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CLAmP AND rOD INTErNAL fIXATION (CrIf) SYSTEmModular implant system for orthopaedic conditions
SurgICAL TEChNIquE
INTErNAL fIXATION INTErNAL fIXATION (CrIf) SYSTEm(CrIf) SYSTEmModular implant system for
SurgICAL TEChNIquE
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet
INTrODuCTION
SurgICAL TEChNIquE
PrODuCT INfOrmATION
TAbLE Of CONTENTS
Clamp and rod Internal fixation System (CrIf) 2
Indications 2
AO Principles 4
Clinical Cases 5
Preparation 8
Lag Screw Placement (optional) 9
rod Preparation 9
Load Clamps on rod 11
Place Construct 12
Implants 14
Instruments 16
recommended Sets 19
Set Lists 20
2 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique
The DePuy Synthes Clamp and rod Internal fixation (CrIf) System is a modular implant system for veterinary use only and is composed of three components: clamps, rods, and screws. The rods can be cut to length and contoured in any plane.
Standard screws fi x the rod to bone via special clamps. Together, these form a unique internal construct that provides great versatility to the surgeon.
Features and Benefi ts• Three sizes available: mini, small, and medium• utilizes standard cortical and cancellous screws• Can be used with open or minimally invasive techniques• Versatile system requires less inventory• rods can be cut to length• rods can be contoured in multiple planes for
optimal anatomic fi t• Clamps can be positioned anywhere on the rod• Clamps can be rotated to either side of the rod to allow
optimal screw placement
CLAmP AND rOD INTErNAL fIXATION SYSTEm
reference: 1. Zahn K, frei r, Wunderle D, et al. mechanical properties of 18 different AO bone plates and the clamp-rod internal fi xation system tested on a gap model construct. Vet Comp Orthop Traumatol. 2008;21(3):185-94.
mini Small medium
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 3
ImPLANT fEATurES
Rods• made of implant-quality medical grade stainless steel • Available in three diameters:
– mini (2.0 mm diameter)– Small (3.0 mm diameter)– medium (5.0 mm diameter)
• Offered in a variety of lengths• may be cut to length
Standard Clamps• Affi x to rod using standard screws• Slide axially to any point along length of rod• Screws can be placed through clamps on either
side of the rod• Screws can be angled up to 5º
End Clamps• Affi x to rod end using standard screws• grip end of rod and prevent axial slippage• Screws can be placed through clamps on either
side of the rod• Screws can be angled up to 5°• Distinguished by notch
Screws• Clamps accept standard DePuy Synthes screws• Either self-tapping or non-self-tapping screws can be used• use appropriate screws for each clamp size:
– mini (2.0 mm cortex)– Small (2.7 mm cortex)– medium (3.5 mm cortex/4.0 mm cancellous)
standard clamp
notch in end clamp
end clamp
mini—2.0 mm
Small—3.0 mm
medium—5.0 mm
Shown actual size
4 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique
In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation.1 They are:
Anatomic Reductionfracture reduction and fixation to restore anatomical relationships.
Stable FixationStability by fixation or splintage, as the personality of the fracture and the injury requires.
Preservation of Blood SupplyPreservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques.
Early, Safe MobilizationEarly, safe mobilization of the part and patient.
The Clamp rod Internal fixation (CrIf) System is intended for canine and feline long-bone repair.
reference: 1. Johnson AL, houlton JEf, Vannini r. AO Principles of Fracture Management in the Dog and Cat. Davos Platz: AO Publishing. 2005.
AO PrINCIPLES
INDICATIONS
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 5
CLINICAL CASES
Patient treated with the Small CRIF SystemA 9-lb., eleven-month-old female cat presented with a comminuted fracture of the left femur.
Patient was treated with the Small CrIf System (3.0 mm rod, small clamps, and 2.7 mm cortex screws).
references: 1. Clinical cases courtesy of Clinic of Veterinary Surgery, Ludwig-maximilians—university of munich germany; Dr. ulrike matis, Dr. Klaus Zahn.2. Zahn K, matis u. The clamp rod internal fixator—application and results in 120 small animal fracture patients. Vet Comp Orthop Traumatol. 2004; 17(3):110–120.
Preoperative cranio-caudal Preoperative lateral
8-month follow-up cranio-caudal
8-month follow-up lateral
Postoperative cranio-caudal Postoperative lateral
6 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique
Clinical Cases
Patient treated with the Medium CRIF SystemA 14-lb., five-year-old male dog presented with a Y-fracture of the left distal humerus.
Patient was treated with a 4.5 mm intercondylar cortical lag screw and the medium CrIf System (5.0 mm rod, medium clamps, and 3.5 mm cortex screws).
Patient treated with the Small CRIF SystemAn 11-lb., four-year-old female cat presented with a non-union of the right tibia 10 weeks after initial repair of a grade 3 open fracture with a Type II external fixator.
The fibula was shortened and the fracture debrided. Cancellous bone was used to fill the gap and the Small CrIf System was implanted (3.0 mm rod, small clamps, and 2.7 mm cortex screws).
Postoperative cranio-caudal
Postoperative lateral
4-month follow-up cranio-caudal
4-month follow-up lateral
Preoperative lateral
Postoperative cranio-caudal
Postoperative lateral
6-week follow-up cranio-caudal
6-week follow-up lateralPreoperative lateral
Preoperative cranio-caudal
Preoperative cranio-caudal
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 7
Clinical Cases
Postoperative cranio-caudal
Implant removal at 4-month follow-up cranio-caudal
Postoperative lateral
Implant removal at 4-month follow-up lateral
Preoperative lateral
4-month follow-up lateral
Preoperative cranio-caudal
4-month follow-up cranio-caudal
Patient treated with the Mini CRIF SystemAn 8.4-lb., eight-month-old female cat presented with a comminuted shaft fracture of the right femur.
Patient was treated with a 2.0 mm lag screw in the main fracture segment and a double mini CrIf System (2.0 mm rod, mini clamps, 2.0 mm cortex screws). removal of CrIf System resulted in remineralization of bone.
references: 1. Clinical cases courtesy of Clinic of Veterinary Surgery, Ludwig-maximilians—university of munich germany; Dr. ulrike matis, Dr. Klaus Zahn.2. Zahn K, matis u. The clamp rod internal fixator—application and results in 120 small animal fracture patients. Vet Comp Orthop Traumatol. 2004; 17(3):110–120.
8 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique
SurgICAL TEChNIquE
1PreparationDetermine which CrIf System is most appropriate based on patient size, weight, bone, fracture pattern, and activity.
Ensure adequate soft tissue coverage where system is to be implanted. Implant profile is slightly larger than corresponding plate system.
Determine the length of the rod and number of clamps required, anticipating where each screw will be fixed to fragments.
Important: It is strongly suggested that at least three clamps and screws are placed in each main bone fragment, especially in soft bone.
CRIF System Product Reference Table
*See page 14 for detailed information
VC2000.01 mini Clamp VC3000.01 Small Clamp VC5000.01 medium Clamp
VC2000.02 mini End Clamp VC3000.02 Small End Clamp VC5000.02 medium End Clamp
Vr201.030– 2.0 mm rods Vr301.045– 3.0 mm rods Vr501.060– 5.0 mm rods Vr201.090 Vr301.120 Vr501.240
VS201.0XX– 2.0 mm Cortex Screws* VS204.0XX– 2.7 mm Cortex Screws* VS301.0XX– 3.5 mm Cortex Screws* VS202.0XX VS205.0XX VS302.0XX VS403.0XX– 4.0 mm Cancellous VS404.0XX Screws*
392.00 bending Irons 312.561 rod bender, for 3.0 mm 312.561 rod bender, for 3.0 mm (2 required) and 5.0 mm rods and 5.0 mm rods
392.970 rod holding forceps, 392.971 rod holding forceps, 392.972 rod holding forceps, for 2.0 mm rods for 3.0 mm rods for 5.0 mm rods
392.973 Clamp Spreader, 392.974 Clamp Spreader, 392.974 Clamp Spreader, for mini Clamps for Small and for Small and medium Clamps medium Clamps
Mini Small Medium
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 9
2Lag screw placement (optional)After reduction, one or more lag screws may be inserted for fracture compression before placement of the CrIf construct. Leave the periosteum intact whenever possible, to preserve the blood supply to the bone fragments.
Surgical Technique
3Rod preparation
Instrument
388.868 Template, for rods
using the rod template, determine required contour of rod.
Note: When clamps are planned for placement near acute bends, the clamps must be placed on the rod prior to rod contouring.
10 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique
Surgical Technique
rod preparation
Instrument
312.561 rod bender, for 3.0 mm and 5.0 mm rodsor392.00 bending Iron (2 required)
Optional instruments
329.24 bending Pliers
329.241 Anvil for 3.0 mm–5.0 mm rods, for use with 329.24
329.30 Plate bending Press
388.911 bending Irons, for 5.0 mm rods, left
388.922 bending Irons, for 5.0 mm rods, right
Contour the rod using appropriate instrument as noted in the CrIf System reference Table on page 8, or any of the optional instruments listed.
If rod requires cutting, ensure signifi cant burrs are removed from cut ends prior to implantation.
To improve torsional stability, the contour of the rod should match the shape of the bone as closely as possible.
The etched line on the rod is a helpful reference for contouring in multi-planes.
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 11
4Load clamps on rod
Instruments
392.973– Clamp Spreaders392.974
392.970– rod holding forceps392.972
It is important to know the number of clamps to be used at this time, since adding clamps later is diffi cult and time-consuming.
Standard technique is to fi rst load all clamps on the contoured rod before placement in the operative site. Alternatively, clamps can be loaded during rod positioning, but this is challenging and should be avoided.
first, load one standard clamp in the clamp spreader. Place this clamp on the rod. Next, load the remaining standard clamps. Clamps can be loaded from both directions. Once all the standard clamps have been loaded on the rod, add the end clamps to the clamp and rod construct.
Tip: If desired, before loading, slightly compress the fl anges of end clamps with rod holding forceps so they will grip the rod. This will prevent the standard clamps from sliding off of the rod and aid in construct handling.
Surgical Technique
12 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique
Surgical Technique
5Place construct
Instruments
319.01, Depth gauges*319.11
323.201, Drill guides*323.26, 323.36
392.970– rod holding forceps392.972
using the rod holding forceps, place the clamp and rod construct in the operative site. Orient each clamp to provide optimal screw purchase in the various bone fragments.
beginning at either end clamp, use the appropriate drill guide or soft tissue protection sleeve to drill the appropriate screw hole.
measure with the depth gauge, tap (if using non-self-tapping screws) and then insert an appropriate size screw.
*found in recommended Sets (see page 19)
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 13
The screw must be fully tightened in order for the clamp to securely grasp the rod. repeat for all remaining clamps.
Important: It is strongly suggested that at least three clamps and screws are placed in each main bone fragment, especially in soft bone.
Surgical Technique
14 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique
ImPLANTS
2.0 mm Cortex ScrewsVS201.006– 6 mm–40 mm lengthsVS201.040
2.0 mm Cortex Screws, self-tappingVS202.006– 6 mm–40 mm lengthsVS202.040
2.7 mm Cortex ScrewsVS204.006– 6 mm–55 mm lengthsVS204.055
2.7 mm Cortex Screws, self-tappingVS205.006– 6 mm–55 mm lengthsVS205.055
3.5 mm Cortex ScrewsVS301.010– 10 mm–70 mm lengthsVS301.070
3.5 mm Cortex Screws, self-tappingVS302.010– 10 mm–70 mm lengthsVS302.070
4.0 mm Cancellous Screws, fully threadedVS403.010– 10 mm–70 mm lengthsVS403.070
4.0 mm Cancellous Screws, partially threadedVS404.010– 10 mm–70 mm lengthsVS404.070
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 15
ClampsVC2000.01 mini Clamp, VC2000.02 mini End Clamp,
– for use with 2.0 mm screws and rods
VC3000.01 Small Clamp, VC3000.02 Small End Clamp,
– for use with 2.7 mm screws and 3.0 mm rods
VC5000.01 medium Clamp, VC5000.02 medium End Clamp,
– for use with 3.5 mm screws and 5.0 mm rods
2.0 mm RodsVr201.030– 30 mm–90 mm lengthsVr201.090
3.0 mm RodsVr301.045– 45 mm–120 mm lengthsVr301.120
5.0 mm RodsVr501.060– 60 mm– 240 mm lengthsVr501.240
Implants
notch in end clamp
notch in end clamp
notch in end clamp
16 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique
INSTrumENTS
312.561 rod bender, for 3.0 mm and 5.0 mm rods– used to contour rod– Accommodates both small and
medium rods
388.868 Template, for rods – malleable rod easily contours to the bone– reduces time required to properly contour rods– reusable for many cases
329.24 bending Pliers
329.30 Plate-bending Press329.30 Plate-bending Press
329.241 Anvil for 3.0 mm–5.0 mm rods, for use with 329.24
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 17
Instruments
392.00 bending Iron (2 required)– used to contour mini rods– used in pairs for optimal function
388.911 bending Iron for 5.0 mm rod, left
388.922 bending Iron for 5.0 mm rod, right
rod holding forceps392.970 for 2.0 mm rod, mini392.971 for 3.0 mm rod, small392.972 for 5.0 mm rod, medium – grips rod during contouring,
clamp loading, and screw insertion
392.970
392.971
392.972
18 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique
Instruments
Clamp Spreaders392.973 for mini Clamps392.974 for Small and medium Clamps – Provides secure handling and easier
loading of clamps
388.72 rod Cutter – for rods up to 6.0 mm
391.990 Plate and rod Cutter – for rods up to 3.0 mm
Also Available
392.973
392.974
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 19
rECOmmENDED SETS
Recommended sets for 2.0 mm cortex screws103.522 mini fragment Standard Instrument Set103.527 mini fragment Standard Implant Set
Recommended sets for 2.7 mm, 3.5 mm and 4.0 mm screws103.501 Small fragment Standard Instrument Set103.518 Small fragment Standard Screw Set
103.527
103.518
103.501
103.521
20 DePuy Synthes Vet Clamp and Rod Internal Fixation (CRIF) System Surgical Technique
CLAmP rOD INTErNAL fIXATOr (CrIf) ImPLANT SET (103.001)
Graphic Case690.516 Clamp and rod Internal fixation (CrIf)
Implant graphic CaseImplantsrods, 2 ea. Size Diameter (mm) Length (mm)Vr201.030 mini 2.0 30Vr201.045 mini 2.0 45Vr201.090 mini 2.0 90
Vr301.045 Small 3.0 45Vr301.090 Small 3.0 90Vr301.120 Small 3.0 120
Vr501.060 medium 5.0 60Vr501.075 medium 5.0 75Vr501.090 medium 5.0 90Vr501.105 medium 5.0 105Vr501.120 medium 5.0 120Vr501.150 medium 5.0 150Vr501.180 medium 5.0 180Vr501.210 medium 5.0 210Vr501.240 medium 5.0 240
Standard Clamps, 10 ea.
Size Screw (mm) rod (mm)VC2000.01 mini 2.0 2.0VC3000.01 Small 2.7 3.0VC5000.01 medium 3.5 5.0
End Clamps, 4 ea.
Size Screw (mm) rod (mm)VC2000.02 mini 2.0 2.0VC3000.02 Small 2.7 3.0VC5000.02 medium 3.5 5.0
388.868 Template, for 3.5 mm rods, 2 ea.
for detailed cleaning and sterilization instructions, please refer to: www.synthes.com/cleaning-sterilization In Canada, the cleaning and sterilization instructions will be provided with the Loaner shipments.
Clamp and Rod Internal Fixation (CRIF) System Surgical Technique DePuy Synthes Vet 21
CLAmP rOD INTErNAL fIXATOr (CrIf) INSTrumENT SET (103.002)
Graphic Case690.517 Clamp rod Internal fixation (CrIf)
Instrument graphic Case
Instruments312.561 rod bender, for 3.0 mm and 5.0 mm rods392.00 bending Iron, for 1.25 mm, 1.6 mm and
2.0 mm Kirschner Wires, 2 ea.392.970 rod holding forceps, for 2.0 mm
rod–mini392.971 rod holding forceps, for 3.0 mm
rod–small392.972 rod holding forceps, for 5.0 mm
rod–medium392.973 Clamp Spreader, for mini Clamps392.974 Clamp Spreader, for Small and
medium Clamps
Also Available388.72 rod Cutter391.990 Plate and rod Cutter
DePuy Synthes Vet1302 Wrights Lane EastWest Chester, PA 19380 Telephone: (610) 719-5000 To order: (800) 523-0322
www.synthesvet.com
Limited Warranty and Disclaimer: DePuy Synthes Vet 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.
WARNING: In the USA, this product has labeling limitations. See package insert for complete information.
CAUTION: USA Law restricts these devices to sale by or on the order of a physician.
Not all products are currently available in all markets.
© DePuy Synthes Vet, a division of DOI 2013. All rights reserved.J7322-C 1/14 DV
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