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Long Volar Plates for Diaphyseal-Metaphyseal Radius Fractures
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-LongSurgical Technique
Introduction
Surgical Technique
Product Information
Image intensifier control
Table of Contents
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 1
2.4/2.7 mm VA LCP® Two-Column Volar Distal 2Radius Plate, Extra-Long
AO Principles 4
Indications 5
MRI Safety Information 6
Preparation 7
Approach 7
Provisional Fixation and Reduction 8
Implant Selection 9
Plate Contouring 11
Plate Positioning and Preliminary Fixation 13
Distal Screw Insertion 17
Proximal Screw Insertion 23
Confirm Joint Reconstruction 28
Final Tightening of VA Locking Screws 29
Implant Removal 30
Implants 31
Sizing Templates 34
Instruments 35
2 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long
The 2.4/2.7 mm VA LCP® Two-Column Volar Distal Radius Plate,Extra-Long, is available in a variety of lengths and head sizes.
Same head design as VA LCP Two-Column Volar Distal Radius Plate• Familiarity with the Variable Angle Two-Column
Volar Distal Radius Plate design and technique• Compatible with VA LCP Two-Column Volar Distal
Radius Plate Guide BlockVarious shaft lengths• 7 holes (105-110 mm depending on head size),
10 holes (145 mm), 13 holes (186 mm)• Accepts 2.4 mm Screws and 2.7 mm Screws in
the shaft of the plate (proximal)
VA Combi holes and Oblong VA Combi holes in the shaft• Allow fl exibility in screw choice: Variable Angle Locking,
Coaxial Locking, and Cortex Screws• Facilitate plate positioning on the bone• With variable angle locking screws, 15° of screw
angulation in all directions to address individual fracture patterns
Available sterile-packed• Immediate availability for use• Minimal storage space
K-wire holes
Various head widths• Narrow (19.5 mm), standard (22.0 mm),
wide (25.5 mm)• Accepts 2.4 mm Screws and 1.8 mm Buttress
Pins in the head of the plate (distal)
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 1
2.4/2.7 mm Variable Angle LCP Two-Column Volar Distal Radius Plate, Extra-Long
Bending Notches and Undercuts• All plates can be bent out-of-plane (fl exion-extension).
The 13-hole plate can be bent out-of-plane, as well as in-plane at the bending notches.
• Undercuts are designed to reduce plate-to-bone contact
Tapered and narrowed proximal end • Facilitate insertion• Designed to reduce soft tissue irritation
Shaft Holes 6-Hole Head Narrow
6-Hole Head Standard
7-Hole HeadWide
7-Hole Shaft ✓ ✓ ✓
10-Hole Shaft n/a ✓ n/a
13-Hole Shaft n/a ✓ n/a
4 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
AO Principles
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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, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme; 2007.
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 5
Indications
The DePuy Synthes 2.4/2.7 mm VA LCP Two-Column Volar Distal Radius Plate, Extra-Long is intended for intra- and extra-articular fractures, osteotomies, nonunions and malunions of the distal radius, with or without extension into the radial diaphysis in adults and adolescents (12-21) where the growth plates have fused or will not be crossed, such as:• Intra-articular fractures exiting the epiphysis• Intra-articular fractures exiting the metaphysis• Physeal crush injuries• Any injuries which cause growth arrest to the
distal radius
Precaution: The DePuy Synthes 2.4/2.7 mm VA LCP Two-Column Volar Distal Radius Plate, Extra-Long was designed for patients where the growth plates have fused or will not be crossed. The use of the 2.4/2.7 mm VA LCP Two-Column Volar Distal Radius Plate, Extra-Long in patients where the growth plates have not fused or will be crossed may result in premature closure of the physis and bone growth inhibition.
6 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
MRI Safety Information
MRI Safety Information The 2.4/2.7 mm VA LCP Two-Column Volar Distal Radius Plate, Extra-Long 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 2.4/2.7 mm VA LCP Two-Column Volar Distal Radius Plate, Extra-Long in the MR environment is unknown. Scanning a patient who has this device may result in patient injury.
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 7
Surgical Technique
1. Preparation
Ensure compatible instrumentation is available.
2. Approach
Make a longitudinal incision slightly radial to the fl exor carpi radialis tendon (FCR). Dissect between the FCR and the radial artery, exposing the pronator quadratus. Detach the pronator quadratus from the lateral border of the radius and elevate it toward the ulna. The incision can be extended proximally depending on the fracture pattern and length of plate used.
To get better exposure of the radius, it is helpful to pronate the forearm.2
Important: Leave the volar wrist capsule intact to avoid devascularization of the fracture fragments and destabilization of the volar wrist ligaments.
2. Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme; 2007.
8 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Surgical Technique
3. Provisional fixation and reduction–distal
Instruments
292.12 1.25 mm Kirschner Wire with trocar tip, length 150 mm, Stainless Steel
292.16 Kirschner Wire, 1.6 mm with trocar tip, length 150 mm, Stainless Steel
398.41 Reduction forceps with points, wide
399.97 Reduction forceps, with points
Reduce the periarticular component of the fracture using the preferred reduction techniques.
Refer to section 6 for additional information regarding reduction techniques.
Note: The reduction method will be fracture-specific.
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 9
Surgical Technique
4. Implant selection
Instruments
03.111.570 Sizing Template, Narrow, 6-hole head, 7-hole shaft, length 105 mm
03.111.670 Sizing Template, Standard, 6-hole head, 7-hole shaft, length 109 mm
03.111.680 Sizing Template, Standard, 6-hole head, 10-hole shaft, length 145 mm
03.111.690 Sizing Template, Standard, 6-hole head, 13-hole shaft, length 186 mm
03.111.770 Sizing Template, Wide, 7-hole head, 7-hole shaft, length 110 mm
Optional Instruments
03.111.121S Sizing Template Set for 2.4/2.7 mm VA LCP Two-Column Volar Distal Radius Plate, Extra-Long, Sterile
03.111.570
03.111.670
03.111.680
03.111.690
03.111.770
Left and right are marked on opposite sides of Trial implants.
13 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Select the plate according to the fracture pattern and anatomy of the radius.
Use the sizing templates to determine the size (width and length) of the plate to be used. Left and right are marked on opposite sides. The sizing templates can be bent to approximate plate shape. Screw holes are etched on sizing templates.
The sizing templates can also be adapted to the anatomy of the bone and used as a bending template.
Precaution: Ensure the proper plate selection by verifying the L (left) and R (right) etching on the sizing template. The plate’s distal lip is slightly lower on the radial side.
Note: Use only manual bending. Excessive and repetitive bending of the sizing templates should be avoided. Excessive bending includes >15° bending out-of-plane (fl exion-extension) in both directions and >30° twisting. In-plane (side to side) bending of the sizing templates is not recommended as it could cause permanent deformation.
Warning: Do not implant sizing templates.
Left and right are marked on opposite sides.
Surgical Technique
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 11
5. Plate contouring (optional)
Instruments
329.04 Bending Iron for 2.7 mm and 3.5 mm plates, 150 mm length, used with Bending Iron (329.05)
329.05 Bending Iron for 2.7 mm and 3.5 mm plates, 150 mm length, used with Bending Iron (329.04)
329.29 Bending Pliers
If necessary, contour the plate to fi t the patient’s anatomy using the bending irons or bending pliers.
Precautions: • Avoid reverse bends and excessive bending.
Reverse bends and excessive bending may weaken the plate and lead to premature plate failure.
• Excessive bending includes >15° bending out-of-plane (fl exion-extension) in both directions and >30° twisting.
• In-plane (side to side) bending can only be performed with the 13-hole plate at a maximum of 10° using the bending notches.
• Perform in-plane bending prior to out-of-plane bending.
Perform in-plane bending prior to out-of-plane bending and/or twisting.
15°
15°
10°
10°
Surgical Technique
12 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Surgical Technique
For in-plane bending of the 13-hole plate, open and adjust the handles of the bending pliers. Slide the proximal end of the plate into the bending pliers as shown. (1)
Check VA portion of the Combi holes adjacent to the bending site with a variable angle drill guide after bending to ensure holes have not been deformed.
Note: Illustrations are shown with a Right plate with the top surface of the plate facing upwards. To bend a Left plate, insert the plate with the bottom of the plate facing upwards in the bending pliers.
1
Incorrect side—Bending pliers with opening on the right.
Correct side—Bending pliers with wider opening on left.
The bending pliers is two-sided. Use the side of the bending pliers with the wider opening to the left. (2)
2
Bending notches positioned in opening of bending pliers.
Align the bending notches in the plate with the open section of the bending pliers as shown. (3) Squeeze the handles together to increase the bend at the tip of the plate. Open the handles to straighten the tip of the plate.
3
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 11
Surgical Technique
6. Plate positioning and preliminary fixation
Instruments
292.12 1.25 mm Kirschner Wire with trocar tip, length 150 mm, Stainless Steel
02.111.500.10 1.25 mm Plate Reduction Wire, with thread, with Small Stop, length 150 mm, Stainless Steel
02.111.501.10 1.25 mm Plate Reduction Wire, with thread, with Large Stop, length 150 mm, Stainless Steel
319.006 Depth Gauge for 2.0 mm and 2.4 mm Screws OR
319.01 Depth Gauge for 2.7 mm and Small Screws
Apply the plate to fit the volar surface. Ensure plate is centered on the bone.
If necessary, use additional instrumentation (reduction clamps, provisional Kirschner wires, plate reduction wires, and lag screws) to aid in restoration of length and alignment. The plate may also be considered a supportive reduction device.
Insert 1.25 mm Kirschner wires or 1.25 mm plate reduction wires with small stop through the desired Kirschner wire holes to provide provisional fixation. 1.25 mm plate reduction wires with large stop can be inserted through nonthreaded screw holes. Remove reduction wires and Kirschner wires when provisional fixation is no longer necessary. Plate reduction wires and Kirschner wires are single-use items; do not re-use Kirschner wires when provisional fixation is no longer necessary. Plate reduction wires and Kirschner wires are single-use items; do not re-use.
Example of potential reduction aids. Reduction will be fracture-specific.
A Lag screwsB Provisional fixation with cortex screwC 1.25 mm Plate reduction wires with large stopD 1.25 mm Plate reduction wire with small stopE 1.25 mm Kirschner wire F Reduction forceps
A
A
B
C
F
C
C
ED
Ensure plate is centered on the bone.
14 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Provisional screw fixation
Instruments
314.453 Screwdriver Shaft, StarDrive™, T8, Short, OR
314.467 Screwdriver Shaft StarDrive, T8, Quick Coupling
311.43 Handle with Quick Coupling
03.111.005 Depth Gauge for 2.0 to 2.7 mm Screws OR
319.01 Depth Gauge for 2.7 mm and Small Screws
Instruments for 2.7 mm Cortex Screws
323.26 2.7 mm Universal Drill Guide
310.534 2.0 mm Drill Bit with Depth Mark, length 110, Quick Coupling
Instruments for 2.4 mm Cortex Screws
323.202 2.4 mm Universal Drill Guide
310.509 1.8 mm Drill Bit with Depth Mark, length 110 mm, Quick Coupling
Determine size of cortex screw to be inserted. Insert a cortex screw into the first appropriate elongated Combi hole.
Use the nonthreaded portion of the elongated Combi hole to insert cortex screws. Cortex screws can be used to compress the plate to bone.
Surgical Technique
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 15
Drill with the drill bit using the universal drill guide.
Drill bits are color-coded according to the screw size:
■ Purple – 1.8 mm Drill Bit, for 2.4 mm Screws
■ Orange – 2.0 mm Drill Bit, for 2.7 mm Screws
Precaution: Use proper irrigation and suction when drilling.
Measure the appropriate screw length using the depth gauge and insert the cortex screw in the elongated hole. Adjust the plate as necessary and tighten the screw.
Perform several radiographic views of the distal radius to ensure alignment and reduction.
Notes: • The size of screw, order of screw insertion, and the
use of Kirschner wires may vary depending on the fracture pattern and reduction technique. The fracture pattern will dictate the appropriate site for this fi rst screw.
• Optionally a tap can be used if insertion of the screw into hard cortical bone is diffi cult.
Taps (Optional)
311.26 Tap for 2.7 mm Cortex Screws
311.23 Tap for 2.4 mm Cortex Screws
Surgical Technique
16 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Surgical Technique
Compression TechniqueTo drill a hole for dynamic compression, place the universal drill guide eccentrically at the edge of the nonthreaded portion of the Combi hole, without applying pressure to the tip
Drill through the universal drill guide. Insert a cortex screw using a screwdriver (1). Tightening of the cortex screw will result in dynamic compression (2).
Note: When and if to perform compression may vary depending on the fracture pattern and reduction technique. The fracture pattern will dictate the appropriate use of compression. Plate illustration has been simplified to show compression.
1 2
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 17
Surgical Technique
7a. Distal screw insertion–variable angle
Instruments
03.110.000 1.8 mm Universal Variable Angle Locking Drill Guide OR
03.110.023 1.8 mm Variable Angle Locking Drill Guide, Cone
310.509 1.8 mm Drill Bit with Depth Mark, Quick Coupling
314.453 Screwdriver Shaft, StarDrive, T8, short OR
314.467 Screwdriver Shaft StarDrive, T8, Quick Coupling
311.43 Handle with Quick Coupling
03.111.005 Depth Gauge for 2.0 to 2.7 mm Screws OR
319.006 Depth Gauge for 2.0 mm and 2.4 mm Screws
Insert and lock the cone portion of the 1.8 mm VA drill guide tip into the cloverleaf design of the VA locking hole.
Use the 1.8 mm drill bit to drill to the desired depth at the desired angle. When drilling, the tip of the drill sleeve should remain fully seated in the hole.
Precaution: Use proper irrigation and suction when drilling.
The funnel for the drill guide allows the drill bit up to a 15° angulation around the central axis of the locking hole.
Use the depth gauge to determine the screw length.
18 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Surgical Technique
Insert the VA locking screws manually with the StarDrive™ T8 Screw Driver Shaft and quick coupling handle and tighten just enough for the screw head to be fully seated in the VA locking hole.
Do not overtighten the screw.
Perform several radiographic views of the distal radius to ensure alignment and reduction.
Insert additional screws as needed.
Note: The order of screw insertion may vary depending on the fracture pattern and reduction technique. The fracture pattern will dictate the appropriate screw placement and order of screw insertion.
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 19
Surgical Technique
7b. Distal screw insertion–coaxial (fi xed angle)
Instruments
03.110.000 1.8 mm Universal Variable Angle Locking Drill Guide OR
03.110.024 1.8 mm Variable Angle Drill Guide, Coaxial
310.509 1.8 mm Drill Bit with Depth Mark, Quick Coupling
314.453 Screwdriver Shaft, StarDrive, T8, short OR
314.467 Screwdriver Shaft StarDrive, T8, Quick Coupling
311.43 Handle with Quick Coupling
03.111.005 Depth Gauge for 2.0 to 2.7 mm Screws OR
319.006 Depth Gauge for 2.0 mm and 2.4 mm Screws
The fi xed-angle end of the drill sleeve only allows the drill bit to follow the nominal trajectory of the VA locking hole.
Insert and lock the coaxial portion of the 1.8 mm VA drill guide tip into the cloverleaf design of the VA locking hole.
Use the 1.8 mm drill bit to drill to the desired depth at the pre-defi ned angle.
23 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Read the screw length directly from the laser mark on the drill bit. Alternatively, use the depth gauge to determine the screw length.
Precaution: Use proper irrigation and suction when drilling.
Insert the VA locking screws manually with the StarDrive T8 Screwdriver shaft and quick coupling handle and tighten just enough for the screw head to be fully seated in the VA locking hole.
Do not overtighten the screw.
Perform several radiographic views of the distal radius to ensure alignment and reduction.
Insert additional screws as needed.
Note: The order of screw insertion may vary depending on the fracture pattern and reduction technique. The fracture pattern will dictate the appropriate screw placement and order of screw insertion.
Surgical Technique
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 21
7c. Distal screw insertion– coaxial (fixed angle) with guide blocks (optional)
Instruments
314.453 Screwdriver Shaft, StarDrive, T8, short OR
314.467 Screwdriver Shaft StarDrive, T8, Quick Coupling
311.43 Handle with Quick Coupling
03.111.005 Depth Gauge for 2.0 to 2.7 mm Screws OR
319.006 Depth Gauge for 2.0 mm and 2.4 mm Screws
03.110.021 1.8 mm Drill Guide With Measuring for Guide Block
03.111.500 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, narrow, 6 holes, right
03.111.501 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, narrow, 6 holes, left
03.111.600 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, 6 holes, right
03.111.601 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, 6 holes, left
03.111.700 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, 7 holes, right
03.111.701 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, 7 holes, left
Surgical Technique
22 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Surgical Technique
Select the corresponding guide block for Two-Column Distal Radius Plate and secure it to the plate using the positioning screw. Slightly tighten the positioning screw with the Screwdriver.
Insert the quick drill sleeve with scale into the guide block hole. Ensure that the quick drill sleeve is firmly seated in the hole. Drill to the desired depth using the 1.8 mm drill bit.
Read the screw length directly from the laser mark on the drill bit.
Alternatively, use the corresponding depth gauge directly through the guide block.
Insert the VA Locking screw manually through the guide block using the screwdriver.
Loosen the positioning screw and remove the guide block after screw insertion.
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 21
Surgical Technique
8a. Proximal screw insertion– variable angle
Instruments
314.453 Screwdriver Shaft, StarDrive, T8, Short OR
314.467 Screwdriver Shaft, StarDrive, T8, Quick Coupling
311.43 Handle with Quick Coupling
03.111.005 Depth Gauge for 2.0 to 2.7 mm Screws OR
319.01 Depth Gauge for 2.7 mm and Small Screws OR
319.006 Depth Gauge for 2.0 mm and 2.4 mm Screws
Instruments for 2.7 mm Variable Angle Locking Screws
03.211.002 2.0 mm Universal Variable Angle Locking Drill Guide OR
03.211.003 2.0 mm Variable Angle Locking Drill Guide, Variable
310.534 2.0 mm Drill Bit with Depth Mark, length 110, Quick Coupling OR
310.19 2.0 mm Drill Bit, Quick Coupling, 100 mm
Instruments for 2.4 mm Variable Angle Locking Screws
03.110.000 1.8 mm Universal Variable Angle Locking Drill Guide OR
03.110.023 1.8 mm Variable Angle Locking Drill Guide, Cone
310.509 1.8 mm Drill Bit with Depth Mark, length 110, Quick Coupling
24 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Determine screw size and select corresponding instrumentation. If using variable angle locking, insert and lock the cone portion of the VA drill guide tip into the cloverleaf design of the VA locking hole.
Use the drill bit to drill to the desired depth at the desired angle. When drilling, the tip of the drill guide should remain fully seated in the hole.
The funnel for the drill sleeve allows the drill bit up to 15° angulation around the central axis of the locking hole.
Precaution: Use proper irrigation and suction when drilling.
Use the depth gauge to determine the screw length.
Insert the VA locking screws manually with the StarDrive T8 Screwdriver shaft and quick coupling handle. Tighten the screw just enough for the screw head to be fully seated in the VA locking hole.
Do not overtighten the screw.
Insert additional screws as needed.
Notes: • The screw size, type of screw, screw placement,
and order of screw insertion may vary depending on the fracture pattern and reduction technique. The fracture pattern will dictate the appropriate screw and order of screw insertion.
• Alternatively, 2.4 mm and 2.7 mm cortex screws can be inserted into the shaft of the plate. Select a drill guide based on the size of the screw. Use the nonthreaded portion of the Combi holes to insert cortex screws. Cortex screws can be used to provide compression.
Surgical Technique
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 25
Surgical Technique
Notes: • A tap can be used if insertion of the screw into
hard cortical bone is diffi cult.• Optionally a tap can be used if insertion of the
screw into hard cortical bone is diffi cult.
See table for corresponding tap for screw size and thread type.
Taps (optional)
311.23 Tap for 2.4 mm Cortex Screws
311.26 Tap for 2.7 mm Cortex Screws
03.111.906 Tap for 2.7 mm Locking Screws
03.111.908 Tap for 2.4 mm Locking Screws
Taps for locking screws are color-coded according to the screw size:
■ Purple – 1.8 mm Tap, for 2.4 mm Screws
■ Orange – 2.0 mm Tap, for 2.7 mm Screws
26 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Surgical Technique
8b. Proximal screw insertion– coaxial (fi xed angle)
Instruments
314.453 Screwdriver Shaft, StarDrive, T8, Short OR
314.467 Screwdriver Shaft StarDrive, T8, Quick Coupling
311.43 Handle with Quick Coupling
03.111.005 Depth Gauge for 2.0 to 2.7 mm Screws OR
319.01 Depth Gauge for 2.7 mm and Small Screws OR
319.006 Depth Gauge for 2.0 mm and 2.4 mm Screws
Instruments for 2.7 mm Variable Angle Locking Screws
03.211.002 2.0 mm Universal Variable Angle Locking Drill Guide OR
03.211.004 2.0 mm Variable Angle Locking Drill Guide, Coaxial
310.534 2.0 mm Drill Bit with depth mark, length 110 mm, Quick Coupling
Instruments for 2.4 mm Variable Angle Locking Screws
03.110.000 1.8 mm Universal Variable Angle Locking Drill Guide OR
03.110.024 1.8 mm Variable Angle Drill Guide, Coaxial
310.509 1.8 mm Drill Bit with depth mark, length 110 mm, Quick Coupling
Determine screw size and select corresponding instruments. The fi xed-angle end of the drill sleeve only allows the drill bit to follow the nominal trajectory of the VA locking hole.
Insert and lock the coaxial portion of the VA drill guide tip into the cloverleaf design of the VA locking hole.
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 27
Use the drill bit to drill to the desired depth at the pre-defi ned angle. Read the screw length directly from the laser mark on the drill bit. Alternatively, use the depth gauge to determine the screw length.
Precaution: Use proper irrigation and suction when drilling.
Insert the VA locking screws manually with the StarDrive T8 Screwdriver shaft and quick coupling handle. Tighten the screw just enough for the screw head to be fully seated in the VA locking hole.
Do not overtighten the screw.
Insert additional screws as needed.
Notes: • The screw size, type of screw, and order of screw
insertion may vary depending on the fracture pattern and reduction technique. The fracture pattern will dictate the appropriate order of screw insertion.
• Alternatively, 2.4 mm and 2.7 mm cortex screws can be inserted into the shaft of the plate. Use the non-threaded portion of the Combi holes to insert cortex screws. Cortex screws can be used to provide compression.
Instruments for 2.7 mm Cortex Screws
323.26 2.7 mm Universal Drill Guide
310.534 2.0 mm Drill Bit with depth mark, length 110 mm, Quick Coupling
Instruments for 2.4 mm Cortex Screws
323.202 2.4 mm Universal Drill Guide
310.509 1.8 mm Drill Bit with depth mark, length 110 mm, Quick Coupling
Note: A tap can be used if insertion of the screw into hard cortical bone is diffi cult. See page 18 for a listing of available taps.
Surgical Technique
28 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
9. Confirm joint reconstruction
Ensure proper joint reconstruction, screw placement, and screw length using multiple radiographic views. Verify that the distal screws are not in the joint by using additional views such as a 10° dorsally tilted, 20° inclined lateral, and 45° pronated oblique view.
Surgical Technique
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 29
Surgical Technique
10. Final tightening of variable angle locking screws
Instruments
03.110.005 Handle for Torque Limiting Attachment
03.110.002 Torque Limiting Attachment, 1.2 Nm OR
511.776 Torque Limiting Attachment, 0.8 Nm
314.453 Screwdriver Shaft, StarDrive, T8, Short OR
314.467 Screwdriver Shaft StarDrive, T8, Quick Coupling
Use the 1.2 Nm Torque Limiting Attachment to perform the fi nal locking step for the 2.7 mm Variable Angle locking screws.
Use the 0.8 Nm Torque Limiting Attachment to perform the fi nal locking step for the 2.4 mm Variable Angle locking screws.
The Torque Limiting Attachment prevents overtightening and ensures that the VA locking screws are securely locked into the plate.
Notes: • For dense bone, visually inspect if the screw is
countersunk after tightening with the Torque Limiting Attachment. If required, carefully tighten without the Torque Limiting Attachment until the screw head is fl ush with the plate surface.
• For fi nal locking of 1.8 mm VA Buttress Pins, 1.8 mm LCP Buttress Pins and 2.7 mm Locking Screws, use the 0.8 Nm Torque Limiting Attachment.
Press
13 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Surgical Technique
11. Implant Removal
Instruments
311.43 Handle with Quick Coupling
314.453 Screwdriver Shaft, StarDrive, T8, Short
Optional Instruments
314.467 Screwdriver Shaft StarDrive, T8, Quick Coupling
314.468 Holding sleeve for StarDrive Screwdriver Shaft, T8
To remove locking screws, first unlock all screws from the plate; then remove the screws completely from the bone.The last screw removed should be a nonlocking screw in the shaft. This prevents the plate from spinning when locking screws are removed.
Note: If the screws cannot be removed with the standard instruments, refer to the DePuy Synthes Screw Removal Set Surgical Technique (J8569) for removal instructions.
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 11
Implants
Plates 2.4/2.7 mm VA LCP Two-Column Volar Distal Radius Plates, Extra-Long
Part Head Head Head Shaft Length Left/ number size width (mm) holes holes (mm) Right
0X.111.570S narrow 19.5 6 7 105 right
0X.111.571S narrow 19.5 6 7 105 left
0X.111.670S standard 22.0 6 7 109 right
0X.111.671S standard 22.0 6 7 109 left
0X.111.680S standard 22.0 6 10 145 right
0X.111.681S standard 22.0 6 10 145 left
0X.111.690S standard 22.0 6 13 186 right
0X.111.691S standard 22.0 6 13 186 left
0X.111.770S wide 25.5 7 7 110 right
0X.111.771S wide 25.5 7 7 110 left
All plates are available sterile only.
X = 2: 316L Stainless SteelX = 4: Commercially Pure Titanium (TiCP)
0X.111.570S 0X.111.571S 0X.111.670S 0X.111.671S
0X.111.680S 0X.111.681S
0X.111.690S 0X.111.691S
0X.111.770S 0X.111.771S
12 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Implants
Screws 2.4 mm Variable Angle Locking Screws*0X.210.108– 2.4 mm Variable Angle Locking Screws0X.210.130 Self-tapping, StarDrive, lengths 8 mm to
30 mm
For use in VA locking holes in the head or shaft of the plate.
2.7 mm Variable Angle Locking Screws0X.211.010– 2.7 mm Variable Angle Locking Screws0X.211.030 Self-tapping, StarDrive, lengths 10 mm
to 30 mm
For use in VA locking holes in the shaft of the plate.
2.4 mm Cortex Screws*X01.756– 2.4 mm Cortex ScrewsX01.780 Self-tapping, StarDrive, lengths 6 mm to
30 mm
For use in VA locking holes or Combi holes.
2.7 mm Cortex ScrewsX02.870– 2.7 mm Cortex ScrewsX02.890 Self-tapping, StarDrive, lengths 10 mm
to 30 mm
For use in Combi holes in the shaft of the plate.
*Screws are also available sterile packed in Sterile Tubes. Add suffi x “TS” to article number.
X = 2: 316L Stainless SteelX = 4: Titanium alloy (Ti-6Al-7Nb)
T8
T8
T8
T8
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 11
X = 2: 316L Stainless SteelX = 4: Titanium alloy (Ti-6Al-7Nb)
Implants
Buttress Pins and Locking Screws
1.8 mm Variable Angle Locking Buttress Pins0X.210.078– 1.8 mm VA Locking Buttress Pins, 0X.210.100 StarDrive, lengths 8 mm to 30 mm
For use in VA locking holes in the head of the plate.
1.8 mm LCP Buttress PinsX00.190– 1.8 mm LCP Buttress Pins, StarDrive X00.199 lengths 12 mm to 30 mm
For use in VA locking holes in the head of the plate.
2.4 mm Locking ScrewsX12.806 – 2.4 mm Locking Screw, StarDriveX12.830 Self-tapping, lengths 6 mm to 30 mm
For use in VA locking holes but only in predefi ned angle using coaxial (fi xed-angle) technique.
2.7 mm Locking ScrewsX02.208 – 2.7 mm Locking Screw, StarDriveX02.230 Self-tapping, lengths 8 mm to 30 mm
For use in VA locking holes but only in predefi ned angle using coaxial (fi xed-angle) technique in the shaft of the plate.
T8
T8
T8
T8
14 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Sizing Templates
Notes: • Screw holes are etched on sizing templates.• Left and right are marked on opposite sides of the
sizing templates.• Part number 03.111.121S is a sterile pack,
including all sizes of the sizing templates for the 2.4/2.7 mm VA LCP Two-Column Volar Distal Radius Plate, Extra-Long
Sizing Templates for 2.4/2.7mm VA LCP Two-Column Volar Distal Radius Plates, Extra-Long
03.111.570
03.111.670
03.111.680
03.111.690
03.111.770
Part numberFor plate head size
For plate head holes
For plate head holes (mm)
For plate shaft holes
For platelength (mm) Left/Right
03.111.570 narrow 6 19.5 7 105 Left/Right
03.111.670 standard 6 22.0 7 109 Left/Right
03.111.680 standard 6 22.0 10 145 Left/Right
03.111.690 standard 6 22.0 13 186 Left/Right
03.111.770 wide 7 25.5 7 110 Left/Right
03.111.121S all 6-7 19.5-25.5 7-13 105-186 Left/Right
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 15
Instruments
292.12 1.25 mm Kirschner Wire, trocar tip, length 150 mm, Stainless Steel
292.16 1.6 mm Kirschner Wire with trocar tip, length 150 mm, Stainless Steel
02.111.500.10 Plate Reduction Wire, 1.25 mm, with (10-pack) thread, with Small Stop, length 150 mm, Stainless Steel
02.111.501.10 Plate Reduction Wire, 1.25 mm, with (10-pack) thread, with Large Stop, length 150 mm, Stainless Steel
310.509 1.8 mm Drill Bit with depth mark, length 110 mm, Quick Coupling
310.534 2.0 mm Drill Bit with depth mark, length 110 mm, Quick Coupling
310.19 2.0 mm Drill Bit, quick coupling, 100 mm
310.26 2.7 mm Drill Bit, Quick Coupling, 100 mm
310.530 2.4 mm Drill Bit, Quick Coupling, 100 mm
16 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Instruments
311.43 Handle with Quick Coupling
314.453 Screwdriver Shaft, StarDrive, T8, short, Quick Coupling
314.467 Screwdriver Shaft, StarDrive‚ T8, Quick Coupling
323.202 2.4 mm Universal Drill Guide
323.26 2.7 mm Universal Drill Guide
329.04 Bending Iron for 2.7 mm and 3.5 mm plates, 150 mm length, used with Bending Iron (329.05)
329.05 Bending Iron for 2.7 mm and 3.5 mm plates, 150 mm length, used with Bending Iron (329.04)
329.29 Bending Pliers
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 17
Instruments
399.97 Reduction Forceps with Points, Ratchet, 130 mm
511.776 Torque Limiting Attachment, 0.8 Nm
03.110.005 Handle for Torque Limiting Attachment
03.110.000 1.8 mm Universal Variable Angle Locking Drill Guide
03.110.023 1.8 mm Variable Angle Locking Drill Guide, Cone
03.110.024 1.8 mm Variable Angle Locking Drill Guide, Coaxial
398.41 Reduction Forceps, with Points, Broad, Ratchet
18 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Instruments
03.211.002 2.0 mm Universal Variable Angle Locking Drill Guide
03.211.003 2.0 mm Variable Angle Locking Drill Guide, Variable
03.211.004 2.0 mm Variable Angle Locking Drill Guide, Coaxial
310.87 Countersink for 2.7 mm Cortex Screws
310.972 Countersink for 2.0 mm and 2.4 mm Screws
311.23 Tap for 2.4 mm Cortex Screws
311.26 Tap for 2.7 mm Cortex Screws
2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique DePuy Synthes 19
Instruments
03.111.906 Tap for 2.7 mm Locking Screws
03.111.908 Tap for 2.4 mm Locking Screws
314.468 Holding Sleeve for StarDrive Screwdriver Shaft, T8
03.111.005 Depth Gauge for 2.0 to 2.7 mm Screws
319.006 Depth Gauge for 2.0 mm and 2.4 mm Screws
319.01 Depth Gauge, for 2.7 mm and Small Screws
03.110.021 1.8 mm Drill Guide With Measuring for Guide Block
03.111.007 Positioning Screw for Guide Block for Two-Column Distal Radius Plate
43 DePuy Synthes 2.4/2.7 mm Variable Angle LCP® Two-Column Volar Distal Radius Plate, Extra-Long Surgical Technique
Instruments
03.111.500 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, narrow, 6 holes, right
03.111.501 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, narrow, 6 holes, left
03.111.600 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, 6 holes, right
03.111.601 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, 6 holes, left
03.111.700 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, 7 holes, right
03.111.701 Guide Block for 2.4 mm Two-Column Volar Distal Radius Plate, 7 holes, left
For detailed cleaning and sterilizationinstructions, please refer towww.depuysynthes.com/hcp/cleaning-sterilization or sterilization instructions, if provided.
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 2017. All rights reserved.DSUS/TRM/0916/1073 2/17 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