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SynthesVeterinary
TPLO Plate. Tibial plateau levelingosteotomie in the canine proximal tibia.
Technique Guide
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Synthes 1
WarningThis description is not sufficient for immediate application ofthe instrumentation. Instruction by a surgeon experienced inhandling this instrumentation is highly recommended.
Table of Contents
Introduction
Surgical Technique
Product Information
Tibial Plateau Leveling Osteotomy Plate 2
Indications 4
AO ASIF Principles of Internal Fixation 5
Implant Features 6
Clinical Cases 8
Plate Contouring and Positioning 9
Drill Guide Technique 10
Screw Insertion Sequence 12
Implants 15
Instruments 19
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Tibial Plateau Leveling Osteotomy Plate
Combi hole accepts locking or cortex screw
Precontoured shape foranatomical fit
Limited-contact profilepreserves bone vascularity
* Patent pending design
The Synthes Tibial Plateau Leveling Osteotomy (TPLO) Plate is part of a stainless steel plate and screw system that mergeslocking screw technology with conventional plating tech-niques. The TPLO Plate has many similarities to existing bonefixation plates, with a few important improvements. Thetechnical innovation of locking screws and an anatomicalcontour provide the ability to create a fixed-angle constructwhile following familiar AO plating principles.`Features and Benefits*– Available in right and left versions– Uses either conventional or locking screws– Precontoured for anatomic fit– Plate head specifically designed to engage more bone– Plate head holes angled away from the articular surface
and osteotomy for optimal locking screw placement.
2 Synthes TPLO Plate Technique Guide
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Head holes accept locking,cortex or cancellous bonescrews
Rounded edges minimizesoft tissue irritation
DCP holes provide axialcompression
A
B
C
Head screw angulationsA. Cranial screw: 5° caudalB. Proximal screw: 3° distal/5° caudalC. Caudal screw: 3° cranial
Synthes 3
LCP combi-holeIntraoperative choice between compression and angularly stable locking
With standard screws:interfragmental or dynamic-axialcompression
With locking screws: stable plate-screw connection withoutloss of reduction, regardless of platemodelling
LCP Locking Compression Plate Angular stable fixation of fragments regardless of bone quality
Minimised risk of primary andsecondary loss of reduction, even underhigh dynamic loading
Reduced impairment of periostealblood supply due to the limited plate contact
Good purchase also in osteoporotic boneand in multifragment factures
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The Synthes Tibial Plateau Leveling Osteotomy (TPLO) Plateis intended for use in stabilizing osteotomies of the canineproximal tibia.
Indications
4 Synthes TPLO Plate Technique Guide
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AO ASIF Principles of Internal Fixation
In 1958, the AO ASIF (Association for the Study of InternalFixation) formulated four basic principles for internal fixation, which are still believed to be valid today.1 The Synthes TibialPlateau Leveling Osteotomy (TPLO) Plate has been designedwith these principles in mind. These principles are:
Anatomical reductionThe TPLO Plate is designed to anatomically fit the proximo-medial canine tibia, providing proper alignment and optimalfunction of the repaired stifle.
Stable fixationThe TPLO Plate provides stable fixation of the canine proxi-mal tibia to promote healing at the osteotomy site. Whenused with locking screws, the plate and screw construct pro-vides a locked, fixed-angle construct.
Preservation of blood supply (to the bone)The limited-contact profile, rounded edges, and anatomicaldesign of this plate assist in preservation of the blood supplyby minimizing surface contact with the bone and disruptionof soft tissue, and preserving bone vascularity.
Early mobilizationThe TPLO Plate provides secure fixation which may contributeto pain reduction and permits early, active rehabilitation con-ducive to optimal recovery.
1 A.L. Johnson, J. Houlton, R. Vannini (2005) AO Principles of Fracture Management in the Dog and Cat, Stuttgart: Thieme.
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6 Synthes TPLO Plate Technique Guide
Stacked Combi hole Combi hole DCP hole
Plate design
HolesThe 3.5 mm TPLO plate is designed with three distinct screw-hole technologies to accommodate all plating modalities.Along its shaft are two DCP holes separated by a centralCombi hole; in its head are three stacked Combi holes.
The DCP holes accept cortex screws that may be placed in either loaded or neutral positions, depending on whetheror not interfragment compression is desired (see UniversalDrill Guide for more detail).
The Combi hole in the center of the plate shaft accepts ei-ther a cortex screw or a locking screw. The cortex screwshould be placed in the unthreaded portion of the Combihole in either a loaded or neutral position. A locking screwmay be used in the threaded portion of the Combi holewhen indicated.
The three stacked Combi holes in the plate head accept ei-ther cortex, cancellous bone, or locking screws. If lockingscrews are to be used in conjunction with cortex or cancel-lous bone screws in the plate head, the locking screws mustbe inserted after the other screws have been inserted andtightened.
Fixed angle stabilityThe threads on the head of the locking screws mate withthe threaded plate holes to form a fixed-angle construct thatcan increase load transfer. When compared to conventionalplate-and-screw constructs, the angular and axial stabilityof locking screws increase the strength of the construct un-der load without requiring precise anatomical contouring.
Angled threaded holes in the head of the TPLO plate helpensure that screws are angled away from the articular sur-face and osteotomy.
Anatomical contourThe anatomically shaped TPLO plate is contoured to matchthe medial aspect of the canine proximal tibia. This can reduce or eliminate the need for additional shaping of theplate. All implants are made of implant quality 316L stainless steel
Limited contactThe limited-contact shaft design reduces plate-to-bone con-tact area to preserve vascularity and optimize bone healing.
Implant Features
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Synthes 7
Locking screws
Screw headThe tapered, double-lead machine thread on the head of thelocking screw mates with the Combi hole in the plate. Thisresults in stable fixation of the bone fragment without hav-ing to compress the fragment to the plate. A perfectly con-toured plate is therefore not required to achieve stable fixa-tion.
Thread profileBecause locking screws do not compress the plate to thebone, the “pull-out” mode of failure is not applicable tolocking screws. Instead, locking screws fail under cantileverloading. For this reason, locking screws are made with alarger core diameter and smaller thread profile. This resultsin increased mechanical strength over comparably sized cortex and cancellous bone screws.
Note: The self-tapping flutes of the locking screw make pretapping unnecessary.
Drive mechanismThe Stardrive recess of a locking screw provides three signifi-cant improvements over an internal hex drive. First, “strip-ping” of screw heads is minimized as a failure mode, whichresults in a much higher tolerance to wear for the screw-driver. Second, the tapered Stardrive recess provides auto-matic screw retention without the need for an additionalscrew holding mechanism. Third, the more efficient Stardriverecess allows a smaller screw head and flush fitting to theplate.
All implants are made of implant quality 316L stainless steel.
Double-lead locking threadsmate with the threadedportion of the plate
Self-tapping flutes
Stardrive recess
Synthes 7
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8 Synthes TPLO Plate Technique Guide
Case 1A 74-lb., six-year-old, neutered femaleLabrador presented with acute lame-ness and a painful stifle.
The use of three locking screws in theplate head ensures optimal stabilizationof the proximal portion of the tibia.The distal portion of the tibia is stabi-lized using cortex screws in the plateshaft.
PreoperativeAP
PreoperativeLateral
PostoperativeAP
PostoperativeLateral
8-week Follow-up AP
8-week Follow-up Lateral
Case 2 An 86-lb., three-year-old, neutered female German Shepherd presentedwith left hind limb lameness of oneweek duration.
This patient was previously diagnosedwith multicentric B-cell lymphoma. Hermedication regime includes Leukeran30 mg every fourteen days, Methotrex-ate 2.5 mg twice weekly, Prednisone25 mg every other day, and Pepcid20 mg once daily.
Similarly to Case 1, three locking screwswere used in the plate head to ensureoptimal stabilization of the proximalportion of the tibia. The distal portionof the tibia was stabilized using cortexscrews in the plate shaft.
Clinical Cases
PreoperativeAP
PreoperativeLateral
PostoperativeAP
PostoperativeLateral
8-week Follow-up AP
8-week Follow-up Lateral
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Plate Contouring and Positioning
Plate contouring
If three locking screws will be used in the plate head holes,perfect contour match to the bone is unnecessary since thelocking screws will not compress the plate to the bone.
If conventional screws will be used in the plate head holes,perfect contour match is desirable.
Note: Contouring of the plate may redirect the angle ofthe locking screws. It is best to avoid contouring around thehead holes as this can distort the internal threads.
Plate positioning
The TPLO Plate should be positioned on the medial surfaceof the tibia, in a manner that best fits the bone contour andosteotomy. The plate is designed to be placed very proxi-mally, just distal to the articular surface. The proximal headscrew is angled 3° distal/5° caudal, away from the articularsurface.
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LCP drill sleeve
The 2.8 mm LCP drill sleeve fits the threaded holes of theTPLO Plate. When a locking screw is planned, a LCP drillsleeve must be used for guiding the drill bit in the proper direction.
Note: The LCP drill sleeve can also be used intraoperativelyas a reference for visualizing the angle at which the lockingscrews will engage the bone.
Drill Guide Technique
323.027
10 Synthes TPLO Plate Technique Guide
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Universal drill guide
The Universal Drill Guide is the only drill guide which func-tions in all Synthes plate holes. When a cortex or cancellousbone screw is used, it is recommended that a Universal DrillGuide be used to guide the drill bit. If the screw is intendedto achieve interfragment compression, the Universal DrillGuide should be placed in the load position, as shown anddescribed in the figure below. If the screw is intended to holdthe plate, the Universal Drill Guide should be placed in theneutral position.
Neutral
Compression (load)
323.360
Compression (load) position
Compression is achieved by placing the Universal Drill Guidein the eccentric position, and maintaining the drill guidebody above the plate as shown.
Neutral position
Neutral position is achieved by placing the Universal DrillGuide in the eccentric position, then compressing the drillguide body into the hole, which will shift the drill guide intothe neutral position as shown.
Note: For illustrative purposes, a Combi hole has been depicted. The same methodology applies to LC-DCP andDCP holes.
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Screw Insertion Sequence
It is recommended that screws be inserted in the sequence described below:
2
Place either a conventional cortex screw or locking screwin the most cranial head hole of the plate. Fully tighten thisscrew. If both cortex and locking screws are used in the platehead, place all cortex screws first and then place all lockingscrews.
Note: Locking screws should not be tightened more than 1.5Nm. Overtightening may cause a cold weld and screw removal may be difficult.*
2 Locking or cortex screw
Cranial
Distal
Caudal
1Cortex screw in compression position (left slightly loose)
* See p.20 for 1.5 Nm Torque Limiting Attachment.
Proximal1
In the proximal DCP shaft hole, place a conventional cortexscrew in compression (load) position. This screw should beleft slightly loose, by about one turn. Ensure that the platecontinues to be pushed proximally against this screw, beforethe next screw is placed.
Note: When locking screws are used, a space between theundersurface of the plate and the proximal bone fragmentmay occur. Do not push the proximal, head portion of theplate onto the bone.
12 Synthes TPLO Plate Technique Guide
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3
Place either a conventional cortex screw or locking screw inthe most proximal head hole of the plate. Fully tighten thisscrew. If both cortex and locking screws are used in the platehead, place all cortex screws first and then place all lockingscrews.
3 Locking or cortex screw
4
In the most distal DCP shaft hole, place a conventional cortexscrew in the compression position. After ensuring that thefirst cortex screw (described in step 1) is slightly loose, fullytighten the compression screw in this hole. Return to the cor-tex screw described in step 1 and tighten fully.*
Note: Check for compression and alignment of osteotomybefore placing the final screw.
4 Cortex screw in compression position
* (fully tighten)
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5 Locking or cortex screw
5
If a jig is used, it may need to be removed to provide accessto this screw hole.
Place either a conventional cortex screw or locking screw inthe most caudal head hole of the plate. Fully tighten thisscrew. If both cortex and locking locking screws are used inthe plate head, place all cortex screws first and then placeall locking screws.
Note: It is highly recommended that at least one lockingscrew be used in the proximal, head portion of the TPLOPlate (steps 2, 3, and 5).
6
In the midshaft Combi hole, place either a conventional cor-tex screw in the nonthreaded portion of the hole or a lockingscrew in the threaded portion of the hole. Fully tighten thisscrew.
Check tightness of screws placed in steps 1–6.
6 Locking or cortexscrew in neutralposition
14 Synthes TPLO Plate Technique Guide
Screw Insertion Sequence
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Synthes 15
Implants
3.5 mm Tibial Plateau Leveling Osteotomy (TPLO) Plate,left
Holes Length Thickness
VP4401.L3 3 holes, proximal 66 mm 3.7 mm 3 holes, distal
3.5 mm Tibial Plateau Leveling Osteotomy (TPLO) Plate,right
Holes Length Thickness
VP4401.R3 3 holes, proximal 66 mm 3.7 mm 3 holes, distal
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16 Synthes TPLO Plate Technique Guide
Cortex Screw � 3.5 mm
Steel Length (mm)
204.010 10
204.012 12
204.014 14
204.016 16
204.018 18
204.020 20
204.022 22
204.024 24
204.026 26
204.028 28
204.030 30
204.032 32
204.034 34
204.036 36
204.038 38
204.040 40
204.042 42
Locking Screw Stardrive � 3.5 mm, self-tapping
Steel Length (mm)
212.101 10
212.102 12
212.103 14
212.104 16
212.105 18
212.106 20
212.107 22
212.108 24
212.109 26
212.110 28
212.111 30
212.112 32
212.113 34
212.114 35
212.115 36
212.116 38
212.117 40
212.118 42
212.119 45
212.120 48
212.121 50
212.122 52
212.123 55
212.124 60
204.044 44
204.045 45
204.046 46
204.048 48
204.050 50
204.055 55
204.060 60
204.065 65
204.070 70
204.075 75
204.080 80
204.085 85
204.090 90
204.095 95
204.100 100
204.105 105
204.110 110
Implants
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Synthes 17
Cortex Screw � 3.5 mm, self-tapping
Steel Length (mm)
204.810 10
204.812 12
204.814 14
204.816 16
204.818 18
204.820 20
204.822 22
204.824 24
204.826 26
204.828 28
204.830 30
204.832 32
204.834 34
204.836 36
204.838 38
204.840 40
204.842 42
204.844 44
204.845 45
204.846 46
204.848 48
204.850 50
204.855 55
204.860 60
204.865 65
204.870 70
204.875 75
204.880 80
204.885 85
204.890 90
204.895 95
204.900 100
204.905 105
204.910 110
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18 Synthes TPLO Plate Technique Guide
Cancellous Bone Screw � 4.0 mm, fully threaded
Steel Length (mm)
206.010 10
206.012 12
206.014 14
206.016 16
206.018 18
206.020 20
206.022 22
206.024 24
206.026 26
206.028 28
206.030 30
206.032 32
206.035 35
206.040 40
206.045 45
206.050 50
206.055 55
206.060 60
Cancellous Bone Screw � 4.0 mm, short thread
Steel Length (mm) Thread length (mm)
207.010 10 5
207.012 12 5
207.014 14 5
207.016 16 6
207.018 18 7
207.020 20 8
207.022 22 9
207.024 24 10
207.026 26 12
207.028 28 14
207.030 30 14
207.035 35 14
207.040 40 14
207.045 45 15
207.050 50 15
207.055 55 16
207.060 60 16
Screw Reference Chart
Thread Diameter 3.5 mm 3.5 mm 4.0 mmScrew Type Cortex Locking Cancellous
Drill Bit for 2.5 mm 2.8 mm 2.5 mmThreaded Hole
Tap 3.5 mm Self-Tapping 4.0 mm
Drive Type 2.5 mm T15 2.5 mm Hexagonal Stardrive Hexagonal
Implants
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Synthes 19
Instruments
310.284 LCP Drill Bit, 2.8 mm, quick coupling
323.027 LCP Drill Sleeve 3.5 mm, for Drill Bits � 2.8 mm
314.041 Stardrive Screwdriver, T15
314.116 Stardrive Screwdriver Shaft, quick coupling
323.055 Centering Sleeve for Kirschner Wire � 1.6 mm, length 70 mm
323.360 3.5 mm Universal Drill Guide
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20 Synthes TPLO Plate Technique Guide
329.916 Bending Pin for LCP Plates, 3.5 mm, with thread
324.024 Instrument for temporary reduction
Also available
323.060 PHILOS Direct Measuring Device forKirschner Wire � 1.6 mm
511.773 Torque Limiting Attachment,quick coupling, 1.5 Nm
Instruments for Locking Screws
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