Less invasive stabilization system (LISS) for LISS and LCP ...

1 Surgical TechniqueThis publication is not intended for distribution in the and implantsapproved by the AO invasive stabilization system ( liss ) for liss and LCP DF Plates. StardriveHex driveImage intensifier controlThis 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 , Reprocessing, Care and MaintenanceFor 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: 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: invasive stabilization system ( liss ) for liss and LCP DF Plates Surgical Technique DePuy Synthes 1 Introduction less invasive stabilization system ( liss ) 2 for liss and LCP DF Plates AO Principles 4 Indications and Contraindications 5 Clinical Cases 6 Surgical Technique Preoperative Planning 8 Preparation 11 Plate Insertion 17 Option A: Insertion of Self-Drilling, 21 Monocortical Locking Screws Option B: Insertion of Self-Tapping, 26 Bicortical Locking Screws Option C: Insertion of Self-Tapping Locking Screws 30 for Periprosthetic Fractures Option: Pulling Device ( Whirly Bird ) 33 Option.

2 Guiding Blocks 34 Implant Removal 37 Additional Information 39 Instruments for Minimally invasive Osteosynthesis 40 Product Information Implants 41 Locking Screws B mm 42 Instruments 43 Sets 46 Bibliography 48 MRI Information 49 Table of Contents2 DePuy Synthes less invasive stabilization system ( liss ) for liss and LCP DF Plates Surgical TechniqueLess invasive stabilization system ( liss ) for liss and LCP DF precontoured low profile plates Limited plate -periosteum contact No need for plate contouringPrecaution: Excessive and repetitive bending is not recommended as it may weaken the plate.

3 Angular stability May prevent screw loosening as well as primary and secondary loss of reduction Offers purchase in osteoporotic bone and in multiple fragment frac-turesLCP combi-holes Combine a dynamic compression unit (DCU) hole with a locking screw hole Permits an internal plate fixation using standard screws, locking screws or a combination of the twoWide variety of anatomically precontoured plates Available in stainless steel and titanium alloy (TAN) LCP DF plates in eight lengths with 5 to 19 holes in the shaft Long LCP DF plates (15 to 19 holes) available in sterile only liss plates in TAN in lengths 5, 9 and 13 holesWide variety of screws Self-tapping or self-drilling locking screws Periprosthetic locking screws with blunt tip for periprosthetic fractures Cortex screws Available in stainless steel and titaniumLess invasive stabilization system ( liss ) for liss and LCP DF Plates Surgical Technique DePuy Synthes 3 liss instrumentation for Stardrive and Hex driveThe torque-limiting screwdriver, the screwdriver shaft and the cleaning in-strument are available for screws with Stardrive and Hex radiolucent liss insertion guide permits a minimally- invasive surgery, allows accurate percutaneous place-ment of screws and facilitates the in-sertion of the guiding tools: guiding block and liss insertion guide The guiding block facilitates mounting of the threaded LCP drill threaded holes in the plate head also accept cortex screws to create : Cortex screws are only recom-mended in cases when compression through the plate is needed or when an independent cortex screw cannot be placed.

4 This decision depends on patient s history, bone quality, physio-logical condition and compliance and has to be made individually for each patient. Use of cortex screws in the plate 1 12:084 DePuy Synthes Expert Lateral Femoral Nail Surgical TechniqueAO PRINCIPLESIn 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, M ller ME, M Allg wer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. R edi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. reductionFracture reduction and fixation to restore anatomical , active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful DePuy Synthes less invasive stabilization system ( liss ) for liss and LCP DF Plates Surgical TechniqueAO Principles1 M ller ME, Allg wer M, Schneider R, Willenegger H.

5 Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer. 1991. 2 R edi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. reductionFracture reduction and fixation to restore anatomical , active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful i nvasive stabilization system ( liss ) f or L ISS and LCP DF Plates Su rgical T echnique DePuy Synthes 5 Indications and ContraindicationsIndicationsLCP DF is indicated for the stabilization of fractures of the distal femur.

6 These include: Distal shaft fractures Supracondylar fractures Intra-articular fractures Periprosthetic fracturesContraindicationsNo specifi c DePuy Synthes less invasive stabilization system ( liss ) for liss and LCP DF Plates Surgical TechniqueCase 1 Male, 20 years old, polytrauma, fracture 33-C3 Clinical CasesPreoperativeFollow-up after 6 weeksFollow-up after 3 monthsFollow-up after 5 monthsLess invasive stabilization system ( liss ) for liss and LCP DF Plates Surgical Technique DePuy Synthes 7 Case 2 Male, 76 years old, isolated fracture 33-B2 PreoperativePostoperativeFollow-up after 4 weeksLCP Distal Femur, rightTitanium St. Steel Holes Length (mm) 5 7 9 11 13 15 17 19 436ED/FAC/GB12345678910111213FE/ AB 30100466 09/2010 Synthes, Inc. or its affiliates All rights reserved Synthes is trademark of Synthes, Inc.

7 Or its affiliates AB{ Synthes GmbHEimattstrasse 3CH-4436 MagnificationCaution: Due to variable magnification factors in x-rays, this template should be used for general pre-operative planning only. For use only with the Original AO system of Instruments and ImplantsLCP Distal Femur, leftED/FAC/GB12345678910111213DB/A/ECGFT itanium St. Steel Holes Length (mm) 5 7 9 11 13 15 17 19 436 AB 30100466 06/2010 Synthes, Inc. or its affiliates All rights reserved Synthes is trademark of Synthes, Inc. or its affiliates ABN Synthes GmbHEimattstrasse 3CH-4436 MagnificationCaution: Due to variable magnification factors in x-rays, this template should be used for general pre-operative planning only. For use only with the Original AO system of Instruments and Implants8 DePuy Synthes less invasive stabilization system ( liss ) for liss and LCP DF Plates Surgical TechniquePreoperative PlanningUse the x-ray templates for LCP DF (Art.)}

8 No. for right and for left femur) to determine the length of the plate and the position of the planning of lag screws may be : Plate bending is not recommended as this may weaken the plate and the plate-screw interface and can compro mise the targeting function of an aiming arm, if in use. However, there may be cases in which plate bending is clinically necessary. In such cases, the plate should only be bent to fit proximal femur anatomy and only bend the plate incrementally and between screw holes using the plate bending press ( ), and never bend back-and-forth. Insert at least one screw distal to the bend. less invasive stabilization system ( liss ) for liss and LCP DF Plates Surgical Technique DePuy Synthes 9 Preoperative screw-length selection using an AP radiographTo select the proper screw length for the condyle, it is possi-ble to perform a preoperative x-ray with the 50 mm wide calibrator and to use the table Place the x-ray calibrator medially or laterally at the height of the Take an AP radiograph of the distal Measure the width of the x-ray calibrator (XRC) on the Measure the maximum condyle width (MCW) on the Determine the real condyle width (RCW).

9 RWC =50 MCWXRC6. Determine the screw lengths for the screw holes A to G using the table below. The positions A to G are indicated on the x-ray template and on the liss DF insertion of locking screws (mm)Real condyle width (RCW)HoleAHoleBHoleCHoleDHoleEHoleFHoleG 60 80 mm6540405565655581 87 mm7540556575756588 95 mm7555656575757596 110 mm8565757575858510 DePuy Synthes less invasive stabilization system ( liss ) for liss and LCP DF Plates Surgical TechniquePreoperative PlanningExampleThe length of the x-ray calibrator on the radiograph (XRC) is 55 mm (magnification ).The maximum condyle width on the radiograph (MCW) amounts to 91 =50 91 = 83 XRCThe real condyle width (RCW) is therefore 83 mm. The screw lengths are therefore:Screw hole Screw length (mm)A 75B 40C 55D 65E 75F 75G 65 Note: The proper placement of the plate on the condyle is essential to ensure the correct screw length.

10 less invasive stabilization system ( liss ) for liss and LCP DF Plates Surgical Technique DePuy Synthes 11 Preparation1 Prepare required setsInstrument liss Instruments and Insertion Handle, for DF and PLT Plates, in Vario Case liss Instruments Stardrive and Insertion Handle, for DF and PLT Plates, in Vario CaseOptional instrument LCP Large Fragment Instruments and Standard Instruments in Vario CasePlate LCP-DF (Stainless Steel), in Modular Tray, Vario Case system LCP-DF (Titanium Alloy/TAN), in Modular Tray, Vario Case SystemNote on long plates: The LCP DF plates with 15 to 19 holes are available in sterile only and not part of a set. Therefore these articles have to be ordered as single items (for article numbers refer to page 41).Screw Modular Insert, for Modular Screw Rack, for Screws B mm, size 1 3, without Contents, Vario Case Modular Insert, for Modular Screw Rack, for Screws B mm, size 1 3, without Contents, Vario Case Modular Insert, for Modular Screw Rack, for Screws B mm, size 1 3, without Contents, Vario Case Modular Screw Rack, with Drawer, Mea-suring Block and Lid, length 200 mm, height 115 mm, size , without Contents, Vario Case system Power Tools* Compact Air Drive AO/ASIF Quick Coupling, for Compact Air Drive and Power Quick Coupling for Kirschner Wires B to mm, for Compact Air Drive and Power Battery Handpiece, modular, for Trauma Recon Power Module, for Trauma Recon Sterile Cover, for Trauma Recon Lid for Battery Handpiece No.