3.5 mm LCP Low Bend Medial Distal Tibia Plates. Part of ...synthes.vo.llnwd.net/o16/Mobile/Synthes North America/Product... · Part of the Synthes locking compression plate (LCP)

3.5 mm LCP Low Bend Medial DistalTibia Plates. Part of the Synthes lockingcompression plate (LCP) system.

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

3.5 mm LCP Low Bend Medial Distal Tibia Plates 2

AO Principles 4

Indications 5

Preparation 6

Reduction 7

Plate Insertion 8

Screw Insertion 13

Implant Removal 17

Implants 18

Instruments 19

Set Lists 22

Image intensifier control

Synthes

3.5 mm LCP Low Bend Medial Distal Tibia Plates

The 3.5 mm LCP Low Bend Medial Distal Tibia Plate is part of the Syntheslocking compression plate (LCP) systemthat merges locking screw technologywith conventional plating techniques.

The Combi holes in the LCP plate shaft combine a dynamic compressionunit (DCU) hole with a locking screwhole. Combi holes provide the flexibilityof axial compression and locking capability throughout the length of the plate shaft.

2 Synthes 3.5 mm LCP Low Bend Medial Distal Tibia Plates Technique Guide

Fixation with the 3.5 mm LCP LowBend Medial Distal Tibia Plate hasmany similarities to traditional plate fixation methods, with a few importantimprovements. Locking screws providethe ability to create a fixed-angle construct while using standard AO plating techniques. Locking capability isimportant for fixed-angle constructs in osteopenic bone or multifragmentfractures where screw purchase is compromised. These screws do not relyon plate-to-bone compression to resist patient load, but function similarly tomultiple, small, angled blade plates.

Synthes 3

Plate features– Head of plate is low profile for mini-

mal prominence on medial malleolus

– 3.5 mm cortex and 4.0 mm cancellousbone screws sit flush with plate inthe nonlocking portion of distalCombi holes to minimize screwprominence

– Rounded edges to minimize soft tissue irritation

– Limited-contact shaft profile

– Available in stainless steel or titanium*

Combi holes in the shaft and head accept the following:– 3.5 mm cortex screws

– 3.5 mm locking screws

– 4.0 mm cancellous bone screws

Six round locking holes in the head accept the following:– 2.7 mm cortex screws

– 3.5 mm cortex screws

– 3.5 mm locking screws

– 4.0 mm cancellous bone screws

* Implant-quality 316L stainless steel or titanium alloy (Ti-6Al-7Nb)

Two distal Combi holes

Three distal locking screws diverge acrosssubchondral bone and are parallel to joint

Four to fourteenCombi holes in the shaft

Distal K-wire hole for plate placement (2.0 mm maximum diameter)


AO Principles

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1 Those principles,as applied to the 3.5 mm LCP Low Bend Medial Distal TibiaPlate, are:

Anatomic reduction Precontoured plate assists reduction of metaphysis to diaphysis and facilitates restoration of the articular surface by exact screw placement.

Stable fixationLocking screws create a fixed-angle construct, providing angular stability.

Preservation of blood supplyTapered end facilitates submuscular plate insertion. Submus-cular plate insertion may help to preserve soft tissue viability.

Limited-contact plate design reduces plate-to-bone contact, limiting vascular trauma and insult to bone.

Early, active mobilizationPlate features combined with AO technique create an environment for bone healing, expediting a return to optimal function.

1. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger, Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag, 1991.

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Indications

The Synthes LCP Distal Tibia Plates are intended for fixationof complex intra- and extra-articular fractures and osteotomiesof the distal tibia, as a part of the Synthes Small FragmentLCP System.

Preparation

1Preparation

Required set

105.434 Small Fragment LCP Instrument and Implant Set, with self-tapping screws

or145.434 Small Fragment LCP Instrument and Titanium

Implant Set, with self-tapping screws

Optional sets

105.90 Bone Forceps Set

105.954M Small Battery Drive Set

115.700 Large Distractor Set

Optional instruments

321.12* Articulated Tension Device

329.02 Bending Iron

329.30 Plate-Bending Press

Warning: The direction of locking screws is predeterminedby the design of the plate. If manual contouring is necessary,verify new screw angles using the screw placement verificationtechnique on page 10.

Complete the preoperative radiographic assessment and prepare the preoperative plan. Determine plate length and instruments to be used.

Position the patient supine on a radiolucent operating table.

Note: For information on fixation principles using conventionaland locked plating techniques, please refer to the Small Fragment Locking Compression Plate (LCP) Technique Guide.


* Found in the Basic Instrument Set, for LC-DCP and DCP (115.04).

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Reduction

2Reduce articular surface

Instruments

394.35 Large Distractor

532.010 Small Battery Drive

532.022 Quick Coupling for K-Wires

ApproachAn open or a percutaneous approach may be used dependingon the fracture. For a percutaneous approach, make an incision to access the medial malleolus and slide the plateunder the soft tissue.

Reduction

Technique tip: Application of an external fixator or large distractor may facilitate visualization and reduction of the joint.

Reduce the fracture fragments and confirm reduction usingimage intensification. Methods of stabilizing reduction include the following:

– Independent Kirschner wires

– K-wires through the plate

– Independent lag screws

– Lag screws through the plate

– Locking screws through the plate

Locking screws do not provide interfragment compression;therefore, any desired compression must be achieved withstandard lag screws. The articular fractures must be reducedand compressed before fixation of the 3.5 mm LCP medialdistal tibia plate with locking screws.

Technique tip: To verify that independent lag screws will not interfere with plate placement, evaluate placement intraoperatively with AP and lateral fluoroscopic images.

Plate Insertion

3Insert plate

Instrument

324.031 Threaded Plate Holder

Percutaneous insertionFor a percutaneous approach, insert the plate through the medial incision. Carefully push the plate under the soft tissue.

Technique tip: Thread a threaded plate holder into one of the distal holes as a handle for percutaneous insertion.

Open insertionOpen the area as necessary to expose the joint. Carefullypush the plate under the soft tissue for placement on the shaft.

Center the plate on the medial malleolus.


Saphenousnerve

Saphenousvein

Synthes 9

4Position plate and fix provisionally

After plate insertion, check alignment on the bone using fluoroscopy. Make any adjustments before inserting screws.

Note: This locking plate is precontoured to fit the medial distal tibia. If the plate contour is changed, it is important to check the position of the screws relative to the joint, usingthe screw placement verification technique.

Optional instrument

324.024 Push-Pull Reduction Device

The plate may be temporarily held in place using any of thefollowing options:

– Push-pull reduction device

– 4.0 mm cancellous bone screw in a distal Combi hole

– Standard plate-holding forceps

– K-wires through the plate

Any of these options will allow moving the plate into final position, and will also prevent plate rotation while insertingthe first locking screw.

Note: Ensure proper reduction before inserting the first locking screw. Once the locking screws are inserted, further reduction is not possible without loosening the locking screws.

Plate Insertion continued


Optional technique: Screw placement verification

Instruments

292.71 1.6 mm Kirschner Wire with Thread

310.288 2.8 mm Drill Bit

312.648 2.8 mm Threaded Drill Guide

323.023 1.6 mm Wire Sleeve

323.025 Direct Measuring Device

532.010 Small Battery Drive

532.022 Quick Coupling for K-Wires

Since the direction of the locking screw depends on the contour of the plate, final screw position may be verified with a K-wire before insertion. This becomes especially important when the plate has been manually contoured or applied near the joint.

With the 2.8 mm threaded drill guide in the desired lockinghole, insert the 1.6 mm wire sleeve into the threaded drill guide.

Insert a 1.6 mm threaded K-wire through the wire sleeve and drill to the desired depth.

Verify K-wire placement under image intensification to determine if final screw placement will be acceptable.

Important: The K-wire position represents the final positionof the locking screw. Confirm that the K-wire does not enterthe joint.

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Plate Insertion continued


Optional technique: Screw placement verification continued

Measure for screw length by sliding the tapered end of the direct measuring device over the K-wire down to the wire sleeve.

Remove the direct measuring device, K-wire and 1.6 mm wire sleeve, leaving the threaded drill guide in place.

Use the 2.8 mm drill bit to drill. Remove the threaded drill guide. Insert the appropriate length locking screw.

Screw Insertion

5Insert distal screws

Determine the combination of screws to be used for fixation. If a combination of locking and cortex screws will be used,cortex screws should be inserted first to pull the plate to the bone.

If a locking screw will be used as the first screw, ensure theplate is held securely to the bone to prevent plate rotation asthe screw is locked to the plate.

In distal Combi holes: For nonlocking screws, use the standard AO screw insertiontechnique. The two Combi holes in the plate head accept3.5 mm cortex, 3.5 mm locking or 4.0 mm cancellous bonescrews. When using a cortex or cancellous bone screw inthese Combi holes, the screwhead will be recessed in the hole.

For distal locking screws:

Instruments

310.288 2.8 mm Drill Bit


314.115 StarDrive Screwdriver, T15

314.116 StarDrive Screwdriver Shaft, T15

319.01 Depth Gauge

Thread the 2.8 mm threaded drill guide into a distal lockinghole until fully seated.

Use the 2.8 mm drill bit to drill to the desired depth.

Remove the drill guide.

Use the depth gauge to determine screw length.

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Screw Insertion continued


5Insert distal screws continued

Instruments

511.770* Torque Limiting Attachment, 1.5 Nmor511.773 Torque Limiting Attachment, 1.5 Nm,

quick coupling

Insert the locking screw under power, using the torque limiting attachment and the StarDrive screwdriver shaft, or insert manually, using the StarDrive screwdriver. Be sure theplate is held securely to the bone to prevent plate rotation as the screw is locked to the plate.

Notes:When using the torque limiting attachment, the screw is securely locked into the plate when a “click” is heard.

Always use a torque limiting attachment when using powerwith the StarDrive screwdriver shaft.

* Also available

Optional technique: Direct measuring with calibrateddrill bits

For locking screws:

Instruments

03.122.001 2.8 mm LCP Drill Guide

03.122.002 2.8 mm Calibrated Drill Bit, quick coupling

314.115 StarDrive Screwdriver Shaft, T15

314.16 StarDrive Screwdriver shaft, T15

Determine where locking screws will be used. Thread the 2.8 mm LCP drill guide into a threaded hole until fullyseated. Use the 2.8 mm calibrated drill bit to drill to desireddepth. Determine the screw length directly from the drill bit.

Insert the screw.

Synthes 15

** Found in the Basic Instrument Set, for LCP-DCP and DCP (115.04).


Screw Insertion continued

6Insert screws in shaft

If using the threaded portion of the Combi holes, repeat the steps as described for distal locking screw insertion.

For nonlocking screws, use the standard AO screw insertion technique.

Implant Removal

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Optional sets

01.240.001 Screw Removal Set

105.971 Broken Screw Removal Set

Unlock all screws from the plate, then remove the screwscompletely from the bone. This prevents simultaneous rotation of the plate when unlocking the last locking screw.

If the screws cannot be removed with the screwdriver, insertthe conical extraction screw with left-handed thread into thescrewhead using the handle with quick coupling and loosenthe locking screw by turning counterclockwise.

Screws Used with the 3.5 mm LCP Low Bend Medial Distal Tibia PlatesStainless Steel and Titanium

2.7 mm Cortex Screws* – May be used in the distal locking holes – Compresses the plate to the bone

3.5 mm Cortex Screws*– May be used in the DCU portion of the Combi holes

in the plate shaft– Compresses the plate to the bone or creates axial

compression

3.5 mm Locking Screws*– Creates a locked, fixed-angle screw/plate construct– Self-tapping tip– Used in the locking portion of the Combi holes or

in round locking holes

4.0 mm Cancellous Bone Screws*– May be used in the DCU portion of the Combi holes

in the plate shaft– Compresses the plate to the bone or creates axial

compression– Fully or partially threaded shaft


*Found in the Small Fragment LCP set

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Instruments

292.71 1.6 mm Kirschner Wire with thread


314.115 StarDrive Screwdriver, T15, self-retaining

314.116 StarDrive Screwdriver Shaft, T15, self-retaining, quick coupling

03.122.001 2.8 mm LCP Drill Guide, long for 3.5 mm LCP plates

03.122.002 2.8 mm Drill Bit, quick coupling, 248 mm/95 mm calibration

310.288 2.8 mm Drill Bit, quick coupling, 165 mm


Instruments continued

319.01 Depth Gauge

323.023 1.6 mm Wire Sleeve

323.025 Direct Measuring Device

324.024 Push-Pull Reduction Device

324.031 Threaded Plate Holder, long

329.04 Bending Iron, for 2.7 mm and 3.5 mm plates,150 mm length

– Used with 329.05

329.05 Bending Iron, for 2.7 mm and 3.5 mm plates,150 mm length

– Used with 329.04

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329.15 Bending Pliers, for 2.7 mm and 3.5 mm plates

394.35 Large Distractor

511.770 Torque Limiting Attachment, 1.5 Nm

511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling

3.5 mm LCP Low Bend Medial Distal Tibia Plate SetsStainless Steel (01.112.060) and Titanium (01.112.061)

Graphic Case60.112.060 Graphic Case for 3.5 mm LCP Low Bend

Medial Distal Tibia Plate

Implants3.5 mm LCP Low Bend Medial Distal Tibia Plates◊, right Stainless Steel Titanium Holes Length (mm)02.112.510 04.112.510 4 10902.112.514 04.112.514 6 13502.112.518 04.112.518 8 16102.112.522 04.112.522 10 18702.112.526 04.112.526 12 21302.112.530 04.112.530 14 239

3.5 mm LCP Low Bend Medial Distal Tibia Plates◊, leftStainless Steel Titanium Holes Length (mm)02.112.511 04.112.511 4 10902.112.515 04.112.515 6 13502.112.519 04.112.519 8 16102.112.523 04.112.523 10 18702.112.527 04.112.527 12 21302.112.531 04.112.531 14 239


◊ Available nonsterile or sterile-packed. Add “S” to catalog number to order sterileproduct.

Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer tohttp://us.synthes.com/Medical+Community/Cleaning+and+Sterilization.htmor to the below listed inserts, which will be included in the shipping container:– Processing Synthes Reusable Medical Devices—Instruments, Instrument Trays

and Graphic Cases—DJ1305– Processing Non-sterile Synthes Implants—DJ1304

Also Available

Synthes 23

Graphic Cases690.468 3.5 mm LCP Medial Distal Tibia Plate,

without tab, Set Graphic Case60.122.001 3.5 mm Titanium LCP Medial Distal Tibia

Plate, without tab, Set Graphic Case

Implants3.5 mm LCP Medial Distal Tibia Plates, without tab◊, right

Stainless Steel Titanium Holes Length (mm)

238.700 438.700 4 116238.702 438.702 6 142238.704 438.704 8 168238.706 438.706 10 194238.708 438.708 12 220238.710 438.710 14 246

3.5 mm LCP Medial Distal Tibia Plates, without tab◊, left

Stainless Steel Titanium Holes Length (mm)

238.701 438.701 4 116238.703 438.703 6 142238.705 438.705 8 168238.707 438.707 10 194238.709 438.709 12 220238.711 438.711 14 246

3.5 mm LCP Medial Distal Tibia Plates◊

Right Left Holes Length (mm)

239.900 239.901 4 116

239.904 239.905 6 142239.908 239.909 8 168239.912 239.913 10 194239.916 239.917 12 220239.920 239.921 14 246

3.5 mm LCP Pilon PlatesHoles Length (mm)

240.082 7 147240.083 9 173

Synthes (USA)1302 Wrights Lane EastWest Chester, PA 19380Telephone: (610) 719-5000To order: (800) 523-0322Fax: (610) 251-9056

Synthes (Canada) Ltd.2566 Meadowpine BoulevardMississauga, Ontario L5N 6P9Telephone: (905) 567-0440To order: (800) 668-1119Fax: (905) 567-3185

© 2009 Synthes, Inc. or its affiliates. All rights reserved. Combi, DCP, LCP, LC-DCP and Synthes are trademarks of Synthes, Inc. or its affiliates. Printed in U.S.A. 11/10 J8810-B

www.synthes.com

Documents

3.5 mm LCP Low Bend Medial Distal Tibia Plates. Part of ...synthes.vo.llnwd.net/o16/Mobile/Synthes North America/Product... · Part of the Synthes locking compression plate (LCP)