DHS/DCS Dynamic Hip and Condylar Screw System. Designed …synthes.vo.llnwd.net/o16/Mobile/Synthes North...DHS/DCS Dynamic Hip and Condylar Screw System. Designed to provide stable

DHS/DCS Dynamic Hip and CondylarScrew System. Designed to providestable internal fixation.

Technique Guide

Introduction

Surgical Technique

Special Techniques

Product Information

Synthes

Image intensifier control

Dynamic Hip Screw (DHS) 2

Dynamic Condylar Screw (DCS) 3

Indications 4

DHS 5

DCS 14

Using the DHS/DCS One-Step Insertion Wrench 23

Using the DCS for Subtrochanteric Fractures 28

Assembling the Instrumentation 37

Reinserting the 2.5 mm Threaded Guide Wire 41

Implant Removal 42

Implants 43

Instruments 46

Set Lists 53

Table of Contents

2 Synthes DHS/DCS Dynamic Hip and Condylar Screw System Technique Guide

The Dynamic Hip Screw is designed to provide strong and stable internal fixation of a variety of intertrochanteric, subtrochanteric and basilar neck fractures, with minimal soft tissue irritation.

StrongThe DHS plates are made of 316L stainless steel and are cold-worked for strength.

StableThe number of screw holes per plate length is maximized,without compromising plate strength. This allows an increasednumber of fixation points with a smaller incision.

DCP (dynamic compression plate) holes in the DHS side plate:– Allow angulation of 4.5 mm cortex screws, for lag screw

fixation of medial fragments, and

– Allow axial compression and multiple-screw fixation of the main fragment in subtrochanteric fractures withshaft extension

Two flats within the DHS plate barrel correspond to the two-flat design of the DHS/DCS lag screw, preventing rotationof the lag screw within the barrel. The two-flat design alsoeases insertion of the plate over the DHS/DCS lag screw.

Minimal soft tissue irritationThe DHS plates have a low-profile design, reducing the riskof trochanteric bursitis.

The DHS plates are available in a wide range of sizes and barrel angles, with standard or short barrels, for varied clinical situations.

The DHS/DCS lag screw, available from 50 mm to 145 mmlengths, easily glides within the DHS plate barrel for controlledcollapse and impaction of fragments. When the fracture requires additional intraoperative compression, the DHS/DCScompression screw can be used; only one size compressionscrew is needed.

The DHS instruments provide direct measurements throughoutthe DHS procedure, allowing proper reaming, tapping andlag screw insertion depth. The built-in stop and locking nuton the DHS triple reamer prevent over-reaming.

Dynamic Hip Screw (DHS)

Synthes 3

The Dynamic Condylar Screw is designed to provide strongand stable internal fixation of certain distal femoral and subtrochanteric fractures, with minimal soft tissue irritation.

StrongThe DCS plates are made of 316L stainless steel and are cold-worked for strength.

StableThe two holes closest to the barrel accept 6.5 mm cancellousbone screws. This enhances stability by allowing additionalfixation of the most distal condylar fracture fragments or fixation of the most proximal subtrochanteric fracture fragments.

DCP holes in the DCS side plate allow angulation of 4.5 mmcortex screws and axial compression across a shaft fracture.

The number of screw holes per plate length is maximized,without compromising plate strength. This allows an increasednumber of fixation points with a smaller incision.

Two flats within the DCS plate barrel correspond to the two-flat design of the lag screw, preventing rotation of theDHS/DCS lag screw within the barrel. The two-flat designalso eases insertion of the plate over the DHS/DCS lag screw.

Minimal soft tissue irritationThe low-profile design reduces the risk of iliotibial band irritation (distal femoral fractures) and trochanteric bursitis(subtrochanteric fractures).

The DCS plates are available with 6 to 16 holes, for variedclinical situations. The DHS/DCS lag screw is available in 50 mm to 145 mm lengths. The DHS/DCS compressionscrew can be used for additional compression; only one size compression screw is needed.

The DCS instruments also provide direct measurementsthroughout the DCS procedure, allowing proper reaming,tapping, and lag screw insertion depth. The built-in stop andlocking nut on the DCS triple reamer prevent over-reaming.

Dynamic Condylar Screw (DCS)


DHSThe DHS is indicated for the following fractures of the proximal femur:– Intertrochanteric fractures

– Subtrochanteric fractures*

– Basilar neck fractures

The DHS is indicated for stable fractures, and unstable fracturesin which a stable medial buttress can be reconstructed. TheDHS provides controlled collapse and compression of fracturefragments. This results in stable fixation and prevents unduestress concentration on the implant.

* For certain subtrochanteric fractures, a 95° device is theimplant of choice (See “Using the DCS for SubtrochantericFractures,” page 28).

DCSThe DCS is indicated for the following fractures of the distal femur:– Intercondylar fractures**

– Supracondylar fractures**

– Unicondylar fractures**

** The following anatomic conditions should exist:

– 4 cm of distal femur should remain intact to provide supportfor the implant.

– A distal portion of the medial condyle should be intact forthe DHS/DCS lag screw to gain good purchase.

If these conditions do not exist, a Synthes 4.5 mm LCPcondylar plate or LCP distal femur plate should be considered.

The DCS is indicated for the following fractures of the proximal femur:– Transverse subtrochanteric fractures†

– Short oblique subtrochanteric fractures†

– Long oblique subtrochanteric fractures†

† With the lesser trochanter avulsed or on the distal fragment (femoral shaft).1

Indications

1. Roy Sanders and P. Regazzoni. “Treatment of Subtrochanteric Femur FracturesUsing the Dynamic Condylar Screw.” Journal of Orthopaedic Trauma, vol. 3, no. 3. New York: Raven Press, 1989. 206-213.

Synthes 5

Surgical Technique—DHS

2. P. Regazzoni, Th. Rüedi, R. Winquist, and M. Allgöwer. The Dynamic Hip ScrewImplant System. Berlin: Springer-Verlag, 1985. 5.

38 mm barrel 25 mm barrel

Plate selection

Barrel lengthThe standard 38 mm barrel length is most commonly indicated.

The 25 mm short barrel is indicated for specific clinical situations, including:– Cases in which the standard barrel may not provide sufficient

glide for the lag screw; i.e., a long impaction distance is expected

– A medial displacement osteotomy

– Unusually small femurs

Barrel angleAn evaluation of the angle subtended between the femoralneck and shaft axes (CCD, or collum-center-diaphysis, angle)of the uninjured femur will aid in the selection of the mostappropriate barrel angle. The 135° barrel angle is most commonly indicated.

Note: Greater barrel angles may produce biomechanical advantages in unstable cases; i.e., better gliding characteristicsand reduced bending stresses on the plate /barrel junction, although correct placement of the implant becomes technicallymore difficult as barrel angles increase.2

Surgical Technique—DHS continued


1Reduce fracture

Instruments

338.01– DHS Angle Guides338.04

900.723 2.5 mm Threaded Guide Wire

Reduce the fracture. Determine anteversion by placing a 2.5 mm threaded guide wire anteriorly along the femoralneck, using the appropriate DHS angle guide. Gently hammerthe wire into the femoral head. This anteversion wire will laterallow correct placement of the central guide wire in the center of the femoral head.

Synthes 7

2Insert guide wire

Instruments

310.19 2.0 mm Drill Bit

338.01– DHS Angle Guides338.04


Align the appropriate DHS angle guide along the axis of the femoral shaft, and place it on the femur. Point the guidetube toward the center of the femoral head. Predrilling ofthe lateral cortex with the 2.0 mm drill bit is recommendedin dense bone. Insert a 2.5 mm threaded guide wire throughthe appropriate DHS angle guide, parallel to the anteversionwire and directed toward the center of the femoral head.This point of introduction varies with barrel angle. When a135° barrel angle is used, the guide wire enters the proximalfemur approximately 2.5 cm distal to the vastus ridge.

Notes:Because it is designed for use with the DHS/DCS instrumentsand implants, the 2.5 mm threaded guide wire, and not analternative wire, must be used.

This guide wire remains in place throughout the procedure. If it is inadvertently withdrawn, reinsert it immediately (see“Reinserting the 2.5 mm Threaded Guide Wire,” page 41).



3Confirm placement

Confirm placement of the 2.5 mm threaded guide wire under image intensification. It must lie along the axis of thefemoral neck in both the AP and lateral views, and parallel to the anteversion wire. If its position is incorrect, insert anew guide wire. Remove and discard the anteversion wire.

4Determine insertion depth

Instrument

338.05 DHS/DCS Direct Measuring Device

Slide the direct measuring device over the guide wire to determine guide wire insertion depth. Calibration on themeasuring device provides a direct reading.

Synthes 9

5Calculate reaming depth and lag screw length

To calculate reaming depth, tapping depth and lag screwlength, subtract 10 mm from the reading. For example:

a. Direct reading 105 mm

b. Reamer setting 95 mm

c. Tapping depth (optional) 95 mmLag screw length 95 mm

6Ream to predetermined depth

Instruments

338.13 DHS Triple Reameror338.43* DHS Triple Reamer (for short barrel plates)

532.010* Small Battery Drive

532.015* Large Quick Coupling

532.032* Battery Casing

532.033* 14.4 V Battery

Assemble the appropriate DHS triple reamer (for either thestandard or short barrel DHS plate) (see “Assembling the Instrumentation,” page 37). Set the reamer to the correctdepth. Insert the DHS triple reamer into the small batterydrive using the large quick coupling attachment. Slide thereamer over the guide wire to simultaneously drill for the lag screw, ream for the plate barrel, and countersink for theplate /barrel junction to the preset depth. When reaming indense bone, continuously irrigate the DHS triple reamer toprevent thermal necrosis.

a.

b.

c.

* Also available



7Tap to predetermined depth (optional)

Instruments

338.08 DHS/DCS T-Handle

338.17 Tap for DHS/DCS, 12.5 mm diameter

338.18 DHS/DCS Centering Sleeve, short

If necessary, tap to the predetermined depth using the tapassembly (see “Assembling the Instrumentation,” page 38).Tapping depth can be seen through the window in the shortcentering sleeve.

8Insert lag screw

Instruments

338.06 DHS/DCS Wrench

338.19 DHS/DCS Centering Sleeve, long

338.20 DHS/DCS Coupling Screw

338.21 DHS/DCS Guide Shaft

Select the DHS/DCS lag screw and assemble the lag screw insertion assembly (see “Assembling the Instrumentation,”page 39). Slide the assembly over the guide wire and into the reamed hole. Seat the long centering sleeve in the holeto center and stabilize the assembly. Insert the lag screw byturning the handle clockwise, until the zero mark on the assembly aligns with the lateral cortex. The threaded tip ofthe lag screw now lies 10 mm from the joint surface. The lagscrew may be inserted an additional 5 mm in porotic bone,for increased holding power and additional controlled collapse.

Note: Keep continuous forward pressure on the DHS/DCSwrench while advancing the lag screw.

95 mm

Synthes 11

9Align handle

Before removing the assembly, align the handle so it is in thesame plane as the femoral shaft (parallel to the femoral shaftaxis when viewed laterally). This allows proper placement ofthe DHS plate onto the lag screw.

10Remove wrench

Instruments


532.022* Quick Coupling for K-Wires

Remove the DHS/DCS wrench and long centering sleeve.Slide the appropriate DHS plate onto the guide shaft/lagscrew assembly until it contacts the lateral cortex. Loosenand remove the coupling screw and guide shaft. Use thesmall battery drive in reverse, with the quick coupling for K-wires, to withdraw the 2.5 mm threaded guide wire.

* Also available



11Seat plate

Instrument

338.28 DHS/DCS Impactor

Gently seat the plate with the DHS/DCS impactor. The vastusridge may be chiseled to further seat the plate on bone.

12Fix plate to femur

Using AO standard screw insertion technique, fix the DHS plateto the femur with 4.5 mm cortex screws.

Synthes 13

13Insert compression screw (optional)

Instrument

314.27 Large Hexagonal Screwdriver

For further, intraoperative compression of the trochantericfracture, the DHS/DCS compression screw may be insertedinto the lag screw. The DHS/DCS compression screw may beused in unstable fractures to prevent disengagement of thelag screw from the plate barrel in non-weight-bearing patients.

Note: Use of the compression screw may cause stripping of the lag screw thread in porotic bone.

B

A


2Determine direction of central guide wire

Instrument

292.20 2.0 mm Kirschner Wire

To determine the direction of the central guide wire, flex theknee to 90°, and mark the axis of the knee joint by placing a K-wire distally over the condyles (A). Place a second K-wireanteriorly over the condyles (B).

Note: Placement of the guide wire determines placement of the DCS implant assembly. Misplacement of the guidewire can result in varus/valgus or rotational malalignment of the fracture fragments.

1Reduce fracture

Instrument


Reduce the fracture. The fracture can be temporarily stabilizedwith 2.5 mm threaded guide wires or Steinmann pins. Placethese wires so they do not interfere with subsequent positioningof the DCS implant assembly (see illustrations accompanyingStep 3 for proper implant positioning). In intercondylar fractures, the wires should be replaced with independent 6.5 mm or 7.3 mm cannulated screws or 6.5 mm cancellousbone screws with washers.

B25º

Surgical Technique—DCS

Synthes 15

3Insert central guide wire

Instruments

338.41 DCS Drill Guide


Using the DCS drill guide, insert the central guide wire (C)parallel to the distal K-wire (A) in the AP view, and parallel to the anterior K-wire (B) in the axial view. Do not insert theguide wire too far medially; consider the inclination of themedial wall of the distal femur. In the sagittal plane, the central guide wire enters the distal femur at a point anteriorto the midline between the condyles, and in line with theshaft axis, approximately 2 cm from the knee joint.

Confirm placement of the central guide wire under image intensification. If it is not parallel to the knee joint axis, inserta new 2.5 mm threaded guide wire.

Notes: Because it is designed for use with the DHS/DCS instrumentsand implants, the 2.5 mm threaded guide wire, and not analternative wire, must be used.


AP view: C is parallel to A

Axial view: C is parallel to B

2 cm

2/3 1/3




a Direct reading 80 mmb Reamer setting 70 mmc Tapping depth (optional) 70 mm

Lag screw length 70 mm

If the compression screw will be used, allow for additionalcompression of the fracture by selecting a lag screw 5 mm shorter (in this case, 65 mm) and inserting it an additional 5 mm.

4Determine guide wire insertion depth

Instrument


Slide the direct measuring device over the guide wire, anddetermine guide wire insertion depth. Calibration on themeasuring device provides a direct reading.

Surgical Technique—DCS continued

80 mm

a. b.

c.

Synthes 17


Instruments




If necessary, use the tap assembly to tap to the predetermineddepth, which can be seen through the window in the shortcentering sleeve (see “Assembling the Instrumentation,”page 38).


Instruments

338.46* DCS Triple Reamer, complete (includes DCS Reaming Head (338.47), 8.0 mm Drill Bit (338.10) and Nut)




532.033* 14.4 V Battery

Assemble the DCS triple reamer (see “Assembling the Instrumentation,” page 37). Set the reamer to the correctdepth. Insert the DCS triple reamer into the small batterydrive using the large quick coupling attachment. Slide thereamer over the guide wire to simultaneously drill for the lag screw, ream for the plate barrel, and countersink for theplate/barrel junction to the preset depth. When reaming indense bone, continuously irrigate the DCS triple reamer toprevent thermal necrosis.

* Also available


9Insert lag screw

Insert the lag screw by turning the handle clockwise until the0 mark on the assembly aligns with the lateral cortex. Thethreaded tip of the lag screw now lies 10 mm from the medialcortex. The lag screw may be inserted an additional 5 mm inporotic bone, for increased holding power.

Note: If a lag screw 5 mm shorter than reaming and tappingdepth is used (in this case, 65 mm), insert it an additional 5 mm,until the 5 mark on the assembly aligns with the lateral cortex.

8Assemble lag screw insertion assembly

Instruments





Select the correct length DHS/DCS lag screw and assemblethe lag screw insertion assembly (see “Assembling the Instrumentation,” page 39). Slide the assembly over theguide wire and into the reamed hole. Seat the long centeringsleeve in the hole to center and stabilize the assembly.

Note: Keep continuous forward pressure on the DHS/DCSwrench while advancing the lag screw.


Synthes 19

11Remove wrench

Instruments



Remove the DHS/DCS wrench and long centering sleeve.Slide the appropriate DCS plate onto the guide shaft / lagscrew assembly. Loosen and remove the coupling screw andguide shaft. Use the small battery drive in reverse, with thequick coupling for K-wires, to withdraw the guide wire.

10Align handle

Before removing the assembly, align the handle so it is parallelwith the femoral shaft axis when viewed laterally. This allowsproper placement of the DCS plate onto the lag screw.

* Also available


13Compress distal fragments with compression screw

Instrument


If the joint fragments were not previously reduced with independent 6.5 mm cancellous bone screws, the DHS/DCScompression screw may be inserted into the lag screw. Inporotic bone, insert the screw very carefully to avoid strippingthe lag screw thread.

12Seat plate

Instrument


Gently seat the plate with the DHS/DCS impactor. The lateralcondylar cortex may be chiseled to further seat the plate on bone.


Synthes 21

15Compress to femoral shaft

Instrument

321.12* Articulated Tension Device

Once an approximate anatomic reduction is achieved, usethe articulated tension device to produce final compressionbetween the femoral shaft and distal fragments. To facilitatereduction of the diaphyseal fragment, particularly in cases ofmedial comminution with shortening, the tension device canalso be used as a distractor.

14Insert 6.5 mm cancellous screws

Further interfragmentary compression can be achieved by using two 6.5 mm cancellous bone screws through the distalround holes of the DCS plate.

* Also available



Using AO standard screw insertion technique, fix the DCS plate to the femur with 4.5 mm cortex screws.


Synthes 23

Special Techniques — Using the DHS/DCS One-Step Insertion Wrench

1Insert guide wire

Instruments

338.047 Variable Angle Guide for DHS



Set the variable angle guide for DHS to the desired angle. Insert the tip of the 2.5 mm threaded guide wire to the subchondral bone in the femoral head.

Use the DHS/DCS direct measuring device to determine thelength of the guide wire.

To determine reaming depth and lag screw length, subtract10 mm from the reading.

Wrench338.302

DHS/DCS One StepLag Screw280.2xx280.3xx

DHS Plate281.xxx

Centering Sleeve338.32

CouplingScrew 338.31

DHS/DCS One-Step Insertion Wrench Assembly


Special Techniques — Using the DHS/DCS One-Step Insertion Wrench continued

2Ream for lag screw and plate

Instruments

338.13 DHS Triple Reameror338.43* DHS Triple Reamer (for short barrel plates)

338.17 DHS/DCS Tap

338.18 Centering Sleeve

Ream the hole for the lag screw and plate over the correctlypositioned guide wire. (See “Assembling the Instrumentation,”page 37.)

Tap using the DHS/DCS tap with centering sleeve. (See “Assembling the Instrumentation,” page 38)

*Also available

Synthes 25

3Assemble wrench

Instruments

338.302 One-Step Insertion Wrench

338.31 Coupling Screw

338.32 Centering Sleeve

Insert the coupling screw into the one-step insertion wrenchand slide the DHS plate onto the shaft of the wrench.

Select the appropriate length lag screw and place on the endof the wrench; the flats of the lag screw must be aligned withthe flats on the wrench. Thread the coupling screw into theend of the lag screw.

3Assemble wrench continued

Place the centering sleeve onto the wrench between the lagscrew and the plate.

Slide the assembly over the 2.5 mm guide wire and into thereamed hole.


Special Techniques—Using the DHS/DCS One-Step Insertion Wrench continued

Synthes 27

4Insert lag screw

Turn the wrench clockwise until the back of the lag screw isseated in the lateral cortex (as observed through the windowon the centering sleeve).

Align the wrench handle with the long axis of the femoralshaft. The tip will be 10 mm from the tip of the guide wire.

To remove the centering sleeve from the wrench, twist theinner and outer sleeves in opposite directions.

10 mm

5Insert plate

Instrument


Advance the side plate along the shaft of the wrench andmanually insert the barrel into the reamed hole.

Seat the plate with the DHS/DCS impactor. Make certain thatthe wrench shaft lies in the channel of the impactor.

Affix the plate to the proximal femur with 4.5 mm cortexscrews, using standard AO technique.


Special Techniques — Using the DCS for Subtrochanteric Fractures

The design of the DCS plate can enhance fixation of selected,stable subtrochanteric fractures because it permits stable fixation in the proximal fragment.3 The DCS plate has a 95°barrel angle, allowing it to enter the femur more proximallythan the DHS plate and allowing insertion of independentscrews into the calcar. Further, its two round proximal plateholes permit insertion of 6.5 mm cancellous bone screws, for stable proximal fixation.

Stable transverse and short oblique subtrochantericfractures When using the DCS plate for these fractures, the plate can actas a tension band against normal medial compressive forces.4

Long oblique subtrochanteric fracturesWhen using the 135° DHS plate to treat long oblique subtrochanteric fractures, use of the proximal plate screwscan prohibit compression. With the 95° DCS plate, however, stable fixation can be achieved by lagging the fracture throughthe plate, since controlled collapse is not anticipated.

Note: When used in the proximal femur, the DCS plate canonly be used to treat stable fractures; i.e., fractures that canbe directly reduced and anatomically reassembled to allowrestoration of the bony medial buttress. Because the DCSplate has a 95° barrel angle, it does not allow for controlledcollapse and compression.

3. Roy Sanders and P. Regazzoni. “Treatment of Subtrochanteric Femur FracturesUsing the Dynamic Condylar Screw.” Journal of Orthopaedic Trauma, vol. 3, no. 3. New York: Raven Press, 1989. 211.

4. Ibid., 212.

Synthes 29

Preoperative considerations

Plate selectionSelect the DCS plate so there are four screws (eight cortices)distal to the fracture in hard diaphyseal bone, or five screws(ten cortices) in porotic bone.

Insertion of the 2.5 mm threaded guide wireThough the general insertion area of the guide wire is known,the precise insertion point varies with the CCD angle, the angle subtended between the femoral neck and shaft axes.Assessment of the CCD angle will allow subsequent placementof the lag screw in its optimal position— in the center of thefemoral neck and in the inferior half of the femoral head (see illustration). This insertion point should be determinedpreoperatively with the aid of planning templates.

Note: The insertion point of the guide wire will vary withCCD angle (angle subtended between the femoral neck andshaft axes), as depicted by the valgus femur in the figure(dotted lines). Example is exag gerated for clarity.


Special Techniques — Using the DCS for Subtrochanteric Fractures continued

2Insert guide wire

Instruments

310.19 2.0 mm Drill Bit

338.41 95º DCS Drill Guide


Place the 95º DCS drill guide along the axis of the femoralshaft so the central guide wire will enter the femur slightlyanterior to the midpoint of the greater trochanter, near the vastus ridge. The precise level at which the guide wireenters the femur should be determined preoperatively (see “Preoperative considerations,” page 29). Insert the centralguide wire parallel to the anteversion wire in the lateral view.Predrilling of the lateral cortex with the 2.0 mm drill bit is recommended in dense bone.

Notes:Because it is designed for use with the DHS/DCS instrumentsand implants, the 2.5 mm threaded guide wire, and not analternative wire, must be used.


1Reduce fracture

Instrument


Reduce the fracture. Determine anteversion by placing a 2.5 mm threaded guide wire anteriorly along the femoralneck, gently hammering it into the femoral head. This anteversion wire will ensure correct placement of the central guide wire.



a. Direct reading 95 mmb. Reamer setting 85 mmc. Tapping depth (optional) 85 mm

Lag screw length 85 mm

4Determine insertion depth

Instrument


Slide the direct measuring device over the guide wire to determine guide wire insertion depth. Calibration on themeasuring device provides a direct reading.

3Confirm placement

Confirm placement of the central guide wire under image intensification, in two views. In the AP view, the wire shouldlie in the center of the neck and in the inferior half of thefemoral head. In the lateral view, it should lie in the middleof the femoral head. The tip of the guide wire should just engage the subchondral bone. If its position is incorrect, inserta new guide wire. Remove and discard the anteversion wire.

Synthes 31

95 mm

a. b.

c.




Instruments

338.46* DCS Triple Reamer, complete (includes DCS Reaming Head (338.47), 8.0 mm Drill Bit (338.10) and Nut)




532.033* 14.4 V Battery

Assemble the DCS triple reamer (see “Assembling the Instrumentation,” page 37). Set the reamer to the correctdepth. Insert the DCS triple reamer into the small batterydrive using the large quick coupling attachment. Slide thereamer over the guide wire to simultaneously drill for the lag screw, ream for the plate barrel, and countersink for theplate/barrel junction to the preset depth. When reaming indense bone, continuously irrigate the DCS triple reamer toprevent thermal necrosis.


Instruments




Secure the proximal fragment with a bone forceps to preventrotation in the sagittal plane. If necessary, tap to the prede-termined depth using the tap assembly (see “Assembling the Instrumentation,” page 38). Tapping depth can be seenthrough the window in the short centering sleeve.

85 mm

* Also available

Synthes 33

8Insert lag screw

Instruments





Select the lag screw and assemble the lag screw inser tion assembly (see “Assembling the Instrumentation,” page 39).Slide the assembly over the guide wire and into the reamedhole. Seat the centering sleeve in the hole to center and stabilize the assembly, and insert the lag screw by turning thehandle clockwise until the 0 mark on the assembly alignswith the lateral cortex. The threaded tip of the lag screwnow lies 10 mm from the medial cortex. The lag screw maybe inserted an additional 5 mm in porotic bone, until the 5 mm mark aligns with the lateral cortex, for increased holding power.

9Align handle

Before removing the assembly, align the handle so it is in thesame plane as the femoral shaft (parallel with the femoralshaft axis when viewed laterally). This allows correct placementof the DCS plate onto the lag screw.

* Also available



10Remove wrench

Remove the DHS/DCS wrench and long centering sleeve.Slide the appropriate DCS plate onto the guide shaft / lagscrew assembly.

11Seat plate

Instruments




Loosen and remove the coupling screw and guide shaft. Usethe small battery drive in reverse, with the quick coupling forK-wires, to withdraw the guide wire. Gently seat the platewith the DHS/DCS impactor. The vastus ridge can be chiseledto further seat the plate on bone.

* Also available

12Insert cancellous bone screws

Instruments

310.31 3.2 mm Drill Bit, quick coupling

310.44 4.5 mm Drill Bit, quick coupling

312.48 4.5 mm/3.2 mm Insert Drill Sleeve

Insert two 6.5 mm cancellous bone screws through the proximalround holes of the DCS plate, using lag screw technique. Todo so, drill a hole through the near cortex with the 4.5 mmdrill bit. Fully seat the 4.5 mm/3.2 mm insert drill sleeve intothe hole. Drill through the sleeve and penetrate the far cortexwith the 3.2 mm drill bit. Measure, tap and insert the 6.5 mmcancellous bone screw. This technique will prevent the drillbit from gliding along the calcar.

13Insert compression screw

Instrument


Insert the DHS/DCS compression screw into the lag screw.This will prevent disengagement of the lag screw from theplate barrel.

Synthes 35

36 Synthes DHS/DCS Dynamic Hip and Condylar Screw System

14Compress to femoral shaft

Instrument

321.12* Articulated Tension Device

Once an approximate anatomic reduction is achieved, the articulated tension device may be used to produce final compression of the fracture.

Note: Do not use the tension device if extensive comminution exists.


Using AO standard screw insertion technique, fix the DCS plateto the femur with 4.5 mm cortex screws.


* Also available

Triple reamer assembly

Instruments

338.11 DHS Reaming Head, standard

338.13 DHS Triple Reamer, complete (includes 338.11)

338.44 DHS Reaming Head, short

338.47 DCS Reaming Head

Caution: The components of the triple reamers are sharpand should be handled carefully.

Note: The triple reamers can be assembled preoperatively.Reaming depth is set intraoperatively.

Select the reaming head that corresponds to the chosen plate(DHS or DCS) and barrel length (DHS standard or DHS short).

Align the setscrew on the reaming head with the flat on thedrill bit. Slide the cutting end of the reaming head over thecoupling end of the drill bit.

Hold the coupling end of the drill bit with one hand, andcontinue sliding the reaming head along the drill bit with the other hand. The proper setting is attained when the non-cutting end of the reaming head reaches the calculateddepth setting. In this example, the depth setting is 95 mm(see inset).

Special Techniques — Assembling the Instrumentation

Synthes 37

Setscrew

338.13

Flat

Special Techniques — Assembling the Instrumentation continued


Tap assembly

Instruments



Slide the short centering sleeve over the tap.

Simultaneously push the quick coupling fitting on the T-handleand insert the tap into the fitting.

Triple reamer assembly continued

Secure the reaming head into the appropriate notch, and lock it in place with the locking nut.

Synthes 39

Release the collar, and check to be sure the tap is securelyseated in the handle.

Lag screw insertion assembly

Instruments



338.20 DHS/DCS Coupling Screw, short


Note: The lag screw insertion assembly must be assembled intraoperatively after the proper length lag screw is chosen.

Insert the coupling screw into the DHS/DCS guide shaft.


Lag screw insertion assembly continued

Screw the coupling screw into the end of the lag screw. The tabs of the guide shaft should seat into the slots of the lag screw.

Slide the long centering sleeve over the wrench.

Firmly insert the guide shaft / lag screw assembly into thewrench until it stops.

Special Techniques — Assembling the Instrumentation continued

Synthes 41

Special Techniques — Reinserting the 2.5 mm Threaded Guide Wire

If the guide wire is inadvertently withdrawn at any time duringthe procedure, reinsert it immediately.

To reinsert guide wire if withdrawn upon removal of triple reamer

Instruments


399.42* Hammer, 500 grams


Insert a lag screw backwards into the short centering sleeve.

Place this assembly into the bone, and use it as a guide for reinsertion of the threaded guide wire. Cannulation inthe DHS/DCS lag screw centers the threaded guide wire in the hole.

Use a hammer to gently reseat the threaded guide wire.

Caution: Do not continue the procedure without thethreaded guide wire, as the risk of misdirecting the triplereamer, tap assembly, or DHS/DCS lag screw is too great.

* Also available


Implant Removal

Implant removal

Instrument


Remove the plate.

Assemble the insertion wrench, using the long couplingscrew. The long coupling screw allows the surgeon to exerttraction while unscrewing the lag screw.

Align the flats inside the wrench with the flats of the lagscrew. Slide the wrench over the lag screw until it is well over the end of the screw.

Pull on the wrench while turning it counterclockwise.

Instrument options for removal

System Will remove:

DHS– Wrench (338.06) DHS DHS One-Step DHHS– Long Coupling Screw (338.22) DHS DHS One-Step DHHS

DHS One-Step– Insertion Wrench (338.302) DHS One-Step DHHS– Coupling Screw (338.31) DHS One-Step DHHS

DHHS– Solid Coupling Screw with DHHS

internal threads (338.313)– Hammer Guide (03.010.059) DHHS– Side/Fixed Hammer, 400 grams DHHS

(03.010.058)

Note: If the DHHS solid coupling screw has external threads on the back-end, use the Inserter Extractor (356.49) and Slotted Hammer (332.20) for removal.

DHS Plates, standard barrel (38 mm barrel)◊

Holes Shaft Length Barrel Angle(mm) 130° 135° 140° 145° 150°

2 46 281.021 281.102 281.220 281.320 281.4023 62 281.031 281.131 281.230 281.330 281.4304 78 281.040 281.140 281.240 281.340 281.4405 94 281.050 281.150 281.250 281.350 281.4506 110 281.060 281.160 281.260 281.360 281.4608 142 281.081 281.180 281.280 281.308 281.480

10 174 281.010 281.100 281.200 281.310 281.40012 206 281.012 281.110 281.212 281.312 281.41014 238 281.014 281.130 281.214 281.314 281.41416 270 — 281.170 281.216 281.316 281.41618 302 — 281.190 — — 281.41820 333 — 281.020 — — 281.421

DHS Plates, short barrel (25 mm barrel)◊

Holes Shaft Length Barrel Angle(mm) 130° 135° 140° 145° 150°

2 46 281.502 281.520 281.620 281.720 281.8203 62 281.503 281.530 281.630 281.730 281.8304 78 281.504 281.540 281.640 281.740 281.8405 94 281.505 281.550 281.650 281.750 281.8506 110 281.506 281.560 281.660 281.760 281.860

Synthes 43

Implants

◊ Available nonsterile and sterile-packed.Add “S” to catalog number to order sterile product.

DCS Plates◊

Holes Shaft Length Barrel Angle(mm) 95°

6 114 281.9608 146 281.980

10 178 281.90012 210 281.92514 242 281.93016 274 281.94018 306 281.95020 338 281.97022 370 281.990



DHS/DCS Lag Screws, 12.7 mm diameter thread◊

– Thread length: 22 mm

– Shaft diameter: 8 mm

– Pitch: 3.0 mm

– Diameter of cannulation: 2.7 mm

Length (mm) Length (mm)

280.501 50 280.000 100280.550 55 280.050 105280.600 60 280.100 110280.650 65 280.150 115280.700 70 280.200 120280.750 75 280.250 125280.800 80 280.300 130280.850 85 280.350 135280.900 90 280.400 140280.950 95 280.451 145


– Thread length: 22 mm

– Shaft diameter: 8 mm

– Pitch: 3.0 mm

– Diameter of cannulation: 2.7 mm


280.454 50 280.504 100280.455 55 280.505 105280.460 60 280.510 110280.465 65 280.515 115280.470 70 280.520 120280.475 75 280.525 125280.480 80 280.530 130280.485 85 280.535 135280.490 90 280.540 140280.495 95 280.545 145

DHS/DCS Compression Screw◊

280.990 36 mm

Implants continued

Synthes 45

DHS/DCS One-Step Lag Screws, 12.7 mm dia. thread◊


280.251 50 280.301 100280.255 55 280.305 105280.260 60 280.310 110280.265 65 280.315 115280.270 70 280.320 120280.275 75 280.325 125280.280 80 280.330 130280.285 85 280.335 135280.290 90 280.340 140280.295 95 280.345 145

DHS/DCS One-Step Lag Screws, 14.0 mm dia. threadLength (mm) Length (mm)

280.651S 50 280.701S 100280.655S 55 280.705S 105280.660◊ 60 280.710◊ 110280.665S 65 280.715S 115280.670◊ 70 280.720◊ 120280.675S 75 280.725S 125280.680◊ 80 280.730◊ 130280.685S 85 280.735S 135280.690◊ 90 280.740◊ 140280.695S 95 280.745S 145

02.102.001* Universal Locking Trochanter Stabilization Plate, 131 mm

281.869* Trochanter Stabilization Plate, 138 mm◊

281.870* Trochanter Stabilization Plate, 148 mm◊


* For trochanter stabilization plate techniques, please refer to the Universal Locking Trochanter Stabilization Plate and Trochanter Stabilization Plate for DHS Technique Guides

02.102.001

281.869


Instruments

292.20 2.0 mm Kirschner Wire, 150 mm, trocar point

310.19 2.0 mm Drill Bit, 100 mm, quick coupling



311.44 T-Handle, with quick coupling

311.46 Tap for 4.5 mm Cortex and 4.5 mm Shaft Screws

312.46 4.5 mm/3.2 mm Double Drill Sleeve

Synthes 47


314.11 Holding Sleeve

314.15 Large Hexagonal Screwdriver Shaft


319.10 Depth Gauge, for large screws

319.97 Screw Forceps

322.43 4.5 mm DCP Hip Drill Guide



338.13 DHS Triple Reamer, complete(includes DHS Reaming Head, standard (338.11), 8.0 mm Drill Bit (338.10) and Nut)

338.11 DHS Reaming head




338.01– DHS Angle Guides 338.04 (135°, 140°, 145° and 150°)

Instruments continued

Synthes 49

338.41 95° DCS Drill Guide


338.22 DHS/DCS Coupling Screw, long





Instruments continued


900.723 2.5 mm Threaded Guide Wire, spade point,230 mm



Synthes 51


338.32 DHS/DCS Centering Sleeve for One-Step Insertion Wrench

338.302 DHS/DCS One-Step Insertion Wrench


One-Step Instruments

338.047 Variable Angle Guide

338.25 Small Impactor Tip

338.740 6.0 mm/4.5 mm Drill Sleeve

338.750 DHS Parallel Drill Guide


One-Step Instruments continued

Synthes 53

DHS/DCS Basic Set, with self-tapping screws (105.831) andDHS/DCS Basic Set (105.31)

Graphic Cases304.250 DHS/DCS Basic Set with self-tapping screws

Graphic Case (for set 105.831)

304.257 DHS/DCS Basic Set Graphic Case (for set105.31)

Instruments (in both sets)292.20 2.0 mm Kirschner Wire, 150 mm, trocar point,

1 pkg. of 10

310.19 2.0 mm Drill Bit, quick coupling, 100 mm, 2 ea.




311.46 Tap for 4.5 mm Cortex and

4.5 mm Shaft Screws, 2 ea.









338.01 135° DHS Angle Guide







338.13 DHS Triple Reamer, complete








338.41 95° DCS Drill Guide



Note: For additional information, please refer to package insert.For detailed cleaning and sterilization instructions, please refer tohttp://us.synthes.com/Medical+Community/Cleaning+and+Sterilization.htmor to the below listed inserts, which will be included in the shipping container:–Processing Synthes Reusable Medical Devices—Instruments, Instrument Traysand Graphic Cases—DJ1305

–Processing Non-sterile Synthes Implants—DJ1304


Instruments (in both sets) continued

900.723 2.5 mm Threaded Guide Wire, spade point, 230 mm, 10 ea.

900.723LBL Graphic Case Labels for 2.5 mm ThreadedGuide Wire (900.723)

Implants in set 105.8314.5 mm Cortex Screws, self-tapping

Length (mm) Qty.214.828 28 3214.830 30 3214.832 32 8214.834 34 8214.836 36 8214.838 38 8214.840 40 10214.842 42 8214.844 44 6214.846 46 6214.848 48 3214.850 50 3214.852 52 3214.854 54 3

Implants in set 105.314.5 mm Cortex Screws

Length (mm) Qty.214.028 28 3214.030 30 3214.032 32 8214.034 34 8214.036 36 8214.038 38 8214.040 40 10214.042 42 8214.044 44 6214.046 46 6214.048 48 3214.050 50 3214.052 52 3214.054 54 3

DHS/DCS Basic Set, with self-tapping screws (105.831) andDHS/DCS Basic Set (105.31) continued

Synthes 55

DHS Basic Set, with self-tapping screws (105.837) andDHS Basic Set (105.37)

Graphic Cases304.250 DHS/DCS Basic Set with self-tapping screws

Graphic Case (for set 105.837)

304.257 DHS/DCS Basic Set Graphic Case (for set 105.37)

Instruments (in both sets)310.19 2.0 mm Drill Bit, quick coupling, 100 mm, 2 ea.




311.46 Tap for 4.5 mm Cortex and 4.5 mm Shaft Screws, 2 ea.
















338.13 DHS Triple Reamer, complete









900.723 2.5 mm Threaded Guide Wire, spade point, 230 mm, 10 ea.

900.723LBL Graphic Case Labels for 2.5 mm ThreadedGuide Wire (900.723)

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


Implants in set 105.8374.5 mm Cortex Screws, self-tapping

Length (mm) Qty.214.828 28 3214.830 30 3214.832 32 8214.834 34 8214.836 36 8214.838 38 8214.840 40 10214.842 42 8214.844 44 6214.846 46 6214.848 48 3214.850 50 3214.852 52 3214.854 54 3

Implants in set 105.374.5 mm Cortex Screws

Length (mm) Qty.214.028 28 3214.030 30 3214.032 32 8214.034 34 8214.036 36 8214.038 38 8214.040 40 10214.042 42 8214.044 44 6214.046 46 6214.048 48 3214.050 50 3214.052 52 3214.054 54 3

DHS Basic Set, with self-tapping screws (105.837) andDHS Basic Set (105.37) continued

Synthes 57

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

DHS Universal Implant Set (105.35)

Graphic Case305.36 DHS Universal Implant Set Graphic Case

ImplantsDHS/DCS Lag Screws, 12.7 mm diameter thread◊

Length (mm) Length (mm)280.000 100 280.451 145280.050 105 280.650 65280.100 110 280.700 70280.150 115 280.750 75280.200 120 280.800 80280.250 125 280.850 85280.300 130 280.900 90280.350 135 280.950 95280.400 140

DHS/DCS Compression Screw, 3 ea.◊

Length (mm)280.990 36

DHS Plates, standard barrel (38 mm)◊

Angle Holes Length (mm)281.140 135° 4 78281.150 135° 5 94281.160 135° 6 110281.240 140° 4 78281.250 140° 5 94281.260 140° 6 110281.340 145° 4 78281.350 145° 5 94281.360 145° 6 110281.440 150° 4 78281.450 150° 5 94281.460 150° 6 110

DHS Plates, short barrel (25 mm)◊

Angle Holes Length (mm)281.540 135° 4 78281.840 150° 4 78


DCS Universal Implant Set (105.32)

Graphic Case304.270 DCS Implant Set Graphic Case

ImplantsDHS/DCS Lag Screws, 12.7 mm diameter thread◊, 2 ea.

Length (mm)280.501 50280.550 55 280.600 60 280.650 65 280.700 70280.750 75

DHS/DCS Compression Screws◊, 6 ea.Length (mm)

280.990 36

95° DCS Plates ◊

Holes Length (mm) Qty.281.900 10 178 2281.925 12 210 1281.930 14 242 1281.940 16 274 1281.960 6 114 2281.980 8 146 2

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

Synthes 59

DHS One-Step Basic Set (105.839) and DHS/DCS One-Step Basic Set (105.833)

DHS One-Step Basic Set (105.839)

Graphic Case690.348 DHS/DCS One-Step Basic Set Graphic Case

Instruments292.20 2.0 mm Kirschner Wire, 150 mm, trocar point,

(10/pkg.),1 pkg. 310.31 3.2 mm Drill Bit, quick coupling, 145 mm, 2 ea.310.44 4.5 mm Drill Bit, quick coupling, 145 mm, 2 ea.311.44 T-Handle with quick coupling311.46 Tap for 4.5 mm Cortex and 4.5 mm Shaft

Screws, 130 mm, 57 mm tap depth, 2 ea.312.46 4.5 mm/3.2 mm Double Drill Sleeve314.11 Holding Sleeve314.15 Large Hexagonal Screwdriver Shaft314.27 Large Hexagonal Screwdriver319.10 Depth Gauge for large screws319.97 Screw Forceps322.43 4.5 mm DCP Hip Drill Guide, neutral and load,

60 mm338.047 Variable Angle Guide for DHS338.05 DHS/DCS Direct Measuring Device, 200 mm

length338.08 DHS/DCS T-Handle, with quick coupling338.13 DHS Triple Reamer, complete338.17 Tap for DHS/DCS, 12.5 mm diameter, 220 mm338.18 DHS/DCS Centering Sleeve, short338.25 Small Impactor Tip338.28 DHS/DCS Impactor338.302 DHS/DCS One-Step Insertion Wrench338.31 DHS/DCS Coupling Screw

(for One-Step Insertion Wrench)338.32 DHS/DCS Centering Sleeve

(for One-Step Insertion Wrench)338.44 DHS Reaming Head, for DHS Triple Reamer

(for short barrel plates)338.730 4.5 mm/3.2 mm Insert Drill Sleeve338.740 6.0 mm/4.5 mm Drill Sleeve338.750 DHS Parallel Drill Guide900.723 2.5 mm Threaded Guide Wire, 230 mm, 10 ea.



DHS One-Step Basic Set (105.839) and DHS/DCS One-Step Basic Set (105.833) continued

DHS One-Step Basic Set (105.839) continued

Implants4.5 mm Cortex Screws, self-tapping:

Length (mm) Qty.214.828 28 3214.830 30 3214.832 32 8214.834 34 8214.836 36 8214.838 38 8214.840 40 10214.842 42 8 214.844 44 6214.846 46 6214.848 48 3214.850 50 3214.852 52 3214.854 54 3

DHS/DCS One-Step Basic Set (105.833)

Includes all components of DHS One-Step Basic Set (105.839),plus:338.41 95° DCS Drill Guide338.47 DCS Reaming Head

Synthes 61

Graphic Case690.344 DHS One-Step Implant Set

Graphic CaseImplantsDHS/DCS One-Step Lag Screws, 12.7 mm thread


280.265 65 280.301 100280.270 70 280.305 105280.275 75 280.310 110280.280 80 280.315 115280.285 85 280.320 120280.290 90 280.325 125280.295 95

130° DHS Plates, standard barrelHoles

281.040 4281.050 5281.060 6


281.140 4281.150 5281.160 6


281.240 4281.250 5281.260 6


281.340 4 holes281.350 5 holes281.360 6 holes

280.990 DHS/DCS Compression Screw, 36 mm, 3 ea.281.440 150° DHS Plate, standard barrel, 4 holes281.540 135° DHS Plate, short barrel, 4 holes281.869 Trochanter Stabilization Plate, 138 mm, 2 ea.281.870 Trochanter Stabilization Plate, 148 mm, 2 ea.

DHS One-Step Implant Set (105.352)



Graphic Case304.295 DCS One-Step Universal Implant Set

Graphic Case

ImplantsDHS/DCS One-Step Lag Screws, 12.7 mm thread, 2 ea.

Length (mm)

280.251 50280.255 55280.260 60280.265 65280.270 70280.275 75

280.990 DHS/DCS Compression Screw, 36 mm, 6 ea.

95° DCS PlatesHoles Qty.

281.960 6 2281.980 8 2281.900 10 2281.925 12 1281.930 14 1281.940 16 1

DCS One-Step Implant Set (105.321)


Synthes 63

Also Available


Sets01.102.001 Universal Locking Trochanter Stabilization

Plate Set

105.12 DHS/DCS Basic Screw Rack with screws (not self-tapping)

105.35S DHS Universal Implant Set, sterile (withoutgraphic case)

105.352S DHS One-Step Implant Set, sterile, without graphic case

105.355 DHS Supplemental Implant Set105.812 DHS/DCS Basic Screw Rack with self-tapping

screws

105.831J DHS/DCS Basic Set with self-tapping screws

and 105.31J DHS/DCS Basic Set (with standard drill bits

310.20, 310.32 and 310.45 to fit Jacobs chuck)

105.837J DHS Basic Set with self-tapping screws

and 105.37J DHS Basic Set (with standard drill bits 310.20,

310.32 and 310.45 to fit Jacobs chuck)

105.839J DHS One-Step Basic Set with self-tapping screws (with standard drill bits 310.32 and310.45 to fit Jacobs chuck)

105.954 Small Battery Drive with 14.4 V Battery Pack Set

Implants02.102.001 Universal Locking Trochanter Stabilization

Plate, 131 mm



280.454 50 280.504 100280.455 55 280.505 105280.460 60 280.510 110280.465 65 280.515 115280.470 70 280.520 120280.475 75 280.525 125280.480 80 280.530 130280.485 85 280.535 135280.490 90 280.540 140280.495 95 280.545 145


Also Available continued

Implants continued

DHS/DCS One-Step Lag Screws, 12.7 mm dia. threadLength (mm)

280.330 130280.335 135280.340 140280.345 145

DHS/DCS One-Step Lag Screws, 14.0 mm dia. threadLength (mm) Length (mm)

280.651S 50 280.701S 100280.655S 55 280.705S 105280.660◊ 60 280.710◊ 110280.665S 65 280.715S 115280.670◊ 70 280.720◊ 120280.675S 75 280.725S 125280.680◊ 80 280.730◊ 130280.685S 85 280.735S 135280.690◊ 90 280.740◊ 140280.695S 95 280.745S 145


Instruments310.20 2.0 mm Drill Bit, 85 mm, Jacobs chuck321.12 Articulated Tension Device

338.005 130° DHS Angle Guide338.43 DHS Triple Reamer, complete (for short

barrel plates)

338.720 4.5 mm/2.0 mm Insert Wire Sleeve (for Parallel Drill Guide)

338.731 4.5 mm/2.8 mm Insert Wire Sleeve (for Parallel Drill Guide)

399.42 Hammer, 500 grams

532.010 Small Battery Drive

532.013 Quick Coupling for Drill Bits

532.015 Large Quick Coupling

532.022 Quick Coupling for K-Wires

532.032 Battery Casing for 14.4 V Battery

532.033 14.4 V Battery

Graphic Case690.371 DHS Supplemental Implant Set Graphic Case

Synthes (USA)1302 Wrights Lane EastWest Chester, PA 19380Telephone: (610) 719-5000To order: (800) 523-0322Fax: (610) 251-9056

Synthes (Canada) Ltd.2566 Meadowpine BoulevardMississauga, Ontario L5N 6P9Telephone: (905) 567-0440To order: (800) 668-1119Fax: (905) 567-3185

© 1990 Synthes, Inc. or its affiliates. All rights reserved. DCS, DCP, DHS, LCP and Synthes are trademarks of Synthes, Inc. or its affiliates. Printed in U.S.A. 4/10 J3045-F

www.synthes.com

Documents

DHS/DCS Dynamic Hip and Condylar Screw System. Designed …synthes.vo.llnwd.net/o16/Mobile/Synthes North...DHS/DCS Dynamic Hip and Condylar Screw System. Designed to provide stable