LCP Anterior Ankle Arthrodesis Plates. Part of the Synthes Locking Compression Plate (LCP) System. Technique Guide Instruments and implants approved by the AO Foundation
Table of Contents Introduction LCP Anterior Ankle Arthrodesis Plates 2 Indications 3 Surgical Technique Preparation 4 Incisions 4 Osteotomy, Resection and Site Preparation Tibia 5 Osteotomy and Resection Fibula 8 Temporary Fixation 10 Insert Distal Screw 11 Axial Compression 11 Insert the 3.5 mm Cortex Screws 12 Insert Distal Angulated Screws 13 Insert the Proximal 4.5 mm Cortex Screws 14 Insert the Proximal Locking Screws 14 Product Information Implants 15 Required Instruments 15 Required Sets 15 image intensifier control Synthes
LCP Anterior Ankle Arthrodesis Plates Foreword LCP Anterior Ankle Arthrodesis Plates incorporate Combi holes, which combine a dynamic compression unit (DCU) hole with a locking screw hole. Features Combi holes in the plate shaft Anatomically contoured Available with 6 (100 mm) or 7 (116 mm) holes All holes accept 4.5 mm cortex, 4.5 mm shaft screws and 6.5 mm cancellous bone screws Locking holes accept 4.0 mm solid, 5.0 mm solid or 5.0 mm cannulated locking screws Distal elongated DCU holes for greater screw angulation and greater bone purchase Proximal notch accepts the articulated tension device (to allow compression or distraction) Available in 316L implant quality stainless steel or commercially pure (CP) titanium. 2 Synthes LCP Anterior Ankle Arthrodesis Plates Technique Guide
Indications The Synthes LCP Anterior Ankle Arthrodesis Plate is indicated for arthrodesis of the ankle joint and distal tibia. Preoperative failed ankle fusion, lateral view Preoperative failed ankle fusion, AP view Postoperative revised ankle fusion, lateral view Postoperative revised ankle fusion, AP view Synthes 3
Surgical Technique 1 Preparation Complete the preoperative radiograph assessment. Position the patient supine on a radiolucent operating table. 2 Incisions Starting at medial malleolus, make a 10 cm 15 cm long anteromedial (pilon type) incision crossing the tibial crest to the lateral side at the musculotendinous junction of the anterior tibia. Make an 8 cm long incision at the posterolateral malleolus. Note: Leave a 7 cm 10 cm bridge between incisions. 7 10 cm Medial incision Lateral incision 4 Synthes LCP Anterior Ankle Arthrodesis Plates Technique Guide
3 Osteotomy, resection and site preparation tibia Osteotomize the medial malleolus tangent to the shaft. Resect the distal articular surface of the tibia, using an oscillating saw. Externally rotate the foot to correspond with the uninvolved leg. Synthes 5
Surgical Technique continued 3 Osteotomy, resection and site preparation tibia continued Instruments 397.74 Bone Impactor 399.54 Chisel 399.56 16 mm Chisel Blade Use a chisel and a 16 mm chisel blade to crack the anterior cortex of the distal tibia. Impact the anterior cortex of the tibia using a rectangular bone impactor to inlay the plate slightly. By not removing the anterior cortex, the plate fixation is bicortical. 6 Synthes LCP Anterior Ankle Arthrodesis Plates Technique Guide
Mark the talus along the medial side at the proposed osteotomy location, using the bovie to make the mark in the cartilaginous surface as shown. Approximately 7 8 dorsiflexion With the involved ankle at 5 dorsiflexion in the sagittal plane and neutral (0 3 valgus) in the frontal plane, make an osteotomy cut to remove as thin a portion as possible from the top of the talus and resect the bone. 0 3 valgus AP view 5 dorsiflexion Lateral view Synthes 7
Surgical Technique continued 4 Osteotomy and resection fibula Osteotomize the fibula and resect: Make an oblique osteotomy approximately 4 5 cm from the tip of the fibula. Interrupt the syndesmosis with a curved osteotome. Make a small split segment in the sagittal plane using a chisel or an oscillating saw. 8 Synthes LCP Anterior Ankle Arthrodesis Plates Technique Guide
Make another oblique fibular cut, creating a 1 cm (approximate) bone segment. Resect the loose portion of the distal fibula. Synthes 9
Surgical Technique continued 5 Temporary fixation With the involved foot in 0 3 valgus and 10 15 outward rotation, temporarily fix the ankle with 2.5 mm Kirschner wires. Prepare the syndesmotic notch with a high-speed burr. To check for final varus/valgus alignment and flexion/ extension alignment before final fixation, place the involved foot on a flat surface such as Synthes graphic case lid. 10 Synthes LCP Anterior Ankle Arthrodesis Plates Technique Guide
6 Insert distal screw Instruments 310.31 3.2 mm Drill Bit 314.27 Large Hexagonal Screwdriver 319.10 Depth Gauge 323.46 4.5 mm Universal Drill Guide Use the 4.5 mm universal drill guide and a 3.2 mm drill bit to predrill the talus for a 6.5 mm cancellous bone screw in the most distal hole (bent section) of the plate. Measure for the appropriate screw length using the depth gauge. Insert the appropriate length 6.5 mm cancellous bone screw using the large hexagonal screwdriver. 7 Axial compression Instrument 321.12 Articulated Tension Device* Use the articulated tension device to place the arthrodesis under maximum compression. * Found in LCP Large Fragment Set Synthes 11
Surgical Technique continued 8 Insert the 3.5 mm cortex screws Instruments 310.25 2.5 mm Drill Bit 323.36 3.5 mm Universal Drill Guide Use the 3.5 mm universal drill guide and 2.5 mm drill bit to predrill for the 3.5 mm cortex screws. Measure for screw length using a depth gauge. Insert one appropriate length 3.5 mm cortex screw through the fibula and talus. Insert another appropriate length 3.5 mm cortex screw through the fibula and distal tibia. Remove all preliminary Kirschner wires. 12 Synthes LCP Anterior Ankle Arthrodesis Plates Technique Guide
9 Insert distal angulated screws Instruments 310.31 3.2 mm Drill Bit 314.27 Large Hexagonal Screwdriver 319.10 Depth Gauge 321.12 Articulated Tension Device* 323.46 4.5 mm Universal Drill Guide While placing the arthrodesis under maximum axial compression using the articulated tension device, use the 4.5 mm universal drill guide and a 3.2 mm drill bit to predrill the tibia for a 4.5 mm shaft screw in the most distal elongated DCU hole of the plate. To gain correct anatomic alignment of the arthrodesis, this screw should be angled distally approximately 30 to the tibia shaft. Measure for screw length using the depth Gauge. Using the large hexagonal screwdriver, select and insert the appropriate length 4.5 mm shaft screw so that the screw tip reaches as far as possible into the talus. Repeat this step for the proximal elongated DCU hole. This 4.5 mm shaft screw should be angled distally approximately 40 to the tibia shaft and pass through the distal tibia. The screw tip should reach as far as possible into the talus. * Found in LCP Large Fragment Set Synthes 13
Surgical Technique continued 10 Insert the proximal 4.5 mm cortex screws Instruments 310.31 3.2 mm Drill Bit 319.10 Depth Gauge 323.46 4.5 mm Universal Drill Guide Insert as many 4.5 mm cortex screws as necessary into the proximal portion of the plate Important: All of the 4.5 mm cortex screws must be inserted prior to insertion of locking screws. Use the 4.5 mm universal drill guide and a 3.2 mm drill bit to predrill the tibia shaft for a 4.5 mm cortex screw in the most distal Combi hole of the plate. Measure for screw length using the depth gauge. Select and insert the appropriate length 4.5 mm cortex screw using the large hexagonal screwdriver. Note: This screw, as well as the remaining screws inserted into the Combi holes, should be perpendicular to the plate and the tibia shaft. Repeat this step for the remaining 4.5 mm cortex screws. 11 Insert the proximal locking screws If necessary, insert two or three locking screws into the proximal portion of the plate using established techniques for inserting locking screws. Refer to the Large Fragment LCP Technique Guide for additional information. 14 Synthes LCP Anterior Ankle Arthrodesis Plates Technique Guide
LCP Anterior Ankle Arthrodesis Plates Implants 02.100.032S 02.100.033S 04.100.032S 04.100.033S LCP Anterior Ankle Arthrodesis Plate 6 holes, 100 mm, sterile LCP Anterior Ankle Arthrodesis Plate, 7 holes, 116 mm, sterile LCP Titanium Anterior Ankle Arthrodesis Plate 6 holes, 100 mm, sterile LCP Titanium Anterior Ankle Arthrodesis Plate 7 holes, 116 mm, sterile Required Instruments 399.54 Chisel Handle 399.555 Chisel Blade, 10 mm width, long 399.565 Chisel Blade, 16 mm width, long 399.575 Chisel Blade, 25 mm width, long 399.585 Chisel Blade, 5 mm width, long Required Sets 115.400 Large Fragment LCP Instrument and Implant Set 105.434 Small Fragment LCP Instrument and Implant Set with self-tapping screws 02.100.032S 02.100.033S Synthes 15
Synthes (USA) 1302 Wrights Lane East West Chester, PA 19380 Telephone: (610) 719-5000 To order: (800) 523-0322 Fax: (610) 251-9056 Synthes (Canada) Ltd. 2566 Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) 567-0440 To order: (800) 668-1119 Fax: (905) 567-3185 www.synthes.com 2006 Synthes, Inc. or its affiliates. All rights reserved. Combi, LCP and Synthes are trademarks of Synthes, Inc. or its affiliates Printed in U.S.A. 3/09 J5288-C