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For Minimally Invasive Osteosynthesis

3.5 mm and 4.5 mm Curved Locking Compression Plates (LCP®)Surgical Technique

3.5 mm and 4.5 mm Curved Locking Compression Plates (LCP®) Surgical Technique DePuy Synthes 1

Table of Contents

3.5 mm and 4.5 mm Curved Locking Compression 2 Plates (LCP)

AO Principles 5

Indications 6

Fixation Principles 7

Minimally Invasive Reduction and 12 Plate Insertion Instruments

Toothed Reduction Handles (Bicortical) 13 for Enhanced Rotational Stability

Plate Contouring (optional) 16

Plate Insertion 17

Reduction and Temporary Plate Placement 20

Screw Insertion 21

Screw Placement Verification 26

Implant Removal 28

Implants 29

Instruments 31

Set Lists 36

Introduction

Surgical Technique

Product Information

MR Information The 3.5 mm and 4.5 mm Curved LCPs 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 3.5 mm and 4.5 mm Curved LCPs in the MR environment is unknown. Scanning a patient who has this device may result in patient injury.

Image intensifier control

2 DePuy Synthes 3.5 mm and 4.5 mm Curved Locking Compression Plates (LCP®) Surgical Technique

The DePuy Synthes Locking Compression Plates (LCP®) are part of a plate and screw system that merges locking screw technology with conventional plating techniques. The Locking Compression Plate System has many similarities to existing plate fixation methods, but with a few important enhancements. Locking screws provide the ability to create a fixed-angle construct while utilizing familiar AO plating techniques. A fixed-angle construct provides advantages in osteopenic bone or multifragment fractures where

traditional screw purchase is compromised. Locking screws do not rely on plate-to-bone compression to maintain stability, but function similarly to multiple small angled blade plates.

Plate featuresThe Locking Compression Plates (LCP) – Uniform hole spacing

– Load (compression) and neutral screw positions

3.5 mm and 4.5 mm Curved Locking Compression Plates (LCP®)


3.5 mm and 4.5 mm Curved Locking Compression Plates (LCP)

Combi holesThe Combi holes allow placement of standard cortex and cancellous bone screws on one side or threaded conical locking screws on the opposite side of each hole.

Threaded hole section for locking screws

Dynamic compression unit (DCU) hole section for standard screws

Locking screw in threaded side of plate hole

Cortex screw in compression side of plate hole

Holes in these plates are oriented so that the compression of the hole is always directed toward the middle of the plate.


Locking screws, self-tapping, with StarDriveTM RecessThe locking screws mate with the threaded plate holes to form a fixed-angle construct.

Locking screw designThe screw design has been modified, as compared to standard cortex screws, to enhance fixation and facilitate the surgical procedure.

3.5 mm and 4.5 mm Curved Locking Compression Plates (LCP)

Self-tapping flutes

StarDrive Recess The StarDrive Recess provides improved torque transmission to the screw while retaining the screw on the screwdriver without the use of a holding sleeve.

Large core diameterThe large core diameter improves bending and shear strength, and distributes the load over a larger area in the bone.

Conical screwheadThe conical head facilitates alignment of the locking screw in the threaded plate hole to provide a secure screw-plate construct.

Thread profileThe shallow thread profile of the locking screws results from the larger core diameter. This is possible because locking screws do not rely solely on the screw threads to create compression between the plate and the bone to maintain stability.


AO Principles

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4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique

AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, 2.

1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal 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.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1,2

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful 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. 2nd ed. Stuttgart, New York: Thieme; 2007.


Indications

The Synthes 3.5 mm Curved LCP Plates are intended for fixation of fractures, osteotomies and nonunions of the clavicle, scapula, olecranon, humerus, radius, pelvis, distal tibia and fibula, particularly in osteopenic bone for adult patients.

The Synthes 4.5 mm Curved LCP Plates are intended for fixation of various long bones, such as the humerus, femur, and tibia. They are also for use in fixation of periprosthetic fractures, osteopenic bone, and nonunions or malunions in adult patients.

The 3.5 mm and 4.5 mm Curved LCP Plates are also intended for fracture fixation of diaphyseal and metaphyseal areas of long bones in pediatric patients.


Fixation Principles

The following points distinguish treatment using locking compression plate technology:– Allows fracture treatment using compression plating

with conventional cortex or cancellous bone screws

– Allows fracture treatment using locked plating with bicortical or unicortical locking screws

– Permits the combination of conventional and locking screw techniques

Note: These LCP Plates are suitable for a large number of fracture types. For that reason, this technique guide does not deal with any specific fracture type. Please refer also to the AO Principles of Fracture Management,2 and the AO Manual of Fracture Management–Internal Fixators.3

Unicortical screw fixationUnicortical locking screws provide stability and load transfer only at the near cortex due to the threaded connection between the plate and the screw. Screw stability and load transfer are accomplished at two points along the screw: the screwhead and near cortex. Because the screw is locked to the plate, fixation does not rely solely on the pullout strength of the screw or on maintaining friction between the plate and the bone.

Bicortical screw fixation has long been the traditional method of compressing a plate to the bone where friction between the plate and the bone maintains stability. Screw stability and load transfer are accomplished at two points along the screw: the near and far cortices.

a. Unicortical screws utilize the locked screw and the near cortex to achieve stability.

b. Bicortical screws require two (2) cortices to achieve stability.

2. Thomas P. Rüedi, et al, ed., AO Principles of Fracture Management, New York: Thieme, 2000.

3. M. Wagner and R. Frigg, AO Manual of Fracture Management– Internal Fixators, New York: Thieme, 2006.

a

b


Fixation Principles

The following examples show the biomechanical features of conventional plating techniques, locked or bridge plating techniques, and a combination of both.

Conventional plating

Absolute stabilityThe tensile force (F1) originating from tightening the screws presses the plate onto the bone (F2). The developing friction (F3) between the plate and the bone leads to stable plate fixation. To ensure absolute stability, the friction resistance must be higher than the axial forces (F4) arising during rehabilitation.

Lag screwInterfragment compression is accomplished by using a lag screw. This is particularly important in intra-articular fractures which require a precise reduction of the joint surfaces. Lag screws can be angled in the plate hole, allowing placement of the screw perpendicular to the fracture line.

Primary loss of reductionIn conventional plating, even though the bone fragments are correctly reduced prior to plate application, fracture dislocation will result if the plate does not fit the bone. In addition, if the lag screw is not seated perpendicular to the fracture line (e.g., spiral fracture of the distal tibia), shear forces will be introduced. These forces may cause loss of reduction.

F3 F2

F2F1

F4 F4


Fixation Principles

Secondary loss of reductionUnder axial load, postoperative, secondary loss of reduction may occur by toggling of the screws. Since cortex screws do not lock to the plate, the screws cannot oppose the acting force and may loosen, or be pushed axially through the plate holes.

Blood supply to the boneThe periosteum is compressed under the plate area, reducing or even interrupting blood supply to the bone. The result is delayed bone healing due to temporary osteoporosis underneath the plate.


Fixation Principles

Bridge/locked plating using locking screws

– Screws lock to the plate, forming a fixed-angle construct

– Bone healing is achieved indirectly by callus formation when using locking screws exclusively

Maintenance of primary reductionOnce the locking screws engage the plate, no further tightening is possible. Therefore, the implant locks the bone segments in their relative positions regardless of degree of reduction.

Precontouring the plate minimizes the gap between the plate and the bone, but an exact fit is not necessary for implant stability. This feature is especially advantageous in minimally or less invasive plating techniques because these techniques do not allow exact contouring of the plate to the bone surface.

Stability under loadBy locking the screws to the plate, the axial force is transmitted over the length of the plate. The risk of a secondary loss of the intraoperative reduction is reduced.

Blood supply to the boneLocking the screw into the plate does not generate additional compression between the plate and the bone. Therefore, the periosteum will be protected and the blood supply to the bone preserved.

Combined internal fixation

The combination of conventional compression plating and locked plating techniques enhances plate osteosynthesis. The result is a combination, or Combi, hole that, depending on the indication, allows standard compression plating, locked/bridge plating or a combination of both.

Internal fixation using a combination of locking screws and standard screws

Note: If a combination of cortex and locking screws is used, a cortex screw should be inserted first to pull the plate to the bone.

If locking screws (1) have been used to fix a plate to a fragment, subsequent insertion of a standard screw (2) in the same fragment without loosening and retightening the locking screw is NOT RECOMMENDED.

Warning: If a locking screw is used first, care should be taken to ensure that the plate is held securely to the bone to avoid spinning of the plate about the bone.

Note: Do not lock the screws at full speed to reduce the risk of stripping the head. This can make it difficult to remove the implant.

Precaution: For long screws and thick cortical bone, ensure sufficient cooling during insertion.

Dynamic compressionOnce the metaphyseal fragment has been fixed with locking screws, the fracture can be dynamically compressed using standard screws in the DCU portion of the Combi hole.

Locked and standard plating techniques– First, use lag screws to anatomically reconstruct the

joint surfaces

– The behavior of a locking screw is not the same as that of a lag screw. With the locked plating technique, the implant locks the bone segments in their relative positions regardless of how they are reduced

– A plate used as a locked/bridge plate does not produce any additional compression between the plate and the bone

– The unicortical insertion of a locking screw causes no loss of stability


Fixation Principles

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Minimally Invasive Reduction and Plate Insertion Instruments

Minimally invasive surgery supports the principles of biological internal fixation by avoiding long incisions and extensive soft tissue stripping associated with conventional techniques. Devascularization of the fragments can be minimized by indirect reduction and an improved healing process can be expected.

The Minimally Invasive Reduction Instruments are intended for obtaining intraoperative fixation using minimally invasive, indirect reduction techniques. The Minimally Invasive Plate Insertion Instruments are indicated for plate insertion through minimal incision(s) after temporary reduction has been achieved.

The Minimally Invasive Reduction and Plate InsertionInstrument Set includes:– Reduction handles to gain and maintain stable

intraoperative fixation of a fracture

– Soft tissue retractors to subcutaneously prepare a plate pathway over long distances through a small incision

– A plate holder with clamping feet for easy, percutaneous manipulation of a plate along the bone

Reduction handlesToothed reduction handles provide rotational stability during manipulation of bone fragments.

Soft tissue retractorsThe offset blade allows easy preparation of a cavity for percutaneous plate insertion. The asymmetric tip allows a choice of insertion angle. The blade length can be adjusted using a combination wrench. The blade can be completely removed for easy cleaning of the cannulated handle.

Plate holderThe plate holder is for percutaneous insertion of most LCP and LC-DCP® Plates. A simple clamping mechanism provides guidance and easy handling of a plate under soft tissue. Nine interchangeable clamping feet are available for use with the plate holder.


Toothed Reduction Handles (Bicortical) for Enhanced Rotational Stability

1Insert threaded rod

Instruments for 3.0 mm threaded rods

325.070 8.0 mm Protection Sleeve, slotted

325.100 8.0 mm/3.0 mm Drill Sleeve

325.160 3.0 mm Threaded Rod, self-drilling tip





Insert a self-drilling threaded rod through the drill sleeve assembly (drill sleeve and protection sleeve) and into the bone so that the self-drilling tip is embedded in the far cortex.

Precaution: Do not insert the drill tip into the opposite cortical bone to prevent damage of the opposite side structure and to avoid removal problems.

Remove the drill sleeve.

Precautions: – 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 of worn bone

cutting instruments in an approved sharps container.


2Attach reduction handle


325.020 Reduction Handle, toothed, for 3.0 mm Threaded Rod


325.150 Adjusting Nut, for 3.0 mm Threaded Rod







Slide the toothed reduction handle over the threaded rod and through the slotted protection sleeve to the bone.

Slide the adjusting nut over the threaded rod and tighten it onto the reduction handle.

Note: Tightening the adjusting nut excessively may cause the threaded rod to strip out of the bone.

Remove the protection sleeve by sliding back the release. A second toothed reduction handle can be attached using the same technique.



3Reduce fracture


390.031 Medium Combination Clamp, MR Safe

395.786 8.0 mm Carbon Fiber Rod


390.005 Large Combination Clamp, MR Conditional

394.86 11.0 mm Carbon Fiber Rod

If needed, apply combination clamps and a carbon fiber rod without tightening the construct.

Reduce the fragments.

4Temporary fixation

Instrument

03.311.007 8 mm/11 mm Wrench

Using the 8 mm/11 mm wrench, firmly tighten the combination clamps to temporarily hold the reduction. After definitive treatment of the fracture, remove the reduction instruments.

The large reduction instruments are shown in these illustrations. Use the same technique for the small reduction instruments.

Note: Reduction instruments, including threaded rods, are not indicated for postoperative use.



Plate Contouring (optional)

Use the AO preoperative planner template for the 3.5 mm and 4.5 mm curved LCP Plates.

Note: Templates are available in two sizes: actual size and 115% magnification in which the image is enlarged 15% to correspond to typical radiological magnification; however, variations in magnification levels are common.

Required sets

105.434 Small Fragment LCP Instrument and Implant Set or 115.400 Large Fragment LCP Instrument and Implant Set or 01.240.201 Periarticular LCP Plating System, with 5.0 mm Locking Screws

Bending instruments

329.04*/ Bending Irons 329.05*

329.29* Bending Pliers

329.30* Plate Bending Press

Use the bending instruments to contour the locking compression plate to the anatomy.

Note: The plate holes are designed to accept some degree of deformation. When bending the plate, place the bending irons on two adjacent holes. This ensures that the threaded holes will not be distorted. Significant distortion of the locking holes will reduce locking effectiveness. Please refer to the AO Principles of Fracture Management,4 and the AO Manual of Fracture Management–Internal Fixators.5

4. Rüedi.5. Wagner.*Also available.

Precautions: – Reverse bending or using 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. – Do not bend the plate at the level of the holes.


Plate Insertion

1Insert soft tissue retractors

Instruments

03.311.007 8 mm/11 mm Wrench

325.010 Soft Tissue Retractor, small, extendible

Optional instrument

328.011 Small Soft Tissue Retractor Blade, long

To adjust the length of the soft tissue retractors, loosen the clamping sleeve with the 8 mm/11 mm wrench. Use the 8 mm wrench for the small retractor. Slide the blade within the handle to an appropriate length and tighten the clamping sleeve.

Warning: Do not over tighten the clamping sleeve as this could lead to breakage.

Do not extend the blade beyond the line marked “MAX.”

Insert the soft tissue retractor through an incision to prepare a cavity for percutaneous plate insertion.


2Assemble plate holder

Instruments for 3.5 mm narrow plates

314.14 Large Hexagonal Key, for large screws

325.041 Clamping Foot, for 328.040, for 3.5 mm LCP and 3.5 mm LC-DCP

328.040 Plate Holder, for Minimally Invasive Plating Osteosynthesis

Instruments for 3.5 mm broad and 4.5 mm narrow plates

328.041 Clamping Foot, for 328.040, for 4.5 mm/5.0 mm Narrow LCP and 4.5 mm Narrow LC-DCP

328.044 Connecting Screw, for Plate Holder

Push the connecting screw through the plate holderuntil it clicks into place (1).

Insert a clamping foot into the plate holder (2).

Engage the connecting screw into the clamping foot,but do not fully tighten (3).

Slide the selected plate into the clamping foot (4).

Firmly tighten the connecting screw with the largehexagonal key.

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Plate Insertion


4Remove plate holder

Instrument

314.14 Large Hexagonal Key, for large screws

Use the large hexagonal key to remove the connecting screw from the plate holder. Remove the plate holder from the clamping foot. Slide the clamping foot from the plate.

Plate Insertion

3Insert plate


Reduction and Temporary Plate Placement

1Reduce and position plate

Instruments for 3.5 mm plates

324.024 Push-Pull Reduction Device

324.023 Threaded Plate Holder or 324.031 Threaded Plate Holder, long

Instruments for 4.5 mm plates

311.449 Push-Pull Reduction Device

324.075 Threaded Plate Holder

The plate may be temporarily held in place with standard plate holding forceps, a push-pull reduction device or a K-wire.

Note: The middle of the plate should be positioned over the fracture site if compression of the fracture fragments is desired.

The push-pull reduction device is designed to temporarily hold the plate to the bone through a plate hole. The device is self-drilling and connects with the DePuy Synthes quick coupling for power insertion. Insert into the near cortex only. After power insertion, turn the collet clockwise until it pulls the plate securely to the bone.

Note: Take care to avoid inserting this device in a hole that will be needed immediately for plate fixation. However, the device may be removed and a screw inserted through the same plate hole.

A threaded plate holder can also be used as an aid to position the plate on the bone. The plate holder may also function as an insertion handle for use with minimally invasive plating techniques.


Screw Insertion

1Insert screws

Determine whether standard cortex screws, cancellous bone screws or locking screws will be used for fixation. A combination of all may be used.

Note: If a combination of cortex, cancellous and locking screws is used, a standard screw should be used first to pull the plate to the bone.

Warning: If a locking screw is used first, care should be taken to ensure that the plate is held securely to the bone to avoid spinning of the plate about the bone.

Insertion of a cortex or cancellous bone screw

Instruments for 3.5 mm cortex or cancellous bone screws

310.25 2.5 mm Drill Bit

314.02 Small Hexagonal Screwdriver

319.01 Depth Gauge, for small screws

323.36 3.5 mm Universal Drill Guide

Instruments for 4.5 mm cortex or cancellous bone screws


314.27 Large Hexagonal Screwdriver

319.10 Depth Gauge, for large screws

323.46 4.5 mm Universal Drill Guide

Predrill both cortices using the universal drill guide for an eccentric (compression) or neutral (buttress) insertion of cortex screws.

Note: The LC-DCP Drill Guide and the DCP® Drill Guide are NOT suitable for use with LCP Plates.


Screw Insertion

1Insert screws continued

Neutral insertion of a standard screwWhen pressing the universal drill guide into the DCU portion of the LCP Plate, it will center itself and allow neutral predrilling.

Dynamic compression, eccentric insertion of a cortex screwTo drill a hole for dynamic compression, place the universal drill guide eccentrically at the edge of the DCU portion of the LCP Plate hole, without applying pressure. Tightening of the cortex screws will result in dynamic compression corresponding to that of the LC-DCP Plate.

Measure for screw length using the depth gauge and insert the appropriate length cortex or cancellous bone screw.


Screw Insertion

Insertion of locking screws

Instruments for 3.5 mm locking screws


312.648 2.8 mm Threaded Drill Guide

314.115 StarDrive Screwdriver, T15 or 314.116 StarDrive Screwdriver Shaft, T15

319.01 Depth Gauge, for small screws

511.770* Torque Limiting Attachment, 1.5 Nm or 511.773* Torque Limiting Attachment, 1.5 Nm, quick coupling



312.449 4.3 mm Threaded Drill Guide

314.118 StarDrive Screwdriver, T25 or 314.119 StarDrive Screwdriver Shaft, T25

319.10 Depth Gauge, for large screws

511.771* Torque Limiting Attachment, 4 Nm or 511.774* Torque Limiting Attachment, 4 Nm, for AO Reaming Coupler

Note: The locking screw is not a lag screw. Use standard screws when a precise anatomical reduction (e.g., joint surfaces) or interfragmentary compression is required. Before inserting the first locking screw, perform anatomical reduction and fix the fracture with lag screws, if necessary. After the insertion of locking screws, an anatomical reduction will no longer be possible without loosening the locking screw.

Screw the threaded drill guide into an LCP Plate hole until fully seated.

*Also available.


Screw Insertion

1Insert screws continued

Insertion of locking screws continued

Note: Since the direction of a locking screw is determined by plate design, final screw position may be verified with a K-wire prior to insertion. This becomes especially important when the plate has been contoured or applied in metaphyseal regions around joint surfaces (refer to “Screw Placement Verification” on page 26).

Warning: Do not try to bend the plate using the threaded drill guide because damage may occur to the plate hole threads.

Use the drill bit to drill the desired depth.Remove the threaded drill guide.

Use the depth gauge to determine screw length.

Precautions: – The use of the threaded drill guide is mandatory in order

to ensure that the locking screw is drilled in the proper perpendicular angle and correctly locked in the plate.

– Always irrigate during drilling to avoid thermal damage to the bone.

– For Long screws and thick cortical bone, ensure sufficient cooling during insertion.

– Do not insert the drill tip into the opposite cortical bone to prevent damage of the opposite side structure and to avoid removal problems.


Insert the locking screw under power using a torque limiting attachment and StarDrive Screwdriver shaft.

Note: Recheck each locking screw before closing to verify that the screws are securely locked to the plate. Screwheads must be flush with the plate in the locked position before they can be considered fully seated.

Warning: Always use a torque limiting attachment (TLA) when using power to insert locking screws.

Alternative method of locking screw insertionUse the StarDrive Screwdriver to manually insert the appropriate length locking screw. Carefully tighten the locking screw, as excessive force is not necessary to produce effective screw-to-plate locking.

Screw Insertion


Screw Placement Verification

2Verify screw placement


292.71 1.6 mm Kirschner Wire with Thread

323.023 1.6 mm Wire Sleeve

323.025 Direct Measuring Device


292.656 2.0 mm Non-Threaded Guide Wire

323.021 Direct Measuring Device

323.046 2.0 mm Wire Sleeve

Since the direction of a locking screw is determined by plate design, final screw position may be verified with a K-wire before insertion. This becomes especially important when the plate has been contoured or applied in metaphyseal regions around joint surfaces.

With the threaded drill guide in place, insert the wire sleeve into the threaded drill guide.

Insert a threaded Kirschner wire through the wire sleeve and drill to the desired depth.

Verify K-wire placement under image intensification to determine if final screw placement is acceptable.

Notes: – The K-wire position represents the final position of the locking screw. – If the angle of the locking screw is not optimal, it can be

corrected. Bend the plate as needed, or move it in a proximal or distal direction. This technique is also suitable to preliminarily fix the plate to the bone.


Measurement may be taken by sliding the tapered end of the direct measuring device over the K-wire down to the wire sleeve.

Remove the direct measuring device, K-wire and wire sleeve, leaving the threaded drill guide in place.

Use the drill bit to drill the near cortex. Remove the threaded drill guide. Insert the appropriate length locking screw.

Screw Placement Verification


Implant Removal

1Unlock and remove screws

To remove the plate, unlock all screws from the plate, then remove the screws completely from the bone. This prevents simultaneous rotation of the plate when removing the last locking screw.

2Insert extraction chisel

Instruments

03.161.200 Extraction Chisel Shaft

03.161.201 Extraction Chisel Tip

03.311.007 8 mm/11 mm Wrench


Insert the extraction chisel shaft into the tip, by aligning the etched lines. Rotate 90° to lock the extraction chisel into place.

Insert the extraction chisel into the handle of the soft tissue retractor, with the large flat surface of the tip facing up. Tighten the clamping sleeve with the 8 mm/11 mm wrench.

Place the extraction chisel over the exposed end of the plateand slide it along the entire length of the plate.

Precaution: The chisel tip is sharp. Use extreme caution when using the chisel in areas where it can come into contact with vascular and neurovascular structures. The chisel tip can be used with 3.5 mm narrow and broad and 4.5 mm narrow LCP Plates.

Remove the chisel and plate.


Screws Used With the 3.5 mm and 4.5 mm Curved Locking Compression Plates

3.5 mm Cortex Screws, self-tapping†

– May be used in the DCU portion of the Combi holes– Compress the plate to the bone or create axial compression

3.5 mm Locking Screws, self-tapping†

– Create a locked, fixed-angle screw-plate construct– Used in the locking portion of the Combi holes– Threaded conical head

4.0 mm Cancellous Bone Screws†

– May be used in the DCU portion of the Combi hole

– Compress the plate to the bone or create axial compression

– Fully or partially threaded shaft

4.0 mm Locking Screws, self-tapping**– Create a locked, fixed-angle screw-plate construct– Used in the locking portion of the Combi holes– Threaded conical head

4.5 mm Cortex Screws, self-tapping**– May be used in the DCU portion of the Combi holes


4.5 mm Cannulated Screws**– May be used in the DCU portion of the Combi holes


– Self-drilling, self-tapping

– Fully or partially threaded shaft

5.0 mm Locking Screws, self-tapping**– Create a locked, fixed-angle screw-plate construct

– Threaded conical head

Note: All screws are available in implant-quality 316L stainless steel. †For use with 3.5 mm LCP Plates.**For use with 4.5 mm LCP Plates.


Curved LCP Plates

– Limited-contact plate design

– Tapered plate ends for submuscular plate insertion

3.5 mm Curved Narrow LCP Plates– Available with 10 to 22 Combi holes

3.5 mm Curved Broad LCP Plates– Available with 10 to 30 staggered Combi holes

4.5 mm Curved Narrow LCP Plates– Available with 10 to 22 Combi holes

4.5 mm Curved Broad LCP Plates*– Available with 12 to 26 staggered Combi holes

Note: All plates are available in implant-quality 316L stainless steel.*Also available.

Screws Used With the 3.5 mm and 4.5 mm Curved Locking Compression Plates

5.0 mm Periprosthetic Locking Screws, self tapping**– Blunt tip allows unicortical fixation of fractures when

an intramedullary implant is present

6.5 mm Cancellous Bone Screws**– May be used in the DCU portion of the first and last

Combi holes of the 4.5 mm narrow and broad LCP Plates


– Fully or partially threaded shaft (16 mm, 24 mm and 32 mm thread lengths)

Note: All screws are available in implant-quality 316L stainless steel.**For use with 4.5 mm LCP Plates.


Instruments

03.161.200 Extraction Chisel Shaft

03.161.201 Extraction Chisel Tip

03.311.007 8 mm/11 mm Wrench

314.14 Large Hexagonal Key



325.041 Clamping Foot for the 328.040, for 3.5 mm LCP and 3.5 mm LC-DCP


325.070 8.0 mm Protection Sleeve, Slotted



325.160 3.0 mm Threaded Rod, self-drilling tip, 270 mm

328.011 Small Soft Tissue Retractor Blade, long


Instruments


328.041 Clamping Foot, for 4.5 mm/5.0 mm Narrow LCP and 4.5 mm Narrow LC-DCP

328.044 Connecting Screw, for 328.040



328.040 Plate Holder, for Minimally Invasive Plating

Instruments


329.04*/ Bending Irons 329.05*

Instruments

390.005 Large Combination Clamp, MR Conditional

*Also available.

329.30* Plate Bending Press


328.160 5.0 mm Threaded Rod, self-drilling tip, 380 mm

329.29* Bending Pliers


390.031 Medium Combination Clamp, MR Safe

394.86 11.0 mm Carbon Fiber Rod, 350 mm

511.770* Torque Limiting Attachment, 1.5 Nm

511.771* Torque Limiting Attachment, 4 Nm

511.773* Torque Limiting Attachment, 1.5 Nm, Quick coupling

511.774* Torque Limiting Attachment, 4 Nm, for AO reaming coupler

395.786 8.0 mm Carbon Fiber Rod, 240 mm

Instruments

*Also available.


3.5 mm/4.5 mm Curved LCP Instrument Set (01.161.200)

Graphic Case60.161.200 3.5 mm/4.5 mm Curved LCP Instrument Graphic Case

Instruments03.161.200 Extraction Chisel Shaft03.161.201 Extraction Chisel Tip03.311.007 8 mm/11 mm Wrench314.14 Large Hexagonal Key325.010 Soft Tissue Retractor, small, extend-ible 325.020 Reduction Handle, toothed, for 3.0 mm Threaded Rod325.041 Clamping Foot for the 328.040, for 3.5 mm LCP and 3.5 mm LC-DCP325.070 8.0 mm Protection Sleeve, Slotted325.100 8.0 mm/3.0 mm Drill Sleeve325.150 Adjusting Nut, for 3.0 mm Threaded Rod325.160 3.0 mm Threaded Rod, self-drilling tip, 270 mm328.011 Small Soft Tissue Retractor Blade, long328.020 Reduction Handle, toothed, for 5.0 mm Threaded Rod328.040 Plate Holder, for Minimally Invasive Plating328.041 Clamping Foot, for 4.5 mm/5.0 mm Narrow LCP and 4.5 mm Narrow LC-DCP328.044 Connecting Screw, for 328.040328.100 11.0 mm Protection Sleeve, slotted328.130 11.0 mm/5.0 mm Drill Sleeve 328.150 Adjusting Nut, for 5.0 mm Threaded Rod328.160 5.0 mm Threaded Rod, self-drilling tip, 380 mm390.005 Large Combination Clamp, MR Conditional390.031 Medium Combination Clamp, MR Safe394.86 11.0 mm Carbon Fiber Rod, 350 mm395.786 8.0 mm Carbon Fiber Rod, 240 mm

Note: For additional information, please refer to package insert.

For detailed cleaning and sterilizationinstructions, please refer towww.synthes.com/cleaning-sterilization orsterilization instructions, if provided.


3.5 mm/4.5 mm Curved Narrow LCP Implant Set (01.161.201)

Graphic Case60.161.201 3.5 mm/4.5 mm Curved LCP Implant Graphic Case

Implants3.5 mm Curved Narrow LCP Plates◊

Holes Holes

02.161.210 10 02.161.218 1802.161.212 12 02.161.220 2002.161.214 14 02.161.222 2202.161.216 16

4.5 mm Curved Narrow LCP Plates◊

Holes Holes

02.161.240 10 02.161.248 1802.161.242 12 02.161.250 2002.161.244 14 02.161.252 2202.161.246 16

3.5 mm Curved Broad LCP Plates◊

Holes Holes

02.161.270 10 02.161.282 2202.161.272 12 02.161.284 2402.161.274 14 02.161.286 2602.161.276 16 02.161.288 2802.161.278 18 02.161.290 3002.161.280 20

Also available226.622– 4.5 mm Curved Broad LCP Plates, 226.682 12–18 holes◊

226.702S– 4.5 mm Curved Broad LCP Plates, 226.762S 20–26 holes

329.04/ Bending Irons 329.05

329.29 Bending Pliers

329.30 Plate Bending Press

511.770 Torque Limiting Attachment, 1.5 Nm




Note: For additional information, please refer to package insert.◊Available nonsterile or sterile-packed. Add “S” to catalog number for sterile product.

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.

© DePuy Synthes 2009–2017. All rights reserved.DSUS/TRM/1016/1164 6/17 DV

Synthes USA, LLC 1101 Synthes AvenueMonument, CO 80132

Manufactured or distributed by:Synthes USA Products, LLC 1302 Wrights Lane EastWest Chester, PA 19380

To order (USA): 800-523-0322 To order (Canada): 855-946-8999

Note: For recognized manufacturer, refer to the product label.

www.depuysynthes.com

for minimally invasive osteosynthesis 3.5 mm and 4.5 mm ...synthes.vo.llnwd.net/o16/llnwmb8/us...

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