2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates

Transcription

1 For Fragment-Specific Fracture Fixation With Variable Angle Locking Technology 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

2 Table of Contents Introduction 2.4 mm Variable Angle LCP Volar Rim 2 Distal Radius Plates AO Principles 4 Indications 5 Clinical Cases 6 Surgical Technique Recommendations on Screw and Plate Insertion 7 Screw Insertion Techniques 7 Screw Type Determination 9 Preparation 10 Approach 11 Plate Insertion 12 Screw Insertion 14 Cortex Screws 14 Variable Angle Locking Screws 16 Postoperative Treatment 23 Implant Removal 23 Product Information Implants 24 Instruments 26 Set Lists 31 MR Information The 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plate 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 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plate System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury. Image intensifier control 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 1

3 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates. For fragment-specific fracture fixation with variable angle locking technology. The anatomically precontoured, low-profile plates for distal volar placement are indicated for complex intra-articular and extra-articular distal radius fractures. All implants are available in stainless steel and titanium. Low-profile construct Beveled distal edge, rounded and polished surface and countersunk screws for reduced soft tissue irritation Additional distal screw options Enable support of radial styloid, lunate facet and DRUJ 2 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

4 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates. For fragment-specific fracture fixation with variable angle locking technology. 1 2 Kirschner wire holes Enable preliminary plate fixation and indicate screw orientation when using guide blocks (Figure 1) Anatomically precontoured Buttressing of distal fragments due to anatomically precontoured plate (Figure 2) Guide block Allows guided drilling and screw insertion in the predefined nominal angle (Figure 3) 3 4 Bendable tabs If necessary, tabs can be bent to suit the individual anatomical conditions of the bone (Figure 4) Elongated VA Combi hole Allows accurate plate positioning and radius length adjustment, offering 4 mm of range with 2.7 mm cortex screws and 4.5 mm of range with 2.4 mm cortex screws (Figure 5) 5 6 Variable angle locking Holes allow up to 15 off-axis screw angulation in all directions, to address individual fracture patterns (Figure 6) 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 3

5 AO Principles AO PRINCIPLES In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation. 1,2 In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation 1, 2. 4_Priciples_03.pdf :08 Anatomic reduction Anatomic reduction Fracture reduction and fixation to Fracture reduction and fixation to restore anatomical relationships. restore anatomical relationships. 1 2 Stable fixation Stable fixation Fracture fixation providing absolute Fracture fixation providing absolute or relative stability, as or relative stability, as required by the patient, the injury, and the personality required by the patient, the injury, of the fracture. and the personality of the fracture. Early, active mobilization Early and safe mobilization and Early, active mobilization rehabilitation of the injured part Early and safe mobilization and and the patient as a whole. rehabilitation of the injured part and the patient as a whole. 4 3 Preservation of blood supply Preservation of the blood blood supply supply Preservation to soft tissues of the and blood bone supply by to gentle soft tissues reduction and bone techniques by gentle and reduction careful handling. techniques and careful handling. 1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal 2nd ed. Stuttgart New York: Thieme; 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 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

6 Indications The 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates are intended for fixation of complex intra- and extraarticular fractures and osteotomies of the distal radius and other small bones in adults, skeletally mature adolescents, and the following adolescent distal radius fractures: intra-articular fractures exiting the epiphysis intra-articular fractures exiting the metaphysis physeal crush injuries any injuries which cause growth arrest to the distal radius 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 5

7 Clinical Cases Case 1 74-year-old female with AO C3 fracture and distal ulna fracture Case 2 43-year-old male with AO C2 fracture Results from case studies are not predictive of results in other cases. Results in other cases may vary. 6 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

8 Recommendations on Screw and Plate Insertion Screw Insertion Techniques Variable angle locking screws can be inserted using two different techniques: Variable angle technique Predefined nominal angle technique Cone-shaped end for off-axis drilling Fixed-angle end for nominal angle drilling Variable angle technique Instrument mm Universal Variable Angle Locking Drill Guide Optional instrument mm Universal Variable Angle Locking Drill Guide, cone To drill variable angle holes up to 15 deviation from the nominal trajectory of the locking hole, key the tip of the universal variable angle locking drill guide into the cloverleaf design of the VA locking hole. Use the cone-shaped end of the VA drill guide to drill variable angle holes at the desired angle. Precaution: It is important not to angulate more than 15 from the central axis of the screw hole. Overangulation could result in inappropriate screw locking. Moreover, the screw head may not be fully countersunk. 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 7

9 Recommendations on Screw and Plate Insertion Screw Insertion Techniques Predefined nominal angle technique Option A: Use of fixed-angle end of VA drill guide Instrument mm Universal Variable Angle Locking Drill Guide Optional instrument mm Universal Variable Locking Drill Guide, coaxial The fixed-angle of the VA drill guide only allows the drill bit to follow the nominal trajectory of the VA locking hole. Option B: Use of guide blocks Instruments mm Drill Guide with Measuring for VCP Guide Block mm Drill Guide with Measuring for Variable Angle LCP Guide Block Guide Blocks for 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates hole head, right hole head, left hole head, right hole head, left Fixation at the nominal angle of the locking holes in the head of the plate may be facilitated by a guide block attached to the plate prior to plate fixation. The guide blocks are used together with the drill guide. Choose the guide block corresponding to the desired plate. Mount the guide block to the plate by turning the guide block attachment screw clockwise. Precaution: If using guide blocks, avoid bending the head portion of the plate. 8 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

10 Recommendations on Screw and Plate Insertion Screw Type Determination Screw type determination Determine whether standard cortex screws or variable angle locking screws will be used for fixation of the shaft. VA locking holes accept: 2.4 mm VA locking screws 1.8 mm VA locking buttress pins 2.4 mm locking screws (only at nominal angle) 2.4 mm cortex screws The compression portion (1) of elongated VA Combi holes accepts: 2.4 mm cortex screws 2.7 mm cortex screws The threaded portion (2) of elongated VA Combi holes accepts: 2.4 mm VA locking screws 1.8 mm VA locking buttress pins 2.4 mm locking screws (only at nominal angle) 2.4 mm cortex screws VA Locking hole 1 2 Elongated VA Combi hole VA locking screws in the distal portion of the plate may be an advantage to support the articular surface and prevent loss of reduction. The final screw placement and the use of VA locking and cortex screws are determined by the fracture pattern. Using cortex screws in the most distal screw holes is not recommended. If a VA locking screw is inserted first, ensure that the plate is held securely to the bone, to prevent the plate from spinning as the screw locks into the plate. When using the predefined nominal angle technique, standard locking screws can also be used instead of VA locking screws in a variable angle hole. Precaution: When a cortex screw is inserted into a variable angle locking hole the screw head will not be completely countersunk. Only use cortex screws in the most distal row when essential for clinical outcome since a prominent screw head may increase the risk of soft tissue irritation. 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 9

11 Preparation Required instrument sets / 2.4 mm Variable Angle LCP (VA-LCP) Distal Radius System Set (stainless steel or titanium) or / 2 3 Instrument Tray for LCP and VA-LCP Distal Radius Systems (stainless steel or titanium) or Instrument Tray for 2.4 mm Cortex and VA-LCP Screws for Modular Case System Required screw sets (unless using / ) / 2.4 mm and 2.7 mm Variable Angle Locking Screw Module for Distal Radius (stainless steel or titanium) or / 2.4 mm and 2.7 mm LCP and Variable Angle Locking Screw Module for Distal Radius (stainless steel or titanium) or / 2.4 mm LCP and Variable Angle Locking Screw Module for Distal Radius (stainless steel or titanium) Select implant Select the plate according to the fracture pattern and anatomy of the bone. Note: Ensure the proper plate selection by verifying the L (left) or R (right) etching on the plate shaft. 11 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

12 Approach Make a longitudinal incision slightly radial to the flexor carpi radialis tendon (FCR). Dissect between the FCR and the radial artery, exposing the pronator quadratus. Detach the pronator quadratus from the lateral border of the radius and elevate it toward the ulna. Precaution: Leave the volar wrist capsule intact to avoid devascularization of the fracture fragments and destabilization of the volar wrist ligaments. 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 11

13 Plate Insertion 1 Reduce fracture Reduce the fracture under radiographic imaging and, if necessary, fix with Kirschner wires or reduction forceps. The reduction method will be fracture-specific. 2 Position plate Optional instruments mm Plate Reduction Wire, threaded tip, with small stop, 150 mm mm Plate Reduction Wire, threaded tip, with large stop, 150 mm mm Kirschner Wire, 150 mm, trocar tip Apply the plate to fit the volar surface. If necessary, insert a 1.25 mm Kirschner wire through the desired Kirschner wire hole to temporarily fix the plate. Option: Plate reduction wires If necessary, a 1.25 mm plate reduction wire, with small stop, may be used through a K-wire hole to temporarily hold the plate to the bone, and in position. Alternatively, a 1.25 mm plate reduction wire, with large stop, may be used through the DCU portion of the Combi hole. Precaution: The plate reduction wires and Kirschner wires are single-use items, do not reuse. 11 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

14 Plate Insertion Optional technique: Contour plate Instrument Bending Pliers, 140 mm, for 1.5 mm and 2.0 mm plates If necessary, bend the tabs of the plate to suit anatomical conditions as indicated. Avoid repetitive bending. Notes: Use nonserrated bending pliers to preserve the plate s smooth finish. The design of the plate holes allows a certain degree of deformation. However, if threaded holes are significantly deformed, locking may be compromised. If using guide blocks, avoid bending the head portion of the plate. 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 11

15 Screw Insertion Cortex Screws 1 Drill for cortex screw Instruments: 2.4 mm cortex screws mm Drill Bit with depth mark, quick coupling, 110 mm mm Universal Drill Guide Instruments: 2.7 mm cortex screws mm Drill Bit, quick coupling, 100 mm mm Universal Drill Guide Using the universal drill guide, drill through the nonthreaded portion of the elongated Combi hole. For 2.4 mm cortex screws, use the 2.4 mm universal drill guide with the 1.8 mm drill bit. For 2.7 mm cortex screws, use the 2.7 mm universal drill guide with the 2.0 mm drill bit. 11 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

16 Screw Insertion Cortex Screws 2 Determine screw length Instrument Depth Gauge for 2.0 mm, 2.4 mm, and 2.7 mm screws Determine screw length with the depth gauge. 3 Insert cortex screw Instruments Handle with quick coupling StarDrive Screwdriver Shaft, T8, 105 mm Optional instrument Short StarDrive Shaft, T8, self-holding, quick coupling, 55 mm Insert the self-tapping cortex screw using a T8 StarDrive Screwdriver. Adjust the plate position as necessary and tighten the screw. 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 11

17 Screw Insertion Variable Angle Locking Screws 1 Drill Option A: Variable angle technique Using VA drill guide with cone Instruments mm Universal Variable Angle Locking Drill Guide mm Drill Bit with depth mark, quick coupling, 110 mm Optional instrument mm Variable Angle Locking Drill Guide, cone Insert and lock the VA drill guide tip into the cloverleaf design of the VA locking hole. Use the 1.8 mm drill bit to drill to the desired depth at the desired angle. The cone of the drill sleeve allows the drill bit to be angled up to 15 around the central axis of the locking hole. To achieve the desired angle, verify the drill bit angle by using radiographic imaging. If necessary, drill at a different angle and verify again by using radiographic imaging. Note: The previously inserted Kirschner wire can be used to reference for the screw angulation by using radiographic imaging. Precaution: It is important not to angulate more than 15 from the central axis of the screw hole. Overangulation could result in inappropriate screw-locking. Moreover, the screw head may not be fully countersunk. 11 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

18 Screw Insertion Variable Angle Locking Screws Option B: Nominal angle technique Using VA locking drill guide Instruments mm Universal Variable Angle Locking Drill Guide mm Drill Bit with depth mark, quick coupling, 110 mm Optional instrument mm Variable Angle Locking Drill Guide, coaxial The fixed-angle end of the drill guide only allows the drill bit to follow the nominal trajectory of the locking hole. Use the 1.8 mm drill bit to drill to the desired depth. Read the screw length directly from the laser mark on the drill bit. Alternatively, use the depth gauge to determine the screw length. 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 11

19 Screw Insertion Variable Angle Locking Screws Option C: Nominal angle technique Using guiding blocks Optional instruments mm Drill Guide with Measuring for Guide Block Guide Blocks for 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates hole head, right hole head, left hole head, right hole head, left Use the volar rim distal radius plate guide block in combination with the drill guide with measuring for guide block. For drilling, insert the drill guide into the locking hole and drill to the desired depth using the 1.8 mm drill bit. Read the screw length directly from the laser mark on the drill bit. Alternatively, use the depth gauge through the guide block to determine the screw length. 11 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

20 Screw Insertion Variable Angle Locking Screws 2 Determine screw length 1 Instrument Depth Gauge for 2.0 mm, 2.4 mm, and 2.7 mm screws Determine the screw length with the depth gauge (Figure 1). If the guide block is being used, measure directly through the guide block (Figure 2) mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 11

21 Screw Insertion Variable Angle Locking Screws 3 Insert VA locking screws Instruments Handle with quick coupling StarDrive Screwdriver Shaft, T8, 105 mm Optional instrument Short StarDrive Screwdriver Shaft, T8, self-holding, quick coupling, 55 mm Insert the 2.4 mm VA locking screws or 1.8 mm VA locking buttress pins manually with the StarDrive Screwdriver and tighten only until the screwhead is fully seated in the locking hole. When using the predefined nominal angle technique, standard 2.4 mm locking screws can be used instead of VA locking screws. Do not fully tighten the screw. This allows the screws to be easily removed and repositioned, if necessary, before final locking. Note: When a guide block is used, the Variable Angle LCP Locking Screw or Buttress Pin or standard LCP Locking Screw or Buttress Pin may be inserted with a T8 StarDrive Screwdriver directly through the guide block. 22 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

22 Screw Insertion Variable Angle Locking Screws 4 Ensure proper joint reconstruction Confirm proper joint reconstruction, screw placement, and screw length, using multiple radiographic views. To ensure that the screws are not in the joint, use additional views such as a 10 dorsally tilted, 20 inclined lateral, and 45 pronated oblique view. 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 22

23 Screw Insertion Variable Angle Locking Screws 5 Lock variable angle screws 1 Instruments Handle for Torque Limiting Attachment Short StarDrive Screwdriver Shaft, T8, self-holding, quick coupling, 55 mm Torque Limiting Attachment, 0.8 Nm, quick coupling Optional instrument StarDrive Screwdriver Shaft, T8, 105 mm 2 Use the 0.8 Nm torque limiting attachment (TLA) for final tightening of the 2.4 mm VA locking screws or 1.8 mm VA locking buttress pins. The TLA attaches to the blue handle for torque limiting attachment, and a T8 StarDrive Screwdriver shaft. The TLA ensures maximum strength of the plate-screw interface and prevents overtightening of the VA locking screws or VA locking buttress pins. With this final locking step, the screws are securely locked into the plate (Figure 2). Precaution: Use of the 0.8 Nm torque limiter (TLA) is mandatory when inserting locking screws into variable angle locking holes to ensure the adequate torque is applied (1). Final locking must be done manually using the TLA. 22 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

24 Postoperative Treatment and Implant Removal Postoperative treatment Postoperative treatment with VA locking compression plates is the same as conventional internal fixation procedures. Note: Due to the distal placement, plate removal may be a consideration once the bone healing process is complete. Precaution: The plate was developed to specifically treat very distal radius fractures which require fixation distal to the watershed line. Patients with volar plate prominence should be screened for symptoms of tendon irritation. In symptomatic patients, elective hardware removal should be considered. Implant removal Instruments Handle with quick coupling Short StarDrive Screwdriver Shaft, T8, self-holding, quick coupling, 55 mm Optional instruments StarDrive Screwdriver Shaft, T8, 105 mm Holding Sleeve, for StarDrive Screwdriver Shaft, T8 To remove locking screws, first unlock all screws from the plate; then remove the screws completely from the bone. The last screw removed should be a nonlocking screw on the shaft. This prevents the plate from spinning when locking screws are removed. Precautions: The design of the plate holes allows a certain degree of deformation. However, if threaded holes are significantly deformed, locking is not sufficiently efficient. Reverse bending or use of the incorrect instrumentation for bending may weaken the plate and lead to premature plate failure (eg, breakage). Do not bend the plate beyond what is required to match the anatomy. If using guiding blocks, avoid bending the head portion of the plate. 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 22

25 Implants Plates 2.4 mm VA LCP Volar Rim Distal Radius Plate, 6 hole head Shaft Length Stainless Steel Titanium Holes (mm) right left 2.4 mm VA LCP Volar Rim Distal Radius Plate, 7 hole head Shaft Length Stainless Steel Titanium Holes (mm) right left Available nonsterile and sterile-packed. Add S to product number for sterile product. 22 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

26 Implants Screws 2.4 mm Variable Angle Locking Screws For use in VA locking holes Self-tapping, StarDrive Recess Lengths from 8 mm to 30 mm Available in stainless steel or titanium alloy* Important: For final locking the 0.8 Nm torque limiting attachment is required. 2.4 mm Cortex Screws For use in round or Combi holes Self-tapping, StarDrive Recess Lengths from 6 mm to 30 mm Available in stainless steel or titanium alloy* 2.4 mm Locking Screws** For use in VA locking holes but only in the predefined nominal angle Self-tapping, StarDrive Recess Lengths from 6 mm to 30 mm Available in stainless steel or titanium alloy* Important: For final locking the 0.8 Nm torque limiting attachment is required. 2.7 mm Cortex Screws** For use in elongated Combi holes Self-tapping, StarDrive Recess Lengths from 6 mm to 30 mm Available in stainless steel or titanium alloy* 1.8 mm Variable Angle Locking Buttress Pins** For use in VA locking holes StarDrive Recess Lengths from 8 mm to 30 mm Available in stainless steel or titanium alloy* Important: For final locking the 0.8 Nm torque limiting attachment is required. * Implant-quality 316L stainless steel or titanium alloy (Ti-6Al-7Nb) ** Optional 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 22

27 Instruments mm Universal Variable Angle Locking Drill Guide Handle for Torque Limiting Attachment Depth Gauge for 2.0 mm, 2.4 mm, and 2.7 mm Screws Guide Block for 2.4 mm VA-LCP Volar Rim Distal Radius Plate, 6 hole head, right Guide Block for 2.4 mm VA-LCP Volar Rim Distal Radius Plate, 6 hole head, left Guide Block for 2.4 mm VA-LCP Volar Rim Distal Radius Plate, 7 hole head, right Guide Block for 2.4 mm VA-LCP Volar Rim Distal Radius Plate, 7 hole head, left 22 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

28 Instruments mm Kirschner Wire, 150 mm, trocar point mm Drill Bit with depth mark, quick coupling, 110 mm Handle with quick coupling Short StarDrive Screwdriver Shaft, T8, self-holding, quick coupling, 55 mm StarDrive Screwdriver Shaft, T8, 105 mm mm Universal Drill Guide Torque Limiting Attachment, 0.8 Nm, quick coupling 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 22

29 Instruments Optional Plate Reduction Wire, 1.25 mm, with thread, with Small Stop, length 150 mm Plate Reduction Wire, 1.25 mm, with thread, with Large Stop, length 150 mm mm Drill Guide with Measuring for VCP Guide Block mm Variable Angle Locking Drill Guide, cone mm Variable Angle Locking Drill Guide, coaxial 22 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

30 Instruments Optional mm Drill Bit, quick coupling, 100 mm mm Universal Drill Guide 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 22

31 Instruments Also Available Sizing Template for 2.4 mm VA-LCP Volar Rim Distal Radius Plate, 6 hole head Length (mm) right left Sizing Template for 2.4 mm VA-LCP Volar Rim Distal Radius Plate, 7 hole head Length (mm) right left 33 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

32 2.4 mm Variable Angle LCP (VA-LCP) Volar Rim Distal Radius Plate Module Set Stainless Steel ( ) and Titanium ( ) Graphic Case Module Bin, 1 2 Length, 1 2 Height, for VA-LCP Volar Rim Plates Note: This bin is not included as part of sets or This bin is to be housed in the Plate Module Shell ( ), and should be combined with other distal radius plate bins and/or auxiliary bins (listed in Also Available Section ) to create a complete module. Instruments Guiding Blocks for 2.4 mm VA-LCP Volar Rim Distal Radius Plate hole head, right hole head, left hole head, right hole head, left Implants 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Head Shaft Length Stainless Steel Titanium Holes Holes (mm) right left right left Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer to or sterilization instructions, if provided. 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 33

33 2.4 mm Variable Angle LCP (VA-LCP) Distal Radius System Stainless Steel ( ) and Titanium ( ) Graphic Cases and Trays Graphic Case, Full Length, 4 bay for Modular Graphic Case System Instrument Tray for LCP and VA-LCP Distal Radius Systems Instrument Tray for Distal Radius, Forceps and Bending Pliers Instrument Tray for Distal Radius, Retractors, Hook and Elevators Instruments mm Plate Reduction Wire, threaded tip with small stop, 150 mm, 1 pkg. of 10 ea mm Plate Reduction Wire, threaded tip with large stop, 150 mm, 1 pkg. of 10 ea mm Universal Variable Angle Locking Drill Guide Handle for Torque Limiting Attachment StarDrive Screwdriver, T mm Drill Guide with Measuring for Guide Block mm Variable Angle Locking Drill Guide, cone mm Variable Angle Locking Drill Guide, coaxial Depth Gauge for 2.4 to 2.7 mm Screws Positioning Screw for Variable Angle LCP Two-Column Plate Guide Block Drill Bits, quick coupling, 100 mm mm mm mm mm Handle, with quick coupling Short StarDrive Screwdriver Shaft, T8, 55 mm StarDrive Screwdriver Shaft, T8, 105 mm Holding Sleeve, for StarDrive Screwdriver Shaft, T Sharp Hook 33 DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

34 2.4 mm Variable Angle LCP (VA-LCP) Distal Radius System Stainless Steel ( ) and Titanium ( ) Threaded LCP Drill Guide mm Universal Drill Guide mm Universal Drill Guide mm K-wire Insert Bending Pliers, 140 mm, for 1.5 mm and 2.0 mm plates Reduction Forceps with Points, broad, ratchet, 132 mm Termite Forceps, 90 mm length Hohmann Retractor, 6 mm width, small, short narrow top, 160 mm length Periosteal Elevator, 3 mm width, curved blade, straight edge Periosteal Elevator, 3 mm width, curved blade, round edge Reduction Forceps, with points, 130 mm length, ratchet Torque Limiting Attachment, 0.8 Nm, quick coupling Includes implant sets: Stainless Steel Titanium mm Variable Angle LCP (VA-LCP) Two-Column Volar Distal Radius Plate Set mm Variable Angle LCP (VA-LCP) Narrow Two-Column Volar Distal Radius Plate Set mm Variable Angle LCP (VA-LCP) Extra-Articular Distal Radius Plate Set Screw Set for 2.4 mm Variable Angle LCP (VA-LCP) Distal Radius System mm Variable Angle LCP (VA-LCP) Dorsal Distal Radius Plate Module Set Kirschner Wires, 150 mm, trocar point, 1 pkg. of 10 ea. Stainless Steel* Titanium** mm mm mm Module Adapters, 4 pkg. of 2 ea. Assembled on both ends of any 1-high module to prevent movement when housed in the module bay of the following graphic cases: , , , , * 316L stainless steel ** Titanium alloy (Ti-6Al-4V) 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 33

35 Also Available. For use with Modular Graphic Case System. Graphic Cases and Accessories Graphic Case, Full Length, 4 Bay Graphic Case, Full Length, One High Graphic Case, 2 3 Length, 4 Bay Graphic Case, 2 3 Length, 2 Bay Graphic Case, 2 3 Length, One High Support Screws for Trays and Screw Racks, for use with Full Length Modular Graphic Cases Lid, Full Length for Modular Graphic Case System Lid, 2 3 Length for Modular Graphic Case System Instrument Trays Length Instrument Tray for LCP and VA-LCP Distal Radius Systems Instrument Tray for Distal Radius, Forceps and Bending Pliers Instrument Tray for Distal Radius, Retractors, Hook and Elevators Length Auxiliary Tray Length Instrument Tray for 2.4 mm Cortex and Variable Angle Screws Plate Module and Bins Module Shell for Plate Trays and Auxiliary Trays, for Modular Graphic Case System Auxiliary Bin, full length, full height Auxiliary Bin, ½ length, ½ height Module Bins ½ length, ½ height For 6 hole head, volar column plates For 7 hole head, volar column plates For 8 hole head, volar column plates For 9 hole head, volar column plates Narrow 6 Hole Head, Two-Column Plates Hole Head, Two-Column Plates Hole Head, Two-Column Plates Screw Module, Screw Blocks, and Accessories Screw Module Shell, for Modular Graphic Case System Lid for Screw Module Shell mm Screw Block for Screw Module Shell mm Screw Block for Screw Module Shell Assembly Screws, for Screw Module Shell (5 pkg.) Label Sheets Graphic Case Label Sheet for Distal Radius Systems Label Pack, for 2.4 mm screws and instruments for Modular Graphic Case System Label Pack, for 2.7 mm screws and instruments for Modular Graphic Case System Screw Type Push Pins (5 each) Blank Buttress Cortex Locking VA Locking Length Marker Push Pins (5 each) Length Length (mm) (mm) Blank DePuy Synthes 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique

36 Also Available. For use with Modular Graphic Case System / 2.4 mm LCP and VA-LCP Distal Radius Instrument Set* (stainless steel or titanium) Instrument Tray Sets / 2 3 Instrument Tray, for LCP and Variable Angle LCP Distal Radius Systems (stainless steel or titanium) Plate Module, with Bin Sets / 2.4 mm Variable Angle LCP Two-Column Plate Module, with Bins (stainless steel or titanium) / 2.4 mm LCP Volar Column Plate Module, with Bins (stainless steel or titanium) Instrument Tray for 2.4 mm Cortex and Variable Angle Locking Screws Instrument Tray for Distal Radius, Forceps and Bending Pliers Instrument Tray for Distal Radius, Retractors, Hook and Elevators / 2.4 mm Two-Column and Volar Column Plate Module, with Bins (stainless steel or titanium) Screw Rack Set / Screw Set for 2.4 mm Variable Angle LCP (VA-LCP) Distal Radius System (stainless steel or titanium) Screw Module Sets / 2.4 mm and 2.7 mm Variable Angle Locking Screw Module for Distal Radius (stainless steel or titanium) / 2.4 mm and 2.7 mm LCP Screw Module, for Distal Radius (stainless steel or titanium) / 2.4 mm and 2.7 mm LCP and Variable Angle Locking Screw Module, for Distal Radius (stainless steel or titanium) / 2.4 mm LCP and Variable Angle Locking Screw Module, for Distal Radius (stainless steel or titanium) * Includes Graphic Case 2.4 mm Variable Angle LCP Volar Rim Distal Radius Plates Surgical Technique DePuy Synthes 33

37 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/0916/1065 6/17 DV