Trochanter Stabilization Plate for DHS Implants
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- Marilyn Bennett
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1 Extends DHS Plate Construct to Help Stabilize Greater Trochanter Trochanter Stabilization Plate for DHS Implants Surgical Technique
2 Table of Contents Introduction Trochanter Stabilization Plate for DHS Implants 2 Indications 2 Surgical Technique Surgical Technique 4 Optional Additional Fixation 8 Implant Removal 11 Product Information Set List 12 MR Information The Trochanter Stabilization Plate for DHS System has not been evaluated for safety and compatibility in the MR environment. It has not been tested for heating, migration or image artifact in the MR environment. The safety of the Trochanter Stabilization Plate for DHS System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury. Trochanter Stabilization Plate for DHS Implants Surgical Technique DePuy Synthes 1
3 Trochanter Stabilization Plate for DHS Implants. Extends DHS Plate construct to help stabilize greater trochanter. The Trochanter Stabilization Plates extend the DHS Plate construct to help stabilize the greater trochanter and facilitate insertion of an antirotation screw into the femoral head. The combination of the DHS Implants and the Trochanter Stabilization Plate prevents lateral displacement of greater trochanter fragments during impaction of the fracture zone. This helps prevent medialization of the shaft relative to the head-neck fragment. Indications Trochanter Stabilization Plates are used with Synthes DHS Plates (four holes or longer) for the following stable and unstable fractures of the proximal femur: Intertrochanteric Subtrochanteric Pertrochanteric Basilar neck Preoperative Postoperative 2 DePuy Synthes Trochanter Stabilization Plate for DHS Implants Surgical Technique
4 Trochanter Stabilization Plate for DHS Implants. Extends DHS Plate construct to help stabilize greater trochanter. Spoon extension minimizes lateral displacement of greater trochanteric fracture fragment(s) Holes for tension band fixation using K-wires, cable, or cerclage wire (2.0 mm or less), or for reattachment of the gluteus medius with sutures Holes for fixation of greater trochanteric fracture fragments with 4.0 mm Cancellous Bone Screws Large screw hole for parallel placement of an antirotation screw in the femoral head Oval hole allows the DHS Lag Screw to glide through the DHS Plate barrel unimpaired Round hole allows secure placement of the DHS Plate before the addition of the Trochanter Stabilization Plate Recessed screw holes for fixation of the Trochanter Stabilization Plate/DHS Plate construct to the femoral shaft, using standard 4.5 mm Cortex Screws Concave U-shape snaps over the DePuy Synthes DHS Plate Lengths of 138 mm and 148 mm The DHS Parallel Drill Guide ( ) allows precise insertion of a screw superior and parallel to the DHS Lag Screw at a distance of 12 mm, 17 mm, or 22 mm. Trochanter Stabilization Plate for DHS Implants Surgical Technique DePuy Synthes 3
5 Surgical Technique 1 Secure DHS Plate Note: To insert a Trochanter Stabilization Plate and an antirotation screw parallel and superior to the DHS Lag Screw, drill the hole for the lag screw more inferior than normal. This allows room for placement of the antirotation screw superior to the DHS Lag Screw. Inferior insertion point Standard insertion point Secure the DHS Plate to the femoral shaft with one screw only, through the second-most-proximal DCP Hole. 4 DePuy Synthes Trochanter Stabilization Plate for DHS Implants Surgical Technique
6 Surgical Technique 2 Contour spoon-shaped end Instrument * Bending Iron, for 4.5 mm plates * Plate-Bending Press Flat-Nosed Parallel Pliers Contour the spoon-shaped end of the Trochanter Stabilization Plate to fit the bone, if necessary. The flat-nosed parallel pliers, and the bending iron for 4.5 mm plates, or the plate-bending press may be used to contour the plate. *Also available. Trochanter Stabilization Plate for DHS Implants Surgical Technique DePuy Synthes 5
7 Surgical Technique 3 Position plate Position the Trochanter Stabilization Plate over the DHS Plate. Ensure that the trochanter stabilization plate is securely seated and that the oval hole allows clearance for the lag screw. 4 Secure plate Instruments mm Drill Bit mm/3.2 mm Double Drill Sleeve Secure the Trochanter Stabilization Plate/DHS Plate construct in position through the remaining screw holes. Drill using the 3.2 mm drill bit with the 4.5 mm/3.2 mm double drill sleeve. Measure the depth of the screw holes and insert the screws according to standard technique. 6 DePuy Synthes Trochanter Stabilization Plate for DHS Implants Surgical Technique
8 Surgical Technique 5 Place DHS/DCS Compression Screw (optional) If desired, place a DHS/DCS Compression Screw using standard DHS Dynamic Hip System technique. Trochanter Stabilization Plate for DHS Implants Surgical Technique DePuy Synthes 7
9 Surgical Technique Optional Additional Fixation Optional fixation methods through the spoon-shaped end of the Trochanter Stabilization Plate include: 4.0 mm cancellous bone screws Cerclage wire Orthopaedic cable Suture (not shown) Individual trochanteric fracture fragments may be fixed using 4.0 mm cancellous bone screws through the large holes. A tension band may be constructed using cerclage wire or cable through the small holes. The gluteus medius may be reattached by passing sutures through the small holes. Fixation with 4.0 mm cancellous bone screws through the large holes Fixation with cerclage wire through the small holes Fixation with orthopaedic cable 8 DePuy Synthes Trochanter Stabilization Plate for DHS Implants Surgical Technique
10 Surgical Technique Optional Additional Fixation Optional insertion of an antirotation screw using the DHS Parallel Drill Guide An antirotation screw may be inserted superior and parallel to the DHS Lag Screw. Use one of the following: 6.5 mm cancellous bone screw 7.0 mm cannulated screw 7.3 mm cannulated screw 1 Remove DHS/ DCS Compression Screw, if necessary 2 Reinsert 2.5 mm guide wire through DHS Lag Screw 3 Slide DHS Parallel Drill Guide Instruments mm/4.5 mm Drill Sleeve DHS Parallel Drill Guide Slide the DHS Parallel Drill Guide over the guide wire through the hole marked 0. Insert the 6.0 mm/4.5 mm drill sleeve into the guide hole marked 12. Trochanter Stabilization Plate for DHS Implants Surgical Technique DePuy Synthes 9
11 Surgical Technique Optional Additional Fixation 4 Insert appropriate sleeve as indicated below Antirotation Screw Type Instrument 7.0 mm Cannulated Screw 4.5 mm/2.0 mm Insert Wire Sleeve ( *) 6.5 mm Cannulated Bone Screw 4.5 mm/3.2 mm Insert Drill Sleeve ( ) 7.3 mm Cannulated Screw 4.5 mm/2.8 mm Insert Wire Sleeve ( *) 5 Measure and place The antirotation screw should be measured and placed according to the appropriate technique. *Also available. 11 DePuy Synthes Trochanter Stabilization Plate for DHS Implants Surgical Technique
12 Implant Removal Remove the implants in the following sequence: 1 All fixation elements (screws, wire, cable, suture) attached to the spoon-shaped end of the trochanter stabilization plate (if used) 2 Antirotation screw (if used) 3 Compression screw (if used) 4 DHS Trochanter Stabilization Plate 5 DHS Plate 6 DHS Lag Screw Please refer to the DHS/DCS Technique Guide and/or the One-Step DHS/DCS Technique Chart for additional information. Trochanter Stabilization Plate for DHS Implants Surgical Technique DePuy Synthes 11
13 Trochanter Stabilization Plate Instrument and Implant Set ( ) Graphic Case Trochanter Stabilization Plate Instrument and Implant Set Instruments mm/ 3.2 mm Insert Drill Sleeve mm/ 4.5 mm Drill Sleeve DHS Parallel Drill Guide Implants Trochanter Stabilization Plate, 2 ea mm mm Available nonsterile and sterile-packed. Add S to product number for sterile product. For detailed cleaning and sterilization instructions, please refer to or to the below listed inserts which will be included in the shipping container: Processing DePuy Synthes Reusable Medical Devices Instruments, Instrument Trays and Graphic Cases DJ1305 Processing Non-sterile DePuy Synthes Implants DJ DePuy Synthes Trochanter Stabilization Plate for DHS Implants Surgical Technique
14 Also Available Bending Iron, for 4.5 mm plates Plate-Bending Press mm/ 2.0 mm Insert Wire Sleeve mm/ 2.8 mm Insert Wire Sleeve Flat Nosed Parallel Pliers DHS One-Step Implant Set Graphic Case DHS/ DCS One-Step Basic Set Graphic Case Implantation of the Trochanter Stabilization Plate requires one instrument set and one implant set from the following: DHS/ DCS Basic Set, with self-tapping screws DHS/DCS One-Step Basic Set, with self-tapping screws DHS Basic Set, with self-tapping screws DHS Universal Implant Set DHS One-Step Implant Set DHS One-Step Basic Set, with self-tapping screws One or more of the following may be required for optional additional fixation: mm Cannulated Screw Instrument and Implant Set mm Cannulated Screw Instrument and Implant Set mm Cannulated Screw Instrument and Implant Set mm/7.3 mm Combined Cannulated Screw Instrument and Implant Set Orthopaedic Cable System Instrument Set Basic Screw Set, with self-tapping screws Small Fragment Instrument and Implant Set, with self-tapping screws Small Fragment Instrument and Implant Set, with self-tapping screws LC-DCP Wire Instrument and Implant Set S 1.7 mm Cable with Crimp, 750 mm, sterile Recommended power equipment Small Battery Drive Trochanter Stabilization Plate for DHS Implants Surgical Technique DePuy Synthes 11
15 Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed. Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information. CAUTION: Federal Law restricts these devices to sale by or on the order of a physician. Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada. Not all products may currently be available in all markets. Manufactured or distributed by: Synthes USA Products, LLC 1302 Wrights Lane East West Chester, PA Synthes USA, LLC 1101 Synthes Avenue Monument, CO To order (USA): To order (Canada): Note: For recognized manufacturer, refer to the product label. DePuy Synthes All rights reserved. DSUS/TRM/0916/1060 6/17 DV
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