LCP Locking Compression Plate. Surgical Technique

LCP Locking Compression Plate Surgical Technique

Image intensifier control This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products 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 LCP Locking Compression Plate 2 LCP Metaphyseal Plates 4 AO Principles 5 Intended Use, Indications and Contraindications 6 Surgical Technique Standard Plate Technique 8 Insert Self-tapping Locking Screws 15 Insert Self-drilling, Self-tapping Locking Screws 24 Indirect Reduction with Locking Screws 26 Drilling with the LCP Universal Drill Guide 29 Insert LCP Spacers 31 Metaphyseal Plates for extra articular fractures 32 Examples of the Combination Technique 36 Remove the Implant 37 Product Information Basic LCP Plates 38 Screws 48 Spacers 51 Cerclage 52 Instruments 54 Discontinued Implants 59 MRI Information 61 Stardrive Hex drive Surgical Technique LCP Locking Compression Plate DePuy Synthes 1

System overview LCP Locking Compression Plate Angular stable implant Angular stable support of fragments LCP and screw constructs work as a unit, avoiding sequential screw failure seen in non-locked plating, providing increased stability 1 Limited plate-periosteum contact Locking screws provide hold also in osteoporotic bone and in multiple fragment fractures 2 Stability of the implant and the construct: Locking screws can be placed in each locking hole of the plate Because the screws are tightly locked in the plate, the risk is reduced for: Tension on the bone Compression between the plate and bone The plate does not have to be precisely shaped to the bone to provide stability 1 Yaffe MA, Saucedo JM, Kalainov DM. Non-locked and locked plating technology for hand fractures. J Hand Surg Am. Dec 2011;36(12):2052-5. 2 Wagner M. General principles for the clinical use of the LCP. Injury. Nov 2003;34 Suppl 2:B31-42. 1 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Reduction maintained under a load LCP combi-hole F A B Stable bridging of comminuted fractures The stable plate-screw connection reduces the risk of secondary loss of reduction in the epiphyseal and metaphyseal regions 2 The screws are locked in the plate, and the physiological load (F) is transferred from the bone to the plate The fragments are fixed in their reduced position without regard to the plate model (internal fixator) The bone fragments are fixed in the position assumed at the time the screws are locked A Stable plate-screw connection Locking screws reduce the risk of screw loosening Excessive torque is not applied to the cortical bone The conical screw head facilitates screw insertion B Compatibility The dynamic compression hole allows the use of standard (Cortex or Cancellous Bone) screws Self-tapping locking screws Use after precisely measuring the length (metaphysis) Monocortical or bicortical use Not necessary to separately tap thread 2 Wagner M. General principles for the clinical use of the LCP. Injury. Nov 2003;34 Suppl 2:B31-42. Standard (Cortex or Cancellous Bone) screws Dynamic compression is created by the eccentric insertion of the standard screws (analogous to LC-DCP) Surgical Technique LCP Locking Compression Plate DePuy Synthes 1

LCP Metaphyseal Plates. For extra-articular fractures. Features LCP combi-holes allow uncompromising combinations The combi-hole allows an internal plate fixation using standardscrews, angular stable locking screws, or a combination of both. This takes into account the most diverse intraoperative requirements. Angular stability allows for improved fixation The angle- and axis-stable locking screws may prevent loss of reduction under load. A precise anatomical contouring of the plate is unnecessary when using this system as a locking internal fixator. Feasability of plate contouring due to thinned plate profile The plate design facilitates anatomical contouring considerably, whilst taking into account the distinctive features of the metaphyseal bone area (e.g. complex bone shapes, thin soft tissue envelope). LCP Metaphyseal Plate 3.5 Extra-articular fixation with the advantage of angled locking screws The two distal holes in the thinned area of the plate, which are angled at 11 towards the centre of the plate, may allow an application of the locking screws in the epiphyseal area. Additional design features Bullet nose plate tip for application of the minimally invasive surgical technique. Temporary fixation can be achieved through the suture hole. Improved vascularization of the periost due to plate undercuts that reduce the plate-to-bone contact. The elongated hole in the shaft are designed to allow fine tuning of the reduction in the longitudinal axis. LCP Metaphyseal Plate 3.5/4.5/5.0 4 DePuy Synthes LCP Locking Compression Plate Surgical Technique

AO Principles AO PRINCIPLES In 1958, the AO formulated four basic principles, which In have 1958, become the AO the formulated guidelines four for basic internal principles, fixation 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. relationships. 1 2 Stable fixation Fracture fixation providing absolute or relative or relative stability, stability, as required as by absolute required the patient, by the the patient, injury, the and injury, the and personality the personality of the fracture. of the fracture. Early, active mobilization Early and safe mobilization and rehabilitation of of the injured part and the patient as as a a whole. 4 3 Preservation of of blood supply Preservation of of the the blood supply to to soft tissues and bone by by gentle gentle reduction reduction techniques techniques and careful and careful handling. 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 Surgical Technique Technique LCP Locking Compression Plate DePuy Synthes 5

Intended Use, Indications and Contraindications Intended Use Locking Compression Plate (LCP) Implants are intended for temporary fixation, correction or stabilization of bones in various anatomical regions. This Surgical Technique applies to the Depuy Synthes LCP Locking Compression Plate Systems and product lines listed below, which include but are not limited to the following indications: Indications The indications for each system will be presented individually. Small Fragment plates (3.5) LCP Plates 3.5 Fixation of small bone fragments using the five standard AO plating principles (buttress plate, neutralization plate, tension band plate, bridge plate, compression plate). LCP Reconstruction Plates 3.5 Fixation of small bone fragments using the five standard AO plating principles (buttress plate, neutralization plate, tension band plate, bridge plate, compression plate). LCP T-Plates 3.5 Fixation of small bone fragments using the five standard AO plating principles (buttress plate, neutralization plate, tension band plate, bridge plate, compression plate). Fracture fixation and fixation after osteotomies, malunions, non-unions; e.g. including but not limited to distal radius, proximal and distal tibia, proximal humerus, clavicular. LCP One-third Tubular Plates 3.5 The LCP One-third Tubular Plates 3.5 are indicated for plating of fractures of long and small bones. The plate should only be used for load-sharing purposes, e.g. buttressing, tension banding, neutralization or compression. 6 DePuy Synthes LCP Locking Compression Plate Surgical Technique

LCP Methaphyseal 3.5 The LCP Metaphyseal Plates are indicated to fix extraarticular fractures in the metaphyseal area that can extend into the shaft area. The 3.5 mm plates are indicated to fix fractures of the distal humerus and distal fibula. Large Fragment plates (4.5/5.0) LCP Methaphyseal 3.5/4.5/5.0 The LCP Metaphyseal Plates are indicated for Extraarti cular fractures of the metaphyseal area that extend into the shaft area. The 4.5/5.0 plates are indicated to fix fractures of the proximal humerus and distal tibial. LCP 4.5/5.0 Narrow Plates LCP T-Plates 4.5/5.0 LCP 4.5/5.0 Broad Plates LCP 4.5/5.0 Broad Curved Plates LCP Reconstruction Plates 4.5/5.0 In general the LCP Generic Plates & Instruments (Large Fragment) are indicated for the osteosynthesis of fractures at the Femur, Tibia, Humerus and Pelvic at proximal, distal and shaft areas. In the case of metaphyseal fractures, comminuted fractures and osteoporotic bone, the clinical results can be improved by the angular stable screw/plate connection. Contraindications No specific contraindications. Surgical Technique LCP Locking Compression Plate DePuy Synthes 7

Standard Plate Technique 1. Reduce the fracture Reduce the fracture under the image intensifier. As needed, provide fixation with Kirschner wire or reducing forceps. Alternative Reduce the fracture indirectly using the plate by means of standard screws (for lag screw technique: to generate interfragmentary compression, use cancellous bone or cortical bone screws, see examples of the Combination Technique on page 36). Precautions: Instruments and screws may have sharp edges or moving joints that may pinch or tear user s glove or skin. Handle devices with care and dispose worn bone cutting instruments in an approved sharps container. 8 DePuy Synthes LCP Locking Compression Plate Surgical Technique

2. Bend the plate Instruments Small fragment 329.040 Bending Iron for Plates 2.4 to 3.5, length 145 mm (for use with 329.050) 329.050 Bending Iron for Plates 2.4 to 3.5, length 145 mm (for use with 329.040) 329.150 Bending Pliers for Plates 2.4 to 4.0, length 230 mm 329.290 Bending Pliers for Reconstruction Plates 2.7 and 3.5 Large fragment 329.300 Bending Press, length 400 mm 329.240 Bending Pliers for Plates 4.5, length 250 mm, complete, with Anvils Nos. 329.250 and 329.260 329.020 Bending Iron for LC-DCP 4.5 and DCP 4.5, length 250 mm (two required) 329.080 Bending Iron for Reconstruction Plates 3.5 and 4.5, length 190 mm Precisely contour the LCP plate to the anatomy using the appropriate bending instruments (as for standard plates), especially in the case of joint fractures. Precautions: 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. Do not bend the plate at the level of the holes. Note: The LCP combi-holes are asymmetrical in the plate. In straight plates, the hole alignment changes in the middle of the plate. This asymmetry enables unidirectional dynamic compression to be exerted. Surgical Technique LCP Locking Compression Plate DePuy Synthes 9

Standard Plate Technique 3. Position plate Position the plate on the bone, and preliminarily fix it. If axial dynamic compression is used, make sure that the middle of the plate is above the fracture line. 11 DePuy Synthes LCP Locking Compression Plate Surgical Technique

4. Select the drill guide position Instruments Small fragment 323.360 Universal Drill Guide 3.5 Large fragment 323.460 Universal Drill Guide 4.5/3.2, for neutral and load position a. Select the neutral position Press the spring-loaded guide against the bone in the DC part of the LCP hole. The inner sleeve retracts. The rounded end of the outer sleeve slides along the hole angle into neutral position. This enables neutral predrilling. b. Select eccentric position (dynamic compression) Place the universal drill guide on the edge of the DC part of the LCP hole without exerting any pressure. The inner sleeve remains in its original state. The dynamic compression is generated by setting and tightening the cortex screw. Note: The LC-DCP Drill Guides are unsuitable for LCP plates. Surgical Technique LCP Locking Compression Plate DePuy Synthes 11

Standard Plate Technique 5. Drill screw hole Instruments Small fragment 310.230 Drill Bit B 2.5 mm, length 180/155 mm, 2-flute, for Quick Coupling Large fragment 310.290 Drill Bit B 3.2 mm, length 195/170 mm, 2-flute, for Quick Coupling Drill with an appropriate drill bit. 6. Determine screw length Instruments Small fragment 319.010 Depth Gauge for Screws B 2.7 to 4.0 mm, measuring range up to 60 mm Large fragment 319.100 Depth Gauge for Screws B 4.5 to 6.5 mm, measuring range up to 110 mm Measure the screw length with the depth gauge. 11 DePuy Synthes LCP Locking Compression Plate Surgical Technique

7. Option: Tap the thread Instruments Small fragment 311.320 Tap for Cortex Screws B 3.5 mm, length 110/50 mm Large fragment 311.460 Tap for Cortex Screws B 4.5 mm, length 125/70 mm If non-self-tapping screws are used, tap a thread manually. Surgical Technique LCP Locking Compression Plate DePuy Synthes 11

Standard Plate Technique 8. Insert standard (Cortex or Cancellous Bone) screw Instruments 311.440 T-Handle with Quick Coupling Small fragment 314.070 Screwdriver, hexagonal, small, 2.5 mm, with Groove Large fragment 314.270 Screwdriver, hexagonal, large, B 3.5 mm, with Groove, length 245 mm Using the screwdriver, manually insert and tighten a standard screw with the measured length. Depending on the selected type of predrilling, no compression (a) or dynamic compression (b) may be generated. Option: Insert a 2.7 mm cortex screw in a small fragment plate Place an LCP Washer 2.7/3.5 (X19.981) in the DC hole part of the 3.5 mm LCP plate. In this case, predrill with a Drill Bit with a 2.0 mm diameter (310.190). Notes: The holes in the straight LCP plates are larger at the two ends to allow the insertion of cancellous bone screws. If a combination of cortex and locking screws is used, a cortex screw should be inserted first to generate interfragmentary compression. (a) no compression (b) dynamic compression 11 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Insert Self-tapping Locking Screws 1. Reduce the fracture and preliminarily fix it Reduce the fracture under the image intensifier, and fix it with Kirschner wires or reducing forceps. 2. Bend the plate Adapt the plate to the anatomy using the appropriate bending instruments. (See section 2 Bend the plate on page 9). Precautions: 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. Do not bend the plate at the level of the holes. 3. Position the plate and preliminarily fix it Position the plate on the bone, and preliminarily fix it (for preliminary fixation using an LCP centering sleeve for Kirschner wires, see step 5). Before setting the first locking screw, make sure that the plate is provisionally fixed well to prevent rotating since it could damage soft tissue when locking the screw. Surgical Technique LCP Locking Compression Plate DePuy Synthes 11

Insert Self-tapping Locking Screws 4. Insert LCP drill sleeve Instruments Small fragment 323.027 LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm Large fragment 323.042 LCP Drill Sleeve 5.0, for Drill Bits B 4.3 mm Carefully screw the LCP drill sleeve into the desired LCP hole until it is gripped completely by the thread. Precaution: The use of the LCP drill sleeve is mandatory in order to ensure that the locking screw is drilled in the proper perpendicular angle and correctly locked in the plate. Notes: To make it easier for the drill sleeve to grip the thread, it may be useful to slightly rotate it to the left (back). In the case of meta-epiphyseal plates, the threaded hole is usually not perpendicular to the plate surface due to the anatomy. 11 DePuy Synthes LCP Locking Compression Plate Surgical Technique

5. Option: Insert Kirschner wire Instruments Small fragment 323.055 Centering Sleeve for Kirschner Wire B 1.6 mm, length 70 mm, for Nos. 323.027 and 323.054 or 324.081 Centering Sleeve for Kirschner Wire B 1.25 mm 292.120.01 Kirschner Wire B 1.25 mm with trocar tip, length 150 mm, Stainless Steel 292.160.01 Kirschner Wire B 1.6 mm with trocar tip, length 150 mm, Stainless Steel Large fragment 323.044 Centering Sleeve for Kirschner Wire B 2.0 mm, length 110 mm, for No. 323.042 292.200.01 Kirschner Wire B 2.0 mm with trocar tip, length 150 mm, Stainless Steel Insert the centering sleeve for Kirschner wires into the LCP drill sleeve. To allow the locking screw alignment to be checked later, use a power tool to insert a Kirschner wire and check its position under the image intensifier (see section metaphyseal plates). This check is especially recommendable in the metaphyseal region. Remove the Kirschner wire and the centering sleeve for Kirschner wires. Note: If the angle of the locking screw is not optimal, it can be corrected. Bend the plate as needed, or move it in a proximal or distal direction. This technique is also suitable to preliminarily fix the plate to the bone. Surgical Technique LCP Locking Compression Plate DePuy Synthes 11

Insert Self-tapping Locking Screws 6. Drill screw hole Instruments Small fragment 310.284 LCP Drill Bit B 2.8 mm with Stop, length 165 mm, 2-flute, for Quick Coupling Large fragment 310.430 LCP Drill Bit B 4.3 mm with Stop, length 221 mm, 2-flute, for Quick Coupling Carefully drill the screw hole using an appropriate drill bit. Shove the stop ring down to the drill sleeve to make reading easier. Remove the drill sleeve. Note: Replacement stop rings can be ordered from the local Depuy Synthes representative. 11 DePuy Synthes LCP Locking Compression Plate Surgical Technique

7. Determine screw length Read the drilled depth directly from the laser mark on the drill bit. Alternative Instruments Small fragment 319.010 Depth Gauge for Screws B 2.7 to 4.0 mm, measuring range up to 60 mm Large fragment 319.100 Depth Gauge for Screws B 4.5 to 6.5 mm, measuring range up to 110 mm Determine the screw length with the depth gauge. Surgical Technique LCP Locking Compression Plate DePuy Synthes 11

Insert Self-tapping Locking Screws 8. Insert locking screw Instruments Small fragment 511.770 Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive or 511.115 Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive 314.116 Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling 314.030 Screwdriver Shaft, hexagonal, small, B 2.5 mm Large fragment 511.771 Torque Limiter, 4.0 Nm, for Compact Air Drive and Power Drive 314.119 Screwdriver Shaft Stardrive 4.5/5.0, T25, self-holding, for AO/ASIF Quick Coupling or 314.163 Torque-limiting Screwdriver Stardrive, T25, self-holding, for Locking Screws B 5.0 mm 314.150 Screwdriver Shaft, hexagonal, large, B 3.5 mm or 314.152 Screwdriver Shaft 3.5, hexagonal, self-holding or 324.052 Torque-limiting Screwdriver 3.5, selfholding, for Locking Screws B 5.0 mm 397.705 Handle for Torque Limiter Nos. 511.770 and 511.771 311.431 Handle with Quick Coupling Before setting the first locking screw, anatomical reconstruction must have occurred and, where necessary, fixed with lag screws. After setting the locking screws, additional reduction can no longer occur without removing the locking screws. The locking screws can either be inserted with a power tool without locking or manually. Warning: If a locking screw is used first, care should be taken to ensure that the plate is held securely to the bone to avoid spinning of the plate about the bone. 22 DePuy Synthes LCP Locking Compression Plate Surgical Technique

a. Insertion with a power tool To insert the locking screw using a power tool, fit a torque limiter to the power tool. Then insert the screwdriver shaft into the torque limiter. Pick up the locking screw and insert it into the plate hole. To insert the screw, start the power tool slowly, increase the speed and then reduce it again before the screw is fully tightened. Uncouple the power tool, and mount the handle with the CAD coupling or the handle with the quick coupling, and manually tighten the screw. After one click, the optimum torque is reached. Warning: Locking screws may be partially inserted using power equipment alone. However, always use a torque limiting attachment (TLA) when using power to insert locking screws. Note: Do not lock the screws at full speed to reduce the risk of stripping the head. This can make it difficult to remove the implant. Precaution: For long screws and thick cortical bone, ensure sufficient cooling during insertion. Surgical Technique LCP Locking Compression Plate DePuy Synthes 22

Insert Self-tapping Locking Screws The following table shows combinations of various drives and torque limiters, and the associated attachments: Drive Torque limiter (TLA) Small fragment 511.770 (1.5 Nm) Small fragment 511.773 (1.5 Nm) Small fragment 511.115 (1.5 Nm) Large fragment 511.771 (4 Nm) Large fragment 511.774 (4 Nm) Power Drive direct without attachment attachment 511.750 attachment 511.750 direct without attachment attachment 511.785 Colibri attachment 532.017 Other power drives AO/ASIF quick coupling AO/ASIF quick coupling AO/ASIF quick coupling for reamer Handle for Torque Limiter (TLA) 397.705 311.431 311.431 397.705 397.706 Stardrive 314.116 314.116 314.116 314.119 314.119 screwdriver shaft Hexagonal 314.030 314.030 314.030 314.150 314.150 screwdriver shaft 22 DePuy Synthes LCP Locking Compression Plate Surgical Technique

b. Manual insertion To insert the locking screw manually, attach the torque limiter handle to the torque limiter and insert a screwdriver shaft. Screw in the locking screw, and lock it in the plate. Only for locking screws large fragment: Alternatively, the Torque-limiting Screwdriver can be used (Hex 324.052, Stardrive 314.163). Surgical Technique LCP Locking Compression Plate DePuy Synthes 22

Insert Self-drilling, Self-tapping Locking Screws 1. Preliminary fixation Provisionally fix the LCP locking plate to the bone. Note: The self-drilling screws are primarily inserted in bone regions where a precise determination of length is not required (diaphysis). They can only be set monocortically. Precaution: Do not insert the drill tip into the opposite cortical bone to prevent damage of the opposite side structure and to avoid removal problems. 22 DePuy Synthes LCP Locking Compression Plate Surgical Technique

2. Insert locking screw Instruments Small fragment 511.770 Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive or 511.115 Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive 314.116 Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling Notes: Especially when the cortical bone is thick and the locking screw is set perpendicular, drilling with the LCP Universal Drill Guide (small fragment: 323.505; large fragment: 323.500) is recommended. The universal drill guide is also used when inserting self-tapping screws in the diaphyseal region. For further information, see page 29. You can alternatively follow steps 4 7 on pages 16 19. Precaution: Always irrigate during drilling to avoid thermal damage to the bone. Cooling is especially recommended for longer screws. 314.030 Screwdriver Shaft, hexagonal, small, B 2.5 mm Large fragment 511.771 Torque Limiter, 4 Nm, for Compact Air Drive and Power Drive or 511.774 Torque Limiter, 4 Nm, for AO/ASIF Quick Coupling for Reamers 314.119 Screwdriver Shaft Stardrive 4.5/5.0, T25, self-holding, for AO/ASIF Quick Coupling 314.150 Screwdriver Shaft, hexagonal, large, B 3.5 mm or 314.152 Screwdriver Shaft 3.5, hexagonal, self-holding 397.705 Handle for Torque Limiter Nos. 511.770 and 511.771 For additional combinations, see the table on page 22. Insert a self-drilling locking screw of the desired length using a power tool with the torque limiting attachment and the screwdriver shaft along the thread axis of the hole and screw it in. Stop the power tool before the screw is locked. Remove the power tool and mount the handle. Lock the screw and tighten it until a click can be heard. Surgical Technique LCP Locking Compression Plate DePuy Synthes 22

Indirect Reduction with Locking Screws 1. Shove the screw holding sleeve over the torque limiting screwdriver Instruments Small fragment 314.091 Holding Sleeve for Screws, for LCP 3.5 314.041 Screwdriver Stardrive 3.5, T15, with Groove, length 200 mm 314.070 Screwdriver, hexagonal, small, 2.5 mm, with Groove Large fragment 314.281 Holding Sleeve for Screws, for LCP 4.5/5.0 314.164 Screwdriver Stardrive 4.5/5.0, T25, with Groove, length 252 mm 314.270 Screwdriver, hexagonal, large, B 3.5 mm, with Groove, length 245 mm or 324.052 Torque-limiting Screwdriver 3.5, selfholding, for Locking Screws B 5.0 mm Mount the screw holding sleeve on the screwdriver. Hold the locking screw by placing the screw holding sleeve over the head of the screw. 22 DePuy Synthes LCP Locking Compression Plate Surgical Technique

2. Insert screw Insert the screw. The screw holding sleeve prevents the screw from locking in the plate. As soon as the screw holding sleeve reaches the plate, the bone is approached by continuing to screw the screw in the plate. 3. Retract the screw holding sleeve After the desired reduction is attained, retract the screw holding sleeve from the head of the locking screw. Surgical Technique LCP Locking Compression Plate DePuy Synthes 22

Indirect Reduction with Locking Screws 4. Lock the screw Instruments Small fragment 511.770 Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive Only for locking screws large fragment: Alternatively, the Torque-limiting Screwdriver can be used (Hex 324.052, Stardrive 314.163). Note: This technique is only suitable for pulling the bone to the plate. To generate interfragmentary compression, use cancellous bone or cortical bone screws (lag screw principle). 314.116 Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling 314.030 Screwdriver Shaft, hexagonal, small, B 2.5 mm Large fragment 511.771 Torque Limiter, 4 Nm, for Compact Air Drive and Power Drive 314.119 Screwdriver Shaft Stardrive 4.5/5.0, T25, self-holding, for AO/ASIF Quick Coupling or 314.163 Torque-limiting Screwdriver Stardrive, T25, self-holding, for Locking Screws B 5.0 mm 314.150 Screwdriver Shaft, hexagonal, large, B 3.5 mm or 314.152 Screwdriver Shaft 3.5, hexagonal, self-holding or 324.052 Torque-limiting Screwdriver 3.5, selfholding, for Locking Screws B 5.0 mm 397.705 Handle for Torque Limiter Nos. 511.770 and 511.771 For additional combinations, see the table on page 22. Remove the screwdriver and holding sleeve. Place the torque limiter handle on the torque limiter, and insert a screwdriver shaft. Screw in the locking screw, and lock it in the plate. 22 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Drilling with the LCP Universal Drill Guide The LCP universal drill guide is only available with a Hex drive. Instruments Small fragments 323.505 LCP Universal Drill Guide 3.5, Stainless Steel 314.030 Screwdriver Shaft, hexagonal, small, B 2.5 mm Large fragments 323.500 LCP Universal Drill Guide 4.5/5.0 314.150 Screwdriver Shaft, hexagonal, large, B 3.5 mm or 314.152 Screwdriver Shaft 3.5, hexagonal, self-holding The LCP universal drill guide can alternatively be used for drilling. The universal drill guide has a drill guide on one side that enables centric and eccentric drilling; a short drill bit is on the other side (small fragments B 2.8 mm; large fragments B 4.3 mm). 1. Insert the LCP universal drill guide Insert the universal drill guide into the threaded part of the LCP hole. Surgical Technique LCP Locking Compression Plate DePuy Synthes 22

Drilling with the LCP Universal Drill Guide 2. Drill through the cortical bone Use a power tool to drill through the proximal cortical bone with the screwdriver shaft in the drill guide. 3. Remove the LCP universal drill guide Remove the drill guide. 4. Set locking screw Set the self-drilling, self-tapping locking screw as described on page 24. 33 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Insert LCP Spacers Instruments Steel Titanium Small fragment 213.009 413.009 Spacer B 3.5 mm Large fragment 213.309 413.309 Spacer B 5.0 mm To reduce the plate-to-bone contact to a minimum, screw an LCP spacer in the plate before positioning the plate. The spacer ensures that a distance of 2 mm will be maintained between the plate and the bone when the screws are later inserted. The spacer can be removed after setting the locking screws. Surgical Technique LCP Locking Compression Plate DePuy Synthes 33

Metaphyseal Plates for extra articular fractures Implant preparation Adapt the LCP Metaphyseal Plate to the anatomy of the bone. Precautions: 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. Do not bend the plate at the level of the holes. 11 Plate fixation Instruments Small fragment 323.027 LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm 324.081 Centering Sleeve for Kirschner Wire B 1.25 mm 292.120.01 Kirschner Wire B 1.25 mm with trocar tip, length 150 mm, Stainless Steel 292.160.01 Kirschner Wire B 1.6 mm with trocar tip, length 150 mm, Stainless Steel Large fragment: 323.042 LCP Drill Sleeve 5.0, for Drill Bits B 4.3 mm 323.044 Centering Sleeve for Kirschner Wire B 2.0 mm, length 110 mm, for No. 323.042 292.200.01 Kirschner Wire B 2.0 mm with trocar tip, length 150 mm, Stainless Steel The two distal holes in the thinned area of the plate, which are angled at 11 towards the centre of the plate, allow for an appropriate anatomical application of the locking screws in the epiphyseal area. Take this into consideration when bending the plate and threading in the threaded LCP Drill Sleeve for 2.8 mm drill bits. 33 DePuy Synthes LCP Locking Compression Plate Surgical Technique

The threaded LCP drill sleeves ensure axially correct drilling. Insert Kirschner wires to determine the direction of the screws or to temporarily fix the plate using the centering sleeve for Kirschner wires. Verify the Kirschner wire position under the image intensifier. The simultaneous use of two threaded LCP drill sleeves in the thinned plate area also assists insertion in the minimally invasive surgical tech nique. Note: For patient positioning and surgical approach refer for example to Rüedi TP, Buckley RE, Moran CG (2007) AO Principles of Fracture Management. 2nd expanded ed. 2002. Stuttgart, New York: Thieme. Warning: Do not position the thinner portion of the plate over the fracture site. Surgical Technique LCP Locking Compression Plate DePuy Synthes 33

Metaphyseal Plates for extra articular fractures Fixation with 3.5 mm locking screws Instruments Small fragment 323.027 LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm 511.115 Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive 511.770 Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive 314.030 Screwdriver Shaft, hexagonal, small, B 2.5 mm 314.116 Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling 311.431 Handle with Quick Coupling Large fragment 323.042 LCP Drill Sleeve 5.0, for Drill Bits B 4.3 mm 1 2 3 511.771 Torque Limiter, 4 Nm, for Compact Air Drive and Power Drive 314.152 Screwdriver Shaft 3.5, hexagonal, self-holding 314.119 Screwdriver Shaft Stardrive 4.5/5.0, T25, self-holding, for AO/ASIF Quick Coupling 397.705 Handle for Torque Limiter Nos. 511.770 and 511.771 324.052 Torque-limiting Screwdriver 3.5, selfholding, for Locking Screws B 5.0 mm 314.163 Torque-limiting Screwdriver Stardrive, T25, self-holding, for Locking Screws B 5.0 mm 1. Axially correct drilling for the self-tapping 3.5 mm locking screws requires the threaded LCP Drill Sleeve for 2.8 mm drill bits. 2. Use the Torque Limiter 1.5 Nm and the Screwdriver Shaft for the motor-driven insertion of the locking screw. 3. Stop the motor before locking, fix the torque limiter and the screw-driver shaft to the Handle with Quick Coupling and tighten the screw. After one click, the optimal torque is reached. 33 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Fixation with 5.0 mm locking screws 4. Axially correct drilling for the self-tapping 5.0 mm locking screws requires the threaded LCP Drill Sleeve for 4.3 mm drill bits. 5. Use the Torque Limiter 4.0 Nm and the Screwdriver Shaft for the motor-driven insertion of the locking screw. 1 2 6. Stop the motor before locking, fix the torque limiter and the screw driver shaft to the Handle and tighten the screw. After one click, the optimal torque is reached. 7. Alternatively, use the Torque-limiting Screwdriver to tighten the screw manually. 3 4 Surgical Technique LCP Locking Compression Plate DePuy Synthes 33

Examples of the Combination Technique Standard screws and angular-stable locking screws can be combined. Example A If a plate is first fixed with standard screws (1), locking screws can be introduced later (2) to fix the fragments at a stable angle. 1 2 1 Example B If a plate is first fixed to a fragment with locking screws (1), do not insert standard screw afterwards in the same fragment (2). In this case, the locking screws must be removed first before inserting the standard screws. 1 2 1 Example C If the metaphyseal fragment is fixed with locking screws (1), the fracture can be dynamically compressed with standard screws (2). To increase the stability of fixation, insert additional locking screws into the diaphyseal fragment (3). 1 2 3 Example D In the case of a diaphyseal fracture, standard screws can be inserted after the locking screws to draw the opposing fragments closer to the plate. 33 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Remove the Implant Implant Removal Unlock all screws from the plate, then remove the screws completely from the bone. This prevents simultaneous rotation of the plate when unlocking the last locking screw. For details regarding implant removal refer to the surgical technique Screw Extraction Set DSEM/TRM/0614/0104. Surgical Technique LCP Locking Compression Plate DePuy Synthes 33

Basic LCP Plates LCP Plates LCP Plates 3.5 Stainless Steel Titanium (TiCP) Holes Length (mm) 223.541 423.541 4 59 223.551 423.551 5 72 223.561 423.561 6 85 223.571 423.571 7 98 223.581 423.581 8 111 223.591 423.591 9 124 223.601 423.601 10 137 223.611 423.611 11 150 223.621 423.621 12 163 223.631 13 176 223.641 14 189 223.651 15 202 223.661 16 215 223.671 18 241 223.681 20 267 223.691 22 293 All implants are also available sterile packed. Add Suffix S to part number. 33 DePuy Synthes LCP Locking Compression Plate Surgical Technique

LCP Plates 4.5/5.0, broad Stainless Steel Titanium (TiCP) Holes Length (mm) 226.561 426.561 6 116 226.571 426.571 7 134 226.581 426.581 8 152 226.591 426.591 9 170 226.601 426.601 10 186 226.611 426.611 11 206 226.621 426.621 12 229 226.631 426.631 13 242 226.641 426.641 14 260 226.651 426.651 15 278 226.661 426.661 16 296 226.671 426.671 17 314 226.681 426.681 18 332 226.701 426.701 20 368 226.721 426.721 22 404 226.741 426.741 24 440 All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 33

Basic LCP Plates LCP Plates LCP Plates 4.5/5.0, broad curved Stainless Steel Titanium (TiCP) Holes Length (mm) 226.622 426.622 12 229 226.632 426.632 13 247 226.642 426.642 14 265 226.652 426.652 15 282 226.662 426.662 16 300 226.672 426.672 17 318 226.682 426.682 18 336 226.692 426.692 19 354 226.702 426.702 20 372 226.712 426.712 21 390 226.722 426.722 22 408 226.732 426.732 23 426 226.742 426.742 24 443 226.752 426.752 25 461 226.762 426.762 26 479 All implants are also available sterile packed. Add Suffix S to part number. 44 DePuy Synthes LCP Locking Compression Plate Surgical Technique

LCP One-third Tubular Plates 3.5 Stainless Steel Titanium (TiCP) Holes Length (mm) 241.321 441.321 2 28 241.331 441.331 3 40 241.341 441.341 4 52 241.351 441.351 5 64 241.361 441.361 6 76 241.371 441.371 7 88 241.381 441.381 8 100 241.391 441.391 9 112 241.401 441.401 10 124 241.421 441.421 12 148 All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 44

Basic LCP Plates LCP Plates LCP Plates 4.5/5.0, narrow Stainless Steel Titanium (TiCP) Holes Length (mm) 224.521 424.521 2 44 224.531 424.531 3 62 224.541 424.541 4 80 224.551 424.551 5 98 224.561 424.561 6 116 224.571 424.571 7 134 224.581 424.581 8 152 224.591 424.591 9 170 224.601 424.601 10 188 224.611 424.611 11 206 224.621 424.621 12 224 224.631 424.631 13 242 224.641 424.641 14 260 224.651 424.651 15 278 224.661 424.661 16 296 224.681 424.681 18 332 224.701 424.701 20 368 224.721 424.721 22 404 224.741 424.741 24 440 All implants are also available sterile packed. Add Suffix S to part number. 44 DePuy Synthes LCP Locking Compression Plate Surgical Technique

LCP Reconstruction Plates 3.5 Stainless Steel Titanium (TiCP) Holes Length (mm) 245.051 445.051 5 70 245.061 445.061 6 84 245.071 445.071 7 99 245.081 445.081 8 113 245.091 445.091 9 128 245.101 445.101 10 142 245.121 445.121 12 171 245.141 445.141 14 200 245.161 445.161 16 228 245.181 445.181 18 257 245.201 445.201 20 286 245.221 445.221 22 315 Round Hole Reconstruction Locking Plates 3.5* Stainless Steel Titanium (TiCP) Holes Length (mm) 245.052 445.052 5 58 245.062 445.062 6 70 245.072 445.072 7 82 245.082 445.082 8 94 245.092 445.092 9 106 245.102 445.102 10 118 245.122 445.122 12 142 245.142 445.142 14 166 245.162 445.162 16 190 245.182 445.182 18 214 245.202 445.202 20 238 245.222 445.222 22 262 * no combi-holes All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 44

Basic LCP Plates LCP Plates LCP Reconstruction Plates 4.5/5.0 Stainless Steel Titanium (TiCP) Holes Length (mm) 229.331 429.331 3 56 229.341 429.341 4 75 229.351 429.351 5 94 229.361 429.361 6 113 229.371 429.371 7 132 229.381 429.381 8 151 229.391 429.391 9 170 229.401 429.401 10 189 229.411 429.411 11 208 229.421 429.421 12 227 229.431 429.431 13 246 229.441 429.441 14 265 229.451 429.451 15 284 229.461 429.461 16 303 All implants are also available sterile packed. Add Suffix S to part number. 44 DePuy Synthes LCP Locking Compression Plate Surgical Technique

LCP Metaphyseal Plates 3.5 Stainless Steel Titanium (TiCP) Holes Length (mm) 223.406 423.406 6 86 223.407 423.407 7 99 223.408 423.408 8 112 223.409 423.409 9 125 223.410 423.410 10 138 223.411 423.411 11 151 223.412 423.412 12 164 223.414 423.414 14 190 223.416 423.416 16 216 223.418 423.418 18 242 LCP Metaphyseal Plates 3.5/4.5/5.0 Stainless Steel Titanium (TiCP) Holes Length (mm) 224.753 424.753 5+3 118 224.754 424.754 5+4 136 224.755 424.755 5+5 154 224.756 424.756 5+6 172 224.757 424.757 5+7 190 224.758 424.758 5+8 208 224.759 424.759 5+9 226 224.761 424.761 5+11 262 224.763 424.763 5+13 298 224.765 424.765 5+15 334 All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 44

Basic LCP Plates LCP Plates LCP T-Plates 3.5, right-angled Stainless Steel Titanium (TiCP) Holes Length (mm) 241.131 441.131 3 50* 241.141 441.141 4 56** 241.151 441.151 5 67* 241.161 441.161 6 78** ** = 3 head holes ** = 4 head holes LCP T-Plates 3.5, oblique-angled Stainless Steel Titanium (TiCP) Holes Length (mm) 241.031 441.031 3 52 right 241.041 441.041 4 63 right 241.051 441.051 5 74 right 241.931 441.931 3 52 left 241.941 441.941 4 63 left 241.951 441.951 5 74 left All implants are also available sterile packed. Add Suffix S to part number. 44 DePuy Synthes LCP Locking Compression Plate Surgical Technique

LCP T-Plates 4.5/5.0 Stainless Steel Titanium (TiCP) Holes Length (mm) 240.131 440.131 3 67 240.141 440.141 4 83 240.151 440.151 5 99 240.161 440.161 6 115 240.171 440.171 7 131 240.181 440.181 8 147 240.201 440.201 10 179 240.221 440.221 12 211 Kirschner Wire with trocar tip Stainless Steel B (mm) length (mm) 292.120.01 1.25 150 292.120S 1.25 150 292.160.01 1.6 150 292.160S 1.6 150 292.200.01 2.0 150 292.200S 2.0 150 All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 44

Screws Locking Screws with Hex drive Self-tapping B 3.5 mm Stainless Steel TAN Length (mm) 213.010 413.010 10 213.012 413.012 12 213.014 413.014 14 213.016 413.016 16 213.018 413.018 18 213.020 413.020 20 213.022 413.022 22 213.024 413.024 24 213.026 413.026 26 213.028 413.028 28 213.030 413.030 30 213.032 413.032 32 213.034 413.034 34 213.035 413.035 35 213.036 413.036 36 213.038 413.038 38 213.040 413.040 40 213.042 413.042 42 213.044 413.044 44 213.045 413.045 45 213.046 413.046 46 213.048 413.048 48 213.050 413.050 50 213.052 413.052 52 213.055 413.055 55 213.058 413.058 58 213.060 413.060 60 213.062 413.062 62 213.065 413.065 65 213.070 413.070 70 213.075 413.075 75 213.080 413.080 80 213.085 413.085 85 213.090 413.090 90 213.095 413.095 95 B 5.0 mm Stainless Steel TAN Length (mm) 213.314 413.314 14 213.316 413.316 16 213.318 413.318 18 213.320 413.320 20 213.322 413.322 22 213.324 413.324 24 213.326 413.326 26 213.328 413.328 28 213.330 413.330 30 213.332 413.332 32 213.334 413.334 34 213.336 413.336 36 213.338 413.338 38 213.340 413.340 40 213.342 413.342 42 213.344 413.344 44 213.346 413.346 46 213.348 413.348 48 213.350 413.350 50 213.355 413.355 55 213.360 413.360 60 213.365 413.365 65 213.370 413.370 70 213.375 413.375 75 213.380 413.380 80 213.385 413.385 85 213.390 413.390 90 All implants are also available sterile packed. Add Suffix S to part number. 44 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Locking Screws with Hex drive Self-drilling, self-tapping B 3.5 mm Stainless Steel Length (mm) 213.112 12 213.116 16 213.120 20 213.124 24 213.130 30 213.135 35 213.140 40 213.145 45 213.150 50 213.155 55 213.160 60 All implants are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 44

Screws Locking Screws with Stardrive Self-tapping B 3.5 mm B 5.0 mm Stainless Steel TAN Length (mm) 212.101 412.101 10 212.102 412.102 12 212.103 412.103 14 212.104 412.104 16 212.105 412.105 18 212.106 412.106 20 212.107 412.107 22 212.108 412.108 24 212.109 412.109 26 212.110 412.110 28 212.111 412.111 30 212.112 412.112 32 212.114 412.114 35 212.116 412.116 38 212.117 412.117 40 212.118 412.118 42 212.134 412.134 44 212.119 412.119 45 212.136 412.136 46 212.120 412.120 48 212.121 412.121 50 212.122 412.122 52 212.123 412.123 55 212.124 412.124 60 212.125 412.125 65 212.126 412.126 70 212.127 412.127 75 212.128 412.128 80 212.129 412.129 85 212.130 412.130 90 212.131 412.131 95 Stainless Steel TAN Length (mm) 212.201 412.201 14 212.202 412.202 16 212.203 412.203 18 212.204 412.204 20 212.205 412.205 22 212.206 412.206 24 212.207 412.207 26 212.208 412.208 28 212.209 412.209 30 212.210 412.210 32 212.211 412.211 34 212.212 412.212 36 212.213 412.213 38 212.214 412.214 40 212.215 412.215 42 212.216 412.216 44 212.217 412.217 46 212.218 412.218 48 212.219 412.219 50 212.220 412.220 55 212.221 412.221 60 212.222 412.222 65 212.223 412.223 70 212.224 412.224 75 212.225 412.225 80 212.226 412.226 85 212.227 412.227 90 All implants are also available sterile packed. Add Suffix S to part number. 55 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Spacers Locking Screws B 5.0 mm for Periprosthetic Fractures Hex drive Stardrive Stainless Steel TAN Length (mm) 02.221.458 04.221.458 8 02.221.460 04.221.460 10 02.221.462 04.221.462 12 222.402 422.402 14 222.404 422.404 18 Stainless Steel TAN Length (mm) 02.221.508 04.221.508 8 02.221.510 04.221.510 10 02.221.512 04.221.512 12 02.221.514 04.221.514 14 02.221.518 04.221.518 18 Spacer B 3.5 mm Hex drive Stainless Steel TAN Length (mm) 213.009 413.009 2 Spacer B 5.0 mm Hex drive Stainless Steel TAN Length (mm) 213.309 413.309 2 All implants are also available sterile packed. Add Suffix S to part number. 219.981 Washer B 3.5/2.7 mm, Stainless Steel 419.981 Washer B 3.5/2.7 mm, Titanium Alloy (TAN) All washers are also available sterile packed. Add Suffix S to part number. Surgical Technique LCP Locking Compression Plate DePuy Synthes 55

Cerclage Cerclage Positioning Pins, Eyes and CerclageFix X98.838.01 X98.838.01S Positioning Pin 3.5 with thread, for LCP Positioning Pin 3.5 with thread, for LCP, sterile X98.803.01 X98.803.01S Positioning Pin 4.5 with thread, for LCP Positioning Pin 4.5 with thread, for LCP, sterile X98.837 Cerclage Positioning Pin for LCP 3.5 and LC-DCP 3.5 X98.837S Cerclage Positioning Pin for LCP 3.5 and LC-DCP 3.5, sterile X98.839 Cerclage Positioning Pin for LCP 4.5 and LC-DCP 4.5 X98.839S Cerclage Positioning Pin for LCP 4.5 and LC-DCP 4.5, sterile 0X.221.002.05 Cerclage Eye for Screws B 3.5 mm, Stardrive and hexagonal socket, pack of 5 units 0X.221.002S Cerclage Eye for Screws B 3.5 mm, Stardrive and hexagonal socket, sterile 0X.221.003.05 Cerclage Eye for Screws B 4.5 mm, Stardrive and hexagonal socket, pack of 5 units 0X.221.003S Cerclage Eye for Screws B 4.5 mm, Stardrive and hexagonal socket, sterile 0X.221.004.05 Cerclage Eye for Hexagonal Socket, B 4.0 mm, cannulated, pack of 5 units 0X.221.004S Cerclage Eye for Hexagonal Socket, B 4.0 mm, cannulated, sterile X81.002 CerclageFix for LPC 4.5/5.0 X81.002S CerclageFix for LCP 4.5/5.0, sterile X81.001 CerclageFix Insert X81.001S CerclageFix Insert, sterile 55 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Cerclage Cables X98.800.01 X98.800.01S Cerclage Cable with Crimp B 1.0 mm Cerclage Cable with Crimp B 1.0 mm, sterile 298.801.01 Cerclage Cable with Crimp B 1.7 mm, Stainless Steel 298.801.01S Cerclage Cable with Crimp B 1.7 mm, Stainless Steel, sterile 611.105.01 Cerclage Cable with Crimp, B 1.7 mm, Cobalt-chrome Alloy 611.105.01S Cerclage Cable with Crimp B 1.7 mm, Cobalt-chrome Alloy, sterile 498.806* TRD Trochanter Reattachment Device, small, for Cable System, Titanium Alloy (TAN) 498.806S* TRD Trochanter Reattachment Device, small, for Cable System, Titanium Alloy (TAN), sterile 498.807* TRD Trochanter Reattachment Device, large, for Cable System, Titanium Alloy (TAN) 498.807S* TRD Trochanter Reattachment Device, large, for Cable System, Titanium Alloy (TAN), sterile X=2: Stainless Steel X=4: Titanium * TRD Trochanter Reattachment Device: CE0086 Manufactured by: Pioneer Surgical Technology, Inc. 375 River Park Circle, Marquette MI 49855 USA Distributed by: Synthes, GmbH, Eimattstrasse 3, 4436 Oberdorf, Switzerland Surgical Technique LCP Locking Compression Plate DePuy Synthes 55

Instruments Drill Sleeves Art. No. Description Small Large fragment fragment 323.027 LCP Drill Sleeve 3.5, X for Drill Bits B 2.8 mm 323.042 LCP Drill Sleeve 5.0, X for Drill Bits B 4.3 mm 324.007 Drill Sleeve 7.2/4.3, X length 130 mm, for LISS Drill Bits Art. No. Description Small Large fragment fragment 310.284 LCP Drill Bit B 2.8 mm X with Stop, length 165 mm, 2-flute, for Quick Coupling 310.430 LCP Drill Bit B 4.3 mm X with Stop, length 221 mm, 2-flute, for Quick Coupling 310.423* Drill Bit B 4.3 mm, X length 280 mm, for No. 324.007 Replacement stop rings can be ordered from the local Depuy Synthes representative. * calibrated for Drill Sleeve 324.007 55 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Torque Limiters and Corresponding Handles Torque Limiter Handle Art. No. Description Art. No. Small Large fragment fragment 511.770 1.5 Nm, for Compact 397.705 X Air Drive and Power Drive 511.773 1.5 Nm, for AO/ASIF 311.431 X Quick Coupling 511.115 1.5 Nm, for Compact 311.431 X Air Drive and Power Drive 511.771 4 Nm, for Compact 397.705 X Air Drive and Power Drive 511.774 4 Nm, for AO/ASIF 397.706 X Quick Coupling for Reamers Surgical Technique LCP Locking Compression Plate DePuy Synthes 55

Instruments Holding Sleeves for Screws Art. No. Description Small Large fragment fragment 314.091 for LCP 3.5 X 314.281 for LCP 4.5/5.0 X Hexagonal Screwdrivers, non-self-holding Art. No. Small Large fragment fragment 314.070 X 314.270 X Hexagonal Screwdriver Shafts Art. No. Description Small Large fragment fragment 314.030 non-self-holding X 314.150 non-self-holding X 314.152 self-holding X 55 DePuy Synthes LCP Locking Compression Plate Surgical Technique

Stardrive Screwdrivers, non-self-holding Art. No. Description Small Large fragment fragment 314.041 T15 X 314.164 T25 X Stardrive Screwdriver Shafts, self-holding Art. No. Description Small Large fragment fragment 314.116 T15 X 314.119 T25 X Torque-limiting Screwdrivers self-holding, for Locking Screws B 5.0 mm Art. No. Description 324.052 Hex drive 314.163 Stardrive T25 SHS Screwdrivers, non-self-holding Art. No. Description Small Large fragment fragment 03.400.101 Screwdriver Shaft 2.5, X hexagonal, Stardrive T15 03.400.111 Handle for X Screwdriver Shaft 2.5 03.400.102 Screwdriver Shaft 3.5, X hexagonal, Stardrive T25 03.400.112 Handle for X Screwdriver Shaft 3.5 Surgical Technique LCP Locking Compression Plate DePuy Synthes 55