3.5 mm VarIable angle lcp medial column fusion PlatIng SYStem. Part of the 2.7 mm and 3.5 mm VA LCP Midfoot/Hindfoot System

Transcription

1 3.5 mm VarIable angle lcp medial column fusion PlatIng SYStem Part of the 2.7 mm and 3.5 mm VA LCP Midfoot/Hindfoot System SurgIcal technique

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3 table of contents Introduction AO Principles and Indications mm Variable Angle LCP Medial Column 2 Fusion Plates Compression System 5 Surgical Technique 3.5 mm Variable Angle Locking Technique mm Variable Angle LCP Medial Column 13 Fusion Plates Product Information Implants 37 Instruments 40 Set Configurations 45 Image intensifier control 2.7 mm and 3.5 mm Variable Angle LCP Midfoot/Hindfoot System Surgical Technique DePuy Synthes Trauma

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5 IntroductIon Introduction

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7 AO Principles and Indications AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation. 1,2 They are: Anatomic reduction Precontoured plates assist reduction to restore length, alignment, and rotation. Anatomic reduction is mandatory for intra-articular fractures to restore joint congruency. Stable fixation Variable angle locking screws create a fixed angle construct, providing angular stability. Preservation of blood supply Preservation of the blood supply to soft tissue and bone by careful handling. Early, active mobilization Plate features combined with AO technique can create an environment for bone healing, expediting a return to optimal function. Indications* The DePuy Synthes 2.7 mm and 3.5 mm Variable Angle LCP Midfoot/Hindfoot System is indicated for fixation of osteotomies, fusions, fractures, nonunions, malunions, and replantations of small bones and small bone fragments in adult and adolescent (aged years) patients, including the foot and ankle, and particularly in osteopenic bone. * these devices have not been evaluated for safety and compatibility in the MR environment. These devices have not been tested for heating and migration in the MR environment. 1 müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group. 3rd ed. Secaucus, NJ: Springer-Verlag; rüedi TP, Buckley RE, Moran CG (eds). AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 1

8 3.5 mm Variable Angle LCP Medial Column Fusion Plates 3.5 mm VA LCP Medial Column Fusion Plates are designed with advanced stabilization capabilities for fusion applications, specifically Charcot foot or severe arthritis. Plates are available for applications including dorsomedial, medial, medial with talus extension, and plantar. Innovative compression instrumentation provides the ability to independently compress each joint through the plate using forceps, 2.8 mm wires, and posts. Compression slots provide the ability to achieve 4 mm 6 mm of compression through the plate Variable Angle Locking Technology provides the ability to adapt screw trajectory to varied patient anatomy and to target specific areas of cortical bone. 3.5 mm VA LCP Medial Column Fusion Plate, 78 mm Designed for arthrodesis of the first naviculocuneiform and tarsometatarsal joints 3.5 mm VA LCP Medial Column Fusion Plate, 95 mm, Talus Extension Designed for arthrodesis of the talonavicular, first naviculocuneiform and tarsometatarsal joints 2 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

9 3.5 mm Variable Angle LCP Medial Column Fusion Plates 3.5 mm VA LCP Medial Column Fusion Plantar Plate, 78 mm Designed for arthrodesis of the first naviculocuneiform and tarsometatarsal Plantar application for increased biomechanical strength, allowing the plate to be applied on the tension side of the medial column* *References: 1. Vincent James Sammarco, Julie Chevillet. The role of internal fixation in surgery of the Charcot foot and the evolution of super-construct techniques. Current Orthopaedic Practice Volume 21, Number 3, May/June Joshua P. Nadaud, Lew C. Schon. Chronic Charcot Midfoot Reconstruction. Techniques in Foot & Ankle Surgery. Volume 9, Number 3, September naohiro Shibuya, Lacey D. Clawson, Monica R. Agarwal. Suspension and Dynamic Compression of the Medial Column 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 3

10 3.5 mm Variable Angle LCP Medial Column Fusion Plates Variable Angle Locking Screws are designed to sit flush within the plate holes* to reduce the likelihood of soft-tissue irritation. 3.5 mm Variable Angle Locking Screw holes accept 3.5 mm Variable Angle Locking screws, 3.5 mm Low-Profile Cortex screws, and 3.5 mm Cortex screws. 3.5 mm Locking screws can be inserted at nominal angle Elongated screw holes accept 3.5 mm Low-profile Cortex or 3.5 mm Cortex screws Plates are pre-contoured, with the ability to contour the plate shaft further, depending on the deformity and patient anatomy. Plates feature 1.6 mm K-wires holes for preliminary plate placement. * Variable Angle Locking screws sit flush within the plate when inserted at nominal angle. 4 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

11 Compression System Compression Forceps Maintain tactile compression during screw insertion using the speed lock mechanism Can be used within the plate through the compression slots or elongated screw hole in the shaft of the plate Compression Wires 2.8 mm diameter, 200 mm overall length Thread lengths from 10 mm to 60 mm in 5 mm increments Allow the plate to be drawn to the bone facilitating preliminary plate fixation Cobalt chromium alloy material that is stiffer than conventional stainless steel* 3.5 mm Compression/Distraction Post for VA Locking Screw Hole Threads into Variable Angle plate holes Use with compression forceps StarDrive recess in head for insertion into plate and final tightening using torque limiter (2.5 Nm) *Cobalt chromium stiffness value: 186 GPa; Stainless Steel stiffness value: 243 MPa 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 5

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13 3.5 mm VarIable angle locking technique 3.5 mm Variable angle locking technique

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15 3.5 mm Variable Angle Locking Technique Drill for Variable Angle Locking screws: Conical (variable angle) 1 Drill for variable angle locking screws A. Conical (off nominal-axis) insertion Instruments mm Variable Angle Double Drill guide with Cone mm Drill Bit, quick coupling, 165 mm or mm Variable Angle Spherical Drill guide, long mm Calibrated Drill Bit, quick coupling, 250 mm, 95 mm calibration To insert the Variable Angle Locking screw off the nominal axis, insert the cone-shaped side of drill guide in the desired variable angle locking screw hole in the plate. The funnel of the drill guide allows a drilling angle within a 30 cone. When drilling off-axis, the drill guide should remain in place and the drill bit may be aimed in any direction within the cone. Verify the drill bit angle and depth under radiographic imaging to ensure the desired angle has been achieved. If necessary, drill at a different angle and verify again under imaging. Precaution: Avoid excessive re-drilling, especially in poor bone quality. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 7

16 3.5 mm Variable Angle Locking Technique Optional Technique The 2.8 mm Variable Angle Spherical Drill Guide can be used to drill for a 3.5 mm Variable Angle Locking Screw. Gently press the spherical tip of the VA drill guide into the variable angle locking hole to ensure the lip of the drill guide stops on the edge of the variable angle locking hole to prevent drilling beyond 15 degrees. Toggle the drill guide to the desired angulation and drill. Note: The screw hole depth can be measured off of the 2.8 mm Calibrated Drill Bit, 250 mm ( ) when using 2.8 mm Spherical Drill Guide ( ). To do so, drill to the desired depth and verify that the plastic stop sits on the drill guide. Remove the drill bit and read the indicated drill depth below the plastic stop. 8 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

17 3.5 mm Variable Angle Locking Technique Drill for Variable Angle Locking screws: Coaxial (fixed angle) B. Coaxial (fixed angle) insertion Instruments mm Variable Angle Double Drill Guide with Cone mm Drill Bit, quick coupling, 165 mm Additionally available mm Fixed Angle Drill Guide Variable angle locking screws can be inserted into the plate in line with the predefined screw trajectory. Drill to the desired depth. Verify the drill bit depth under radiographic imaging. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 9

18 3.5 mm Variable Angle Locking Technique USE THE DEPTH GAUGE TO MEASURE FOR THE CORRECT SCREW LENGTH Instrument Depth Gauge for Small Screws Additionally available Percutaneous Depth Gauge for 2.7 mm screws Percutaneous Depth Gauge Adaptor for 3.5 mm screws Use the depth gauge to measure for the correct screw length. 11 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

19 3.5 mm Variable Angle Locking Technique Insert Variable Angle Locking Screws 2 Insert variable angle locking screws Instruments Handle with Quick Coupling StarDrive Screwdriver Shaft, quick coupling, T15 Insert the correct length variable angle locking screw. The Variable Angle Locking screws can be inserted manually or with power. For manual insertion, use the StarDrive Screwdriver Shaft and handle with quick coupling. Initial insertion of Variable Angle Locking screws may be done using power equipment. Do not lock the screws with power tools. Confirm screw position and length prior to final tightening. Final tightening must be done manually with the torque limiter. Precaution: Do not engage the screw head with the plate hole while inserting under power. Screw engagement and final locking must be done manually with the torque limiter Do not use the torque limiting handle for screw removal 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 11

20 3.5 mm Variable Angle Locking Technique Lock Variable Angle Locking Screws 3 Lock Variable Angle screws Instruments Nm Torque Limiting Handle with Quick Coupling StarDrive Screwdriver Shaft, T15 Use the torque limiter for final tightening of Variable Angle Locking screws. The use of the torque limiter is mandatory when engaging the screws into variable angle locking holes to ensure the appropriate amount of torque is applied. Confirm screw position and length prior to final tightening. Precaution: Do not lock the screws to the plate under power. Screw engagement and final tightening must be done manually with the torque limiting attachment or handle: 2.5 Nm torque limiting handle for 3.5 mm Do not use the torque limiters for screw removal 11 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

21 3.5 mm Va lcp medial column fusion PlateS 3.5 mm Va lcp medial fusion Plates

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23 Preparation Required sets mm VA LCP Medial Column Fusion Instrument and Implant Set or mm VA LCP Medial Column Fusion Plate Module Set / Ankle Trauma Set Optional sets / Small Fragment LCP Instrument and Implant set for 3.5 mm Cortex screws General Instrument Set Joint Preparation Instrument Set 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 11

24 3.5 mm VA LCP Medial Column Fusion Plates 1 Position patient Place the patient in the supine position. Place a bump under the contralateral hip to facilitate visualization of the medial side. 2 Approach Make a medial utility incision 1 cm below the medial malleolus, from the navicular down to the first metatarsal. When inserting the 3.5 mm VA LCP Medial Column Fusion Plantar Plate, make an incision at the junction of the plantar and medial skin, right above the abductor and inferior border of the first metatarsal. Note: Take care to avoid the tibialis anterior tendon. 11 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

25 3.5 mm VA LCP Medial Column Fusion Plates 3 Prepare joint surfaces Expose and prepare all the joints for fusion. Anatomically align the tarsometatarsal axis. If necessary, correct deformities with bone resection or bone graft. The corrections should be performed to the estimated final shape of the foot. K-wires used to temporarily hold joints in place must be placed to avoid interference with final plate placement. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 11

26 3.5 mm VA LCP Medial Column Fusion Plates Additionally available Distraction Forceps mm Compression Wires mm length, 20 mm 40 mm thread or Bone Spreader, 8 mm tip width, one tooth, 210 mm Additionally available set Joint Preparation Instrument Set The Joint Preparation set chisels can be used to help prepare the bone for fusion. Distraction forceps and 1.6 mm Compression wires, or a Bone Spreader can be used to open the joint for joint preparation. Note: Reference the Orthopaedic Foot Instrument Technique Guide for the Joint Preparation technique steps and product assembly. 11 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

27 3.5 mm VA LCP Medial Column Fusion Plates 4 Contour plate (optional) Instruments bending Iron for 2.7 mm and 3.5 mm plates bending Iron for 2.7 mm and 3.5 mm plates Additionally available Plate-Bending Press The Medial Column Fusion Plates may require additional contouring in the shaft depending on patient anatomy and the desired correction of the medial arch. The plate should only be bent in between the Variable Angle Locking screw holes. Precaution: Excessive contouring may weaken the plate. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 11

28 3.5 mm VA LCP Medial Column Fusion Plates 5 Position plate Instrument mm Kirschner Wire with Trocar Point, 150 mm Remove any bony prominences if needed. Provisionally fix the plate to the bone with 1.6 mm K-wires. Confirm proper plate positioning prior to screw insertion. Precaution: Care should be taken to protect the anterior tibial tendon during plate application to maintain its integrity, as it inserts on the plantar medial aspect of the foot. The 3.5 mm VA LCP Medial Column Fusion Plate, 78 mm is designed to span the navicular, cuneiform, and first metatarsal. The 3.5 mm VA LCP Medial Column Fusion Plate, 95 mm is designed to span the talus, navicular, cuneiform, and first metatarsal. 11 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

29 3.5 mm VA LCP Medial Column Fusion Plates The 3.5 mm VA LCP Medial Column Fusion Plantar Plate, 78 mm is designed to span the navicular, cuneiform, and first metatarsal. Note: Osteophytes may need to be removed to facilitate placement of the plantar plate. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 11

30 3.5 mm VA LCP Medial Column Fusion Plates 6 Insert screws and independently compress each joint To insert 3.5 mm Variable Angle Locking screws, follow the technique as described on page 7. If using the compression technique to independently compress each joint, follow the technique specified on the following pages for each plate: A) Medial Column Fusion Plate, 78 mm page 21 B) medial Column Fusion Plate, Talus Extension, page mm C) Medial Column Fusion Plantar Plate, 78 mm page 30 Instruments for Compression Technique mm Compression Wires, 200 mm length, 15 mm 40 mm thread lengths Large Compression Forceps mm Compression/Distraction Post for VA Locking Hole Nm Torque Limiting Handle with Quick Coupling StarDrive Screwdriver Shaft, quick coupling, T Handle with Quick Coupling 22 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

31 3.5 mm VA LCP Medial Column Fusion Plates a) 3.5 mm VA LCP Medial Column Fusion Plate, 78 mm To compress the naviculocuneiform joint: a 1) Insert a 3.5 mm VA Locking screw into the navicular portion of the plate in the lateral hole following the Variable Angle Locking screw insertion technique on page mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 22

32 3.5 mm VA LCP Medial Column Fusion Plates a) 3.5 mm VA LCP Medial Column Fusion Plate, 78 mm a 2) Insert a compression post into the navicular portion of the plate in the medial or center hole. Precaution: The compression post needs to be inserted and locked using the 2.5 Nm torque limiter. Using a wire driver, insert a 2.8 mm compression wire into the compression slot in the cuneiform portion of the plate. Insert the wire as far distal as anatomy permits to maximize compression. Precaution: Bicortical fixation is recommended To minimize stripping of the wire threads, wire insertion should proceed slowly when the spherical stop nears the plate. Control the insertion for tactile confirmation of compression between the wire, the plate, and the bone Remove K-wires before compressing. a 3) Compress the joint using the compression forceps. Thread the speed nut counterclockwise so the forceps are in their open position. Place the compression forceps into position, with the tips around the spheres of the compression wire and post. Compress by squeezing the handles. Precaution: Do not exert excessive force as this may cause the compression wire to strip out of the bone. To lock the device, thread the speed nut clockwise while maintaining pressure on the forceps. Note: The total amount of compression that can be achieved through the compression slot is 6 mm. 22 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

33 3.5 mm VA LCP Medial Column Fusion Plates a) 3.5 mm VA LCP Medial Column Fusion Plate, 78 mm a 4) Insert a 3.5 mm VA Locking screw in the proximal hole of the cuneiform portion of the plate following the Variable Angle Locking screw insertion technique on page 7. Remove the compression forceps and 2.8 mm compression wire. Leave the compression post in the current position. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 22

34 3.5 mm VA LCP Medial Column Fusion Plates a) 3.5 mm VA LCP Medial Column Fusion Plate, 78 mm To compress the first tarsometatarsal joint: a 5) Insert a 2.8 mm compression wire into the elongated screw hole in the metatarsal portion of the plate. Insert the wire as far distal as anatomy permits to maximize compression. Reference a2 for specific technique. Remove K-wires before compressing. a 6) Compress the joint using the compression forceps. Reference a3 for specific technique. Note: The elongated screw hole can achieve up to 4 mm of compression. 22 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

35 3.5 mm VA LCP Medial Column Fusion Plates a) 3.5 mm VA LCP Medial Column Fusion Plate, 78 mm a 7) Insert a 3.5 mm VA Locking screw in either open hole in the metatarsal portion of the plate following the Variable Angle Locking screw insertion technique on page 7. Remove the 2.8 mm compression wire and the compression post. Precaution: The compression posts should be removed using the StarDrive Screwdriver Shaft and Handle with quick coupling. Do not remove the posts with the torque limiter. Insert additional screws into the open holes of the plate as needed. Precaution: It is recommended to fill three 3.5 mm Variable Angle Locking screw holes in the navicular portion of the plate, and two screw holes per additional segment.* *Testing on file at DePuy Synthes Companies, April mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 22

36 3.5 mm VA LCP Medial Column Fusion Plates b) 3.5 MM VA LCP Medial Column Fusion Plate, 95 mm, TALUS EXTENSION To compress the naviculocuneiform joint: b 1) Insert a 3.5 mm VA Locking screw into the navicular portion of the plate in the lateral hole following the Variable Angle Locking screw insertion technique on page 7. b 2) Insert a compression post in the open hole in the navicular portion of the plate. Precaution: The compression post needs to be inserted and locked using the 2.5 Nm torque limiter. Using a wire driver, insert a 2.8 mm compression wire into the compression slot in the cuneiform portion of the plate. Reference a2 for specific technique. Precaution: Bicortical fixation is recommended. Remove K-wires before compressing. 22 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

37 3.5 mm VA LCP Medial Column Fusion Plates b) 3.5 MM VA LCP Medial Column Fusion Plate, 95 mm, TALUS EXTENSION b 3) Compress the joint using the compression forceps. Reference a3 for specific technique. Note: The total amount of compression that can be achieved through the compression slot is 6 mm. b 4) Insert a 3.5 mm VA Locking screw in the most proximal hole within cuneiform portion of the plate following the Variable Angle Locking screw insertion technique on page 7. Remove the compression forceps and compression wire. Leave the compression post in the current position. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 22

38 3.5 mm VA LCP Medial Column Fusion Plates B) 3.5 MM VA LCP MEDIAL COLUMN FUSION PLATE, 95 MM, TALUS EXTENSION To compress the first tarsometatarsal joint: b 5) Insert a 2.8 mm compression wire into the elongated screw hole within the metatarsal portion of the plate. Reference a2 for specific technique. Remove K-wires before compressing. b 6) Compress the joint using compression forceps. Reference a3 for specific technique. Note: The elongated screw hole can achieve up to 4 mm of compression. b 7) Insert a 3.5 mm VA Locking screw into an open hole within the metatarsal portion of the plate following the Variable Angle Locking screw insertion technique on page 7. Remove the compression forceps and the 2.8 mm compression wire. Leave the compression post in the current position. 22 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

39 3.5 mm VA LCP Medial Column Fusion Plates B) 3.5 MM VA LCP MEDIAL COLUMN FUSION PLATE, 95 MM, TALUS EXTENSION To compress the talonavicular joint: b 8) Insert a 2.8 mm compression wire into the compression slot within the talus portion of the plate. Reference a2 for specific technique. Remove K-wires before compressing. b 9) Compress the joint using compression forceps. Reference a3 for specific technique. Note: The total amount of compression that can be achieved through the compression slot is 4 mm. b 10) Insert a 3.5 mm VA Locking screw into the lateral screw hole within the talus portion of the plate following the Variable Angle Locking screw insertion technique on page 7. Remove the compression forceps, 2.8 mm compression wire, and compression post. Insert additional screws into the open holes of the plate as needed following the VA Locking screw insertion technique on page 7. Precaution: It is recommended to fill two 3.5 mm VA Locking screw holes per segment.* *Testing on file at DePuy Synthes Companies, April mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 22

40 3.5 mm VA LCP Medial Column Fusion Plates c) 3.5 mm VA LCP Medial Column Fusion Plantar Plate, 78 mm To compress the naviculocuneiform joint: c 1) Insert a 3.5 mm VA Locking screw into the lateral hole in the navicular portion of plate following the Variable Angle Locking screw insertion technique on page 7. c 2) Insert a compression post into the open hole in the navicular portion of the plate. Precaution: The compression post needs to be inserted and locked using the 2.5 Nm torque limiter. Using a wire driver, insert a 2.8 mm compression wire into the compression slot within the cuneiform portion of the plate. Reference a2 for specific technique. Precaution: Bicortical fixation is recommended. Remove K-wires before compressing. 33 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

41 3.5 mm VA LCP Medial Column Fusion Plates c) 3.5 mm VA LCP Medial Column Fusion Plantar Plate, 78 mm c 3) Compress the joint using the compression forceps. Reference a3 for specific technique. Note: The total amount of compression that can be achieved through the compression slot is 6 mm. c 4) Insert a 3.5 mm VA Locking screw in the proximal hole within the cuneiform portion of the plate following the Variable Angle Locking screw insertion technique on page 7. Remove the compression forceps and the compression wire. Leave the compression post in the current position. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 33

42 3.5 mm VA LCP Medial Column Fusion Plates c) 3.5 mm VA LCP Medial Column Fusion Plantar Plate, 78 mm To compress the first tarsometatarsal joint: c 5) Insert a 2.8 mm compression wire into the elongated screw hole within the metatarsal portion of the plate. Reference a2 for specific technique. Remove K-wires before compressing. c 6) Compress the joint using the compression forceps. Reference a3 for specific technique. Note: The elongated screw hole can achieve up to 4 mm of compression. 33 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

43 3.5 mm VA LCP Medial Column Fusion Plates c) 3.5 mm VA LCP Medial Column Fusion Plantar Plate, 78 mm c 7) Insert a 3.5 mm VA Locking screw in the metatarsal portion of the plate following the Variable Angle Locking screw insertion technique on page 7. Remove the compression wire and compression post. Precaution: The compression posts should be removed using the StarDrive Screwdriver Shaft and Handle with quick coupling. Do not remove the posts with the torque limiter. Insert additional screws into the open holes of the plate as needed. Precaution: It is recommended to fill two Variable Angle Locking screw holes per segment.* *Testing on file at DePuy Synthes Companies, April mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 33

44 3.5 mm VA LCP Medial Column Fusion Plates 7 Lock Variable Angle Locking Screws Lock the 3.5 mm Variable Angle Locking screws manually with the 2.5 Nm torque limiting handle, as described in the Variable Angle Locking Technique on page 12. Confirm fixation and positioning of the plate and screws under fluoroscopic imaging. 33 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

45 3.5 mm VA LCP Medial Column Fusion Plates Implant removal Instruments StarDrive Screwdriver Shaft, T Handle with Quick Coupling Optional set Screw Removal Set Optional instrument Conical Extraction Screw, for 2.7 mm and 3.5 mm Cortex Screws If implant removal is desired, unlock all screws manually from the plate using the proper screwdriver shaft and handle. Then remove the screws completely from the bone. Precaution: Do not use the torque limiters for screw removal. If the screws cannot be removed with the screwdriver, insert the conical extraction screw with the left-handed thread into the screwhead using the handle with quick coupling, and loosen the screw by turning counterclockwise. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 33

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47 ImPlantS and InStrumentS Implants and Instruments

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49 ScreWS for the 3.5 mm VarIable angle lcp medial column fusion PlateS The 3.5 mm Variable Angle LCP Medial Column Fusion plates accept the following screws: 3.5 mm Variable Angle Locking Screws threaded, rounded head locks securely into the variable angle locking holes locked screws allow unicortical screw fixation and load transfer to the near cortex used with 2.8 mm drill bit t15 StardrIVe recess Self-tapping color coded for easier identification Screws in set: 12 mm 50 mm ( ) additionally available: 10 mm 95 mm ( ) 3.5 mm Low-profile Cortex Screws for use in locking, non-locking, or combi holes used to provide compression or neutral fixation low-profile head used with 2.5 mm drill bit t15 StardrIVe recess Self-tapping tip Screws in set: 12 mm 50 mm ( ) additionally available: 10 mm 110 mm ( ) 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 37

50 Screws for the 3.5 mm Variable angle lcp medial column fusion Plates 3.5 mm Locking Screws* only for axial insertion in the variable angle locking holes threaded, conical head locks securely into the variable angle locking holes used with 2.8 mm drill bit t15 StardrIVe recess Self-tapping tip additionally available: 10 mm 95 mm ( ) 3.5 mm Cortex Screws* for use in locking, non-locking, or combi holes used to provide compression or neutral fixation used with 2.5 mm drill bit Self-tapping tip available with t15 StardrIVe or Small hexagonal recess additionally available: StardrIVe recess 10 mm 150 mm ( ) hexagonal recess 10 mm 110 mm ( ) *also available. 38 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

51 IMPLANTs 3.5 mm VA LCP Medial Column Fusion Plate* Right Left Stainless Steel Right/Left Size (mm) Right Left mm VA LCP Medial Column Fusion Plate, Talus Extension* Right Left Stainless Steel Right/Left Size (mm) Right Left mm VA LCP Medial Column Fusion Plantar Plate* Right Left Stainless Steel Right/Left Size (mm) Right Left 78 * available non sterile or sterile packed. Add S to catalog number to order sterile product. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 33

52 Instruments for 3.5 mm Variable Angle LCP Medial Column Fusion Plates For 3.5 mm Variable Angle Locking and Cortex Screws mm Drill Bit, quick coupling, 165 mm mm Calibrated Drill Bit, quick coupling, 250 mm, 95 mm calibration mm Variable Angle Double Drill Guide with cone mm Fixed Angle Drill Guide mm Variable Angle Spherical Drill Guide, Long mm Drill Bit, quick coupling, 180 mm mm Drill Bit, quick coupling, 110 mm mm/2.5 mm Double Drill Sleeve 44 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

53 Instruments for 3.5 mm Variable Angle LCP Medial Column Fusion Plates Depth Gauge for small screws Handle with quick coupling StarDrive Screwdriver Shaft quick coupling, T Nm Torque Limiting Handle with quick coupling mm Kirschner Wire with trocar point, 150 mm Large Compression Forceps 2.8 mm Compression Wires, 200 mm thread length (mm) mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 44

54 Instruments for 3.5 mm Variable Angle LCP Medial Column Fusion Plates mm Compression/Distraction Post for VA locking hole bending Irons for 2.7 mm and 3.5 mm plates for 2.7 mm and 3.5 mm plates also available Percutaneous Depth Gauge for 2.7 mm screws Percutaneous Depth Gauge Adaptor for 3.5 mm screws Large Distraction Forceps 44 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

55 General Instruments bone Spreader, 8 mm beak width, one tooth, 210 mm length hohmann Retractor, 8 mm width, narrow tip, 148 mm length Sharp Hook-Small Taper bending Irons for 2.7 mm and 3.5 mm plates for 2.7 mm and 3.5 mm plates Bending/Cutting Pliers Universal Bending Pliers Stagbeetle Forceps, 125 mm 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 44

56 general Instruments Periosteal elevators mm curved blade, round edge mm curved blade, straight edge mm curved blade, round edge reduction forceps with ratchet points mm mm mm reduction forceps with serrated Jaw ratchet, 144 mm also available hohmann retractor, 8 mm round tip, 215 mm hohmann retractor, 8 mm narrow tip, 215 mm 44 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

57 3.5 mm VA LCP Medial Column Fusion Instrument and Implant Set Stainless Steel ( ) Graphic Case Graphic Case, Full Length, 2 High tray for 3.5 mm VA LCP Medial Column Fusion Plates and Instruments Screw Rack for 3.5 mm Variable Angle Locking and 3.5 mm Cortex, Low-Profile Head Screws tray for Compression/Distraction Forceps and Instruments Support Posts for Screw Rack for Modular Graphic Cases Instruments Tray Handle with quick coupling mm Fixed Angle Drill Guide mm Variable Angle Double Drill Guide with cone mm Variable Angle Spherical Drill Guide, Long Nm Torque Limiting Handle with quick coupling* mm Kirschner Wire with trocar point, 150 mm mm Drill Bit, quick coupling, 180 mm, 2 ea mm Drill Bit, quick coupling, 165 mm, 2 ea mm Drill Bit, quick coupling, 110 mm, 2 ea mm/2.5 mm Double Drill Sleeve StarDrive Screwdriver Shaft, quick coupling, T15, 2 ea Depth Gauge for small screws bending Irons for 2.7 mm and 3.5 mm plates for 2.7 mm and 3.5 mm plates * recalibration of the Torque Limiter: DePuy Synthes Companies recommends annual servicing and inspection by the original manufacturer. The Torque Limiter has to be sent to your DePuy Synthes repair center annually for calibration. The user accepts the responsibility for this annual calibration. For detailed cleaning and sterilization instructions, please refer to: In Canada, the cleaning and sterilization instructions will be provided with the Loaner shipments. 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 44

58 3.5 mm VA LCP Medial Column Fusion Instrument and Implant Set Stainless Steel ( ) Tray Large Compression Forceps mm Compression/Distraction Post for VA Locking Hole, 2 ea mm Calibrated Drill Bit, quick coupling, 250 mm, 95 mm calibration 2.8 mm Compression Wires, 200 mm, thread length (mm) Screw Rack Screw Forceps Implants Tray mm VA LCP Medial Column Fusion Plate* Stainless Steel Right/Left Size (mm) Right Left mm VA LCP Medial Column Fusion Plate, Talus Extension* Stainless Steel Right/Left Size (mm) Right Left mm VA LCP Medial Column Fusion Plantar Plate* Stainless Steel Right/Left Size (mm) Right Left 78 *Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 44 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

59 3.5 mm VA LCP Medial Column Fusion Instrument and Implant Set Stainless Steel ( ) Screw Rack mm Variable Angle Locking Screws, self-tapping, with T15 StarDrive recess* mm, 3 ea., mm, 2 ea. Stainless Length Stainless Length Steel (mm) Steel (mm) mm Cortex Screws, Low Profile Head, self-tapping, T15 StarDrive recess, 2 ea. Stainless Length Stainless Length Steel (mm) Steel (mm) mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 44

60 3.5 mm VA LCP Medial Column Fusion Plate Module Set Stainless Steel ( ) Graphic Case Module Shell module Bin for 3.5 mm VA LCP Medial Column Fusion Plates Auxiliary Bin, Full Length, 1/2 Height label pack for 3.5 mm VA LCP Medial Column Fusion Plate Set Implants Module Bin mm VA LCP Medial Column Fusion Plate* Stainless Steel Right/Left Size (mm) Right Left mm VA LCP Medial Column Fusion Plate, Talus Extension* Stainless Steel Right/Left Size (mm) Right Left mm VA LCP Medial Column Fusion Plantar Plate* Stainless Steel Right/Left Size (mm) Right Left 78 *Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 44 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

61 General Instrument Set ( ) Graphic Case Graphic Case, Full Length, 1 High General Instrument Tray, Full Length Label pack for General Instrument Set Instruments hohmann Retractor, 8 mm width, narrow tip, 148 mm, 4 ea bone Spreader, 8 mm tip width, one tooth, 210 mm length Sharp Hook-Small Taper bending Irons for 2.7 mm and 3.5 mm plates for 2.7 mm and 3.5 mm plates Bending/Cutting Pliers Universal Bending Pliers, 2 ea Stagbeetle Forceps, 125 mm Periosteal elevators mm curved blade, round edge mm curved blade, straight edge mm curved blade, round edge reduction Forceps with points, ratchet mm mm mm reduction Forceps with serrated jaw ratchet, 144 mm 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 44

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64 CAUTION: Federal Law Restricts These Devices To Sale By Or On The Order Of A Physician. Some devices listed in this technique guide 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. Manufactured or distributed in the United States by: Synthes, Inc Goshen Parkway West Chester, PA Telephone: (610) To order: (800) Legal manufacturer in Canada: Synthes (Canada) Ltd Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) To order: (800) Fax: (905) DePuy Synthes Trauma, a division of DOI All rights reserved. DSUS/TRM/0814/0193 8/14 DV