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HANSSON PINLOC ® Femoral neck fracture system 1. Locate the optimal point for skin incision The 3,2 mm guidewires are used to locate the optimal point for skin incision. (A Transparent Implant Posititioning Template can be applied to the monitor of the image intensifier to facilitate the insertion of the Guide Wire.) 2. Make incision Make a 40 mm longitudinal incision and divide the deep fascia in the direction of the fibres. The area of the femur where the plate is to be positioned is cleared with a raspatorium. Introduce the 8 mm Triangular Guide. 3. Introduce the inferior Guide Wire In the AP-view, the tip of the Guide Wire should be at the level of the lesser trochanter. It is essential to have the Guide Wire close to the inner inferior cortex. In the lateral view, it should be central. Select a Triangular Guide There are three Triangular Guides with different distances between the sleeves (6,8 or 10 mm). Always start by introducing two additional Guide Wire Sleeves into the 8 mm Triangular Guide. 4. Introduce the Triangular Guide The Guide Wire Sleeves have the same outer diameter as the Hansson Pins. The surgeon can assess if the Hansson Pins can be inserted without cutting through the posterior and/or anterior cortex. 5. Assemble the Pinloc Plate and the instruments Based on the previous assessment, the correct plate can be selected. The assembled Plate is introduced over the Guide Wire. It is important to tighten the Drill Sleeves with the Drill Sleeve Handle. The Drill is advanced to the subchondral bone of the femoral head. It is important to ensure that the Guide Wire or the Drill does not penetrate the hip joint. The Drill is left in position. 7. Drill the posterior canal The assembled plate can be rotated around the inferior Drill to position the sharp tip of the Solid Drill in the correct alignment. In the lateral view, it is essential to have the Solid Drill close to the inner posterior cortex. Once the alignment of the Solid Drill is satisfactory, the Solid Drill is advanced to the subchondral bone of the femoral head. 8. Drill the anterior canal The sharp tip of the Solid Drill will indicate the direction of the Solid Drill. If the femoral neck is too narrow for the anterior Hansson Pin, a short Anterior Peg can be inserted to stabilize the lateral cortex without passing through the femoral neck. 6. Drill the inferior canal Introduce the Drill through the inferior Drill Sleeve. The Drill Sleeve handle is used to push and hold the assembled Plate. A Drill Adapter can be used to facilitate the insertion of the Drills. 9. Measure the anterior canal The required Pin length is read off the scale on the Solid Drill protruding from the anterior Drill Sleeve. If the measured value is between two pin lengths, always choose the shorter pin length or adjust the depth manually if possible, using the Ratchet Handle attached to the Solid Drill. Instrument-to-Pin Assembly Assemble the instruments and the Hansson Pin. Make sure to align the arrows as displayed in the illustrations. 10. Introduce the anterior Pin A Pin of the length required for the anterior canal is mounted on the T-handle Hex and inserted into the anterior pre-drilled canal. The T-handle Hex is turned Clockwise as far as it will go. 11. Deploy the hook of the anterior Pin When the Pin is properly locked in the Plate, the hook will automatically point towards the center of the femoral head. Deploy the hook by turning the assembled screwdriver whilst gently pushing medially on the T-handle Hex. Do not over-tighten the introduction screw. 12. Introduce the posterior Pin and then the inferior Pin The same procedure (steps 9-11) is repeated when introducing the posterior and then the inferior Pin. 13. Check the position of the Pins Before closing the skin incision, it is important to make sure that none of the Pins have penetrated the joint. Turn for extraction and instrument list In the frontal view, the posterior Solid Drill should be positioned just above the center of the femoral neck and head. It is important to avoid the area where the laterial epiphyseal arteries enter the femoral head (A). T-handle Hex 6 mm Hansson Pin Screwdriver Hex 3 mm Ratchet Handle
