LCP Distal Fibula Plates. Part of the Synthes locking ... Mobile/Synthes International...Synthes locking compression plate (LCP) system. ... Part of the Synthes locking compression

  • View
    230

  • Download
    5

Embed Size (px)

Text of LCP Distal Fibula Plates. Part of the Synthes locking ... Mobile/Synthes International...Synthes...

  • LCP Distal Fibula Plates. Part of theSynthes locking compression plate (LCP)system.

    Surgical Technique

    This publication is not intended fordistribution in the USA.

    Instruments and implants approved by the AO Foundation.

  • Table of Contents

    Introduction

    Surgical Technique

    Product Information

    MRI Information

    LCP Distal Fibula Plates 2

    AO Principles 4

    Indications 5

    Preoperative Planning 6

    Patient Positioning and Approach 8

    Implantation 10

    Implant Removal 19

    Plates 20

    Screws 22

    Instruments for screws 2.4/2.7 23

    Instruments for screws 3.5/4.0 25

    Sets 27

    28

    LCP Distal Fibula Plates Surgical Technique DePuy Synthes 1

    Image intensifier control

    WarningThis description alone does not provide sufficient background for direct use of theinstrument set. Instruction by a surgeon experienced in handling these instrumentsis highly recommended.

    Processing, Reprocessing, Care and MaintenanceFor general guidelines, function control and dismantling of multi-part instruments,as well as processing guidelines for implants, please contact your local salesrepresentative or refer to:http://emea.depuysynthes.com/hcp/reprocessing-care-maintenanceFor general information about reprocessing, care and maintenance of Synthesreusable devices, instrument trays and cases, as well as processing of Synthesnon-sterile implants, please consult the Important Information leaflet (SE_023827)or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

  • The LCP Distal Fibula Plates are part of the Synthes lockingcompression plate system that merges locking screw techno -logy with conventional plating techniques.

    The plates are available in stainless steel and titanium. Theplates feature an anatomic shape and profile, both distallyand along the fibular shaft. The combi-holes in the LCP plateshaft combine a dynamic compression unit (DCU) hole with alocking screw hole. Combi-holes provide maximum flexibilitywith the options of axial compression and locking capabilitythroughout the length of the plate shaft. Kirschner wireholes accept Kirschner wires (up to 2.0 mm) to temporarilyfix the plate to the distal fibula, to temporarily reduce articu-lar fragments, and to confirm the location of the plate, rela-tive to the distal fibula.

    Fixation with the LCP Distal Fibula Plates provides the samebenefits of traditional plate fixation methods, with a few im-portant improvements. Locking screws provide the ability tocreate a fixed-angle construct while using standard AO plat-ing techniques. The ability to place locking screws is espe-cially important in osteopenic bone, short bone fragments,and multi-fragment fractures, where screw purchase is com-promised. These screws do not rely on plate-to-bone com-pression to resist patient load, but function similarly to multi-ple, small, angled blade plates.

    LCP Distal Fibula Plates. Part of theSynthes locking compression plate (LCP)system.

    2 DePuy Synthes LCP Distal Fibula Plates Surgical Technique

  • LCP Lateral Distal Fibula Plate

    LCP Posterolateral Distal Fibula Plate

    Screw profiles in coaxial hole

    Cortex screw 2.4 Cortex screw 2.7 Locking screw 2.7(head 2.4)

    Five coaxial distal holes accept 2.4 mm and 2.7 mmlocking and cortex screws toprovide multiple screw options

    Preshaped design

    Recesses for screwheads incoaxial holes minimize screwprominence to create a low-profile construct

    Combi-holes in shaft accept3.5 mm locking screws,3.5 mm cortex screws, and4.0 mm cancellous bone screws

    Six round locking holes and twocoaxial holes accept 2.4 mmand 2.7 mm locking and cortexscrews to provide multiplescrew options

    Preshaped design

    Recesses for screwheads incoaxial holes minimize screwprominence to create a low-profile construct

    Combi-holes in shaft accept 3.5 mm locking screws, 3.5 mm cortex screws, and 4.0 mm cancellous bone screws

    Four Kirschner wire holesin the head accept 2.0 mmKirschner wires

    LCP Distal Fibula Plates Surgical Technique DePuy Synthes 3

  • AO Principles

    In 1958, the AO formulated four basic principles, whichhave become the guidelines for internal fixation.1, 2 Thoseprinciples, as applied to the LCP Distal Fibula Plates are:

    Anatomic reductionThe anatomic plate profile assists with reduction of the distalfibula to the diaphysis and assessment of length, rotationand alignment of the distal fibula. Multiple distal screws atthe distal fibula allow maintenance of the articular reductionand stabilization of the distal segment relative to the fibularshaft.

    Stable fixationThe combination of conventional and locking screws offersoptimum fixation regardless of bone density.

    Preservation of blood supplyThe anatomic design of the plate minimizes additional insultto the local soft tissues. The proximal plate end is roundedfor ease of insertion. The distal plate end is beveled to mini-mize additional soft tissue damage and local tissue irritation.

    Early, active mobilizationPlate features combined with AO technique create an envi-ronment for early bone healing, expediting return to func-tion.

    1Mller ME, Allgwer M, Schneider R, Willenegger H (1995) Manual of InternalFixation. 3rd, expanded and completely revised ed. 1991. Berlin, Heidelberg,New York: Springer

    2Redi TP, Buckley RE, Moran CG (2007) AO Principles of Fracture Management.2nd expanded ed. 2002. Stuttgart, New York: Thieme

    4 DePuy Synthes LCP Distal Fibula Plates Surgical Technique

  • Indications

    The LCP Distal Fibula Plates are intended for fixation of frac-tures, osteotomies and non-unions of the metaphyseal anddiaphyseal region of the distal fibula, especially in osteopenicbone.

    LCP Distal Fibula Plates Surgical Technique DePuy Synthes 5

  • Note: The techniques for implanting the lateral and postero-lateral distal fibula plates are similar. The following describesimplantation of a lateral plate.

    Complete the preoperative radiographic assessment and pre-pare the preoperative plan. Determine plate length and distalscrew locations to ensure proper plate selection and position,and screw placement in the distal fibula.

    Required sets

    LCP Lateral Distal Fibula Plates Set

    01.112.072 LCP Lateral Distal Fibula Plates (Stainless Steel), in Modular Tray, Vario Case System

    01.112.074 LCP Lateral Distal Fibula Plates (Titanium), in Modular Tray, Vario Case System

    LCP Posterolateral Distal Fibula Plates Set

    01.112.052 LCP Posterolateral Distal Fibula Plates (Stainless Steel), in Modular Tray, Vario Case System

    01.112.054 LCP Posterolateral Distal Fibula Plates (Titanium), in Modular Tray, Vario Case System

    Modular small fragment instrument trays*

    68.122.013 Modular Tray for Small Fragment Basic Instruments

    68.122.015 Modular Tray for Screw Insertion 3.5/4.0 mm

    68.104.007 Modular Tray for Screw Insertion 2.4/2.7 mm

    Preoperative Planning

    *It is also possible to use the non-modular LCP Small Fragment Instrument Set andLCP Compact Foot Basic Instruments or other Instrument Sets for LCP 2.4/2.7.

    6 DePuy Synthes LCP Distal Fibula Plates Surgical Technique

  • Modular screw rackAll screws are available in a modular screw rack which can bearranged as needed.

    68.122.020 Modular Insert 2/3, for Modular Screw Rack for Screws 3.5/4.0 mmor68.122.060 Modular Insert 1/3, for Modular Screw Rack for Screws 3.5 mm

    68.122.021 Modular Insert 1/3, for Modular Screw Rack for Screws 2.7/2.4 mm

    68.000.113 Screw Rack, size 1/2, for Modular Insert

    Optional modular small fragment instrument trays

    68.122.019 Modular Tray for Small Fragment Bending Instruments

    68.122.014 Modular Tray for Small Fragment Reduction Instruments

    LCP Distal Fibula Plates Surgical Technique DePuy Synthes 7

  • 1Position patient

    Position the patient supine with a sandbag (bump) under-neath the buttock of the affected side. This allows the footto lie in a neutral position and prevents the normal externalrotation of the leg. Elevate the leg on a padded rest with theknee slightly flexed to assist placement in a neutral position.

    Visualization of the distal fibula under image intensificationin both the lateral and AP views is recommended.

    Note: The direction of the locking screws is determined bythe