Variable Angle LCP 1 MTP Fusion Plates 2.4/2.7. Part of ...atlasteb.ir › Uploads › 14515664_Variable Angle LCP 1st... · anatomy and fixation options. The bending pliers are designed

Variable Angle LCP 1st MTP FusionPlates 2.4/2.7. Part of the Variable AngleLCP Forefoot /Midfoot System 2.4 /2.7.

Technique Guide

Synthes 1 Synthes 1

Table of Contents

Introduction

Controlled Compression Technique

Screw Insertion Techniques

Surgical Technique

Product Information

Variable Angle LCP 1st MTP Fusion Plates 2.4 /2.7 2

Indications 4

5

9

Approach and Preparation 10

Implantation 13

Implant Removal 25

Screws 26

Plates 28

Instruments 30

Synthes Biomaterials Overview 36

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

2 Synthes Variable Angle LCP 1st MTP Fusion Plates 2.4 /2.7 Technique Guide

Variable Angle LCP 1st MTP FusionPlates 2.4/2.7. Part of the Variable AngleLCP Forefoot/Midfoot System 2.4 /2.7.

Features and Benefits

Oblong combi-hole for plate positioning and compression

Anatomic, low profile designedspecifically for 1st MTP arthrodesis

Fusion line marking indicates the fusion site to ensure proper plate placement

Compression wire holes allow pre -liminary fixation of the plate to the bone

Plantar side undercut for contouringaround medial phalangeal eminence

Compression featureCompression holes used with compres-sion wires and forceps allow for tactilecompression up to 4 mm.

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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Small and medium plates– Small and medium plates are offered

in 3 different dorsiflexion angles:0°, 5°, 10°

– Left and right plates

Large plates– Large plates are offered with 5° dor-

sisiflexion angle– Left and right plates

Revision plates– Revision plates are offered with 0°

dorsiflexion and an extra variable an-gle locking hole to secure a boneblock

– Left and right plates

Proximal and distal reamers– Used to prepare articulating joint

surfaces for fusion – specifically be-tween metatarsals and phalanges

– Cannulated for use over a Kirschnerwire for better control

– 14–24 mm reamers accept 1.6 mmKirschner wire

– Proximal reamer is concave-shapedand forms the sphere on the jointsurface

– Distal reamer is convex-shaped andforms the pocket in the joint surface

Indications

The 1st MTP Fusion Plate of the Variable Angle LCP Forefoot/Midfoot System 2.4 /2.7 is indicated for deforma-tions of the 1st metatarsophalangeal (MTP) joint (HalluxRigidus) and fractures, nonunions and replantations of thefirst metatarsal bone, particularly in osteopenic bone.


Spherical stop

Compressionslot

Compressionwire hole

Synthes 5

The plates included in the Variable Angle LCP Forefoot / Mid-foot System 2.4 / 2.7 aid in reconstructive foot surgery by allowing controlled compression with the use of compressionwires and compression forceps.

Compression feature– Allows for up to 4 mm of compression– Tactile compression– Designed within the plate to minimize additional soft

tissue dissection– Allows for final screw fixation after compression is

achieved

Compression wires– 1.6 mm diameter, 150 mm overall length– Seven thread lengths: 10, 15, 20, 25, 30, 35 and 40 mm– Stop feature allows for quick and easy preliminary plate

fixation, which eliminates the need for plate holding forceps or another hand to hold the plate to the bone

– Spherical stop:– Designed to be seated on top of compression wire

holes and compression slots, and inside variable angleLCP holes

– Allows for off-axis wire insertion while maintaining thecompression feature capability

– Material: Cobalt chromium alloy that is stiffer than con-ventional stainless steel

Compression forceps– Spherical shaped recess matches the spherical stops on

the compression wires, which ensures the forceps graspthe stops regardless of the angle in which the wires wereinserted

– Locking ratcheting mechanism holds compression duringinsertion of fixation screws

– Simple lightweight design does not require holding duringinsertion of fixation screws


1Position plate

Place the plate on the bone, ensuring that the plate is placedappropriately according to the specific procedure.



Synthes 7

2Insert compression wires

Instrument

03.211.410.01– Compression Wire � 1.6 mm, 03.211.440.01 length 150 mm, thread length 10 – 40 mm

Estimate the appropriate thread length needed for the plateand bone combination. Bicortical fixation is recommended.

Using a wire driver, insert the compression wire through thecompression wire hole and through both bone cortices.

Important: To minimize stripping of the bone threads, slowthe insertion once the spherical stop of the wire gets close tothe plate. Slowly control the insertion to achieve good com-pression of the wire to the plate and to the bone. Highpower insertion and stripping of the bone threads can leadto loosening of the compression wires and reduced compres-sion.

Insert the second compression wire into the far side of theslot.


3Compress using forceps

Instrument

03.211.400 Compression Forceps for use with Compression Wire

Move the ratcheting switch so the forceps ratchet when closing preventing the spring from opening the forceps.

Place the compression forceps in position, ensuring that thearms are around the compression wire spheres.

Compress by squeezing the handles.

Important: Compression is tactile, but be careful not to overcompress. This may cause the compression wires to strip outof the bone.

When the ratcheting mechanism is in the correct position,compression can be maintained without holding the forceps.This leaves the hands free for image intensifier control ofcompression gap closure and for inserting final fixationscrews.


Synthes 9

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

Use of funnel-shaped VA-LCP Drill Sleeve

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

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

Approach and Preparation

1Approach

Make a dorsomedial incision extending from the proximalinter phalangeal joint of the hallux to the middle of the firstmetatarsal. This incision should be medial to the extensorhallucis longus tendon. Isolate and retract the superficialnerve and vessel. Make a linear capsular incision to exposethe first metatarsal head and proximal phalanx base.

Dissect down to the joint. Bend the phalanx down to exposethe joint.

2Insert Kirschner wire

Instrument

292.560 Kirschner Wire � 1.6 mm with double tip, length 150 mm, Stainless Steel

Insert the 1.6 mm Kirschner wire into the base of the firstmetatarsal. Ensure the wire is centered in the canal.

A chielectomy may be necessary to remove impinging boneand create a flat surface for the plate.


Synthes 11

3Ream proximally

Instruments

03.211.114 Cannulated Proximal Reamer � 14 mm






Select the appropriate reamer. Always start with a larger sizeand work down to a smaller size.

Slide the proximal reamer over the guide wire. Ream to re-move cartilage from the joint.

Important: When preparing the joint, it is possible to remove too much bone, which may result in shortening.Ream only enough to remove the cartilage and exposethe joint surface for fusion.

Approach and Preparation

4Ream distally

Instruments

03.211.014 Cannulated Distal Reamer � 14 mm






Bend the toe downwards to expose the phalanx.

Remove the Kirschner wire from the metatarsal. Insert aKirschner wire into the center of the phalanx.

Slide the appropriate distal reamer over the Kirschner wireand ream to remove cartilage from the joint.

Important: When preparing the joint, it is possible to remove too much bone, which may result in shortening.Ream only enough to remove the cartilage and exposethe joint surface for fusion.

Remove the reamer and Kirschner wire.


Synthes 13

Implantation

2Contour plate

Instrument

03.211.005 Bending Pliers for VA Locking Plates

The 1st MTP fusion plates can be contoured to fit the specificanatomy and fixation options.

The bending pliers are designed to protect the variable angleholes during contouring. The feature on the pliers lines upwith the cloverleaf design in the plate. Two pliers are used tocontour the plate.

Important– If possible, bend the plate between the VA holes. Do not

deform the threaded part of the holes or over-bendthe plates during bending as this may adversely affect insertion of VA locking screws.

– Do not repeatedly bend the plates back and forth as thismay weaken the plate.

1Select and position plate

Select the plate that allows for the desired level of correction.

A sterile flat surface can be placed on the bottom of the footto measure the desired amount of toe dorsiflexion. The platemay be contoured slightly to achieve the desired outcome.

Place the plate on the joint surface, aligning the etched lineon the plate with the joint to ensure proper plate position.


Implantation

3Apply reduction and compression

Instruments

03.211.400 Compression Forceps for use with Compression Wire

03.211.410.01 Compression Wire � 1.6 mm, length 150 mm, thread length 10 mm







If required, compression may be achieved as described inthe Controlled Compression Technique section (p. 6) of thistechnique guide.

It is recommended to insert an independent lag screw to aidin stabilization. Insert the screw starting medial and distal tothe joint on the phalanx, crossing the joint and ending in thelateral side of the metatarsal head.

Synthes 15

4Insert independent 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

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

03.111.038 Handle with Quick Coupling

314.467 Screwdriver Shaft, Stardrive, T8, self-holding

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

Insert an additional independent cortex screw depending onthe corresponding indication and situation. For compressionof the additional independent screw it is recommended touse the lag screw technique.

For 2.4 mm cortex screws, use the 2.4 universal drill guideand pre-drill the screw hole with the 1.8 mm drill bit. For2.7 mm cortex screws, use the 2.7 universal drill guide andpre-drill 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 cortex screw) or the 2.4 mm drill bit (for 2.4 mmcortex screw) with the double drill guide.

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

Synthes 17

5Pre-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




310.509 Drill Bit � 1.8 mm, with marking, length110 /85 mm, 2-flute, for Quick Coupling





Determine the size of screws to be used, 2.4 or 2.7 mm, andwhether they will be inserted at a variable angle (5a) or atthe pre-defined nominal angle (5b).


Implantation

5aPre-drill using variable angle technique


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







Variable angle locking screws allow for manipulation aroundthe independent lag screw.

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

Synthes 19

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 nomi-nal trajectory of the hole.

To achieve the desired angle, verify the drill bit angle anddepth under image intensification. If incorrect, drill at a different angle and verify again under image intensification.

Use the according depth gauge to measure the correct screwlength.


Implantation

5bPre-drill using pre-defined nominal angle technique





Optional instrument



310.509 Drill Bit � 1.8 mm, with marking, length110 / 85 mm, 2-flute, for Quick Coupling



Optional instrument


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

Synthes 21

Insert and lock the VA-LCP drill sleeve tip into the cloverleafdesign of the VA-LCP hole. The coaxial drill guide will self retain 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 tothe desired depth.

Verify the drill bit depth under image intensification.

Use the according depth gauge to measure the correct screwlength.


Implantation

6Insert VA locking screws

Instruments – VA screws 2.4/2.7 mm


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 desired position.

Insert additional screws as needed.

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

Synthes 23

7Lock 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. Thetorque 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 lockedin the plate to achieve maximum strength of the plate-screwinter face.

Remove the compression wires.


Implantation

8Ensure proper reconstruction

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

Synthes 25




To remove locking screws, first unlock all locking screws before removing them completely. Otherwise, the plate mayrotate and damage the soft tissue.

Implant Removal


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.

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

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

Synthes 27

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


Plates

1st MTP Fusion Plates 2.4/2.7, VA locking, small

Art. No. Length Dorsiflexion Left/Right(mm)

0X.211.230 42 0° Right

0X.211.231 42 0° Left

0X.211.232 42 5° Right

0X.211.233 42 5° Left

0X.211.234 42 10° Right

0X.211.235 42 10° Left

1st MTP Fusion Plates 2.4/2.7, VA locking, medium


0X.211.236 52 0° Right

0X.211.237 52 0° Left

0X.211.238 52 5° Right

0X.211.239 52 5° Left

0X.211.240 52 10° Right

0X.211.241 52 10° Left

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


R

L

R

L

Synthes 29

1st MTP Fusion Plates 2.4/2.7, VA locking, large


0X.211.242 57 5° Right

0X.211.243 57 5° Left

1st MTP Fusion Plates 2.4/2.7, VA locking, for Revision


0X.211.244 53 0° Right

0X.211.245 53 0° Left

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


R

L

R

L


Instruments

311.430 Handle with Quick Coupling, length 110 mm

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

Synthes 31

Instruments for insertion of 2.7 mm screws

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

Instruments for insertion of 2.4 mm screws

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




310.509 Drill Bit � 1.8 mm, with marking, length110/85 mm, 2-flute, for Quick Coupling

Synthes 33

03.211.400 Compression Forceps for use withCompression Wire








Instruments for compression


Cannulated proximal and distal reamers

Art. No. Proximal / Diameter Distal (mm)

03.211.114 Proximal 14

03.211.014 Distal 14

03.211.116 Proximal 16

03.211.016 Distal 16

03.211.118 Proximal 18

03.211.018 Distal 18

03.211.120 Proximal 20

03.211.020 Distal 20

03.211.122 Proximal 22

03.211.022 Distal 22

03.211.124 Proximal 24

03.211.024 Distal 24

Instruments

Additional instrument

03.211.005 Bending Pliers for VA Locking Plates

Synthes 35

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


0123

Synthes GmbHEimattstrasse 3CH-4436 Oberdorfwww.synthes.com

All technique guides are available as PDF files at www.synthes.com/lit

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Documents

Variable Angle LCP 1 MTP Fusion Plates 2.4/2.7. Part of ...atlasteb.ir › Uploads › 14515664_Variable Angle LCP 1st... · anatomy and fixation options. The bending pliers are designed