Part of the DePuy Synthes Locking Compression Plate (LCP®) System

3.5 mm LCP® Low BendMedial Distal Tibia PlatesSurgical Technique

Medial Distal Tibia PlatesMedial Distal Tibia PlatesSurgical TechniqueSurgical Technique

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 1

Introduction

Surgical Technique

Product Information

Table of Contents

3.5 mm LCP Low Bend Medial Distal Tibia Plates 2

AO Principles 4

Indications 5

Preparation 6

Reduction 7

Plate Insertion 8

Screw Insertion 13

Implant Removal 17

Implants 18

Instruments 19

Set Lists 22

MR Information The 3.5 mm LCP Low Bend Medial Distal Tibia Plate System has not been evaluated for safety and compatibility in the MR environment. It has not been tested for heating, migration, or image artifact in the MR environment. The safety of the 3.5 mm LCP Low Bend Medial Distal Tibia Plate System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury.

Image intensifier control

2 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique

3.5 mm LCP Low Bend Medial Distal Tibia Plates

The 3.5 mm LCP® Low Bend Medial Distal Tibia Plate is part of the Depuy Synthes Locking Compression Plate (LCP) System that merges locking screw technology with conventional plating techniques.

The Combi holes in the LCP Plate shaft combine a dynamic compression unit (DCU) hole with a locking screw hole. Combi holes provide the fl exibility of axial compression and locking capability throughout the length of the plate shaft.

Fixation with the 3.5 mm LCP Low Bend Medial Distal Tibia Plate has many similarities to traditional plate fi xation methods, with a few important improvements. Locking screws provide the ability to create a fi xed-angle construct while using standard AO plating techniques. Locking capability is important for fi xed-angle constructs in osteopenic bone or multifragment fractures where screw purchase is compromised. These screws do not rely on plate-to-bone compression to resist patient load, but function similarly to multiple, small, angled blade plates.

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 3

3.5 mm LCP Low Bend Medial Distal Tibia Plates

Plate features– Head of plate is low profi le for

minimal prominence on medial malleolus

– 3.5 mm cortex and 4.0 mm cancellous bone screws sit fl ush with plate in the nonlocking portion of distal Combi holes to minimize screw prominence

– Rounded edges to minimize soft tissue irritation

– Limited-contact shaft profi le

– Available in stainless steel or titanium*

Combi holes in the shaft and head accept the following:– 3.5 mm cortex screws

– 3.5 mm locking screws

– 4.0 mm cancellous bone screws

Six round locking holes in the head accept the following:– 2.7 mm cortex screws

– 3.5 mm cortex screws

– 3.5 mm locking screws

– 4.0 mm cancellous bone screws

*Implant-quality 316L stainless steel or titanium alloy (Ti-6Al-7Nb).

Two distal Combi holes

Three distal locking screws diverge across subchondral bone and are parallel to joint

Four to fourteen Combi holes in the shaft

Distal K-wire hole for plate placement (2.0 mm maximum diameter)

4 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique

AO Principles

1

4

2

3

4_Priciples_03.pdf 1 05.07.12 12:08

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique

AO PRINCIPLES

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

1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.

2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

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

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

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

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

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

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

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

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

1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; 1991.

2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart New York: Thieme; 2007.

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 5

Indications

The Synthes LCP Distal Tibia Plates are intended for fixation of complex intra- and extra-articular fractures and osteotomies of the distal tibia, as a part of the Synthes Small Fragment LCP System.

6 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique

Preparation

1Preparation

Required set

105.434 Small Fragment LCP Instrument and Implant Set, with self-tapping screws or 145.434 Small Fragment LCP Instrument and Titanium Implant Set, with self-tapping screws

Optional sets

105.90 Bone Forceps Set

105.954M Small Battery Drive Set

115.700 Large Distractor Set

Optional instruments

321.12* Articulated Tension Device

329.02 Bending Iron

329.30 Plate-Bending Press

Warning: The direction of locking screws is predetermined by the design of the plate. If manual contouring is necessary, verify new screw angles using the screw placement verification technique on page 10.

Complete the preoperative radiographic assessment and prepare the preoperative plan. Determine plate length and instruments to be used.

Position the patient supine on a radiolucent operating table.

Note: For information on fixation principles using conventional and locked plating techniques, please refer to the Small Fragment Locking Compression Plate (LCP) Technique Guide.

*Found in the Basic Instrument Set, for LC-DCP and DCP (115.04).

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 1

Reduction

2Reduce articular surface

Instruments

394.35 Large Distractor

532.010 Small Battery Drive

532.022 Quick Coupling for K-Wires

ApproachAn open or a percutaneous approach may be used depending on the fracture. For a percutaneous approach, make an incision to access the medial malleolus and slide the plate under the soft tissue.

Reduction

Note: Application of an external fi xator or large distractor may facilitate visualization and reduction of the joint.

Reduce the fracture fragments and confi rm reduction using image intensifi cation. Methods of stabilizing reduction include the following:

– Independent Kirschner wires

– K-wires through the plate

– Independent lag screws

– Lag screws through the plate

– Locking screws through the plate

Locking screws do not provide interfragment compression; therefore, any desired compression must be achieved with standard lag screws. The articular fractures must be reduced and compressed before fi xation of the 3.5 mm LCP Medial Distal Tibia Plate with locking screws.

Precaution: To verify that independent lag screws will not interfere with plate placement, evaluate placement intraoperatively with AP and lateral fl uoroscopic images.

8 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique

Plate Insertion

3Insert plate

Instrument

324.031 Threaded Plate Holder

Percutaneous insertionFor a percutaneous approach, insert the plate through the medial incision. Carefully push the plate under the soft tissue.

Note: Thread a threaded plate holder into one of the distal holes as a handle for percutaneous insertion.

Open insertionOpen the area as necessary to expose the joint. Carefully push the plate under the soft tissue for placement on the shaft.

Center the plate on the medial malleolus.

Precaution: When choosing a percutaneous approach take care not to damage the saphenous nerve or saphenous vein.

Saphenous nerve

Saphenous vein

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 9

Plate Insertion

4Position plate and fi x provisionally

After plate insertion, check alignment on the bone using fl uoroscopy. Make any adjustments before inserting screws.

Note: This locking plate is precontoured to fi t the medial distal tibia. If the plate contour is changed, it is important to check the position of the screws relative to the joint, using the screw placement verifi cation technique.

Optional instrument

324.024 Push-Pull Reduction Device

The plate may be temporarily held in place using any of the following options:

– Push-pull reduction device

– 4.0 mm cancellous bone screw in a distal Combi hole

– Standard plate-holding forceps

– K-wires through the plate

Any of these options will allow moving the plate into fi nal position, and will also prevent plate rotation while inserting the fi rst locking screw.

Note: Ensure proper reduction before inserting the fi rst locking screw. Once the locking screws are inserted, further reduction is not possible without loosening the locking screws.

10 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique

Plate Insertion

Optional technique: Screw placement verifi cation

Instruments

292.71 1.6 mm Kirschner Wire with Thread

310.288 2.8 mm Drill Bit

312.648 2.8 mm Threaded Drill Guide

323.023 1.6 mm Wire Sleeve

323.025 Direct Measuring Device

532.010 Small Battery Drive

532.022 Quick Coupling for K-Wires

Since the direction of the locking screw depends on the contour of the plate, fi nal screw position may be verifi ed with a K-wire before insertion. This becomes especially important when the plate has been manually contoured or applied near the joint.

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 11

Plate Insertion

With the 2.8 mm threaded drill guide in the desired locking hole, insert the 1.6 mm wire sleeve into the threaded drill guide.

Insert a 1.6 mm threaded K-wire through the wire sleeve and drill to the desired depth.

Verify K-wire placement under image intensifi cation to determine if fi nal screw placement will be acceptable.

Precaution: The K-wire position represents the fi nal position of the locking screw. Confi rm that the K-wire does not enter the joint.

12 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique

Plate Insertion

Optional technique: Screw placement verifi cation continued

Measure for screw length by sliding the tapered end of the direct measuring device over the K-wire down to the wire sleeve.

Remove the direct measuring device, K-wire and 1.6 mm wire sleeve, leaving the threaded drill guide in place.

Use the 2.8 mm drill bit to drill. Remove the threaded drill guide. Insert the appropriate length locking screw.

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 13

Screw Insertion

5Insert distal screws

Determine the combination of screws to be used for fi xation. If a combination of locking and cortex screws will be used, cortex screws should be inserted fi rst to pull the plate to the bone.

If a locking screw will be used as the fi rst screw, ensure the plate is held securely to the bone to prevent plate rotation as the screw is locked to the plate.

In distal Combi holes: For nonlocking screws, use the standard AO screw insertion technique. The two Combi holes in the plate head accept 3.5 mm cortex, 3.5 mm locking or 4.0 mm cancellous bone screws. When using a cortex or cancellous bone screw in these Combi holes, the screwhead will be recessed in the hole.

For distal locking screws:

Instruments

310.288 2.8 mm Drill Bit

312.648 2.8 mm Threaded Drill Guide

314.115 StarDrive Screwdriver, T15

314.116 StarDrive Screwdriver Shaft, T15

319.01 Depth Gauge

Thread the 2.8 mm threaded drill guide into a distal locking hole until fully seated.

Use the 2.8 mm drill bit to drill to the desired depth.

Remove the drill guide.

Use the depth gauge to determine screw length.

14 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique

Screw Insertion

5Insert distal screws continued

Instruments

511.770* Torque Limiting Attachment, 1.5 Nmor511.773 Torque Limiting Attachment, 1.5 Nm,

quick coupling

Insert the locking screw under power, using the torque limiting attachment and the StarDriveTM Screwdriver shaft, or insert manually, using the StarDrive Screwdriver. Be sure the plate is held securely to the bone to prevent plate rotation as the screw is locked to the plate.

Notes: When using the torque limiting attachment, the screw is securely locked into the plate when a “click” is heard.

Always use a torque limiting attachment when using power with the StarDrive Screwdriver shaft.

*Also available.

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 15

Screw Insertion

Optional technique: Direct measuring with calibrated drill bits

For locking screws:

Instruments

03.122.001 2.8 mm LCP Drill Guide

03.122.002 2.8 mm Calibrated Drill Bit, quick coupling

314.115 StarDrive Screwdriver Shaft, T15

314.16 StarDrive Screwdriver shaft, T15

Determine where locking screws will be used. Thread the 2.8 mm LCP Drill Guide into a threaded hole until fully seated. Use the 2.8 mm calibrated drill bit to drill to desired depth. Determine the screw length directly from the drill bit.

Insert the screw.

**Found in the Basic Instrument Set, for LC-DCP and DCP (115.04).

16 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique

Screw Insertion

6Insert screws in shaft

If using the threaded portion of the Combi holes, repeat the steps as described for distal locking screw insertion.

For nonlocking screws, use the standard AO screw insertion technique.

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 11

Implant Removal

Optional sets

01.240.001 Screw Removal Set

105.971 Broken Screw Removal Set

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

If the screws cannot be removed with the screwdriver, insert the conical extraction screw with left-handed thread into the screwhead using the handle with quick coupling and loosen the locking screw by turning counterclockwise.

18 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique

Screws Used with the 3.5 mm LCP Low Bend Medial Distal Tibia PlatesStainless Steel and Titanium

2.7 mm Cortex Screws* – May be used in the distal locking holes – Compresses the plate to the bone

3.5 mm Cortex Screws*– May be used in the DCU portion of the Combi holes

in the plate shaft– Compresses the plate to the bone or creates axial

compression

3.5 mm Locking Screws*– Creates a locked, fi xed-angle screw/plate construct– Self-tapping tip– Used in the locking portion of the Combi holes or

in round locking holes

4.0 mm Cancellous Bone Screws*– May be used in the DCU portion of the Combi holes

in the plate shaft– Compresses the plate to the bone or creates axial

compression– Fully or partially threaded shaft

*Found in the Small Fragment LCP set.

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 19

Instruments

292.71 1.6 mm Kirschner Wire with thread

312.648 2.8 mm Threaded Drill Guide

314.115 StarDrive Screwdriver, T15, self-retaining

314.116 StarDrive Screwdriver Shaft, T15, self-retaining, quick coupling

03.122.001 2.8 mm LCP Drill Guide, long for 3.5 mm LCP plates

03.122.002 2.8 mm Drill Bit, quick coupling, 248 mm/95 mm calibration

310.288 2.8 mm Drill Bit, quick coupling, 165 mm

20 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique

Instruments

319.01 Depth Gauge

323.023 1.6 mm Wire Sleeve

323.025 Direct Measuring Device

324.024 Push-Pull Reduction Device

324.031 Threaded Plate Holder, long

329.04 Bending Iron, for 2.7 mm and 3.5 mm plates, 150 mm length

– Used with 329.05

329.05 Bending Iron, for 2.7 mm and 3.5 mm plates, 150 mm length

– Used with 329.04

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Surgical Technique DePuy Synthes 21

Instruments

511.770 Torque Limiting Attachment, 1.5 Nm

511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling

394.35 Large Distractor

329.15 Bending Pliers, for 2.7 mm and 3.5 mm plates

22 DePuy Synthes 3.5 mm LCP® Low Bend Medial Distal Tibia Plates Technique Guide Surgical Technique

3.5 mm LCP Low Bend Medial Distal Tibia Plate SetsStainless Steel (01.112.060) and Titanium (01.112.061)

Graphic Case60.112.060 Graphic Case for 3.5 mm LCP Low Bend

Medial Distal Tibia Plate

Implants3.5 mm LCP Low Bend Medial Distal Tibia Plates◊, right Stainless Steel Titanium Holes Length (mm)02.112.510 04.112.510 4 109 02.112.514 04.112.514 6 135 02.112.518 04.112.518 8 161 02.112.522 04.112.522 10 187 02.112.526 04.112.526 12 213 02.112.530 04.112.530 14 239

3.5 mm LCP Low Bend Medial Distal Tibia Plates◊, left Stainless Steel Titanium Holes Length (mm)02.112.511 04.112.511 4 109 02.112.515 04.112.515 6 135 02.112.519 04.112.519 8 161 02.112.523 04.112.523 10 187 02.112.527 04.112.527 12 213 02.112.531 04.112.531 14 239

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

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

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

3.5 mm LCP® Low Bend Medial Distal Tibia Plates Technique Guide Surgical Technique DePuy Synthes 23

Also Available

Graphic Cases690.468 3.5 mm LCP Medial Distal Tibia Plate,

without tab, Set Graphic Case60.122.001 3.5 mm Titanium LCP Medial Distal Tibia

Plate, without tab, Set Graphic Case

Implants3.5 mm LCP Medial Distal Tibia Plates, without tab◊, right

Stainless Steel Titanium Holes Length (mm)

238.700 438.700 4 116 238.702 438.702 6 142 238.704 438.704 8 168 238.706 438.706 10 194 238.708 438.708 12 220 238.710 438.710 14 246

3.5 mm LCP Medial Distal Tibia Plates, without tab◊, left

Stainless Steel Titanium Holes Length (mm)

238.701 438.701 4 116 238.703 438.703 6 142 238.705 438.705 8 168 238.707 438.707 10 194 238.709 438.709 12 220 238.711 438.711 14 246

3.5 mm LCP Medial Distal Tibia Plates◊

Right Left Holes Length (mm)

239.900 239.901 4 116

239.904 239.905 6 142 239.908 239.909 8 168 239.912 239.913 10 194 239.916 239.917 12 220 239.920 239.921 14 246

3.5 mm LCP Pilon Plates Holes Length (mm)240.082 7 147240.083 9 173

Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed.

Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information.

CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.

Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada.

Not all products may currently be available in all markets.

© DePuy Synthes 2009–2017. All rights reserved.DSUS/TRM/1016/1161 5/17 DV

Synthes USA, LLC 1101 Synthes AvenueMonument, CO 80132

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

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

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

www.depuysynthes.com