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Right-Angled Drilling and Screw Insertion
90° Screwdriver Surgical Technique
90° Screwdriver
The DePuy Synthes 90° Screwdriver consists of a screwdriver handle, shaft, screw holder, screwholder insert and a variety of attachments such as drill bits and screwdriver blades for manual and powered right-angled predrilling and insertion of screws.
Low-profile head – Minimal overall height – Optimized drive design – Easy to clean – Facilitates intraoral treatment of subcondylar fractures.
Broad range of applications Minimally invasive predrilling and insertion of screws in the mandible, without a transbuccal approach.
Reliable transmission of force – Drive shaft designed to transmit the torque required for screw insertion – Optimized bearings minimize mechanical wear and prolong instrument life
Examples: – Plate fixation of bilateral sagittal split osteotomies (BSSO) – Endoscopically supported plate fixation of subcondylar fractures Screwholder The screwholder can be turned at an angle behind the head. – Easier visibility – Simple handling – Minimally invasive
Minimal overall height
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DePuy Synthes 90° Screwdriver
Surgical Technique
Predrilling Suitable for right-angled predrilling. – Can be attached to a power source by removing the Turning Handle: maximum input speed 15,000 rpm – Adaptor for Intra-Coupling (05.001.103.98) allows the 90° Screwdriver to connect to the DePuy Synthes Electric Pen Drive for drilling under power – Easy exchange of drill bits and screwdriver blades
Indications and Warnings
Indications The Synthes 90° Screwdriver is indicated for the manual and powered predrilling and insertion of bone fixation screws in oral and maxillofacial surgery. Warnings – To prevent injuries, ensure that the 90° Screwdriver is not connected to power when inserting or removing drill bits. – Always use irrigation when drilling under power to minimize the risk of necrosis. – Allow the device to cool for 2 minutes after drilling or before changing attachments. – To minimize the risk of overheating and to ensure optimal function of the instrument and attachments, Synthes recommends the use of the Synthes Maintenance Spray after each use of the 90° Screwdriver. Improper use may cause the system to overheat and injure the patient or user. Refer to the Maintenance section of the manual for more details. – To avoid risk of damage to the instrument or patient, do not exceed the 15,000 rpm maximum input speed for the 90° Screwdriver. – Do not use force or bend the drill bit when drilling. This may damage the instrument and cause injury to the patient or user. – These devices can break during use (when subjected to excessive forces or outside the recommended surgical technique). While the surgeon must make the final decision on removal of the broken part based on associated risk in doing so, we recommend that whenever possible and practical for the individual patient, the broken part should be removed. – Medical devices containing stainless steel may elicit an allergic reaction in patients with hypersensitivity to nickel.
90° Screwdriver
Surgical Technique
DePuy Synthes
2
Assembly
Instruments 03.505.003 Shaft for 90º Screwdriver 03.505.004
Handle for 90º Screwdriver
03.505.005
Turning Handle for 90º Screwdriver
03.505.007
Gear Cover for 90º Screwdriver
03.505.008
Gear for 90º Screwdriver
03.505.010
Screwholder for 90º Screwdriver, without Insert
Warning: To prevent injuries, ensure that the 90º Screwdriver is not attached to power when inserting attachments. 1 Attach the Screwholder to the shaft end of the Handle. 2 Attach the Shaft to the threaded end of the Handle. 3 Insert the Gear into the head of the Shaft. 4 Assemble the Gear Cover to the head of the Shaft. Use the pins located on the Turning Handle to tighten the Gear Cover in place. (Must be done before the Turning Handle is assembled.) 5 Attach the Turning Handle to the Handle. 6 To remove attachments, repeat Steps 1–5 in reverse order.
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2
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4
5
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DePuy Synthes 90° Screwdriver
Surgical Technique
Drilling
Instruments 05.001.010.98 Electric Pen Drive, 60,000 rpm 05.001.103.98 Adaptor for Intra-Coupling for Pen Drive 05.505.003
05.001.010.98
Instrument for Removal of Inserts, for 90º Screwdriver
Note: The Adaptor for Intra-Coupling, for attachment to the DePuy Synthes Electric Pen Drive, meets ISO 3964/EN 23 964 standard.
05.001.103.98
Warning: Do not exceed 15,000 rpm maximum input speed for 90º Screwdriver. The 90º Screwdriver has a gear ratio of 2:1. The 90º Screwdriver Handle has an ISO standard* intra-coupling for connecting to an appropriate dental power source (Figure 1). The screwdriver can also be connected to the Electric Pen Drive using the Adaptor for Intra-Coupling for Pen Drive.
Figure 1
05.505.003
Precaution: The 90° screwdriver may only be used in combination with power sources which are compliant with the guidelines for medical devices. Remove the Turning Handle from the proximal end of the screwdriver Handle to access the intra-coupling for drilling under power. To drill with the 90º Screwdriver: 1 Load a drill bit by pressing the head of the screwdriver onto the coupling end of the 90º screwdriver drill bit, with the drill bit held in place in the mini module. 2 Remove the Turning Handle from the screwdriver Handle, and insert an appropriate powered drive unit with an intra-coupling into the screwdriver Handle. The powered drive unit must have an intra-coupling in order to connect to the screwdriver Handle. ote: Use the Adaptor for Intra-Coupling with the Electric N Pen Drive.
* ISO 3964/EN 23 964
90° Screwdriver
Surgical Technique
DePuy Synthes
3
Drilling
3 Drill hole Precaution (for thoracic application only): Use the 2.2 mm MatrixRIB® Fixation System drill guide for 90° screwdriver to ensure perpendicular drilling for proper engagement of the locking screw in the plate. Precautions: Drill speed rate should never exceed 1,800 rpm, particularly in dense, hard bone. This corresponds to a maximum input speed of 3600 rpm (gear ratio of 2:1). Higher drill speed rates can result in: – thermal necrosis of the bone, – soft tissue burns, – an oversized hole, which can lead to reduced pullout force, increased ease of the screws stripping in bone, suboptimal fixation, and/or the need for emergency screws. – Avoid damaging the plate threads with the drill. – Always irrigate during drilling to avoid thermal damage to the bone. – Irrigate and apply suction for removal of debris potentially generated during implantation or removal. – Do not use force or bend the drill bit when drilling. This may damage the instrument and cause injury to the patient or user. – Allow the device to cool for 2 minutes after drilling or before changing attachments. Improper use may cause the system to overheat and injure the patient or user.
Clinically relevant drill speed Input Speed (set at power source)
Drill Speed
3600 RPM
1800 RPM
Theoretical maximum input speed to avoid the mechanical destruction of the screwdriver Input Speed (set at power source)
Drill Speed
15000 RPM
7500 RPM
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DePuy Synthes 90° Screwdriver
Surgical Technique
4 To remove the drill bit, use the insert removal pin located on the module (or use the Instrument for Removal of Inserts) by pressing the pin firmly through the hole in the Gear Cover. Precaution: When removing the screwdriver blade using the removal instrument it is recommended to keep one hand over the blade, as it “pops” up and may fall on the floor.
Inserting Screws
Instruments 03.505.011 03.505.012
Screwholder Inserts for Screws, 1.5 mm and 2.0 mm 2.4 mm
05.505.003
Instrument for Removal of Inserts
The Screwholder Insert can be used for improved blade retention of screws. When not in use, it can be retracted and positioned behind the screwdriver head for better visibility of the operative site. 1 Attach the appropriate Screwholder Insert to the coupling on the Screwholder (optional). 2 Press the head of the screwdriver onto the coupling of the 90º screwdriver blade, with the blade held in place in a mini module. 3 Using the holes located on the edge of each module to hold screws, press the screwdriver blade securely into the screwhead. 4 Slide the Screwholder forward so that the screw is held securely to the blade by the Screwholder Insert. Precautions: – After partial insertion of the screw, the screwholder needs to be pulled back before fully tightening the screw to allow the screw to be fully inserted. – When the screwholder insert is not in use, it can be retracted and positioned behind the screwdriver head for better visibility of the operative site.
5 Manually turn the Turning Handle clockwise to insert the screw. To remove the screw, turn the Turning Handle counterclockwise. Gently rock the screwdriver head from side to side to release the screwdriver blade from the screwhead. Precaution: Do not use a power source for screw insertion because the high torque may result in screw stripping. 6 To remove the 90º screwdriver blade, use the insert removal pin located on each module (or use the Instrument for Removal of Inserts) by pressing the pin firmly through the hole in the Gear Cover. Precaution: When removing the 90º screwdriver blade using the removal instrument, it is recommended to keep one hand over the blade, as it “pops” up and may fall on the floor.
Mini module Easy to pick up and remove screwdriver shafts and drill bits.
Screwholder Screwholder insert
90° Screwdriver
Surgical Technique
DePuy Synthes
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Cleaning
Cleaning Warning: Universal precautions for handling contaminated/ biohazardous materials should be observed. Preparation for Decontamination 1. The 90° Screwdriver should be reprocessed as soon as is reasonably practical following use. 2. Disassemble the device according to the instructions on page 6 before cleaning. 3. Remove sharp parts for manual cleaning or place into a separate tray. 4. Lumens and cannulas should be manually processed before cleaning. 5. Soak and/or rinse heavily soiled parts or cannulated parts before cleaning, to loosen any dried soil or debris. Use a neutral pH enzymatic soak or detergent to soak parts. Follow the enzymatic cleaner or detergent manufacturer’s instructions for use, for correct exposure time, temperature and concentration. Use cool tap water to rinse all parts. 6. DePuy Synthes parts must be cleaned separately from DePuy Synthes instrument trays and DePuy Synthes graphic cases unless otherwise noted. Lids should be removed from the graphic case and modules for the cleaning process, if applicable. 7. It is the responsibility of the end user to ensure that all equipment used to reprocess DePuy Synthes devices is properly installed, validated, maintained and calibrated.
90° Screwdriver
Surgical Technique
DePuy Synthes
7
Cleaning
Mechanical method Precleaning 1. Disassemble the 90° Screwdriver according to the instructions on page 6 before cleaning. 2. Rinse soiled parts under running cold tap water for a minimum of two minutes. Remove gross soil using a soft bristled brush or soft, lint-free cloth. 3. Manually clean the device for a minimum of two-and-ahalf minutes in a freshly prepared neutral pH enzymatic or detergent solution. Follow the enzymatic cleaner or detergent manufacturer’s instructions for the correct dilution, temperature and exposure time. Use a soft-bristled brush to remove soil and debris. Actuate movable device features to expose areas to detergent solution. Clean device under water to prevent aerosolization of contaminants. Note: fresh solution is a newly made, clean solution. 4. Rinse the parts using cool to lukewarm running tap water for a minimum of two minutes. Use a syringe, pipette or water jet to flush lumens and channels. Actuate moveable device features in order to rinse thoroughly under running water. 5. Visually inspect parts. Repeat steps 2 through 4 until no visible soil remains on device. 6. Assemble components into case and load into an automated washer.
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DePuy Synthes 90° Screwdriver
Surgical Technique
Cleaning
Mechanical method Equipment: Washer-disinfector, neutral enzymatic cleaner and/or detergent with a pH ≤8.5. Use the following cycle parameters: Cycle
Time (minutes)
Temperature/Water
Type of Detergent
Prewash
2
Cold tap water
N/A
Enzymatic wash
5
Cool to warm tap water
Neutral pH ≤8.5
Wash 1
2
Warm tap water (>40°C)
Detergent with pH ≤8.5
Rinse
5
Warm to hot DI or PURW (>40°C)
N/A
Dry
20
<120°C
N/A
Drying If a dry cycle is not included in a mechanical washer or if the device is not processed in a mechanical washer: – Dry each part thoroughly inside and out to prevent rusting and malfunction. – Use a soft, lint-free cloth to avoid damage to the surfaces. – Pay special attention to threads, ratchets, and hinges or areas where fluid can accumulate. – Open and close parts so that all areas are reached. Dry hollow parts using the air jet with clean compressed air.
90° Screwdriver
Surgical Technique
DePuy Synthes
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Maintenance
Instruments 05.001.098.98 Maintenance Spray, for Electric Pen Drive 05.505.002 Spray Adaptor for 90° Screwdriver
Warning: Universal precautions for handling contaminated/ biohazardous materials should be observed. Before sterilization, the screwdriver Shaft and the Handle must be oiled. Use the DePuy Synthes Maintenance Spray for Electric Pen Drive, as in Step 8 of the disassembly chart, and follow the steps below. 1 Reassemble the screwdriver Shaft, as in Step 6 of the disassembly chart. 2 Click the Spray Adaptor onto the Maintenance Spray. 3 Press the assembled screwdriver Shaft tightly onto the Spray Adaptor. 4 Wrap the other end of the Shaft with a cloth to catch excess oil or hold over a wash basin. 5 Apply spray once briefly (approximately 1 sec.). Always spray away from the body. 6 Remove excess oil with a cloth after spraying. 7 Repeat the same procedure (Steps 3–6) for the screwdriver Handle. Attention: Only use the DePuy Synthes Maintenance Spray for Electric Pen Drive. Its composition is compatible with requirements in the operating room. Lubricants with other compositions may compromise the mechanism and void the warranty.
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DePuy Synthes 90° Screwdriver
Surgical Technique
Sterilization
Sterilization – DePuy Synthes nonsterile devices should be sterilized before use. – The following are the recommendations for the sterilization of DePuy Synthes devices: Cycle Type
Minimum Sterilization Minimum Sterilization Exposure Time Exposure Temperature
Minimum Dry Time
Prevacuum
4 minutes
20 minutes
132°C (270°F)
Notes – Dry times may be highly variable due to differences in packaging materials (e.g. nonwoven wraps), environmental conditions, steam quality, device materials, total mass, sterilizer performance, and varying cool-down time. The user should employ verifiable methods (e.g. visual inspection) for achieving adequate drying, where the manufacturer’s recommendations and the user’s results differ. – These parameters are only valid for devices that are adequately cleaned. – These parameters are only valid for a properly installed, maintained, and calibrated AAMI-compliant healthcare sterilizer. The instructions provided above have been validated by the medical device manufacturer as being capable of preparing a nonsterile DePuy Synthes medical device. It remains the responsibility of the processor to ensure that the processing is actually performed, using equipment, materials and personnel in the reprocessing facility, and achieves the desired result. This requires verification and routine monitoring of the process. Likewise, any deviation by the processor from the instructions provided should be properly evaluated for effectiveness and potential adverse consequences.
90° Screwdriver
Surgical Technique
DePuy Synthes
11
90° Screwdriver Set (01.505.002)
Instrument Tray and Modules 60.505.003 Instrument Tray for 90° Screwdriver 60.505.004 Mini Module 1.5 mm for Instrument Tray, for 90° Screwdriver 60.505.005 Mini Module 2.0 mm for Instrument Tray, for 90° Screwdriver 60.505.006 Mini Module 2.4 mm for Instrument Tray, for 90° Screwdriver 68.505.009 Lid for Instrument Tray, for 90° Screwdriver Instruments 03.505.003 Shaft for 90° Screwdriver, 2 ea. 03.505.004 Handle for 90° Screwdriver, 2 ea. 03.505.005 Turning Handle for 90° Screwdriver, 2 ea. 03.505.006 Drivershaft for 90° Screwdriver, 2 ea. 03.505.007 Gear Cover for 90° Screwdriver, 4 ea. 03.505.008 Gear for 90° Screwdriver, 4 ea. 03.505.010 Screwholder for 90° Screwdriver, without Insert, 2 ea. Screwholder Inserts for Screws, for 90° Screwdriver 03.505.011 1.5 mm and 2.0 mm 03.505.012 2.4 mm 1.0 mm Drill Bits, for 90° Screwdriver 03.505.020 11 mm length, 4 mm stop 03.505.022 15 mm length, 8 mm stop 03.505.024 19 mm length, 12 mm stop 1.1 mm Drill Bits, for 90° Screwdriver 03.505.030 11 mm length, 4 mm stop 03.505.032 15 mm length, 8 mm stop 03.505.034 19 mm length, 12 mm stop 1.5 mm Drill Bits, for 90° Screwdriver 03.505.041 13 mm length, 6 mm stop 03.505.044 15 mm length, 8 mm stop 03.505.047 19 mm length, 12 mm stop 03.505.065 21 mm length, 14 mm stop 03.505.066 23 mm length, 16 mm stop 03.505.067 25 mm length, 18 mm stop 1.8 mm Drill Bits, for 90° Screwdriver 03.505.051 13 mm length, 6 mm stop 03.505.054 15 mm length, 8 mm stop 03.505.057 19 mm length, 12 mm stop
Note: For additional information, please refer to package insert.
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DePuy Synthes 90° Screwdriver
Surgical Technique
Cruciform Screwdriver Shafts, self-retaining, for 90° Screwdriver, 2 ea. 03.505.101 1.5 mm/2.0 mm 03.505.103 2.4 mm StarDrive Screwdriver Shafts, self-retaining, for 90° Screwdriver, 2 ea. 03.505.110 1.3 mm 03.505.111 1.5 mm 03.505.112 2.0 mm PlusDrive Screwdriver Shafts, self-retaining, for 90° Screwdriver, 2 ea. 03.505.120 1.3 mm 03.505.121 1.5 mm/2.0 mm 05.505.002 Spray Adaptor for 90° Screwdriver 05.505.003 Instrument for Removal of Inserts, for 90° Screwdriver
90° Screwdriver Set (01.505.002)
Matrix Instrument Tray and Modules 68.505.042 Instrument Tray for Mini Module for 90° Screwdriver 68.505.043 Lid for 68.505.042 68.505.040 MatrixMANDIBLE Mini Module Tray for 90° Screwdriver 68.505.050 MatrixMIDFACE Mini Module Tray for 90° Screwdriver
03.503.081 MatrixMANDIBLE Screwdriver Blade, self-retaining, for 90° Screwdriver 03.503.083 MatrixMIDFACE Screwdriver Blade, self-retaining, for 90° Screwdriver Also Available 05.001.098.98 Maintenance Spray, for Electric Pen Drive 05.001.103.98 Adaptor for Intra-Coupling for Pen Drive
MatrixMIDFACE Drill Bits 1.1 mm Drill Bits, for 90° Screwdriver 03.505.035 11 mm length, 4 mm stop 03.505.036 13 mm length, 6 mm stop 03.505.037 15 mm length, 8 mm stop 1.25 mm Drill Bits, for 90° Screwdriver 03.505.026 17 mm length, 10 mm stop 03.505.027 19 mm length, 12 mm stop MatrixMANDIBLE Drill Bits 1.5 mm Drill Bits, for 90° Screwdriver 03.505.075 13 mm length, 6 mm stop 03.505.076 15 mm length, 8 mm stop 03.505.078 19 mm length, 12 mm stop 1.8 mm Drill Bits, for 90° Screwdriver 03.505.081 13 mm length, 6 mm stop 03.505.082 15 mm length, 8 mm stop 03.505.084 19 mm length, 12 mm stop 03.505.085 21 mm length, 14 mm stop 03.505.086 23 mm length, 16 mm stop 03.505.087 25 mm length, 18 mm stop 2.4 mm Drill Bits, for 90° Screwdriver 03.505.091 13 mm length, 6 mm stop 03.505.092 15 mm length, 8 mm stop 03.505.094 19 mm length, 12 mm stop
90° Screwdriver
Surgical Technique
DePuy Synthes
11
For detailed cleaning and sterilization instructions, please refer to www.depuysynthes.com/hcp/cleaning-sterilization or sterilization instructions, if provided.
Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed. Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information. CAUTION: Federal Law restricts these devices to sale by or on the order of a physician. Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada. Not all products may currently be available in all markets.
Manufactured or distributed by: Synthes USA Products, LLC 1302 Wrights Lane East West Chester, PA 19380
Synthes USA, LLC 1101 Synthes Avenue Monument, CO 80132
To order (USA): 800-523-0322 To order (Canada): 855-946-8999 Note: For recognized manufacturer, refer to the product label. www.depuysynthes.com © DePuy Synthes 2009–2017. All rights reserved. DSUS/CMF/0117/0669 4/17 DV