Ankle ORIF (Open Reduction Internal Fixation) with Smith & Nephew Non-Locking Small Fragment Set & Smith & Nephew 4.0 Cannulated Screw Set
Basic instruments needed for hand & ankle surgeries
– Retractors:
– Army / Navy
– Senn (Miller Abbott)
– Ragnell
– Baby Hohmann
– Curettes to scrape clot & callous formation out of the fracture before fixation
– Rongeurs to clean tissue out of the fracture site before fixation
– Periosteal Elevators to clean tissue off bone before application of the hardware
– Awl is pointed instrument that manually compresses fracture together during fracture reduction
– Drill (we use the a Cordless Mini Driver) with AO Trinkle Adapter (quick connect for drill bit & power Screwdriver) & Wire Driver (for k-wires / c-wires) available
There are 2 main types of screws in fragment sets, Cortical & Cancellous Screw
Cortical Screws are used when the screw being used is bi-cortical (drilling near cortex to far cortex). Cortical bone is hard & dense (like a 2×4 piece of wood) so the threads on a Cortical screw are narrow & close together.
Cancellous Screws are used when drilling uni-cortical, (near cortex of the bone yet NOT drilling through the far cortex, staying in the cancellous bone). Cancellous bone is soft & spongy (like sheetrock). Threads of cancellous screws that are wide apart.
There are 2 main types of plates in fragment sets: 1/3 Tubular & DCP (Dynamic Compression Plate)
1/3 Tubular Plates are thin, have a partial tubular shape, & have round holes. These plates are used on non weight bearing bones. For an ankle ORIF the Fibula (lateral side) is the non weight bearing bone.
DCPs (Dynamic Compression Plates) are thick plates may have scalloped cut outs on the underside (LC-DCP) the holes in the plate are oval (so the screws can go in at an angle & compress the fracture). DCPs are usually used on weight bearing bones (more commonly used on the radius in the forearm)
Remember when choosing a drill bit to choose a bit with a smaller diameter than the screw you will be using (ex: 2.5mm or 2.7mm drill bit for a 3.5mm screw). If you use the same diameter drill bit as the screw you are putting in the threads won’t catch.
DRILL: smaller than screw being used
MEASURE: w/ depth gauge to find out length of screw
SCREW: Bi-cortical = Cortical Screw
Uni-cortical= Cancellous Screw
Blue Towel on left side is the 4.0 Cannulated Screw Instruments
- Skin Protector for Guide Wires
- Guide Wires (min 2)
- Depth Gauge
- Cannulated Drill (to drill over guide wire)
- Cannulated Screwdriver (w/ countersink tip) to put screw on over guide wire
Blue Towel on right side is the Small Fragment Instruments
- 1/3rd Tubular plates (for plating Fibula)
- Plate Benders (if needed)
- Drill Guide
- 2.5mm or 2.7mm Drill Bit for 3.5mm & 4.0mm Screws
- 3.5mm Drill Bit (if needed to over drill to make 3.5mm screw a sliding screw)
- Depth Gauge
- Screwdriver (on top of screws)
