LCP Pediatric Hip Plate 2.7. For proximal femoral osteotomies.

Transcription

1 LCP Pediatric Hip Plate 2.7. For proximal femoral osteotomies. Technique Guide This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.

2 Image intensifier control Warning This description alone does not provide sufficient background for direct use of the product. Instruction by a surgeon experienced in handling this product is highly recommended. Reprocessing, Care and Maintenance of Synthes Instruments For general guidelines, function control and dismantling of multi-part instruments, please refer to:

3 Table of Contents Introduction LCP Pediatric Hip Plate System 2 AO Principles 4 Foreword 5 Indications 6 Clinical Cases 7 Surgical Technique Preoperative Planning 9 Patient Positioning and Approach 12 Positioning Wire Insertion 13 Proximal Screws 18 Osteotomy 20 Proximal Fixation 21 Reduction 26 Distal Fixation 27 Postoperative Treatment 28 Product Information LCP Pediatric Hip Plate Implants 29 Instruments 30 Instruments for LCP and VA-LCP Plates Modules 34 LCP Pediatric Hip Plate System 36 Implants 36 Bibliography 41 LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 1

4 LCP Pediatric Hip Plate 2.7. For proximal femoral osteotomies. LCP Pediatric Hip Plate System The LCP Pediatric Hip Plates are an innovative concept consisting of the LCP Pediatric Hip Plates 2.7, 3.5 and 5.0. LCP Pediatric Hip Plates cover treatment options for stable fixation of varus and valgus deformities as well as rotation osteotomies and proximal femoral fracture treatment. The highly successful Locking Compression Plate (LCP) technology, which has enjoyed great success in adult surgery over recent years, has been incorporated into this system dedicated to pediatrics. For more information about the available plate sizes and their corresponding screw angles, please refer to page 36. Varus plate 2.7 Varus plate DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

5 LCP Pediatric Hip Plate System The LCP Pediatric Hip Plates have a universal design for the left and right femur. They have the following main characteristics, which ensure excellent fixation in the bone: LCP Pediatric Hip Plates 3.5 and 5.0 have three neck screws in the proximal part and combi-holes for locking or cortex screws in the distal part LCP Pediatric Hip Plate 2.7 has two neck screws in the proximal part and combi-holes for locking or cortex screws in the distal part Features and Benefits In comparison to conventional blade/plate systems, the LCP Pediatric Hip Plates have four main advantages: Angular stability Reduces the risk of primary and secondary loss of correction. In the majority of cases involving older pediatric patients external splintage is no longer necessary. For the LCP Pediatric Hip Plate 2.7, external splintage, such as a spica, is recommended as the plate is small and the infant non-compliant. Easy and safe surgical technique Initial plate positioning with Kirschner wires rather than using a chisel allows easy adjustment with less bone damage. Medialization For LCP Pediatric Hip Plates 3.5 and 5.0 there is the possibility of additional medialization, which means that just one off-set is required for each plate size. Valgus plate 5.0 Low profile The low profile plate design and locking construct allow less muscle disruption and reduce the risk of soft tissue irritation. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 3

6 AO Principles Stable fixation The fixation of the LCP plate with angular stable screws reduces the risk of loss of correction in osteotomies intra- and postoperatively. Preservation of blood supply The features of the child periosteum allow blood supply to be preserved even if the periosteum is elevated. Early mobilization The use of LCP implants allows an early and active mobilization, including cast-free postoperative management (Pediatric Hip Plates 3.5 and 5.0) in younger and handicapped children where appropriate. For the LCP Pediatric Hip Plate 2.7, external splintage, such as a spica, is recommended as the plate is small and the infant non-compliant. 4 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

7 Foreword For many years, the angled blade plates, devised by Dr Müller, were the standard implants used by the AO school of surgeons. They combine implant strength with an excellent hold in the bone but some surgeons have found them difficult to insert. The LCP Pediatric Hip Plate 2.7 is versatile, easy to insert and reproduces the strength and hold of the angled blade plates. Proximal screw placement is always preceded by guide wire insertion while locking screws provide the necessary rigidity. External splintage, such as a spica, is recommended as the plate is small and the infant non-compliant. This surgical technique describes the steps and principles involved when using the LCP Pediatric Hip Plate 2.7 to perform a typical varus osteotomy in combination with external or internal rotation. Further, the flexibility of the system allows the surgeon to adapt the osteotomy to the patient. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 5

8 Indications The LCP Pediatric Hip Plate system consists of indication specific plates. This surgical technique focuses on the LCP Pediatric Hip Plate 2.7 and describes a varus osteotomy of the proximal femur. The LCP Pediatric Hip Plate 2.7 is intended for use in infants up to three years, depending on body weight and bone quality. Indications: Neglected dislocation of the hip in combination with open reduction Developmental coxa valga Severe hip dysplasia Important: Ensure that the plate selected has a neck/screw angle which corresponds to preoperative planning. 6 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

9 Clinical Cases Case 1* 18 month old girl, with severe dysplasia and subluxation of the right hip. Intraoperative arthrogram in AP view and abduction with 35 internal rotation shows good head positioning. Preoperative, AP view Preoperative, AP view in abduction An intertrochanteric osteotomy was performed with a LCP Pediatric Hip Plate 2.7, 110. Postoperative x-rays show good containment after correction of varisation and 30 external rotation. External splintage, such as a spica, was applied as the plate is small and the infant non-compliant. Postoperative, AP view Postoperative, Lateral view * Images courtesy of: Theddy F. Slongo, MD Children's University Hospital Bern, Switzerland. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 7

10 Clinical Cases Case 2* 18 month old girl with neglected dislocation of the left hip. The left hip had a 150 preoperative CCD angle. An open reduction was performed in combination with an intertrochanteric osteotomy, which reduced the CCD angle to 115 (34 correction angle) in combination with 30 external rotation correction. The osteotomy was fixed using a LCP Pediatric Hip Plate 2.7, 110. Preoperative, AP view Preoperative, AP view, in abduction Postoperative x-rays show good correction and centralization of the hip in AP and lateral views. Postoperative, AP view Postoperative, Lateral view 6 weeks postoperative follow-up shows no loss of reduction, no plate or screw loosening and good callus formation. Follow up 6 weeks, AP view Follow up 6 weeks, Lateral view * Images courtesy of: Dr Geoff Donald, MD Royal Children s Hospital, Brisbane, Queensland, Australia. 8 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

11 Preoperative Planning 1 Determine correction angle Preoperative planning is vital for proximal femoral osteo - tomies. Although there are different ways of planning, they are all designed to achieve the same result. 1 The first step is to decide on the desired final position after osteotomy, in particular the neck/shaft angle that is to be achieved. Options: 1) Take an AP pelvis x-ray (1). 2) Take an AP pelvis x-ray in abduction and with internal rotation to assess the cover (2). 3) Create a blueprint to assess the correction that will achieve cover. (3) 4) Choose a target neck/shaft angle based on the patient s pathology (4). 2 2 Select plate The angle of the plate should be close to that of the desired neck/shaft angle. The offset of the 100 and 110 LCP Pediatric Hip Plates for varus deformities makes them ideal for varus osteotomies. 3 4 LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 9

12 Preoperative Planning 3 Determine point of reference The femoral shaft or neck can be used as a reference while planning and later inserting the positioning Kirschner wire. a) Shaft referencing To calculate the correction angle, subtract the desired neck/shaft angle from the initial pathological neck/shaft angle. For example: Current pathological neck/shaft angle: 150 Desired neck/shaft angle: 120 Correction angle: 30 To calculate the insertion angle of the positioning Kirschner wire using the aiming block and the positioner for aiming block on the shaft, add together the newly calculated correction angle and the plate angle. For example: 110 Plate angle + 30 correction angle = 140 Insert positioning Kirschner wire at 140 to the shaft b) Neck referencing The positioning Kirschner wire is inserted at an angle to the femoral neck. To calculate the insertion angle of the positioning Kirschner wire using the aiming block and positioner for aiming block, subtract the plate angle from the desired neck/shaft angle. For example: Desired neck/shaft angle: 130 Plate angle: 110 Insert positioning Kirschner wire at 20 to the femoral neck 10 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

13 4 Plate Type This surgical technique focuses on the LCP Pediatric Hip Plate 2.7 and describes a varus osteotomy of the proximal femur using a LCP Pediatric Hip Plate 2.7, 110 (corresponds to implant Art. No ). C A B D The surgical technique refers to screw holes using the designation as marked in this picture. 1 2 A: Neck screw B: Calcar screw C and D: Positioning Kirschner wires 1 and 2: LCP or cortex shaft screws LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 11

14 Patient Positioning and Approach 1 Position patient Position the patient in a supine or lateral position. A radiolucent table is recommended for the supine position. 2 Approach Use a standard lateral approach for the proximal femur. 12 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

15 Positioning Wire Insertion 1 Localize trochanteric epiphysis and determine anteversion Instrument Kirschner Wire 2.0 mm with threaded tip, length 150/15 mm, Stainless Steel Place the Kirschner wire on the ventral aspect of the femoral neck to determine the anteversion. Align the Kirschner wire with the central line of the femoral neck. Note: Carefully position the Kirschner wire to avoid interference with the positioner for aiming block. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 13

16 Positioning Wire Insertion 2 Insert positioning Kirschner wires in holes C and D 1 Instruments Guide Wire 2.0 mm with threaded tip with trocar, length 230 mm, Stainless Steel Aiming Block for Screws 2.7 mm, for LCP Pediatric Hip Plates Positioner for Aiming Block, for LCP Pediatric Hip Plates Screwdriver Stardrive, SD8, cylindrical, with Groove, shaft 3.5 mm Set the calculated positioning Kirschner wire angle (see Preoperative Planning section) on the positioner for aiming block and tighten the Stardrive screw (1). Slide the aiming block over the positioner for aiming block (2) DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

17 The wing of the positioner for aiming block must be placed parallel to the proximal femoral shaft in AP and lateral view. The positioner for aiming block and the two front spikes of the aiming block must be in contact with the femur (3). 3 The entry points for the positioning Kirschner wires are mm distal to the trochanteric epiphysis in AP view. Note: If there is extreme coxa valga, the positioner for aiming block must be placed more distally to prevent the neck screw from perforating the piriformis fossa. Insert the positioning Kirschner wires in holes C and D parallel to the anteversion Kirschner wire in the lateral/axial view, such that they define the middle third of the femoral neck (4). 4 LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 15

18 Positioning Wire Insertion Begin with the posterior positioning Kirschner wire to avoid interference with the anteversion wire (5). Once this wire is in place the anteversion wire can be removed. Then insert the positioning Kirschner wire in the anterior hole (6). 5 To avoid slippage of the positioner for aiming block, do not remove the positioning Kirschner wires until the top neck screw is in place. All subsequent steps refer to the positioning Kirschner wires, therefore their exact position is crucial. Tip: Use the 230 mm wire to reduce the risk of interference with the power tool. Tip: To facilitate insertion, center-punch the surface of the bone at the entry point before inserting positioner and wire. Note: Do not bend the Kirschner wires during insertion as this may result in correction errors. This can occur when flexing the hip in lateral/axial view. Note: If extension or flexion is required at the osteotomy, the aiming block for screws with the positioner for aiming block has to be rotated accordingly before insertion of the second positioning Kirschner wire DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

19 Verify optimal placement of the positioning Kirschner wires with the image intensifier in AP and lateral view. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 17

20 Proximal Screws Insert Kirschner guide wires for proximal screws 1 Instruments Aiming Block for Screws 2.7 mm, for LCP Pediatric Hip Plates Kirschner Wire 2.0 mm with threaded tip, length 150/15 mm, Stainless Steel Positioner for Aiming Block, for LCP Pediatric Hip Plates Screwdriver Stardrive, SD8, cylindrical, with Groove, shaft 3.5 mm Direct Measuring Device for Kirschner Wires 2.0 mm, length 150 mm, for LCP Pediatric Hip Plates 2.7 Use the aiming block to insert the Kirschner guide wire in hole A (1).To ensure optimal screw length, the Kirschner wire should not be placed closer than 5 mm from the femoral head growth plate (2). Use image intensifier control to check the correct distance from the growth plate. 2 Note: The direct measuring device can only be used for 150 mm Kirschner wires. 18 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

21 Once the Kirschner guide wire has been correctly inserted in hole A, remove the positioner for aiming block and the aiming block. The Kirschner guide wire defines the position and length of the screw and predrills the hole for the 2.7 mm screws. Note: Avoid bending the positioning Kirschner wire with the aiming block while inserting the guide wire as this may result in correction mistakes. Tip: To remove the positioner for aiming block and the aiming block, loosen the Stardrive screw on the positioner for aiming block. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 19

22 Osteotomy Instrument Positioner for Osteotomy, for LCP Pediatric Hip Plates The optimal position of the osteotomy for the 2.7 mm plate is 9 mm distal to the positioning Kirschner wires in holes C and D. Determine the distance with the corresponding end of the positioner for osteotomy (1). Hold the positioner for osteotomy against the positioning Kirschner wires and mark the distance with the oscillating saw or another sharp instrument on the bone (2). 2 Note: Prior to cutting the osteotomy insert Kirschner wires into the greater trochanter and the distal fragment (either the shaft or the knee) to control the rotation. Even if no rotation is planned, it is recommended to insert the two Kirschner wires or to make a mark on the bone. This ensures that rotational alignment is not lost. Perform the osteotomy in one cut perpendicular to the femoral shaft with an oscillating saw (3). Use constant irrigation and cooling. 3 Note: If there is extreme coxa valga, the osteotomy cut has to be 3 4 mm further distal, otherwise the distance for the calcar screw is too short. 20 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

23 Proximal Fixation 1 Position Plate 1 Instruments LCP Drill Sleeve 2.7, for Drill Bits 2.0 mm, for LCP Pediatric Hip Plates Positioner for Osteotomy, for LCP Pediatric Hip Plates Direct Measuring Device for Kirschner Wires 2.0 mm, length 150 mm, for LCP Pediatric Hip Plates Fixation in the proximal neck/head fragment must always be performed with locking screws. Ensure that the locking screws are at least 5 mm away from the growth plate of the femoral head. Insert the drill sleeve into hole A. Tighten the drill sleeve with the wrench for the positioner for osteotomy (2). Slide the plate over the two Kirschner wires (1). Note: If the plate stands off the proximal fragment too much, remove a small bone wedge from the lateral cortex near the osteotomy. 3 Tip: Hold the femoral neck/head fragment with forceps taking care not to disturb the plate positioning or manipulate the Kirschner wires. This provides better handling of the proximal fragment and greater rotational stability (3). LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 21

24 Proximal Fixation 2 Determine femoral neck screw length Instrument Direct Measuring Device for Kirschner Wires 2.0 mm, length 150 mm, for LCP Pediatric Hip Plates 2.7 Use the direct measuring device to determine the screw length by measuring the insertion depth of the Kirschner guide wire (1,2). Remove the drill sleeve and the Kirschner guide wire from hole A. If necessary, use the wrench at one end of the positioner for osteotomy. Note: The correct screw length can only be determined if the direct measuring device is used with the 150 mm Kirschner wire. 22 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

25 3 Insert femoral neck screw in hole A Instruments Torque Limiter, 0.8 Nm, with AO/ASIF Quick Coupling Screwdriver Shaft Stardrive, SD8, cylindrical, with Groove, shaft 3.5 mm, for AO/ASIF Quick Coupling Screwdriver Stardrive, SD8, cylindrical, with Groove, shaft 3.5 mm Handle for Torque Limiters 0.4/0.8/1.2 Nm Insert the screw in hole A. Option A Manual insertion To insert the locking screw manually, attach the handle for torque limiter to the torque limiter and insert the screwdriver shaft. Insert the locking screw, and lock it in the plate. The optimum torque is reached after one click. Option B Insertion with a power tool To insert the locking screw using a power tool, pick up the locking screw and insert it into the plate hole until the screw head is slightly above the plate. Do not fully tighten the screw with the power tool. Uncouple the power tool, mount the handle and manually tighten the screw. The optimum torque is reached after one click. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 23

26 Proximal Fixation 4 Insert calcar screw in hole B 1 Instruments Drill Bit 2.0 mm, with double marking, length 140/115 mm, 3-flute, for Quick Coupling LCP Drill Sleeve 2.7, for Drill Bits 2.0 mm, for LCP Pediatric Hip Plates Depth Gauge for MatrixMANDIBLE, measuring range from 6 to 40 mm Screwdriver Stardrive, SD8, cylindrical, with Groove, shaft 3.5 mm Screwdriver Shaft Stardrive, SD8, cylindrical, with Groove, shaft 3.5 mm, for AO/ASIF Quick Coupling Screwdriver Shaft, Stardrive, SD8, self-holding Torque Limiter, 0.8 Nm, with AO/ASIF Quick Coupling 2 Mount the drill sleeve onto hole B (1) and use the drill bit 2.0 mm to drill a bicortical hole for the calcar screw (2). Remove the drill sleeve and determine the screw length with the depth gauge. 24 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

27 Insert the screw in hole B (3). Then remove the positioning Kirschner wires in holes C and D (4). 3 4 LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 25

28 Reduction Instrument Reduction Forceps, toothed, soft lock, length 194 mm For optimal fixation, the plate must be aligned parallel with the femoral shaft axis in AP and lateral views. Once the plate is aligned, secure it with the reduction forceps. Important: If the plate is not aligned parallel to the femoral shaft axis in AP view, it can lead to variations of the planned neck/shaft CCD angle. Tip: The alignment can be facilitated with forceps fixed on the proximal part. This serves as a handle during the repositioning of the osteotomy. 26 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

29 Distal Fixation Instruments Screwdriver Shaft Stardrive, SD8, cylindrical, with Groove, shaft 3.5 mm, for AO/ASIF Quick Coupling Depth Gauge for MatrixMANDIBLE, measuring range from 6 to 40 mm Torque Limiter, 0.8 Nm, with AO/ASIF Quick Coupling Handle with Quick Coupling, length 110 mm LCP Drill Sleeve 2.7, for Drill Bits 2.0 mm, for LCP Pediatric Hip Plates Direct Measuring Device for Kirschner Wires 2.0 mm, length 150 mm, for LCP Pediatric Hip Plates Drill Bit 2.0 mm, with double marking, length 140/115 mm, 3-flute, for Quick Coupling Universal Drill Guide The LCP Pediatric Hip Plate 2.7 is a combi-hole plate, therefore either locking or cortex screws can be used in the shaft. Screw the LCP drill sleeve into the LCP portion of hole 1 until it is completely gripped by the thread. Drill the screw hole using the drill bit 2.0 mm (1). Remove the drill sleeve. Determine the screw length with the depth gauge and insert the screw. Repeat this step for screw insertion in hole 2 (2). Note: When cortex screws 2.7 mm are inserted, the universal drill guide 2.7 can be used. Drill threaded holes with the drill bit 2.0 mm and measure the screw length with the depth gauge. Note: Cortical screws cannot safely be inserted after a locking screw has been used in the distal fragment. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 27

30 Postoperative Treatment External splintage, such as a spica, is recommended as the plate is small and the infant non-compliant. Frequently this plate will be used in combination with other procedures that require immobilization, such as open fracture reduction. Note: A hip spica in abduction allows a release of stress on the muscles. 28 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

31 LCP Pediatric Hip Plate 2.7 Implants Plates LCP Pediatric Hip Plate 2.7, 100, width 12 mm, length 46 mm LCP Pediatric Hip Plate 2.7, 110, width 12 mm, length 46 mm LCP Pediatric Hip Plate 2.7, 130, width 12 mm, length 46 mm Screws Cortex screws, self-tapping, Stainless Steel Cortex Screws Stardrive 2.7 mm, lengths mm Locking screws, self-tapping, Stainless Steel Locking Screws Stardrive 2.7 mm (head LCP 2.4), lengths 6 60 mm All implants are available non-sterile or sterile packed. Add suffix "S" to the article number to order sterile products. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 29

32 LCP Pediatric Hip Plate 2.7 Instruments Aiming Block for Screws 2.7 mm, for LCP Pediatric Hip Plates Positioner for Aiming Block, for LCP Pediatric Hip Plates LCP Drill Sleeve 2.7, for Drill Bits 2.0 mm, for LCP Pediatric Hip Plates Direct Measuring Device for Kirschner Wires 2.0 mm, length 150 mm, for LCP Pediatric Hip Plates Positioner for Osteotomy, for LCP Pediatric Hip Plates Kirschner Wire 2.0 mm with threaded tip, length 150/15 mm, Stainless Steel Guide Wire 2.0 mm with threaded tip with trocar, length 230 mm, Stainless Steel 30 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

33 Positioning Plate, triangular, length 45 mm, 90 /50 / Positioning Plate, triangular, length 45 mm, 80 /70 / Positioning Plate, triangular, length 45 mm, 100 /60 / Depth Gauge for MatrixMANDIBLE, measuring range from 6 to 40 mm Combined Holding Sleeve for Cortex Screws Stardrive 2.4/2.7 mm, SD8, for Screwdriver Shafts 3.5 mm Holding Sleeve for LCP Screws Stardrive 2.4/2.7 mm (head LCP 2.4), SD8, for Screwdriver Shafts 3.5 mm Screwdriver Stardrive, SD8, cylindrical, with Groove, shaft 3.5 mm Screwdriver Shaft Stardrive, SD8, cylindrical, with Groove, shaft 3.5 mm, for AO/ASIF Quick Coupling LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 31

34 LCP Pediatric Hip Plate 2.7 Instruments Bone Holding Forceps, self-centering, soft lock, length 191 mm Reduction Forceps, toothed, soft lock, length 194 mm 32 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

35 LCP Pediatric Hip Plate 2.7 Instruments for LCP and VA-LCP Plates Torque Limiter, 0.8 Nm, with AO/ASIF Quick Coupling Handle for Torque Limiters 0.4/0.8/1.2 Nm Drill Bit 2.0 mm, with double marking, length 140/115 mm, 3-flute, for Quick Coupling Handle with Quick Coupling, length 110 mm Screwdriver Shaft, Stardrive, SD8, self-holding Universal Drill Guide 2.7 LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 33

36 LCP Pediatric Hip Plate 2.7 Modules Module for implants, Modular Tray for LCP Pediatric Plates 2.7, size 1/2, without Contents, Vario Case System Rack for Locking Screws 2.7 mm (head LCP 2.4), for Insert No Rack for Cortex Screws 2.7 mm, for Insert No Lid for Modular Tray, size 1/2 Module for instruments, Modular Tray for Instruments for LCP Pediatric Plates 2.7, size 1/2, without Contents, Vario Case System Lid for Modular Tray, size 1/ * Tray for Instruments for LCP and VA-LCP Plates 2.4, size 1/4, without Lid, without Contents Lid for Modular Tray, size 1/4 *Tray also contains 2.7 instrumentation. The 2.4 instrumentation is not required for this surgical technique. 34 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

37 Labelling clips Labelling Clip for Instruments for LCP Pediatric Plates 2.7, Vario Case System Labelling Clip for LCP Pediatric Plates 2.7, Vario Case System LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 35

38 LCP Pediatric Hip Plate System Implants Product range of LCP Pediatric Plates The product range consists of different plate sizes: LCP Pediatric Hip Plates 2.7 LCP Pediatric Hip Plates 3.5 and 5.0 LCP Pediatric Condylar Plates 3.5 and 5.0 Available sterile or unsterile packed For proximal femur Plates for varus osteotomies (2.7, 3.5 and 5.0) The plates are available with screw angles of 100, 110 or 130 and 2 (2.7) or 3 (3.5 / 5.0) distal fixation screws. Plates for valgization osteotomies (3.5 and 5.0) The plates are available with a screw angle of 140 and 3 distal fixation screws. Plates for fractures and derotation osteotomies (3.5 and 5.0) The plates are available with a screw angle of 130 and 3, 5 or 7 distal fixation screws. For distal femur Plates for fractures and deformities (3.5 and 5.0) The plates are available with a screw angle of 90 and 3, 5 or 7 distal fixation screws. Overview of available technique guides: LCP Pediatric Hip Plate 3.5 and 5.0 for varus osteotomies (Art. No ) LCP Pediatric Hip Plate 2.7 for varus osteotomies (Art. No ) LCP Pediatric Hip Plate 3.5 and 5.0 for fractures / derotational osteotomies (Leaflet) (Art. No ) LCP Pediatric Hip Plate Straight Valgus 3.5 and 5.0 for valgus osteotomies (Art. No ) LCP Pediatric Condylar Plate 3.5 and 5.0 for supracondylar deformities and fractures (Art. No ) 36 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

39 For proximal femur Plates for varus osteotomies LCP Pediatric Hip Plate 2.7, 100, width 12 mm, length 46 mm LCP Pediatric Hip Plate 2.7, 110, width 12 mm, length 46 mm LCP Pediatric Hip Plate 2.7, 130, width 12 mm, length 46 mm LCP Pediatric Hip Plate 3.5, 100, width 19 mm, length 73 mm LCP Pediatric Hip Plate 3.5, 110, width 19 mm, length 73 mm LCP Pediatric Hip Plate 5.0, 100, width 23 mm, length 90 mm LCP Pediatric Hip Plate 5.0, 110, width 23 mm, length 90 mm Plate for valgization osteotomy LCP Pediatric Hip Plate 3.5, 140, straight, width 19 mm, length 70 mm LCP Pediatric Hip Plate 5.0, 140, straight, width 23 mm, length 90 mm All implants are available non-sterile or sterile packed. Add suffix "S" to the article number to order sterile products. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 37

40 LCP Pediatric Hip Plate System Implants Plates for fractures and derotation osteotomies LCP Pediatric Hip Plate 3.5, 130, width 19 mm, length 62 mm LCP Pediatric Hip Plate 5.0, 130, width 23 mm, length 79 mm LCP Pediatric Hip Plate 3.5, 130, width 19 mm, length 88 mm LCP Pediatric Hip Plate 5.0, 130, width 23 mm, length 111 mm LCP Pediatric Hip Plate 3.5, 130, width 19 mm, length 114 mm LCP Pediatric Hip Plate 5.0, 130, width 23 mm, length 143 mm LCP Pediatric Hip Plate 3.5, 130, width 19 mm, length 140 mm LCP Pediatric Hip Plate 5.0, 130, width 23 mm, length 175 mm All implants are available non-sterile or sterile packed. Add suffix "S" to the article number to order sterile products. 38 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

41 For distal femur Plates for fractures and deformities LCP Pediatric Condylar Plate 3.5, 90, width 19 mm, length 75 mm, 3 shaft holes LCP Pediatric Condylar Plate 5.0, 90, width 23 mm, length 95 mm, 3 shaft holes LCP Pediatric Condylar Plate 3.5, 90, width 19 mm, length 101 mm, 5 shaft holes LCP Pediatric Condylar Plate 5.0, 90, width 23 mm, length 127 mm, 5 shaft holes LCP Pediatric Condylar Plate 3.5, 90, width 19 mm, length 127 mm, 7 shaft holes LCP Pediatric Condylar Plate 5.0, 90, width 23 mm, length 159 mm, 7 shaft holes All implants are available non-sterile or sterile packed. Add suffix "S" to the article number to order sterile products. LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 39

42 LCP Pediatric Hip Plate System Implants Screw overview Cortex screws, self-tapping, Stainless Steel Cortex Screws Stardrive 2.7 mm, lengths 6 60 mm Cortex Screws 3.5 mm, lengths mm Cortex Screws Stardrive 3.5 mm, lengths mm Cortex Screws 4.5 mm, lengths mm Locking screws, self-tapping, Stainless Steel Locking Screws Stardrive 2.7 mm (head LCP 2.4), lengths 6 60 mm Locking Screws 3.5 mm, lengths mm Locking Screws Stardrive 3.5 mm, lengths mm Locking Screws 5.0 mm, lengths mm Locking Screws Stardrive 5.0 mm, lengths mm All implants are available non-sterile or sterile packed. Add suffix "S" to the article number to order sterile products. 40 DePuy Synthes LCP Pediatric Hip Plate 2.7 Technique Guide

43 Bibliography Hefti F et al. Kinderorthopädie in der Praxis. Berlin, Heidelberg, New York: Springer Müller ME. Die hüftnahen Femurosteotomien. 2. Auflage. Stuttgart: Thieme Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd, expanded and completely revised ed. Berlin, Heidelberg, New York: Springer Morrissy RT, SL Weinstein. Atlas of Pediatric Orthopedic Surgery. Philadelphia: Williams & Wilkins Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd expanded edition. Stuttgart, New York: Thieme LCP Pediatric Hip Plate 2.7 Technique Guide DePuy Synthes 41

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