LCP Locking Compression Plate. Surgical Technique

Transcription

1 LCP Locking Compression Plate Surgical Technique

2 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 Maintenance For 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: For 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:

3 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 Surgical Technique LCP Locking Compression Plate DePuy Synthes 1

4 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 stability 1 Limited plate-periosteum contact Locking screws provide hold also in osteoporotic bone and in multiple fragment fractures 2 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): Wagner M. General principles for the clinical use of the LCP. Injury. Nov 2003;34 Suppl 2:B DePuy Synthes LCP Locking Compression Plate Surgical Technique

5 Reduction maintained under a load LCP combi-hole F A B Stable bridging of comminuted fractures The stable plate-screw connection reduces the risk of secondary loss of reduction in the epiphyseal and metaphyseal regions 2 The screws are locked in the plate, and the physiological load (F) is transferred from the bone to the plate The fragments are fixed in their reduced position without regard to the plate model (internal fixator) The bone fragments are fixed 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 2 Wagner M. General principles for the clinical use of the LCP. Injury. Nov 2003;34 Suppl 2:B Standard (Cortex or Cancellous Bone) screws Dynamic compression is created by the eccentric insertion of the standard screws (analogous to LC-DCP) Surgical Technique LCP Locking Compression Plate DePuy Synthes 1

6 LCP Metaphyseal Plates. For extra-articular fractures. Features LCP combi-holes allow uncompromising combinations The 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 fixation The 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 profile The plate design facilitates anatomical contouring considerably, whilst taking into account the distinctive features of the metaphyseal bone area (e.g. complex bone shapes, thin soft tissue envelope). LCP Metaphyseal Plate 3.5 Extra-articular fixation with the advantage of angled locking screws The 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. LCP Metaphyseal Plate 3.5/4.5/5.0 4 DePuy Synthes LCP Locking Compression Plate Surgical Technique

7 AO Principles AO PRINCIPLES In 1958, the AO formulated four basic principles, which In have 1958, become the AO the formulated guidelines four for basic internal principles, fixation 1,2 which. have become the guidelines for internal fixation 1, 2. 4_Priciples_03.pdf :08 Anatomic reduction Fracture reduction and fixation to restore restore anatomical relationships. relationships. 1 2 Stable fixation Fracture fixation providing absolute or relative or relative stability, stability, as required as by absolute required the patient, by the the patient, injury, the and injury, the and personality the personality of the fracture. of the fracture. Early, active mobilization Early and safe mobilization and rehabilitation of of the injured part and the patient as as a a whole. 4 3 Preservation of of blood supply Preservation of of the the blood supply to to soft tissues and bone by by gentle gentle reduction reduction techniques techniques and careful and careful handling. handling. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3 rd ed. Berlin, Heidelberg, New York: Springer Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2 nd ed. Stuttgart, New York: Thieme DePuy Synthes Expert Lateral Femoral Nail Surgical Surgical Technique Technique LCP Locking Compression Plate DePuy Synthes 5

8 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: Indications The indications for each system will be presented individually. Small Fragment plates (3.5) LCP Plates 3.5 Fixation 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 3.5 Fixation 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 3.5 Fixation 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, malunions, 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. buttressing, tension banding, neutralization or compression. 6 DePuy Synthes LCP Locking Compression Plate Surgical Technique

9 LCP Methaphyseal 3.5 The LCP Metaphyseal Plates are indicated to fix extraarticular fractures in the metaphyseal area that can extend into the shaft area. The 3.5 mm plates are indicated to fix fractures of the distal humerus and distal fibula. Large Fragment plates (4.5/5.0) LCP Methaphyseal 3.5/4.5/5.0 The LCP Metaphyseal Plates are indicated for Extraarti 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 Plates LCP T-Plates 4.5/5.0 LCP 4.5/5.0 Broad Plates LCP 4.5/5.0 Broad Curved Plates LCP Reconstruction Plates 4.5/5.0 In general the LCP Generic Plates & Instruments (Large Fragment) are indicated for the osteosynthesis of fractures at the Femur, Tibia, Humerus and Pelvic at proximal, distal and shaft areas. In the case of metaphyseal fractures, comminuted fractures and osteoporotic bone, the clinical results can be improved by the angular stable screw/plate connection. Contraindications No specific contraindications. Surgical Technique LCP Locking Compression Plate DePuy Synthes 7

10 Standard Plate Technique 1. Reduce the fracture Reduce the fracture under the image intensifier. As needed, provide fixation with Kirschner wire or reducing forceps. Alternative Reduce 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 container. 8 DePuy Synthes LCP Locking Compression Plate Surgical Technique

11 2. Bend the plate Instruments Small fragment Bending Iron for Plates 2.4 to 3.5, length 145 mm (for use with ) Bending Iron for Plates 2.4 to 3.5, length 145 mm (for use with ) Bending Pliers for Plates 2.4 to 4.0, length 230 mm Bending Pliers for Reconstruction Plates 2.7 and 3.5 Large fragment Bending Press, length 400 mm Bending Pliers for Plates 4.5, length 250 mm, complete, with Anvils Nos and Bending Iron for LC-DCP 4.5 and DCP 4.5, length 250 mm (two required) 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 instrumentation 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. Surgical Technique LCP Locking Compression Plate DePuy Synthes 9

12 Standard Plate Technique 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. 11 DePuy Synthes LCP Locking Compression Plate Surgical Technique

13 4. Select the drill guide position Instruments Small fragment Universal Drill Guide 3.5 Large fragment Universal Drill Guide 4.5/3.2, for neutral and load position a. Select the neutral position Press 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 predrilling. 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 compression is generated by setting and tightening the cortex screw. Note: The LC-DCP Drill Guides are unsuitable for LCP plates. Surgical Technique LCP Locking Compression Plate DePuy Synthes 11

14 Standard Plate Technique 5. Drill screw hole Instruments Small fragment Drill Bit B 2.5 mm, length 180/155 mm, 2-flute, for Quick Coupling Large fragment 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 Depth Gauge for Screws B 2.7 to 4.0 mm, measuring range up to 60 mm Large fragment Depth Gauge for Screws B 4.5 to 6.5 mm, measuring range up to 110 mm Measure the screw length with the depth gauge. 11 DePuy Synthes LCP Locking Compression Plate Surgical Technique

15 7. Option: Tap the thread Instruments Small fragment Tap for Cortex Screws B 3.5 mm, length 110/50 mm Large fragment Tap for Cortex Screws B 4.5 mm, length 125/70 mm If non-self-tapping screws are used, tap a thread manually. Surgical Technique LCP Locking Compression Plate DePuy Synthes 11

16 Standard Plate Technique 8. Insert standard (Cortex or Cancellous Bone) screw Instruments T-Handle with Quick Coupling Small fragment Screwdriver, hexagonal, small, 2.5 mm, with Groove Large fragment 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 ( ). 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 11 DePuy Synthes LCP Locking Compression Plate Surgical Technique

17 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 instrumentation 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. 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. Surgical Technique LCP Locking Compression Plate DePuy Synthes 11

18 Insert Self-tapping Locking Screws 4. Insert LCP drill sleeve Instruments Small fragment LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm Large fragment LCP Drill Sleeve 5.0, for Drill Bits B 4.3 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 mandatory in order to ensure that the locking screw is drilled in the proper perpendicular angle and correctly 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 surface due to the anatomy. 11 DePuy Synthes LCP Locking Compression Plate Surgical Technique

19 5. Option: Insert Kirschner wire Instruments Small fragment Centering Sleeve for Kirschner Wire B 1.6 mm, length 70 mm, for Nos and or Centering Sleeve for Kirschner Wire B 1.25 mm Kirschner Wire B 1.25 mm with trocar tip, length 150 mm, Stainless Steel Kirschner Wire B 1.6 mm with trocar tip, length 150 mm, Stainless Steel Large fragment Centering Sleeve for Kirschner Wire B 2.0 mm, length 110 mm, for No Kirschner Wire B 2.0 mm with trocar tip, length 150 mm, Stainless Steel 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 optimal, 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. Surgical Technique LCP Locking Compression Plate DePuy Synthes 11

20 Insert Self-tapping Locking Screws 6. Drill screw hole Instruments Small fragment LCP Drill Bit B 2.8 mm with Stop, length 165 mm, 2-flute, for Quick Coupling Large fragment 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. 11 DePuy Synthes LCP Locking Compression Plate Surgical Technique

21 7. Determine screw length Read the drilled depth directly from the laser mark on the drill bit. Alternative Instruments Small fragment Depth Gauge for Screws B 2.7 to 4.0 mm, measuring range up to 60 mm Large fragment Depth Gauge for Screws B 4.5 to 6.5 mm, measuring range up to 110 mm Determine the screw length with the depth gauge. Surgical Technique LCP Locking Compression Plate DePuy Synthes 11

22 Insert Self-tapping Locking Screws 8. Insert locking screw Instruments Small fragment Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive or Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling Screwdriver Shaft, hexagonal, small, B 2.5 mm Large fragment Torque Limiter, 4.0 Nm, for Compact Air Drive and Power Drive Screwdriver Shaft Stardrive 4.5/5.0, T25, self-holding, for AO/ASIF Quick Coupling or Torque-limiting Screwdriver Stardrive, T25, self-holding, for Locking Screws B 5.0 mm Screwdriver Shaft, hexagonal, large, B 3.5 mm or Screwdriver Shaft 3.5, hexagonal, self-holding or Torque-limiting Screwdriver 3.5, selfholding, for Locking Screws B 5.0 mm Handle for Torque Limiter Nos and Handle with Quick Coupling Before setting the first locking screw, anatomical reconstruction must have occurred and, where necessary, fixed with lag screws. After setting the locking screws, additional reduction can no longer occur without removing 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. 22 DePuy Synthes LCP Locking Compression Plate Surgical Technique

23 a. Insertion with a power tool To insert the locking screw using a power tool, fit a torque limiter to the power tool. Then insert the screwdriver 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 difficult to remove the implant. Precaution: For long screws and thick cortical bone, ensure sufficient cooling during insertion. Surgical Technique LCP Locking Compression Plate DePuy Synthes 22

24 Insert Self-tapping Locking Screws The following table shows combinations of various drives and torque limiters, and the associated attachments: Drive Torque limiter (TLA) Small fragment (1.5 Nm) Small fragment (1.5 Nm) Small fragment (1.5 Nm) Large fragment (4 Nm) Large fragment (4 Nm) Power Drive direct without attachment attachment attachment direct without attachment attachment Colibri attachment Other power drives AO/ASIF quick coupling AO/ASIF quick coupling AO/ASIF quick coupling for reamer Handle for Torque Limiter (TLA) Stardrive screwdriver shaft Hexagonal screwdriver shaft 22 DePuy Synthes LCP Locking Compression Plate Surgical Technique

25 b. Manual insertion To insert the locking screw manually, attach the torque limiter handle to 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 , Stardrive ). Surgical Technique LCP Locking Compression Plate DePuy Synthes 22

26 Insert Self-drilling, Self-tapping Locking Screws 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 opposite cortical bone to prevent damage of the opposite side structure and to avoid removal problems. 22 DePuy Synthes LCP Locking Compression Plate Surgical Technique

27 2. Insert locking screw Instruments Small fragment Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive or Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling Notes: Especially when the cortical bone is thick and the locking screw is set perpendicular, drilling with the LCP Universal Drill Guide (small fragment: ; large fragment: ) is recommended. The universal drill guide is also used when inserting self-tapping screws in the diaphyseal region. For further information, see page 29. You can alternatively follow steps 4 7 on pages Precaution: Always irrigate during drilling to avoid thermal damage to the bone. Cooling is especially recommended for longer screws Screwdriver Shaft, hexagonal, small, B 2.5 mm Large fragment Torque Limiter, 4 Nm, for Compact Air Drive and Power Drive or Torque Limiter, 4 Nm, for AO/ASIF Quick Coupling for Reamers Screwdriver Shaft Stardrive 4.5/5.0, T25, self-holding, for AO/ASIF Quick Coupling Screwdriver Shaft, hexagonal, large, B 3.5 mm or Screwdriver Shaft 3.5, hexagonal, self-holding Handle for Torque Limiter Nos and 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. Surgical Technique LCP Locking Compression Plate DePuy Synthes 22

28 Indirect Reduction with Locking Screws 1. Shove the screw holding sleeve over the torque limiting screwdriver Instruments Small fragment Holding Sleeve for Screws, for LCP Screwdriver Stardrive 3.5, T15, with Groove, length 200 mm Screwdriver, hexagonal, small, 2.5 mm, with Groove Large fragment Holding Sleeve for Screws, for LCP 4.5/ Screwdriver Stardrive 4.5/5.0, T25, with Groove, length 252 mm Screwdriver, hexagonal, large, B 3.5 mm, with Groove, length 245 mm or Torque-limiting Screwdriver 3.5, selfholding, for Locking Screws B 5.0 mm Mount the screw holding sleeve on the screwdriver. Hold the locking screw by placing the screw holding sleeve over the head of the screw. 22 DePuy Synthes LCP Locking Compression Plate Surgical Technique

29 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. Surgical Technique LCP Locking Compression Plate DePuy Synthes 22

30 Indirect Reduction with Locking Screws 4. Lock the screw Instruments Small fragment Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive Only for locking screws large fragment: Alternatively, the Torque-limiting Screwdriver can be used (Hex , Stardrive ). Note: This technique is only suitable for pulling the bone to the plate. To generate interfragmentary compression, use cancellous bone or cortical bone screws (lag screw principle) Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling Screwdriver Shaft, hexagonal, small, B 2.5 mm Large fragment Torque Limiter, 4 Nm, for Compact Air Drive and Power Drive Screwdriver Shaft Stardrive 4.5/5.0, T25, self-holding, for AO/ASIF Quick Coupling or Torque-limiting Screwdriver Stardrive, T25, self-holding, for Locking Screws B 5.0 mm Screwdriver Shaft, hexagonal, large, B 3.5 mm or Screwdriver Shaft 3.5, hexagonal, self-holding or Torque-limiting Screwdriver 3.5, selfholding, for Locking Screws B 5.0 mm Handle for Torque Limiter Nos and 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. 22 DePuy Synthes LCP Locking Compression Plate Surgical Technique

31 Drilling with the LCP Universal Drill Guide The LCP universal drill guide is only available with a Hex drive. Instruments Small fragments LCP Universal Drill Guide 3.5, Stainless Steel Screwdriver Shaft, hexagonal, small, B 2.5 mm Large fragments LCP Universal Drill Guide 4.5/ Screwdriver Shaft, hexagonal, large, B 3.5 mm or Screwdriver Shaft 3.5, hexagonal, 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. Surgical Technique LCP Locking Compression Plate DePuy Synthes 22

32 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. 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 DePuy Synthes LCP Locking Compression Plate Surgical Technique

33 Insert LCP Spacers Instruments Steel Titanium Small fragment Spacer B 3.5 mm Large fragment 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. Surgical Technique LCP Locking Compression Plate DePuy Synthes 33

34 Metaphyseal Plates for extra articular fractures Implant preparation Adapt the LCP Metaphyseal Plate to the anatomy of the bone. Precautions: Reverse bending or use of the incorrect instrumentation 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. 11 Plate fixation Instruments Small fragment LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm Centering Sleeve for Kirschner Wire B 1.25 mm Kirschner Wire B 1.25 mm with trocar tip, length 150 mm, Stainless Steel Kirschner Wire B 1.6 mm with trocar tip, length 150 mm, Stainless Steel Large fragment: LCP Drill Sleeve 5.0, for Drill Bits B 4.3 mm Centering Sleeve for Kirschner Wire B 2.0 mm, length 110 mm, for No Kirschner Wire B 2.0 mm with trocar tip, length 150 mm, Stainless Steel 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 consideration when bending the plate and threading in the threaded LCP Drill Sleeve for 2.8 mm drill bits. 33 DePuy Synthes LCP Locking Compression Plate Surgical Technique

35 The threaded LCP drill sleeves ensure axially correct drilling. 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 intensifier. The simultaneous use of two threaded LCP drill sleeves in the thinned plate area also assists insertion in the minimally 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 Stuttgart, New York: Thieme. Warning: Do not position the thinner portion of the plate over the fracture site. Surgical Technique LCP Locking Compression Plate DePuy Synthes 33

36 Metaphyseal Plates for extra articular fractures Fixation with 3.5 mm locking screws Instruments Small fragment LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive Screwdriver Shaft, hexagonal, small, B 2.5 mm Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling Handle with Quick Coupling Large fragment LCP Drill Sleeve 5.0, for Drill Bits B 4.3 mm Torque Limiter, 4 Nm, for Compact Air Drive and Power Drive Screwdriver Shaft 3.5, hexagonal, self-holding Screwdriver Shaft Stardrive 4.5/5.0, T25, self-holding, for AO/ASIF Quick Coupling Handle for Torque Limiter Nos and Torque-limiting Screwdriver 3.5, selfholding, for Locking Screws B 5.0 mm 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. 33 DePuy Synthes LCP Locking Compression Plate Surgical Technique

37 Fixation with 5.0 mm locking screws 4. 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 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. 3 4 Surgical Technique LCP Locking Compression Plate DePuy Synthes 33

38 Examples of the Combination Technique Standard screws and angular-stable locking screws can be combined. Example A If 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 B If 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 removed first before inserting the standard screws Example C If 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 fragment (3) Example D In the case of a diaphyseal fracture, standard screws can be inserted after the locking screws to draw the opposing fragments closer to the plate. 33 DePuy Synthes LCP Locking Compression Plate Surgical Technique

39 Remove the Implant Implant Removal Unlock all screws from the plate, then remove the screws completely from the bone. This prevents simultaneous 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. Surgical Technique LCP Locking Compression Plate DePuy Synthes 33

40 Basic LCP Plates LCP Plates LCP Plates 3.5 Stainless Steel Titanium (TiCP) Holes Length (mm) All implants are also available sterile packed. Add Suffix S to part number. 33 DePuy Synthes LCP Locking Compression Plate Surgical Technique

41 LCP Plates 4.5/5.0, broad Stainless Steel Titanium (TiCP) Holes Length (mm) All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 33

42 Basic LCP Plates LCP Plates LCP Plates 4.5/5.0, broad curved Stainless Steel Titanium (TiCP) Holes Length (mm) All implants are also available sterile packed. Add Suffix S to part number. 44 DePuy Synthes LCP Locking Compression Plate Surgical Technique

43 LCP One-third Tubular Plates 3.5 Stainless Steel Titanium (TiCP) Holes Length (mm) All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 44

44 Basic LCP Plates LCP Plates LCP Plates 4.5/5.0, narrow Stainless Steel Titanium (TiCP) Holes Length (mm) All implants are also available sterile packed. Add Suffix S to part number. 44 DePuy Synthes LCP Locking Compression Plate Surgical Technique

45 LCP Reconstruction Plates 3.5 Stainless Steel Titanium (TiCP) Holes Length (mm) Round Hole Reconstruction Locking Plates 3.5* Stainless Steel Titanium (TiCP) Holes Length (mm) * no combi-holes All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 44

46 Basic LCP Plates LCP Plates LCP Reconstruction Plates 4.5/5.0 Stainless Steel Titanium (TiCP) Holes Length (mm) All implants are also available sterile packed. Add Suffix S to part number. 44 DePuy Synthes LCP Locking Compression Plate Surgical Technique

47 LCP Metaphyseal Plates 3.5 Stainless Steel Titanium (TiCP) Holes Length (mm) LCP Metaphyseal Plates 3.5/4.5/5.0 Stainless Steel Titanium (TiCP) Holes Length (mm) All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 44

48 Basic LCP Plates LCP Plates LCP T-Plates 3.5, right-angled Stainless Steel Titanium (TiCP) Holes Length (mm) * ** * ** ** = 3 head holes ** = 4 head holes LCP T-Plates 3.5, oblique-angled Stainless Steel Titanium (TiCP) Holes Length (mm) right right right left left left All implants are also available sterile packed. Add Suffix S to part number. 44 DePuy Synthes LCP Locking Compression Plate Surgical Technique

49 LCP T-Plates 4.5/5.0 Stainless Steel Titanium (TiCP) Holes Length (mm) Kirschner Wire with trocar tip Stainless Steel B (mm) length (mm) S S S All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 44

50 Screws Locking Screws with Hex drive Self-tapping B 3.5 mm Stainless Steel TAN Length (mm) B 5.0 mm Stainless Steel TAN Length (mm) All implants are also available sterile packed. Add Suffix S to part number. 44 DePuy Synthes LCP Locking Compression Plate Surgical Technique

51 Locking Screws with Hex drive Self-drilling, self-tapping B 3.5 mm Stainless Steel Length (mm) All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 44

52 Screws Locking Screws with Stardrive Self-tapping B 3.5 mm B 5.0 mm Stainless Steel TAN Length (mm) Stainless Steel TAN Length (mm) All implants are also available sterile packed. Add Suffix S to part number. 55 DePuy Synthes LCP Locking Compression Plate Surgical Technique

53 Spacers Locking Screws B 5.0 mm for Periprosthetic Fractures Hex drive Stardrive Stainless Steel TAN Length (mm) Stainless Steel TAN Length (mm) Spacer B 3.5 mm Hex drive Stainless Steel TAN Length (mm) Spacer B 5.0 mm Hex drive Stainless Steel TAN Length (mm) All implants are also available sterile packed. Add Suffix S to part number Washer B 3.5/2.7 mm, Stainless Steel Washer B 3.5/2.7 mm, Titanium Alloy (TAN) All washers are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 55

54 Cerclage Cerclage Positioning Pins, Eyes and CerclageFix X X S Positioning Pin 3.5 with thread, for LCP Positioning Pin 3.5 with thread, for LCP, sterile X X S Positioning Pin 4.5 with thread, for LCP Positioning Pin 4.5 with thread, for LCP, sterile X 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 X 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 Cerclage Eye for Screws B 3.5 mm, Stardrive and hexagonal socket, pack of 5 units 0X S Cerclage Eye for Screws B 3.5 mm, Stardrive and hexagonal socket, sterile 0X Cerclage Eye for Screws B 4.5 mm, Stardrive and hexagonal socket, pack of 5 units 0X S Cerclage Eye for Screws B 4.5 mm, Stardrive and hexagonal socket, sterile 0X Cerclage Eye for Hexagonal Socket, B 4.0 mm, cannulated, pack of 5 units 0X S Cerclage Eye for Hexagonal Socket, B 4.0 mm, cannulated, sterile X CerclageFix for LPC 4.5/5.0 X81.002S CerclageFix for LCP 4.5/5.0, sterile X CerclageFix Insert X81.001S CerclageFix Insert, sterile 55 DePuy Synthes LCP Locking Compression Plate Surgical Technique

55 Cerclage Cables X X S Cerclage Cable with Crimp B 1.0 mm Cerclage Cable with Crimp B 1.0 mm, sterile Cerclage Cable with Crimp B 1.7 mm, Stainless Steel S Cerclage Cable with Crimp B 1.7 mm, Stainless Steel, sterile Cerclage Cable with Crimp, B 1.7 mm, Cobalt-chrome Alloy S Cerclage Cable with Crimp B 1.7 mm, Cobalt-chrome Alloy, sterile * TRD Trochanter Reattachment Device, small, for Cable System, Titanium Alloy (TAN) S* TRD Trochanter Reattachment Device, small, for Cable System, Titanium Alloy (TAN), sterile * TRD Trochanter Reattachment Device, large, for Cable System, Titanium Alloy (TAN) S* TRD Trochanter Reattachment Device, large, for Cable System, Titanium Alloy (TAN), sterile X=2: Stainless Steel X=4: Titanium * TRD Trochanter Reattachment Device: CE0086 Manufactured by: Pioneer Surgical Technology, Inc. 375 River Park Circle, Marquette MI USA Distributed by: Synthes, GmbH, Eimattstrasse 3, 4436 Oberdorf, Switzerland Surgical Technique LCP Locking Compression Plate DePuy Synthes 55

56 Instruments Drill Sleeves Art. No. Description Small Large fragment fragment LCP Drill Sleeve 3.5, X for Drill Bits B 2.8 mm LCP Drill Sleeve 5.0, X for Drill Bits B 4.3 mm Drill Sleeve 7.2/4.3, X length 130 mm, for LISS Drill Bits Art. No. Description Small Large fragment fragment LCP Drill Bit B 2.8 mm X with Stop, length 165 mm, 2-flute, for Quick Coupling LCP Drill Bit B 4.3 mm X with Stop, length 221 mm, 2-flute, for Quick Coupling * Drill Bit B 4.3 mm, X length 280 mm, for No Replacement stop rings can be ordered from the local Depuy Synthes representative. * calibrated for Drill Sleeve DePuy Synthes LCP Locking Compression Plate Surgical Technique

57 Torque Limiters and Corresponding Handles Torque Limiter Handle Art. No. Description Art. No. Small Large fragment fragment Nm, for Compact X Air Drive and Power Drive Nm, for AO/ASIF X Quick Coupling Nm, for Compact X Air Drive and Power Drive Nm, for Compact X Air Drive and Power Drive Nm, for AO/ASIF X Quick Coupling for Reamers Surgical Technique LCP Locking Compression Plate DePuy Synthes 55

58 Instruments Holding Sleeves for Screws Art. No. Description Small Large fragment fragment for LCP 3.5 X for LCP 4.5/5.0 X Hexagonal Screwdrivers, non-self-holding Art. No. Small Large fragment fragment X X Hexagonal Screwdriver Shafts Art. No. Description Small Large fragment fragment non-self-holding X non-self-holding X self-holding X 55 DePuy Synthes LCP Locking Compression Plate Surgical Technique

59 Stardrive Screwdrivers, non-self-holding Art. No. Description Small Large fragment fragment T15 X T25 X Stardrive Screwdriver Shafts, self-holding Art. No. Description Small Large fragment fragment T15 X T25 X Torque-limiting Screwdrivers self-holding, for Locking Screws B 5.0 mm Art. No. Description Hex drive Stardrive T25 SHS Screwdrivers, non-self-holding Art. No. Description Small Large fragment fragment Screwdriver Shaft 2.5, X hexagonal, Stardrive T Handle for X Screwdriver Shaft Screwdriver Shaft 3.5, X hexagonal, Stardrive T Handle for X Screwdriver Shaft 3.5 Surgical Technique LCP Locking Compression Plate DePuy Synthes 55