VARIABLE ANGLE LOCKING HAND SYSTEM for Fragment-Specific Fracture Fixation with Variable Angle Locking and Locking Technology
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VARIABLE ANGLE LOCKING HAND SYSTEM For fragment-specific fracture fixation with variable angle locking and locking technology SURGICAL TECHNIQUE TABLE OF CONTENTS INTRODUCTION Variable Angle Locking Hand System Overview 2 AO Principles 5 Indications 6 Featured Plates & Technique Highlights 7 Screws in the System 18 Featured Instruments 20 SURGICAL TECHNIQUE Preoperative Planning and Reduction 27 Lag Screw Insertion (Optional) 29 Prepare and Insert Plate 37 Insert Screw 50 Implant Removal 51 PRODUCT INFORMATION Implants 54 Instruments 63 Graphic Cases 70 Set Lists 77 Image intensifier control Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies VARIABLE ANGLE LOCKING HAND SYSTEM OVERVIEW The DePuy Synthes Variable Angle Locking Hand System consists of plates that are anatomic, procedure-specific, and available in both stainless steel and titanium. The Variable Angle Locking Hand System offers instrumentation to aid in: x fracture reduction x provisional fixation x plate adaptation x construct creation Designed for the Surgeon and Patient A dedicated, global surgeon team was integral to the design of this system through extensive consultation and participation in multiple design labs. Surgeon interviews, design and development meetings, and collaboration with key opinion leaders determined the clinical components necessary for the DePuy Synthes Variable Angle Locking Hand System. DePuy Synthes Companies are dedicated to improving patient care. System Snapshot x Extensive system of anatomically precontoured plates x First to the market with 1.3 mm locking screws for hand plating1 x Forceps that aid in fracture reduction and lag screw application x Forceps that aid in plate fixation x Self-retaining screwdrivers x Plates available in 316L stainless steel and titanium x Color-coded instruments 1DePuy Synthes Companies market analysis of leading orthopaedic companies, conducted May 2015. 2 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique Variable Angle Locking Hand System Overview SYSTEM TECHNOLOGY Variable Angle Locking Technology 1.5 mm and 2.0 mm plates feature variable angle locking coaxial holes. Four columns of threads in the variable angle locking hole provide four points for threaded locking between the plate and the Variable Angle Locking Screw to create a fixed-angle construct at the desired screw angle. x 1.5 mm variable angle plate holes accept: – 1.5 mm variable angle locking screws – 1.5 mm cortex screws – 1.5 mm locking screws. These screws can only be used on-axis x 2.0 mm variable angle plate holes accept: – 2.0 mm variable angle locking screws – 2.0 mm cortex screws – 2.0 mm locking screws. These screws can only be used on-axis x Variable Angle Locking Screws can be angled anywhere within a 30° cone x 1.5 mm and 2.0 mm cortex screws can be used in the plate positioning slots, if present, for traditional compression and fixation Locking Technology x 1.3 mm plates feature locking, coaxial holes. Fully threaded locking holes provide threaded locking between the plate and the locking screw to create a fixed-angle construct x 1.3 mm locking plate holes accept: – 1.3 mm locking screws – 1.3 mm cortex screws Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 3 Variable Angle Locking Hand System Overview SYSTEM FEATURES FEATURES BENEFITS Extensive range of implant options Accommodates a variety of fractures and patient sizes Anatomically contoured plates Designed with contour to adapt to bony anatomy Plates designed for lateral and direct Accommodates plate placement to help dorsal application avoid tendon insertion points Low-profile, anatomically precontoured Designed to reduce soft tissue irritation plates Recessed screw heads Designed to sit flush with the plate surface Variable Angle Locking Technology Offers screw placement options in a variety of fragment patterns and around the joint Provides fixed angle stability for metaphyseal and osteopenic bone Elongated plate holes Facilitate plate positioning Modular, color-coded system Aids in clear identification of instruments for Operating Room staff and Central Processing Facilitates proper instrumentation usage by size Comprehensive instrumentation Aids surgeon in all aspects of procedure: plate adaption, provisional fixation, and bone preparation Implants offered in both stainless steel Allows options for surgeon preference and and titanium patient need T4 and T6 self-retaining screwdriver Aid in screw handling, measuring, and shafts delivery Hex coupling screwdriver handle Ergonomic connection mechanism in a handle design that disassembles for cleaning Reduction Forceps Aids reduction and lag screw application via forceps Plate Holding Forceps Holds plate intraoperatively 4 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique AO PRINCIPLES AO PRINCIPLES In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1, 2 InThose 1958, principles the AO formulatedare: four basic principles, which have become the guidelines for internal fixation1, 2. 4_Priciples_03.pdf 1 05.07.12 12:08 AnatomicAnatomic reductionreduction StableStable fixationfixation FractureFracture reductionreduction and fifixationxation toto FractureFracture fixation fixation providingproviding absoluteabso- restorerestore anatomicalanatomical relationships.relationships. orlute relative or relative stability, stability, as required as by therequired patient, by thethe injury, patient, and the the injury, 1 2 personalityand the personality of the fracture. of the fracture. Early,Early, activeactive mobilizationmobilization PreservationPreservation of of blood blood supply supply EarlyEarly andand safesafe mobilizationmobilization and 4 3 PreservationPreservation of of the the blood blood supply supply rehabilitationrehabilitation ofof thethe injuredinjured part toto softsoft tissues tissues and and bone bone by by gentle andand thethe patientpatient asas aa whole.whole. reductiongentle reduction techniques techniques and and carefulcareful handling. handling. 1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer; 1991. 2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal 2nd ed. Stuttgart, New York: Thieme; 2007. 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. Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 5 4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique INDICATIONS The DePuy Synthes Variable Angle Locking Hand System is intended for fracture fixation of the hand and other small bones and small bone fragments, in adults and adolescents (12–21 years) particularly in osteopenic bone. System indications include the following: x Open reduction and internal fixation of fractures, mal-unions, and non-unions x Following excision of benign bone tumors x Replantations and reconstructions x Arthrodeses of joints involving small bones x Osteotomies, including deformity correction such as rotation, lengthening, shortening x Pathological fractures, including impending pathologic fractures Caution: When using this system to treat skeletally immature patients, physiological status of the physes and individual stature of the patient should be assessed before considering treatment options as damage to the physes may occur, leading to potential growth arrest. MR SAFETY INFORMATION These devices have not been evaluated for safety and compatibility in the MR environment. The devices have not been tested for heating or migration in the MR environment. 6 DePuy Synthes Companies Variable Angle Locking Hand System Surgical Technique FEATURED PLATES & TECHNIQUE HIGHLIGHTS The plates contained in this section are featured implants of the DePuy Synthes Variable Angle Locking Hand System. Refer to the product information section for a complete list of all plate configurations offered as part of this system. Phalangeal Head Plate Available sizes: Designed with an anatomic contour and hole configuration Left Right to facilitate fixation of fractures of the middle and proximal 1.3 mm 02.130.157 02.130.156 phalangeal head. 04.130.157 04.130.156 x Elongated hole for adjustment of plate position 1.5 mm 02.130.257 02.130.256 x Ulnar or radial plate placement 04.130.257 04.130.256 x Curved plate designed to follow the natural curve of the phalanx 02 = Stainless Steel x Screw configuration in the head is designed to span 04 = Titanium the attachment of the collateral ligament x Available in Right and Left orientations x Designed for periarticular fractures and articular fractures of the distal phalanx Left Right Surgical Approach Ulnar Radial Right Hand Right Plate Left Plate Left Hand Left Plate Right Plate Variable Angle Locking Hand System Surgical Technique DePuy Synthes Companies 7 Featured Plates & Technique Highlights When implanting this plate, the following screw order 1 placement is suggested. x Place a cortex screw in the elongated hole (1), leaving the screw slightly loose. Screw placement is at the midaxial line. Place plate prior to the K-wire so that the cortex screw can be positioned at the midaxial line x Provisionally fix the condyles. Place a K-wire in the center of the condyle, so the wire is located between the two 2 distal holes