Technique Guide. Compact 2.0 LOCK Mandible. The locking system for the mandible.

Transcription

1 Technique Guide Compact 2.0 LOCK Mandible. The locking system for the mandible.

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3 Table of Contents Introduction Compact 2.0 LOCK Mandible 2 AO Principles 4 Indications and Contraindications 5 Surgical Technique Surgical Technique 6 Steps for Bone Resection (Optional) 13 Ordering Information Set 15 Plates 16 Screws 16 Instruments 17 Warning This description is not sufficient for immediate application of the instrumentation. Instruction by a surgeon experienced in handling this instrumentation is highly recommended. Synthes 1

4 Compact 2.0 LOCK Mandible. The locking system for the mandible. System Features and Benefits Four plate profiles one screw dimension Low-profile plating system Choice of rigidity level depending on individual situation System covers a broad range of indications: small plates for simple trauma medium plates for extra stability if required large and extra-large plates for more complex trauma and microvascular reconstruction Choice of self-tapping or self-drilling screws Provides locked or non-locked 2.0 mm screw plate fixation 2.0 mm screws fit all plate profiles The locking design: Provides construct stability Provides a positive stop for locking screws Preserves reduction intraoperatively by maintaining plate-to-bone position Plates Low plate profile and stability; favorable in atrophic mandibles Easy three-dimensional contouring without plate hole deformation Low plate palpability Available in a wide variety of straight, angled and curved shapes Hole spacing is designed for fixation in reconstructive surgery 1.0 Small 1.3 Medium 1.5 Large Extra-large Synthes Compact2.0LOCKMandible TechniqueGuide

5 Screws 2.0 mm LOCK screw self-tapping and self-drilling Stable fixation of bone fragments and grafts, even with poor quality bone Absence of plate pressure on the bone preserves blood supply Special conical double threads beneath the screw head engage and lock into threaded plate holes Self-tapping available in 5 18 mm lengths, and self-drilling in 5, 6 and 8 mm lengths, for monocortical and bicortical applications Self-tapping for easy insertion Made of high-strength titanium alloy 2.0 mm Cortex Screw self-tapping and self-drilling (non locking) Without thread in the screw head Synthes 3

6 AO Principles In 1958, the AO (Association for the Study of Internal Fixation) formulated four basic principles, which have become the guidelines for internal fixation 1. Those principles as applied to the 2.0 LOCK Mandible system are: Anatomic reduction Fracture reduction and fixation to restore anatomical relationships. A comprehensive implant and instrument selection offers the ability to address most simple and complex fixation needs. Stable fixation Stability by rigid fixation (compression plating) or splintage, as the personality of the fracture and the injury requires. The Compact 2.0 LOCK Mandible locking plate and screw locking technology are optimized to achieve stable bone fixation. Preservation of blood supply Preservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques. Instrumentation and new gentle profiles and edges on implants minimize disruption of soft tissue and preserves vascular blood flow for bone healing. Early mobilization Early and safe mobilization of the part and patient. The Compact 2.0 LOCK Mandible system implants, combined with AO technique, provide stable fixation enough to allow a functional aftercare. 1 Müller ME, Allgöwer M, Schneider R, Willenegger H (1991) AO Manual of Internal Fixation. 3rd Edition. Berlin: Springer-Verlag 4 Synthes Compact2.0LOCKMandible TechniqueGuide

7 Indications and Contraindications Indications Mandible trauma Orthognathic surgery Reconstructive surgery with microvascular bone grafts Plate thickness Plate type Primary clinical use Secondary clinical use 1.0 mm Small plates: Tension band Straight Adaption Strut/Box/L/Y Mandible traumatology Orthognathic 1.3 mm Medium plates: Adaption plates Crescent Angled DCP plates Mandible traumatology NA 1.5 mm Large plates: Curved/Crescent Straight Angled Mandible traumatology NA 2.0 mm Extra large plates: Straight Single Angle Double Angle Primary mandibular reconstruction (used with microvascular bone graft) Comminuted fractures Contraindications Reconstructive surgery without microvascular bone grafts Synthes 5

8 Surgical Technique 1 Exposure and reduction After completing the preoperative plan, expose the fracture or osteotomy site. For trauma, reduce the fracture as required. 2 Select and prepare implants Instrument Holding forceps for plates 1.0 to 2.4 Select the appropriate plate (see preceding page) depending on indication. Orient the plate so that the topside of the plate is facing out. Determine the appropriate screw type (locking and/or nonlocking, self-tapping and/or self-drilling). 6 Synthes Compact2.0LOCKMandible TechniqueGuide

9 3 Optional: Cut the plate to length Instrument Plate cutter with Deburring Device, for plates 1.0 to 2.4, length 180 mm Optional Bending/Cutting pliers with nose for LOCK Plates 2.0 Small, medium and large plates Cut to length, if necessary. Small plates may be cut using the plate cutter or the bending/cutting pliers with nose. Extra large plates Cut to length, if necessary. Extra large plates may be cut using the plate cutter. Synthes 7

10 Surgical Technique 4 Select and form the bending template Select the appropriate shape and length bending template and form it to the boney anatomy. Note: Stable fixation requires a minimum of 2 3 screws per segment. 5 Contour the plate Instruments Pliers, flat-nosed, pointed, for Plates 1.0 to Combined Pliers for Plates 1.0 and 2.0, for Cutting and Bending Bending/Cutting pliers with nose for LOCK Plates 2.0 (optional instrument) Small and medium plates In plane, out-of-plane and torsional bending Small and medium plates can be contured using the combined pliers and the flat nosed pliers. 8 Synthes Compact2.0LOCKMandible TechniqueGuide

11 Large and extra large plates Can be contoured using the bending/cutting pliers with nose and the flat nosed pliers. In plane bending Out-of-plane bending Bending the last hole out-of-plane with nose. Torsional bending Grasp the plate in the appropriate jaw of the flat nosed pliers, and apply a twisting motion until achieving the desired torsional bend. Synthes 9

12 Surgical Technique 6 Position the plate Instrument Holding Forceps with Ball, ratchet lock, length 180 mm (optional instrument) Place the plate over the fracture or osteotomy site. Use the plate holding forceps to secure the plate to the bone, if desired. 7 Drill the first hole Option 1: Drill using standard drill sleeve/double drill guide Instruments Drill sleeve 1.5, for LOCK Plates Drill bit B 1.5 mm, 2-flute, total/usable length 80/55mm, for J-Latch Coupling Double Drill Guide 2.0/1.5 Insert the drill sleeve into the first plate hole nearest the fracture or osteotomy site. When using the standard drill sleeve/double drill guide with locking screws, ensure that it is centered in all planes to align the screw s locking threads properly in the plate. Note: Standard 1.5 mm drill sleeve and double drill guide to be used with non-locking screws or when good visualization is possible. 10 Synthes Compact2.0LOCKMandible TechniqueGuide

13 Option 2: Drill using threaded sleeve Instruments Drill sleeve with thread 1.5, for LOCK Plates Drill bit B 1.5 mm, 2-flute, total/usable length 125/100 mm, for J-Latch Coupling When using the threaded drill sleeve, rotate the drill guide clockwise to engage the threads in the plate. Note: 1.5 mm threaded drill sleeve to be used with locking screws. 8 Measure screw length Instrument Depth Gauge for Screws B 1.5/2.0, measuring range up to 45 mm Determine the appropriate screw length using the depth gauge. Synthes 11

14 Surgical Technique 9 Insert the screw Instruments Screwdriver Shaft PlusDrive 1.5/2.0, long, selfholding, for Hexagonal Coupling Handle, medium, with Hexagonal Coupling Insert the proper length 2.0 mm locking or non-locking screw through the plate and tighten until secure. 10 Drill holes and place the remaining screws Insert the second screw on the opposite side of the fracture or osteotomy site following the previously outlined procedure. Insert all remaining screws alternating to each side of the mandible. Securely tighten all screws unless resection is to follow. Apply additional fixation as desired. 12 Synthes Compact2.0LOCKMandible TechniqueGuide

15 Steps for Bone Resection (Optional) 1 Resect the mandible Instruments Screwdriver Shaft PlusDrive 1.5/2.0, long, selfholding, for Hexagonal Coupling Handle, medium, with Hexagonal Coupling Once the plate is in place, remove the plate and screws, taking note of each screw s placement. Resect the mandible. 2 Reposition the plate Place the plate back onto the mandible in its original position. Reinsert each predetermined screw. Check all screws to ensure a secure fit in the plate. Synthes 13

16 Steps for Bone Resection (Optional) 3 Apply bone graft 2 A vascularized bone graft must be applied to all 2.0 mm constructs used in reconstructing the mandible. Caution: If no vascularized bone graft is applied, a 2.4 mm UniLOCK plate or larger system should be used. 2 Prein J (1998) Manual of Internal Fixation in the Cranio-Facial Skeleton. Berlin: Springer-Verlag 14 Synthes Compact2.0LOCKMandible TechniqueGuide

17 Ordering Information Compact 2.0 LOCK Mandible, PlusDrive Units Module Compact 2.0 LOCK Mandible, 3/3, with Lid, without Contents LOCK Plate 2.0, small, with centre space, 4 holes, length 28 mm, Pure Titanium LOCK Plate 2.0, small, with centre space, 6 holes, length 40 mm, Pure Titanium LOCK Mandible Adaption Plate 2.0, small, 20 holes, length 119 mm, Pure Titanium LOCK Mandible Plate 2.0, medium, with centre space, 6 holes, length 43 mm, Pure Titanium LOCK Mandible Plate 2.0, medium, 12 holes, length 77 mm, Pure Titanium LOCK Mandible Plate 2.0, large, with centre space, 6 holes, length 53 mm, Pure Titanium LOCK Mandible Plate 2.0, large, 6 holes, length 47 mm, Pure Titanium LOCK Mandible Plate 2.0, large, 12 holes, length 95 mm, Pure Titanium LOCK Mandible Plate 2.0, large, 20 holes, length 159 mm, Pure Titanium LOCK Mandible Plate 2.0, angled, right, large, 6+21 holes, length 189/81 mm, Pure Titanium LOCK Mandible Plate 2.0, angled, left, large, 6+21 holes, length 189/81 mm, Pure Titanium C LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 5 mm,, pack of 4 units in Clip C C C C C C C C C C C LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 6 mm,, pack of 4 units in Clip 3 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 8 mm,, pack of 4 units in Clip 3 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 10 mm,, pack of 4 units in Clip 3 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 12 mm,, pack of 4 units in Clip 3 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 14 mm,, in Clip 4 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 16 mm,, in Clip 4 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 18 mm,, in Clip 4 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 4 mm,, pack of 4 units in Clip 2 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 6 mm,, pack of 4 units in Clip 3 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 8 mm,, pack of 4 units in Clip 3 Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 6 mm,, pack of 1 unit in Clip C Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 8 mm,, pack of 1 unit in Clip Drill Sleeve 1.5, with thread, for LOCK Plates Screwdriver Shaft PlusDrive 1.5/2.0, long, self-holding, for Hexagonal Coupling Drill Bit B 1.5 mm, length 125 mm, 2-flute, for J-Latch Coupling Drill Bit B 1.5 mm, length 80 mm, 2-flute, for J-Latch Coupling Drill Bit B 1.5 mm with Stop, length 44.5/6 mm, 2-flute, for J-Latch Coupling Drill Bit B 1.5 mm with Stop, length 44.5/8 mm, 2-flute, for J-Latch Coupling Drill Bit B 1.5 mm with Stop, length 44.5/12 mm, 2-flute, for J-Latch Coupling Labelling Clips for Screws and Screwdriver Shafts B 2.0 mm, PlusDrive 1 Synthes 15

18 Ordering Information Also available Screws Plates LOCK Adaption Plate 2.0, 12 holes, Pure Titanium LOCK DCP Mandible Plate 2.0, medium, 4 holes, Pure Titanium LOCK DCP Mandible Plate 2.0, medium, 5 holes, Pure Titanium LOCK DCP Mandible Plate 2.0, medium, 6 holes, Pure Titanium LOCK DCP Mandible Plate 2.0, medium, 8 holes, Pure Titanium LOCK DCP Mandible Plate 2.0, medium, angled, 6 holes, Pure Titanium LOCK DCP Mandible Plate 2.0, medium, angled, 8 holes, Pure Titanium LOCK Mandible Plate 2.0, medium, crescent, 5 holes, Pure Titanium LOCK Mandible Plate 2.0, medium, crescent, 7 holes, Pure Titanium LOCK Tension Band Plate 2.0, right, prebent, 4 holes, Pure Titanium LOCK Tension Band Plate 2.0, left, prebent, 4 holes, Pure Titanium LOCK Plate 2.0, double-row, 12 holes, Pure Titanium, malleable LOCK Plate 2.0, double-row, 9 holes, Pure Titanium, malleable LOCK Frame Plate 2.0, square, 4 holes, Pure Titanium, malleable LOCK Strut Plate 2.0, 8 holes, Pure Titanium, flexible LOCK Strut Plate 2.0, curved, 8 holes, Pure Titanium, flexible LOCK Double-Y-Plate 2.0, Pure Titanium, flexible LOCK L-Plate 2.0, right, Pure Titanium, flexible LOCK L-Plate 2.0, left, Pure Titanium, flexible LOCK Mandible Plate 2.0, large, double-angled, holes, Pure Titanium LOCK Mandible Plate 2.0, large, double-angled, holes, Pure Titanium LOCK Mandible Plate 2.0, large, double-angled, holes, Pure Titanium LOCK Mandible Plate 2.0, extra-large, 12 holes, Pure Titanium LOCK Mandible Plate 2.0, extra-large, 20 holes, Pure Titanium LOCK Mandible Plate 2.0, right, extra-large, 6+21 holes, Pure Titanium LOCK Mandible Plate 2.0, left, extra-large, 6+21 holes, Pure Titanium LOCK Mandible Plate 2.0, double-angled, extra-large, holes, Pure Titanium LOCK Mandible Plate 2.0, double-angled, extra-large, holes, Pure Titanium LOCK Mandible Plate 2.0, double-angled, extra-large, holes, Pure Titanium All the plates can be ordered sterile by adding an S to the item number, e.g is S in sterile. LOCK screws, self tapping LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 5 mm, LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 6 mm, LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 8 mm, LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 10 mm, LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 12 mm, LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 14 mm, LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 16 mm, LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 18 mm, Available in Packs of 1 and 5; packs of 1 in Clip (sterile and non-sterile). Pack of 4 in Clip (until 12 mm; sterile and non-sterile)*. LOCK screws, self drilling LOCK Screw PlusDrive B 2.0 mm, self-drilling, length 5 mm, LOCK Screw PlusDrive B 2.0 mm, self-drilling, length 6 mm, LOCK Screw PlusDrive B 2.0 mm, self-drilling, length 8 mm, Available in Packs of 1 and 5; packs of 1 in Clip (sterile and non-sterile). Pack of 4 in Clip (sterile and non-sterile)*. Cortex screws, self-tapping Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 4 mm, Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 6 mm, Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 8 mm, Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 10 mm, Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 12 mm, Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 14 mm, Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 16 mm, Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 18 mm, Available in Packs of 1 and 5; packs of 1 in Clip (sterile and non-sterile). Pack of 4 in Clip (until 12 mm; sterile and non-sterile)*. 16 Synthes Compact2.0LOCKMandible TechniqueGuide

19 Cortex screws, self-drilling Cortex Screw PlusDrive B 2.0 mm, self-drilling, length 4 mm, Cortex Screw PlusDrive B 2.0 mm, self-drilling, length 6 mm, Cortex Screw PlusDrive B 2.0 mm, self-drilling, length 8 mm, Available in Packs of 1 and 5; packs of 1 in Clip (sterile and non-sterile). Pack of 4 in Clip (sterile and non-sterile)*. Emergency screws, self-tapping Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 6 mm, Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 8 mm, Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 10 mm, Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 12 mm, Available in Packs of 1 and 5; packs of 1 in Clip (sterile and non-sterile)*. * To order: Pack of 5 screws, add.05 after the item number, e.g becomes e.g Pack of 1 screw in Clip, add.01c after the item number, e.g becomes e.g C. Pack of 4 screws in Clip, add.04c after the item number, e.g becomes e.g C. Sterile screws in Packs of 1 screw in Clip, replace.01c with S, e.g C becomes S Sterile screws in Packs of 4 screws in Clip, replace C with S, e.g C becomes S Instruments Countersink with Centering Pin, for Screws B 2.0 mm with Hexagonal Coupling Drill Sleeve 1.5, with thread, short, for LOCK Mandible Plates Drill Sleeve 1.5, with thread, long, for LOCK Mandible Plates Bending Template for LOCK Mandible Plate 2.0, crescent-shaped, 5+7 holes, length 42 mm Bending Template for LOCK DCP Mandible Plate 2.0, angled, 6+8 holes, length 42 mm Bending Template for LOCK DCP Mandible Plate 2.0, holes, length 68 mm Bending Template for LOCK Mandible Plate 2.0, double-angled, holes, length 202 mm Bending Template for LOCK Mandible Plate 2.0, double-angled, holes, length 221 mm Bending Template for LOCK Mandible Plate 2.0, double-angled, holes, length 240 mm Standard Instruments Compact 2.0 Mandible, 3/3, with Lid Units Instrument Tray Compact 2.0 Mandible, 3/3, with Lid Pliers, flat-nosed, pointed, for Plates 1.0 to Holding Forceps for Plates 1.0 to Holding Forceps for Cortex Screws B 1.0 to 2.4 mm Combined Pliers for Plates 1.0 to 2.0, for Cutting and Bending Depth Gauge for Screws B 1.5 to 2.0 mm, measuring range up to 45 mm Handle, medium with Hexagonal Coupling Double Drill Guide 2.0/ Plate Cutter with Deburring Device, for Plates 1.0 to 2.4, length 180 mm 1 Optional Bending/Cutting Pliers with Nose, for LOCK Plates Holding Forceps with Ball, ratchet lock, length 180 mm Drill sleeve 1.5, for Lock Plates 2.0 Note: For more plates, screws, templates and instruments please refer to Synthes CMF Catalogue and its updates.

20 Synthes GmbH Eimattstrasse Oberdorf Switzerland Tel: Fax: This publication is not intended for distribution in the USA. All surgical techniques are available as PDF files at DePuy Synthes CMF, a division of Synthes GmbH All rights reserved DSEM/CMF/0115/ /15