lcp pediatric condylar plate 90°, 3.5 and 5.0. for distal ...synthes.vo.llnwd.net/o16/llnwmb8/int...

LCP Pediatric Condylar Plate 90°, 3.5 and 5.0. For distal femur osteotomies.

Surgical Technique

This publication is not intended for distribution in the USA.

Image intensifier control

WarningThis description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended.

Processing, Reprocessing, Care and MaintenanceFor general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to:http://emea.depuysynthes.com/hcp/reprocessing-care-maintenanceFor general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

LCP Pediatric Condylar Plate 90°, 3.5 and 5.0 Surgical Technique DePuy Synthes 1

Table of Contents

Introduction LCP Pediatric Condylar Plate System 2

AO Principles 4

Indications 5

Clinical Cases 6

Surgical Technique Preoperative Planning 8

Patient Positioning and Approach 10

Guide Wire Insertion 11

Osteotomy 17

Distal Fixation 19

Reduction 27

Proximal Fixation 28

Medialization 34

Product Information Implants 38

Instruments 43

LCP Pediatric Plate System Module Overview 55

Bibliography 56

MRI Information 57

2 DePuy Synthes LCP Pediatric Condylar Plate 90°, 3.5 and 5.0 Surgical Technique

LCP Pediatric Condylar Plates are specifically designed lock-ing compression plates for osteotomies of the distal femur in children and adolescents. The LCP features incorporated are fixed angle locking screws in the metaphysis and combi holes for the diaphysis that allow a choice of locked or cortical screws. LCP Pediatric Condylar Plates 3.5 and 5.0 have a universal design for the left and right femur. Osteotomies for correction in every plane can be stabilized with these plates. The LCP Pediatric Condylar Plate belongs to the family of LCP Pediatric Hip Plates and requires that instrumentation for its use.

LCP Pediatric Condylar Plate 90°, 3.5 and 5.0. For distal femur osteotomies.

LCP Pediatric Condylar Plate System


The LCP Pediatric Condylar Plate offers several advantages:

Angular stabilityReduces the risk of primary and secondary loss of correction. The angular stability eliminates the need for additional immobilization in the majority of cases.

Easy and safe surgical techniqueInitial plate positioning with Kirschner wires allows easy ad-justment with less bone damage.

MedializationMedialization of the shaft can be achieved using the plate as an internal fixator, preventing golf club deformity of the dis-tal femur.

Anatomic designThis plate fits the distal femur proximal to the growth plate allowing easy positioning.

Low profilePlate design and locking construct minimize muscle disrup-tion and reduce soft-tissue irritation.

Features and Benefits


AO Principles

Stable fixationThe fixation of the LCP plate with angular stable screws re-duces the risk of intra- and postoperative loss of correction in osteotomies.

Preservation of blood supplyThe structure and nature of the pediatric periosteum allow blood supply to be maintained even if the periosteum is elevated.

Early mobilizationThe use of LCP implants allows early and active mobilization, including cast-free postoperative management (3.5/5.0 sys-tem) in younger and handicapped children where appropriate.


Indications

This surgical technique focuses on the LCP Pediatric Condylar Plate 90°, 3.5 and 5.0 for deformity correction in the distal femur in all planes with or without additional rotation correc tion.

The LCP Pediatric Condylar Plate is intended for use in pedi-atric patients up to adolescence and for small-stature adult patients.

Specific indications include: – Fixed flexion contracture of knee in neurological conditions – Deformity correction in the distal femur – Rotational malalignment of the femur (if distal correction

preferred) – Supracondylar fractures of the femur

Important: Make sure to choose the appropriate plate for the patient’s age, size and bone quality.


Clinical Cases

Case 1*

Preoperative, AP10 years old male with spas-tic diplegia.

Preoperative, lateralFracture of the inferior pole of the patella as a sign of high stress caused by fixed flexion contracture of 30°.

Postoperative, AP and lateralAnatomical position of the plate in AP view following supra-condylar extending osteotomy with 30° of extension and 15° of external rotation shown in lateral view. This procedure was combined with patellar tendon shortening.

Preoperative, AP and lateral8 year old girl with arthrogryposis multiplex congenita and bilateral severe, fixed knee flexion deformity.

Postoperative, AP and lateralEight weeks after bilateral supracondylar 25° extension osteotomy with complete consolidation.

Case 2*


* Images provide with permission from Prof. Dr Reinald Brunner and Dr Erich Rutz, MD Children’s University Hospital of Basel, UKBB, Switzerland

Case 3*

Preoperative, AP and lateral17 years old male with spastic diplegia and fixed flexion con-tracture of 25°.

Postoperative, AP and lateralComplete consolidation after one year.

Postoperative, AP and lateralSix weeks after bilateral supracondylar extension osteotomy of 25° and 20° of external rotation stable correction is shown.


Surgical TechniquePreoperative Planning

Preoperative planning of osteotomies of the distal femur is somewhat different from that for hip osteotomies.

The principles, however, are identical:

1 Decide what corrections in what planes are required. This may be achieved by a combination of clinical exami-nation, x-rays (for example long leg views for alignment), CT scans (to assess femoral torsion) or frequently through examination under anesthesia

2 Decide how the implant should be placed to achieve the correction e.g. bone wedges to be excised, opening wedges to be created (unusual in the distal femur due to the neurovascular structures), shortening of the femur re-quired to relax for soft tissues (common in neurological disease with contracture)

Note: The condylar plate is contoured such that distal screws will be at 90° to the midline of the shaft if the plate is fitted on the surface of the bone. Generally, the distal screws should be parallel to the growth plate in the coronal plane, although care must be taken to establish that there is no de-formity of the distal fragment that would negate this as-sumption.

A

C

1

2

3

DB


Plate type

This technique guide focuses on the LCP Pediatric Condylar Plates 3.5 and 5.0 and describes the options of axial correc-tions in the distal femur.

The pictures represent the LCP Pediatric Condylar Plate 3.5 (corresponding to implant Art. No. 02.108.410). The surgical technique involves the use of screw holes where applicable. Please see the designation of each hole as indicated.

The surgical technique described is based on a 30° extension and 30° external rotation osteotomy.

A, B, C: Distal locking screwsD: Positioning Kirschner wire1, 2 and 3: Locking or cortical screws


Patient Positioning and Approach

1Positioning and preparation of the patient

The operation is performed with the patient supine on a ra-diolucent table. The whole leg is prepared up to the inguinal region.

Note: In difficult cases it may be advisable to prepare both legs to allow a visual check of both legs.

2Approach

A standard lateral approach to the distal femur reflecting the vastus lateralis anteriorly should be used. The level of the in-cision should be determined under image intensifier control.

Tip: The use of a sterile tourniquet may facilitate the ap-proach.


1Localize the frontal plane of the distal femur

Instrument

292.200 Kirschner Wire B 2.0 mm with trocar tip, length 150 mm, Stainless Steel

After subperiosteal preparation of the distal femur, place a Kirschner wire extra-periosteally over the front of the femur 1 cm above the physis or by rotating the leg under image in-tensifier control until the patella is perfectly anterior and in the midline. Check the alignment of the Kirschner wire in the frontal plane.

Guide Wire Insertion


2Insert positioning Kirschner wire in hole D

Instruments for 3.5 mm plate

03.108.001 Aiming Block for Screws B 3.5 mm, for LCP Pediatric Hip Plates

03.108.006 Positioner for Aiming Block

292.790 Kirschner Wire B 2.0 mm with threaded tip, length 150/15 mm, Stainless Steel




292.790 Kirschner Wire B 2.0 mm with threaded tip, length 150/15 mm, Stainless Steel

Assemble the positioner and the aiming block accordingly (1).

Localize distal femoral growth plate under image intensifier control.

The insertion point for the positioning Kirschner wire de-pends on the age and size of the patient. For the 3.5 mm plate insertion is 1.0 – 2.0 cm and the 5.0 mm plate 1.5 – 2.5 cm above the distal physis.

Note: In extension osteotomy the insertion point will need to be more proximal and more posterior as the plane of the two distal screws will not be parallel to the physis in the sagittal view (2).


2

1

30°


Using the positioner/aiming block assembly to determine the angle for correction in the coronal (frontal) plane may prove difficult. This is because the cortex of the distal femur is at an angle to the line of the shaft due to the supracondylar flare. In the coronal (frontal) plane, the positioning wire is therefore inserted parallel to the physis and the positioner/aiming block assembly is used to determine the angle of correction in the sagittal plane.

Insert the positioning Kirschner wire in the appropriate hole in the aiming block (hole D) so that it is parallel to the ante-rior surface orientation Kirschner wire and such that when the block is rotated for the correction in the sagittal plane there will be space for the main Kirschner wires that corre-spond to the screws (3; 4).

When the positioning Kirschner wire is correctly positioned, remove the anterior orientation Kirschner wire.

3

4


3Insert Kirschner guide wires for distal screws



03.108.005 Kirschner Wire B 2.8 mm with spade point tip


03.108.040 Adapter for Kirschner Wires B 2.8 mm, for LCP Pediatric Hip Plates 3.5/5.0

314.070 Screwdriver, hexagonal, small, B 2.5 mm, with Groove

333.080 Positioning Plate, triangular, length 45 mm, 100°/60°/20°







03.108.040 Adapter for Kirschner Wires B 2.8 mm, for LCP Pediatric Hip Plates 3.5/5.0







1Rotate the aiming block and positioner into the correct posi-tion for the sagittal plane correction. This can be done by calculation but is more commonly achieved by placing the positioner in line with the tibia in the position of maximum achievable extension.

Insert the 2.8 mm Kirschner guide wires for plate holes A and B through the aiming block (1).


To prevent any interference with other wires, adjust the Kirschner wire adapter before inserting the Kirschner guide wire for hole B. (Insertion of wire for hole B shown in red in picture 2).

2



Instrument

03.108.008 Positioner for Osteotomy

Level of the osteotomyThe osteotomy needs to be at least 15 mm proximal to the aiming block for the 3.5 mm plate and 20 mm for the 5.0 mm plate. Make a mark with an oscillating saw (1).

Important: Prior to cutting, the bone wires should be in-serted to allow assessment and control of rotation. In the distal fragment the initial positioning wire is adequate. In the proximal fragment, a bicortical wire should be inserted such that it does not interfere with the osteotomy. It is helpful to calculate the rotational correction before inserting this wire so that after the osteotomy is fixed the wire lies parallel to the positioning wire in the distal fragment (2). If no rotational correction is planned, then clearly marking the femur with the saw may adequately control rotation.

Osteotomy

2

1


The first cut of the osteotomy should be parallel to the Kirschner wires and sufficiently proximal to allow the third screw in hole C to gain adequate purchase (3).If considerable sagittal plane correction is planned then that must be taken into account. If the positioner for osteotomy is laid against the wires, this gives the minimum distance that will allow insertion of the screw in hole C.

Note: The cut is best made freehand under image intensifier control, keeping the blade parallel to the Kirschner wires in both planes.

Opening wedge osteotomy can be used in deformity correc-tion. It is generally not recommended when treating contrac-ture in neurological conditions. A second cut to the osteot-omy is therefore recommended in this situation and this should be made in the proximal fragment at a right angle to the line of the shaft in all planes (5). The size of the wedge is determined by preoperative planning and depending on the clinical situation.

The resulting wedge is removed (6).

Note: Before completing the distal cut, it is recommend to make the proximal cut to half the diameter of the bone (4). This guarantees optimal fit of both fragments after reduction.

Note: Frequently some shortening is required, in which case the fragment of bone excised will be trapezoidal rather than wedge shaped.

3 4

65

Osteotomy


1Position plate



03.108.009 LCP Drill Sleeve 3.5, for Drill Bits B 2.8 mm, for LCP Pediatric Hip Plate


03.108.004 Reduction Sleeve 4.3/2.8



Insert the drill sleeves into plate holes A and B until they are completely gripped by the thread. Slide the plate over the Kirschner guide wires and the positioning Kirschner wire (1;2).

Note for 5.0 mm plate: An additional reduction sleeve must be inserted in each LCP drill sleeve before sliding the plate over the wires.

Note: Fixation in the distal fragment must always be done with locking screws.

Distal Fixation

2

1


Distal Fixation

2Determine screw length and insert distal femoral locking screws A and B


03.108.003 Direct Measuring Device for Kirschner Wires B 2.8 mm, length 200 mm






310.430 LCP Drill Bit B 4.3 mm with Stop, length 221 mm, 2-flute, for Quick Coupling

Determine the screw length by measuring the insertion depth of the Kirschner guide wire with the direct measuring device for Kirschner guide wires. Slide the appropriate end of the measuring device over the Kirschner wire against the LCP drill sleeve and determine the proper screw length (1). Remove the Kirschner wire and the LCP drill sleeve in hole A. If necessary, use the wrench at one end of the positioner for osteotomy (2).

Insert the screw in hole A (see step 3 for insertion options).

2

1


Note for 5.0 mm plate: Remove the reduction sleeve and then measure the Kirschner wire length over the drill sleeve. Enlarge the hole from 2.8 to 4.3 mm with the LCP drill bit. Then remove the drill sleeve and insert the screw as above.

Important: It is recommended to use a power tool to insert the self-tapping screw.


Distal Fixation

3Distal fixation


511.770 Torque Limiter, 1.5 Nm, for Compact Air Drive and Power Drive

314.030 Screwdriver Shaft, hexagonal, small, B 2.5 mm

314.116 Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling

397.705 Handle for Torque Limiter Nos. 511.770 and 511.771


511.771 Torque Limiter, 4 Nm, for Compact Air Drive and Power Drive

314.152 Screwdriver Shaft 3.5, hexagonal, self-holding

314.119 Screwdriver Shaft Stardrive 4.5/5.0, T25, self-holding, for AO/ASIF Quick Coupling



Two options are available:

Option A – Manual insertionTo insert the locking screw manually, attach the torque lim-iter handle corresponding to the plate size to the torque lim-iter and insert a screwdriver shaft. Insert the locking screw, and lock it in the plate. The optimum torque is reached after one click.

Option B – Insertion with a power toolTo insert the locking screw using a power tool, pick up the locking screw and insert it into the plate hole until the screw head is slightly above the plate. Do not fully tighten the screw with the power tool. Uncouple the power tool, fit the handle and tighten the screw manually. The optimum torque is reached after one click using the corresponding torque limiter.

Insert the screw in hole B in the same way as in hole A (1;2).

Note: Do not remove the positioning wire until the end of the proximal fixation.

2

1


Distal Fixation

4Insert locking screw in hole C




319.010 Depth Gauge for Screws B 2.7 to 4.0 mm, measuring range up to 60 mm











314.164 Screwdriver Stardrive 4.5/5.0, T25, with Groove, length 240 mm



1Mount the LCP drill sleeve onto hole C and drill the hole with the LCP drill bit through both cortices. Either read off the screw length from the calibrated drill or determine the screw length with the depth gauge (1).


Insert the screw in hole C (2;3).2

3

Distal Fixation


Instruments

399.121 Bone Holding Forceps, self-centering, soft lock, length 239 mm

399.124 Reduction Forceps, toothed, soft lock, length 250 mm

Reduce the plate onto the femoral shaft and check the align-ment on the image intensifier (1;2). Decide whether medial-ization will be required. Check visually that the plate is parallel to the shaft in the sagittal plane.

Important: After reduction, the initial positioning wire in the distal fragment lies parallel to the bicortical wire in the proximal part to achieve correct axial alignment (3).

Note: If medialization is required, follow the steps as described on pages 34 – 37.

Reduction

3

2

1


Since this is an LCP plate, either locking or cortical screws can be used. After a locking screw has been inserted into in the proximal fragment it is not permissible to insert a cortical screw; locking screws can however be inserted after cortical screws.

Option A: Proximal fixation with locking screwsInsert screws in holes 1, 2 and 3.



314.116 Screwdriver Shaft Stardrive, 3.5, T15, self-holding, for AO/ASIF Quick Coupling






Proximal Fixation







511.771 Torque Limiter, 4 mm, for Compact Air Drive and Power Drive



Insert screw in hole 3 (3). 3

2

1Drill the screw hole 3 over the LCP drill sleeve using an ap-propriate drill bit. Either read off the screw length from the calibrated drill or determine the screw length with the depth gauge (1;2).


Repeat this step for screw insertion in holes 1 and 2 (4).

Then remove the initial positioning wire in the distal frag-ment and the bicortical positioning wire in the proximal part.

4

Proximal Fixation


Option B: Proximal fixation with cortical screwsInsert screws in holes 1, 2 and 3.


310.250 Drill Bit B 2.5 mm, length 110/85 mm, 2-flute, for Quick Coupling



314.041 Screwdriver Stardrive 3.5, T15, with Groove, length 200 mm



312.280 Double Drill Guide 3.5/2.5

323.360 Universal Drill Guide 3.5


310.310 Drill Bit B 3.2 mm, length 145/120 mm, 2-flute, for Quick Coupling

314.270 Screwdriver, hexagonal, large, B 3.5 mm, with Groove, length 245 mm



314.119 Screwdriver Shaft Stardrive 4.5 /5.0, T25, self-holding, for AO/ASIF Quick Coupling



323.460 Universal Drill Guide 4.5 /3.2, for neutral and load position


1If cortical screw fixation is selected, this is generally because compression at the osteotomy site is desired. Using the spring-loaded drill guide without pressing the guide down on the plate, place the drill hole as proximally as possible in the combi-hole to achieve compression when the screw is tightened (1).

Proximal Fixation


Choose the appropriate size drill bit. Measure the screw length with the depth gauge and place a self-tapping cortex screw in hole 1.

Repeat this step for screw insertion in holes 2 and 3.Then remove the initial positioning wire in the distal fragment and the bicortical positioning wire in the proximal part. (2)

2


Note: In order to facilitate medialization, locking screws must be used throughout.






03.108.007 Instrument for medialization






Medialization






03.108.007 Instrument for medialization







Drill the screw hole and remove the drill sleeve. Determine the screw length with the depth gauge and insert a locking screw (2).

Check the position throughout under image intensifier guid-ance to ensure satisfactory reduction and medialization.

Attach the medialization instruments to holes 1 and 3. Turn the knob on the bars until the required amount is pro-truding. Then screw an LCP drill sleeve into LCP hole 2. Reduce the plate to the shaft of the femur until complete contact of the bars of the medialization device with the bone is achieved and hold it with the reduction forceps (1).

2

1


After the screw in hole 2 is securely fixed, remove the instru-ment for medialization in hole 1 and insert a drill sleeve. Pre-drill the screw hole and remove the drill sleeve. Determine the screw length with the depth gauge and insert a locking screw. Repeat step two for hole 3 (3).

Note: Tighten the screws manually with the torque limiter.

Medialization

3


Additional medialization (if required)

If the mechanical axis is not in line, additional medialization is required.

1. Remove screws in holes 1 and 32. Loosen screw in hole 2 if already inserted.

It may be necessary to use a longer screw3. Place positioning plates (triangles) over holes 1 and 3 to

prevent protrusion of the bar into the pre-existing holes.4. Further adjust the knob on both medialization instru-

ments in holes 1 and 3 to the new correction level.5. Tighten screw in hole 2.6. Add screws 1 and 3.

Note: Should the correction not turn out as planned, further correction may be achieved by re-positioning locking screws in the proximal fragment to correct unintended deviation.


Product range of LCP Pediatric PlatesThe product range consists of different plate sizes: – LCP Pediatric Hip Plates 2.7 – LCP Pediatric Hip Plates 3.5 and 5.0 – LCP Pediatric Condylar Plates 3.5 and 5.0 – Available sterile or unsterile packed

For proximal femurPlates for varus osteotomies (2.7, 3.5 and 5.0)The plates are available with screw angles of 100° or 110°, 130° and 2 (2.7) or 3 (3.5 / 5.0) distal fixation screws.

Plates for valgization osteotomies (3.5 and 5.0)The plates are available with a screw angle of 140° and 3 distal fixation screws.

Plates for fractures and rotation osteotomies (3.5 and 5.0)The plates are available with a screw angle of 130° and 3, 5, 7 or 9 distal fixation screws.

For distal femur Plates for fractures and deformities (3.5 and 5.0)The plates are available with a screw angle of 90° and 3, 5 or 7 distal fixation screws.

Overview of available technique guides: – LCP Pediatric Hip Plate 3.5 and 5.0 for varus osteotomies

(Art. No.036.001.073) – LCP Pediatric Hip Plate 2.7 for varus osteotomies

(Art. No.036.001.060) – LCP Pediatric Hip Plate 3.5 and 5.0 for fracture treatment

and rotation correction (Leaflet) (Art. No. 036.001.063) – LCP Pediatric Hip Plate Straight Valgus 3.5 and 5.0 for

valgus osteotomies (Art. No. 036.001.057) – LCP Pediatric Condylar Plate 3.5 and 5.0 for distal femoral

osteotomies (Art. No. 036.001.065)

Product InformationImplants


Plate for valgization osteotomy

02.108.316 LCP Pediatric Hip Plate 3.5, 140°, straight,width 19 mm, length 70 mm

02.108.326 LCP Pediatric Hip Plate 5.0, 140°, straight,width 23 mm, length 90 mm

For proximal femurPlates for varus osteotomies

02.108.300 LCP Pediatric Hip Plate 2.7, 100°,width 12 mm, length 46 mm

02.108.301 LCP Pediatric Hip Plate 2.7, 110°, width 12 mm, length 46 mm






Implants

Plates for fractures and derotation osteotomies











For distal femur Plates for supracondylar fractures and deformities

02.108.410 LCP Pediatric Condylar Plate 3.5, 90°, shaft 3 holes







Screw overviewCortex screws, self-tapping, stainless steel

202.866 – Cortex Screws Stardrive B 2.7 mm,202.969 lengths 6 – 60 mm

204.816 – Cortex Screws B 3.5 mm,204.860 lengths 16 – 60 mm

02.200.016 – Cortex Screws Stardrive B 3.5 mm,02.200.070 self-tapping, lengths 16 – 70 mm

214.818 – Cortex Screws B 4.5 mm, self-tapping,214.870 lengths 18 – 70 mm

Locking screws, self-tapping, stainless steel

202.206 – Locking Screws Stardrive B 2.7 mm 202.260 (head LCP 2.4), lengths 6 – 60 mm

213.016 – Locking Screws B 3.5 mm,213.060 lengths 16 – 60 mm

212.104 – Locking Screws Stardrive B 3.5 mm,212.124 lengths 16 – 60 mm

213.318 – Locking Screws B 5.0 mm,213.375 lengths 18 – 75 mm

212.203 – Locking Screws Stardrive B 5.0 mm,212.224 lengths 18 – 75 mm

All implants are also available sterile packed.Add Suffix “S” to part number.

Implants


Instruments

Positioners for Aiming Blocks

03.108.034 Positioner for Aiming Block, for LCP Pediatric Hip Plates 2.7



Aiming Blocks

03.108.033 Aiming Block for Screws B 2.7 mm, for LCP Pediatric Hip Plates 2.7



Instruments


Positioners for Osteotomy

03.108.039 Positioner for Osteotomy, for LCP Pediatric Hip Plates 2.7


Drill Sleeves and Reduction Sleeve

03.108.036 LCP Drill Sleeve 2.7, for Drill Bits B 2.0 mm, for LCP Pediatric Hip Plates 2.7




03.108.037 Direct Measuring Device for Kirschner Wires B 2.0 mm, for LCP Pediatric Hip Plates 2.7



Instruments

03.108.040 Kirschner Wire Adaptor

292.650 Guide Wire B 2.0 mm with threaded tip with trocar, length 230 mm, Stainless Steel

292.790 Kirschner Wire B 2.0 mm with threaded tip, length 150 / 15 mm, Stainless Steel

Positioning Wires, Guide Wires and Adapter

292.200 Kirschner Wire B 2.0 mm with trocar tip, length 150 mm, Stainless Steel



310.284 LCP Drill Bit B 2.8 mm with Stop, length 165 mm, 2-fl ute, for Quick Coupling

310.250 Drill Bit B 2.5 mm, length 110/85 mm, 2-fl ute, for Quick Coupling

Drill Bits

323.062 Drill Bit B 2.0 mm, with double marking, length 140/115 mm, 3-fl ute, for Quick Coupling



310.430 LCP Drill Bit B 4.3 mm with Stop, length 221 mm, 2-fl ute, for Quick Coupling


Instruments





Drill Guides




03.503.036 Depth Gauge for MatrixMANDIBLE, measuring range from 6 to 40 mm

Depth Gauges



Instruments

314.041 Screwdriver Stardrive 3.5, T15, with Groove, length 200 mm

313.302 Screwdriver Stardrive, T8, cylindrical, with Groove, shaft B 3.5 mm

314.270 Screwdriver, hexagonal, large, B 3.5 mm, with Groove, length 245 mm

Screwdrivers and Screwdriver shafts








313.304 Screwdriver Shaft Stardrive, T8, cylindrical, with Groove, shaft B 3.5 mm, for AO/ASIF Quick Coupling


Instruments

Bone Holding Forceps and Reduction Forceps








511.776 Torque Limiter, 0.8 Nm, with AO/ASIF Quick Coupling

Torque Limiters

03.110.005 Handle for Torque Limiters 0.4/0.8/1.2 Nm




Positioning Plates



Others

03.108.007 Instrument for Medialization

313.300 Combined Holding Sleeve for Cortex Screws Stardrive B 2.4/2.7 mm, T8, for Screwdriver Shafts B 3.5 mm

Instruments


LCP Pediatric Plate System Module Overview

Modules for implants, standard

68.108.032 Modular Tray for LCP Pediatric Plates 2.7, size 1/2, without Contents, Vario Case System



Modules for instruments, standard

68.108.041 Modular Tray for Instruments for LCP Pediatric Plates 2.7, size 1/2, without Contents, Vario Case System

68.108.040 Modular Tray for Instruments for LCP Pediatric Plates 3.5 and 5.0, size 1/1, without Contents, Vario Case System

68.108.042 Modular Tray for General Instruments, for LCP Pediatric Plates 3.5 and 5.0, size 1/1, without Contents, Vario Case System

Labeling clips

68.108.033 Labeling Clip for LCP Pediatric Plates 3.5, Vario Case System



68.108.043 Labeling Clip for Instruments for LCP Pediatric Plates 3.5 and 5.0, Vario Case System

68.108.044 Labeling Clip for Instruments for LCP Pediatric Plates 2.7, Vario Case System

68.108.045 Labeling Clip for General Instruments, for LCP Pediatric Plates 3.5 and 5.0, Vario Case System


Bibliography

Kay M.R., Rethlefsen P.T., Hale J.M, Skaggs D., Tolo V. (2003) J of Pediatric Orthopaedics 23: 150-154. Comparison of Proximal and Distal Rotational Femoral Osteotomy in Chil-dren with Cerebral Palsy.

Mortazavi S.M.J., Heidari P., Esfandiari H., Motamedi M. (2008). J of Haemophilia 4, 85-90. Trapezoid supracondylar femoral extension osteotomy for knee flexion contractures in patients with haemophilia.

Oppenheim W.L., Fischer S.R., Salusky I. (1997). J of Pediatric Orthopaedics 17: 41-49. Surgical Correction of Angular De-formity of the Knee in Children with Renal Osteodystrophy.

Piripiris M., Trivett A., Baker R., Rodda J., Nattrass G.R., Gra-ham H.K. (2003). J of Bone and Joint Surgery Vol 85-B. No. 2. Femoral derotation osteotomy in spastic diplegia. Proximal or Distal?

Hefti F et al. (1998) Kinderorthopädie in der Praxis. Berlin Heidelberg New York: Springer

Morrissy RT, Weinstein SL (2001) Atlas of Pediatric Orthope-dic Surgery. Philadelphia: Williams & Wilkins-Verlag

Müller M.E., Schneider R. et al., AO manual of internal fixa-tion. 3rd Edition ed. 1991, Berlin-Heidelberg-New York: Springer.


MRI Information

Torque, Displacement and Image Artifacts according to ASTM F 2213-06, ASTM F 2052-06e1 and ASTM F2119-07Non-clinical testing of worst case scenario in a 3 T MRI system did not reveal any relevant torque or displacement of the construct for an experimentally measured local spatial gradient of the magnetic field of 3.69 T/m. The largest image artifact extended approximately 169 mm from the construct when scanned using the Gradient Echo (GE). Testing was conducted on a 3 T MRI system.

Radio-Frequency-(RF-)induced heating according to ASTM F2182-11aNon-clinical electromagnetic and thermal testing of worst case scenario lead to peak temperature rise of 9.5 °C with an average temperature rise of 6.6 °C (1.5 T) and a peak temperature rise of 5.9 °C (3 T) under MRI Conditions using RF Coils [whole body averaged specific absorption rate (SAR) of 2 W/kg for 6 minutes (1.5 T) and for 15 minutes (3 T)].

Precautions: The above mentioned test relies on non-clini-cal testing. The actual temperature rise in the patient will depend on a variety of factors beyond the SAR and time of RF application. Thus, it is recommended to pay particular attention to the following points: – It is recommended to thoroughly monitor patients under-

going MR scanning for perceived temperature and/or pain sensations.

– Patients with impaired thermo regulation or temperature sensation should be excluded from MR scanning proce-dures.

– Generally it is recommended to use a MR system with low field strength in the presence of conductive implants. The employed specific absorption rate (SAR) should be reduced as far as possible.

– Using the ventilation system may further contribute to reduce temperature increase in the body.

0123

Synthes GmbHEimattstrasse 34436 OberdorfSwitzerlandTel: +41 61 965 61 11Fax: +41 61 965 66 00www.depuysynthes.com

This publication is not intended for distribution in the USA.

All surgical techniques are available as PDF files at www.depuysynthes.com/ifu ©

DeP

uy S

ynth

es T

raum

a, a

div

isio

n of

Syn

thes

Gm

bH. 2

015.

A

ll rig

hts

rese

rved

. 03

6.0

01.0

65

DSE

M/T

RM

/081

5/0

458

09/1

5

lcp pediatric condylar plate 90°, 3.5 and 5.0. for distal ...synthes.vo.llnwd.net/o16/llnwmb8/int...

Documents