Long Volar Plates for Diaphyseal-Metaphyseal Radius Fractures LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
Table of Contents Introduction LCP Dia-Meta Volar Distal Radius Plates 2 AO Principles 4 Indications 5 Clinical Case 6 Surgical Technique Preparation 7 Contour Plate (optional) 8 Position Patient 9 Approach 9 Reduce Fracture 10 Insert Proximal Screws 11 Insert Distal Screws 12 Close Incision 14 Implant Removal 14 Product Information Implants 15 Instruments 18 Set List 21 MR Information The LCP Dia-Meta Volar Distal Radius Plates System has not been evaluated for safety and compatibility in the MR environment. It has not been tested for heating, migration or image artifact in the MR environment. The safety of the LCP Dia-Meta Volar Distal Radius Plates System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury. Image intensifier control LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 1
LCP Dia-Meta Volar Distal Radius Plates The LCP Dia-Meta (Diaphyseal Metaphyseal) Volar Distal Radius Plate is an anatomic plate designed for fractures of the distal radius that extend into the radial shaft. The plate design combines 2.4 mm locking technology in the distal radius with 3.5 mm LCP Plate technology in the radial shaft. Dia-Meta plates are left and right specific and are offered in six different lengths to address a wide variety of fractures. 2 DePuy Synthes LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
LCP Dia-Meta Volar Distal Radius Plates Features and benefits Precontoured plate offers an anatomic fit in the distal radius and radial shaft All plates are straight up to 5 holes. Beyond the fifth hole the shaft is precontoured to match the radial bow 4-hole head configuration is similar to the 2.4 mm LCP Extra-Articular Volar Distal Radius Plate Distal locking screws offer a fixed angle construct to support the articular surface Smooth surface finishing and rounded edges designed to minimize tendon irritation and adhesion Available left or right, with 5, 7, 9, 11, 13*, or 15* hole shaft lengths Available in 316L stainless steel or commercially pure (CP) titanium 2.4 mm locking holes in head of plate 3.5 mm Combi holes in plate shaft can accept 3.5 mm cortex, 3.5 mm locking, or 4.0 mm cancellous screws Relief notches at alternating holes after the 7th hole, to facilitate additional contouring Combi holes can provide angular stability with locking screws or compression with cortex screws Plate head 25 angulation in head of plate fits volar distal radius Screw angles are identical to the angles in the 4-hole head 2.4 mm LCP Extra-Articular Volar Distal Radius Plate 90 80 25 100 (2x) 5 5 7.5 15 * 13 and 15 hole plates available sterile only LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 3
AO Principles AO PRINCIPLES In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation. 1,2 In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation 1, 2. 4_Priciples_03.pdf 1 05.07.12 12:08 Anatomic Anatomic reduction reduction Fracture Fracture reduction reduction and and fixation fixation to to restore restore anatomical anatomical relationships. relationships. 1 2 Stable Stable fixation fixation Fracture Fracture fixation fixation providing providing absolute absolute or relative or relative stability, stability, as required as by the required patient, by the the injury, patient, and the the injury, personality and the personality of the fracture. of the fracture. Early, Early, active mobilization Early Early and and safe safe mobilization and rehabilitation of of the injured part and and the the patient as as a whole. 4 3 Preservation Preservation of of blood blood supply supply Preservation Preservation of of the the blood blood supply supply to to soft soft tissues tissues and and bone bone by by gentle reduction gentle reduction techniques techniques and and careful careful handling. handling. 1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; 1991. 2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal 2nd ed. Stuttgart New York: Thieme; 2007. 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. 4 DePuy Synthes LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
Indications LCP Dia-Meta Volar Distal Radius Plates are indicated for fractures, osteotomies, and nonunions of the radius and other small bones. LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 5
Clinical Case 61-year-old female, distal radius fracture Used a 7-hole shaft dia-meta plate Preoperative AP Preoperative lateral Postoperative AP Postoperative lateral 6 DePuy Synthes LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
Preparation 1 Preparation Required sets 105.434/ Small Fragment LCP Instrument and 145.434 Implant Set, with self-tapping screws (stainless steel or titanium) and 105.515/ 2.4 mm LCP Distal Radius Plate Instrument 145.515 and Implant Set (stainless steel or titanium) or 01.111.120/ LCP Modular Mini Fragment Instrument 01.111.140 and Implant Set (stainless steel or titanium) 105.434 105.515 01.111.120 LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 7
Contour Plate (optional) 2 Contour plate (optional) Instruments 329.04 Bending Irons, for 2.7 mm and 3.5 mm plates and 329.05 or 329.15* Bending Pliers, for 2.7 and 3.5 mm plates If necessary, carefully contour the plate to fit the patient s radial anatomy using the bending irons or bending pliers. Be careful to avoid overbending of the plate which could cause damage to the plate threads. Precaution: 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. *Also available 8 DePuy Synthes LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
Position Patient and Approach 3 Position patient Place the patient in the supine position with the hand and arm on a hand table, preferably radiolucent for fluoroscopic imaging. The elbow should be fully extended and in full supination. 2 4 Approach Make a longitudinal incision slightly radial to the flexor carpi radialis tendon (FCR). Dissect between the FCR and the radial artery, exposing the pronator quadratus. Detach the pronator quadratus from the lateral border of the radius and elevate it toward the ulna. The incision can be extended proximally depending on the fracture pattern and length of plate used. To get better exposure of the radius, it is helpful to pronate the forearm. 2 Precaution: Leave the volar wrist capsule intact to avoid devascularization of the fracture fragments and destabilization of the volar wrist ligaments. 2. T.P. Ruedi, R.E. Buckley, C.G. Moran: AO Principles of Fracture Management, 2nd Edition. New York: Thieme. 2007. p.348. LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 9
Reduce Fracture 5 Reduce fracture and position plate Instruments 310.25 2.5 mm Drill Bit, quick coupling, 110 mm 314.02 Small Hexagonal Screwdriver with Holding Sleeve 319.01 Depth Gauge, for 2.7 mm and small screws 323.36 3.5 mm Universal Drill Guide After reducing the fracture, apply the plate to fit the volar surface and insert a 3.5 mm cortex screw into the first appropriate elongated Combi hole. Drill for a 3.5 mm cortex screw. Insert a 3.5 mm cortex screw in the nonthreaded portion of an elongated Combi hole. Adjust the plate as necessary and tighten the screw. Note: The fracture pattern will dictate the appropriate site for this first screw. 11 DePuy Synthes LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
Insert Proximal Screws 6 Insert proximal screws Instruments 310.25 2.5 mm Drill Bit, quick coupling, 110 mm 310.288 2.8 mm Drill Bit, quick coupling, 165 mm 312.648 2.8 mm Threaded Drill Guide 314.02 Small Hexagonal Screwdriver with Holding Sleeve 314.115 StarDrive Screwdriver, T15, self-retaining 319.01 Depth Gauge, for 2.7 mm and small screws 323.36 3.5 mm Universal Drill Guide Determine where 3.5 mm locking or 3.5 mm cortex screws will be used in the shaft of the plate. Insert these screws as needed, according to the fracture pattern. If a combination of locking and cortex screws is planned, a cortex screw should be used first to pull the plate to the bone. Drill for a 3.5 mm cortex screw using the 2.5 mm drill bit, with the 3.5 mm universal drill guide. Use the hexagonal screwdriver to insert the screw. 3.5 mm locking screws may be placed in the threaded portion of the Combi hole. Drill using the 2.8 mm drill bit with the 2.8 mm threaded drill guide. Use the T15 StarDrive Screwdriver to insert the locking screws. LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 11
Insert Distal Screws 7 Insert distal screws and confirm joint reconstruction Instruments 310.509 1.8 mm Drill Bit with depth mark, quick coupling, 110 mm 311.43 Handle, with quick coupling 314.467 StarDrive Screwdriver Shaft, T8 323.029 Threaded LCP Drill Guide, 1.8 mm Insert 2.4 mm locking screws into the distal portion (head) of the plate. The order of screw insertion in the metaphysis may vary depending on the fracture pattern and reduction technique. Verify plate and distal screw location with the drill bit or K-wires before inserting multiple screws. 11 DePuy Synthes LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
Insert Distal Screws Alternative instrument 323.035* 1.8 mm Threaded Drill Guide, short The short 1.8 mm threaded drill guide can also be used in the distal locking holes. Use of the short threaded drill guide allows drill guides to be inserted in all four distal locking holes simultaneously. Drill for a 2.4 mm locking screw using the 1.8 mm drill bit, with a 1.8 mm threaded drill guide. Use the T8 StarDrive Screwdriver to insert the screw. Confirm proper joint reconstruction, screw placement and screw length using multiple C-arm views. To assure the most distal screws are not in the joint, use additional views such as 10 tilted PA, 20 inclined lateral, and 45 pronated oblique. * Also available LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 11
Close Incision and Implant Removal Close incision Use the appropriate method for surgical closure of the incision. Implant removal To remove locking screws, unlock all screws from the plate and then begin to remove the screws completely from the bone. This avoids rotation of the plate when removing the last locking screw. 11 DePuy Synthes LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
Screws Used with the LCP Dia-Meta Volar Distal Radius Plates Stainless Steel and Titanium 2.4 mm Locking Screws* For use in distal (head) round locking holes only Threaded, conical head locks securely into the plate to provide angular stability Locked screws allow unicortical screw fixation and load transfer to the near cortex T8 StarDrive Recess mates with self-retaining screwdriver StarDrive Recess provides improved torque transmission Self-tapping Implant-quality 316L stainless steel or titanium alloy (Ti-6AI-7Nb) 6 mm 30 mm lengths (2 mm increments) 212.806 212.830 412.806 412.830 3.5 mm Locking Screws** For use in the locking portion of Combi holes in the plate shaft Threaded, conical head locks securely into the plate to provide angular stability Locked screws allow unicortical screw fixation and load transfer to the near cortex T15 StarDrive Recess mates with self-retaining screwdriver and provides improved torque transmission Self-tapping Implant-quality 316L stainless steel or titanium alloy (Ti-6AI-7Nb) 10 mm 30 mm lengths (2 mm increments) 212.101 212.111 412.101 412.111 3.5 mm Cortex Screws** For use in nonlocking portion of Combi holes in the plate shaft Used to provide compression or neutral fixation Self-tapping Implant-quality 316L stainless steel or titanium alloy (Ti-6AI-7Nb) 10 mm 30 mm lengths (2 mm increments) 204.810 204.830 404.810 404.830 * Available in 2.4 mm LCP Distal Radius Sets (105.515/145.515) or LCP Modular Mini Fragment Sets (01.111.120/01.111.140) ** Available in Small Fragment LCP Sets (105.434/145.434) LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 11
Implants LCP Dia-Meta Volar Distal Radius Plates Plates are available in 316L stainless steel or commercially pure (CP) titanium Left plates 5 holes shaft, left Approximate overall length: 95 mm (0x.110.105) 7 holes shaft, left Approximate overall length: 125 mm (0x.110.107) 9 holes shaft, left Approximate overall length: 154 mm (0x.110.109) * 13 and 15 hole plates available sterile only. Available nonsterile or sterile-packed. Add S to catalog number for sterile product. x = 2 for stainless steel x = 4 for CP titanium 11 holes shaft, left Approximate overall length: 184 mm (0x.110.111) 13 holes shaft, left* Approximate overall length: 212 mm (0x.110.113S) 15 holes shaft, left* Approximate overall length: 240 mm (0x.110.115S) 11 DePuy Synthes LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
Implants Right plates 5 holes shaft, right Approximate overall length: 95 mm (0x.110.005) 7 holes shaft, right Approximate overall length: 125 mm (0x.110.007) 9 holes shaft, right Approximate overall length: 154 mm (0x.110.009) 11 holes shaft, right Approximate overall length: 184 mm (0x.110.011) 13 holes shaft, right* Approximate overall length: 212 mm (0x.110.013S) 15 holes shaft, right* Approximate overall length: 240 mm (0x.110.015S) LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 11
Selected Instruments from the Small Fragment LCP Instrument and Implant Set 310.25 2.5 mm Drill Bit, quick coupling, 110 mm 310.288 2.8 mm Drill Bit, quick coupling, 165 mm 311.43 Handle, with quick coupling 312.648 2.8 mm Threaded Drill Guide 314.02 Small Hexagonal Screwdriver with Holding Sleeve 314.115 StarDrive Screwdriver, T15 319.01 Depth Gauge, for 2.7 mm and small screws 11 DePuy Synthes LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
Selected Instruments from the Small Fragment LCP Instrument and Implant Set 323.36 3.5 mm Universal Drill Guide 329.04 Bending Iron, for 2.7 mm and 3.5 mm plates, 150 mm length Used with 329.05 329.05 Bending Iron, for 2.7 mm and 3.5 mm plates, 150 mm length Used with 329.04 LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 11
Selected Instruments from the 2.4 mm LCP Distal Radius Instrument and Implant Set or LCP Modular Mini Fragment Instrument and Implant Set 310.509 1.8 mm Drill Bit with depth mark, quick coupling, 110 mm 314.467 StarDrive Screwdriver Shaft, T8 319.006 Depth Gauge, for 2.0 mm/ 2.4 mm screws 323.029 Threaded LCP Drill Guide, 1.8 mm Also Available 323.035 1.8 mm Threaded Drill Guide, short 22 DePuy Synthes LCP Dia-Meta Volar Distal Radius Plates Surgical Technique
LCP Dia-Meta Volar Distal Radius Plate Sets Stainless Steel (01.110.025) and Titanium (01.110.026) Module 60.110.032 LCP Dia-Meta Volar Distal Radius Plate Implant Module Implants LCP Dia-Meta Volar Distal Radius Plates Stainless Steel Titanium Shaft Holes 02.110.005 04.110.005 5 right 02.110.007 04.110.007 7 right 02.110.009 04.110.009 9 right 02.110.011 04.110.011 11 right 02.110.105 04.110.105 5 left 02.110.107 04.110.107 7 left 02.110.109 04.110.109 9 left 02.110.111 04.110.111 11 left Required Sets 105.434/ Small Fragment LCP Instrument and Implant 145.434 Set, with self-tapping screws (stainless steel or titanium) and 105.515/ 2.4 mm LCP Distal Radius Plate Instrument 145.515 and Implant Set (stainless steel or titanium) or 01.111.120/ LCP Modular Mini Fragment Instrument 01.111.140 and Implant Set (stainless steel or titanium) Also Available LCP Dia-Meta Volar Distal Radius Plates* Stainless Steel Titanium Shaft Holes 02.110.013S 04.110.013S 13 right 02.110.015S 04.110.015S 15 right 02.110.113S 04.110.113S 13 left 02.110.115S 04.110.115S 15 left 323.035 1.8 mm Threaded Drill Guide, short 329.15 Bending Pliers, for 2.7 mm and 3.5 mm plates Available nonsterile or sterile packed. Add S to catalog number for sterile product. * Plates are available sterile only and will fit into the implant module. Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer to www.synthes.com/cleaning-sterilization or sterilization instructions, if provided. LCP Dia-Meta Volar Distal Radius Plates Surgical Technique DePuy Synthes 22
Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed. Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information. CAUTION: Federal Law restricts these devices to sale by or on the order of a physician. Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada. Not all products may currently be available in all markets. Manufactured or distributed by: Synthes USA Products, LLC 1302 Wrights Lane East West Chester, PA 19380 Synthes USA, LLC 1101 Synthes Avenue Monument, CO 80132 To order (USA): 800-523-0322 To order (Canada): 855-946-8999 Note: For recognized manufacturer, refer to the product label. www.depuysynthes.com DePuy Synthes 2008 2017. All rights reserved. DSUS/TRM/0916/1064 6/17 DV