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Tornier Latitude Manual
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Tornier Latitude Manual

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S u r g i c a l
Technique
Elbow Prosthesis
Latitude
®
www.tornier.com

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Summary of Contents for Tornier Latitude

  • Page 1 S u r g i c a l Technique Elbow Prosthesis Latitude ® www.tornier.com...
  • Page 2 INSTRUMENTATION The Latitude ® surgical technique has been developed in conjunction with: Shawn O’Driscoll, MD, PhD (Mayo Foundation), Ken Yamaguchi, MD (Washington University, Barnes Jewish Hospital) Graham King, MD, MSc (University of Western Ontario) Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 3 • Optimal bone preservation. • Anatomic distribution of loads on polyethylene. CLINICAL OBJECTIVES • Latitude for use in a wide range of indications. • Latitude to reproduce patient flexion-extension axis. • Total Latitude to use either unlinked or linked. • Latitude to reconstruct the radio-humeral joint.
  • Page 4 22.4 mm with a mean of 19 mm (fig. 03). (fig. 03) • The placement of the Latitude elbow is based on the normal flexion-extension axis. • 3 sizes of stem and 4 sizes of spool (small, medium, large, large +).
  • Page 5 7° varus/valgus movement Humeral spools have been designed with a concave barrel shaped trochlea to preserve linear contact throughout 7° of valgus/varus movement with the ulnar component (fig. 05). (fig. 05) Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 6 • 3 sizes of stems and 2 lengths design allows for ease of assembly (standard and short figs 08 and 09). • The Latitude ulnar stem is designed with an optional cap so that the components can be unlinked or linked. Anterior fin to prevent...
  • Page 7 40 % of instability and premature wear. 60 % • The placement of the Latitude elbow radial component is based on the flexion-extension axis. (fig. 10) • 4 sizes of heads (Ø 18, 20, 22 and 24 mm) and 2 stem diameters (5.0 mm and 6.5 mm).
  • Page 8 Anatomical spools Trochlear cutting guides Flexion-extention axis drilling guide Capitellum cutting guides Humeral rasps Humeral trial components Ulnar rasps Ulnar cutting guides Ulnar diaphysis drill guides Bell saws Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 9 • Correction of functional deformities • Revision procedures where other treatments or devices have failed • Treatment or fractures that are unmanageable using other techniques • Same indications for Latitude Anatomic (Hemi Elbow Prosthesis) • The prosthesis is for cemented use only 2 Contraindications Refer to the instruction for use delivered with the implant.
  • Page 10 Custom Products Department 6 weeks before surgery. Département des produits spéciaux TORNIER 161, rue Lavoisier Montbonnot 38334 Saint Ismier Cedex – France Tél : +33 (0)4 76 61 35 00 Fax : +33 (0)4 76 61 35 33 Incompatibility Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 11 LATITUDE ANATOMIC SURGITAL TECHNIQUE 5. LATITUDE ANATOMIC SURGICAL TECHNIQUE (Hemi Elbow Prosthesis) • Refer to pages 11 to 22 for the Latitude Anatomic surgical technique (fig. 13). Note The Latitude Anatomic Prosthesis does not take spool offset into consideration. • Refer to page 33 for the cement and bone graft technique •...
  • Page 12 (fig. 16c). The medial intermuscular septum is excised. (fig. 16c) The ulnar nerve is mobilized and transposed anteriorly into the subcutaneous tissue (fig. 16d). It is carefully protected throughout the remainder of the procedure. (fig. 16d) Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 13 The ligament origins are marked with a colored suture to facilitate subsequent reattachment. (fig. 16g) Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 14 This determination will be used throughout the procedure. Should the patient’s humeral condyle size fall between two anatomical sized trial spools, pick the smaller one for the remainder of the procedure. (fig. 17c) Instruments to use Capitellum radii gauge Anatomical spool Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 15 Remove the central portion of the distal humerus (trochlea, sulcus and lateral ridge) to the proximal aspect of the olecranon fossa with either an oscillating saw or large (fig. 19) rongeur (fig. 19). Instruments to use Stabilization pin Drilling guide Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 16 Drill the flexion-extension axis and then remove the guide (fig. 20c). (fig. 20c) Anterior view As a check, reinsert the flexion-extension pin to confirm correct alignment (fig. 21). (fig. 21) Posterior view Instruments to use Axis pin Drilling guide Drill bit Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 17 (small, medium, large). Determine spool offset by placing offset gauge between the flexion-extension axis pin and the intramedullary alignment rod (fig. 24b). (fig. 24b) Instruments to use Medullary Offset determining gauge Humeral diaphysis reamer Burr Flexion/extension axis pin alignment rod Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 18 (fig. 25b). axis pin (fig. 25b) Instruments to use Offset determining gauge Flexion/extension Humeral trochlea Assembly screw Humeral trochlea axis pin cutting guide support cutting block Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 19 (fig. 28). Take care to avoid damaging anterior structures. (fig. 28) Instruments to use Diaphysis aiming guide Humeral trochlea Assembly screw Humeral trochlea Stabilization pin Drill bit cutting guide support cutting block Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 20 Smooth the cut surface with a humeral broach or burr (fig. 31). (fig. 31) Instruments to use Stabilization pin Pin puller Diaphysis Medullary Humeral diaphysis aiming guide alignment rod canal broach Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 21 The indication of side right or left should point posteriorly so that it can be read by the surgeon (fig. 34b). (fig. 34b) Instruments to use Capitellum cutting guide Flexion/extension Humeral diaphysis axis pin canal broach Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 22 Position the round part (capitellum) of the spool on the left for a left trial/on the right for a right trial stem. Place the appropriate size trial humeral screw from medial to lateral. Tighten using the 4.5 mm hex screwdriver. Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 23 Position the trial stem assembly in the humeral shaft. Use the impactor to seat the implant flush with the bone (fig. 37). (fig. 37) Instruments to use 4.5 hexagonal screwdriver Trial spool Trial humeral screw Impactor Trial humeral stem Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 24 (fig. 38c) Insert the selected spool on the cutting axis. (fig. 38d) Instruments to use Locking screw Ulnar/radial cutting guide Anatomical spool Ulnar/radial Tightening screws Forearm positioning guide cutting guide sliding block Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 25 (fig. 40b). (fig. 40b) Anterior view The correct positioning of the jig is essential to ensure proper radial head and ulnar resection. (fig. 40a) Medial view Instruments to use Ulnar/radial cutting guide Anatomical spool Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 26 Bell saw collar completed when the collar of the saw sits on the lateral ring (fig. 42). Ensure the ulnar nerve is protected. (fig. 42) Instruments to use Ulnar/radial cutting guide Bell saw Anatomical spool Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 27 The position of the guide should be aligned as shown with reference to the tip of the coranoid and olecranon. (fig. 44b) Instruments to use Ulnar diaphysis axis drill bit Ulnar diaphysis axis Ulnar diaphysis axis drill guide drill guide handle Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 28 (fig. 46). Use the orientation of the flat spot on the posterior surface of the ulna to assist in correctly rotating the ulnar broach. (fig. 46) Instruments to use Ulnar broaches Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 29 Gently ream the canal making sure not to penetrate the lateral or dorsal cortex (fig. 47c). Flexible reamers (not included), can be used if preferred. (fig. 47c) Instruments to use Ulnar broaches Ulnar reamer handle Ulnar reamer Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 30 Position the trial stem in the ulnar canal and then seat it flush with the ulna using the impactor (fig. 48a-b). (fig. 48a) (fig. 48b) Instruments to use Trial ulnar stems Impactor Trial radial stem impactor Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 31 (fig. 51b). The radial head trial seats freely on the stem and is not a snap fit. (fig. 51b) Instruments to use Trial radial stem Impactor Trial radial stem impactor Trial radial head Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 32 If the trial reduction is not satisfactory, check that the trial stems sit properly on the bone (fig. 53a) and that no soft tissue impingement has occurred. Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 33 To remove the humeral component, grasp the humeral trial spool with the humeral extractor clamp (fig. 55). Then gently tap retrograde and remove the component. (fig. 54) (fig. 55) Instruments to use Optional trial Humeral component Ulnar stem extractor ulnar screw extractor Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 34 The bone graft is wedged firmly in place (fig. 58). (fig. 58) Unlinked • The supplied ulnar screw is left in the ulnar component. • Proceed with ligament repair and closure. Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 35 • Reduce humeral and ulnar components to approximately 140° of flexion, insert ulnar cap into the ulnar stem (fig. 59). (fig. 59) • Tighten the screw until the torque release is reached (fig. 60). (fig. 60) Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 36 • Using the tab bending tool and a mallet (fig. 61a), bend the cap tab over the screw (fig. 61b). (fig. 61a) (fig. 61b) Instruments to use Torgue screwdriver adaptator Ulnar cap lug bending tool Mallet Cement restrictor inserter Torque handle Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 37 10 weeks postoperatively. Night extension splinting is initiated immediately postoperatively to maximize elbow extension. Instruments to use Suture passer Fiberwire is a trademark from Arthrex, FL. Ethibond is a trademark from Johnson & Johnson, NJ. Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 38 The radial head cut is (cannulated, trochar or flat) into the performed at the level cutting guide. Insert the selected of the notch on the side spool on the cutting axis. of the triceps on guide. Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 39 The ulnar cap must be assembled to the ulnar stem after revision of the plastic bushing. (picture 3) Indeed, the ulnar cap is the only way to secure the plastic bushing on the ulnar stem (picture 7). (picture 7) Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 40 Burr - Ø 6 Right side Ref. MKY059 Ref. MKY058 Left side Ref. MKY060 Humeral diaphysis Stabilization pin reamer - Ø 6 Ø 3 - Length 55 mm Ref. MKY007 Ref. MKY062 Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 41 Ref. MHG001 Medium size, right Ref. MKY087 Medium size, left Ref. MKY090 Large size, right Ref. MKY088 Large size, left Ref. MKY091 Large + size, right Ref. MKY139 Large + size, left Ref. MKY140 Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 42 Medium size Ref. MKY076 Ref. MKY052 Large size Ref. MKY077 Forearm positioning guide Ref. MKY046 Ulnar reamer - standard stems Ulnar/radial cutting guide Ref. MKY132 sliding block Ref. MKY047 Ulnar reamer handle Ref. MKY131 Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 43 Ref. MKY121 Ulnar stem extractor Ref. MWA118 Torque screwdriver adaptor (hexagon 2,5 mm) Cement insert restrictor Ref. MKY122 Ref. MKY149 Trial ulnar cap Small size Ref. MKY113 Medium size Ref. MKY114 Large size Ref. MKY115 Latitude Elbow Prosthesis Surgical Technique UCLT101...
  • Page 44 Ulnar stem large right DKY085 Ulnar stem small left DKY086 Ulnar stem medium left DKY087 Ulnar stem large left 161, rue Lavoisier. Montbonnot. 38334 Saint-Ismier Cedex. France. Tel.: 33 (0)4 76 61 35 00. Fax: 33 (0)4 76 61 35 33. www.tornier.com...