variable angle locking hand system

80 Pages·2016·4.82 MB·English

VARIABLE ANGLE LOCKING
HAND SYSTEM
For fragment-specific fracture fixation with
variable angle locking and locking technology
Instruments and implants approved by the AO Foundation.
This publication is not intended for distribution in the USA.
SURGICAL TECHNIQUE
Image intensifier control
This 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 Maintenance
For 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-maintenance
For 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
TABLE OF CONTENTS
INTRODUCTION Variable Angle Locking Hand System Overview 2
AO Principles 5
Intended Use and Indications 6
Featured Plates and Technique Highlights 7
Screws in the System 18
Featured Instruments 20

SURGICAL TECHNIQUE Preoperative Planning and Reduction 27
Lag Screw Insertion (Optional) 29
Prepare and Insert Plate 37
Trial Implants 37
Insert Screw 50
Implant Removal 51

PRODUCT INFORMATION Implants 54
Kirschner Wires 63
Instruments 64
Optional Instruments 68
Trial Implants 69
Case Components and Modules 73
Also Available 76
MRI Information 77
Variable Angle Locking Hand System Surgical Technique DePuy Synthes 1
VARIABLE ANGLE LOCKING HAND SYSTEM
OVERVIEW
The DePuy Synthes Variable Angle Locking Hand System
consists of plates that are anatomic, procedure-specifi c,
and available in both stainless steel and titanium.
The Variable Angle Locking Hand System offers
instrumentation to aid in:
• fracture reduction
• provisional fi xation
• plate adaptation
• construct creation
Designed for the Surgeon and Patient
A dedicated, global surgeon team was integral to the
design of this system through extensive consultation and
participation in multiple design labs. Surgeon interviews,
design and development meetings, and collaboration
with key opinion leaders determined the clinical
components necessary for the DePuy Synthes Variable
Angle Locking Hand System. DePuy Synthes Companies
are dedicated to improving patient care.
System Snapshot
• Extensive system of anatomically precontoured plates
• First to the market with 1.3 mm locking screws for
hand plating1
• Forceps that aid in fracture reduction and lag screw
application
• Forceps that aid in plate fi xation
• Self-retaining screwdrivers
• Plates available in 316L stainless steel and titanium
• Color-coded instruments
1 DePuy Synthes Companies market analysis of leading
orthopaedic companies, conducted May 2015.
1 DePuy Synthes Variable Angle Locking Hand System Surgical Technique
SYSTEM TECHNOLOGY
Variable Angle Locking Technology
Variable Angle Locking Plates 1.5 mm and 2.0 mm feature
Variable Angle Locking coaxial holes. Four columns of
threads in the Variable Angle Locking hole provide four
points for threaded locking between the Plate and the
Variable Angle Locking Screw to create a fixed-angle
construct at the desired screw angle.
• Variable Angle Locking plate 1.5 holes accept:
– Variable Angle Locking screws B 1.5 mm
– Cortex screws B 1.5 mm
– Locking screws B 1.5 mm. These screws can only
be used on-axis
• Variable Angle Locking plate 2.0 holes accept:
– Variable Angle Locking screws B 2.0 mm
– Cortex screws B 2.0 mm
– Locking screws B 2.0 mm. These screws can only be
used on-axis
• Variable Angle Locking screws can be angled anywhere
within a 30° cone
• Cortex screws B 1.5 mm and 2.0 mm can be used in
the plate positioning slots, if present, for traditional
compression and fixation
Locking Technology
• Locking plates 1.3 feature locking, coaxial holes.
Fully threaded locking holes provide threaded locking
between the plate and the locking screw to create
a fixed-angle construct
• Locking plate 1.3 holes accept:
– Locking screws B 1.3 mm
– Cortex screws B 1.3 mm
Variable Angle Locking Hand System Surgical Technique DePuy Synthes 3
Variable Angle Locking Hand System Overview

SYSTEM FEATURES
Features Benefits
Extensive range of implant options Accommodates a variety of fractures and patient sizes
Anatomically contoured plates Designed with contour to adapt to bony anatomy
Plates designed for lateral and direct dorsal Accommodates plate placement to help avoid tendon
application insertion points
Low-profile, anatomically precontoured plates Designed to reduce soft tissue irritation
Recessed screw heads Designed to sit flush with the plate surface
Variable Angle Locking Technology Offers screw placement options in a variety of fragment
patterns and around the joint
Provides fixed angle stability for metaphyseal and
osteopenic bone
Elongated plate holes Facilitate plate positioning
Modular, color-coded system Aids in clear identification of instruments for Operating
Room staff and Central Processing
Facilitates proper instrumentation usage by size
Comprehensive instrumentation Aids surgeon in all aspects of procedure: plate adaption,
provisional fixation, and bone preparation
Implants offered in both stainless steel and titanium Allows options for surgeon preference and patient need
T4 and T6 self-retaining screwdriver shafts Aid in screw handling, measuring, and delivery
Hex coupling screwdriver handle Ergonomic connection mechanism in a handle design
that disassembles for cleaning
Reduction Forceps Aids reduction and lag screw application via forceps
Plate Holding Forceps Holds plate intraoperatively
4 DePuy Synthes Variable Angle Locking Hand System Surgical Technique
AO PRINCIPLES
AO PRINCIPLES
In 1958, the AO formulated four basic principles, which
have become the guidelines for internal fixation.1, 2
ITnh 1o9s5e 8p,r tinhcei pAleOs ,f oasrm auplpaltieedd tfoo utrh eb aVsaicr ipabrilnec Aipnlegsl,e w hich
hLaovcek ibnegc Homaned t Shyes tgeumid,e alirnee:s for internal fixation1, 2.
4_Priciples_03.pdf 1 05.07.12 12:08
Anatomic reduction Stable fixation
Anatomic reduction Stable fixation
Fracture reduction and fixation to Fracture fixation providing absolute
Fracture reduction and fixation to Fracture fixation providing abso-
restore anatomical relationships. or relative stability, as required by
restore anatomical relationships. lute or relative stability, as
the patient, the injury, and the
required by the patient, the injury,
1 2 personality of the fracture.
and the personality of the
fracture.
Early, active mobilization Preservation of blood supply
Early, active mobilization 4 3 Preservation of blood supply
Early and safe mobilization and Preservation of the blood supply
Early and safe mobilization and Preservation of the blood supply
rehabilitation of the injured part to soft tissues and bone by
rehabilitation of the injured part to soft tissues and bone by gentle
and the patient as a whole. gentle reduction techniques and
and the patient as a whole. reduction techniques and
careful handling.
careful handling.
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.
12. n Mdü ellde.r SMtuEt,t Agallrgtö, wNeewr M Y,o Srkc:h Tnheiiedmere R. ,2 W00il7le.negger H. Manual of Internal
Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer; 1991.
2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management.
2nd ed. Stuttgart, New York: Thieme; 2007.
Variable Angle Locking Hand System Surgical Technique DePuy Synthes 5
4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique
INTENDED USE AND INDICATIONS
Intended Use
Variable Angle Locking Hand System Implants are
intended for temporary fixation, correction or stabi-
lization of bones in anatomical region of the hand.
Indications
The Variable Angle Locking Hand System is indicated for
the treatment of fractures, deformities and degenerative
diseases in the hand.
Precaution: When using this system to treat skeletally
immature patients, physiological status of the physes
and individual stature of the patient should be
assessed before considering treatment options as
damage to the physes may occur, leading to potential
growth arrest.
6 DePuy Synthes Variable Angle Locking Hand System Surgical Technique
FEATURED PLATES AND TECHNIQUE HIGHLIGHTS
The plates contained in this section are featured im-
plants of the DePuy Synthes Variable Angle Locking
Hand System. Refer to the product information section
for a complete list of all plate configurations offered as
part of this system.
Phalangeal Head Plate
Available sizes:
Designed with an anatomic contour and hole configuration Left Right
to facilitate lateral fixation of fractures of the middle and 1.3 mm 02.130.157 02.130.156
proximal phalangeal head. 04.130.157 04.130.156
• Elongated hole for adjustment of plate position 1.5 mm 02.130.257 02.130.256
• Ulnar or radial plate placement 04.130.257 04.130.256
• Curved plate designed to follow the natural curve of
the phalanx 02 = Stainless Steel
• Screw configuration in the head is designed to span 04 = Titanium
the attachment of the collateral ligament
• Available in Right and Left orientations
• Designed for periarticular fractures and articular
fractures of the distal phalanx Left
Right
Surgical Approach
Ulnar Radial
Right Hand
Right Plate Left Plate
Left Hand
Left Plate Right Plate
Variable Angle Locking Hand System Surgical Technique DePuy Synthes 7
Featured Plates and Technique Highlights
When implanting this plate, the following screw order
1
placement is suggested.
• Place a cortex screw in the elongated hole (1), leaving
the screw slightly loose. Screw placement is at the
midaxial line. Place plate prior to the K-wire so that the
cortex screw can be positioned at the midaxial line
• Provisionally fix the condyles. Place a K-wire in the center
of the condyle, so the wire is located between the two
distal holes (2). The K-wire should be placed in the center 2
of the axis of the joint. K-wire placement is relative to the
fan-shaped, central collateral ligament. Note that the
3
footprint of the ligament is larger than the center of the
axis. Make small adjustments to K-wire placement to
avoid intra-articular placement of screws, while still
creating a stable construct. Variations in K-wire placement
are at surgeon’s discretion, considering periarticular tissue
and fracture size. For Plates 1.3, use a K-wire B 0.6 mm.
For plates 1.5, use a K-wire B 0.8 mm
• Adjust the plate along the bone shaft, as necessary, so 4
that the K-wire abuts the plate. Tighten the cortex
screw in the elongated hole
• Place a screw in most distal hole (3)
• Place screw in most volar hole (4)
• Confirm placement and depth of screws under
radiographic imaging
• Place remaining screws in the head and plate shaft,
depending on fracture pattern
Refer to surgical technique section for general plate and
screw application techniques where this suggested
screw insertion order can be applied.
8 DePuy Synthes Variable Angle Locking Hand System Surgical Technique