Technique Guide Compact 2.0 LOCK Mandible. The locking system for the mandible.
Table of Contents Introduction Compact 2.0 LOCK Mandible 2 AO Principles 4 Indications and Contraindications 5 Surgical Technique Surgical Technique 6 Steps for Bone Resection (Optional) 13 Ordering Information Set 15 Plates 16 Screws 16 Instruments 17 Warning This description is not sufficient for immediate application of the instrumentation. Instruction by a surgeon experienced in handling this instrumentation is highly recommended. Synthes 1
Compact 2.0 LOCK Mandible. The locking system for the mandible. System Features and Benefits Four plate profiles one screw dimension Low-profile plating system Choice of rigidity level depending on individual situation System covers a broad range of indications: small plates for simple trauma medium plates for extra stability if required large and extra-large plates for more complex trauma and microvascular reconstruction Choice of self-tapping or self-drilling screws Provides locked or non-locked 2.0 mm screw plate fixation 2.0 mm screws fit all plate profiles The locking design: Provides construct stability Provides a positive stop for locking screws Preserves reduction intraoperatively by maintaining plate-to-bone position Plates Low plate profile and stability; favorable in atrophic mandibles Easy three-dimensional contouring without plate hole deformation Low plate palpability Available in a wide variety of straight, angled and curved shapes Hole spacing is designed for fixation in reconstructive surgery 1.0 Small 1.3 Medium 1.5 Large 4.8 5.0 6.5 2.0 Extra-large 6.7 2 Synthes Compact2.0LOCKMandible TechniqueGuide
Screws 2.0 mm LOCK screw self-tapping and self-drilling Stable fixation of bone fragments and grafts, even with poor quality bone Absence of plate pressure on the bone preserves blood supply Special conical double threads beneath the screw head engage and lock into threaded plate holes Self-tapping available in 5 18 mm lengths, and self-drilling in 5, 6 and 8 mm lengths, for monocortical and bicortical applications Self-tapping for easy insertion Made of high-strength titanium alloy 2.0 mm Cortex Screw self-tapping and self-drilling (non locking) Without thread in the screw head Synthes 3
AO Principles In 1958, the AO (Association for the Study of Internal Fixation) formulated four basic principles, which have become the guidelines for internal fixation 1. Those principles as applied to the 2.0 LOCK Mandible system are: Anatomic reduction Fracture reduction and fixation to restore anatomical relationships. A comprehensive implant and instrument selection offers the ability to address most simple and complex fixation needs. Stable fixation Stability by rigid fixation (compression plating) or splintage, as the personality of the fracture and the injury requires. The Compact 2.0 LOCK Mandible locking plate and screw locking technology are optimized to achieve stable bone fixation. Preservation of blood supply Preservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques. Instrumentation and new gentle profiles and edges on implants minimize disruption of soft tissue and preserves vascular blood flow for bone healing. Early mobilization Early and safe mobilization of the part and patient. The Compact 2.0 LOCK Mandible system implants, combined with AO technique, provide stable fixation enough to allow a functional aftercare. 1 Müller ME, Allgöwer M, Schneider R, Willenegger H (1991) AO Manual of Internal Fixation. 3rd Edition. Berlin: Springer-Verlag 4 Synthes Compact2.0LOCKMandible TechniqueGuide
Indications and Contraindications Indications Mandible trauma Orthognathic surgery Reconstructive surgery with microvascular bone grafts Plate thickness Plate type Primary clinical use Secondary clinical use 1.0 mm Small plates: Tension band Straight Adaption Strut/Box/L/Y Mandible traumatology Orthognathic 1.3 mm Medium plates: Adaption plates Crescent Angled DCP plates Mandible traumatology NA 1.5 mm Large plates: Curved/Crescent Straight Angled Mandible traumatology NA 2.0 mm Extra large plates: Straight Single Angle Double Angle Primary mandibular reconstruction (used with microvascular bone graft) Comminuted fractures Contraindications Reconstructive surgery without microvascular bone grafts Synthes 5
Surgical Technique 1 Exposure and reduction After completing the preoperative plan, expose the fracture or osteotomy site. For trauma, reduce the fracture as required. 2 Select and prepare implants Instrument 347.981 Holding forceps for plates 1.0 to 2.4 Select the appropriate plate (see preceding page) depending on indication. Orient the plate so that the topside of the plate is facing out. Determine the appropriate screw type (locking and/or nonlocking, self-tapping and/or self-drilling). 6 Synthes Compact2.0LOCKMandible TechniqueGuide
3 Optional: Cut the plate to length Instrument 391.951 Plate cutter with Deburring Device, for plates 1.0 to 2.4, length 180 mm Optional 329.143 Bending/Cutting pliers with nose for LOCK Plates 2.0 Small, medium and large plates Cut to length, if necessary. Small plates may be cut using the plate cutter or the bending/cutting pliers with nose. Extra large plates Cut to length, if necessary. Extra large plates may be cut using the plate cutter. Synthes 7
Surgical Technique 4 Select and form the bending template Select the appropriate shape and length bending template and form it to the boney anatomy. Note: Stable fixation requires a minimum of 2 3 screws per segment. 5 Contour the plate Instruments 347.901 Pliers, flat-nosed, pointed, for Plates 1.0 to 2.4 391.965 Combined Pliers for Plates 1.0 and 2.0, for Cutting and Bending 329.143 Bending/Cutting pliers with nose for LOCK Plates 2.0 (optional instrument) Small and medium plates In plane, out-of-plane and torsional bending Small and medium plates can be contured using the combined pliers and the flat nosed pliers. 8 Synthes Compact2.0LOCKMandible TechniqueGuide
Large and extra large plates Can be contoured using the bending/cutting pliers with nose and the flat nosed pliers. In plane bending Out-of-plane bending Bending the last hole out-of-plane with nose. Torsional bending Grasp the plate in the appropriate jaw of the flat nosed pliers, and apply a twisting motion until achieving the desired torsional bend. Synthes 9
Surgical Technique 6 Position the plate Instrument 398.660 Holding Forceps with Ball, ratchet lock, length 180 mm (optional instrument) Place the plate over the fracture or osteotomy site. Use the plate holding forceps to secure the plate to the bone, if desired. 7 Drill the first hole Option 1: Drill using standard drill sleeve/double drill guide Instruments 312.155 Drill sleeve 1.5, for LOCK Plates 2.0 316.510 Drill bit B 1.5 mm, 2-flute, total/usable length 80/55mm, for J-Latch Coupling 312.220 Double Drill Guide 2.0/1.5 Insert the drill sleeve into the first plate hole nearest the fracture or osteotomy site. When using the standard drill sleeve/double drill guide with locking screws, ensure that it is centered in all planes to align the screw s locking threads properly in the plate. Note: Standard 1.5 mm drill sleeve and double drill guide to be used with non-locking screws or when good visualization is possible. 10 Synthes Compact2.0LOCKMandible TechniqueGuide
Option 2: Drill using threaded sleeve Instruments 312.156 Drill sleeve with thread 1.5, for LOCK Plates 2.0 316.520 Drill bit B 1.5 mm, 2-flute, total/usable length 125/100 mm, for J-Latch Coupling When using the threaded drill sleeve, rotate the drill guide clockwise to engage the threads in the plate. Note: 1.5 mm threaded drill sleeve to be used with locking screws. 8 Measure screw length Instrument 319.520 Depth Gauge for Screws B 1.5/2.0, measuring range up to 45 mm Determine the appropriate screw length using the depth gauge. Synthes 11
Surgical Technique 9 Insert the screw Instruments 313.252 Screwdriver Shaft PlusDrive 1.5/2.0, long, selfholding, for Hexagonal Coupling 311.006 Handle, medium, with Hexagonal Coupling Insert the proper length 2.0 mm locking or non-locking screw through the plate and tighten until secure. 10 Drill holes and place the remaining screws Insert the second screw on the opposite side of the fracture or osteotomy site following the previously outlined procedure. Insert all remaining screws alternating to each side of the mandible. Securely tighten all screws unless resection is to follow. Apply additional fixation as desired. 12 Synthes Compact2.0LOCKMandible TechniqueGuide
Steps for Bone Resection (Optional) 1 Resect the mandible Instruments 313.252 Screwdriver Shaft PlusDrive 1.5/2.0, long, selfholding, for Hexagonal Coupling 311.006 Handle, medium, with Hexagonal Coupling Once the plate is in place, remove the plate and screws, taking note of each screw s placement. Resect the mandible. 2 Reposition the plate Place the plate back onto the mandible in its original position. Reinsert each predetermined screw. Check all screws to ensure a secure fit in the plate. Synthes 13
Steps for Bone Resection (Optional) 3 Apply bone graft 2 A vascularized bone graft must be applied to all 2.0 mm constructs used in reconstructing the mandible. Caution: If no vascularized bone graft is applied, a 2.4 mm UniLOCK plate or larger system should be used. 2 Prein J (1998) Manual of Internal Fixation in the Cranio-Facial Skeleton. Berlin: Springer-Verlag 14 Synthes Compact2.0LOCKMandible TechniqueGuide
Ordering Information 01.504.224 Compact 2.0 LOCK Mandible, PlusDrive Units 61.504.024 Module Compact 2.0 LOCK Mandible, 3/3, with Lid, without Contents 1 447.224 LOCK Plate 2.0, small, with centre space, 4 holes, length 28 mm, Pure Titanium 2 447.225 LOCK Plate 2.0, small, with centre space, 6 holes, length 40 mm, Pure Titanium 2 447.051 LOCK Mandible Adaption Plate 2.0, small, 20 holes, length 119 mm, Pure Titanium 1 447.101 LOCK Mandible Plate 2.0, medium, with centre space, 6 holes, length 43 mm, Pure Titanium 1 447.102 LOCK Mandible Plate 2.0, medium, 12 holes, length 77 mm, Pure Titanium 1 447.103 LOCK Mandible Plate 2.0, large, with centre space, 6 holes, length 53 mm, Pure Titanium 1 447.104 LOCK Mandible Plate 2.0, large, 6 holes, length 47 mm, Pure Titanium 1 447.105 LOCK Mandible Plate 2.0, large, 12 holes, length 95 mm, Pure Titanium 1 447.106 LOCK Mandible Plate 2.0, large, 20 holes, length 159 mm, Pure Titanium 1 447.108 LOCK Mandible Plate 2.0, angled, right, large, 6+21 holes, length 189/81 mm, Pure Titanium 1 447.109 LOCK Mandible Plate 2.0, angled, left, large, 6+21 holes, length 189/81 mm, Pure Titanium 1 401.291.04C LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 5 mm,, pack of 4 units in Clip 2 401.292.04C 401.294.04C 401.295.04C 401.296.04C 401.297.01C 401.298.01C 401.299.01C 401.041.04C 401.043.04C 401.044.04C 401.792.01C LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 6 mm,, pack of 4 units in Clip 3 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 8 mm,, pack of 4 units in Clip 3 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 10 mm,, pack of 4 units in Clip 3 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 12 mm,, pack of 4 units in Clip 3 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 14 mm,, in Clip 4 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 16 mm,, in Clip 4 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 18 mm,, in Clip 4 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 4 mm,, pack of 4 units in Clip 2 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 6 mm,, pack of 4 units in Clip 3 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 8 mm,, pack of 4 units in Clip 3 Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 6 mm,, pack of 1 unit in Clip 4 401.794.01C Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 8 mm,, pack of 1 unit in Clip 4 312.156 Drill Sleeve 1.5, with thread, for LOCK Plates 2.0 1 313.252 Screwdriver Shaft PlusDrive 1.5/2.0, long, self-holding, for Hexagonal Coupling 2 316.520 Drill Bit B 1.5 mm, length 125 mm, 2-flute, for J-Latch Coupling 1 316.510 Drill Bit B 1.5 mm, length 80 mm, 2-flute, for J-Latch Coupling 1 317.660 Drill Bit B 1.5 mm with Stop, length 44.5/6 mm, 2-flute, for J-Latch Coupling 2 317.680 Drill Bit B 1.5 mm with Stop, length 44.5/8 mm, 2-flute, for J-Latch Coupling 2 317.720 Drill Bit B 1.5 mm with Stop, length 44.5/12 mm, 2-flute, for J-Latch Coupling 2 61.504.024.01 Labelling Clips for Screws and Screwdriver Shafts B 2.0 mm, PlusDrive 1 Synthes 15
Ordering Information Also available Screws Plates 447.050 LOCK Adaption Plate 2.0, 12 holes, Pure Titanium 447.204 LOCK DCP Mandible Plate 2.0, medium, 4 holes, Pure Titanium 447.205 LOCK DCP Mandible Plate 2.0, medium, 5 holes, Pure Titanium 447.206 LOCK DCP Mandible Plate 2.0, medium, 6 holes, Pure Titanium 447.208 LOCK DCP Mandible Plate 2.0, medium, 8 holes, Pure Titanium 447.210 LOCK DCP Mandible Plate 2.0, medium, angled, 6 holes, Pure Titanium 447.212 LOCK DCP Mandible Plate 2.0, medium, angled, 8 holes, Pure Titanium 447.215 LOCK Mandible Plate 2.0, medium, crescent, 5 holes, Pure Titanium 447.217 LOCK Mandible Plate 2.0, medium, crescent, 7 holes, Pure Titanium 447.304 LOCK Tension Band Plate 2.0, right, prebent, 4 holes, Pure Titanium 447.305 LOCK Tension Band Plate 2.0, left, prebent, 4 holes, Pure Titanium 447.308 LOCK Plate 2.0, double-row, 12 holes, Pure Titanium, malleable 447.309 LOCK Plate 2.0, double-row, 9 holes, Pure Titanium, malleable 447.310 LOCK Frame Plate 2.0, square, 4 holes, Pure Titanium, malleable 447.312 LOCK Strut Plate 2.0, 8 holes, Pure Titanium, flexible 447.315 LOCK Strut Plate 2.0, curved, 8 holes, Pure Titanium, flexible 447.317 LOCK Double-Y-Plate 2.0, Pure Titanium, flexible 447.318 LOCK L-Plate 2.0, right, Pure Titanium, flexible 447.319 LOCK L-Plate 2.0, left, Pure Titanium, flexible 447.404 LOCK Mandible Plate 2.0, large, double-angled, 4+20+4 holes, Pure Titanium 447.405 LOCK Mandible Plate 2.0, large, double-angled, 5+22+5 holes, Pure Titanium 447.406 LOCK Mandible Plate 2.0, large, double-angled, 6+24+6 holes, Pure Titanium 447.412 LOCK Mandible Plate 2.0, extra-large, 12 holes, Pure Titanium 447.420 LOCK Mandible Plate 2.0, extra-large, 20 holes, Pure Titanium 447.422 LOCK Mandible Plate 2.0, right, extra-large, 6+21 holes, Pure Titanium 447.423 LOCK Mandible Plate 2.0, left, extra-large, 6+21 holes, Pure Titanium 447.424 LOCK Mandible Plate 2.0, double-angled, extra-large, 4+20+4 holes, Pure Titanium 447.425 LOCK Mandible Plate 2.0, double-angled, extra-large, 5+22+5 holes, Pure Titanium 447.426 LOCK Mandible Plate 2.0, double-angled, extra-large, 6+24+6 holes, Pure Titanium All the plates can be ordered sterile by adding an S to the item number, e.g. 447.224 is 447.224S in sterile. LOCK screws, self tapping 401.291 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 5 mm, 401.292 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 6 mm, 401.294 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 8 mm, 401.295 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 10 mm, 401.296 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 12 mm, 401.297 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 14 mm, 401.298 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 16 mm, 401.299 LOCK Screw PlusDrive B 2.0 mm, self-tapping, length 18 mm, Available in Packs of 1 and 5; packs of 1 in Clip (sterile and non-sterile). Pack of 4 in Clip (until 12 mm; sterile and non-sterile)*. LOCK screws, self drilling 401.955 LOCK Screw PlusDrive B 2.0 mm, self-drilling, length 5 mm, 401.956 LOCK Screw PlusDrive B 2.0 mm, self-drilling, length 6 mm, 401.957 LOCK Screw PlusDrive B 2.0 mm, self-drilling, length 8 mm, Available in Packs of 1 and 5; packs of 1 in Clip (sterile and non-sterile). Pack of 4 in Clip (sterile and non-sterile)*. Cortex screws, self-tapping 401.041 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 4 mm, 401.043 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 6 mm, 401.044 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 8 mm, 401.045 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 10 mm, 401.046 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 12 mm, 401.047 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 14 mm, 401.048 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 16 mm, 401.049 Cortex Screw PlusDrive B 2.0 mm, self-tapping, length 18 mm, Available in Packs of 1 and 5; packs of 1 in Clip (sterile and non-sterile). Pack of 4 in Clip (until 12 mm; sterile and non-sterile)*. 16 Synthes Compact2.0LOCKMandible TechniqueGuide
Cortex screws, self-drilling 401.061 Cortex Screw PlusDrive B 2.0 mm, self-drilling, length 4 mm, 401.063 Cortex Screw PlusDrive B 2.0 mm, self-drilling, length 6 mm, 401.065 Cortex Screw PlusDrive B 2.0 mm, self-drilling, length 8 mm, Available in Packs of 1 and 5; packs of 1 in Clip (sterile and non-sterile). Pack of 4 in Clip (sterile and non-sterile)*. Emergency screws, self-tapping 401.792 Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 6 mm, 401.794 Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 8 mm, 401.795 Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 10 mm, 401.796 Emergency Screw PlusDrive B 2.4 mm, self-tapping, length 12 mm, Available in Packs of 1 and 5; packs of 1 in Clip (sterile and non-sterile)*. * To order: Pack of 5 screws, add.05 after the item number, e.g. 401.291 becomes e.g. 401.291.05. Pack of 1 screw in Clip, add.01c after the item number, e.g. 401.291 becomes e.g. 401.291.01C. Pack of 4 screws in Clip, add.04c after the item number, e.g. 401.291 becomes e.g. 401.291.04C. Sterile screws in Packs of 1 screw in Clip, replace.01c with S, e.g. 401.291.01C becomes 401.291S Sterile screws in Packs of 4 screws in Clip, replace C with S, e.g. 401.291.04C becomes 401.291.04S Instruments 310.811 Countersink with Centering Pin, for Screws B 2.0 mm with Hexagonal Coupling 397.440 Drill Sleeve 1.5, with thread, short, for LOCK Mandible Plates 2.0 312.154 Drill Sleeve 1.5, with thread, long, for LOCK Mandible Plates 2.0 329.571 Bending Template for LOCK Mandible Plate 2.0, crescent-shaped, 5+7 holes, length 42 mm 329.572 Bending Template for LOCK DCP Mandible Plate 2.0, angled, 6+8 holes, length 42 mm 329.573 Bending Template for LOCK DCP Mandible Plate 2.0, 4+6+8 holes, length 68 mm 329.574 Bending Template for LOCK Mandible Plate 2.0, double-angled, 4+20+4 holes, length 202 mm 329.575 Bending Template for LOCK Mandible Plate 2.0, double-angled, 5+22+5 holes, length 221 mm 329.576 Bending Template for LOCK Mandible Plate 2.0, double-angled, 6+24+6 holes, length 240 mm Standard Instruments Compact 2.0 Mandible, 3/3, with Lid Units 61.502.092 Instrument Tray Compact 2.0 Mandible, 3/3, with Lid 1 347.901 Pliers, flat-nosed, pointed, for Plates 1.0 to 2.4 2 347.981 Holding Forceps for Plates 1.0 to 2.4 1 347.985 Holding Forceps for Cortex Screws B 1.0 to 2.4 mm 1 391.965 Combined Pliers for Plates 1.0 to 2.0, for Cutting and Bending 1 319.520 Depth Gauge for Screws B 1.5 to 2.0 mm, measuring range up to 45 mm 1 311.006 Handle, medium with Hexagonal Coupling 2 312.220 Double Drill Guide 2.0/1.5 1 391.951 Plate Cutter with Deburring Device, for Plates 1.0 to 2.4, length 180 mm 1 Optional 329.143 Bending/Cutting Pliers with Nose, for LOCK Plates 2.0 398.660 Holding Forceps with Ball, ratchet lock, length 180 mm 312.155 Drill sleeve 1.5, for Lock Plates 2.0 Note: For more plates, screws, templates and instruments please refer to Synthes CMF Catalogue 035.000.610 and its updates.
Synthes GmbH Eimattstrasse 3 4436 Oberdorf Switzerland Tel: +41 61 965 61 11 Fax: +41 61 965 66 00 www.depuysynthes.com This publication is not intended for distribution in the USA. All surgical techniques are available as PDF files at www.synthes.com/lit 0123 DePuy Synthes CMF, a division of Synthes GmbH. 2015. All rights reserved. 036.000.059 DSEM/CMF/0115/0051 02/15