3.5 mm variable angle lcp medial column fusion plating systemsynthes.vo.llnwd.net/o16/llnwmb8/us...

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SURGICAL TECHNIQUE 3.5 MM VARIABLE ANGLE LCP ® MEDIAL COLUMN FUSION PLATING SYSTEM Part of the 2.7 mm and 3.5 mm VA LCP ® Midfoot/Hindfoot System

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  • SurgIcal technIqueSurgIcal technIque

    3.5 mm VarIable angle lcP® medIal column fuSIon PlatIng SYStemPart of the 2.7 mm and 3.5 mmVA LCP® Midfoot/Hindfoot System

  • Image intensifier control

    2.7 mm and 3.5 mm Variable Angle LCP Midfoot/Hindfoot System Surgical Technique DePuy Synthes Trauma

    IntroductIon

    SurgIcal technIque

    Product InformatIon

    ao Principles and Indications 1

    3.5 mm Variable angle lcP® medial column 2 fusion Plates

    compression System 5

    3.5 mm Variable angle locking technique 7

    3.5 mm Variable angle lcP medial column 13 fusion Plates

    Implants 37

    Instruments 40

    Set configurations 45

    table of contentS

  • IntroductIonIntroduction

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 1

    ao PrIncIPleS and IndIcatIonS

    ao PrIncIPleSIn 1958, the ao formulated four basic principles, which have become the guidelines for internal fixation.1,2 they are:

    Anatomic reductionPrecontoured plates assist reduction to restore length, alignment, and rotation. anatomic reduction is mandatory for intra-articular fractures to restore joint congruency.

    Stable fixationVariable angle locking screws create a fixed angle construct, providing angular stability.

    Preservation of blood supplyPreservation of the blood supply to soft tissue and bone by careful handling.

    Early, active mobilizationPlate features combined with ao technique can create an environment for bone healing, expediting a return to optimal function.

    IndIcatIonS*the DePuy Synthes 2.7 mm and 3.5 mm Variable angle lcP midfoot/hindfoot System is indicated for fixation of osteotomies, fusions, fractures, nonunions, malunions, and replantations of small bones and small bone fragments in adult and adolescent (aged 12-21 years) patients, including the foot and ankle, and particularly in osteopenic bone.

    1 müller me, allgöwer m, Schneider r, Willenegger h. Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group. 3rd ed. Secaucus, nJ: Springer-Verlag; 1991.

    2 rüedi tP, buckley re, moran cg (eds). AO Principles of Fracture Management. 2nd ed. Stuttgart, new York: thieme. 2007.

    * these devices have not been evaluated for safety and compatibility in the mr environment. these devices have not been tested for heating and migration in the mr environment.

  • 2 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    3.5 mm VarIable angle lcP medIal column fuSIon PlateS

    3.5 mm VA LCP Medial Column Fusion Plates are designed with advanced stabilization capabilities for fusion applications, specifically charcot foot or severe arthritis.

    Plates are available for applications including dorsomedial, medial, medial with talus extension, and plantar.

    Innovative compression instrumentation provides the ability to independently compress each joint through the plate using forceps, 2.8 mm wires, and posts.• compression slots provide the ability to achieve

    4 mm–6 mm of compression through the plate

    Variable angle locking technology provides the ability to adapt screw trajectory to varied patient anatomy and to target specific areas of cortical bone.

    3.5 mm VA LCP Medial Column Fusion Plate, 78 mm• designed for arthrodesis of the first naviculocuneiform

    and tarsometatarsal joints

    3.5 mm VA LCP Medial Column Fusion Plate, 95 mm, Talus Extension• designed for arthrodesis of the talonavicular, first

    naviculocuneiform and tarsometatarsal joints

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 3

    3.5 mm Variable angle lcP medial column fusion Plates

    3.5 mm VA LCP Medial Column Fusion Plantar Plate, 78 mm• designed for arthrodesis of the first naviculocuneiform

    and tarsometatarsal• Plantar application for increased biomechanical

    strength, allowing the plate to be applied on the tension side of the medial column*

    *references:1. Vincent James Sammarco, Julie chevillet. the role of internal fixation in surgery

    of the charcot foot and the evolution of “super-construct” techniques. current orthopaedic Practice Volume 21, number 3, may/June 2010.

    2. Joshua P. nadaud, lew c. Schon. chronic charcot midfoot reconstruction. techniques in foot & ankle Surgery. Volume 9, number 3, September 2010.

    3. naohiro Shibuya, lacey d. clawson, monica r. agarwal. Suspension and dynamic compression of the medial column

  • 4 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    3.5 mm Variable angle lcP medial column fusion Plates

    Variable Angle Locking Screws are designed to sit flush within the plate holes* to reduce the likelihood of soft-tissue irritation.• 3.5 mm Variable angle locking Screw

    holes accept 3.5 mm Variable angle locking screws, 3.5 mm low-Profile cortex screws, and 3.5 mm cortex screws. 3.5 mm locking screws can be inserted at nominal angle

    • elongated screw holes accept 3.5 mm low-profile cortex or 3.5 mm cortex screws

    Plates are pre-contoured, with the ability to contour the plate shaft further, depending on the deformity and patient anatomy.

    Plates feature 1.6 mm K-wires holes for preliminary plate placement.

    * Variable angle locking screws sit flush within the plate when inserted at nominal angle.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 5

    comPreSSIon SYStem

    Compression Forceps• maintain tactile compression during screw insertion

    using the speed lock mechanism• can be used within the plate through the

    compression slots or elongated screw hole in the shaft of the plate

    Compression Wires• 2.8 mm diameter, 200 mm overall length• thread lengths from 10 mm to 60 mm in 5 mm

    increments• allow the plate to be drawn to the bone facilitating

    preliminary plate fixation• cobalt chromium alloy material that is stiffer than

    conventional stainless steel*

    3.5 mm Compression/Distraction Post for VA Locking Screw Hole• threads into Variable angle plate holes• use with compression forceps• Stardrive recess in head for insertion into plate and

    final tightening using torque limiter (2.5 nm)

    *cobalt chromium stiffness value: 186 gPa; Stainless Steel stiffness value: 243 mPa

  • 3.5 mm VarIable angle locKIng technIque

    3.5 mm

    Variable angle

    locking technique

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 7

    drIll for VarIable angle locKIng ScreWS: conIcal (VarIable angle)

    1Drill for variable angle locking screwsA. Conical (off nominal-axis) insertion

    3.5 mm VarIable angle locKIng technIque

    Instruments

    03.127.002 2.8 mm Variable angle double drill guide with cone 310.288 2.8 mm drill bit, quick coupling, 165 mm or 03.127.004 2.8 mm Variable angle Spherical drill guide, long 03.113.024 2.8 mm calibrated drill bit, quick coupling, 250 mm, 95 mm calibration

    to insert the Variable angle locking screw off the nominal axis, insert the cone-shaped side of drill guide in the desired variable angle locking screw hole in the plate.

    the funnel of the drill guide allows a drilling angle within a 30° cone.

    When drilling off-axis, the drill guide should remain in place and the drill bit may be aimed in any direction within the cone.

    Verify the drill bit angle and depth under radiographic imaging to ensure the desired angle has been achieved.

    If necessary, drill at a different angle and verify again under imaging.

    Precaution: Avoid excessive re-drilling, especially in poor bone quality.

  • 8 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    3.5 mm Variable angle locking technique

    Optional Techniquethe 2.8 mm Variable angle Spherical drill guide can be used to drill for a 3.5 mm Variable angle locking Screw.

    gently press the spherical tip of the Va drill guide into the variable angle locking hole to ensure the lip of the drill guide stops on the edge of the variable angle locking hole to prevent drilling beyond 15 degrees.

    toggle the drill guide to the desired angulation and drill. Note: The screw hole depth can be measured off of the 2.8 mm Calibrated Drill Bit, 250 mm (03.113.024) when using 2.8 mm Spherical Drill Guide (03.127.004). To do so, drill to the desired depth and verify that the plastic stop sits on the drill guide. Remove the drill bit and read the indicated drill depth below the plastic stop.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 9

    drIll for VarIable angle locKIng ScreWS: coaxIal (fIxed angle)

    3.5 mm Variable angle locking technique

    B. Coaxial (fixed angle) insertion

    Instruments

    03.127.002 2.8 mm Variable angle double drill guide with cone

    310.288 2.8 mm drill bit, quick coupling, 165 mm

    Additionally available

    03.127.001 2.8 mm fixed angle drill guide

    Variable angle locking screws can be inserted into the plate in line with the predefined screw trajectory.

    drill to the desired depth.

    Verify the drill bit depth under radiographic imaging.

  • 11 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    uSe the dePth gauge to meaSure for the correct ScreW length

    3.5 mm Variable angle locking technique

    Instrument

    319.09 depth gauge for Small Screws

    Additionally available

    03.118.007 Percutaneous depth gauge for 2.7 mm screws

    03.118.009 Percutaneous depth gauge adaptor for 3.5 mm screws

    use the depth gauge to measure for the correct screw length.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 11

    InSert VarIable angle locKIng ScreWS

    3.5 mm Variable angle locking technique

    2Insert variable angle locking screws

    Instruments

    03.111.038 handle with quick coupling

    314.116 StardrIVe™ Screwdriver Shaft, quick coupling, t15

    Insert the correct length variable angle locking screw.

    the Variable angle locking screws can be inserted manually or with power. for manual insertion, use the StardrIVe™ Screwdriver Shaft and handle with quick coupling. Initial insertion of Variable angle locking screws may be done using power equipment. do not lock the screws with power tools.

    confirm screw position and length prior to final tightening. final tightening must be done manually with the torque limiter.

    Precaution: • Do not engage the screw head with the plate hole

    while inserting under power. Screw engagement and final locking must be done manually with the torque limiter

    • Do not use the torque limiting handle for screw removal

  • 12 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    locK VarIable angle locKIng ScreWS

    3.5 mm Variable angle locking technique

    3Lock Variable Angle screws

    Instruments

    03.127.016 2.5 nm torque limiting handle with quick coupling

    314.116 StardrIVe Screwdriver Shaft, t15

    use the torque limiter for final tightening of Variable angle locking screws.

    the use of the torque limiter is mandatory when engaging the screws into variable angle locking holes to ensure the appropriate amount of torque is applied. confirm screw position and length prior to final tightening.

    Precaution: Do not lock the screws to the plate under power. Screw engagement and final tightening must be done manually with the torque limiting attachment or handle: • 2.5 Nm torque limiting handle for 3.5 mm• Do not use the torque limiters for screw removal

  • 3.5 mm Va lcP medIal column fuSIon PlateS

    3.5 mm

    Va lc

    P medial

    fusion Plates

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 13

    PreParatIon

    Required sets

    01.211.043 3.5 mm Va lcP medial column fusion Instrument and Implant Set or 01.211.044 3.5 mm Va lcP medial column fusion Plate module Set 01.118.012/ ankle trauma Set 01.118.014

    Optional sets

    01.212.005/ Small fragment lcP Instrument and 01.212.008 Implant set for 3.5 mm cortex screws

    01.211.045 general Instrument Set

    01.211.001 Joint Preparation Instrument Set

  • 14 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    1Position patient

    Place the patient in the supine position. Place a bump under the contralateral hip to facilitate visualization of the medial side.

    3.5 mm Va lcP medIal column fuSIon PlateS

    2Approach

    make a medial utility incision 1 cm below the medial malleolus, from the navicular down to the first metatarsal.

    When inserting the 3.5 mm VA LCP Medial Column Fusion Plantar Plate, make an incision at the junction of the plantar and medial skin, right above the abductor and inferior border of the first metatarsal.

    Note: Take care to avoid the tibialis anterior tendon.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 15

    3.5 mm Va lcP medial column fusion Plates

    3Prepare joint surfaces

    expose and prepare all the joints for fusion. anatomically align the tarsometatarsal axis. If necessary, correct deformities with bone resection or bone graft. the corrections should be performed to the estimated final shape of the foot.

    K-wires used to temporarily hold joints in place must be placed to avoid interference with final plate placement.

  • 11 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    3.5 mm Va lcP medial column fusion Plates

    Additionally available

    03.211.401 distraction forceps

    03.211.420– 1.6 mm compression Wires 03.211.440 150 mm length, 20 mm–40 mm thread or 03.211.456 bone Spreader, 8 mm tip width, one tooth, 210 mm

    Additionally available set

    01.211.001 Joint Preparation Instrument Set

    the Joint Preparation set chisels can be used to help prepare the bone for fusion. distraction forceps and 1.6 mm compression wires, or a bone Spreader can be used to open the joint for joint preparation.

    Note: Reference the Orthopaedic Foot Instrument Technique Guide for the Joint Preparation technique steps and product assembly.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 17

    3.5 mm Va lcP medial column fusion Plates

    4Contour plate (optional)

    Instruments

    329.04 bending Iron for 2.7 mm and 3.5 mm plates

    329.05 bending Iron for 2.7 mm and 3.5 mm plates

    Additionally available

    329.30 Plate-bending Press

    the medial column fusion Plates may require additional contouring in the shaft depending on patient anatomy and the desired correction of the medial arch. the plate should only be bent in between the Variable angle locking screw holes.

    Precaution: Excessive contouring may weaken the plate.

  • 18 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    3.5 mm Va lcP medial column fusion Plates

    5Position plate

    Instrument

    292.16 1.6 mm Kirschner Wire with trocar Point, 150 mm

    remove any bony prominences if needed. Provisionally fix the plate to the bone with 1.6 mm K-wires. confirm proper plate positioning prior to screw insertion.

    Precaution: Care should be taken to protect the anterior tibial tendon during plate application to maintain its integrity, as it inserts on the plantar medial aspect of the foot.

    the 3.5 mm Va lcP medial column fusion Plate, 78 mm is designed to span the navicular, cuneiform, and first metatarsal.

    the 3.5 mm Va lcP medial column fusion Plate, 95 mm is designed to span the talus, navicular, cuneiform, and first metatarsal.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 19

    3.5 mm Va lcP medial column fusion Plates

    the 3.5 mm Va lcP medial column fusion Plantar Plate, 78 mm is designed to span the navicular, cuneiform, and first metatarsal.

    Note: Osteophytes may need to be removed to facilitate placement of the plantar plate.

  • 21 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    3.5 mm Va lcP medial column fusion Plates

    6Insert screws and independently compress each joint

    to insert 3.5 mm Variable angle locking screws, follow the technique as described on page 7.

    If using the compression technique to independently compress each joint, follow the technique specified on the following pages for each plate:

    a) medial column fusion Plate, 78 mm page 21b) medial column fusion Plate, talus extension, page 26

    95 mmc) medial column fusion Plantar Plate, 78 mm page 30

    Instruments for Compression Technique

    03.118.015– 2.8 mm compression Wires, 200 mm 03.118.040 length, 15 mm–40 mm thread lengths

    03.118.002 large compression forceps

    03.118.005 3.5 mm compression/distraction Post for Va locking hole

    03.127.016 2.5 nm torque limiting handle with quick coupling

    314.116 StardrIVe Screwdriver Shaft, quick coupling, t15

    03.111.038 handle with quick coupling

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 21

    a) 3.5 mm Va lcP medIal column fuSIon Plate, 78 mm

    3.5 mm Va lcP medial column fusion Plates

    To compress the naviculocuneiform joint:

    a 1)Insert a 3.5 mm Va locking screw into the navicular portion of the plate in the lateral hole following the Variable angle locking screw insertion technique on page 7.

  • 22 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    a) 3.5 mm Va lcP medIal column fuSIon Plate, 78 mm

    3.5 mm Va lcP medial column fusion Plates

    a 2)Insert a compression post into the navicular portion of the plate in the medial or center hole.

    Precaution: The compression post needs to be inserted and locked using the 2.5 Nm torque limiter.

    using a wire driver, insert a 2.8 mm compression wire into the compression slot in the cuneiform portion of the plate. Insert the wire as far distal as anatomy permits to maximize compression.

    Precaution: • Bicortical fixation is recommended• To minimize stripping of the wire threads, wire

    insertion should proceed slowly when the spherical stop nears the plate. Control the insertion for tactile confirmation of compression between the wire, the plate, and the bone

    remove K-wires before compressing.

    a 3)compress the joint using the compression forceps. thread the speed nut counterclockwise so the forceps are in their open position. Place the compression forceps into position, with the tips around the spheres of the compression wire and post.

    compress by squeezing the handles.

    Precaution: Do not exert excessive force as this may cause the compression wire to strip out of the bone.

    to lock the device, thread the speed nut clockwise while maintaining pressure on the forceps.

    Note: The total amount of compression that can be achieved through the compression slot is 6 mm.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 23

    a) 3.5 mm Va lcP medIal column fuSIon Plate, 78 mm

    3.5 mm Va lcP medial column fusion Plates

    a 4)Insert a 3.5 mm Va locking screw in the proximal hole of the cuneiform portion of the plate following the Variable angle locking screw insertion technique on page 7.

    remove the compression forceps and 2.8 mm compression wire. leave the compression post in the current position.

  • 24 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    a) 3.5 mm Va lcP medIal column fuSIon Plate, 78 mm

    3.5 mm Va lcP medial column fusion Plates

    To compress the first tarsometatarsal joint:

    a 5) Insert a 2.8 mm compression wire into the elongated screw hole in the metatarsal portion of the plate. Insert the wire as far distal as anatomy permits to maximize compression. reference a2 for specific technique.

    remove K-wires before compressing.

    a 6)compress the joint using the compression forceps. reference a3 for specific technique.

    Note: The elongated screw hole can achieve up to 4 mm of compression.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 25

    3.5 mm Va lcP medial column fusion Plates

    a 7)Insert a 3.5 mm Va locking screw in either open hole in the metatarsal portion of the plate following the Variable angle locking screw insertion technique on page 7.

    remove the 2.8 mm compression wire and the compression post.

    Precaution: The compression posts should be removed using the STARDRIVE Screwdriver Shaft and Handle with quick coupling. Do not remove the posts with the torque limiter.

    Insert additional screws into the open holes of the plate as needed.

    Precaution: It is recommended to fill three 3.5 mm Variable Angle Locking screw holes in the navicular portion of the plate, and two screw holes per additional segment.*

    a) 3.5 mm Va lcP medIal column fuSIon Plate, 78 mm

    *testing on file at dePuy Synthes companies, april 2013.

  • 21 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    3.5 mm Va lcP medial column fusion Plates

    b) 3.5 mm Va lcP medIal column fuSIon Plate, 95 mm, taluS extenSIon

    To compress the naviculocuneiform joint:

    b 1)Insert a 3.5 mm Va locking screw into the navicular portion of the plate in the lateral hole following the Variable angle locking screw insertion technique on page 7.

    b 2)Insert a compression post in the open hole in the navicular portion of the plate.

    Precaution: The compression post needs to be inserted and locked using the 2.5 Nm torque limiter.

    using a wire driver, insert a 2.8 mm compression wire into the compression slot in the cuneiform portion of the plate. reference a2 for specific technique.

    Precaution: Bicortical fixation is recommended.

    remove K-wires before compressing.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 27

    b) 3.5 mm Va lcP medIal column fuSIon Plate, 95 mm, taluS extenSIon

    3.5 mm Va lcP medial column fusion Plates

    b 3)compress the joint using the compression forceps. reference a3 for specific technique.

    Note: The total amount of compression that can be achieved through the compression slot is 6 mm.

    b 4)Insert a 3.5 mm Va locking screw in the most proximal hole within cuneiform portion of the plate following the Variable angle locking screw insertion technique on page 7.

    remove the compression forceps and compression wire. leave the compression post in the current position.

  • 28 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    b) 3.5 mm Va lcP medIal column fuSIon Plate, 95 mm, taluS extenSIon

    3.5 mm Va lcP medial column fusion Plates

    To compress the first tarsometatarsal joint:

    b 5)Insert a 2.8 mm compression wire into the elongated screw hole within the metatarsal portion of the plate. reference a2 for specific technique.

    remove K-wires before compressing.

    b 6)compress the joint using compression forceps.

    reference a3 for specific technique.

    Note: The elongated screw hole can achieve up to 4 mm of compression.

    b 7)Insert a 3.5 mm Va locking screw into an open hole within the metatarsal portion of the plate following the Variable angle locking screw insertion technique on page 7.

    remove the compression forceps and the 2.8 mm compression wire. leave the compression post in the current position.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 29

    b) 3.5 mm Va lcP medIal column fuSIon Plate, 95 mm, taluS extenSIon

    3.5 mm Va lcP medial column fusion Plates

    To compress the talonavicular joint:

    b 8)Insert a 2.8 mm compression wire into the compression slot within the talus portion of the plate. reference a2 for specific technique.

    remove K-wires before compressing.

    b 9)compress the joint using compression forceps.

    reference a3 for specific technique.

    Note: The total amount of compression that can be achieved through the compression slot is 4 mm.

    b 10)Insert a 3.5 mm Va locking screw into the lateral screw hole within the talus portion of the plate following the Variable angle locking screw insertion technique on page 7.

    remove the compression forceps, 2.8 mm compression wire, and compression post.

    Insert additional screws into the open holes of the plate as needed following the Va locking screw insertion technique on page 7.

    Precaution: It is recommended to fill two 3.5 mm VA Locking screw holes per segment.*

    *testing on file at dePuy Synthes companies, april 2013.

  • 31 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    c) 3.5 mm Va lcP medIal column fuSIon Plantar Plate, 78 mm

    3.5 mm Va lcP medial column fusion Plates

    To compress the naviculocuneiform joint:

    c 1)Insert a 3.5 mm Va locking screw into the lateral hole in the navicular portion of plate following the Variable angle locking screw insertion technique on page 7.

    c 2)Insert a compression post into the open hole in the navicular portion of the plate.

    Precaution: The compression post needs to be inserted and locked using the 2.5 Nm torque limiter.

    using a wire driver, insert a 2.8 mm compression wire into the compression slot within the cuneiform portion of the plate. reference a2 for specific technique.

    Precaution: Bicortical fixation is recommended.

    remove K-wires before compressing.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 31

    3.5 mm Va lcP medial column fusion Plates

    c) 3.5 mm Va lcP medIal column fuSIon Plantar Plate, 78 mm

    c 3)compress the joint using the compression forceps. reference a3 for specific technique.

    Note: The total amount of compression that can be achieved through the compression slot is 6 mm.

    c 4)Insert a 3.5 mm Va locking screw in the proximal hole within the cuneiform portion of the plate following the Variable angle locking screw insertion technique on page 7.

    remove the compression forceps and the compression wire. leave the compression post in the current position.

  • 32 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    c) 3.5 mm Va lcP medIal column fuSIon Plantar Plate, 78 mm

    3.5 mm Va lcP medial column fusion Plates

    To compress the first tarsometatarsal joint:

    c 5)Insert a 2.8 mm compression wire into the elongated screw hole within the metatarsal portion of the plate. reference a2 for specific technique.

    remove K-wires before compressing.

    c 6)compress the joint using the compression forceps.

    reference a3 for specific technique.

    Note: The elongated screw hole can achieve up to 4 mm of compression.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 33

    c) 3.5 mm Va lcP medIal column fuSIon Plantar Plate, 78 mm

    3.5 mm Va lcP medial column fusion Plates

    c 7)Insert a 3.5 mm Va locking screw in the metatarsal portion of the plate following the Variable angle locking screw insertion technique on page 7.

    remove the compression wire and compression post.

    Precaution: The compression posts should be removed using the STARDRIVE Screwdriver Shaft and Handle with quick coupling. Do not remove the posts with the torque limiter.

    Insert additional screws into the open holes of the plate as needed.

    Precaution: It is recommended to fill two Variable Angle Locking screw holes per segment.*

    *testing on file at dePuy Synthes companies, april 2013.

  • 34 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    3.5 mm Va lcP medial column fusion Plates

    7Lock Variable Angle Locking Screws

    lock the 3.5 mm Variable angle locking screws manually with the 2.5 nm torque limiting handle, as described in the Variable angle locking technique on page 12.

    confirm fixation and positioning of the plate and screws under fluoroscopic imaging.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 35

    3.5 mm Va lcP medial column fusion Plates

    Implant removal

    Instruments

    314.116 StardrIVe Screwdriver Shaft, t15

    03.111.038 handle with quick coupling

    Optional set

    01.240.001 Screw removal Set

    Optional instrument

    309.520 conical extraction Screw, for 2.7 mm and 3.5 mm cortex Screws

    If implant removal is desired, unlock all screws manually from the plate using the proper screwdriver shaft and handle. then remove the screws completely from the bone.

    Precaution: Do not use the torque limiters for screw removal.

    If the screws cannot be removed with the screwdriver, insert the conical extraction screw with the left-handed thread into the screwhead using the handle with quick coupling, and loosen the screw by turning counterclockwise.

  • ImPlantS and InStrumentSIm

    plants and Instruments

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 37

    ScreWS for the 3.5 mm VarIable angle lcP medIal column fuSIon PlateS

    The 3.5 mm Variable Angle LCP Medial Column Fusion plates accept the following screws:

    3.5 mm Variable Angle Locking Screwsthreaded, rounded head locks securely into the variable angle locking holes• locked screws allow unicortical screw fi xation and load

    transfer to the near cortex• used with 2.8 mm drill bit• t15 StardrIVe recess• Self-tapping• color coded for easier identifi cation• Screws in set: 12 mm–50 mm (02.127.112–02.127.150)• additionally available: 10 mm–95 mm

    (02.127.110–02.127.195)

    3.5 mm Low-profi le Cortex Screwsfor use in locking, non-locking, or combi holes• used to provide compression or neutral fi xation • low-profi le head• used with 2.5 mm drill bit• t15 StardrIVe recess• Self-tapping tip• Screws in set: 12 mm–50 mm (02.206.212–02.206.250)• additionally available: 10 mm–110 mm

    (02.206.210–02.206.310)

  • 38 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    Screws for the 3.5 mm Variable angle lcP medial column fusion Plates

    3.5 mm Locking Screws*only for axial insertion in the variable angle locking holes• threaded, conical head locks securely into the variable

    angle locking holes• used with 2.8 mm drill bit• t15 StardrIVe recess• Self-tapping tip• additionally available: 10 mm –95 mm

    (212.101–212.131)

    3.5 mm Cortex Screws*for use in locking, non-locking, or combi holes• used to provide compression or neutral fi xation • used with 2.5 mm drill bit• Self-tapping tip • available with t15 StardrIVe or Small hexagonal recess • additionally available: StardrIVe recess 10 mm–150 mm

    (02.200.010–02.200.150)hexagonal recess 10 mm–110 mm (204.810–204.910)

    *also available.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 39

    ImPlantS

    3.5 mm VA LCP Medial Column Fusion Plate*

    Stainless Steel Right/Left Size (mm)

    02.211.416 right 78

    02.211.417 left 78

    3.5 mm VA LCP Medial Column Fusion Plate, Talus Extension*

    Stainless Steel Right/Left Size (mm)

    02.211.420 right 95

    02.211.421 left 95

    3.5 mm VA LCP Medial Column Fusion Plantar Plate*

    Stainless Steel Right/Left Size (mm)

    02.211.418 right 78

    02.211.419 left 78

    * available non sterile or sterile packed. add “S” to catalog number to order sterile product.

    right

    right

    right

    left

    left

    left

  • 41 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    InStrumentS for 3.5 mm VarIable angle lcP medIal column fuSIon PlateS

    310.288 2.8 mm drill bit, quick coupling, 165 mm

    03.127.002 2.8 mm Variable angle double drill guide with cone

    03.127.001 2.8 mm fixed angle drill guide

    03.127.004 2.8 mm Variable angle Spherical drill guide, long

    for 3.5 mm VarIable angle locKIng and cortex ScreWS

    310.23 2.5 mm drill bit, quick coupling, 180 mm

    310.35 3.5 mm drill bit, quick coupling, 110 mm

    312.28 3.5 mm/2.5 mm double drill Sleeve

    03.113.024 2.8 mm calibrated drill bit, quick coupling, 250 mm, 95 mm calibration

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 41

    Instruments for 3.5 mm Variable angle lcP medial column fusion Plates

    03.111.038 handle with quick coupling

    319.09 depth gauge for small screws

    314.116 StardrIVe Screwdriver Shaft quick coupling, t15

    03.127.016 2.5 nm torque limiting handle with quick coupling

    292.16 1.6 mm Kirschner Wire with trocar point, 150 mm

    03.118.002 large compression forceps

    2.8 mm compression Wires, 200 mm thread length (mm)03.118.015 1503.118.020 2003.118.025 2503.118.030 3003.118.035 3503.118.040 40

  • 42 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    Instruments for 3.5 mm Variable angle lcP medial column fusion Plates

    bending Irons 329.04 for 2.7 mm and 3.5 mm plates 329.05 for 2.7 mm and 3.5 mm plates

    alSo aVaIlable

    03.118.007 Percutaneous depth gauge for 2.7 mm screws

    03.118.009 Percutaneous depth gauge adaptor for 3.5 mm screws

    03.118.005 3.5 mm compression/distraction Post for Va locking hole

    03.118.003 large distraction forceps

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 43

    03.211.456 bone Spreader, 8 mm beak width, one tooth, 210 mm length

    03.211.467 hohmann retractor, 8 mm width, narrow tip, 148 mm length

    319.391 Sharp hook-Small taper

    bending Irons 329.04 for 2.7 mm and 3.5 mm plates329.05 for 2.7 mm and 3.5 mm plates

    391.962 bending/cutting Pliers

    391.963 universal bending Pliers

    398.96 Stagbeetle forceps, 125 mm

    general InStrumentS

  • 44 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    general Instruments

    Periosteal elevators399.36 6 mm curved blade, round edge399.48 3 mm curved blade, straight edge399.481 3 mm curved blade, round edge

    reduction forceps with ratchet points 399.94 174 mm 399.97 130 mm399.98 200 mm

    399.99 reduction forceps with serrated Jaw ratchet, 144 mm

    alSo aVaIlable399.195 hohmann retractor, 8 mm round tip,

    215 mm

    399.197 hohmann retractor, 8 mm narrow tip, 215 mm

  • 3.5 mm Va lcP medIal column fuSIon InStrument and ImPlant Set StaInleSS Steel (01.211.043)

    Graphic Case61.116.034 graphic case, full length, 2 high

    60.211.026 tray for 3.5 mm Va lcP medial column fusion Plates and Instruments

    60.211.027 Screw rack for 3.5 mm Variable angle locking and 3.5 mm cortex, low-Profile head Screws

    60.211.028 tray for compression/distraction forceps and Instruments

    60.116.019 Support Posts for Screw rack for modular graphic cases

    Instruments

    Tray 60.211.02603.111.038 handle with quick coupling

    03.127.001 2.8 mm fixed angle drill guide

    03.127.002 2.8 mm Variable angle double drill guide with cone

    03.127.004 2.8 mm Variable angle Spherical drill guide, long

    03.127.016 2.5 nm torque limiting handle with quick coupling*

    292.16 1.6 mm Kirschner Wire with trocar point, 150 mm

    310.23 2.5 mm drill bit, quick coupling, 180 mm, 2 ea.

    310.288 2.8 mm drill bit, quick coupling, 165 mm, 2 ea.

    310.35 3.5 mm drill bit, quick coupling, 110 mm, 2 ea.

    312.28 3.5 mm/2.5 mm double drill Sleeve

    314.116 StardrIVe Screwdriver Shaft, quick coupling, t15, 2 ea.

    319.09 depth gauge for small screws

    bending Irons

    329.04 for 2.7 mm and 3.5 mm plates

    329.05 for 2.7 mm and 3.5 mm plates

    for detailed cleaning and sterilization instructions, please refer to: www.synthes.com/cleaning-sterilization In canada, the cleaning and sterilization instructions will be provided with the loaner shipments.

    3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 45

    * recalibration of the torque limiter: dePuy Synthes companies recommends annual servicing and inspection by the original manufacturer. the torque limiter has to be sent to your dePuy Synthes repair center annually for calibration. the user accepts the responsibility for this annual calibration.

    60.211.026

  • Implants

    Tray 60.211.0263.5 mm Va lcP medial column fusion Plate*

    Stainless Steel right/left Size (mm)

    02.211.416 right 78

    02.211.417 left 78

    3.5 mm Va lcP medial column fusion Plate, talus extension*

    Stainless Steel right/left Size (mm)

    02.211.420 right 95

    02.211.421 left 95

    3.5 mm Va lcP medial column fusion Plantar Plate*

    Stainless Steel right/left Size (mm)

    02.211.418 right 78

    02.211.419 left 78

    41 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    3.5 mm Va lcP medial column fusion Instrument and Implant Set Stainless Steel (01.211.043)

    Tray 60.211.02803.118.002 large compression forceps

    03.118.005 3.5 mm compression/distraction Post for Va locking hole, 2 ea.

    03.113.024 2.8 mm calibrated drill bit, quick coupling, 250 mm, 95 mm calibration

    2.8 mm compression Wires, 200 mm, thread length (mm)

    03.118.015 15

    03.118.020 20

    03.118.025 25

    03.118.030 30

    03.118.035 35

    03.118.040 40

    Screw Rack 60.211.027319.97 Screw forceps

    60.211.028

    *available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.

  • 3.5 mm Va lcP medial column fusion Instrument and Implant Set Stainless Steel (01.211.043)

    3.5 mm cortex Screws, low Profile head, self-tapping, t15 StardrIVe recess, 2 ea.

    Stainless length Stainless length Steel (mm) Steel (mm)

    02.206.212 12 02.206.232 32

    02.206.214 14 02.206.234 34

    02.206.216 16 02.206.236 36

    02.206.218 18 02.206.238 38

    02.206.220 20 02.206.240 40

    02.206.222 22 02.206.242 42

    02.206.224 24 02.206.244 44

    02.206.226 26 02.206.246 46

    02.206.228 28 02.206.248 48

    02.206.230 30 02.206.250 50

    3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 47

    Screw Rack 60.211.0273.5 mm Variable angle locking Screws, self-tapping, with t15 StardrIVe recess* 12–40 mm, 3 ea., 42–50 mm, 2 ea.

    Stainless length Stainless length Steel (mm) Steel (mm)

    02.127.112 12 02.127.132 32

    02.127.114 14 02.127.134 34

    02.127.116 16 02.127.136 36

    02.127.118 18 02.127.138 38

    02.127.120 20 02.127.140 40

    02.127.122 22 02.127.142 42

    02.127.124 24 02.127.144 44

    02.127.126 26 02.127.146 46

    02.127.128 28 02.127.148 48

    02.127.130 30 02.127.150 50

    60.211.027

  • 48 DePuy Synthes Trauma 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique

    3.5 mm Va lcP medIal column fuSIon Plate module Set StaInleSS Steel (01.211.044)

    Graphic Case60.116.052 module Shell

    60.211.029 module bin for 3.5 mm Va lcP medial column fusion Plates

    60.116.201 auxiliary bin, full length, 1/2 height

    60.211.034 label pack for 3.5 mm Va lcP medial column fusion Plate Set

    Implants Module Bin 60.211.0293.5 mm Va lcP medial column fusion Plate*

    Stainless Steel right/left Size (mm)

    02.211.416 right 78

    02.211.417 left 78

    3.5 mm Va lcP medial column fusion Plate, talus extension*

    Stainless Steel right/left Size (mm)

    02.211.420 right 95

    02.211.421 left 95

    3.5 mm Va lcP medial column fusion Plantar Plate*

    Stainless Steel right/left Size (mm)

    02.211.418 right 78

    02.211.419 left 78

    *available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.

  • 3.5 mm Variable Angle LCP Medial Column Fusion Plates Surgical Technique DePuy Synthes Trauma 49

    general InStrument Set (01.211.045)

    Graphic Case61.116.003 graphic case, full length, 1 high

    60.211.030 general Instrument tray, full length

    60.211.037 label pack for general Instrument Set

    Instruments03.211.467 hohmann retractor, 8 mm width,

    narrow tip, 148 mm, 4 ea.

    03.211.456 bone Spreader, 8 mm tip width, one tooth, 210 mm length

    319.391 Sharp hook-Small taper

    bending Irons

    329.04 for 2.7 mm and 3.5 mm plates

    329.05 for 2.7 mm and 3.5 mm plates

    391.962 bending/cutting Pliers

    391.963 universal bending Pliers, 2 ea.

    398.96 Stagbeetle forceps, 125 mm

    Periosteal elevators

    399.36 6 mm curved blade, round edge

    399.48 3 mm curved blade, straight edge

    399.481 3 mm curved blade, round edge

    reduction forceps with points, ratchet

    399.94 174 mm

    399.97 130 mm

    399.98 200 mm

    399.99 reduction forceps with serrated jaw ratchet, 144 mm

  • Legal manufacturer in Canada:

    Synthes (Canada) Ltd. 2566 meadowpine boulevard mississauga, ontario l5n 6P9 telephone: (905) 567-0440 to order: (800) 668-1119 fax: (905) 567-3185

    Manufactured or distributed in the United States by:

    Synthes, Inc.1301 goshen ParkwayWest chester, Pa 19380 telephone: (610) 719-5000 to order: (800) 523-0322

    www.depuysynthes.com

    © dePuy Synthes trauma, a division of doI 2014. all rights reserved.dSuS/trm/0814/0193 8/14 dV

    CAUTION: Federal Law Restricts These Devices To Sale By Or On The Order Of A Physician.

    Some devices listed in this technique guide 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.