4.5 mm lcp distal femur platesynthes.vo.llnwd.net/o16/llnwmb8/us mobile/synthes north americ… ·...

Instruments and implants approved by the AO Foundation

4.5 mm LCP® Distal Femur PlateFor comminuted fractures of the proximal phalanx in horses

Surgical Technique

Table of Contents

Surgical Technique 4.5 mm LCP® Distal Femur Plate DePuy Synthes Vet 1

Introduction 4.5 mm LCP Distal Femur Plate 2

Locking Screws 3

AO Principles 4

Indications 5

Surgical Technique Preparation 6

Plate Positioning and Contouring 8

Screw Insertion 12

Product Information Implants 17

Instruments 19

Recommended Sets 21

2 DePuy Synthes Vet Surgical Technique 4.5 mm LCP® Distal Femur Plate

Introduction

For comminuted fractures of the proximal phalanx in horses

The DePuy Synthes Vet 4.5 mm LCP® Distal Femur Plate is part of a stainless-steel plate and screw system that merges locking screw technology with conventional plating techniques. The technical innovation of locking screws provides the ability to create a fixed-angle construct while following less invasive AO plating principles.

Features:• Locking screws engaged in the plate create a fixed-angle construct that

improves fixation and allows bridging plate fixation in multi- fragment fractures.

• Combi Holes accept 5.0 mm locking screws in the threaded section or 4.5 mm and 5.5 mm cortex screws in the DCU section.

• Distal Combi Holes in expanded plate head accept 5.0 mm locking screws or 5.5 mm and 4.5 mm cortex screws.

• Compatible with Large Fragment System.

• Limited contact design.

• Plate shaft design permits use of a less invasive surgical technique.

• 316L Stainless Steel.

4.5 mm LCP® Distal Femur Plate


Introduction

Screw Head The tapered, double-lead machine thread on the head of the locking screw engages the threads of the locking plate holes. The resulting fixed-angle construct bridges the major area of comminution in the proximal phalanx and maintains alignment of the digit as healing progresses.

Thread Profile Because locking screws do not compress the plate to the bone, the “pull-out” mode of failure is not applicable to locking screws. For this reason, locking screws are made with a smaller thread profile and a larger core diameter. This results in increased mechanical strength over comparably sized cortex screws.

Drive Mechanism The StarDrive™ Recess of a locking screw provides three significant improvements over an internal hex drive. First, “stripping” of the screw head is minimized as a failure mode, which results in a much higher tolerance to wear for the screwdriver.1 Second, the tapered StarDrive Recess provides automatic screw retention without the need for an additional screw holding mechanism. Third, the more efficient StarDrive Recess allows a smaller screw head and allows the screw head to sit flush with the plate.

Caution: DePuy Synthes, part of the Johnson & Johnson Family of Companies implants and instruments are manufactured with proprietary processes that are precisely tailored to meet unique product specifications. Though other companies may be able to estimate the DePuy Synthes Companies general product design, DePuy Synthes Companies product dimensions are proprietary. The precision design of DePuy Synthes Companies products is very important for long-term product function and optimal fit between implants.

Double-lead locking threads mate with the threaded portion of the plate

StarDrive Recess

Self-tapping flutes

Locking Screws

Only the finest quality materials are used to manufacture DePuy Synthes Companies implants. The metals DePuy Synthes Companies uses have been scientifically proven to be of the best biocompatibility and quality available today.

With these features and qualities, the mixing of DePuy Synthes Companies implants with the implants from other companies is not recommended. The overall performance may be compromised due to differences in design, chemical composition, mechanical properties, and quality.

Given these qualities are trade-secret, no competitor of DePuy Synthes Companies can make a genuine claim “the same as DePuy Synthes Companies.” Combining implants from other companies with DePuy Synthes Companies implants could reduce product performance. Consequently, it is strongly recommended to not mix parts from different manufacturers.

1. Test data on file at DePuy Synthes (Ref Test Report #SET_20110610)


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

Anatomic ReductionFracture reduction and fixation to restore anatomical relationships.

Stable FixationStability by fixation or splintage, as the personality of the fracture and the injury requires.

Preservation of Blood SupplyPreservation of the blood supply to soft t issue and bone by careful handling.

Early, Safe MobilizationEarly, safe mobilization of the part and patient.

1. Muller ME, Allgower M, Schneider R, Willenegger H. Manual of Internal Fixation: Techniques Recommended by the AO-ASIF Group. 3rd ed. Berlin Springer Verlag, 1991

2. Ruedi TP, Buckley RE, Mo r a n CG (eds) AO Principles of Fracture Management 2nd ed Stuttgart, New York Thieme 2007

AO Principles

Introduction


Introduction

IndicationsThe DePuy Synthes Vet 4.5 mm LCP Distal Femur Plate is intended for comminuted1 fractures of the proximal phalanx in horses.

1. Fractures lacking an intact strut of bone extending from the proximal to distal articular surfaces thus negating fragment reconstruction.


Surgical Technique

PreparationPosition Patient Position the patient in the lateral recumbency position with the affected limb uppermost. Fix the leg horizontally with a support above the carpus/tarsus. The hoof should be fitted for attachment to a pulley if traction is required to effect indirect fracture reduction. The horse must be fixed to the table in case traction is required.

1Cartilage Removal

Instruments

310.48 4.5 mm Drill Bit, quick coupling, 195 mm

312.46 4.5 mm/3.2 mm Double Drill Sleeve

VW1403.28 1.4 mm Kirschner Wire w/Trocar Point, 280 mm

Metacarpophalangeal joint cartilage should be removed to an approximate depth of 25 mm, through a lateral and medial incision with a 4.5 mm drill and curettes (dorsal part).

Note: A long needle or k-wire can be placed proximally through the extensor tendon and parallel to the joint, to indicate the axis of the joint.

Pastern cartilage should be removed by drilling through a lateral stab incision to an approximate depth of 55-60 mm with a 4.5 mm drill.


Surgical Technique

2Initial Fracture Reduction

Instruments




311.48 Tap for 4.5 mm Cortex and Shaft Screws, 180 mm/110 mm tap depth

314. 27 Large Hexagonal Screwdriver

319.10 Depth Gauge, for large screws




311.55 Tap for 5.5 mm Cortex Screws, 197 mm/ 100 mm tap depth

310.99 Countersink, for 4.5 mm Cortex Screws

2aThe fracture is aligned manually, or by use of a traction pulley. The goal is to restore length and provide alignment using indirect means such as traction and manipulation and avoid surgically exposing the fracture fragments.

The frontal plane fracture extending into the proximal articular surface of P1 is first reconstructed and stabilized with 5.5 mm cortex screws placed in lag fashion through stab incisions. Alternatively, 4.5 mm screws can be used, but are less desirable.

Note: If a pre-operative CT scan is available, it should be used to check the abaxial direction of the screws to engage palmar eminences.

Note: Complementary stabilization between fragments can be performed at the end of the procedure by adding one or two cortical screws through the plate or separately. However, following the principles of biological fracture fixation, most smaller fragments are not incorporated into the fixation.


3Place the plate above the skin, in the estimated position (typically proximo-distal). Using radiographic and fluoroscopy guidance, select the correct plate:

1. Use a left plate for a left limb and a right for a right limb, with the convexity of the plate on the medial side, usually the most predominant side of trauma. This may vary according to fracture configuration.

2. The expanded head of the plate should fit on the dorsal cortex of the proximal aspect of P2.

3. Hole A lies directly over the proximal interphalangeal joint in the Dorso-palmar/ plantar view.

4. The distal end of plate should not extend too far distally to minimize impingement on the distal interphalangeal joint.

5. The proximal end of plate should be centered on MC3.

Note: Plate has a R/L curvature and will course slightly abaxial as it passes over the distal MC3 and Metacarpophalangeal joint region.

Plate Positioning and Contouring

Surgical Technique

A


4Plate Contouring and Tunnel Creation

Instruments

329.30 Plate-Bending Press

4aUsing radiographic or fluoroscopy guidance, identify the level of the metacarpophalangeal joint angle on the plate.

Bend the plate approximately 5° more in dorsiflexion, between screw holes at the estimated level of the Metacarpophalangeal joint (usually between hole 4 and 5 in the plate shaft). A 15° to 20° total angle is usually adequate for a 30° fetlock angulation. See page 12 for hole locations

4b

Optional Instruments

03.100.044 Periosteal elevator 20 mm width, straight blade 200 mm handle

399.41 Hammer 350 g

328.010 Soft Tissue Retractor, large, extendible

Perform 3 dorsal midline incisions approximately 4 cm long through skin and extensor tendon, near the proximal end of the plate, the Metacarpophalangeal joint, and the distal end of the plate.

Note: The middle incision is created by extending one of the medial stab incisions along P1.

4cAt the distal incision, create a pocket under the tendon and joint capsule overlying the distal end of P1 and proximal end of P2, for the head of the plate. Elevate the tendon and joint capsule with a large periosteal elevator, both medial and lateral from the incision to create adequate space for the expanded head of the plate.

Surgical Technique

5°


Surgical Technique

4dWith the skin retracted, make medial and lateral relief incisions in the extensor tendon approximately 1.5 cm abaxial to the sagittal incision – these will facilitate closure once the plate is in position.

Note: Take care to not incise the skin inadvertently. Fix several towel clamps to the tendon to assist retraction and plate movement.

4eAt the level of the Metacarpophalangeal joint use a sharp periosteal elevator and scalpel to dissect beneath the joint capsule insertions (especially distally) and free the bone surfaces.

Proximally, use the large periosteal elevator to initiate a tunnel under the extensor tendon.

4fUse the tissue elevator to create the tunnel under the extensor tendon extending the length between all incisions – this is most easily accomplished using the tissue elevator passed from the incision overlying the Metacarpophalangeal joint and working proximal to the incision overlying MC3 and then reversing direction and working the tissue retractor from the Metacarpophalangeal joint incision to the incision overlying the proximal interphalangeal joint.

If necessary, a hammer can be used to assist passing the tissue elevator. Once the tunnel is created, enlarge the tunnel with a side-to-side motion to facilitate plate positioning.


Surgical Technique

5Plate Insertion and Positioning

Instruments

324.075 Threaded Plate Holder

398.95 Termite Forceps, 90 mm

5aNote: Refer to the diagram in Step 6 for plate hole locations.

Keep towel clamps on medial and lateral part of the tendon at each distal and middle incision to ensure the plate goes under the tendon.

Insert a Threaded Plate Holder into the plate.

From the distal incision, insert the plate shaft under the tendon and push it toward the proximal incision.

Once inserted ensure the entire plate is placed under the tendon.

5bCheck for proper plate position under radiography or fluoroscopy:

1. Close bone-plate contact.

2. Bones are functionally aligned – check for length, angulation and rotation.

3. Expanded head of the plate is centered on the dorsal cortex of the proximal end of P2 (holes D, E, F).

4. Hole A lies directly over the proximal interphalangeal joint in the Dorso-palmar/ plantar view.

5. Proximal end of plate is centered on cannon bone.

AFE D


Surgical Technique

6

Instruments

311.449 Push-Pull Reduction Device for 4.5 mm LCP Plates

312.449 4.3 mm Threaded Drill guide

322.535 5.5 mm Universal Drill Guide



222.256 Shown

Head

Shaft

]

]11

3

4

8

9

10

5

6

7

2

GB

1

A

D

C

E

F

Screw Insertion


Surgical Technique

6aNote: Refer to the diagram in Step 6 for plate hole locations.

Insert a 3.0 mm Steinman pin (not shown) through hole A into the proximal interphalangeal joint; this will aid in maintaining the appropriate proximo-distal position of the plate.

Check for the latero-medial and dorso-palmar/plantar position with imaging.

6bPlace the first push-pull reduction device through hole G or C. Pre-drill the hole for the push-pull device with a 2.5 mm drill.

Note: Take care to insert the device perpendicular to the plate. A threaded drill guide inserted into an adjacent hole can be used for reference. Ensure the plate contacts the dorsal cortical bone by tightening the push-pull device.

Note: Take care to maintain sagittal position of the plate at the proximal and distal ends.

6cCheck appropriate plate position with a dorso-palmar/plantar image and insert second push pull device through the most proximal shaft hole to maintain plate position.

Once images confirm the desired position of the plate, fill the holes in the distal end of the plate overlying the P2 (D, E, F) with 5.0 mm locking screws.

G

F

ED

C


Surgical Technique

6dInsert one 5.5 mm cortex screw in the neutral position to engage the distal end of MC3, proximal to the bending site at the Mc/Mt3-P joint (see image, hole 6) and compress the plate to the bone. If additional contact between the plate and bone is needed, insert an additional 5.5 mm cortex screw.

Remove the push-pull devices and Steinmann pin.

6


Surgical Technique

6eFill all remaining plate holes.

If the fracture configuration permits, place 5.0 mm locking screws in the distal end of P1.

At least two 5.0 mm locking screws are placed in distal MC3. The remaining screw holes in MC3 can be filled with 5.5 mm cortex screws or 5.0 mm locking screws.

Finally place two 5.5 mm cortex screws in lag fashion abaxial to the plate to engage the proximal sesamoid bones.

Additional screws may be added into P1 however, attempting to engage highly comminuted fragments is contra-indicated.


7Closure

7aNote: It is imperative to cover the implants with the overlying digital extensor tendon to provide maximal soft tissue coverage and reduce the risk of infection.

Use large diameter, absorbable monofilament suture in a cruciate pattern to appose the edges of the tendon incision directly underlying the skin incision at the level of proximal interphalangeal joint. The relief incisions, which lie abaxial to the skin incision, are not apposed.

7bUse large diameter, absorbable monofilament suture in a cruciate pattern to close the tendon over the plate at the Metacarpophalangeal joint and MC3.

7cSubcutaneous tissues are apposed where possible using monofilament, absorbable suture.

Skin incisions are closed routinely.

Surgical Technique


4.5 mm LCP Distal Femur Plate, Right Shaft Holes Length (mm)

222.254 9 236

222.256 11 276

222.258 13 316

4.5 mm LCP Distal Femur Plate, Left Shaft Holes Length (mm)

222.255 9 236

222.257 11 276

222.259 13 316

Product Information

Implants


VW1403.28 1.4 mm Kirschner Wire w/Trocar Point 280 mm

5.5 mm Cortex Screws, non-self-tapping, with Hexagonal recess

VS501.024- VS501.060 24 mm - 60 mm (in 2 mm increments)

VS501.064 64 mm


5.0 mm Locking Screws, self-tapping, with StarDrive Recess



Also Available: 4.5 mm Cortex Screws, self-tapping, with Hexagonal recess


VS402.076 76 mm

VS402.080 - VS402.100 80 mm - 100 mm (in 5 mm increments)

4.5 mm Cortex Screws, non-self-tapping, with Hexagonal recess

VS401.014- VS401 .072 14 mm - 72 mm (in 2 mm increments)

VS401.076 76 mm

VS401.080 - VS401.100 80 mm - 100 mm (in 5 mm increments)

Product Information

Implants

Thread Diameter 5.5 mm 4.5 mm 5.0 mm Screw Type Cortex Cortex Locking

Drill Bit for Threaded Hole 4.0 mm 3.2 mm 4.3 mm

Tap 5.5 mm 4.5 mm Self-Tapping

Drive Type 3.5 mm 3.5 mm T25 StarDrive Hexagonal Hexagonal Recess




310.401 4.0 mm Drill Bit/QC/160 mm

310.431 4.3 mm Drill Bit/QC/180 mm



310.99 Countersink, for 4.5 mm Cortex Screws

311.48 Tap for 4.5 mm Cortex and 4.5 mm Shaft Screws,180 mm/110 mm tap depth

311.449 Push-Pull Reduction Device For 4.5 mm LCP® Plates

311.55 Tap for 5.5 mm Cortex Screws, 197 mm/ 100 mm tap depth

Product Information

Instruments



312.449 4.3 mm Threaded Drill Guide



314. 27 Large Hexagonal Screwdriver

319.10 Depth Gauge, for large screws

324.075 Threaded Plate Holder

329.30 Plate-Bending Press

Product Information

Instruments


Product Information

Instruments

Also Available:



311.44 T-Handle with Quick Coupling

314.15 Large Hexagonal Screwdriver Shaft


03.100.044 Periosteal Elevator 20 mm Width Straight Blade 200 mm Handle

328.010 Soft Tissue Retractor, large, extendible

399.41 Hammer 350 Grams

311.66 Tap for 6.5 mm Cancellous Screws, 197 mm/ 150 mm calibration

314.11 Holding Sleeve

SD311.007 Tap for 5.0 mm Locking Screw, 130 mm


103.530 Large Fragment Instrument Set

103.531 Large Fragment Standard Instrument Set

103.532 Large Fragment Locking nstrument Set

103.536 Large Fragment Standard 5.5 mm Screw Set

103.537 Large Fragment Standard 4.5 mm Screw Set

103.538 Large Fragment Locking Screw Set

Note: Large Fragment Instrument Set (103 530) consists of Large Fragment Standard Instrument Set (103 531), with graphic case, and Large Fragment Locking Instrument Set (103 532).

Set Information

For detailed cleaning and sterilization instructions, please refer to: https://www.depuysynthes.com/hcp/cleaning-sterilization For Instructions for Use and other product information, please refer to: https://www.e-ifu.com

In Canada, the cleaning and sterilization instructions will be provided with the Loaner shipments

Recommended Sets

https://www.depuysynthes.com/hcp/cleaning-sterilization

DePuy Synthes Vet1302 Wrights Lane EastWest Chester, PA 19380 Telephone: (610) 719-5000 To order: (800) 523-0322

https://jjmdanimalhealth.com

© DePuy Synthes 2020. All rights reserved.129426-191212 DSUS

In the USA, this product has labeling limitations. See package insert for complete information. USA Law restricts these devices to sale by or on the order of a physician.

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4.5 mm lcp distal femur platesynthes.vo.llnwd.net/o16/llnwmb8/us mobile/synthes north americ… ·...

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