LCP Locking Compression Plate - synthes.vo.llnwd.netsynthes.vo.llnwd.net/o16/LLNWMB8/INT Mobile/Synthes International... · Surgical Technique LCP Locking Compression Plate DePuy

LCP Locking Compression PlateSurgical Technique

Image intensifier control

This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is 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 sales representative or refer to:http://emea.depuysynthes.com/hcp/reprocessing-care-maintenanceFor general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

Surgical Technique LCP Locking Compression Plate DePuy Synthes 1

Table of Contents

Introduction LCP Locking Compression Plate 2

LCP Metaphyseal Plates 4

AO Principles 5

Intended Use, Indications and Contraindications 6

Surgical Technique Standard Plate Technique 8

Insert Self-tapping Locking Screws 15

Insert Self-drilling, Self-tapping Locking Screws 24

Indirect Reduction with Locking Screws 26

Drilling with the LCP Universal Drill Guide 29

Insert LCP Spacers 31

Metaphyseal Plates for extra articular fractures 32

Examples of the Combination Technique 36

Remove the Implant 37

Product Information Basic LCP Plates 38

Screws 48

Spacers 51

Cerclage 52

Instruments 54

Discontinued Implants 59

MRI Information 61

Stardrive

Hex drive

1 DePuy Synthes LCP Locking Compression Plate Surgical Technique

System overview

LCP Locking Compression Plate

Angular stable implant

Angular stable support of fragments

LCP and screw constructs work as a unit, avoiding sequential screw failure seen in non-locked plating, providing increased stability1

Limited plate-periosteum contact

Locking screws provide hold also in osteoporotic bone and in multiple fragment fractures2

Stability of the implant and the construct: Locking screws can be placed in each locking hole of the plate

Because the screws are tightly locked in the plate, the risk is reduced for:• Tension on the bone• Compression between the plate

and bone

The plate does not have to be precisely shaped to the bone to provide stability

1 Yaffe MA, Saucedo JM, Kalainov DM. Non-locked and locked plating technology for hand fractures. J Hand Surg Am. Dec 2011;36(12):2052-5.

2 Wagner M. General principles for the clinical use of the LCP. Injury. Nov 2003;34 Suppl 2:B31-42.

A

B

F


Reduction maintained under a load LCP combi-hole

Stable bridging of comminuted fractures

The stable plate-screw connection reduces the risk of secondary loss of reduction in the epiphyseal and metaphyseal regions2

The screws are locked in the plate, and the physiological load (F) is transferred from the bone to the plate

2 Wagner M. General principles for the clinical use of the LCP. Injury. Nov 2003;34 Suppl 2:B31-42.

The fragments are fi xed in their reduced position without regard to the plate model (internal fi xator)

The bone fragments are fi xed in the position assumed at the time the screws are locked

A Stable plate-screw connection• Locking screws reduce the risk of

screw loosening• Excessive torque is not applied to

the cortical bone• The conical screw head facilitates

screw insertion

B Compatibility• The dynamic compression hole

allows the use of standard (Cortex or Cancellous Bone) screws

Self-tapping locking screws

• Use after precisely measuring the length (metaphysis)

• Monocortical or bicortical use• Not necessary to separately tap

thread

Standard (Cortex or Cancellous Bone) screws

• Dynamic compression is created by the eccentric insertion of the stan-dard screws (analogous to LC-DCP)


LCP Metaphyseal Plates. For extra-articular fractures.

LCP combi-holes allow uncompromising combinationsThe combi-hole allows an internal plate fixation using standardscrews, angular stable locking screws, or a combination of both. This takes into account the most diverse intraoperative requirements.

Angular stability allows for improved fixationThe angle- and axis-stable locking screws may prevent loss of reduction under load. A precise anatomical contouring of the plate is unnecessary when using this system as a locking internal fixator.

Feasability of plate contouring due to thinned plate profileThe plate design facilitates anatomical contouring con-siderably, whilst taking into account the distinctive fea-tures of the metaphyseal bone area (e.g. complex bone shapes, thin soft tissue envelope).

Extra-articular fixation with the advantage of angled locking screwsThe two distal holes in the thinned area of the plate, which are angled at 11° towards the centre of the plate, may allow an application of the locking screws in the epiphyseal area.

Additional design features• Bullet nose plate tip for application of the minimally

invasive surgical technique.• Temporary fixation can be achieved through the

suture hole.• Improved vascularization of the periost due to plate

undercuts that reduce the plate-to-bone contact.• The elongated hole in the shaft are designed to allow

fine tuning of the reduction in the longitudinal axis.

Features

LCP Metaphyseal Plate 3.5

LCP Metaphyseal Plate 3.5/4.5/5.0

1

4

2

3

4_Priciples_03.pdf 1 05.07.12 12:08

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique

AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, 2.

1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.

2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.


AO Principles

1 Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer. 1991.

2 Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.

Stable fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Anatomic reductionFracture reduction and fixation to restore anatomical relation-ships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1,2.


Intended Use, Indications and Contraindications

Intended Use Locking Compression Plate (LCP) Implants are intended for temporary fixation, correction or stabilization of bones in various anatomical regions.

This Surgical Technique applies to the Depuy Synthes LCP Locking Compression Plate Systems and product lines listed below, which include but are not limited to the following indications:

IndicationsThe indications for each system will be presented indi-vidually.

Small Fragment plates (3.5) LCP Plates 3.5Fixation of small bone fragments using the five standard AO plating principles (buttress plate, neutralization plate, tension band plate, bridge plate, compression plate).

LCP Reconstruction Plates 3.5Fixation of small bone fragments using the five standard AO plating principles (buttress plate, neutralization plate, tension band plate, bridge plate, compression plate).

LCP T-Plates 3.5Fixation of small bone fragments using the five standard AO plating principles (buttress plate, neutralization plate, tension band plate, bridge plate, compression plate). Fracture fixation and fixation after osteotomies, mal-unions, non-unions; e.g. including but not limited to distal radius, proximal and distal tibia, proximal humerus, clavicular.

LCP One-third Tubular Plates 3.5 The LCP One-third Tubular Plates 3.5 are indicated for plating of fractures of long and small bones. The plate should only be used for load-sharing purposes, e.g. but-tressing, tension banding, neutralization or compression.


LCP Methaphyseal 3.5The LCP Metaphyseal Plates are indicated to fix extra- articular fractures in the metaphyseal area that can extend into the shaft area. The 3.5 mm plates are indi-cated to fix fractures of the distal humerus and distal fibula.

Large Fragment plates (4.5/5.0)LCP Methaphyseal 3.5/4.5/5.0The LCP Metaphyseal Plates are indicated for Extra- arti cular fractures of the metaphyseal area that extend into the shaft area.

The 4.5/5.0 plates are indicated to fix fractures of the proximal humerus and distal tibial.

LCP 4.5/5.0 Narrow PlatesLCP T-Plates 4.5/5.0LCP 4.5/5.0 Broad PlatesLCP 4.5/5.0 Broad Curved PlatesLCP Reconstruction Plates 4.5/5.0

In general the LCP Generic Plates & Instruments (Large Fragment) are indicated for the osteosynthesis of frac-tures at the Femur, Tibia, Humerus and Pelvic at proxi-mal, distal and shaft areas.

In the case of metaphyseal fractures, comminuted frac-tures and osteoporotic bone, the clinical results can be improved by the angular stable screw/plate connection.

ContraindicationsNo specific contraindications.


Standard Plate Technique

1. Reduce the fracture

Reduce the fracture under the image intensifier. As needed, provide fixation with Kirschner wire or reducing forceps.

AlternativeReduce the fracture indirectly using the plate by means of standard screws (for lag screw technique: to generate interfragmentary compression, use cancellous bone or cortical bone screws, see examples of the Combination Technique on page 36).

Precautions: • Instruments and screws may have sharp edges or

moving joints that may pinch or tear user’s glove or skin.

• Handle devices with care and dispose worn bone cutting instruments in an approved sharps con-tainer.


2. Bend the plate

Instruments

Small fragment

329.040 Bending Iron for Plates 2.4 to 3.5, length 145 mm (for use with 329.050)

329.050 Bending Iron for Plates 2.4 to 3.5, length 145 mm (for use with 329.040)

329.150 Bending Pliers for Plates 2.4 to 4.0, length 230 mm

329.290 Bending Pliers for Reconstruction Plates 2.7 and 3.5

Large fragment

329.300 Bending Press, length 400 mm

329.240 Bending Pliers for Plates 4.5, length 250 mm, complete, with Anvils Nos. 329.250 and 329.260

329.020 Bending Iron for LC-DCP 4.5 and DCP 4.5, length 250 mm (two required)

329.080 Bending Iron for Reconstruction Plates 3.5 and 4.5, length 190 mm

Precisely contour the LCP plate to the anatomy using the appropriate bending instruments (as for standard plates), especially in the case of joint fractures.

Precautions:• Reverse bending or use of the incorrect instrumen-

tation for bending may weaken the plate and lead to premature plate failure (e.g. breakage). Do not bend the plate beyond what is required to match the anatomy.

• Do not bend the plate at the level of the holes.

Note: The LCP combi-holes are asymmetrical in the plate. In straight plates, the hole alignment changes in the middle of the plate. This asymmetry enables unidirectional dynamic compression to be exerted.



3. Position plate

Position the plate on the bone, and preliminarily fix it. If axial dynamic compression is used, make sure that the middle of the plate is above the fracture line.


4. Select the drill guide position

Instruments

Small fragment

323.360 Universal Drill Guide 3.5

Large fragment

323.460 Universal Drill Guide 4.5/3.2, for neutral and load position

a. Select the neutral positionPress the spring-loaded guide against the bone in the DC part of the LCP hole. The inner sleeve retracts. The rounded end of the outer sleeve slides along the hole angle into neutral position. This enables neutral pre-drilling.

b. Select eccentric position (dynamic compression)Place the universal drill guide on the edge of the DC part of the LCP hole without exerting any pressure. The inner sleeve remains in its original state. The dynamic com-pression is generated by setting and tightening the cortex screw.

Note: The LC-DCP Drill Guides are unsuitable for LCP plates.



5. Drill screw hole

Instruments

Small fragment

310.230 Drill Bit B 2.5 mm, length 180/155 mm, 2-flute, for Quick Coupling

Large fragment

310.290 Drill Bit B 3.2 mm, length 195/170 mm, 2-flute, for Quick Coupling

Drill with an appropriate drill bit.

6. Determine screw length

Instruments

Small fragment

319.010 Depth Gauge for Screws B 2.7 to 4.0 mm, measuring range up to 60 mm

Large fragment


Measure the screw length with the depth gauge.


7. Option: Tap the thread

Instruments

Small fragment

311.320 Tap for Cortex Screws B 3.5 mm, length 110/50 mm

Large fragment

311.460 Tap for Cortex Screws B 4.5 mm, length 125/70 mm

If non-self-tapping screws are used, tap a thread manually.


8. Insert standard (Cortex or Cancellous Bone) screw

Instruments

311.440 T-Handle with Quick Coupling

Small fragment

314.070 Screwdriver, hexagonal, small, 2.5 mm, with Groove

Large fragment

314.270 Screwdriver, hexagonal, large, B 3.5 mm, with Groove, length 245 mm

Using the screwdriver, manually insert and tighten a standard screw with the measured length. Depending on the selected type of predrilling, no compression (a) or dynamic compression (b) may be generated.

Option: Insert a 2.7 mm cortex screw in a small fragment plate Place an LCP Washer 2.7/3.5 (X19.981) in the DC hole part of the 3.5 mm LCP plate. In this case, predrill with a Drill Bit with a 2.0 mm diameter (310.190).

Notes: • The holes in the straight LCP plates are larger at

the two ends to allow the insertion of cancellous bone screws.

• If a combination of cortex and locking screws is used, a cortex screw should be inserted first to generate interfragmentary compression.

(a) no compression (b) dynamic compression



Insert Self-tapping Locking Screws

1. Reduce the fracture and preliminarily fix it

Reduce the fracture under the image intensifier, and fix it with Kirschner wires or reducing forceps.

2. Bend the plate

Adapt the plate to the anatomy using the appropriate bending instruments. (See section 2 “Bend the plate” on page 9).

Precautions:• Reverse bending or use of the incorrect instrumen-


• Do not bend the plate at the level of the holes.

3. Position the plate and preliminarily fix it

Position the plate on the bone, and preliminarily fix it (for preliminary fixation using an LCP centering sleeve for Kirschner wires, see step 5).

Before setting the first locking screw, make sure that the plate is provisionally fixed well to prevent rotating since it could damage soft tissue when locking the screw.


4. Insert LCP drill sleeve

Instruments

Small fragment

323.027 LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm

Large fragment

323.042 LCP Drill Sleeve 5.0, for Drill Bits B4.3 mm

Carefully screw the LCP drill sleeve into the desired LCP hole until it is gripped completely by the thread.

Precaution: The use of the LCP drill sleeve is man-datory in order to ensure that the locking screw is drilled in the proper perpendicular angle and cor-rectly locked in the plate.

Notes: • To make it easier for the drill sleeve to grip the

thread, it may be useful to slightly rotate it to the left (back).

• In the case of meta-epiphyseal plates, the threaded hole is usually not perpendicular to the plate sur-face due to the anatomy.



5. Option: Insert Kirschner wire

Instruments

Small fragment

323.055 Centering Sleeve for Kirschner Wire B 1.6 mm, length 70 mm, for Nos. 323.027 and 323.054

or324.081 Centering Sleeve for Kirschner Wire

B 1.25 mm

292.120.01 Kirschner Wire B 1.25 mm with trocar tip, length 150 mm, Stainless Steel


Large fragment

323.044 Centering Sleeve for Kirschner Wire B 2.0 mm, length 110 mm, for No. 323.042


Insert the centering sleeve for Kirschner wires into the LCP drill sleeve. To allow the locking screw alignment to be checked later, use a power tool to insert a Kirschner wire and check its position under the image intensifier (see section metaphyseal plates). This check is especially recommendable in the metaphyseal region. Remove the Kirschner wire and the centering sleeve for Kirschner wires.

Note: If the angle of the locking screw is not opti-mal, it can be corrected. Bend the plate as needed, or move it in a proximal or distal direction. This technique is also suitable to preliminarily fix the plate to the bone.


6. Drill screw hole

Instruments

Small fragment

310.284 LCP Drill Bit B 2.8 mm with Stop, length 165 mm, 2-flute, for Quick Coupling

Large fragment

310.430 LCP Drill Bit B 4.3 mm with Stop, length 221 mm, 2-flute, for Quick Coupling

Carefully drill the screw hole using an appropriate drill bit.

Shove the stop ring down to the drill sleeve to make reading easier. Remove the drill sleeve.

Note: Replacement stop rings can be ordered from the local Depuy Synthes representative.



7. Determine screw length

Read the drilled depth directly from the laser mark on the drill bit.

Alternative

Instruments

Small fragment


Large fragment


Determine the screw length with the depth gauge.


8. Insert locking screw

Instruments

Small fragment

511.770 Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive

or511.115 Torque Limiter, 1.5 Nm,

for Compact Air Drive and Power Drive

314.116 Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling

314.030 Screwdriver Shaft, hexagonal, small, B 2.5 mm

Large fragment


314.119 Screwdriver Shaft Stardrive 4.5/5.0, T25, self-holding, for AO/ASIF Quick Coupling

or314.163 Torque-limiting Screwdriver Stardrive,

T25, self-holding, for Locking Screws B 5.0 mm

314.150 Screwdriver Shaft, hexagonal, large, B 3.5 mm

or314.152 Screwdriver Shaft 3.5, hexagonal,

self-holdingor324.052 Torque-limiting Screwdriver 3.5, self-

holding, for Locking Screws B 5.0 mm

397.705 Handle for Torque Limiter Nos. 511.770 and 511.771

311.431 Handle with Quick Coupling

Before setting the first locking screw, anatomical recon-struction must have occurred and, where necessary, fixed with lag screws. After setting the locking screws, additional reduction can no longer occur without remov-ing the locking screws. The locking screws can either be inserted with a power tool without locking or manually.

Warning: If a locking screw is used first, care should be taken to ensure that the plate is held securely to the bone to avoid spinning of the plate about the bone.



a. Insertion with a power toolTo insert the locking screw using a power tool, fit a torque limiter to the power tool. Then insert the screw-driver shaft into the torque limiter.

Pick up the locking screw and insert it into the plate hole. To insert the screw, start the power tool slowly, increase the speed and then reduce it again before the screw is fully tightened. Uncouple the power tool, and mount the handle with the CAD coupling or the handle with the quick coupling, and manually tighten the screw. After one click, the optimum torque is reached.

Warning: Locking screws may be partially inserted using power equipment alone. However, always use a torque limiting attachment (TLA) when using power to insert locking screws.

Note: Do not lock the screws at full speed to reduce the risk of stripping the head. This can make it diffi-cult to remove the implant.

Precaution: For long screws and thick cortical bone, ensure sufficient cooling during insertion.


The following table shows combinations of various drives and torque limiters, and the associated attachments:


Drive Torque limiter (TLA)

Small fragment511.770(1.5 Nm)



Large fragment511.771(4 Nm)

Large fragment511.774(4 Nm)

Power Drive direct without attachment

attachment 511.750 attachment 511.750 direct without attachment

attachment 511.785

Colibri attachment 532.017

Other power drives

AO/ASIFquick coupling

AO/ASIFquick coupling

AO/ASIFquick coupling for reamer

Handle for Torque Limiter (TLA)

397.705 311.431 311.431 397.705 397.706

Stardrive 314.116 314.116 314.116 314.119 314.119 screwdriver shaft

Hexagonal 314.030 314.030 314.030 314.150 314.150 screwdriver shaft


b. Manual insertionTo insert the locking screw manually, attach the torque limiter handle to the torque limiter and insert a screw-driver shaft. Screw in the locking screw, and lock it in the plate.

Only for locking screws large fragment: Alternatively, the Torque-limiting Screwdriver can be used (Hex 324.052, Stardrive 314.163).


1. Preliminary fixation

Provisionally fix the LCP locking plate to the bone.

Note: The self-drilling screws are primarily inserted in bone regions where a precise determination of length is not required (diaphysis). They can only be set monocortically.

Precaution: Do not insert the drill tip into the oppo-site cortical bone to prevent damage of the opposite side structure and to avoid removal problems.

Insert Self-drilling, Self-tapping Locking Screws


2. Insert locking screw

Instruments

Small fragment


or511.115 Torque Limiter, 1.5 Nm,

for Compact Air Drive and Power Drive



Large fragment

511.771 Torque Limiter, 4 Nm, for Compact Air Drive and Power Drive

or511.774 Torque Limiter, 4 Nm, for AO/ASIF

Quick Coupling for Reamers




self-holding


For additional combinations, see the table on page 22.

Insert a self-drilling locking screw of the desired length using a power tool with the torque limiting attachment and the screwdriver shaft along the thread axis of the hole and screw it in. Stop the power tool before the screw is locked. Remove the power tool and mount the handle. Lock the screw and tighten it until a click can be heard.

Notes:• Especially when the cortical bone is thick and the

locking screw is set perpendicular, drilling with the LCP Universal Drill Guide (small fragment: 323.505; large fragment: 323.500) is recommended. The universal drill guide is also used when insert-ing self-tapping screws in the diaphyseal region. For further information, see page 29.

• You can alternatively follow steps 4–7 on pages 16–19.

Precaution: Always irrigate during drilling to avoid thermal damage to the bone. Cooling is especially recommended for longer screws.


1. Shove the screw holding sleeve over the torque limiting screwdriver

Instruments

Small fragment

314.091 Holding Sleeve for Screws, for LCP 3.5

314.041 Screwdriver Stardrive 3.5, T15, with Groove, length 200 mm

314.070 Screwdriver, hexagonal, small, 2.5 mm, with Groove

Large fragment

314.281 Holding Sleeve for Screws, for LCP 4.5/5.0

314.164 Screwdriver Stardrive 4.5/5.0, T25, with Groove, length 252 mm

314.270 Screwdriver, hexagonal, large, B 3.5 mm, with Groove, length 245 mm

or324.052 Torque-limiting Screwdriver 3.5, self-


Mount the screw holding sleeve on the screwdriver. Hold the locking screw by placing the screw holding sleeve over the head of the screw.

Indirect Reduction with Locking Screws


2. Insert screw

Insert the screw. The screw holding sleeve prevents the screw from locking in the plate. As soon as the screw holding sleeve reaches the plate, the bone is approached by continuing to screw the screw in the plate.

3. Retract the screw holding sleeve

After the desired reduction is attained, retract the screw holding sleeve from the head of the locking screw.


4. Lock the screw

Instruments

Small fragment




Large fragment



or314.163 Torque-limiting Screwdriver Stardrive,

T25, self-holding, for Locking Screws B 5.0 mm



self-holding or324.052 Torque-limiting Screwdriver 3.5, self-



For additional combinations, see the table on page 22.

Remove the screwdriver and holding sleeve. Place the torque limiter handle on the torque limiter, and insert a screwdriver shaft. Screw in the locking screw, and lock it in the plate.

Only for locking screws large fragment: Alternatively, the Torque-limiting Screwdriver can be used (Hex 324.052, Stardrive 314.163).

Note: This technique is only suitable for pulling the bone to the plate. To generate interfragmentary com-pression, use cancellous bone or cortical bone screws (lag screw principle).

Indirect Reduction with Locking Screws


The LCP universal drill guide is only available with a Hex drive.

Instruments

Small fragments

323.505 LCP Universal Drill Guide 3.5, Stainless Steel


Large fragments

323.500 LCP Universal Drill Guide 4.5/5.0



self-holding

The LCP universal drill guide can alternatively be used for drilling. The universal drill guide has a drill guide on one side that enables centric and eccentric drilling; a short drill bit is on the other side (small fragments B 2.8 mm; large fragments B 4.3 mm).

1. Insert the LCP universal drill guide

Insert the universal drill guide into the threaded part of the LCP hole.

Drilling with the LCP Universal Drill Guide


2. Drill through the cortical bone

Use a power tool to drill through the proximal cortical bone with the screwdriver shaft in the drill guide.

Drilling with the LCP Universal Drill Guide

3. Remove the LCP universal drill guide

Remove the drill guide.

4. Set locking screw

Set the self-drilling, self-tapping locking screw as described on page 24.


Instruments

Steel Titanium

Small fragment

213.009 413.009 Spacer B 3.5 mm

Large fragment

213.309 413.309 Spacer B 5.0 mm

To reduce the plate-to-bone contact to a minimum, screw an LCP spacer in the plate before positioning the plate. The spacer ensures that a distance of 2 mm will be maintained between the plate and the bone when the screws are later inserted.

The spacer can be removed after setting the locking screws.

Insert LCP Spacers

11°


Metaphyseal Plates for extra articular fractures

Implant preparationAdapt the LCP Metaphyseal Plate to the anatomy of the bone.

Precautions: • Reverse bending or use of the incorrect instrumen-


• Do not bend the plate at the level of the holes. Plate fixation

Instruments

Small fragment


324.081 Centering Sleeve for Kirschner Wire B 1.25 mm



Large fragment:


323.044 Centering Sleeve for Kirschner Wire B 2.0 mm, length 110 mm, for No. 323.042


The two distal holes in the thinned area of the plate, which are angled at 11° towards the centre of the plate, allow for an appropriate anatomical application of the locking screws in the epiphyseal area. Take this into con-sideration when bending the plate and threading in the threaded LCP Drill Sleeve for 2.8 mm drill bits.


The threaded LCP drill sleeves ensure axially correct drill-ing.

Insert Kirschner wires to determine the direction of the screws or to temporarily fix the plate using the centering sleeve for Kirschner wires.

Verify the Kirschner wire position under the image inten-sifier.

The simultaneous use of two threaded LCP drill sleeves in the thinned plate area also assists insertion in the min-imally invasive surgical tech nique.

Note: For patient positioning and surgical approach refer for example to Rüedi TP, Buckley RE, Moran CG (2007) AO Principles of Fracture Management. 2nd expanded ed. 2002. Stuttgart, New York: Thieme.

Warning: Do not position the thinner portion of the plate over the fracture site.

1 2 3


Fixation with 3.5 mm locking screws

Instruments

Small fragment






311.431 Handle with Quick Coupling

Large fragment



314.152 Screwdriver Shaft 3.5, hexagonal, self-holding



324.052 Torque-limiting Screwdriver 3.5, self- holding, for Locking Screws B 5.0 mm

314.163 Torque-limiting Screwdriver Stardrive, T25, self-holding, for Locking Screws B 5.0 mm

1. Axially correct drilling for the self-tapping 3.5 mm locking screws requires the threaded LCP Drill Sleeve for 2.8 mm drill bits.

2. Use the Torque Limiter 1.5 Nm and the Screwdriver Shaft for the motor-driven insertion of the locking screw.

3. Stop the motor before locking, fix the torque limiter and the screw-driver shaft to the Handle with Quick Coupling and tighten the screw. After one click, the optimal torque is reached.

Metaphyseal Plates for extra articular fractures

1 2

43


Fixation with 5.0 mm locking screws4. Axially correct drilling for the self-tapping 5.0 mm

locking screws requires the threaded LCP Drill Sleeve for 4.3 mm drill bits.

5. Use the Torque Limiter 4.0 Nm and the Screwdriver Shaft for the motor-driven insertion of the locking screw.

6. Stop the motor before locking, fix the torque limiter and the screw driver shaft to the Handle and tighten the screw. After one click, the optimal torque is reached.

7. Alternatively, use the Torque-limiting Screwdriver to tighten the screw manually.

1 2 1

1 2 3

1 2 1


Examples of the Combination Technique

Standard screws and angular-stable locking screws can be combined.

Example AIf a plate is first fixed with standard screws (1), locking screws can be introduced later (2) to fix the fragments at a stable angle.

Example BIf a plate is first fixed to a fragment with locking screws (1), do not insert standard screw afterwards in the same fragment (2). In this case, the locking screws must be re-moved first before inserting the standard screws.

Example CIf the metaphyseal fragment is fixed with locking screws (1), the fracture can be dynamically compressed with standard screws (2). To increase the stability of fixation, insert additional locking screws into the diaphyseal frag-ment (3).

Example DIn the case of a diaphyseal fracture, standard screws can be inserted after the locking screws to draw the oppos-ing fragments closer to the plate.


Remove the Implant

Implant RemovalUnlock all screws from the plate, then remove the screws completely from the bone. This prevents simulta-neous rotation of the plate when unlocking the last locking screw.

For details regarding implant removal refer to the surgical technique “Screw Extraction Set” DSEM/TRM/0614/0104.


Basic LCP Plates

LCP PlatesLCP Plates 3.5

Stainless Steel Titanium (TiCP) Holes Length (mm)

223.541 423.541 4 59

223.551 423.551 5 72

223.561 423.561 6 85

223.571 423.571 7 98

223.581 423.581 8 111

223.591 423.591 9 124

223.601 423.601 10 137

223.611 423.611 11 150

223.621 423.621 12 163

223.631 13 176

223.641 14 189

223.651 15 202

223.661 16 215

223.671 18 241

223.681 20 267

223.691 22 293

All implants are also available sterile packed. Add Suffix “S” to part number.


LCP Plates 4.5/5.0, broad


226.561 426.561 6 116

226.571 426.571 7 134

226.581 426.581 8 152

226.591 426.591 9 170

226.601 426.601 10 186

226.611 426.611 11 206

226.621 426.621 12 229

226.631 426.631 13 242

226.641 426.641 14 260

226.651 426.651 15 278

226.661 426.661 16 296

226.671 426.671 17 314

226.681 426.681 18 332

226.701 426.701 20 368

226.721 426.721 22 404

226.741 426.741 24 440



LCP Plates 4.5/5.0, broad curved


226.622 426.622 12 229

226.632 426.632 13 247

226.642 426.642 14 265

226.652 426.652 15 282

226.662 426.662 16 300

226.672 426.672 17 318

226.682 426.682 18 336

226.692 426.692 19 354

226.702 426.702 20 372

226.712 426.712 21 390

226.722 426.722 22 408

226.732 426.732 23 426

226.742 426.742 24 443

226.752 426.752 25 461

226.762 426.762 26 479

Basic LCP PlatesLCP Plates



LCP One-third Tubular Plates 3.5


241.321 441.321 2 28

241.331 441.331 3 40

241.341 441.341 4 52

241.351 441.351 5 64

241.361 441.361 6 76

241.371 441.371 7 88

241.381 441.381 8 100

241.391 441.391 9 112

241.401 441.401 10 124

241.421 441.421 12 148



LCP Plates 4.5/5.0, narrow


224.521 424.521 2 44

224.531 424.531 3 62

224.541 424.541 4 80

224.551 424.551 5 98

224.561 424.561 6 116

224.571 424.571 7 134

224.581 424.581 8 152

224.591 424.591 9 170

224.601 424.601 10 188

224.611 424.611 11 206

224.621 424.621 12 224

224.631 424.631 13 242

224.641 424.641 14 260

224.651 424.651 15 278

224.661 424.661 16 296

224.681 424.681 18 332

224.701 424.701 20 368

224.721 424.721 22 404

224.741 424.741 24 440




* no combi-holesAll implants are also available sterile packed. Add Suffix “S” to part number.

LCP Reconstruction Plates 3.5


245.051 445.051 5 70

245.061 445.061 6 84

245.071 445.071 7 99

245.081 445.081 8 113

245.091 445.091 9 128

245.101 445.101 10 142

245.121 445.121 12 171

245.141 445.141 14 200

245.161 445.161 16 228

245.181 445.181 18 257

245.201 445.201 20 286

245.221 445.221 22 315

Round Hole Reconstruction Locking Plates 3.5*


245.052 445.052 5 58

245.062 445.062 6 70

245.072 445.072 7 82

245.082 445.082 8 94

245.092 445.092 9 106

245.102 445.102 10 118

245.122 445.122 12 142

245.142 445.142 14 166

245.162 445.162 16 190

245.182 445.182 18 214

245.202 445.202 20 238

245.222 445.222 22 262


LCP Reconstruction Plates 4.5/5.0


229.331 429.331 3 56

229.341 429.341 4 75

229.351 429.351 5 94

229.361 429.361 6 113

229.371 429.371 7 132

229.381 429.381 8 151

229.391 429.391 9 170

229.401 429.401 10 189

229.411 429.411 11 208

229.421 429.421 12 227

229.431 429.431 13 246

229.441 429.441 14 265

229.451 429.451 15 284

229.461 429.461 16 303





LCP Metaphyseal Plates 3.5


223.406 423.406 6 86

223.407 423.407 7 99

223.408 423.408 8 112

223.409 423.409 9 125

223.410 423.410 10 138

223.411 423.411 11 151

223.412 423.412 12 164

223.414 423.414 14 190

223.416 423.416 16 216

223.418 423.418 18 242

LCP Metaphyseal Plates 3.5/4.5/5.0


224.753 424.753 5+3 118

224.754 424.754 5+4 136

224.755 424.755 5+5 154

224.756 424.756 5+6 172

224.757 424.757 5+7 190

224.758 424.758 5+8 208

224.759 424.759 5+9 226

224.761 424.761 5+11 262

224.763 424.763 5+13 298

224.765 424.765 5+15 334



LCP T-Plates 3.5, right-angled


241.131 441.131 3 50*

241.141 441.141 4 56**

241.151 441.151 5 67*

241.161 441.161 6 78**

** = 3 head holes** = 4 head holes

LCP T-Plates 3.5, oblique-angled


241.031 441.031 3 52 right

241.041 441.041 4 63 right

241.051 441.051 5 74 right

241.931 441.931 3 52 left

241.941 441.941 4 63 left

241.951 441.951 5 74 left




LCP T-Plates 4.5/5.0


240.131 440.131 3 67

240.141 440.141 4 83

240.151 440.151 5 99

240.161 440.161 6 115

240.171 440.171 7 131

240.181 440.181 8 147

240.201 440.201 10 179

240.221 440.221 12 211

Kirschner Wire with trocar tip

Stainless Steel B (mm) length (mm)

292.120.01 1.25 150

292.120S 1.25 150

292.160.01 1.6 150

292.160S 1.6 150

292.200.01 2.0 150

292.200S 2.0 150



Locking Screws with Hex driveSelf-tapping

B 3.5 mm

Stainless Steel TAN Length (mm)

213.010 413.010 10

213.012 413.012 12

213.014 413.014 14

213.016 413.016 16

213.018 413.018 18

213.020 413.020 20

213.022 413.022 22

213.024 413.024 24

213.026 413.026 26

213.028 413.028 28

213.030 413.030 30

213.032 413.032 32

213.034 413.034 34

213.035 413.035 35

213.036 413.036 36

213.038 413.038 38

213.040 413.040 40

213.042 413.042 42

213.044 413.044 44

213.045 413.045 45

213.046 413.046 46

213.048 413.048 48

213.050 413.050 50

213.052 413.052 52

213.055 413.055 55

213.058 413.058 58

213.060 413.060 60

213.062 413.062 62

213.065 413.065 65

213.070 413.070 70

213.075 413.075 75

213.080 413.080 80

213.085 413.085 85

213.090 413.090 90

213.095 413.095 95

B 5.0 mm


213.314 413.314 14

213.316 413.316 16

213.318 413.318 18

213.320 413.320 20

213.322 413.322 22

213.324 413.324 24

213.326 413.326 26

213.328 413.328 28

213.330 413.330 30

213.332 413.332 32

213.334 413.334 34

213.336 413.336 36

213.338 413.338 38

213.340 413.340 40

213.342 413.342 42

213.344 413.344 44

213.346 413.346 46

213.348 413.348 48

213.350 413.350 50

213.355 413.355 55

213.360 413.360 60

213.365 413.365 65

213.370 413.370 70

213.375 413.375 75

213.380 413.380 80

213.385 413.385 85

213.390 413.390 90

Screws


Locking Screws with Hex driveSelf-drilling, self-tapping

B 3.5 mm

Stainless Steel Length (mm)

213.112 12

213.116 16

213.120 20

213.124 24

213.130 30

213.135 35

213.140 40

213.145 45

213.150 50

213.155 55

213.160 60




Screws

Locking Screws with StardriveSelf-tapping

B 3.5 mm


212.101 412.101 10

212.102 412.102 12

212.103 412.103 14

212.104 412.104 16

212.105 412.105 18

212.106 412.106 20

212.107 412.107 22

212.108 412.108 24

212.109 412.109 26

212.110 412.110 28

212.111 412.111 30

212.112 412.112 32

212.114 412.114 35

212.116 412.116 38

212.117 412.117 40

212.118 412.118 42

212.134 412.134 44

212.119 412.119 45

212.136 412.136 46

212.120 412.120 48

212.121 412.121 50

212.122 412.122 52

212.123 412.123 55

212.124 412.124 60

212.125 412.125 65

212.126 412.126 70

212.127 412.127 75

212.128 412.128 80

212.129 412.129 85

212.130 412.130 90

212.131 412.131 95

B 5.0 mm


212.201 412.201 14

212.202 412.202 16

212.203 412.203 18

212.204 412.204 20

212.205 412.205 22

212.206 412.206 24

212.207 412.207 26

212.208 412.208 28

212.209 412.209 30

212.210 412.210 32

212.211 412.211 34

212.212 412.212 36

212.213 412.213 38

212.214 412.214 40

212.215 412.215 42

212.216 412.216 44

212.217 412.217 46

212.218 412.218 48

212.219 412.219 50

212.220 412.220 55

212.221 412.221 60

212.222 412.222 65

212.223 412.223 70

212.224 412.224 75

212.225 412.225 80

212.226 412.226 85

212.227 412.227 90



Spacers

Locking Screws B 5.0 mm for Periprosthetic Fractures

Hex drive


02.221.458 04.221.458 8

02.221.460 04.221.460 10

02.221.462 04.221.462 12

222.402 422.402 14

222.404 422.404 18

Stardrive


02.221.508 04.221.508 8

02.221.510 04.221.510 10

02.221.512 04.221.512 12

02.221.514 04.221.514 14

02.221.518 04.221.518 18

Spacer B 5.0 mm

Hex drive


213.309 413.309 2

219.981 Washer B 3.5/2.7 mm, Stainless Steel

419.981 Washer B 3.5/2.7 mm, Titanium Alloy (TAN)

All washers are also available sterile packed. Add Suffix “S” to part number.

Spacer B 3.5 mm

Hex drive


213.009 413.009 2


Cerclage

Cerclage Positioning Pins, Eyes and CerclageFixX98.838.01 Positioning Pin 3.5 with thread, for LCPX98.838.01S Positioning Pin 3.5 with thread, for LCP,

sterile

X98.803.01 Positioning Pin 4.5 with thread, for LCPX98.803.01S Positioning Pin 4.5 with thread, for LCP,

sterile

X98.837 Cerclage Positioning Pin for LCP 3.5 and LC-DCP 3.5

X98.837S Cerclage Positioning Pin for LCP 3.5 and LC-DCP 3.5, sterile

X98.839 Cerclage Positioning Pin for LCP 4.5 and LC-DCP 4.5

X98.839S Cerclage Positioning Pin for LCP 4.5 and LC-DCP 4.5, sterile

0X.221.002.05 Cerclage Eye for Screws B 3.5 mm, Stardrive and hexagonal socket,

pack of 5 units0X.221.002S Cerclage Eye for Screws B 3.5 mm, Stardrive and hexagonal socket, sterile

0X.221.003.05 Cerclage Eye for Screws B 4.5 mm, Stardrive and hexagonal socket,

pack of 5 units0X.221.003S Cerclage Eye for Screws B 4.5 mm, Stardrive and hexagonal socket, sterile

0X.221.004.05 Cerclage Eye for Hexagonal Socket, B 4.0 mm, cannulated, pack of 5 units

0X.221.004S Cerclage Eye for Hexagonal Socket, B 4.0 mm, cannulated, sterile

X81.001 CerclageFix InsertX81.001S CerclageFix Insert, sterile

X81.002 CerclageFix for LPC 4.5/5.0X81.002S CerclageFix for LCP 4.5/5.0, sterile


Cerclage Cables

298.801.01 Cerclage Cable with Crimp B 1.7 mm, Stainless Steel

298.801.01S Cerclage Cable with Crimp B 1.7 mm, Stainless Steel, sterile

611.105.01 Cerclage Cable with Crimp, B 1.7 mm, Cobalt-chrome Alloy

611.105.01S Cerclage Cable with Crimp B 1.7 mm, Cobalt-chrome Alloy, sterile

X98.800.01 Cerclage Cable with Crimp B 1.0 mmX98.800.01S Cerclage Cable with Crimp B 1.0 mm,

sterile

498.806* TRD – Trochanter Reattachment Device, small, for Cable System, Titanium Alloy (TAN)498.806S* TRD – Trochanter Reattachment Device, small, for Cable System, Titanium Alloy (TAN), sterile

498.807* TRD – Trochanter Reattachment Device, large, for Cable System, Titanium Alloy (TAN)498.807S* TRD – Trochanter Reattachment Device, large, for Cable System, Titanium Alloy (TAN), sterile

X=2: Stainless SteelX=4: Titanium

* TRD – Trochanter Reattachment Device: CE0086 Manufactured by: Pioneer Surgical Technology, Inc. 375 River Park Circle, Marquette MI 49855 USA Distributed by: Synthes, GmbH, Eimattstrasse 3, 4436 Oberdorf, Switzerland


Drill Sleeves

Art. No. Description Small Large fragment fragment

323.027 LCP Drill Sleeve 3.5, X for Drill Bits B 2.8 mm

323.042 LCP Drill Sleeve 5.0, X for Drill Bits B 4.3 mm

324.007 Drill Sleeve 7.2/4.3, X length 130 mm, for LISS

Instruments

Drill Bits


310.284 LCP Drill Bit B 2.8 mm X with Stop, length 165 mm, 2-flute, for Quick Coupling

310.430 LCP Drill Bit B 4.3 mm X with Stop, length 221 mm, 2-flute, for Quick Coupling

310.423* Drill Bit B 4.3 mm, X length 280 mm, for No. 324.007

Replacement stop rings can be ordered from the local Depuy Synthes representative.

* calibrated for Drill Sleeve 324.007


Torque Limiters and Corresponding Handles

Torque Limiter Handle

Art. No. Description Art. No. Small Large fragment fragment

511.770 1.5 Nm, for Compact 397.705 X Air Drive and Power Drive

511.773 1.5 Nm, for AO/ASIF 311.431 X Quick Coupling

511.115 1.5 Nm, for Compact 311.431 X Air Drive and Power Drive

511.771 4 Nm, for Compact 397.705 X Air Drive and Power Drive

511.774 4 Nm, for AO/ASIF 397.706 X Quick Coupling for Reamers


Instruments

Holding Sleeves for Screws


314.091 for LCP 3.5 X

314.281 for LCP 4.5/5.0 X

Hexagonal Screwdrivers, non-self-holding

Art. No. Small Large fragment fragment

314.070 X

314.270 X

Hexagonal Screwdriver Shafts


314.030 non-self-holding X

314.150 non-self-holding X

314.152 self-holding X


SHS Screwdrivers, non-self-holding


03.400.101 Screwdriver Shaft 2.5, X hexagonal, Stardrive T15

03.400.111 Handle for X Screwdriver Shaft 2.5

03.400.102 Screwdriver Shaft 3.5, X hexagonal, Stardrive T25

03.400.112 Handle for X Screwdriver Shaft 3.5

Stardrive Screwdrivers, non-self-holding


314.041 T15 X

314.164 T25 X

Stardrive Screwdriver Shafts, self-holding


314.116 T15 X

314.119 T25 X

Torque-limiting Screwdrivers self-holding, for Locking Screws B 5.0 mm

Art. No. Description

324.052 Hex drive

314.163 Stardrive T25


Instruments

Centering Sleeves for Kirschner Wires


324.081 B 1.25 mm X

323.055 B 1.6 mm, X length 70 mm

323.044 B 2.0 mm, X length 110 mm


Discontinued Implants

Stainless Steel Titanium (TiCP)

241.831 441.831

241.841 441.841

241.851 441.851

241.861 441.861

Stainless Steel Titanium (TiCP)

240.341 440.341

240.351 440.351

240.361 440.361

Stainless Steel

240.231 240.431

240.241 240.441

240.251 240.451

240.261 240.461

Titanium (TiCP)

440.231 440.431

440.241 440.441

440.251 440.451

440.261 440.461

LCP L-Buttress Plates 4.5/5.0 (Discontinued – December 2016)

LCP T-Buttress Plates 4.5/5.0 (Discontinued – December 2016)

LCP Clover Leaf Plates 3.5 (Discontinued – December 2016)


B 3.5 mm (Discontinued – June 2016)

TAN

413.112

413.116

413.120

413.124

413.130

413.135

413.140

413.145

413.150

413.155

413.160

B 5.0 mm (Discontinued – June 2017)

Stainless Steel TAN

213.414 413.414

213.418 413.418

213.422 413.422

213.426 413.426

213.430 413.430

213.435 413.435

213.440 413.440

213.445 413.445

213.450 413.450

213.455 413.455

213.460 413.460

213.465 413.465

213.470 413.470

213.475 413.475

213.480 413.480

213.485 413.485

213.490 413.490

Locking Screws with Hex drive, Self-drilling, self-tapping

Discontinued Implants

MRI Information

Torque, Displacement and Image Artifacts according to ASTM F 2213-06, ASTM F 2052-14 and ASTM F 2119-07Non-clinical testing of worst case scenario in a 3 T MRI -system did not reveal any relevant torque or displace-ment of the construct for an experimentally measured local spatial gradient of the magnetic field of 3.69 T/m. The largest image artifact extended approximately 169 mm from the construct when scanned using the Gradient Echo (GE). Testing was conducted on a 3 T MRI system.

Radio-Frequency-(RF-)induced heating according to ASTM F 2182-11aNon-clinical electromagnetic and thermal testing of worst case scenario lead to peak temperature rise of 9.5 °C with an average temperature rise of 6.6 °C (1.5 T) and a peak temperature rise of 5.9 °C (3 T) under MRI Conditions using RF Coils (whole body averaged specific absorption rate [SAR] of 2 W/kg for 6 minutes [1.5 T] and for 15 minutes [3 T]).

Precautions: The above mentioned test relies on non-clinical testing. The actual temperature rise in the patient will depend on a variety of factors be-yond the SAR and time of RF application. Thus, it is recommended to pay particular attention to the following points:• It is recommended to thoroughly monitor patients

undergoing MR scanning for perceived tempera-ture and/or pain sensations.

• Patients with impaired thermoregulation or temperature sensation should be excluded from MR scanning procedures.

• Generally, it is recommended to use a MR system with low field strength in the presence of conduc-tive implants. The employed specific absorption rate (SAR) should be reduced as far as possible.

• Using the ventilation system may further contrib-ute to reduce temperature increase in the body.


Synthes GmbHEimattstrasse 34436 OberdorfSwitzerlandTel: +41 61 965 61 11Fax: +41 61 965 66 00www.depuysynthes.com 0123

Not all products are currently available in all markets.

This publication is not intended for distribution in the USA.

All surgical techniques are available as PDF files at www.depuysynthes.com/ifu ©

DeP

uy S

ynth

es T

raum

a, a

div

isio

n of

Syn

thes

Gm

bH. 2

017.

A

ll rig

hts

rese

rved

. 03

6.00

0.01

9 D

SE

M/T

RM

/011

5/02

78(4

) 10

/17

Documents

LCP Locking Compression Plate - synthes.vo.llnwd.netsynthes.vo.llnwd.net/o16/LLNWMB8/INT Mobile/Synthes International... · Surgical Technique LCP Locking Compression Plate DePuy