PRO

Pelvis and
Acetabulum System
Operative technique
PRO | Operative technique

Pelvic and acetabular fracture

Operative technique

Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Indications and contraindications . . . . . . . . . . . . . . . . 5

PRO system design – implants . . . . . . . . . . . . . . . . . . . 6

Design summary . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Matta pelvic plates . . . . . . . . . . . . . . . . . . . . . . . . . 6

PRO quadrilateral surface plates . . . . . . . . . . . . . . 8

Matta pelvic system screws . . . . . . . . . . . . . . . . . . 10

PRO system design – instruments . . . . . . . . . . . . . . . . 11

PRO system design – trays . . . . . . . . . . . . . . . . . . . . . . 15

Retractors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

PRO carbon fiber retractors . . . . . . . . . . . . . . . . . . 16

Matta sciatic nerve retractors . . . . . . . . . . . . . . . . 18

PRO retractor 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

PRO retractor 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

PRO retractor 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

PRO suction retractor . . . . . . . . . . . . . . . . . . . . . . . 19

Reduction instruments . . . . . . . . . . . . . . . . . . . . . . . 20

Ball spike pushers . . . . . . . . . . . . . . . . . . . . . . . . . 20

PRO reduction instruments . . . . . . . . . . . . . . . . . . 21

PRO jaw clamps . . . . . . . . . . . . . . . . . . . . . . . . 22

PRO Weber clamps . . . . . . . . . . . . . . . . . . . . . . 24

PRO Jungbluth clamps . . . . . . . . . . . . . . . . . . . 25

PRO Farabeuf clamps . . . . . . . . . . . . . . . . . . . 26

Additional Matta reduction clamps . . . . . . . . 27

Screw fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Spiked screw inserter . . . . . . . . . . . . . . . . . . . . . . 28

Swiveling spiked disk . . . . . . . . . . . . . . . . . . . 28

Washer loading stand . . . . . . . . . . . . . . . . . . . . 28

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 PRO | Operative technique

Periosteal elevators . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Plate contouring and bending techniques . . . . . . . . . 30

PRO plate bender. . . . . . . . . . . . . . . . . . . . . . . . . . . 31

PRO plate bending holder. . . . . . . . . . . . . . . . . . . . 32

PRO in-situ bender . . . . . . . . . . . . . . . . . . . . . . . . . 32

Plate and screw fixation. . . . . . . . . . . . . . . . . . . . . . . . 33

Handle for plate insertion . . . . . . . . . . . . . . . . . . . 33

Plate screw inserter . . . . . . . . . . . . . . . . . . . . . . . . 33

Angled depth gauge. . . . . . . . . . . . . . . . . . . . . . . . . 33

Pelvic ring fracture types and fixation. . . . . . . . . . . . 34

Pubic symphysis disruption. . . . . . . . . . . . . . . . . . 34

Ilium fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Sacroiliac dislocation . . . . . . . . . . . . . . . . . . . . . . . 35

Sacroiliac fracture / dislocation . . . . . . . . . . . . . . . 35

Sacrum fracture . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Acetabular fracture types and fixation. . . . . . . . . . . . 37

Posterior wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Posterior column. . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Anterior wall. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Anterior column . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Transverse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

T-shaped. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Transverse and posterior wall. . . . . . . . . . . . . . . . 40

Posterior column and posterior wall. . . . . . . . . . . 40

Both column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Anterior column and posterior hemi-transverse . . . . 42

Suprapectineal plate technique. . . . . . . . . . . . . . . . . . 43

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PRO | Operative technique

Introduction
The surgical approaches and operative techniques
described on the pages to follow are for the treatment
of complex injuries to the pelvic structures.
• In order to treat these injuries, the surgeon must be
well-trained and / or have some years of experience
as a pelvis specialist
•W
 orkshop or specimen lab training is recommended
prior to attempting the surgery techniques herein
described
•S
 urgeon education programs are offered by
Stryker on a local and regional basis
See package insert (Instruction For Use No. V15011 and
V15013) for a complete list of potential adverse effects,
contraindications, warnings and precautions.
The package inserts for all unsterile components of
the pelvis system (“Instructions for Use”) contains the
instructions for sterilization.

Acknowledgments
Stryker acknowledges Michael Archdeacon, M.D, Pierre
Guy, M.D., Joel Matta, M.D., and H. Claude Sagi, M.D.
for their support in the preparation of this material.
This publication sets forth detailed recommended
procedures for using Stryker devices and instruments.
It offers guidance that you should heed; but, as with
any such technical guide, each surgeon must consider
the particular needs of each patient and make
appropriate adjustments when and as required.
A workshop training is recommended prior to
performing your first surgery. All non-sterile devices
must be cleaned and sterilized before use.
Follow the instructions provided in our cleaning
and sterilization guide (OT-RG-1). Multi-component
instruments must be disassembled for cleaning.
Please refer to the corresponding assembly /
disassembly instructions.
Please remember that the compatibility of different
product systems have not been tested unless specified
otherwise in the product labeling.
The surgeon must discuss all relevant risks, including
the finite lifetime of the device, with the patient, when
necessary.

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 PRO | Operative technique

Indications and contraindications

Indications for use Contraindications
Matta pelvic plates The physician’s education, training and professional
judgment must be relied upon to choose the most
The Stryker Matta pelvic plates are indicated for:
appropriate device and treatment.
•F
 ractures of the acetabulum, sacrum,
Conditions presenting an increased risk of failure
ilium, and entire pelvic ring
include:
•R
 evision surgery of pseudoarthroses,
•A
 ny active or suspected latent infection or marked
non-unions, and mal-unions
local inflammation in or about the affected area
•O
 steotomies
•C
 ompromised vascularity that would inhibit adequate
• A
 rthrodeses blood supply to the fracture or the operative site
•S
 acroiliac joint dislocations • Bone stock compromised by disease, infection or prior
implantation that can not provide adequate support
•S
 ymphysis pubis disruptions
and / or fixation of the devices
PRO quadrilateral surface plates • Material sensitivity, documented or suspected
The Stryker PRO plates are indicated • Obesity. An overweight or obese patient can produce
for the following regions of the pelvis: loads on the implant that can lead to failure of the
•A
 nterior column fixation of the device or to failure of the device itself

• A nterior column combined •P

 atients having inadequate tissue coverage
with posterior hemi-transverse over the operative site

•Q
 uadrilateral surface • Implant utilization that would interfere with
anatomical structures or physiological performance
•A
 ny mental or neuromuscular disorder which would
create an unacceptable risk of fixation failure or
complications in postoperative care
•O
 ther medical or surgical conditions which
would preclude the potential benefit of surgery

Please see package insert for warnings, precautions,

adverse effects, and other essential product
information on the product labels.

CAUTION
Stryker systems have not been evaluated for
safety and compatibility in magnetic resonance
(MR) environment and have not been tested for
heating or migration in the MR environment
unless specified on the product labels.

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PRO | Operative technique

PRO system design

Implants

Matta plates design summary

Stainless steel cold-worked Variety of rigid and flexible

and annealed plates plates designed to fit the pelvis
surface.
Curved plates for male Pre-contoured R88 and R108
and female anatomy curvatures designed to fit male
and female pelvic anatomy.
Dedicated pubic Pre-contoured plates with an
symphysis plates increased midsection designed
specifically for stabilizing the
pubic symphysis.
Round and tapered plate edges Designed to facilitate plate
sliding submuscularly.
Wide screw angulation with Enhanced for more choices for
Ø3.5mm screws screw placement, especially for
posterior wall fixation. Ø3.5mm
screws allow for a 70° cone of
angulation.

Matta pelvic plate types

Curved and straight plates

•H
 ard (cold-worked) material, 2.5mm thick,
16mm spacing between the holes
• Curved R108 plates with holes ranging
from 4 – 16*, 18 and 20
•C
 urved R88 plates with holes ranging
from 3 – 16*, 18 and 20
• Straight plates (cold-worked) with holes
ranging from 2 – 16*, 18 and 20

Flex plates Symphysis plates

• Soft (annealed) material, 2.5mm thick, 12mm • Hard (cold-worked) material, 3.2mm thick, 16mm
spacing between the holes, higher malleability spacing between the holes, 75mm radius
than hard plates
• Symphysis plates offered in 4 hole and 6 hole options
•S
 traight plates (annealed) with holes ranging
from 3 – 16*, 18 and 20 *Offered in 1 hole increments.

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 PRO | Operative technique

PRO system design

Implants

Matta pelvic plate types

Female pelvis

Radius 88mm

Male pelvis

Radius 108mm

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PRO | Operative technique

PRO system design

Implants

PRO quadrilateral
surface plates
Three QLS plates are offered in the
PRO system: one suprapectineal
plate and a large and small
infrapectineal plate.
• Pre-contoured and designed using
proprietary SOMA bone database Infrapectineal plate Infrapectineal plate Suprapectineal
and software applications (large) (small) plate

• Material: annealed stainless steel

• T
 hickness: 2.5mm
• Ø3.5mm and Ø4.5mm screws
may be used with all plates
•A
 vailable in left and right options

Infrapectineal plate,
large and small
The design of the infrapectineal 14 screw holes in the small handle for plate insertion (see blue
plates allows them to buttress the and 16 screw holes in the large circle in figures below), but it can
quadrilateral surface in treatment infrapectineal plate are pre-angled attach to any screw hole.
of acetabular fractures with central away from the acetabulum and
The anterior extension may be
dislocation, comminution, and accept 3.5mm and 4.5mm screws.
bent over the pubic ramus to get
disassociation of the quadrilateral
The central perpendicular hole multiplanar fixation in this region.
surface from the posterior column.
is designed for attachment to the

L extension bent over pubic ramus Infrapectineal plate Infrapectineal plate

(large) (small)

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 PRO | Operative technique

PRO system design

Implants

Suprapectineal plate
The design of the suprapectineal
plates allows them to buttress the
quadrilateral surface in treatment
of the following fractures:
• A nterior column
• A nterior column and posterior
hemi-transverse
• A ssociated both column
• High transtectal transverse that Suprapectineal plate
exits the posterior column near
the sciatic notch
The single plate construct enables
screw fixation along the pelvic brim
and posterior column.

16 screw holes are pre-angled away

from the acetabulum and accept 3.5
and 4.5mm screws.
The central perpendicular hole
is designed for attachment to the
handle for plate insertion (see blue
circle in figure to the right), but it
can attach to any screw hole.

Refer to page 44 for additional

technique guidance for the
suprapectineal plate.

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PRO | Operative technique

PRO system design

Implants

Matta pelvic system

screws
Ø3.5mm self-tapping cortical
screws are recommended for
plate fixation. The plates are
designed to have low screw /
plate profiles and accept Ø3.5mm
screws to be inserted at angles
up to ± 35° in all directions.
35º
This increased screw angulation
may be helpful to avoid penetrating
the hip joint or to be able to drive
Ø3.5mm Ø4.5mm Ø3.5mm screw
a screw obliquely in the area of the angulation
iliac bone, avoiding a previously
inserted, isolated screw.
Ø4.5mm cortical screws may also
be used, however are less common.
Instrumentation is offered to allow
the surgeon to fix plates to the bone
and allow accurate independent
screw placement.

NOTICE NOTICE
Use a sharp drill bit when Always use the designated drill
drilling bone, particularly in sleeve/Plate Screw Inserter (see
areas of hard, dense bone. This page 34) to assure accurate
may offer the surgeon more placement of the screw and to
control and help avoid plunging protect the adjacent soft tissues
that may injure neurovascular against the generation of heat
structures, viscera, or other and build-up of debris.
soft tissue structures. It may
The drill sleeves are also
also lessen heat generation.
designed to prevent damage to
Blunt drills should be discarded the drill bit and to avoid the
and replaced. drill bits being seized or
blocked in the sleeve.

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 PRO | Operative technique

PRO system design

Instruments

Instrument design summary

Carbon fiber retractors Four retractors designed to

match the anatomic region being
dissected. Retractors accept a light
pipe and suction tube for improved
visualization in deeper cavities
and may be fixed in place with
K-wires. Because they are made
of radiolucent carbon fiber, there
is no need to remove them for
fluoroscopy.

K-wires Two Ø3.2mm K-wires (150mm and

220mm lengths) are offered in the
system to fix the retractors into place.

Angled ball spikes Ball spike pushers are offered

straight and at 15° and 30° angles,
designed for fracture reduction in
deep spaces.

Spiked screw inserters for The spiked screw inserter is

Ø3.5mm and Ø4.5mm screws an instrument for reduction
and independent placement
of Ø3.5mm or Ø4.5mm screws.
The instruments are cannulated
to allow for drilling and screw
insertion through the instrument.

Spiked disk for Larger spiked disk with

spiked screw inserter K-wire holes may be used
with the spiked screw inserter
to allow for increased bone
contact to aid with reduction.

Washer pick-up stand A washer may be loaded into

the Ø3.5mm spiked screw
inserter utilizing the washer
loading stand and allows for
easy washer placement and
screw insertion in a single step.
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PRO | Operative technique

PRO system design

Instruments

Instrument design summary

Plate screw inserter The plate screw inserter can be

used to push the plate down to
the bone. It is also cannulated
to allow for drilling, measuring,
and inserting a screw through
the instrument. The tip allows
for swiveling and centering in
the screw hole.

Handle for plate insertion The handle for plate insertion

can be attached to any hole in
the PRO and / or Matta plates to
facilitate plate insertion. The
handle swivels to further assist
with access and to achieve the
desired plate placement.

Long scaled drills and Ø2.5mm and Ø3.2mm x 450mm

drill guides drills are offered in the PRO
system to allow for drilling
into deep spaces and through
the cannulated spiked screw
inserters and plate screw inserter.

Overdrills Ø3.5mm and Ø4.5mm x 390mm

overdrills are now offered in
the PRO system in order to lag
through the cannulated spiked
screw inserters and plate screw
inserter.

Long screwdriver Screwdrivers with a handle or AO

attachment are available to allow
for screw insertion through the
cannulated instruments (Spiked
Screw Inserter and Plate Screw
Inserter).

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 PRO | Operative technique

PRO system design

Instruments

Instrument design summary

Plate bender Designed for three-dimensional

contouring of all Matta and PRO
Q LS plates.

Plate bending holder Allows for secure and controlled

plate bending for both Matta and
PRO plates.

In-situ bender Offers an option for in-situ

plate bending.

Angled depth gauge Design allows for measuring along

tangential or angulated drill paths
in deep spaces.

Range of reduction instruments Variety of reduction forceps and

enhanced clamp designs offer many
options for fracture reduction and
fragment repositioning.

Screwdriver holding sleeve Offers efficiency in screw pick-up,

insertion, and removal.

Elastosil handles Surgeon may select a handle

according to his / her preference.

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PRO | Operative technique

PRO system design

Instruments

Instrument design summary

Four options of reduction pins Surgeon may select a pin

(5mm or 6mm in 150mm appropriate to fragment or bone
or 180mm lengths) size.

Sciatic nerve retractors

Availability in two sizes,
large and small.

Spiked disks Offer enhanced utility options

with reduction forceps and ball
spike pushers, which may allow
for increased bone contact. K-wire
holes have been incorporated to
allow for temporary fixation
during reduction.

MPS plate templates Allow plate bending outside

of the operative field.

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 PRO | Operative technique

PRO system design

Trays

Tray design summary

Basic instrument tray Tray is designed to accommodate

with pre-formed inserts basic instruments for three screw
sizes as well as additional specialty
instruments designed for working
in a deep surgical space through
less invasive surgical approaches.

Dedicated retractor tray An assortment of specialty

retractors are included with
the system.

Accessory instrument caddy An optional instrument caddy has

been added to the PRO system that
will fit into the open space in the
top layer of the PRO instrument
tray. The caddy is designed to house
the optional instruments including
the Ø4.5mm spiked screw inserter,
drill sleeve, screwdriver, and
Ø3.2mm drill, as well as the
overdrills.

Specialty reduction tray An assortment of specialty pelvic

reduction clamps designed for a
variety of surgical approach.

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PRO | Operative technique

PRO system design

Retractors

Four retractors are designed to

address the major issues related
to working in deep wounds:
• Illumination
• Obstructing of fluoroscopy
images by retractors
• Limited visibility of structures
due to fluids in the wound
• Handling

Illumination
To enhance illumination in the
surgical field, retractors 1, 2 and 3
may be equipped with a light pipe
attachment.
This single-use, disposable fiber
optic clip-on is designed to allow
a consistent delivery of light
to the deepest dissected area.
Surgeon preference will dictate
which retractor to put the light
pipe attachment on.
The light pipe attaches to the
fiber optic cable of a Stryker light
source or standard endoscopic
light source found in the OR via
a Storz connection.

CAUTION
If there is excessive heat, the
light source should be turned
off until the light pipe has
sufficiently cooled.

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 PRO | Operative technique

PRO system design

Retractors

Imaging
The retractors are made of
laminated carbon fiber and are
radiolucent, therefore they do not
need to be removed for fluoroscopy.

Suction feature
The suction retractor is specially The X-ray above shows a radiolucent retractor held in place with a K-wire,
designed so it not only functions as pictured with an infrapectineal plate.
a deep retractor in the areas of the
greater or lesser sciatic notch, but
additionally serves as a suction
device to irrigate blood and fluids
that accumulate at the base of the
wound.
The suction tip is a component in
the retractor tray that gets inserted
into sterile, 1 / 4" suction tubing.
The groove that runs the length of
the suction retractor accommodates
the tubing.
Starting at the working end of the
retractor, seat the suction tip first
and progressively insert the tubing Producer Description REF Inner Ø*
into the groove of the retractor.
SCT - connector:
Dahlhausen 07.068.25.210 ~5.6mm (-)
funnel / vac.control
NOTICE
Argyle: suction tube,
Covidien 8888301606 ~6.3mm (¼”)
 ecause of best fit
B molded connectors
characteristics, suction Amsino Suction connecting tube AS825 ~6.3mm (¼”)
tubing from the companies Cardinal Medi-vac non-conductive
CAT. 66A ~6.3mm (¼”)
to the right is recommended: Health suction tube
Legend M.D. Suction connecting tube Item#: RSCT201 ~6.8mm (¼”)
I t might be that the suction
tubing has to be cut at one Non-conductive connecting
Medline DYND50246 ~6.3mm (¼”)
tube
side prior the attachment
Medi Plast Orthopaedic suction Set 60QP09061 ~6.3-6.6mm (-)
of the suction tip.
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PRO | Operative technique

PRO system design

Retractors

Handling
Once the position of the retractors
is established, they may be fixed
with Ø3.2mm K-wires (150mm
and 220mm lengths) provided
in the retractor tray.

WARNING
Never put undue tension on
retracted structures and adjust
the retraction periodically to
ensure the safe use of the
devices.
NOTICE
Seat the Ø3.2mm K-wire to the
bone before drilling to avoid
unintended contact and debris.

Matta sciatic nerve

retractors

Two sciatic nerve retractors

(large and small) are available
to allow for retraction in this
area.

Sciatic nerve retractor

PRO retractor 1

Originally designed to be placed

near the pubic tubercle, retractor
1 may be equipped with a light
pipe and held in place with a
Ø3.2mm K-wire.
The retractor may be used in
additional anatomic areas as
the surgeon sees fit.
Retractor 1

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 PRO | Operative technique

PRO system design

Retractors

PRO retractor 2

Originally designed to be placed K-wires to reduce the risk of

over the acetabular rim near the inadvertently penetrating the joint.
ilio-pubic eminence, retractor 2
This retractor may be used in
may be equipped with a light pipe.
additional anatomic areas as
However, there is no opportunity
the surgeon sees fit.
to fix this retractor in place with
Retractor 2

PRO retractor 3

Originally designed to be placed Due to this anatomic positioning,

in the iliac fossa to retract the iliac retractor 3 may be the most ideal
vessels and ilio-psoas muscles, for light pipe attachment.
retractor 3 may be equipped with a
This retractor may be used in
light pipe and has 2 holes for K-wire
additional anatomic areas as
fixation to allow for rotation.
the surgeon sees fit. Retractor 3

PRO suction retractor

Originally designed to be placed This retractor may be used in

in the lesser sciatic notch to additional anatomic areas as
retract the bladder away from the surgeon sees fit.
the posterior column and QLS,
the suction retractor has the CAUTION
ability to run standard tubing When using suction retractor,
though the channel in the retractor Suction retractor
continue to monitor the amount
to simultaneously provide suction of blood loss as per standard
and retraction. operating procedure.

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PRO | Operative technique

PRO system design

Reduction instruments

Angled ball spike

Angled at 15° and 30° respectively,

the angled ball spikes have increased
length and are designed for
working in narrow corridors
or in areas where the irregular
contours of the bone do not allow
reduction clamps to be used.
The angle allows flush application
of the spike or disk at tangential
surfaces, such as the interior
intrapelvic and QLS areas.
To distribute reduction forces over
a comminuted area, a spiked disk
can be attached to the ball tip.
The angled ball spikes may also be
used in conjunction with reduction
clamps to fine tune reduction.

Straight ball spike

This reduction instrument is

used as a pusher with pointed
ball tip to reduce bone fragments.
To distribute reduction forces over
a comminuted area, the spiked disk
can be attached to the ball tip.

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 PRO | Operative technique

PRO system design

Reduction instruments

Design summary

Color coding Clamps and tray are color coded

to allow easier identification and
communication in the OR and
during clean up.

Four spike design Tip design on angled jaw clamps

is based on a 4-point ball spike,
to provide the required grip on
the bone surface and distribution
of the applied force.

Longer speedlocks Longer speedlocks offer a larger

opening and enhance tip and arm
angulation.

Asymmetry Offset jaw clamps allow a wide

range of application and are
conducive to various surgical
approaches.

Improved The wide Jungbluth, Contoured

visualization Weber, and angled Farabeuf are
examples of clamps that are
intuitively designed to sit away
from the surgeon’s working area or
allow use with other instruments.

Distraction / The Farabeuf's ratchet mechanism

compression allows the clamp to be placed in
compression or distraction mode
to compress or distract fracture
fragments.

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PRO | Operative technique

PRO system design

Jaw clamps

The jaw clamps are primarily with a threaded speedlock

used for acetabular fracture mechanism. The crown-spike tips
reduction through various allow for oblique application of
windows of the ilioinguinal force onto a bony surface and
approach, the Kocher-Langenbeck optional connection to the spiked
approach, or Anterior Intrapelvic disks available in either the Matta
Approach. The clamps are fitted or PRO pelvis systems.

Standard jaw clamps

The standard angled jaw clamps

are the workhorses which may be
used in a variety of circumstances.
The sharp points allow for a secure
hold on the bone while the balls
prevent penetration of bone with
a thin cortex. The handles angle
away from both the surgeon’s line
of sight and critical soft tissue
structures.

Offset jaw clamps

The jaws of these clamps are offset

with an overbite or underbite to
accommodate particular surgical
approaches and bony anatomy.
The angle of the tine and offset
of the jaw are designed to
accommodate surfaces that are
tangential to prevent skiving
of one tine or the other.

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 PRO | Operative technique

PRO system design

Jaw clamps

Large offset jaw clamps

The large offset jaw clamps

were designed to reduce
acetabular fractures in areas
where more clearance is needed
between the jaws and where the
bony anatomy precludes the use
of more symmetric clamps.

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PRO | Operative technique

PRO system design

Weber clamps

Pointed reduction forceps may be holes using a Ø3.2mm or Ø3.5mm

applied directly to the bone or for drill bit.
more stability, in shallow pre-drilled

Standard Weber

The Standard Weber may be applied

directly to the bone in a variety of
applications to stabilize the pubic
symphysis or displaced pelvic
fragments.

Contoured Weber

The Contoured Weber has a reverse

bend designed to angle the handles
away from the area of reduction
and fixation.

Narrow Weber
(Straight, Straight)

The Narrow Weber has two straight

tines which may be used
in areas where access is limited.

Asymmetric Webers
(Straight, Curved)

Left and right asymmetric webers

have one curved and one straight
tine, which may be placed in
shallow pre-drilled holes to gain
stability.

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 PRO | Operative technique

PRO system design

Jungbluth clamps

Both Jungbluths in the PRO

system are intended to be used
with Ø3.5mm screws. A screw
is inserted on each side of the
fracture, allowing considerable
reduction forces and manipulation
in all three planes.

The wide Jungbluth has more

clearance between the handles to
allow an angled jaw clamp to pass
through the greater sciatic notch or
to be used in conjunction with the
spiked screw inserter.

The narrow Jungbluth may be

effective in locations where the
anatomy and lack of available
space preclude the use of the
wide Jungbluth.

25
PRO | Operative technique

PRO system design

Farabeuf clamps

The Farabeuf may be used for

smaller manipulations and fine
tuning to grasp fragments or as
reduction forceps with provisional
Ø3.5mm screws.

The angled Farabeuf is designed to

avoid impingement of soft tissues
against the handles of the clamp
and may be particularly useful
during reduction of the sacroiliac
joint from an anterior approach.

Both Farabeufs feature a

ratchet mechanism that enables
compression or distraction settings.
Flip the bar labeled “C” to put
clamp in compression mode,
or reverse it to display “D” for
distraction mode.

Distraction Compression

26
 PRO | Operative technique

PRO system design

Additional matta reduction clamps

Verbrugge forceps

For instances where only one

screw is inserted, therefore
requiring application of only one
jaw, the Verbrugge forceps may be
used. The other jaw takes hold of
another part of the bony surface.

Reduction forceps,
king tong

These forceps with three-pointed

ball tips allow for reduction of
perpendicular fractures. The long
handles allow for increased leverage
for challenging reductions.
This instrument is available in
both a 2x1 and 1x1 jaw version.

Jungbluth for Ø4.5mm

screws

If a larger screw is needed, the

Matta Jungbluth can accommodate
application of a Ø4.5mm screw.

27
PRO | Operative technique

PRO system design

Screw fixation

Washer loading
A washer may be pre-loaded into
the Ø3.5mm Spiked screw inserter
using the Washer loading stand
(b) on the back table.
After drilling and inserting a
Ø3.5mm screw, the washer will
be deployed with the screw as it
passes through the cannula of the
instrument.
Washer
Ø3.5mm and Ø4.5mm (a) Spiked disk
spiked screw inserters (b) Washer loading stand

The Spiked Screw Inserters are

tools for reduction and placement
of independent Ø3.5mm and Ø4.5mm
screws.
The instruments are cannulated
through which a drill sleeve, drill
bit, screw, and screwdriver can be
passed.
Once drilled, a measurement may
be read off the scaled drill bill and
the appropriate screw size selected.
The screw may be inserted through
the cannulation in the handle
followed by the screwdriver. The
self-centering design allows the
screwdriver to automatically align
with the screw head inside the
shaft.
Each instrument and accessory is
color coded according to screw size. CAUTION
A yellow ring indicates that the
The washer loading function is • I t is recommended that the
instrument is for a Ø3.5mm screw.
only available for Ø3.2mm Drill Sleeve is inserted into
A black ring indicates that the
screws. the Spiked Screw Inserter
instrument is for a Ø4.5mm screw.
handle outside of the wound,
If more surface area contact or load observing it pass beyond the
distribution is desired, the footplate CAUTION washer to prevent an
(a) may be attached to the crowned The measurement for correct inadvertent release of the
tip of the Spiked screw inserter. screw length must be taken washer into the wound.
This optional attachment includes with the drill sleeve touching
three hole options for Ø3.2mm K-wire the bone. The measurement is
fixation and 20º of angulation. read directly off the drill.
28
 PRO | Operative technique

PRO system design

Periosteal elevators

Three periosteal elevators are

available to aid the dissection and
atraumatic exposure of the bone
surface in preparation for definitive
fixation.

Periosteal Elevator,
Straight

The Straight Periosteal Elevator

may be used to elevate periosteum
and soft tissues from straight bone
surfaces.

Periosteal Elevator,
Standard

Periosteal Elevator,
Reverse

Anterior Intra-pelvic approach Ilioinguinal approach

Angled versions may be used to
elevate the periosteum and soft
tissues from angled bone surfaces
such as the ilium and quadrilateral
surface.

Kocher-Langenbeck approach Ilioinguinal approach

29
PRO | Operative technique

PRO system design

Plate contouring and bending techniques

The fit of the plate on the bony

surface should be as precise as
possible, so the insertion of
screws will maintain position
of the fragments (Fig. 1).
During plating and screw insertion,
it is common that the bone is drawn
toward the plate and not the plate
toward the bone (Fig, 2). Therefore,
in certain instances it may be
advantageous to contour the plate
Fig. 1 – correct
to a slight mismatch to the bone to
aid in obtaining and / or maintaining If the plate fits precisely.
the optimal reduction.
It is important to utilize the proper
instrumentation and bending
techniques when manipulating
plates. Proper technique may help
prevent wedging of the plate by
bending tools and weakening of
the plate by repeated, corrective
contouring.

WARNING
The plate must be shaped
correctly to fit the reduced
Fig. 2 – incorrect
contours of the bone to prevent
a fragment from being drawn When tightening the screws, the fragment may be drawn towards the plate.
towards the plate during the
tightening of screws.

30
 PRO | Operative technique

PRO system design

Plate contouring and bending techniques

PRO plate bender

The PRO plate bender is designed to
contour Matta and PRO plates.
Two sides for in-plane curving and
the tip for out-of-plane bending
provide the surgeon multiple
options to contour the plate.

For a plate to fit adequately on a

bone, it should be possible to shape
it in all directions. Plates may be:

Curved
(Fig. 1a, 1b)
To adapt to the shapes of Curving (Fig. 1a) Curving (Fig. 1b)
the pelvis and acetabulum.

Bent
(Fig. 2a, 2b)
Along its main axis.

Twisted
(Fig. 3a, 3b)
Along its main axis, to
give it a helicoidal shape.

Bent (Fig. 2a) Bent (Fig. 2b)

CAUTION
It is not intended to cut any
of the plates. All verification
testing has been performed on
intact plates.

Twisted (Fig. 3a) Twisted (Fig. 3b)

31
PRO | Operative technique

PRO system design

Plate contouring and bending techniques

PRO plate bending holder

The PRO plate bending holder is
available to assist with contouring
Matta and PRO pelvic plates.
Designed to give the surgeon more
control of the bending process and
prevent the plate from slipping,
this instrument may be useful in
adjusting the angle between the two
surfaces of the PRO suprapectineal
plate (Fig. 4).
This instrument may also be used
in conjunction with other bending
tools, such as the PRO plate bender
to twist or achieve an out-of-plane
bend (Fig. 5).

(Fig. 4) (Fig. 5)

PRO in-situ bender

Two in-situ benders are offered
to perform contouring adjustments
while the plate is partially fixed to
the bone. It has dual functioning
ends – one straight and one angled.
The L-extension on the
infrapectineal plate is designed
to allow the surgeon to use these
bending sticks to conform it to the
pubic tubercle and place a screw for
anterior fixation of the plate (Fig. 6).

CAUTION
Extensive repeated bending of
non-annealed Matta Plates can (Fig. 6)
lead to loss of strength.
Contouring does not decrease
fatigue resistance for annealed
Matta Straight Acetabular
Plates.

32
 PRO | Operative technique

PRO system design

Plate and screw fixation

Handle for plate insertion

The handle for plate insertion may
be attached to the PRO QLS plates
and / or Matta plates to facilitate
plate insertion.
The handle may be attached
to any screw hole, depending
on the surgeons’ needs.

The QLS plates have one dedicated

screw hole which is ideal to attach
to the plate insertion handle (see
blue circles in images to the right).
The other screw holes may be used
as well, but they are pre-angled so
one must note the direction of the
pre-angulation when attaching
the handle.

33
PRO | Operative technique

PRO system design

Plate and screw fixation

Plate screw inserter

The plate screw inserter allows
drilling and screw placement
through the plate with one
instrument.
The tip of the instrument can swivel
in the plate holes to allow accurate
placement of screws that need to be
angulated.
The plate screw inserter uses
the same drill guides, drills and
screwdrivers as the spiked screw
inserter.
The accessories are color coded,
with a yellow ring indicating drill
guide, drill and screwdriver for
Ø3.5mm screws.

CAUTION CAUTION
 ake care not to over-angle
T When inserting screws through
the drill and drill sleeve the Plate Screw Inserter under
beyond the 70º cone acute angles, the instrument
(for Ø3.5mm screws). should be pulled back slightly
from the plate before final
tightening to allow the screw
to be fully seated.

Angled depth gauge

The angled depth gauge offers
a design suited for measuring
along tangential or angulated
drill paths such as the posterior
column or quadrilateral surface
area. It allows for measurement
of screws up to 70mm.

Make sure the metal tip is pulled

back (retracted) prior to inserting
through the screw hole.

34
 PRO | Operative technique

PRO system design

Pelvic ring fracture types and fixation

Pubic symphysis disruption

Approach: Fixation:
The Pfannenstiel approach to the • I solated pubic symphysis
anterior pelvic ring represents a disruption can be fixed using
standard for ORIF of a disrupted a dedicated 4 or 6–hole Matta
symphysis pubis. pubic symphysis plate

Ilium fracture

Approach: Fixation:
Fractures of the ilium may • A screw is inserted from the • A Matta 4–hole straight plate
be reduced and fixed through anterior inferior iliac spine, can be used to traverse the
the lateral window using the passing 1cm–2cm above the fracture line in the area of
ilioinguinal approach or a acetabulum the pelvic brim
posterior pelvic ring surgical
•A
 dditionally, an independent lag
approach.
screw in the iliac crest is placed,
starting from the anterior branch
35
PRO | Operative technique

PRO system design

Pelvic ring fracture types and fixation

Sacroiliac dislocation

Approach: Fixation:
Sacroiliac dislocations may be • An Asnis III cannulated iliosacral
reduced and fixed through an screw may be used for fixation of
anterior or posterior pelvic ring dislocation
surgical approach.

Sacroiliac fracture / dislocation

Approach: Fixation:
Sacroiliac fracture dislocations •A
 n independent lag screw • A 6–hole Matta flex plate
may be reduced and fixed through is placed starting from the stabilizes the reduction
a posterior pelvic ring surgical posterior-inferior iliac spine of the iliac crest
approach. to stabilize the reduction of the
• An Asnis III cannulated iliosacral
inferior aspect of the iliac wing
lag screw fixes the sacroiliac joint

36
 PRO | Operative technique

PRO system design

Pelvic ring fracture types and fixation

Sacrum fracture

Approach: Fixation:
Sacrum fractures may be reduced •A
 sacrum fracture may be fixed • Alternatively a Ø6.5mm
and fixed through a posterior pelvic with two Asnis III cannulated cancellous screw may be placed
ring surgical approach. lag screws into the S1 or S2 vertebral bodies
through the lateral iliac wing

37
PRO | Operative technique

PRO system design

Acetabular fracture types and fixation

Posterior wall

Approach: Fixation:
Posterior wall fractures may • Two independent lag screws • A
 6 or 7–hole Matta curved R108
be reduced and fixed using the initially fix the fragments with plate or alternatively an 8–hole
Kocher-Langenbeck approach. the desired anatomical reduction Matta flex plate may span the
fragments along its axis and
serve as a neutralization plate
Posterior column

Approach: Fixation: CAUTION

Posterior column fractures may • Definitive fixation can be started All central screws should
be reduced and fixed using the with an independent lag screw be perpendicular to the
Kocher-Langenbeck approach. from the distal fragment into the quadrilateral surface to avoid
posterior buttress of the Ilium penetration of the hip joint
• To maintain the reduction,
a 6-hole Matta curved plate or
8-hole Matta flex plate may be
used along the acetabular margin
38
 PRO | Operative technique

PRO system design

Acetabular fracture types and fixation

Anterior wall

Approach: Fixation:
Anterior wall fractures may •O
 ne or two independent lag • A Matta curved plate bridges the
be reduced and fixed using screws fix the reduced fragments fragment on the pelvic brim from
the ilioinguinal approach. the iliac fossa to the intact part
of the pubic ramus

Anterior column

Approach: Fixation:
Anterior column fractures may •A
 n independent lag screw •A
 minimum of two screws should
be reduced and fixed using the maintains the reduction be placed beyond the fracture line
ilioinguinal or anterior intrapelvic
•A
 10–hole Matta curved •A
 lternatively, the PRO
approach.
plate is shaped to adapt it to suprapectineal quadrilateral
the pelvic brim from the pubic surface plate may be used
tubercle to the vicinity of the
sacroiliac joint

39
PRO | Operative technique

PRO system design

Acetabular fracture types and fixation

Transverse

Approach: Posterior fixation: • The anterior column is stabilized

with an independent lag screw
The Kocher-Langenbeck •T
 hrough the Kocher-Langenbeck
approach is typically used approach, the posterior column is Anterior fixation:
to access transverse fractures. stabilized with an independent lag
•T
 hrough the ilioinguinal or
Alternatively, they may be accessed screw
anterior intrapelvic approach,
anteriorly using the ilioinguinal or
• A 6–hole Matta curved plate may the PRO suprapectineal or
anterior intrapelvic approach.
serve as a neutralization plate infrapectineal quadrilateral
surface plate may be used
T-shaped

Approach: Posterior fixation:

A Kocher-Langenbeck approach •T
 hrough the Kocher-Langenbeck • The anterior column is stabilized
is frequently used to perform an approach, the posterior column is with an independent lag screw
ORIF of a T-shaped fracture. In stabilized with an independent lag
Anterior fixation:
some circumstances, combined screw
anterior and posterior approaches •T
 hrough the ilioinguinal or
•A
 Matta curved or flex plate may
or an extended ilio-femoral anterior intrapelvic approach,
serve as a neutralization plate
approach may be necessary. the PRO suprapectineal or
infrapectineal quadrilateral
40 surface plate may be used
 PRO | Operative technique

PRO system design

Acetabular fracture types and fixation

Transverse and posterior wall

Approach: Fixation:
Combined transverse and posterior •T
 wo independent lag screws • A Matta 8–hole flex plate
wall fractures may be reduced and stabilize the transverse fracture or alternatively, a 6 or 7–hole
fixed using the Kocher-Langenbeck component Matta curved plate is applied
approach. to buttress the posterior wall
•O
 ne or two independent lag
screws maintain the reduction
of the posterior wall fragment

Posterior column and posterior wall

Approach: Fixation:
Combined posterior column • Initial
 fixation of the posterior •D
 efinitive stabilization of the
and Posterior Wall fractures may column with an independent posterior wall and column with
be reduced and fixed using the lag screw and / or a 5 or 6–hole a 7 or 8–hole Matta curved plate,
Kocher-Langenbeck approach. Matta curved plate buttressing the posterior wall and
anchoring securely to the ilium
• I f the posterior wall fragment
and ischium with cortical screws
is large enough, it should be
attached to the column with
one or two lag screws
41
PRO | Operative technique

PRO system design

Acetabular fracture types and fixation

Both column

Approach: Fixation:
Both column fractures may •T
 wo independent lag screws in • An
 8–hole Matta flex plate may
be reduced and fixed using the the iliac crest stabilize the iliac be placed along the iliac crest to
iliofemoral, extended iliofemoral, wing fracture fragments stabilize the iliac wing fracture
or anterior intrapelvic approach.
• One or two independent lag • A 10 or 12–hole Matta curved
screws running from the upper plate along the pelvic brim can
aspect of the true pelvis can fix stabilize the anterior column
the posterior column
•A
 lternatively, a PRO
•O
 ne independent lag screw can fix suprapectineal quadrilateral
the separated posterior fragment surface plate may be used
of the pelvic brim just lateral to
the sacroiliac joint

42
 PRO | Operative technique

PRO system design

Acetabular fracture types and fixation

Anterior column and posterior hemi-transverse

Approach: Anterior column reduction: Posterior column fixation:

Anterior column / posterior Reduction typically starts Fixation of the posterior column is
hemi-transverse fractures may with the anterior column. typically provided by lag screws or
be reduced and fixed using the position screws, which are inserted
ilioinguinal approach or anterior Anterior column fixation: from the pelvic brim into the safe
intrapelvic approach. Stabilization of the anterior column zone that extends from the cranial
typically starts peripherally with limit of the greater sciatic notch
the iliac crest and can be achieved distally to the ischium, depending
with either plates or screws. This on the starting point.
may be augmented by a buttress
plate placed along the pelvic brim,
Pelvic buttress plate:
extending from the area lateral to A PRO suprapectineal plate can
the sacroiliac joint to the superior be placed on the quadrilateral
pubic ramus. surface to buttress comminution or
counteract posterior column medial
In some cases, it is possible to
displacement.
achieve stable fixation with a
lag screw technique alone. In addition, one or two independent
lag screws can be placed in the
Posterior column reduction: posterior portion of the plate.
Once the anterior column is reduced
and provisionally stabilized, the
posterior column can be addressed. CAUTION
Take care to avoid penetration
of the hip joint when
independent lag screws are
placed in the posterior portion
of the plate.

43
PRO | Operative technique

PRO system design

Suprapectineal plate technique

Suprapectineal plate
The suprapectineal quadrilateral
surface plate was designed with
a specific fracture pattern in mind:
specifically, in situations where
the anterior column is disrupted
and the quadrilateral surface is
comminuted and disassociated from
the posterior column – such as the b
a
anterior column posterior hemi-
transverse.
The important feature of this plate
is that it provides simultaneous
fixation in both the anterior and
posterior columns. It buttresses
the anterior column with the WARNING
suprapectineal portion of the plate
Always properly reduce the
(a), and the quadrilateral surface
fracture and stabilize with
with the infrapectineal portion (b).
reduction clamps and/or lag/
Therefore, in order for this plate position screws prior to the
to function optimally, it must be in placement of the plate, as it is
intimate contact with both surfaces not a reduction tool.
(anterior column and quadrilateral
surface) simultaneously.

WARNING
Always carefully apply the plate
in such a way that when the
first screw is placed into a hole
on one of the surfaces that the
plate does not come away from
the other surface.
The following technical suggestion
is one possible way to avoid this
occurrence.
First, use the plate insertion handle
to hold the plate by the central hole
and apply a laterally directed force
to ensure that the plate is flush
against the quadrilateral surface.

44
 PRO | Operative technique

PRO system design

Suprapectineal plate technique

Next, using a Ø2.5mm drill bit,

drill eccentrically in the hole
opposite the posterior arm of the
plate and place a Ø3.5mm screw
into the suprapectineal portion.
This will simultaneously bring
the plate down onto the anterior
column and lateralize the plate to
further ensure that good contact
is made between the plate and
both surfaces.

45
PRO | Operative technique

PRO system design

Suprapectineal plate technique

Prior to insertion of any more

screws, the surgeon must ensure
that the plate is rotated and aligned
correctly with the anterior aspect of
the pelvis.
At this stage, with only one point
of fixation in the posterior aspect
of the plate, the plate can still be
fine-tuned or adjusted to align with
the anterior pelvis without affecting
the reduction. A small reduction
clamp can be placed onto the plate
to bring it down to the pubic body.
A screw is then placed through
the plate into the superior pubic
ramus followed by the pubic body
to secure the anterior portion of the
plate to the anterior column in a
buttress fashion and maintain the
rotation.

46
 PRO | Operative technique

PRO system design

Suprapectineal plate technique

Next, the infrapectineal portion

of the plate is anchored to the
posterior column. It is important to
use a screw hole that is as far distal
on the infrapectineal portion of
the plate as possible since this will
help to ensure that maximal plate
surface area contact is achieved to
optimally buttress the quadrilateral
surface.
The plate screw inserter will
help to facilitate placement of
this screw deep in the base of
the wound.
At this point the three key aspects
of the plate have been secured to
their respective anchor points in
the anterior column, innominate
bone, and posterior column, thus
maintaining firm contact with the
anterior column and quadrilateral
surface.

47
 0123
This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or her own professional clinical
judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice
and recommends that surgeons be trained in the use of any particular product before using it in surgery.
Manufacturer:
The information presented is intended to demonstrate a Stryker product. A surgeon must always refer to the package insert, product
Stryker GmbH
label and/or instructions for use, including the instructions for Cleaning and Sterilization (if applicable), before using any Stryker product.
Bohnackerweg 1
Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual
2545 Selzach
markets. Please contact your Stryker representative if you have questions about the availability of Stryker products in your area. Switzerland
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service stryker.com
marks: Asnis, Stryker. All other trademarks are trademarks of their respective owners or holders.

The products listed above are CE marked.

Content ID: PRO-ST-1 Rev 3, 06-2017

Copyright 2017