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Surgical­Technique - synthes.vo.llnwd.net

DCP and LC-DCP Systems. Dynamic Compression Plates (DCP) and Dynamic Compression Plates with Limited Bone Contact (LC-DCP). surgical TechniqueThis publication is not intended for distribution in the and implantsapproved by the AO intensifier controlThis description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling these instruments is highly , 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: technique DCP and LC-DCP Systems DePuy Synthes 1 Table of ContentsIntroduction DCP and LC-DCP Systems 2AO Principles 4 Intended Use 5 Indications and Contraindications 6 surgical technique Preparation 7 Drill Guides for DCP and LC-DCP 9 Compression Plate.

Surgical Technique DCP and LC-DCP Systems DePuy Synthes 3 Undercuts­of­the­LC-DCP­limit­contact­between­plate­and­ bone. Non-symmetrical holes The­DCP­allows­up­to­25°­longitudinal­and­7°­transverse­

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Transcription of Surgical­Technique - synthes.vo.llnwd.net

1 DCP and LC-DCP Systems. Dynamic Compression Plates (DCP) and Dynamic Compression Plates with Limited Bone Contact (LC-DCP). surgical TechniqueThis publication is not intended for distribution in the and implantsapproved by the AO intensifier controlThis description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling these instruments is highly , 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: technique DCP and LC-DCP Systems DePuy Synthes 1 Table of ContentsIntroduction DCP and LC-DCP Systems 2AO Principles 4 Intended Use 5 Indications and Contraindications 6 surgical technique Preparation 7 Drill Guides for DCP and LC-DCP 9 Compression Plate.

2 Simple Fracture 12 Compression Plate: Multifragmentary Fracture 15 Buttress Plate 18 Neutralization Plate (Protecting Plate) 19 Product Information Screws, Drills and Taps 20 Mini Fragment System , , 22 Compact Hand , , , , 32 Compact Hand Module 32 Compact Hand Module 34 Compact Hand Module 37 Compact Hand Module 40 Small Fragment Plates 44 Large Fragment Plates 45 MRI Information 482 DePuy Synthes DCP and LC-DCP Systems surgical Techniquemid sectionNon-symmetrical holesSome Dynamic Compression Plates feature non-symmetrical holes which allow to achieve compression in only one direction. These plates feature a mid section which is placed at the position of fragments to be non-symmetrical DCP holes are shaped like a portion of an inclined and angled cylinder. They possess one compres-sion point at the inclined side and one neutral point in the Compression Plates are available in dimensions ranging from to mm, Limited Contact Dynamic Compression Plates range from to and LC-DCP Systems.

3 Dynamic Compression Plates (DCP) and Dynamic Compression Plates with Limited Bone Contact (LC-DCP).Plate hole geometriesSymmetrical holesMost to mm Dynamic Compression Plates have sym-metrical holes similar to the LC-DCP hole. The symmetrical shape of the plate holes enables compression to be achieved in both directions, thus plate positioning is not restricted by the presence of a shaped DCP holes possess one compression and one neutral point on both sides. With some small and mini plates, the neutral points meet in the technique DCP and LC-DCP Systems DePuy Synthes 3 Undercuts of the LC-DCP limit contact between plate and holesThe DCP allows up to 25 longitudinal and 7 transverse screw holesThe DCP hole allows up to 50 longitudinal screw angulation for an increased range of applications. LC-DCP holes allow even wider angulations up to 80 . Both plate types allow for 14 transverse screw angulationsThe uniform stiffness of the LC-DCP allows smooth contouring of the plate to the bone.

4 It may protect the plate from localized high bending stiffness (LC-DCP only)L C- D C PStandardSymmetrical LC-DCP 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 DCP and LC-DCP Systems surgical TechniqueAO Principles 1 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. fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the reductionFracture reduction and fixation to restore anatomical , active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, technique DCP and LC-DCP Systems DePuy Synthes 5 Intended Use Intended UseDCP and LC-DCP System Implants are intended for tempo-rary fi xation, correction or stabi lization of bones in various anatomical DePuy Synthes DCP and LC-DCP Systems surgical TechniqueIndications and ContraindicationsIndicationsThis surgical technique applies to the below Synthes DCP and LC-DCP systems and plate lines.

6 Mini Fragment System , , Fractures of the middle and distal phalanges and tarsals Fractures of the metacarpals and metatarsals Osteotomies and arthrodeses on the hand and foot Fractures of the distal radius (double-plate technique )Compact Hand , , , , sizes : Fixation of small fragments Fractures of the distal and intermediate phalanges Avulsion fracturesImplant sizes : Fractures of the phalanges and metacarpals Capturing of fragments with lag screw techniqueImplant sizes : Fractures of the phalanges and metacarpals Capturing of fragments with lag screw techniqueCloverleaf Plates Distal tibia for comminuted fractures to buttress its medial side Proximal humerus for comminuted fractures of the hu-meral headOne-third tubular plate Fractures of smaller sized bones such as fibula, humerus and specific Plate , DCP Plate , T-Plate Fracture fixation and fixation after for example osteoto-mies, malunions, nonunions including but not limited to distal radius, proximal and disital tibia, proximal humerus, and Plate , DCP Plate , T-Plate , T-Buttress Plate , L-Buttress Plate Fractures and osteotomies of large bones such as femur, tibia and humerusSemi-Tubular Plate Fractures and osteotomies of smaller sized bones such as humerus, radius, ulna, clavicle, fibula.

7 Tibia and pelvis Condylar Buttress Plate Buttressing of multifragmentary distal femur fractures Supracondylar fractures Intra-articular and extra-articular condylar fractures Malunions and nonunions of the distal femur Periprosthetic fracturesLateral Tibial Head Buttress Plate Indicated for the stabilization of fractures of the proximal tibia. These include proximal shaft fractures, metaphyseal fractures, intra-articular fractures, periprosthetic fracturesProximal Tibial Plate for nonunions, malunions and fractures of the proximal tibia including simple, comminuted, lateral wedge, depression, medial wedge, bicondylar and combinations of lateral wedge and depression technique DCP and LC-DCP Systems DePuy Synthes 7 Preparation1 Plate contouringFor the treatment of juxta-articular fractures (distal tibia, tibial plateau, distal femur, distal humerus, radius etc.), good plate contouring to the shape of the bone is very important. Only then satisfactory reduction and adequate stability may be titanium has mechanical properties differing from stain-less steel.

8 Due to its lower modulus of elasticity, titanium is more springy. Therefore, titanium plates should be slightly over-bent to obtain the desired design of the LC-DC Plate ensures uniform rigidity, hence a continuous curvature after bending. The plates should not be bent beyond the necessary bending pliers or bending irons for plate : Avoid repeated bending. Sharp indentations on the plate surface, especially around the plate holes, may impair resistance to fatigue and should be avoided. Reverse bending or use of the incorrect instrumentation for bending may weaken the plate and lead to premature plate failure ( breakage). Do not bend the plate be-yond what is required to match the anatomy. 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 DePuy Synthes DCP and LC-DCP Systems surgical TechniqueReduction in implant stress by using a lag screw through the plate1.

9 2 Use of lag screws to achieve additional stability In certain circumstances, the use of a plate for fracture com-pression may be sufficient. In many fractures, however, it is advantageous to insert a lag screw through the plate to in-crease fracture stability and to achieve interfragmentary compression in the far cortex. If a fracture gap remains, the plate is subjected to high bending a lag screw through the plate reduces implant Klaue K et al. (1982) Die Entlastung der Osteosyntheseplatte durch interfragment re Plattenzugschraube. Helv. Chir. Acta 52, 19 23 PreparationSurgical technique DCP and LC-DCP Systems DePuy Synthes 9abDifferent drill guide types are available to perform drilling for DCP and LC-DCP fixation in both neutral and compression drill guides (DCP, sizes )Standard drill guides feature a simple tube to protect soft tissues while drilling. Depending on the positioning of the tube within the hole, neutral or eccentric (compression) drill-ing can be Guides for DCP and LC-DCP Neutral and eccentric drillingExamplea Drilling in neutral position Position the tube in the middle of the DCP Drilling in eccentric position compression Position the tube in plate hole remote from the DePuy Synthes DCP and LC-DCP Systems surgical Techniqueneutral positioninclined positioncompression positionbuttress position2 Universal drill guides (DCP and LC-DCP, sizes )Universal drill guides feature one end with a spring-loaded mechanism which facilitates all types of applications: Neutral position, compression position, buttress position (LC-DCP only) and especially the positioning of inclined lag screws through the Neutral position Depress the drill guide.

10 The upper part of the inner sleeve projects. Position the drill guide in the plate hole which is remote from the fracture (LC-DCP). When used with DC plates the drill guide automatically slides into the correct middle position when Compression position Do not depress the drill guide. The upper part is flush. Position the drill guide in the plate hole remote from the fracture. c Inclined position This technique is used for inserting lag screws through the plate. Place the drill guide in the hole adjacent to the fracture, depress (upper part projects), and set the desired drill Buttress position (LC-DCP only) Depress the drill guide as shown for neutral position (upper part projects). Position the drill guide in the plate hole adjacent to the Guides for DCP and LC-DCP surgical technique DCP and LC-DCP Systems DePuy Synthes 11neutral positionbuttress position: arrow points away from the fracturecompression position= symbol for a fracture linearrow points towards the fracture3LC-DCP drill guides ( and LC-DC plates)The LC-DCP drill guides can be used with LC-DC plates only.


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