IJS® – Elbow Surgical Approach

IJS® – Elbow Surgical Approach

  • 1. SUPERFICIAL EXPOSURE
    Make an incision midway between the lateral epicondyle and the olecranon.
    Note: Place the tourniquet proximal on the arm to allow for free elbow motion.

  • 2. DEEP EXPOSURE
    Perform a lateral approach to the elbow joint through the surgeon’s preferred muscle interval.

  • 3. CENTER OF ROTATION
    Locate and mark the anatomic center on the lateral capitellum.
    Note: This is identified as the center of a circle that fits the curvature of the capitellum on the lateral view.
    Full visualization of the lateral epicondyle to the capitellum is critical to accurately establish the anatomic center of rotation.

  • 4. AXIS GUIDE SIZING
    Open the joint by applying a varus stress allowing access to insert the proper sized Axis Guide.
    The handle of the Axis Guide should be positioned in-line with the humeral shaft and into the trochlear notch, engaging the medial trochlear expansion.
    Note: There are three sizes of Axis Guides available.

  • 5. GUIDE WIRE ATTACHMENT
    Insert the K-wire Guide into the Axis Guide so that it is close to the lateral epicondyle without making contact, and then rotate it clockwise to lock it in place.
    Caution:
    Avoid contacting the lateral epicondyle with the K-wire Guide as it will prevent the Axis Guide from properly engaging the medial trochlear expansion, causing the assembly to be improperly positioned.

  • 6. GUIDE WIRE INSERTION
    Advance the Guide-Wire (1.5mm K-wire) through the K-wire Guide and into the humerus, stopping short of the medial cortex.
    Caution:
    DO NOT violate the medial cortex as it may result in ulnar nerve injury.
    Note:
    The supplied Guide-Wires (1.5mm K-wire) are specifically designed to provide exact depth readings with the system’s Depth Gauge

  • 7. AXIS GUIDE REMOVAL
    Remove the entire assembly leaving the Guide Wire (1.5mm K-wire) in place.

  • 8. FLUOROSCOPIC CONFIRMATION
    Confirm that the Guide Wire (1.5mm K-wire) has been inserted to the correct depth and that the axis of rotation has been properly established using fluoroscopy.

  • 9. AXIS PIN MEASUREMENT
    Place the Depth Gauge over the Guide Wire (1.5mm K-wire) to measure the drilling depth for the proper length of Axis Pin.
    If between sizes, choose a shorter length.
    Note:
    There are nine lengths of Axis Pin available.

  • 10. AXIS PIN DRILLING
    Drill over the Guide Wire (1.5mm K-wire) to the measured depth using the 2.7mm cannulated IJS-E Drill.
    Remove the Guide Wire (1.5mm K-wire) after drilling.
    Note:
    The 2.7mm cannulated IJS-E Drill has etched

  • 11. BASE PLATE POSITIONING
    Position the Base Plate on the proximal aspect of the ulna.
    Note:
    The use of fluoroscopy will help to position the base plate.

  • 12. BASE PLATE DRILLING
    Drill for bicortical fixation through the sliding slot on the Base Plate using the 2.5mm drill bit, aiming towards the coronoid process and away from the radial notch.
    Measure using the Depth Gauge for the appropriate length 3.5mm compression screw (Polyaxial Non Locking).
    Caution:
    Avoid drilling into the articular surfaces.
    Note:
    The center-sliding slot of the Base Plate facilitates positioning.

  • 13. BASE PLATE FIXATION
    Insert the corresponding 3.5mm compression screw (Polyaxial Non Locking) using the T-10 Driver.
    Repeat step 12 and 13 for the remaining two compression screw holes of the Base Plate.
    Caution:
    Avoid drilling into the articular surfaces.

  • 14. CONSTRUCT ALIGNMENT
    If the head of the Gold Locking Screw or the arrow of the Purple Locking Joint are NOT pointing proximally:
    – Loosen the Purple Locking Screw and remove the Connecting Arm to flip the Purple Locking Joint 180° so that its arrow is pointing proximal.
    – Then reinsert the Connecting Arm back into the Purple Locking Joint with the Gold Locking Screw also pointing proximal.

  • 15. INSERTING THE AXIS PIN
    Adjust the Connecting Arm to allow the selected Axis Pin to be inserted through the eyelet of the Boom Arm and into the humerus.
    Note:
    A needle holder or the optional Counter Torque Tool can be used to hold the Boom Arm while inserting the Axis Pin.

  • 16. LOCKING THE AXIS PIN
    Use a needle holder or the optional Counter Torque Tool to stabilize the Boom Arm while fully tightening the Axis Pin using the T-10 Driver.
    Note:
    A needle holder or Counter Torque Tool allows for proper tightening of the Axis Pin.

  • 17. ELBOW REDUCTION
    Anatomically reduce the elbow joint.
    Note:
    Shoulder rotational torque is minimized by placing the patient’s hand over their face while also greatly aiding in the reduction.

  • 18. LOCKING THE CONSTRUCT
    Using the T-10 Driver and a needle holder or optional Counter Torque Tool, lock the reduction by first tightening the Gold Locking Screw and then the Purple Locking Screw.
    Warning:
    Both the Gold and Purple Locking Screws must be fully tightened to maintain the reduction.

  • 19. FINAL FLUOROSCOPIC CONFIRMATION
    Confirm that the reduction is maintained through the full ROM using fluoroscopic imaging.

  • 20. TRIMMING THE CONNECTING ARM
    Using a pin cutter, remove any excess length from the Connecting Arm that exits the Purple Locking Joint.
    Warning:
    The Connecting Arm must be trimmed as short as possible where it exits the Purple Locking Joint to minimize the potential for soft tissue irritation.

  • 21. WOUND CLOSURE
    Close the incision in your normal fashion.

IJS® – Elbow System Explanting Procedure

  • 1. LOCATING THE AXIS PIN
    Palpate the lateral epicondyle to locate and mark the head of the Axis Pin.
    Note:
    Use of fluoroscopic imaging will aid in locating the position for each of the construct screws.

  • 2. AXIS PIN REMOVAL
    Make a stab incision over the marked area and remove the Axis Pin using the T-10 Driver.

  • 3. LOCATING THE BASE PLATE
    Palpate the posterior surface of the ulna to locate and mark the position of the Base Plate.
    Note:
    Access can be gained through the previous exposure

  • 4. EXPOSING THE BASE PLATE
    Make an incision to expose the Base Plate.

  • 5. COMPRESSION SCEW REMOVAL
    Using the T-10 Driver, remove the three 3.5mm compression screws (Polyaxial Non Locking).

  • 6. CONSTRUCT REMOVAL
    Remove the Base Plate construct.
    Close both incisions and dress the wound in your normal fashion.