posttraumatic cases, early motion may be prescribed.
For rheumatoid arthritis cases, late motion initiation
may be appropriate.
®
The size of the phalangeal medullary canal is
generally the limiting factor in implant size
determination. Use clinical judgment and the
x-ray templates to assess implant sizing.
Step Eleven:
Ascension Silicone MCP
FIGURE 18:
DISTAL BROACH
ALIGNMENT
surgical technique
until the seating plane of the broach is flush to 1mm
deeper than the osteotomy (FIGURE 18 ). During
broaching, assess fit and movement resistance. If a
larger size is needed, repeat the broaching process
with the next larger size broach until the largest size
possible can be fully inserted.
7
3/8/06 9:30 AM
Page 2
Ascension Silicone MCP
®
surgical technique
®
surgical technique
Ascension Silicone MCP
SMCP_SrgTchWW-C_Cover
ASCENSION ORTHOPEDICS, INC.
8700 CAMERON ROAD, SUITE 100
AUSTIN, TEXAS, USA 78754
512.836.5001 512.836.6933 fax
CUSTOMER SERVICE: 877.370.5001 (toll-free in U.S.)
[email protected]
www.ascensionortho.com
Caution: U.S. federal law restricts this device
to sale by or on the order of a physician.
© 2006
LC-04-507-001 rev C
WW
WW