variable angle lcp opening wedge plates 2.4/2.7. part of ...synthes.vo.llnwd.net/o16/llnwmb8/int...

Variable Angle LCP Opening WedgePlates 2.4/2.7. Part of the VariableAngle LCP Forefoot /Midfoot System2.4 /2.7.

Technique Guide

Image intensifier control

WarningThis description alone does not provide sufficient background for direct use ofthe product. Instruction by a surgeon experienced in handling this product ishighly recommended.

Reprocessing, Care and Maintenance of Synthes InstrumentsFor general guidelines, function control and dismantling of multi-part instruments,please contact your local sales representative or refer to:www.synthes.com/reprocessing

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Table of Contents

Introduction

Screw Insertion Techniques

Surgical Technique

Product Information

Variable Angle LCP Opening Wedge Plates 2.4 /2.7 2

Indications 4

5

Approach 6

Implantation 7

Implant Removal 20

Screws 21

Plates 23

Instruments 24

Synthes Biomaterials Overview 28

2 Synthes Variable Angle LCP Opening Wedge Plates 2.4 /2.7 Technique Guide

Variable Angle LCP Opening WedgePlates 2.4/2.7. Part of the Variable AngleLCP Forefoot /Midfoot System 2.4 /2.7.

Features and Benefits

Anatomic, low profile designedspecifically for opening wedge osteo -tomies for hallux valgus correction andother foot deformities

Compression wire holes for prelimi-nary fixation of the plate to the bone

Spacer includes a tapered tip for easierinsertion into the osteotomy site

6 plates with varying spacer lengths:– 3 mm, 4 mm, 5 mm, 6 mm and

7 mm – One plate without spacer

Variable angleScrew holes allow up to 15° off-axisscrew angulation in all directions

Minimized soft tissue irritationLow profile plates with rounded edgesand highly polished surface minimizesoft tissue irritation

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Opening Wedge Measuring Instrument

Ratchet mechanismholds osteo tomy open

Measurement scale indicates the appropriate size wedge for the desiredopening

Thin tip slides into osteotomy site and opens the wedge for the desired correction

4 Synthes Variable Angle LCP Opening Wedge Plates 2.4 /2.7 mm Technique Guide

Indications

The Opening Wedge Plate of the Variable Angle LCP Fore-foot /Midfoot System 2.4 /2.7 is indicated for deformations(e.g. hallux valgus), nonunions, and replantations of the firstmetatarsal bone, particularly in osteopenic bone.

Use of funnel-shaped VA-LCP Drill Sleeve

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VA-LCP Drill Sleeve, coaxial, for Drill Bits (03.211.004/03.110.024)

The plate holes of the Variable Angle LCP Technology 2.4 / 2.7 accept 2.4 mm and 2.7 mm Variable Angle (VA)Locking Screws.

Screws can be inserted using two different techniques:– Variable angle technique– Pre-defined nominal angle technique

Variable angle techniqueTo drill variable angle holes at a ±15° deviation from thenominal trajectory of the locking hole, insert the tip of theconical VA-LCP drill sleeve (03.211.003 / 03.110.023) and keyinto the cloverleaf design of the VA-LCP hole.

Note: It is important not to angulate more than 15° fromthe central axis of the screw hole. Overangulation may resultin difficulty while locking the screw and inadequate screw locking.

Pre-defined nominal angle techniqueThe fixed-angle VA-LCP drill sleeve (03.211.004 / 03.110.024)only allows the drill bit to follow the nominal trajectory ofthe locking hole.

Screw Insertion Techniques

VA-LCP drill sleeve, conical, for Drill Bits (03.211.003/03.110.023)


Approach

Make a 3 to 4 cm dorsomedial incision from the first tarsalmetatarsal (TMT) joint, distally along the midline of the firstmetatarsal.

Dissect down to the bone and isolate the medial branch ofthe superficial fibular nerve.

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1Create osteotomy

Identify a point medial on the metatarsal, approximately1.5 cm distal to the TMT joint. Create an osteotomy startingfrom the medial side of the metatarsal but do not cutthrough the bone. Leave the lateral cortex intact to act as ahinge point for opening the wedge.

Implantation


Implantation

2Open osteotomy and measure

Instrument

03.211.009 Opening Wedge Measuring Device

Open the osteotomy using osteotomes or the openingwedge measuring device. Slide the tip of the opening wedgedevice into the osteotomy. Open the osteotomy by squeezingthe handle until the desired correction is achieved.

The measuring instrument should be placed in the final im-plant position to ensure correct alignment and measurement.

Use image intensifier control to confirm that the desired cor-rection has been achieved.

Read the measurement on the back of the instrument to de-termine the appropriate spacer size.

Remove the measuring instrument.

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3Position plate

Select the appropriate plate that allows the desired level ofcorrection as measured.

Position the plate with the top of the T proximal to the os-teotomy.

Insert the plate into the osteotomy. The tip of the spacer hasa lead-in design to aid in inserting the wedge into the osteo -tomy.

A compression wire can be used to hold the plate in position.


4Pre-drill for VA locking screws

Instruments – VA screws 2.7 mm

310.534 Drill Bit � 2.0 mm, with marking, length110 /85 mm, 2-flute, for Quick Coupling

03.211.003 VA-LCP Drill Sleeve 2.7, conical, for Drill Bits � 2.0 mm

03.211.004 VA-LCP Drill Sleeve 2.7, coaxial, for Drill Bits � 2.0 mm

323.260 Universal Drill Guide 2.7

03.111.005 Depth Gauge for Screws � 2.0 to 2.7 mm, measuring range up to 40 mm







Determine the size of screws to be used, 2.4 or 2.7 mm, andwhether they will be inserted at a variable angle (4a) or atthe pre-defined nominal angle (4b).

Implantation

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4aPre-drill using variable angle technique









Insert and lock the VA-LCP drill sleeve tip into the cloverleafdesign of the VA-LCP hole. The cone will self retain in thehole.

Implantation


Use the 2.0 mm drill bit (2.7 mm VA screw) or the 1.8 mmdrill bit (2.4 mm VA screw) to drill at the desired angle and tothe desired depth.

The cone of the drill sleeve allows the drill bit to be angledup to 15° around the central axis of the locking hole.

Important: To ensure that the drill guide is locked correctly,do not angle the drill bit in excess of ±15° from the nominaltrajectory of the hole.

To achieve the desired angle, verify the drill bit angle anddepth under image intensifier control. If incorrect, drill at adifferent angle and verify again under image intensification.

Use the according depth gauge to measure the correct screwlength.

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4bPre-drill using pre-defined nominal angle technique



03.211.004 VA-LCP Drill Sleeve 2.7, coaxial for Drill Bits � 2.0 mm


Optional instrument




03.110.024 VA-LCP Drill Sleeve 2.4, coaxial for Drill Bits � 1.8 mm


Optional instrument


Variable angle locking screws and standard locking screwscan be inserted into the plate at the predefined hole angle orcoaxial.


Implantation

Insert and lock the VA-LCP drill sleeve tip into the cloverleafdesign of the VA-LCP hole. The coaxial drill guide will self re-tain in the hole.

Use the 2.0 mm drill bit (for VA locking screw and standard2.7 mm locking screws) or the 1.8 mm drill bit (for VA lock-ing screw and standard 2.4 mm locking screws) to drill to thedesired depth.

Verify the drill bit depth under image intensification.

Use the according depth gauge to measure the correct screwlength.

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5Insert VA locking screws

Instruments – VA screws 2.4/2.7 mm

314.467 Screwdriver Shaft, Stardrive, T8, self-holding

311.430 Handle with Quick Coupling, length 110 mmor03.111.038 Handle with Quick Coupling

Insert the correct length variable angle locking screw manu-ally using the screwdriver shaft and handle with quick cou-pling. Insert the screw until the screw head is seated (withlimited force) in the variable angle locking hole.

Important: Do not over-tighten screws. This allows thescrews to be easily removed should they not be in the de-sired position.

Insert additional screws as needed.

Confirm proper reconstruction, screw placement and screwlength under image intensification.


Implantation

6Lock VA locking screws



03.110.002 Torque Limiter, 1.2 Nm, with AO/ASIF Quick Coupling

03.110.005 Handle for Torque Limiters 0.4 /0.8 /1.2 Nm

Use the 1.2 Nm torque limiting attachment (TLA) to performthe final locking step for variable angle locking screws.The torque limiting attachment attaches to the T8 Stardrivescrewdriver shaft and the blue handle of the torque limitingattachment.

After appropriate screw angle and screw length has been finalized, manually insert the screw using the TLA assembly.

Use of the TLA is mandatory for variable angle locking holesto ensure the correct amount of torque is applied when in-serting the screws.

With this final locking step, the screws are securely locked inthe plate to achieve maximum strength of the plate-screwinter face.

Remove the compression wires.

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7Optional: Insert cortex screw

Instruments – cortex screws 2.7 mm

310.534 Drill Bit � 2.0 mm, with marking, length 110 /85 mm, 2-flute, for Quick Coupling

310.260 Drill Bit � 2.7 mm, length 100 /75 mm, 2-flute, for Quick Coupling



03.111.038 Handle with Quick Coupling


Instruments – cortex screws 2.4 mm

310.509 Drill Bit � 1.8 mm, with marking, length 110 /85 mm, 2-flute, for Quick Coupling

310.530 Drill Bit � 2.4 mm, length 100 /75 mm, 2-flute, for Quick Coupling






Implantation

Determine where 2.4 mm or 2.7 mm cortex screws will beused in the holes of the plate.

For 2.4 mm cortex screws, use the 2.4 universal drill guide.Predrill the screw hole with the 1.8 mm drill bit.

For 2.7 mm cortex screws, use the 2.7 universal drill guide.Predrill the screw hole with the 2.0 mm drill bit.

To drill a gliding hole for compression, use the 2.7 mm drillbit (for 2.7 mm cortex screw) or the 2.4 mm drill bit(for 2.4 mm cortex screw) with the double drill guide.

Determine the screw length with the depth gauge and insertthe screw.

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8Ensure proper reconstruction

Ensure proper joint reconstruction, screw placement andscrew length under image intensification. Verify that thescrews are not in the soft tissue.





To remove locking screws, first unlock all locking screws be-fore removing them completely. Otherwise, the plate may ro-tate and damage the soft tissue.

Implant Removal

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Screws

All non-sterile screws are also available sterile packed. Add suffix “S” to article number to order sterile product.

X=2: Stainless steelX=4: TAN

Variable angle locking screws (VA-LCP) 2.7 mm

0X.211.010– VA Locking Screw Stardrive � 2.7 mm040 (head 2.4), self-tapping, length 10–40 mm

0X.211.042S– VA Locking Screw Stardrive � 2.7 mm 060S (head 2.4), self-tapping, length 42–60 mm, sterile

Threaded, rounded head locks securely into the threaded VA-LCP holes to provide angular stability at angles deter-mined by the surgeon.

Also securely locks into standard locking holes (LCP) of theplate at the pre-defined angle.

Important: For final locking, the 1.2 Nm TLA torque limitingattachment is required.

Optional:Variable angle locking screws (VA-LCP) 2.4 mm

0X.210.106– VA Locking Screw Stardrive � 2.4 mm,140 self-tapping, length 6–40 mm

0X.210.142S– VA Locking Screw Stardrive � 2.4 mm,160S self-tapping, length 42–60 mm, sterile


Screws

Cortex screws 2.7 mm

X02.870– Cortex Screw Stardrive � 2.7 mm, 900 self-tapping, length 10–40 mm

X02.962S– Cortex Screw Stardrive � 2.7 mm,969S self-tapping, length 42–60 mm, sterile

All non-sterile screws are also available sterile packed. Add suffix “S” to article number to order sterile product.


Cortex screws 2.4 mm

X01.756– Cortex Screw Stardrive � 2.4 mm, 790 self-tapping, length 6–40 mm

0X.210.942S– Cortex Screw Stardrive � 2.4 mm,960S self-tapping, length 42–60 mm, sterile

For use in round or combi-holes.

Optional: Locking head screws 2.4/2.7 mm

X12.806– Locking Screw Stardrive � 2.4 mm,830 self-tapping, length 6–30 mm

X02.206– Locking Screw Stardrive � 2.7 mm 260 (head LCP 2.4), self-tapping, length 6–60 mm

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Opening Wedge Plates 2.4/2.7, VA locking

Art. No. Length (mm) Spacer (mm)

0X.211.210 32 0

0X.211.211 32 3

0X.211.212 32 4

0X.211.213 32 5

0X.211.214 32 6

0X.211.215 32 7

Plates

All plates are available non-sterile and sterile packed. Add suffix “S” to article number to order sterile product.



311.430 Handle with Quick Coupling, length 110 mm

Instruments

314.467 Screwdriver Shaft, Stardrive, T8,self-holding

03.110.002 Torque Limiter, 1.2 Nm, with AO / ASIF Quick Coupling

03.110.005 Handle for Torque Limiters 0.4 / 0.8 / 1.2 Nm

03.111.005 Depth Gauge for Screws � 2.0 to 2.7 mm,measuring range up to 40 mm


03.211.001 Holding Pin for VA Locking Plates 2.4 / 2.7

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310.260 Drill Bit � 2.7 mm, length 100 / 75 mm, 2-flute, for Quick Coupling

310.534 Drill Bit � 2.0 mm, with marking,length 110 / 85 mm, 2-flute, for Quick Coupling




Instruments for insertion of 2.7 mm screws


Instruments

Instruments for insertion of 2.4 mm screws

310.530 Drill Bit � 2.4 mm, length 100 /75 mm,2-flute, for Quick Coupling





Synthes 27

03.211.009 Opening Wedge Measuring Device

Instrument for opening wedge plates


Norian SRS

*Facilitated through SynthesOsteoinductive power

Osteoconductive, resorbable, synthetic Enhancing chronOS with biological factors Injectable remodelling

Injectable stability

Furthermore a comprehensive portfolioof allograft products is available in selected countries.

For more detailed information about aspecific product or availability of allo-grafts please contact your local Synthesrepresentative.

DBX*

Synthes Biomaterials Overview

Synthetic and allogenic bone replace-ment materials have the advantage ofuniform quality, unlimited availabilityand absence of potential complicationsat a donor site.

chronOS

Additionally, the application of syntheticand allogenic bone graft substitutes reduces the duration of the surgery.

Synthes offers a wide range of syntheticbiomaterial products in different application forms and with distinct bio-logical properties:

chronOS Perfusion Concept chronOS Inject

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variable angle lcp opening wedge plates 2.4/2.7. part of ...synthes.vo.llnwd.net/o16/llnwmb8/int...

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