LCP Pilon Plate 2.7/3.5. Surgical Technique

Transcription

1 LCP Pilon Plate 2.7/3.5 Surgical Technique

2 Image intensifier control This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For 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: For 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:

3 Table of Contents Introduction LCP Pilon Plates 2.7/3.5 2 AO Principles 3 Indications and Contraindications 4 Surgical technique 5 Verify Placement 14 Implant Removal 15 Product Information 16 Implants 16 Instruments 17 MRI Information 20 Surgical Technique LCP Pilon Plate 2.7/3.5 DePuy Synthes 1

4 LCP Pilon Plates 2.7/3.5 The LCP Pilon Plate 2.7/3.5 is part of the locking compression plate (LCP) system that merges locking screw technology with conventional plating techniques. Shaft holes accept 3.5 mm locking screws in the threaded portion, and 3.5 mm cortex screws or 4.0 mm cancellous bone screws in the DCU portion Distal holes accept 3.5 mm locking screws, 2.7 mm cortex screws, 3.5 mm cortex screws or 4.0 mm cancellous bone screws Features Can be cut and contoured for anatomic fit on left or right distal tibia May be placed on the anterior, medial, anteromedial, or anterolateral distal tibia The Combi holes in the plate shaft combine a dynamic compression unit (DCU) hole with a locking screw hole, providing the flexibility of axial compression and locking throughout the length of the plate Locking screws engaged in the plate create a fixed-angle construct that improves fixation in osteopenic bone and multifragment fractures The distal portion and arms may be contoured or holes may be removed as necessary Stainless steel implants Screwhead profile in plate arms 2.7 mm cortex screw 3.5 mm cortex screw 3.5 mm locking screw 2 DePuy Synthes LCP Pilon Plate 2.7/3.5 Surgical Technique

5 AO Principles AO PRINCIPLES In 1958, the AO formulated four basic principles, which have In 1958, become the AO the formulated guidelines four for internal basic principles, fixation 1,2. which have become the guidelines for internal fixation 1, 2. 4_Priciples_03.pdf :08 Anatomic reduction Fracture reduction and fixation to restore restore anatomical relationships. 1 2 Stable fixation Fracture fixation providing absolute or relative or relative stability, stability, as required as by absolute required the patient, by the patient, injury, and the the injury, personality the personality of the fracture. of the and fracture. Early, active mobilization Early and safe mobilization and rehabilitation of the injured part and the patient as a whole. 4 3 Preservation of blood supply Preservation of the blood supply to soft tissues and bone by gentle gentle reduction reduction techniques techniques and careful and careful handling. handling. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3 rd ed. Berlin, Heidelberg, New York: Springer Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2 nd ed. Stuttgart, New York: Thieme DePuy Synthes Expert Lateral Femoral Nail Surgical Technique Surgical Technique LCP Pilon Plate 2.7/3.5 DePuy Synthes 3

6 Indications and Contraindications Indications Distal articular fractures of the tibia (pilon fractures) with emphasis on complex articular reconstruction Contraindications No specific contraindications 4 DePuy Synthes LCP Pilon Plate 2.7/3.5 Surgical Technique

7 Surgical Technique 1. Surgical access Preferably use the anterior or medial access. Where appropriate, the anterior access may be combined with a posteromedial access. Note: For information on fixation principles using conventional and locked plating techniques, please refer to the LCP Locking Compression Plate surgical technique (DSEM/TRM/0115/0278). 2. Visualise joint Visualise the joint fracture by means of an arthrotomy and distraction. If necessary apply a tibio-talar femoral distractor. 3. Reduce fracture Reduce the fragments anatomically and fix temporarily using Kirschner Wires or with definitive lag screws. Confirm reduction using image intensification. 4. Bend template Instrument Bending Template Temporarily position the bending template over the distal tibia. Use the template to decide which portions of the plate should be removed and how the plate should be contoured. Note: Most cases will require contouring the plate and/or removing holes from each arm of the plate to fit the patient s anatomy. Surgical Technique LCP Pilon Plate 2.7/3.5 DePuy Synthes 5

8 Surgical technique 5. Cut plate Instrument Cutting Pliers with Positioning Pin Use the Cutting Pliers with Positioning Pin for cutting the distal arms. Cut the distal arms in accordance with the positioning of the plate onto the bone. The Cutting Pliers with Positioning Pin can be used to trim and smooth cut surfaces in the plate arms. The hole to be removed should be inside the jaws of the Cutting Pliers with Positioning Pin. To aid in alignment, the adjacent plate hole should be positioned on the seating pin. 6 DePuy Synthes LCP Pilon Plate 2.7/3.5 Surgical Technique

9 6. Contour the plate Instrument Bending Pins Alternative Instruments Bending Iron (two required) Bending Pliers 6a. Contour the distal end of the plate Use the Bending Pins to contour the distal arms and distal end of the plate to match the shape of the bending template ( ). Only insert pins next to each other. Alternatively, contour the plate using the Bending Pliers or Bending Irons. Note: Bend the plate between the threaded holes to avoid damage to the thread. Precautions: Reverse bending or use of 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. Surgical Technique LCP Pilon Plate 2.7/3.5 DePuy Synthes 7

10 Surgical technique 6b. Contour plate shaft Instrument Bending Iron (two required) Use bending irons to contour the shaft. Do not use the bending pins. 7a. Insert Plate Instrument LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm Open technique For proper reduction in complex fractures, perform open reduction and internal fixation according to AO guidelines. Minimally invasive technique For minimally invasive insertion, make a single incision distally and carefully push the plate under the soft tissue. Make stab incisions to insert screws into the shaft. Use a LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm in one of the distal holes as a handle for percutaneous insertion. 8 DePuy Synthes LCP Pilon Plate 2.7/3.5 Surgical Technique

11 7b. Position plate Position and adapt the plate such that the distal screws can be inserted as subchondrally as possible. 8. Provisionally fix plate Before inserting the first LCP locking screw, ensure that the plate shows good provisional fixation. 9. Determine screw type and diameter Select LCP Locking Screws B 2.7 mm or B 3.5 mm, or Cortex Screws B 2.7 mm or B 3.5 mm. A combination of all screw types is possible. Alternative Cancellous Bone Screws B 4.0 mm may also be used. Note: If both cortex and LCP locking screws are used in one plate, the cortex screws must be inserted first. This ensures that the plate is compressed against the bone before the LCP locking screws are inserted. Note: For reasons of stability, only use the LCP locking screws B 2.7 mm and the cortex screws B 2.7 mm in the distal section of the plate (round threaded holes). Surgical Technique LCP Pilon Plate 2.7/3.5 DePuy Synthes 9

12 Surgical technique 10. Predrill screw holes a. When predrilling for standard screws with the Universal Drill Guide ( or ) and the matching bit, predrill the screw hole neutrally (1) or off-centre (2). 2 1 Use the following bits: For cortex screw B 2.7 mm: Drill Bit B 2.0 mm ( or ) For cortex screw B 3.5 mm and cancellous bone screw B 4.0 mm (alternative): Drill Bit B 2.5 mm ( or ) Note: When using a cortex screw B 2.7 mm or 3.5 mm as a lag screw, predrill the cortex of the nearby fragment with a larger bit (Drill Bit B 2.7 mm [ ] for cortex screw B 2.7 mm; Drill Bit B 3.5 mm [ ] for cortex screw B 3.5 mm). b. When predrilling for LCP locking screws, screw the LCP Drill Sleeve 2.7 mm ( ) or 3.5 mm ( ) into the desired threaded hole until the sleeve is fully gripped by the thread. The LCP drill sleeve ensures that the LCP locking screw is locked in the plate in the correct alignment. The angular stability is reduced if the LCP locking screws are inserted obliquely. Note: Do not bend the plate with the drill sleeve as this may damage the sleeve. Predrill the screw hole with a suitable bit. Use the following drill bits: For LCP locking screw B 2.7 mm: Drill Bit B 2.0 mm ( or ) For LCP locking screw B 3.5 mm: Drill Bit B 2.8 mm ( ) Note: Select the plate holes and screw lengths used in the contoured distal arm of the plate in such a way as to avoid collision of screws. 11 DePuy Synthes LCP Pilon Plate 2.7/3.5 Surgical Technique

13 11. Determine screw length Instrument Depth Gauge for Screws B 2.7 to 4.0 mm, measuring range up to 60 mm Determine the screw length with the Depth Gauge. 12. Insert standard screws without compression with compression Instrument Screwdriver, hexagonal, small, with Holding Sleeve Insert the cortex screws with the small, hexagonal Screwdriver B 2.5 mm. Surgical Technique LCP Pilon Plate 2.7/3.5 DePuy Synthes 11

14 Surgical technique 13. Insert LCP locking screws Instruments Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive Screwdriver Shaft, hexagonal, small, B 2.5 mm Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling Torque Limiter, 1.5 Nm, for AO/ASIF Quick Coupling Handle for Torque Limiter Nos and a. To insert the LCP locking screws mechanically, attach the Torque Limiter 1.5 Nm to the power tool unit (Compact Air Drive or Power Drive ). Insert the Hexagonal Screwdriver Shaft, Hexagonal, small or the Screwdriver Shaft Stardrive 3.5 into the torque limiter. Pick up the LCP locking screw and insert it into the plate hole. To insert the screw, start the power tool unit slowly, increase the speed and then reduce again before the screw is fully tightened. The torque is automatically limited and a clearly audible click signifies that the maxi mum level has been reached. Stop the power tool unit immediately and disconnect from the screw. 1.5 Nm 1.5 Nm Note: Do not lock the screw at full speed as this risks damaging the hexagonal or Stardrive recess, making implant removal more difficult. Ensure that adequate cooling is provided when inserting fairly long screws into thick cortical bone. With porous bone there is a risk that the LCP locking screw fails to follow the predrilled hole, resulting in a slightly oblique hole during mechanical insertion of the screw with subsequent partial loss of angular stability. In case of porous bone, manual locking (with the handle for torque limiter) of the screws is recommended to ensure better guidance through the predrilled hole. 11 DePuy Synthes LCP Pilon Plate 2.7/3.5 Surgical Technique

15 b. To insert the LCP locking screws manually, attach the torque limiter 1.5 Nm, for AO/ASIF Quick Coupling to the Handle for Torque Limiter and insert the screwdriver shaft. Lock the LCP locking screws in the plate. Precaution: Always use a torque limiting attachment when using power or for manual insertion. Note: When using the torque limiter, the screw is securely locked into the plate when a click is heard. Surgical Technique LCP Pilon Plate 2.7/3.5 DePuy Synthes 11

16 Verify Placement Optional: Screw placement verification Instruments mm Kirschner Wire with Thread LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm Centering Sleeve for Kirschner Wire B 1.6 mm, for No Since the direction of a locking screw is determined by plate design or any contouring, final screw position may be verified with a Kirschner Wire prior to insertion. This becomes especially important when the plate has been contoured or applied in metaphyseal regions around joint surfaces. With the LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm in place, insert the Centering Sleeve for Kirschner Wire B 1.6 mm, for No Insert a threaded 1.6 mm Kirschner Wire through the Centering Sleeve for Kirschner Wire and drill to the desired depth. Verify Kirschner Wire placement under image intensification to determine if final screw placement is acceptable. Precaution: The Kirschner Wire position represents the final position of the locking screw. Confirm that the Kirschner Wire does not enter the joint or interfere with other screws. Remove the Kirschner Wire and the Centering Sleeve for Kirschner Wire B 1.6 mm, leaving the LCP Drill Sleeve 3.5, in place. Use the 2.8 mm drill bit to drill the near cortex. Remove the LCP Drill Sleeve 3.5. Insert the appropriate length locking screw. 11 DePuy Synthes LCP Pilon Plate 2.7/3.5 Surgical Technique

17 Implant Removal To remove the plate, first unlock all screws before removing them definitively in a second step, otherwise the plate may rotate while the last screw is being removed and cause soft tissue damage. If the screws cannot be removed with the screwdriver (e.g. if the hexagonal or Stardrive recess of the locking screws is da ma ged or if the screws are stuck in the plate), insert the conical Extraction Screw ( ) with left-handed thread in the screw head using the T-handle with Quick Coupling ( ) and loosen the locking screw by turning counterclockwise. For details regarding implant removal refer to the surgical technique Screw Extraction Set DSEM/TRM/0614/0104. Surgical Technique LCP Pilon Plate 2.7/3.5 DePuy Synthes 11

18 Implants Plates* Stainless Steel Titanium (TiCP) LCP Pilon Plate 2.7/3.5, cruciform, 7-hole shaft LCP Pilon Plate 2.7/3.5, cruciform, 9-hole shaft * All plates are available nonsterile or sterile packed. Add suffix S to article number to order sterile product. LCP locking screws* X X X X LCP Locking Screw B 2.7 mm, self-tapping LCP Locking Screw Stardrive B 2.7 mm, self-tapping LCP Locking Screw B 3.5 mm, self-tapping LCP Locking Screw Stardrive B 3.5 mm, self-tapping * All screws are available nonsterile or sterile packed. Add suffix S to article number to order sterile product. Standard screws* X X X Cortex Screw B 2.7 mm, self-tapping Cortex Screw B 3.5 mm, self-tapping Cancellous Screw B 4.0 mm, * All screws are available nonsterile or sterile packed. Add suffix S to article number to order sterile product. 11 DePuy Synthes LCP Pilon Plate 2.7/3.5 Surgical Technique

19 Instruments Bending template Bending Template for Nos. X and X Cutting Pliers with Positioning Pin Bending instruments Bending Pin for LCP Plates 3.5, with thread Bending Pliers for Plates Bending Iron for LCP Pilon Plates 2.7/3.5, length 190 mm Note: The required LCP standard instruments and the required small fragment instruments are not listed. Surgical Technique LCP Pilon Plate 2.7/3.5 DePuy Synthes 11

20 Instruments Instruments Depth Gauge for Screws B 2.7 to 4.0 mm, measuring range up to 60 mm Universal Drill Guide Universal Drill Guide Drill Bit B 2.0 mm, length 100/75 mm, 2-flute, for Quick Coupling Drill Bit B 2.0 mm, length 125/100 mm, 2-flute, for Quick Coupling Drill Bit B 2.5 mm, length 180/155 mm, 2-flute, for Quick Coupling Drill Bit B 2.5 mm, length 110/85 mm, 2-flute, for Quick Coupling Drill Bit B 2.7 mm, length 100/75 mm, 2-flute, for Quick Coupling Drill Bit B 3.5 mm, length 110/85 mm, 2-flute, for Quick Coupling LCP Drill Bit B 2.8 mm with Stop, length 165 mm, 2-flute, for Quick Coupling 18 DePuy Synthes LCP Pilon Plate 2.7/3.5 Surgical Technique

21 Instruments LCP Drill Sleeve 2.7, for Drill Bits B 2.0 mm LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm Screwdriver, hexagonal, small, with Holding Sleeve Screwdriver Shaft, hexagonal, small, B 2.5 mm Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling Handle for Torque Limiter Nos and Extraction Screw for Screws B 3.5 mm T-Handle with Quick Coupling Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive Torque Limiter, 1.5 Nm, for AO/ASIF Quick Coupling Surgical Technique LCP Pilon Plate 2.7/3.5 DePuy Synthes 19

22 MRI Information Torque, Displacement and Image Artifacts according to ASTM F , ASTM F and ASTM F Non-clinical testing of worst case scenario in a 3 T MRI system did not reveal any relevant torque or displacement of the construct for an experimentally measured local spatial gradient of the magnetic field of 3.69 T/m. The largest image artifact extended approximately 169 mm from the construct when scanned using the Gradient Echo (GE). Testing was conducted on a 3 T MRI system. Radio-Frequency-(RF-)induced heating according to ASTM F a Non-clinical electromagnetic and thermal testing of worst case scenario lead to peak temperature rise of 9.5 C with an average temperature rise of 6.6 C (1.5 T) and a peak temperature rise of 5.9 C (3 T) under MRI Conditions using RF Coils [whole body averaged specific absorption rate (SAR) of 2 W/kg for 6 minutes (1.5 T) and for 15 minutes (3 T)]. Precautions: The above mentioned test relies on non-clinical testing. The actual temperature rise in the patient will depend on a variety of factors beyond the SAR and time of RF application. Thus, it is recommended to pay particular attention to the following points: It is recommended to thoroughly monitor patients undergoing MR scanning for perceived temperature and/or pain sensations. Patients with impaired thermo regulation or temperature sensation should be excluded from MR scanning procedures. Generally it is recommended to use a MR system with low field strength in the presence of conductive implants. The employed specific absorption rate (SAR) should be reduced as far as possible. Using the ventilation system may further contribute to reduce temperature increase in the body. 22 DePuy Synthes LCP Pilon Plate 2.7/3.5 Surgical Technique

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24 DSEM/TRM/0815/0477(1) 12/16 Synthes GmbH Eimattstrasse 3 Not all products are currently available in all markets Oberdorf Switzerland This publication is not intended for distribution in the USA. Tel: Fax: All surgical techniques are available as PDF files at DePuy Synthes Trauma, a division of Synthes GmbH All rights reserved