Zimmer Cable Ready Pin System Abbreviated Surgical Technique Rev2 09 2006

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Zimmer®

Cable-Ready®

Cable Pin

System

Abbreviated

Surgical Technique

Patella Fixation

Zimmer Cable-Ready Cable Pin System

Traditionally, patella fractures have been repaired

with a variety of bone screw or wiring techniques.

The AO technique emphasized the principle of a

tension band over the anterior surface of the patella.

Fixation was obtained through a combination of K-wires

drilled across the fracture followed by an external

tension band to apply compression at the fracture site.

Although the principles are sound, there have been

three concerns associated with this fixation method.

1. Hardware Irritation - Because the K-wires are

smooth, they tend to back out, causing loss of fixation

and /or irritation from the pin. The ends of the wires

and the twisted knot can be challenging to bury and

may irritate soft tissues.

2. Lack of Rigid Fixation - Conventional fixation

methods, may also present challenges in obtaining

rigid fixation for early range of motion and weight

bearing. The wires are relatively more rigid than cables

which makes them less easy to pass. Care must be

taken during tensioning to avoid stressing or

breaking the wire.

3. Hardware Removal - The pins and wires can

cause pain, and usually require a second operation

for removal.

The Cable Pin available with the Cable-Ready® Cable

Grip System is intended for fixation of olecranon

fractures, greater tuberosity humeral fractures, medial

malleolus fractures, patellar fractures, proximal

humerus fractures, femur fractures and greater

trochanteric reattachment.

Patella Fixation Using the Cable-Ready Cable Grip System

Features of the Cable Pin

The concept of a cable pin combines the priciples of

the AO technique with those of modern materials.

A cable has biomechanical properties that make it

superior to wire. It is more flexible, which makes it

easier to insert and remove. In addition, a cable has

superior static strength and much greater fatigue

strength than monofilament wire. An appropriately

designed cable system has a lower profile and is

less irritating to soft tissues.

The Cable Pin system combines a partially threaded

4.0mm cancellous lag screw (pin) with a cable.

The cable is attached to the smooth shank end of

the pin. The opposite end of the pin contains the

threaded cancellous portion. Once the partially

threaded pin portion is inserted into the bone, the

cables are wrapped around the bone externally, and

are tensioned. The cable tension prevents the pin from

backing out, and created compression at the fracture

site. The cable, by being attached to the pin, is also

prevented from migrating. The cable pin technique

enables the surgeon to have simultaneous,

interconnected internal and external fixation

of the bone.

Surgical Technique for Patella

Reduce the fractured patella components and apply a

reduction clamp. Predrill across the fracture sire with a

2.5mm drill bit. While predrilling is often unnecessary

for other indications, the patella typically has dense

bone and predrilling is necessary.

1

Drill Hole

Using a drill guide to protect the patellar ligament,

pass a 2.5mm drill bit vertically through the patella in

a superior direction. Direct the drill bit parallel to the

articular surface, angling it slightly posterior or neutral

(Fig. 1). Drill a second 2.5mm hole parallel to the first.

Generally, patellar fractures are in the middle to distal

one-third of the patella and the Cable Pin is directed

superiorly. If the patellar fracture is in the proximal

one-third of the patella, the Cable Pin can be reversed

and directed inferiorly.

Zimmer Cable-Ready Cable Pin System

2Insert Pin

Thread the cable through the cannulated Cable Pin

Tubular Driver until the hex of the pin at the cable-

pin junction is locked into the driver tip (Fig. 2). Then

load the Cable Pin/driver assembly into a cannulated

trauma drill.

Drill the threaded portion of

the pin across the fracture

site from inferior to superior

until the tip is slightly

countersunk into the bone

(Fig. 3). This will prevent protusion of the pin into the

soft tissues. Disconnect the driver from the Cable Pin

by pulling it away form the cable.

Insert a second Cable Pin through the second hole

in a similar manner.

Note: Care must be taken to ensure spinning cable

does not catch on items, such as clothing or drapes.

Fig. 1

Fig. 2

Fig. 3

3Create “Figure Eight”

Create a horizontally directed drill

hole anterior to the pins in the

superior pole of the patella

(Fig. 4). Cross the two cables

in a figure eight over the

anterior surface of the

patella. Pass the leader

of one cable through the

horizontal drill hole in the

patella and pull it through (Fig. 5).

4Load Crimper & Cables

Load an oval crimp into

the jaws of the Cable

Pin Crimper (Fig. 6).

Squeeze the crimper

handle until the ratchet

clicks once to secure the

crimp. Then pull out the

disposable crimp passer.

Pass the free ends of the

cable in opposite directions through the crimp.

Pass the cables into the spools at the end of one of the

handles of the crimper (Fig. 7). The hole in the spool

must line up with the line on top of the spool to insert

the cable. Pull the cables evenly to remove slack.

The spools are self-locking and self-loosening when

tension is applied or released on the cable.

Fig. 4

Fig. 5

Fig. 7

Fig. 6

5

Insert the Crimper Tensioning Handle, which is keyed

into a hex on the Cable Pin Crimper. Tension the cable

by turning the handle (Fig. 8&9). A scale on the crimper

handle indicated the tension. Adjust the tension,

depending on the type and quality of bone. Carefully

observe the effects of tensioning at the fracture site.

Generally, with good quality bone the cables can be

tensioned to the upper line.

Tension & Crimp 6

When the appropriate tension has been achieved,

squeeze the handles of the crimper until a click is

heard and the handles automatically open (Fig. 10).

This is a safety mechanism to help assure that the

crimp is fully crimped before the jaws open. The

crimper jaws are tapered and low profile to enable the

surgeon to position the crimp in a low profile location.

If possible, do not locate the crimp over a bony

prominence with only subcutaneous coverage.

It is best to bury the crimp before crimping,

if necessary.

Turn the crimper tensioning handle to release

the tension. Remove the Cable Pin Crimper.

Crimp

Fig. 8

Fig. 9

Fig. 10

Contact your Zimmer representative or visit us at www.zimmer.com

Please refer to package insert for complete product

information, including contraindications, warnings,

precautions and adverse effects.

97-2232-011-00 Rev. 2 5ML Printed in the USA ©1999, 2002, 2006 Zimmer, Inc.

Ordering Information

Catalog No. Description

00-2232-050-05 Cable Pin Tubular Driver

00-2232-050-07 Cable Pin Crimper Assembly

00-2232-050-08 Crimper Tensioning Handle

00-2232-050-17 T-Handle/Long Hex Driver Assembly

00-2232-050-18 Cable Pin Implant Set*, 35mm

00-2232-050-19 Cable Pin Implant Set*, 40mm

00-2232-050-20 Cable Pin Implant Set*, 45mm

00-2232-050-21 Cable Pin Implant Set*, 65mm

00-2232-095-00 Cable Pin Instrument Case

* Each implant set contains two Cable Pin/Cable Assemblies and two

Crimp/Crimp Passer assemblies.

7

Pull each cable back, and use the Cable Cutter to cut

the excess cable flush at the crimp (Fig. 11).

Cut Cables

Fig. 11

Finished

Assembly

8

To remove the cable pin, cut the cable on each side

of the crimp, and remove the crimp. Carefully dissect

the two ends of the cable down to the base of the pin.

Keep the cables intact to use as a guide to the location

of the internal pins.

Load the Cable Pin Tubular Driver into a trauma drill

which is set on reverse. Insert the free end of the cable

into the bit. Slide the bit down the cable until it engag-

es with the hex of the pin. Once engaged, use the drill

to back out the pin. Alternatively, use the T-handle/

Long Hex Driver to remove the pin.

If this technique is not possible, use an easy out pin

remover to back out the pin.

Cable Pin Removal

00-2232-050-08 Crimper Tensioning Handle

00-2232-050-18 Cable Pin Implant Set*, 35mm