Part of the DePuy Synthes Variable Angle Locking Compression Plate (VA LCP®) System 2.7 mm/3.5 mm Variable Angle LCP® Ankle Trauma System Surgical Technique Table of Contents Introduction 2.7 mm/3.5 mm Variable Angle LCP Ankle 5 Trauma System AO Principles 6 Indications 7 System Features 2.7 mm/3.5 mm Variable Angle LCP Technology 9 Plates – Distal Tibia Plates 10 – Anteromedial Distal Tibia Plates 11 – Anterolateral Distal Tibia Plates 12 – Distal Tibia T- and L- Plates 13 – Lateral Distal Fibula Plates 14 Compression and Distraction System 15 Guide Blocks 17 Reduction Forceps 18 Surgical Technique Compression and Distraction System Technique: 19 Compressing or Distracting a Fracture or Osteotomy 2.7 mm/3.5 mm Variable Angle Locking Technique 23 2.7 mm/3.5 mm VA LCP Medial and Anteromedial Distal Tibia Plate Technique – Preparation 31 – Reduce Articular Surface 33 – Insert Plate 34 – Position Plate and Fix Provisionally 35 – Insert Distal Screws 36 – Anteromedial Plate—Insert Screws in Arm 38 – Insert Shaft Screws 38 – Lock Variable Angle Screws 39 MR Information – Confirm Reduction and Fixation 39 The 2.7 mm/3.5 mm Variable Angle LCP Ankle Trauma 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 2.7 mm/3.5 mm Variable Angle LCP Ankle Trauma System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury. Image intensifier control 2.7 mm/3.5 mm Variable Angle LCP® Ankle Trauma System Surgical Technique DePuy Synthes 1 Table of Contents Surgical Technique 2.7 mm/3.5 mm VA LCP Anterolateral Distal Tibia Plate Technique – Preparation 41 – Reduce Articular Surface 43 – Insert Plate 44 – Position Plate and Fix Provisionally 45 – Insert Distal Screws 46 – Insert Shaft Screws 47 – Lock Variable Angle Screws 47 – Confirm Reduction and Fixation 48 – Repair Joint Capsule 48 2.7 mm VA LCP Lateral Distal Fibula Plate Technique – Preparation 49 – Reduce Fracture 51 – Insert Plate 52 – Position Plate and Fix Provisionally 53 – Insert Distal Screws 54 – Insert Shaft Screws 55 – Insert Screw(s) in Syndesmotic slots 56 – Lock Variable Angle Screws 57 – Confirm Reduction and Fixation 57 2.7 mm VA LCP Distal Tibia T- and L-Plate Technique – Preparation 59 – Reduce Articular Surface 61 – Insert Plate 62 – Position Plate and Fix Provisionally 63 – Insert Shaft Screw 64 – Insert Distal Screws 65 – Lock Variable Angle Screws 66 – Confirm Reduction and Fixation 66 Implant Removal 67 2 DePuy Synthes 2.7 mm/3.5 mm Variable Angle LCP® Ankle Trauma System Surgical Technique Table of Contents Product Information Implants 69 Instruments 75 Set Configurations 84 2.7 mm/3.5 mm Variable Angle LCP® Ankle Trauma System Surgical Technique DePuy Synthes 3 Introduction and Indications 2.7 mm/3.5 mm Variable Angle LCP Ankle Trauma System The 2.7 mm/3.5 mm Variable Angle LCP® Ankle Trauma System consists of: – Medial Distal Tibia Plates of articular fragments and to confirm – Anteromedial Distal Tibia Plates the location of the plate relative to the – Anterolateral Distal Tibia Plates distal tibia and fibula. These are – Distal Tibia T- and L-Plates periarticular plates that are less thick – Lateral Distal Fibula Plates in the metaphyseal region and not ideal for the treatment of primarily The plates are part of the metaphyseal or tibial shaft fractures. DePuy Synthes Variable Angle These are primarily for the treatment Locking Compression (VA LCP) of articular injuries. System that merges variable angle locking screw technology with Fixation with the system has many conventional plating techniques. similarities to traditional plate fixation methods with several important The plates are available in stainless improvements. Variable angle locking steel and feature an anatomic shape screws provide the ability to create a and profile, both distally and along the fixed-angle construct at the desired limited-contact shaft. The Combi holes screw angle while using standard in the shaft portion of the Variable AO plating techniques. Variable angle Angle LCP Plate combine a dynamic locking provides the capability for compression unit (DCU) hole with a fixed-angle constructs in osteopenic variable angle locking screw hole. bone in multifragmentary fractures Combi holes provide the flexibility of where screw purchase is compromised axial compression and variable angle and in fracture patterns where the locking capability throughout the screw direction must be altered to allow length of the plate shaft. The Combi maximum fragment engagement. holes allow fixation with locking screws Similar to other locking screws, the in the threaded section for angular variable angle screws do not rely on stability, and cortex screws in the dynamic plate-to-bone compression to resist compression unit (DCU) section for patient load, but function similarly to compression. Distally, the fixed-angle multiple, small, angled blade plates. construct is designed to facilitate fixation of small metaphyseal and epiphyseal The sets are modular which allows segments where traditional screw customized selection of implants. This fixation may be limited. The K-wire holes may reduce inventory and overall costs accept wires up to 1.6 mm in diameter by eliminating seldom-used implants. to provisionally maintain the reduction 2.7 mm/3.5 mm Variable Angle LCP® Ankle Trauma System Surgical Technique DePuy Synthes 5 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 fixation1, 2. 4_Priciples_03.pdf 1 05.07.12 12:08 Anatomic reduction Stable fixation Anatomic reduction Stable fixation Fracture reduction and fixation to Fracture fixation providing absolute Fracture reduction and fixation to Fracture fixation providing abso- restore anatomical relationships. or relative stability, as required by restore anatomical relationships. lute or relative stability, as the patient, the injury, and the required by the patient, the injury, 1 2 personality of the fracture. and the personality of the fracture. EEaarrllyy,, aaccttiivvee mmoobbiilliizzaattiioonn PPrreesseervrvataitoino no fo bf lboloodo dsu spupplyply 4 3 EEaarrlyly aanndd ssaaffee mmoobbiilliizzaattiioonn aanndd PPrreesseervrvaatitoionn o of ft hthee b blolooodd s uspupplpyl y rreehhaabbiliiltitaattiioonn ooff tthhee iinnjjuurreedd ppaarrtt ttoo ssoofftt t itsisssuuees sa anndd b boonnee b by yg entle aanndd tthhee ppaattiieenntt aass aa wwhhoollee.. rgedenutclteio rne dteucchtinoinq uteesc hannidq u es and ccaarreeffuul lh haannddlilningg.. 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. 6 DePuy Synthes 2.7 mm/3.5 mm Variable Angle LCP® Ankle Trauma System Surgical Technique 4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique Indications The Synthes 2.7 mm/3.5 mm Variable Angle LCP Ankle Trauma System is intended for fixation of the ankle in adults and adolescents (12–21) in which the growth plates have fused, and particularly in osteopenic bone. Medial and Anteromedial Distal Tibia Plates Intended for fixation of osteotomies, fractures, nonunions, malunions, and replantations of bones and bone fragments of the diaphyseal and metaphyseal regions of the distal tibia. Anterolateral Distal Tibia Plates Intended for fixation of osteotomies, fractures, nonunions, malunions, and replantations of bones and bone fragments of the diaphyseal and metaphyseal regions of the distal tibia. Distal Tibia T-Plates and Distal Tibia L-Plates Intended to buttress partial articular fractures and bone fragments of the distal tibia. Lateral Distal Fibula Plates Intended for fixation of osteotomies, fractures, nonunions, malunions, and replantations of bones and bone fragments of the diaphyseal and metaphyseal regions of the distal fibula. 2.7 mm/3.5 mm Variable Angle LCP® Ankle Trauma System Surgical Technique DePuy Synthes 7 System Features 2.7 mm/3.5 mm Variable Angle LCP Technology Plates The plates feature variable angle locking holes, with or without the dynamic compression portion. Four columns of threads in the variable angle locking hole provide four points of threaded locking between the plate and the variable angle locking screw to create a fixed-angle construct at the desired screw angle. – Plate holes accept 2.7 mm and 3.5 mm variable angle locking screws – 2.7 mm or 3.5 mm variable angle locking screws create a fixed-angle construct, with up to 15° off-nominal axis screw angulation (variable angulation within a 30° cone of angulation) – Standard 2.7 mm and 3.5 mm locking screws can be used in the variable angle holes. However, these screws can only be placed coaxially (along the nominal axis of the variable angle holes) – 2.7 mm or 3.5 mm cortex screws can be used in the plate positioning slots for traditional compression and fixation. The 2.7 mm cortex screws can be used in the locking holes in the head of plates – 2.7 mm metaphyseal screws can be used in the plate head to compress the plate to the bone – 4.0 mm or 3.5 mm cortex screws can be used in the slotted holes in the fibula plates for placement of syndesmotic screws Note: Refer to plate features for details on screw locations and sizes for each plate (see pages 10–14). 2.7 mm/3.5 mm Variable Angle LCP® Ankle Trauma System Surgical Technique DePuy Synthes 9