Technique Guide. LCP Dynamic Helical Hip System (DHHS). Part of the Synthes Large Fragment LCP System.

Transcription

1 Technique Guide LCP Dynamic Helical Hip System (DHHS). Part of the Synthes Large Fragment LCP System.

2 Table of Contents Introduction LCP Dynamic Helical Hip System (DHHS) 2 AO Principles 4 Indications 5 Surgical Technique Place Guide Wire 6 Determine Helix Blade Length 8 Ream 9 Assemble Helix Blade Inserter 10 Insert Helix Blade 12 Position Sideplate/Key Alignment Shaft 15 Position Sideplate/Plate Impactor (optional) 16 Insert Screws 17 Lock Rotation/Key Impactor 17 Intraoperative Compression (optional) 18 Confirm Implant Placement 18 Implant Removal 19 Product Information Implants 20 Instruments 21 Set Lists 26 Image intensifier control Synthes

3 LCP Dynamic Helical Hip System (DHHS) The Locking Compression Plate (LCP) Dynamic Helical Hip System (DHHS) provides strong and stable internal fixation of a variety of intertrochanteric, subtrochanteric and basilar neck fractures in which a stable medial buttress can be reconstructed. Additionally, implantation methods are simplified by minimized instrumentation. DHHS Helix Blade The LCP DHHS helix blades easily glide within the LCP DHHS plate barrel for controlled collapse and impaction of fragments. When the fracture requires additional intraoperative compression, the LCP DHHS Compression Screw ( ) can be used. Combi holes The LCP DHHS plates are low profile and have a limited-contact undersurface for minimal soft tissue irritation. The LCP DHHS plates are made of coldworked 316L stainless steel. Construct stability The helix blade improves resistance to cut-out and increases the rotational stability of the femoral head fragment when compared to traditional intertrochanteric lag screws. 1 LCP DHHS compression screw Limited-contact undersurface 1. M. Sommers, C. Roth, H. Hall, L. Ehmke, J. Krieg, S. Madey, and M. Bottlang, Cut-Out Resistance of Implants for Intertrochanteric Fracture Fixation, JOT, Vol 18, Number 6, July Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

4 The LCP DHHS plate barrel contains a locking key. Two flats within the key correspond with the flats of the helix blade shaft. This enables the surgeon to manipulate the position of the sideplate prior to final fixation. Once the plate is positioned appropriately, the key may be advanced, making the helix blade rotationally stable within the barrel. No bone is removed from the femoral head before implantation of the helix blade. This creates a more stable and mechanically sound interface between the helix blade and bone. The number of screw holes per plate length is maximized, without compromising plate strength. This allows an increased number of fixation points with a smaller incision. The Combi holes in the LCP DHHS sideplate: Combine a dynamic compression unit (DCU) hole with a locking screw hole, allowing compression in the DCU section of the hole or locking screw fixation in the threaded section Provide directional compression and fixed-angle screw purchase Allow longitudinal screw angulation for lag screw fixation of medial fragments Allow 14 of transverse screw angulation Are uniformly spaced to provide greater intraoperative flexibility for screw and/or wire or cable fixation Ease of use Single-piece reamer does not need adjustment prior to use The helix blade does not have screw threads and creates its own path as it is inserted, eliminating the need for a tap and reducing overall torsional forces on the femoral head during implantation Use of the helix blade inserter assembly reduces the overall operative time to implant the helix blade when compared to implanting conventional hip lag screws The self-contained, user-activated key mechanism of the LCP DHHS sideplate eliminates the need for additional instrumentation for intraoperative insertion of separate antirotational locking devices within the barrel Plate barrel Internal key mechanism Synthes 3

5 AO Principles In 1958, the AO formulated four basic principles which have become the guidelines for internal fixation. 2 Those principles as applied to the LCP Dynamic Helical Hip System are: Anatomic reduction The LCP DHHS sideplate and helix blade allow controlled collapse and interfragmentary compression while maintaining rotational control of the medial fragment. Stable fixation Use of the helix blade provides improved rotational control of the femoral head fragment versus single-screw fixation, which results in improved life-to-cut-out. The number of screw holes per plate length is maximized to allow an increased number of fixation points. The locking screws in the plate shaft also create a fixed-angle construct, providing angular stability. Preservation of blood supply The limited-contact design reduces plate-to-bone contact and vascular trauma. Use of the helix blade results in reduced bone removal compared to a standard hip screw. Early, active mobilization Plate features combined with AO technique create an environment for bone healing, expediting a return to optimal function. 2. M.E. Müller, M. Allgöwer, R. Schneider, H. Willenegger: AO Manual of Internal Fixation, 3rd Edition. Berlin; Springer-Verlag Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

6 Indications The LCP DHHS is indicated for the following fractures of the proximal femur: Intertrochanteric fractures Subtrochanteric fractures* Basilar neck fractures LCP DHHS is indicated for stable and unstable fractures in which a stable medial buttress can be reconstructed. * For certain subtrochanteric fractures, a 95 device is the implant of choice. Please refer to the DHS/DCS Dynamic Hip and Condylar Screw System Technique Guide, section Using the DCS for Subtrochanteric Fractures. Synthes 5

7 Place Guide Wire 1 Place guide wire Instruments Dynamic Helical Hip System Angle Guide, variable mm Threaded Guide Wire, spade point, 230 mm Optional instrument mm Drill Bit Fracture reduction should be done in the same manner as for a standard DHS procedure. Determine anteversion by placing a guide wire anteriorly along the femoral neck. Insert the wire into the femoral head. The anteversion wire will later assist in correct placement of the central guide wire in the center of the femoral head. The angle subtended between the femoral neck and shaft axis (C.C.D., or collum-center-diaphysis, angle) of the uninjured femur will aid in selection of the most appropriate barrel angle. The 135 barrel angle is most commonly indicated. The LCP DHHS plates are available with barrel angles of 130, 135, 140, 145 and 150. Barrel angle Note: Greater barrel angles may produce biomechanical advantages in unstable cases; i.e., better gliding characteristics and reduced bending stresses on the plate/barrel junction, although correct placement of the implant becomes technically more difficult as barrel angle increases. 3 Position the DHHS variable angle guide at the desired angle. Align the variable angle guide parallel to the axis of the femoral shaft and place it on the lateral cortex of the femur. Note: The T-handle of the DHHS variable angle guide rotates 90 to a locked position, for easier use. 3. P. Regazzoni, Th. Rüedi, R. Winquist, and M. Allgöwer, The Dynamic Hip Screw Implant System. Berlin: Springer-Verlag, Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

8 Insert a 2.5 mm threaded guide wire through the variable angle guide, parallel to the anteversion wire and toward the center of the femoral head. The entry point varies with barrel angle. When the 135 barrel angle is used, the guide wire enters the proximal femur approximately 2.5 cm distal to the vastus ridge. Predrilling of the lateral cortex with the 2.0 mm drill bit is recommended in dense bone. Confirm placement of the guide wire under image intensifi - cation. It must lie along the axis of the femoral neck in both the anteroposterior (AP) and lateral views. The appropriate final position is in the center of the femoral head in both AP and lateral views. The tip of the guide wire should be a few millimeters short of the subchondral bony plate. When inserted, the tip of the helix blade will coincide with the tip of the guide wire. Note: This guide wire remains in place throughout the procedure. If the guide wire position is incorrect, remove the wire and insert a new 2.5 mm threaded guide wire. Remove and discard the anteversion wire. Synthes 7

9 Determine Helix Blade Length 2 Determine helix blade length Instrument Depth Gauge, for LCP DHHS angle guide, variable Attach the depth gauge to the angle guide. Read the required helix blade length directly from the depth gauge. No subtraction is necessary, a direct measurement should be used for best results. 25 mm 38 mm When the proper helix blade length, position, and plate angle have been determined, remove the angle guide. Select a standard- or short-barrel plate, with an appro priate number of shaft holes, based on the requirements dictated by the fracture pattern. The standard 38 mm barrel length is most commonly indicated. Choose the 25 mm short barrel for specific clinical situations, including: Use of a helix blade shorter than 85 mm Cases in which the standard barrel may not provide sufficient glide for the helix blade; i.e., a long impaction distance is expected A medial displacement osteotomy An unusually small femur Combine these selections with the required plate angle as determined in Step 1. Note: The short-barrel plate MUST be used with helix blades shorter than 85 mm to allow for proper sliding of the helix blade in the plate barrel, and for fracture compression. 8 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

10 Ream 3 Ream Instruments Contoured Reamer, 60 mm Large Quick Coupling The contoured reamer does not ream into the femoral head and is designed to prevent over-reaming. Insert the 60 mm contoured reamer into the ComPact Air Drive (or similar drill) using the large quick coupling attachment. Slide the reamer over the guide wire to ream for the helix blade inserter assembly and countersink for the plate/barrel junction. When reaming in dense bone, use of continuous irrigation is recommended to prevent thermal necrosis. Alternative instrument * Contoured Reamer, 56 mm For smaller stature patients, the 56 mm contoured reamer may be used for standard- and short-barrel plates with barrel angles up to 135. *Also available Synthes 9

11 Assemble Helix Blade Inserter 4 Assemble helix blade inserter Instruments LCP DHHS Inserter Guide align flats LCP DHHS Coupling Screw, 324 mm LCP DHHS Inserter Shaft Place the LCP DHHS inserter shaft fully into the LCP DHHS inserter guide. When assembling the helix blade inserter, align the flats of the helix blade with the flats on the sides of the inserter guide. Insert the shaft (back end) of the selected helix blade into the tip of the inserter guide and orient the hexagonal recess of the helix blade onto the hexagonal tip of the inserter shaft. 10 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

12 Insert the LCP DHHS coupling screw into the back of the inserter shaft (Figure 1) until the coupling screw knob is visible in the window at the back of the inserter shaft (Figure 2). Finger-tighten the coupling screw. Technique tip: Hold the helix blade and inserter assembly together with one hand, tilting the assembly downward. Use the free hand to insert and tighten the coupling screw. Figure 1 Figure 2 Helix blade Inserter guide Coupling screw Inserter shaft Synthes 11

13 Insert Helix Blade 5 Insert helix blade Instruments LCP DHHS Inserter Guide LCP DHHS Inserter Shaft Hammer, 700 grams helix, starting position swivel plate Before placing the insertion instrument into the reamed cavity, pull back on the LCP DHHS inserter shaft so that only the helix is exposed. This ensures the helix blade is inserted to the proper depth and orientation. Place the inserter assembly over the guide wire and into the reamed cavity. Note: Depending on whether the left or right hip is being treated, the corresponding etch on the helix inserter instrumentation should be visible. Important: The swivel plate on the LCP DHHS inserter guide must be parallel with, and flush to, the shaft of the femur. This will determine the final position and depth of the helix blade. 12 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

14 Drive the helix blade into position using even and steady blows with the 700 gram hammer. The inserter shaft assembly controls the depth and rotation of the helix blade. Monitor the advancement of the helix blade under image intensification to ensure proper placement. When the helix blade is fully inserted, the inserter assembly will prevent any further advancement. Additionally, the circumferential etch around the inserter shaft will align with the back edge of the inserter guide sleeve when the helix blade is fully implanted (Figure 1). etch Figure 1 Synthes 13

15 Insert Helix Blade continued 5 Insert helix blade continued After full insertion of the helix blade, the inserter assembly can be removed by unscrewing the coupling screw and retracting the inserter assembly. The guide wire and the helix blade remain in the femur. Optional instrument Large Hexagonal Screwdriver The coupling screw may be loosened with a large (3.5 mm) hexagonal screwdriver, if necessary. 14 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

16 Position Sideplate/Key Alignment Shaft 6 Position sideplate/key alignment shaft Instruments * DHS/DCS Impactor LCP DHHS Key Alignment Shaft LCP DHHS Key Impactor LCP DHHS Impactor Cap To place the LCP DHHS sideplate over the helix blade, the LCP DHHS key alignment shaft must be used. Align the flats on the alignment shaft with the flats of the internal key of the sideplate, then insert the alignment shaft through the plate barrel. Slide the sideplate and key alignment shaft over the 2.5 mm threaded guide wire. Insert the alignment shaft into the back of the helix blade. The alignment shaft has a hexagonal tip that mates with the end of the helix blade, to ensure that the internal sideplate key and the helix blade shaft are properly aligned. Slide the sideplate down the key alignment shaft and onto the shaft of the helix blade. Technique tip: If the plate does not slide easily into the reamed cavity, gently moving the alignment shaft up and down can assist in the placement. If the plate still will not slide into the reamed cavity, the DHS/DCS impactor may be used. After the plate has been fully seated into the reamed cavity, it may be aligned with the axis of the femur as needed. The internal plate key is free to rotate with no movement of the helix blade, until keyed. When the barrel of the plate is fully inserted in the reamed cavity, remove the alignment shaft. If the sideplate is not completely flush against the lateral cortex, use of the LCP DHHS impactor with plastic cap may be necessary. * Also available Synthes 15

17 Position Sideplate/Plate Impactor (optional) 7 Position sideplate/plate impactor (optional) Instruments LCP DHHS Key Impactor LCP DHHS Impactor Cap Hammer, 700 grams Alternative instruments * DHS/DCS Impactor LCP DHHS Key Alignment Shaft To use the impactor cap, slide it onto the tip of the cannulated LCP DHHS key impactor until fully seated. A positive click will be noticed when assembling. Place the impactor cap and shaft assembly over the 2.5 mm guide wire and seat it directly into the barrel hole of the sideplate. Use of light blows with the hammer is recommended until the sideplate is seated completely against the lateral cortex. Caution: Do not use the impactor cap and shaft to seat the plate if the plate is more than 5 mm off the bone. If the plate appears to be more than 5 mm off the bone, the flats on the helix blade and the internal flats on the key may not be properly aligned. Impacting the plate in this condition could cause further unwanted advance ment of the helix blade. In this situation, reinsertion of the LCP DHHS key alignment shaft and use of the DHS/DCS impactor may be necessary to seat the plate against the lateral cortex. * Also available 16 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

18 Insert Screws and Lock Rotation/Key Impactor 8 Insert screws Remove the 2.5 mm threaded guide wire. Affix the LCP DHHS sideplate to the bone with 4.5 mm cortex screws, 5.0 mm locking screws, or a combination of both.* 9 Lock rotation/key impactor Instruments LCP DHHS Key Impactor Hammer, 700 grams Once the desired placement of the LCP DHHS sideplate has been achieved, the surgeon can use the cannulated LCP DHHS key impactor to advance the internal sideplate key and to stabilize rotation of the helix blade. Note: Make sure to remove the plastic impactor tip before proceeding. Insert the 300 mm cannulated LCP DHHS key impactor into the barrel of the sideplate until it is fully seated. Moderate taps with the hammer will lock rotation, rendering the helix blade rotationally stable, but still allow dynamic collapse. * For information on fixation principles using conventional and locked plating techniques, please refer to the Large Fragment Locking Compression Plate (LCP) Technique Guide. Synthes 17

19 Intraoperative Compression (optional) and Confirm Implant Placement 10 Intraoperative compression (optional) For further intraoperative compression of the trochanteric fracture, the LCP DHHS compression screw may be inserted in the helix blade. The LCP DHHS compression screw may be used in unstable fractures to prevent disengagement of the helix blade from the plate barrel in non-weightbearing patients. 4.5 mm cortex screw 5.0 mm locking screw Note: Use of the compression screw may cause the helix blade to pull out of osteoporotic bone. 11 Confirm implant placement Take final C-arm images or x-rays to confirm proper implant placement. 18 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

20 Implant Removal Implant removal Instruments * Slide/ Fixed Hammer, 400 grams * Hammer Guide, for Slide/ Fixed Hammer StarDrive Screwdriver, T Large Hexagonal Screwdriver Solid Coupling Screw, for removal only Use either the 3.5 mm hexagonal or T25 StarDrive screwdriver to remove any 4.5 mm cortex screws or 5.0 mm locking screws from the LCP DHHS sideplate. Remove the LCP DHHS sideplate to expose the end of the helix blade. Once the sideplate has been removed, thread the solid coupling screw onto the end of the shaft of the helix blade. Thread the hammer guide for slide/fixed hammer onto the solid coupling screw. Use the slide/fixed hammer to extract the helix blade. Instrument options for removal System Will remove: DHS DHS DHS One-Step DHHS Wrench (338.06) Long Coupling Screw (338.22) DHS One-Step DHS One-Step DHHS Insertion Wrench ( ) Coupling Screw (338.31) DHHS Slide/ Fixed Hammer, 400 grams ( ) Hammer Guide ( ) Solid Coupling Screw w/ internal threads ( ) DHHS Note: If the DHSS Solid Coupling Screw has external threads on the back-end, for removal use: Inserter-Extractor ( )** and Slotted Hammer (332.20)** * The slide/fixed hammer and hammer guide can be found in the Titanium Humeral Nail EX Instrument and Titanium Implant Set ( ). ** The inserter-extractor and slotted hammer can be found in the Titanium Tibial Nail Insertion Set ( and ). Synthes 19

21 Implants LCP DHHS Sideplates, standard barrel (38 mm barrel) Shaft Shaft length Barrel angle holes (mm) S S S S S S S S S S S S S S S S S S S S N/A S S S S N/A S N/A N/A S N/A S N/A N/A S 25 mm 38 mm LCP DHHS Sideplates, short barrel (25 mm barrel) Shaft Shaft length Barrel angle holes (mm) S S S S S S S S S S S S S S S S S Length Length (mm) (mm) S S S S 150 Available nonsterile and sterile-packed. Add S to catalog number to order sterile product. Items listed with catalog numbers ending with S are available sterile only. 20 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

22 LCP DHHS Compression Screws S LCP DHHS Enhanced Compression Screw, sterile LCP DHHS Compression Screw Universal Locking Trochanter Stabilization Plate, 131 mm Available nonsterile and sterile-packed. Add S to catalog number to order sterile product. Items listed with catalog numbers ending with S are available sterile only. Synthes 21

23 Instruments mm Drill Bit, quick coupling, 145 mm mm Drill Bit, quick coupling, 180 mm mm Drill Bit, quick coupling, 145 mm T-Handle, with quick coupling Tap for 4.5 mm screws mm Threaded Drill Guide 22 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

24 mm/3.2mm Double Drill Sleeve mm/3.2 mm Insert Drill Sleeve Holding Sleeve StarDrive Screwdriver, T25, self-retaining, 245 mm StarDrive Screwdriver Shaft, T25, self-retaining, 165 mm Large Hexagonal Screwdriver Shaft Synthes 23

25 Instruments continued Large Hexagonal Screwdriver Depth Gauge, for large screws Screw Forceps mm Universal Drill Guide Dynamic Helical Hip System Angle Guide, variable 24 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

26 Solid Coupling Screw, for removal only Depth Gauge, for LCP DHHS angle guide, variable Contoured Reamer, 60 mm LCP DHHS Inserter Guide LCP DHHS Key Alignment Shaft LCP DHHS Coupling Screw, 324 mm Synthes 25

27 Instruments continued LCP DHHS Inserter Shaft LCP DHHS Key Impactor, cannulated, 300 mm LCP DHHS Impactor Cap Hammer, 700 grams Large Quick Coupling mm Threaded Guide Wire, spade point, 230 mm 26 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

28 LCP DHHS Implant Set ( ) Graphic Case Graphic Case, for Dynamic Helical Hip System Implant Set Implants* LCP DHHS Compression Screw, 2 ea. Helix Blades* Length (mm) Qty Length (mm) Qty LCP DHHS Sideplates, standard barrel* Barrel Shaft Shaft Length Angle Holes (mm) Qty Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer to or to the below listed inserts, which will be included in the shipping container: Processing Synthes Reusable Medical Devices - Instruments, Instrument Trays and Graphic Cases DJ1305 Processing Non-sterile Synthes Implants DJ1304 Available nonsterile and sterile-packed. Add S to catalog number to order sterile product. Synthes 27

29 LCP DHHS Basic Set ( ) Graphic Case Graphic Case, for Dynamic Helical Hip System Basic Set Instruments mm Drill Bit, quick coupling, 145 mm mm Drill Bit, quick coupling, 180 mm, 2 ea mm Drill Bit, quick coupling, 145 mm T-Handle, with quick coupling Tap for 4.5 mm Cortex and Shaft Screws, 130 mm, 57 mm tap depth mm Threaded Drill Guide, 2 ea mm/3.2 mm Double Drill Sleeve mm/3.2 mm Insert Drill Sleeve Holding Sleeve StarDrive Screwdriver, T25, self-retaining, 245 mm StarDrive Screwdriver Shaft, T25, self-retaining, 165 mm Large Hexagonal Screwdriver Shaft Large Hexagonal Screwdriver Depth Gauge, for large screws Screw Forceps mm Universal Drill Guide Dynamic Helical Hip System Angle Guide, variable Solid Coupling Screw, for removal only Depth Gauge, for LCP DHHS angle guide, variable Contoured Reamer, 60 mm LCP DHHS Inserter Guide LCP DHHS Key Alignment Shaft LCP DHHS Coupling Screw, 324 mm LCP DHHS Inserter Shaft LCP DHHS Key Impactor, cannulated, 300 mm LCP DHHS Impactor Cap, 2 ea Hammer, 700 grams Large Quick Coupling mm Threaded Guide Wire, spade point, 230 mm, 10 ea. 28 Synthes LCP Dynamic Helical Hip System (DHHS) Technique Guide

30 Implants 5.0 mm Locking Screws, self-tapping, with T25 StarDrive recess Length (mm) Qty. Length (mm) Qty mm Cortex Screws, self-tapping, with 3.5 mm hexagonal recess Length (mm) Qty. Length (mm) Qty Also Available Universal Locking Trochanter Stabilization Plate Set Universal Locking Trochanter Stabilization Plate, 131 mm S LCP DHHS Enhanced Compression Screw, sterile Slide/Fixed Hammer, 400 grams Hammer Guide, for Slide/Fixed Hammer DHS/DCS Impactor DHHS Reaming Head Contoured Reamer, 56 mm Synthes

31 Synthes (USA) 1302 Wrights Lane East West Chester, PA Telephone: (610) To order: (800) Fax: (610) Synthes (Canada) Ltd Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) To order: (800) Fax: (905) Synthes, Inc. or its affiliates. All rights reserved. Combi, DCS, DHHS, DHS, LCP and Synthes are trademarks of Synthes, Inc. or its affiliates. Printed in U.S.A. 11/11 J5262-E