2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System. For fragment-specific fracture fixation with variable angle locking technology.

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1 Technique Guide 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System. For fragment-specific fracture fixation with variable angle locking technology.

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3 Table of Contents Introduction 2.4 mm Variable Angle LCP Volar 2 Extra-Articular Distal Radius System Synthes Biomaterials Overview 4 AO Principles 5 Indications 6 Clinical Cases 7 Surgical Technique Preparation 8 Implantation 9 Optional Bone Void Filler Insertion 15 Closing of Incision 15 Product Information Screw Overview 16 Plate Overview 18 Instruments mm Variable Angle LCP Module 22 Image intensifier control Warning This description is not sufficient for immediate application of the instrumentation. Instruction by a surgeon experienced in handling this instrumentation is highly recommended. Synthes 1

4 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Variable Angle LCP (VA-LCP) The variable angle LCP (VA-LCP) holes combined with variable angle locking screws allow up to 15 off-axis angulation in all directions The variable angle (VA) locking screws offer a fixed-angle construct to support the articular surface Fixation can be achieved in osteoporotic bone Manufactured in stainless steel and pure titanium Plates are available left or right with 3-hole or 5-hole shaft length Elongated combi-hole LCP combi-holes allow fixed-angle locking screw fixation with angular stability in the threaded section, or compression with cortex screws in the non-threaded section Choice of 4-hole or 5-hole head configuration Fragment-specific fixation Due to the 15 off the central axis the surgeon can perform fragmentspecific fixation with a fixed-angle construct (1). The nominal angles of the VA locking screws are identical to the fixed-angle 2.4 mm LCP extraarticular volar distal radius plate (2). (1) (2x) (2) Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

5 Variable angle (VA) locking hole The VA locking hole contains four columns of threads. These columns provide four points of threaded locking between the VA-LCP plate and the variable angle locking screw, forming a fixed-angle construct at the desired screw angle (1). The head of the 2.4 mm VA locking screw has rounded shape that facilitates various angles within the locking hole (2). The shafts of the 2.4 mm VA locking screw and the standard 2.4 mm locking screw are identical. The combi-hole accepts a 2.4 mm VA locking screw or a cortex screw (3). VA locking hole (1) (2) Combi-hole (3) VA-LCP Drill Guide The drill guide allows up to a 15 angulation around the central axis of the locking hole. Synthes 3

6 Synthes Biomaterials Overview Synthetic and allogenic bone replacement materials have the advantage of uniform quality, unlimited availability and absence of potential complications at a donor site. Additionally, the application of synthetic and allogenic bone graft substitutes reduces the duration of the surgery. Synthes offers a wide range of synthetic biomaterial products in different application forms and with distinct biological properties: chronos chronos Perfusion Concept chronos Inject Osteoconductive, resorbable, synthetic Enhancing chronos with biological factors Injectable remodelling Norian SRS DBX* Injectable stability Osteoinductive power *Facilitated through Synthes Furthermore a comprehensive portfolio of allograft products is available in selected countries. For more detailed information about a specific product or availability of allografts please contact your local Synthes representative. 4 Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

7 AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation. 1 Those principles, as applied to the 2.4 mm Variable Angle LCP Volar Extra- Articular Distal Radius System, are: Anatomic reduction The use of variable angle locking technology allows fragment specific fixation by providing the flexibility to lock screws in trajectories that can diverge from the central axis of the plate hole. Variable screw angles provide fixation options for a variety of fracture patterns. Stable fixation Variable angle locking screws create a locked construct, providing angular stability. Preservation of blood supply Limited-contact plate design reduces plate-to-bone contact, limiting vascular trauma. Additionally, locked plates do not require close contact with the bone. Early, active mobilization Early mobilization per standard AO technique creates an environment for bone healing, expediting a return to optimal function. 1 Müller ME, Allgöwer M, Schneider R, Willenegger H (1991) AO Manual of Internal Fixation, 3rd Edition. Berlin; Springer-Verlag Synthes 5

8 Indications The 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius Plates are indicated for fixation of intra- and extra-articular fractures and osteotomies of the distal radius. 6 Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

9 Clinical Cases Case 1 48-year-old female, cause of injury unknown Preoperative AP Preoperative lateral Postoperative AP Postoperative lateral Case 2 71-year-old female, cause of injury unknown Preoperative AP Preoperative lateral Postoperative AP Postoperative lateral Synthes 7

10 Preparation 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. Important: Leave the volar wrist capsule intact to avoid devascularization of the fracture fragments and destabilization of the volar wrist ligaments. 8 Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

11 Implantation 1 Reduce fracture and position plate Instruments for 2.4 mm Cortex screws Drill Bit 1.8 mm, with marking, length 110/85 mm, 2-flute, for Quick Coupling Handle with Quick Coupling, length 110 mm Screwdriver Shaft, Stardrive, T8, self-holding Depth Gauge for Screws 2.0 and 2.4 mm Universal Drill Guide 2.4 Reduce the fracture. The reduction method will be fracturespecific. Apply the plate to fit the extra-articular volar surface and insert a 2.4 mm cortex screw in the elongated hole in the plate shaft. Adjust the plate position if necessary and tighten the screw. The order of screw insertion in the shaft and metaphysis may vary depending on the fracture pattern and reduction technique. Synthes 9

12 Implantation 2 Insert proximal screws Instruments for 2.4 mm VA locking screws Drill Bit 1.8 mm, with marking, length 110/85 mm, 2-flute, for Quick Coupling LCP Drill Sleeve 2.4, with Scale up to 30 mm, for Drill Bits 1.8 mm Depth Gauge for Screws 2.0 and 2.4 mm Screwdriver Shaft, Stardrive, T8, self-holding Torque Limiter 0.8 Nm Handle, with Quick Coupling Optional instrument Handle for Torque Limiters 0.4/0.8/1.2 Nm Instruments for 2.4 mm cortex screws Drill Bit 1.8 mm, with marking, length 110/85 mm, 2-flute, for Quick Coupling Handle, with Quick Coupling Screwdriver Shaft, Stardrive, T8, self-holding Depth Gauge for Screws 2.0 and 2.4 mm Universal Drill Guide 2.4 Determine where 2.4 mm VA locking screws or 2.4 mm cortex screws will be used in the shaft of the plate. Insert these screws beginning with the most proximal screw. For VA locking screws, carefully insert the LCP drill sleeve 2.4 in line with the hole s axis until it is seated in the desired locking hole. Use the 1.8 mm drill bit. Read the screw length directly from the laser mark on the drill bit, or use the corresponding depth gauge to determine the screw length. Technique tip: Insert the self-tapping VA locking screws with the torque limiter 0.8 Nm. 10 Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

13 3 Insert VA locking screws distally Instruments VA-LCP Drill Guide 2.4, for Drill Bits 1.8 mm Screwdriver Shaft, Stardrive, T8, self-holding Drill Bit 1.8 mm, with marking, length 110/85 mm, 2-flute, for Quick Coupling Handle, with Quick Coupling Depth Gauge for Screws 2.0 and 2.4 mm The VA-LCP drill guide tip is inserted and keyed into the cloverleaf design of the VA-LCP hole. Use the funnel-shaped end of the VA-LCP drill guide to drill variable angle holes at the desired angle. Note: The VA-LCP drill guide is inserted into the head of the plate at the same angle as the 2.4 mm threaded drill guide in the fixed-angle extraarticular plate. Caution: Do not use LCP drill sleeves in VA-locking holes. Synthes 11

14 Implantation 4 Drill for VA screw distally When the VA-LCP drill guide is engaged in the VA locking hole, use the 1.8 mm drill bit to drill to the desired depth at the desired angle. The funnel of the drill guide allows the drill bit a total angle variation of 30 (1, 2). Verify the drill bit angle under C-arm to ensure the desired angle has been achieved. If necessary, drill at a different angle and verify again under C-arm. Use the depth gauge for 2.0 mm and 2.4 mm screws to measure the correct screw length. (1) The fixed-angle end of the drill guide only allows the drill bit to follow the nominal trajectory of the locking hole (3). (2) (3) 12 Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

15 5 Preliminary screw placement Instruments Handle with Quick Coupling, length 110 mm Screwdriver Shaft, Stardrive, T8, self-holding Insert the VA locking screws manually with the self retaining T8 Stardrive screwdriver shaft and Quick Coupling handle until just before the screw head is seated in the locking hole. Do not over-tighten the screw so they can be easily removed if necessary. 6 Confirm proper joint reconstruction Confirm proper joint reconstruction, screw placement and screw length using multiple C-arm views. Ensure that the distal screws are not in the joint using additional views such as a 10 dorsally tilted, 20 inclined lateral, and 45 pronated oblique view. Synthes 13

16 Implantation 7 Locking of variable angle screws in VA holes Instruments Torque Limiter, 0.8 Nm, with AO/ASIF Quick Coupling Handle with Quick Coupling, length 110 mm Screwdriver Shaft, Stardrive, T8, self-holding Optional instrument Torque Limiter, 1.2 Nm, with AO/ASIF Quick Coupling Handle for Torque Limiters 0.4/0.8/1.2 Nm Use the torque limiting attachment to perform the final locking step for the VA locking screws. The torque limiting attachment prevents over-tightening and makes sure that the VA locking screws are securely locked into the plate. Caution: A torque limiting attachment is to be used for inserting VA locking screws in VA holes. 14 Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

17 Optional Bone Void Filler Insertion Closing of Incision Optional bone void filler insertion Determine if there is a bone void that requires filling to maintain reduction and aid in bone healing. Use autogenous bone graft or a synthetic bone graft or allograft product (see page 4). Closing of incision Use the appropriate method for surgical closure of the incision. Synthes 15

18 Screw Overview Variable angle locking screws 2.4 mm Variable angle locking screws, with Stardrive recess Threaded, spherical head locks securely into the threaded VA-LCP holes to provide angular stability at angles determined by the surgeon Locked screws allow unicortical screw fixation and load transfer to near cortex 6 mm to 30 mm lengths (2 mm increments) Self-tapping tip Important: Use of 08. or 1.2 Nm TLA torque limiting attachment required Cortex screws 2.4 mm Cortex screws, self-tapping, with Stardrive recess For use in round or combi-holes Low-profile head in the plate holes Used to provide compression or neutral fixation 6 mm to 30 mm lengths (2 mm increments) Self-tapping tip 16 Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

19 2.7 mm Cortex screws, self-tapping, with Stardrive recess For use in combi-holes Used to provide compression or neutral fixation 10 mm to 30 mm lengths (2 mm increments) Self-tapping tip Notes For information on fixation principles using conventional and locked plating techniques, please refer to the LCP Technique Guide ( ). The Stardrive recess in the screw head offers improved torque transfer, high strength, and self-retention of screws, when compared to cruciform and hexagonal drives. Please note in the surgical report that a screw with Stardrive recess has been used. This will remind the surgeon to have a Stardrive screwdriver available for screw removal. Synthes 17

20 Plate Overview 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius Plates, Stainless Steel Left plates Right plates All plates are also available sterile 18 Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

21 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius Plates, Titanium Left plates Right plates All plates are also available sterile Synthes 19

22 Instruments Special instruments for VA-LCP screw insertion in VA holes VA-LCP Drill Guide 2.4, for Drill Bits 1.8 mm Optional Torque Limiter, 1.2 Nm, with AO/ASIF Quick Coupling 20 Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

23 Instruments* Drill Bit 1.8 mm, with marking, length 110/85 mm, 2-flute, for Quick Coupling Handle with Quick Coupling, length 110 mm Screwdriver Shaft, Stardrive, T8, self-holding Holding Sleeve for Screws Stardrive 2.4 mm, T8, for Screwdriver Shafts 3.5 mm, for No Depth Gauge for Screws 2.0 and 2.4 mm, measuring range up to 40 mm LCP Drill Sleeve 2.4, with Scale up to 30 mm, for Drill Bits 1.8 mm mm Universal Drill Guide Torque Limiter, 0.8 Nm, with AO/ASIF Quick Coupling *All listed instruments are part of the standard locking Distal Radius System 2.4 Synthes 21

24 Instruments Optional instruments* Drill Bit 2.7 mm, length 100/75 mm, 2-flute, for Quick Coupling Drill Bit 2.4 mm, length 100/75 mm, 2-flute, for Quick Coupling Drill Bit 2.0 mm, with marking, length 110/85 mm, 2-flute, for Quick Coupling Depth Gauge for Screws 2.7 to 4.0 mm, measuring range up to 60 mm Universal Drill Guide Handle for Torque Limiters 0.4/0.8/1.2 Nm *All listed instruments are part of the standard locking Distal Radius System Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

25 2.4 mm Variable Angle LCP Module The module contains the following plates, screws and instruments: Module with content VA-LCP Distal Radius Plates 2.4, extraarticular, Pure Titanium VA-LCP Distal Radius Plates 2.4, extraarticular, Stainless Steel Synthes 23

26 2.4 mm Variable Angle LCP Module Implants in module 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius Plates Stainless Steel Titanium Head Shaft Holes Holes right left right left right left right left 2.4 mm Variable Angle Locking Screws, with Stardrive recess Stainless Steel Titanium Length (mm) Quantity optional optional Synthes 2.4 mm Variable Angle LCP Volar Extra-Articular Distal Radius System Technique Guide

27 Instruments in module VA-LCP Drill Guide 2.4, for Drill Bits 1.8 mm X Kirschner Wire 1.25 mm with trocar tip, length 150 mm Torque Limiter, 0.8 Nm, with AO/ASIF Quick Coupling Additionally available Torque Limiter, 1.2 Nm, with AO/ASIF Quick Coupling X Kirschner Wire 1.6 mm with trocar tip, length 150 mm

28 Synthes GmbH Eimattstrasse 3 CH-4436 Oberdorf Presented by: SE_ AA /2008 Synthes, Inc. or its affiliates All rights reserved Synthes, LCP and Stardrive are trademarks of Synthes, Inc. or its affiliates

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