DCP and LC-DCP Systems. Dynamic Compression Plates (DCP) and Dynamic Compression Plates with Limited Bone Contact (LC-DCP). Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.
Image intensifier control This description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling these instruments is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance
Table of Contents Introduction DCP and LC-DCP Systems 2 AO Principles 4 Intended Use 5 Indications 6 Surgical Technique Preparation 7 Drill Guides for DCP and LC-DCP 9 Compression Plate: Simple Fracture 12 Compression Plate: Multifragmentary Fracture 15 Buttress Plate 18 Neutralization Plate (Protecting Plate) 20 Product Information Screws, Drills and Taps 21 Mini Fragment System 1.5, 2.0, 2.7 23 Compact Hand 1.0, 1.3, 1.5, 2.0, 2.4 33 Compact Hand Module 1.0/1.3 33 Compact Hand Module 1.5 35 Compact Hand Module 2.0 38 Compact Hand Module 2.4 41 Surgical Technique DCP and LC-DCP Systems DePuy Synthes 1
DCP and LC-DCP Systems. Dynamic Compression Plates (DCP) and Dynamic Compression Plates with Limited Bone Contact (LC-DCP). Dynamic Compression Plates are available in dimensions ranging from 1.3 to 4.5 mm, Limited Contact Dynamic Compression Plates range from 2.0 to 4.5 mm. Plate hole geometries Non-symmetrical holes Some Dynamic Compression Plates feature non-symmetrical holes which allow to achieve compression in only one direction. These plates feature a mid section which is placed at the position of fragments to be compressed. The non-symmetrical DCP holes are shaped like a portion of an inclined and angled cylinder. They possess one compression point at the inclined side and one neutral point in the middle. mid section Symmetrical holes Most 1.3 to 3.5 mm Dynamic Compression Plates have symmetrical holes similar to the LC-DCP hole. The symmetrical shape of the plate holes enables compression to be achieved in both directions, thus plate positioning is not restricted by the presence of a mid-section. Symmetrically shaped DCP holes possess one compression and one neutral point on both sides. With some small and mini plates, the neutral points meet in the middle. 2 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Screw angulations Non-symmetrical holes The DCP allows up to 25 longitudinal and 7 transverse screw angulation. Symmetrical holes The DCP hole allows up to 50 longitudinal screw angulation for an increased range of applications. LC-DCP holes allow even wider angulations up to 80. Both plate types allow for 14 transverse screw angulation. Symmetrical LC-DCP hole Undercuts Undercuts of the LC-DCP limit contact between plate and bone, minimizing the risk of tissue necrosis under the plate. Uniform stiffness (LC-DCP only) The uniform stiffness of the LC-DCP allows smooth contouring of the plate to the bone. It protects the plate from localized high bending stresses. LC-DCP Standard Surgical Technique DCP and LC-DCP Systems DePuy Synthes 3
AO Principles AO PRINCIPLES In 1958, the AO formulated four basic principles, which have In become 1958, the guidelines AO formulated internal four basic fixation principles, 1,2. which have become the guidelines for internal fixation 1, 2. 4_Priciples_03.pdf 1 05.07.12 12:08 Anatomic reduction Fracture reduction and fixation to restore restore anatomical relationships. 1 2 Stable fixation Fracture fixation providing absolute absolute or relative stability, stability, as required as by the or relative patient, required the by injury, the patient, and the the personality injury, of and the the fracture. personality of the fracture. Early, active mobilization Early and safe mobilization and rehabilitation of the injured part and and the patient the patient as a whole. as a whole. 4 3 Preservation of blood supply Preservation of of the blood supply to soft tissues and bone by by gentle reduction gentle reduction techniques techniques and careful and handling. careful handling. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991. 2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007. 1 Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3 rd ed. Berlin, Heidelberg, New York: Springer. 1991. 2 Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2 nd ed. Stuttgart, New York: Thieme. 2007. 4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique 4 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Intended Use Intended Use DCP and LC-DCP System Implants are intended for temporary fixation, correction or stabi lization of bones in various anatomical regions. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 5
Indications This technique guide applies to the below Synthes DCP and LC-DCP systems and plate lines: Mini Fragment System 1.5, 2.0, 2.7 Fractures of the middle and distal phalanges and tarsals Fractures of the metacarpals and metatarsals Osteotomies and arthrodeses on the hand and foot Fractures of the distal radius (double-plate technique) Compact Hand 1.0, 1.3, 1.5, 2.0, 2.4 Implant sizes 1.0/1.3: Fixation of small fragments Fractures of the distal and intermediate phalanges Avulsion fractures Implant sizes 1.5: Fractures of the phalanges and metacarpals Capturing of fragments with lag screw technique Implant sizes 2.0/2.4: Fractures of the phalanges and metacarpals Capturing of fragments with lag screw technique Cloverleaf Plates 3.5 Distal tibia for comminuted fractures to buttress its medial side Proximal humerus for comminuted fractures of the humeral head One-third tubular plate 3.5 Fractures of smaller sized bones such as fibula, humerus and ulna. Low Profile 3.5 Pelvic System Pelvic and Acetabular Fractures and Osteotomies LC-DCP/DCP 3.5 Straight Plate, DCP 3.5 T-Plate Fracture fixation and fixation after for example osteotomies, malunions, nonunions including but not limited to distal radius, proximal and disital tibia, proximal humerus, clavicula. LC-DCP/DCP 4.5 Straight Plate, DCP 4.5 T-Plate/ T-Buttress Plate/L-Plate Fractures and osteotomies of large bones such as femur, tibia and humerus Standard Reconstruction Plate 3.5/4.5 Pelvic and Acetabular Fractures and Osteotomies Semi-Tubular Plate 4.5 Fractures and osteotomies of smaller sized bones such as humerus, radius, ulna, clavicula, fibula, tibia and pelvis Condylar Buttress Plate 4.5 Buttressing of multifragmentary distal femur fractures Supracondylar fractures Intra-articular and extra-articular condylar fractures Malunions and nonunions of the distal femur Periprosthetic fractures Lateral Tibial Head Buttress Plate 4.5 Indicated for the stabilization of fractures of the proximal tibia. These include proximal shaft fractures, metaphyseal fractures, intra-articular fractures, periprosthetic fractures Proximal Tibial Plate 4.5 Intended for nonunions, malunions and fractures of the proximal tibia including simple, comminuted, lateral wedge, depression, medial wedge, bicondylar and combinations of lateral wedge and depression fractures. 6 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Preparation 1 Plate contouring For the treatment of juxta-articular fractures (distal tibia, tibial plateau, distal femur, distal humerus, radius etc.), good plate contouring to the shape of the bone is very important. Only then satisfactory reduction and adequate stability may be achieved. Pure titanium has mechanical properties differing from stainless steel. Due to its lower modulus of elasticity, titanium is more springy. Therefore, titanium plates should be slightly over-bent to obtain the desired contour. The design of the LC-DC plate ensures uniform rigidity, hence a continuous curvature after bending. The plates should not be bent beyond the necessary extent. Use bending pliers or bending irons for plate contouring. Precaution: Avoid repeated bending. Sharp indentations on the plate surface, especially around the plate holes, may impair resistance to fatigue and should be avoided. Reverse bending or use of the incorrect instrumentation for bending may weaken the plate and lead to premature plate failure (e.g. breakage). Do not bend the plate beyond what is required to match the anatomy. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 7
Preparation 2 Use of lag screws to achieve additional stability In certain circumstances, the use of a plate for fracture compression may be sufficient. In many fractures, however, it is advantageous to insert a lag screw through the plate to increase fracture stability and to achieve interfragmentary compression in the far cortex. If a fracture gap remains, the plate is subjected to high bending stresses. Using a lag screw through the plate reduces implant stress.1 1 Klaue K et al. (1982) Die Entlastung der Osteosyntheseplatte durch interfragmentäre Plattenzugschraube. Helv. Chir. Acta 52, 19 23 Reduction in implant stress by using a lag screw through the plate 1. 8 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Drill Guides for DCP and LC-DCP Different drill guide types are available to perform drilling for DCP and LC-DCP fixation in both neutral and compression mode. 1 Standard drill guides (DCP, sizes 1.3 4.5) Standard drill guides feature a simple tube to protect soft tissues while drilling. Depending on the positioning of the tube within the hole, neutral or eccentric (compression) drilling can be performed. Example a Drilling in neutral position Position the tube in the middle of the DCP hole. b Drilling in eccentric position compression Position the tube in plate hole remote from the fracture. a b Neutral and eccentric drilling Surgical Technique DCP and LC-DCP Systems DePuy Synthes 9
Drill Guides for DCP and LC-DCP 2 Universal drill guides (DCP and LC-DCP, sizes 1.5 4.5) Universal drill guides feature one end with a spring-loaded mechanism which facilitates all types of applications: Neutral position, compression position, buttress position (LC-DCP only) and especially the positioning of inclined lag screws through the plate. a c b a Neutral position Depress the drill guide. The upper part of the inner sleeve projects. Position the drill guide in the plate hole which is remote from the fracture (LC-DCP). When used with DC plates the drill guide automatically slides into the correct middle position when depressed. b Compression position Do not depress the drill guide. The upper part is flush. Position the drill guide in the plate hole remote from the fracture. d neutral position inclined position compression position c Inclined position This technique is used for inserting lag screws through the plate. Place the drill guide in the hole adjacent to the fracture, depress (upper part projects), and set the desired drill angle. d Buttress position (LC-DCP only) Depress the drill guide as shown for neutral position (upper part projects). Position the drill guide in the plate hole adjacent to the fracture. buttress position 11 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
3 LC-DCP drill guides (3.5 and 4.5 LC-DC plates) The LC-DCP drill guides can be used with LC-DC plates only. They feature dedicated ends for neutral application (green) and for application in compression mode (yellow). green yellow LC-DCP drill guides carry an arrow enabling correct positioning of the screw. a Neutral position Use the green drill guide to place a screw in neutral position. The arrow on the green drill guide must point towards the fracture. Compression cannot be achieved with the green drill guide. b Compression Use the yellow drill guide to achieve compression. The arrow on the yellow drill guide must point towards the fracture. = symbol for a fracture line a b c Buttress position Use the green drill guide. A buttress effect is achieved when the arrow points away from the fracture. green yellow Pre-drilling in inclined position with LC-DCP drill guides is not recommended because correct positioning of the screw cannot be ensured. LC-DCP drill guides are designed to only fit the hole in a more or less vertical position. For pre-drilling in inclined position use the universal drill guide instead (refer to 2c). c neutral position compression position green Implant Removal In case the physician decides to remove the implants, they can be removed by using general surgical instruments. buttress position arrow points away from the fracture Surgical Technique DCP and LC-DCP Systems DePuy Synthes 11
Compression Plate: Simple Fracture Note: Required drill bits for threaded and gliding holes and taps for the individual screw sizes can be found in the chapter Screws, Drills and Taps (refer to page 20). Choose a plate of the appropriate length. Ensure that there are enough plate holes over both fragments and that a lag screw can be inserted if necessary. Illustrations show the procedure with the neutral and compression drill guide of the LC-DCP drill guide using a 3.5 and 4.5 LC-DC plate. 1 Drill first hole adjacent to fracture Use an appropriately sized drill bit for threaded holes and drill the first hole adjacent to the fracture. Use the green drill guide in neutral position with the arrow pointing towards the fracture. Alternatively, use the universal drill guide in depressed mode (upper part projects) and place it in the hole remote from the fracture. Determine screw length, tap the thread, and insert the screw. Whenever possible, the screws for axial compression should be placed in such a way that the apex of the fragment is drawn into the open wedge between plate and bone. This greatly reduces the risk of the fragment slipping. Alternative: When using a shaft screw with an unthreaded portion below the head, overdrill the near cortex using a tissue protecting sleeve or standard drill guide and an appropriately sized drill bit for gliding holes. 11 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
2 Drill second hole Drill through both cortices into the opposite fragment with the yellow drill guide in compression position (arrow points towards the fracture). Alternatively, use the universal drill guide placing it in the hole remote from the fracture. Do not depress it (upper part stands flush). yellow Determine screw length, tap the thread, and insert the screw. Whenever possible, the screws for axial compression should be placed in such a way that the apex of the fragment is drawn into the open wedge between plate and bone. This greatly reduces the risk of the fragment slipping. Alternative: When using a shaft screw with an unthreaded portion below the head, overdrill the near cortex using a tissue protecting sleeve or standard drill guide and an appropriately sized drill bit for gliding holes. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 11
Compression Plate: Simple Fracture 3 Insert interfragmentary lag screw To increase stability in the far cortex and to decrease plate wear, insert an interfragmentary lag screw. Drill through both cortices with an universal drill guide in depressed mode (inner sleeve projects) and an appropriately sized drill bit for threaded holes. The hemispheric underside of the universal drill guide permits ideal positioning of the screw head. Widen the hole in the near cortex with a drill bit for gliding holes. Push the tissue protecting sleeve upwards, insert the drill bit into the hole, then slide the tissue protecting sleeve down until it touches the plate. When drilling, care should be taken that the course of the gliding hole follows exactly that of the previous drill hole. As an alternative to a regular cortex screw a shaft screw, used as a lag screw, may be inserted. This ensures efficient gliding of the screw shaft in the gliding hole resulting in a considerably higher tension effect. Like this in the far cortex tension is achieved, too. In the remaining screw holes insert screws in neutral position apart from the hole directly above the fracture. Implant Removal In case the physician decides to remove the implants, they can be removed by using general surgical instruments. 11 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Compression Plate: Multifragmentary Fracture Note: Required drill bits for threaded and gliding holes and taps for the individual screw sizes can be found in the chapter Screws, Drills and Taps (refer to page 20). Fractures should be treated consecutively. 1 Treat first fracture For treatment of the first fracture, follow the previously described example step by step. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 11
Compression Plate: Multifragmentary Fracture 2 Treat second fracture Treat the second fracture using the universal drill guide. Drill a hole into the third fragment using the universal drill guide in compression position and a drill bit for threaded holes. Seat the drill guide at the side of the hole remote from the fracture without depressing the drill guide (upper part is flush). Drill a gliding hole, measure screw length and tap the thread. Insert a screw into the hole. The use of a shaft screw is recommended. Next insert a screw into the middle fragment. Prepare the screw hole with a drill bit for threaded holes and the universal drill guide depressed for neutral position (upper part of inner sleeve projecting). 11 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Place the screw. Prepare seating for the lag screw with the universal drill guide and a drill bit for threaded screws. Position the universal drill guide adjacent to the fracture, depress the drill guide (inner sleeve projects), set drilling angle and drill. If there is the risk of the drill bit colliding with the screw in the vicinity, the drill bit has to be inclined. Drill the gliding hole. Widen the near cortex using an appropriately sized drill bit for gliding holes and the tissue protecting sleeve. Measure the screw length and tap the thread. By inserting a shaft screw as lag screw, additional stability is achieved. Tighten lag and compression screws alternately. The remaining screw holes are filled with neutrally placed screws. Implant Removal In case the physician decides to remove the implants, they can be removed by using general surgical instruments. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 11
Buttress Plate Note: Required drill bits for threaded and gliding holes and taps for the individual screw sizes can be found in the chapter Screws, Drills and Taps (refer to page 20). The buttress plate technique is shown using the example of a shear fracture of the lateral part of the tibial head combined with a short oblique fracture. First the distal oblique fracture is treated as in the previously illustrated examples. green 11 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
All the screw holes in the buttress region are prepared with the universal drill guide or the green drill guide (neutral position) of the LC-DCP drill guide. The arrow of the drill guide must point away from the fracture. The proximally positioned cancellous bone screws and cortex screws act as lag screws. The thread grips only in the opposite fragment, so that there is compression between the fragments. The use of the green drill guide with the arrow pointing away from the fracture prevents the tibial plateau fragment and the plate from slipping. In this situation, the screw heads are buttressed by the hole edge adjacent to the fracture. Implant Removal In case the physician decides to remove the implants, they can be removed by using general surgical instruments. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 11
Neutralization Plate (Protecting Plate) Adapt spiral fracture with two separate lag screws. Position the plate to bridge the fracture using the LC-DCP drill guide (3.5 and 4.5 screws only) or the universal drill guide. When using the green drill guide of the LC-DCP drill guide the arrow must point towards the fracture. When using the universal drill guide seat it at the hole edge remote from the fracture, depress the outer sleeve so that the upper part projects for neutral position. green To complete fracture treatment, determine screw lengths and insert screws after having tapped the threads. Implant Removal In case the physician decides to remove the implants, they can be removed by using general surgical instruments. 22 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Screws, Drills and Taps Cortex Screws for Minifragments Screws drills taps Screw recess Cruciform Cruciform Cruci- Hex form Cruci- Star- Hex form drive Cruci- Stardrive form Hex Stardrive 1.0 mm 1.3 mm 1.5/2.0 mm 1.5 mm 1.5/ 2.0 mm T6 1.5 mm 2.4 mm T8 2.5 mm T8 Screw type 1.0 mm 1.3 mm 1.5 mm 2.0 mm 2.4 mm 2.7 mm self-tapping not self-tapping Gliding hole Threaded hole Drill Bit for gliding hole 1.0 mm 1.3 mm 1.5 mm 2.0 mm 2.4 mm 2.7 mm Drill Bit for threaded hole 0.8 mm 1.0 mm 1.1 mm 1.5 mm 1.8 mm 2.0 mm Tap 1.3 mm 1.5 mm 2.0 mm 2.4 mm 2.7 mm The screws are available in steel and titanium. Sterilizable paper max. 134 C Surgical Technique DCP and LC-DCP Systems DePuy Synthes 22
Screws, Drills and Taps Cortex Screws, Cancellous Bone Screws and Shaft Screws for Small and Large Fragments Screws drills taps Screw recess Hex Hex Hex Hex Hex 2.5 mm 2.5 mm 2.5 mm 3.5 mm 3.5 mm Screw type 2.7 mm 3.5 mm 4.0 mm 4.5 mm 6.5 mm Cortical bone self-tapping non-self-tapping Shaft screw Cancellous bone screws Full thread Long thread Short thread Gliding hole Threaded hole Drill Bit for gliding hole 2.7 mm 3.5 mm 4.5 mm 4.5 mm Drill Bit for threaded hole 2.0 mm 2.5 mm 2.5 mm 3.2 mm 3.2 mm Tap 2.7 mm 3.5 mm 4.0 mm 4.5 mm 6.5 mm The screws are available in steel and titanium. Sterilizable paper max. 134 C 22 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Mini Fragment System 1.5, 2.0, 2.7 Cases and Modules Stainless Steel Titanium 305.500 305.505 Graphic Case for Mini Instrument Set, without Contents Instruments 310.110 Drill Bit B 1.1 mm, length 60/35 mm, 2-flute, for Quick Coupling 310.150 Drill Bit B 1.5 mm, length 85/60 mm, 2-flute, for Quick Coupling 310.190 Drill Bit B 2.0 mm, length 100/75 mm, 2-flute, for Quick Coupling 310.260 Drill Bit B 2.7 mm, length 100/75 mm, 2-flute, for Quick Coupling 310.870 Countersink 2.7, length 62 mm 310.880 Countersink 1.5 to 2.4, length 52 mm, for Mini Quick Coupling 310.950 Handle with Mini Quick Coupling 311.010 Handle with Mini Quick Coupling, Stainless Steel 311.150 Tap for Cortex Screws B 1.5 mm, length 50/20 mm 311.190 Tap for Cortex Screws B 2.0 mm, length 53/24 mm 311.260 Tap for Cortex Screws B 2.7 mm, length 100/33 mm 311.430 Handle with Quick Coupling, length 110 mm 312.140 Double Drill Guide 1.5/1.1, for No. 311.150 312.200 Triple Drill Guide 2.0, with 3 holes 312.220 Double Drill Guide 2.0/1.5 312.240 Double Drill Guide 2.7/2.0 314.020 Screwdriver, hexagonal, small, with Holding Sleeve 314.030 Screwdriver Shaft, hexagonal, small, B 2.5 mm Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 22
Mini Fragment System 1.5, 2.0, 2.7 314.060 Holding Sleeve, for Nos. 314.020, 314.030, 314.070, 314.550 and 314.570 314.670 Screwdriver Shaft 1.5/2.0, cruciform, with Holding Sleeve, length 66 mm, blue 319.040 Depth Gauge for Screws, measuring range up to 50 mm 319.110 Depth Gauge for Screws B 1.5 and 2.0 mm, measuring range up to 26 mm 319.390 Sharp Hook, length 155 mm 319.970 Screw Forceps, self-holding, length 85 mm 329.010 Bending Iron for Plates 1.5 and 2.0, length 130 mm 329.120 Bending Pliers for Plates 1.5 to 2.7, length 140 mm 391.820 Wire Bending Pliers, length 155 mm, for Wires up to B 1.25 mm 391.950 Cutting Pliers for Plates 1.5 to 2.7, length 256 mm 391.970 Wire Cutter, short, length 175 mm 392.020 Bending Iron for Kirschner Wires, for Wires B 0.8 to 1.25 mm 398.400 Reduction Forceps with Points, narrow, ratchet lock, length 132 mm 398.410 Reduction Forceps, with Points, wide, ratchet lock, length 132 mm 398.960 Stagbeetle Forceps, ratchet lock, length 125 mm 398.990 Holding Forceps for Small Plates, ratchet lock, length 135 mm 399.000 Holding Forceps for Finger Plates, ratchet lock, length 135 mm 399.180 Bone Lever, small, short narrow tip, width 6 mm, length 160 mm 399.190 Bone Lever, small, short narrow tip, width 8 mm, length 160 mm 399.450 Bone Lever, width 15 mm, length 120 mm, end of handle ring-shaped Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 22 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
399.480 Periosteal Elevator, slightly curved blade, straight edge, width 3 mm, length 187/87 mm 399.970 Reduction Forceps with Points, ratchet lock, length 130 mm Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 22
Mini Fragment System 1.5, 2.0, 2.7 Plates Stainless Steel Titanium 246.190 446.190 Mini Plate 1.5, straight, 20 holes, length 100 mm 246.230 446.230 Mini T-Plate 1.5, head 3 holes, shaft 9 holes, length 50 mm 446.233 Mini T-Plate 1.5, shaft 8 holes, head 3 holes, length 44 mm, Pure Titanium 446.234 Mini T-Plate 1.5, shaft 8 holes, head 4 holes, length 44 mm, Pure Titanium 246.240 446.240 Mini T-Plate 1.5, head 4 holes, shaft 9 holes, length 50 mm 246.480 446.480 Mini H-Plate 1.5, 4 holes 246.610 Mini Condylar Plate 1.5, pin left, Stainless Steel 246.620 Mini Condylar Plate 1.5, pin right, Stainless Steel 446.630 Mini Condylar Plate 1.5, shaft 6 holes, length 36 mm, pin left, Pure Titanium 446.640 Mini Condylar Plate 1.5, shaft 6 holes, length 36 mm, pin right, Pure Titanium 243.090 Mini Adaption Plate 2.0, 20 holes, length 100 mm 243.130 Mini Plate 2.0, straight, 3 holes, length 17 mm 243.140 Mini Plate 2.0, straight, 4 holes, length 23 mm Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 22 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Stainless Steel Titanium 243.150 Mini Plate 2.0, straight, 5 holes, length 29 mm 243.160 Mini Plate 2.0, straight, 6 holes, length 35 mm 243.190 443.190 Mini Plate 2.0, straight, 20 holes, length 100 mm 243.230 443.230 Mini T-Plate 2.0, head 3 holes, shaft 9 holes, length 50 mm 243.240 443.240 Mini T-Plate 2.0, head 4 holes, shaft 9 holes, length 50 mm 243.310 Mini L-Plate 2.0, left, head 2 holes, shaft 2 holes 243.320 Mini L-Plate 2.0, right, head 2 holes, shaft 2 holes 243.330 Mini L-Plate 2.0, oblique, left, head 2 holes, shaft 2 holes 243.340 Mini L-Plate 2.0, oblique, right, head 2 holes, shaft 2 holes 243.410 Mini T-Plate 2.0, head 2 holes, shaft 2 holes 243.540 443.540 DCP 2.0, 4 holes, length 22 mm 243.550 443.550 DCP 2.0, 5 holes, length 27 mm 243.560 443.560 DCP 2.0, 6 holes, length 32 mm 243.570 443.570 DCP 2.0, 7 holes, length 37 mm 243.580 443.580 DCP 2.0, 8 holes, length 42 mm Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 22
Mini Fragment System 1.5, 2.0, 2.7 Stainless Steel Titanium 243.610 443.610 Mini Condylar Plate 2.0, pin left 243.620 443.620 Mini Condylar Plate 2.0, pin right 242.030 442.030 Quarter Tubular Plate 2.7 with Collar, 3 holes, length 26 mm 242.040 442.040 Quarter Tubular Plate 2.7 with Collar, 4 holes, length 34 mm 242.050 442.050 Quarter Tubular Plate 2.7 with Collar, 5 holes, length 42 mm 242.060 442.060 Quarter Tubular Plate 2.7 with Collar, 6 holes, length 50 mm 242.070 442.070 Quarter Tubular Plate 2.7 with Collar, 7 holes, length 58 mm 242.080 442.080 Quarter Tubular Plate 2.7 with Collar, 8 holes, length 66 mm 242.310 L-Plate 2.7, left, shaft 3 holes, head 2 holes 242.320 L-Plate 2.7, right, shaft 3 holes, head 2 holes 242.330 442.330 L-Plate 2.7, oblique, left, shaft 3 holes, head 2 holes 242.340 442.340 L-Plate 2.7, oblique, right, shaft 3 holes, head 2 holes 242.410 442.410 T-Plate 2.7, shaft 3 holes, head 2 holes 242.610 442.610 Condylar Plate 2.7, 6 holes, pin left 242.620 442.620 Condylar Plate 2.7, 6 holes, pin right 244.020 444.020 DCP 2.7, 2 holes, length 20 mm Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 22 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Stainless Steel Titanium 244.030 DCP 2.7, 3 holes, length 28 mm 244.040 444.040 DCP 2.7, 4 holes, length 36 mm 244.050 444.050 DCP 2.7, 5 holes, length 44 mm 244.060 444.060 DCP 2.7, 6 holes, length 52 mm 244.070 444.070 DCP 2.7, 7 holes, length 60 mm 244.080 444.080 DCP 2.7, 8 holes, length 68 mm 244.090 444.090 DCP 2.7, 9 holes, length 76 mm 244.100 444.100 DCP 2.7, 10 holes, length 84 mm 244.110 DCP 2.7, 11 holes, length 92 mm 244.120 444.120 DCP 2.7, 12 holes, length 100 mm 244.220 444.220 DCP 2.7, 2 holes, length 26 mm 449.936 LC-DCP 2.0, 6 holes, length 36 mm 449.938 LC-DCP 2.0, 8 holes, length 48 mm 449.931 LC-DCP 2.0, 4 holes, length 24 mm Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 22
Mini Fragment System 1.5, 2.0, 2.7 Screws and Washers Cortex Screw B 1.5 mm Stainless Steel Titanium Length (mm) 210.006 400.006 6 210.007 400.007 7 210.008 400.008 8 210.009 400.009 9 210.010 400.010 10 210.011 400.011 11 210.012 400.012 12 210.014 400.014 14 210.016 400.016 16 210.018 400.018 18 210.020 400.020 20 Cortex Screw B 2.0 mm Stainless Steel Titanium Length (mm) 211.006 401.006 6 211.008 401.008 8 211.010 401.010 10 211.012 401.012 12 211.014 401.014 14 211.016 401.016 16 211.018 401.018 18 211.020 401.020 20 211.022 401.022 22 211.024 401.024 24 211.026 26 211.028 28 211.030 30 211.032 32 211.034 34 211.036 36 211.038 38 Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 33 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Cortex Screw B 2.7 mm Stainless Steel Titanium Length (mm) 202.006 402.006 6 202.008 402.008 8 202.010 402.010 10 202.012 402.012 12 202.014 402.014 14 202.016 402.016 16 202.018 402.018 18 202.020 402.020 20 202.022 402.022 22 202.024 402.024 24 Washer B 7.0/3.6 mm Stainless Steel Titanium 219.980 419.980 for Screws B 2.7 to 4.0 mm Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 33
Mini Fragment System 1.5, 2.0, 2.7 Wires Cerclage Wire Stainless Steel B (mm) Length (mm) 291.240 0.6 175 291.260 0.8 200 Kirschner Wire With trocar tip, pack of 10 units Stainless Steel B (mm) Length (mm) 292.060.10 0.6 70 292.080.10 0.8 70 292.100.10 1.0 150 292.120.10 1.25 150 292.160.10 1.6 150 Also available (production on request) 243.000.509 DCP 2.0, 9 holes, Stainless Steel 243.000.510 DCP 2.0, 10 holes, length 52 mm, Stainless Steel 243.000.512 DCP 2.0, 12 holes, length 62 mm, Stainless Steel 243.880 Mini T-Plate 1.5/2.0, shaft 4 holes, length 35 mm, Stainless Steel 243.234 T-Adaption Plate 2.0, head 3 holes, shaft 10 holes, Stainless Steel 310.511 Drill Bit B 1.8 mm, length 100/64 mm, 2-flute, for Jacobs Chuck 310.531 Drill Bit B 2.4 mm, length 100/64 mm, 2-flute, for Jacobs Chuck Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 33 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Compact Hand 1.0, 1.3, 1.5, 2.0, 2.4 Compact Hand Module 1.0/1.3 Module Stainless Steel Titanium 682.483 682.480 Module Compact Hand 1.0/1.3, with Lid, without Contents, green/yellow Instruments 310.882 Countersink 1.3 to 2.0, length 50 mm, for Mini Quick Coupling 312.133 Double Drill Guide 1.3/1.0 314.413 Screwdriver Shaft 1.3, cruciform, with Holding Sleeve, length 62 mm, for Mini Quick Coupling 314.481 Screwdriver Shaft 1.0, cruciform, with Holding Sleeve, length 62 mm, with Mini Quick Coupling 316.385 Drill Bit B 0.8 mm, length 40/16 mm, 2-flute, for Mini Quick Coupling 513.005 Drill Bit B 1.0 mm, length 46/34 mm, 2-flute, for Mini Quick Coupling 513.035 Drill Bit B 1.3 mm, length 46/34 mm, 2-flute, for Mini Quick Coupling Plates Stainless Steel Titanium 221.312 421.312 Adaption Plate 1.3, 12 holes 221.320 421.320 Strut Plate 1.3, obliqueangled, right, 8 holes 221.321 421.321 Strut Plate 1.3, obliqueangled, left, 8 holes 221.333 421.333 T-Adaption Plate 1.3, head 3 holes, shaft 8 holes 221.334 421.334 T-Adaption Plate 1.3, head 4 holes, shaft 8 holes 221.335 421.335 Y-Adaption Plate 1.3, 11 holes Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 33
Compact Hand 1.0, 1.3, 1.5, 2.0, 2.4 Compact Hand Module 1.0/1.3 Screws Cortex Screw B 1.0 mm, self-tapping Stainless Steel Titanium Length (mm) 200.526 400.526 6 200.527 400.527 7 200.528 400.528 8 200.529 400.529 9 200.530 400.530 10 200.531 400.531 11 200.532 400.532 12 200.533 400.533 13 200.534 400.534 14 Cortex Screw B 1.3 mm, self-tapping Stainless Steel Titanium Length (mm) 200.686 400.686 6 200.687 400.687 7 200.688 400.688 8 200.689 400.689 9 200.690 400.690 10 200.691 400.691 11 200.692 400.692 12 200.693 400.693 13 200.694 400.694 14 200.695 400.695 15 200.696 400.696 16 200.698 400.698 18 Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 33 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Compact Hand Module 1.5 Module Stainless Steel Titanium 682.488 682.485 Module Compact Hand 1.5, with Lid, without Contents, red Instruments 310.880 Countersink 1.5 to 2.4, length 52 mm, for Mini Quick Coupling 312.140 Double Drill Guide 1.5/1.1, for No. 311.150 314.667 Screwdriver Shaft 1.5, cruciform, with Holding Sleeve, length 66 mm, with Mini Quick Coupling 513.030 Drill Bit B 1.1 mm, length 45/33 mm, 2-flute, for Mini Quick Coupling 513.080 Drill Bit B 1.5 mm, length 52/40 mm, 2-flute, for Mini Quick Coupling Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 33
Compact Hand 1.0, 1.3, 1.5, 2.0, 2.4 Compact Hand Module 1.5 Plates Stainless Steel Titanium 246.191 446.191 Adaption Plate 1.5, 12 holes 246.231 446.231 T-Adaption Plate 1.5, head 3 holes, shaft 8 holes 246.241 446.241 T-Adaption Plate 1.5, head 4 holes, shaft 8 holes 246.242 446.242 Y-Adaption Plate 1.5, 11 holes, prebent profile 246.482 446.482 Strut Plate 1.5, obliqueangled, right, 8 holes, prebent profile 246.483 446.483 Strut Plate 1.5, obliqueangled, left, 8 holes, prebent profile 446.612 Y-Plate 1.5, shaft 8 holes, head 3 holes, length 46 mm, Pure Titanium Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 33 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Screws Cortex Screw B 1.5 mm, self-tapping Stainless Steel Titanium Length (mm) 200.806 400.806 6 200.807 400.807 7 200.808 400.808 8 200.809 400.809 9 200.810 400.810 10 200.811 400.811 11 200.812 400.812 12 200.813 400.813 13 200.814 400.814 14 200.816 400.816 16 200.818 400.818 18 200.820 400.820 20 200.822 400.822 22 200.824 400.824 24 Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 33
Compact Hand 1.0, 1.3, 1.5, 2.0, 2.4 Compact Hand Module 2.0 Module Stainless Steel Titanium 682.493 682.490 Module Compact Hand 2.0, with Lid, without Contents, blue Instruments 310.880 Countersink 1.5 to 2.4, length 52 mm, for Mini Quick Coupling 312.220 Double Drill Guide 2.0/1.5 314.672 Screwdriver Shaft 2.0, cruciform, with Holding Sleeve, length 66 mm, with Mini Quick Coupling 323.200 Universal Drill Guide 2.0 513.090 Drill Bit B 1.5 mm, length 67/55 mm, 2-flute, for Mini Quick Coupling 513.140 Drill Bit B 2.0 mm, length 67/55 mm, 2-flute, for Mini Quick Coupling Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 33 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Plates Stainless Steel Titanium 223.588 443.588 LC-DCP 2.0, 8 holes, length 51 mm 243.091 443.091 Adaption Plate 2.0, 12 holes 243.231 443.231 T-Adaption Plate 2.0, head 3 holes, shaft 8 holes 243.241 443.241 T-Adaption Plate 2.0, head 4 holes, shaft 8 holes 243.242 443.242 Y-Adaption Plate 2.0, 11 holes 243.480 443.480 Mini H-Plate 2.0, 4 holes 243.584 443.584 LC-DCP 2.0, 4 holes, length 27 mm 243.585 443.585 LC-DCP 2.0, 5 holes, length 33 mm 243.586 443.586 LC-DCP 2.0, 6 holes, length 39 mm 243.587 443.587 LC-DCP 2.0, 7 holes, length 45 mm 447.032 Plate 2.0, straight, 12 holes, length 71 mm, Pure Titanium 447.232 T-Plate 2.0, shaft 8 holes, head 2 holes, length 53 mm, Pure Titanium 447.233 T-Plate 2.0, shaft 8 holes, head 3 holes, length 53 mm, Pure Titanium 447.612 Y-Plate 2.0, 3 + 8 holes, length 55 mm, Pure Titanium Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 33
Compact Hand 1.0, 1.3, 1.5, 2.0, 2.4 Compact Hand Module 2.0 Screws Cortex Screw B 2.0 mm, self-tapping Stainless Steel Titanium Length (mm) 201.806 401.806 6 201.807 401.807 7 201.808 401.808 8 201.809 401.809 9 201.810 401.810 10 201.811 401.811 11 201.812 401.812 12 201.813 401.813 13 201.814 401.814 14 201.816 401.816 16 201.818 401.818 18 201.820 401.820 20 201.822 401.822 22 201.824 401.824 24 201.826 401.826 26 201.828 401.828 28 201.830 401.830 30 201.832 401.832 32 201.834 401.834 34 201.836 401.836 36 201.838 401.838 38 Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 44 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Compact Hand Module 2.4 Module Stainless Steel Titanium 682.513 682.510 Module Compact Hand 2.4, with Lid, without Contents, violet Instruments 310.880 Countersink 1.5 to 2.4, length 52 mm, for Mini Quick Coupling 312.920 Drill Sleeve 1.8, with centering thread 313.940 Screwdriver, cruciform, with Holding Sleeve, for Cortex Screws B 2.4 mm 314.672 Screwdriver Shaft 2.0, cruciform, with Holding Sleeve, length 66 mm, with Mini Quick Coupling 317.861 Drill Bit B 1.8 mm, length 80/66 mm, 2-flute, for Mini Quick Coupling 317.871 Drill Bit B 2.4 mm, length 80/66 mm, 2-flute, for Mini Quick Coupling 323.202 Universal Drill Guide 2.4 Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 44
Compact Hand 1.0, 1.3, 1.5, 2.0, 2.4 Compact Hand Module 2.4 Plates Stainless Steel Titanium 449.906 Plate 2.4, straight, 6 holes, 36 mm, Pure Titanium 249.912 449.912 Adaption Plate 2.4, 12 holes, for Compact Hand 2.4 249.913 449.913 T-Adaption Plate 2.4, head 2 holes, shaft 8 holes, for Compact Hand 2.4 249.914 449.914 T-Adaption Plate 2.4, head 3 holes, shaft 8 holes, for Compact Hand 2.4 249.919 T-Adaption Plate 2.4, head 3 holes, shaft 10 holes 249.915 449.915 Y-Adaption Plate 2.4, 11 holes, for Compact Hand 2.4 249.916 449.916 Condylar Plate 2.4, pin right, for Compact Hand 2.4 249.917 449.917 Condylar Plate 2.4, pin left, for Compact Hand 2.4 249.924 449.924 LC-DCP 2.4, 4 holes, length 35 mm, for Compact Hand 2.4 249.926 449.926 LC-DCP 2.4, 6 holes, length 51 mm, for Compact Hand 2.4 249.928 449.928 LC-DCP 2.4, 8 holes, length 67 mm, for Compact Hand 2.4 Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 44 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
Screws and Buttress Pins Cortex Screw B 2.4 mm, self-tapping, for Compact Hand 2.4 Stainless Steel Titanium Length (mm) 201.636 401.636 6 201.637 401.637 7 201.638 401.638 8 201.639 401.639 9 201.640 401.640 10 201.641 401.641 11 201.642 401.642 12 201.643 401.643 13 201.644 401.644 14 201.646 401.646 16 201.648 401.648 18 201.650 401.650 20 201.652 401.652 22 201.654 401.654 24 201.656 401.656 26 201.658 401.658 28 201.660 401.660 30 201.662 401.662 32 201.664 401.664 34 201.666 401.666 36 201.668 401.668 38 201.670 401.670 40 Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 44
Compact Hand 1.0, 1.3, 1.5, 2.0, 2.4 Compact Hand Module 2.4 Buttress Pin B 1.8 mm Stainless Steel Titanium Length (mm) 201.962 401.962 12 201.964 401.964 14 201.966 401.966 16 201.968 401.968 18 Also available 446.032 Plate 1.5, straight, 12 holes, length 59 mm, Pure Titanium 446.031 Plate 1.5, straight, 6 holes, length 29 mm, Pure Titanium Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. 44 DePuy Synthes DCP and LC-DCP Systems Surgical Technique
MRI Information Torque, Displacement and Image Artifacts according to ASTM F 2213-06, ASTM F 2052-06e1 and ASTM F 2119-07 Non-clinical testing of worst case scenario in a 3 T MRI system did not reveal any relevant torque or displacement of the construct for an experimentally measured local spatial gradient of the magnetic field of 3.69 T/m. The largest image artifact extended approximately 169 mm from the construct when scanned using the Gradient Echo (GE). Testing was conducted on a 3 T MRI system. Radio-Frequency-(RF-)induced heating according to ASTM F 2182-11a Non-clinical electromagnetic and thermal testing of worst case scenario lead to peak temperature rise of 9.5 C with an average temperature rise of 6.6 C (1.5 T) and a peak temperature rise of 5.9 C (3 T) under MRI Conditions using RF Coils (whole body averaged specific absorption rate [SAR] of 2 W/kg for 6 minutes [1.5 T] and for 15 minutes [3 T]). Precautions: The above mentioned test relies on non-clini cal testing. The actual temperature rise in the patient will depend on a variety of factors beyond the SAR and time of RF application. Thus, it is recommended to pay particular attention to the following points: It is recommended to thoroughly monitor patients undergoing MR scanning for perceived temperature and/or pain sensations. Patients with impaired thermoregulation or temperature sensation should be excluded from MR scanning proce dures. Generally, it is recommended to use a MR system with low field strength in the presence of conductive implants. The employed specific absorption rate (SAR) should be reduced as far as possible. Using the ventilation system may further contribute to reduce temperature increase in the body. Surgical Technique DCP and LC-DCP Systems DePuy Synthes 45
Synthes GmbH Eimattstrasse 3 Not all products are currently available in all markets. 4436 Oberdorf Switzerland This publication is not intended for distribution in the USA. Tel: +41 61 965 61 11 Fax: +41 61 965 66 00 All surgical techniques are available as PDF files at www.depuysynthes.com www.depuysynthes.com/ifu 0123 DePuy Synthes Trauma, a division of Synthes GmbH. 2016. All rights reserved. 036.001.093 DSEM/TRM/1115/0556 05/16