Dynamic Locking Screw (DLS) System TG - …synthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North...

Dynamic Locking Screw (DLS) System.For use with locking compression plate(LCP) systems.

Technique Guide

Table of Contents

Dynamic Locking Screw System Technique Guide Synthes

Image intensifier control

Introduction

Surgical Technique

Product Information

Dynamic Locking Screw (DLS) System 2

Locking Compression Plate (LCP) 4

AO Principles 5

Indications and Contraindications 6

Preparation 7

Dynamic Locking Screw Technique 8

Implant Removal 13

Implants 14

Instruments – for 3.7 mm DLS Screws 15– for 5.0 mm DLS Screws 16

Set Lists 18

Dynamic Locking Screw (DLS) System. For use with locking compression plate (LCP) systems.

Angular stable screwLocking screws can be placed in eachthreaded hole of the appropriate LCPplate.

Screws locking tightly in the plate aredesigned to:– aid in minimizing tension on the

bone– aid in minimizing compression

between plate and bone– aid in protecting the periosteum

from potential damage and retaincirculation

Pin-sleeve design of the DLS allows micro-motion within the angular stablesystem.

StarDrive recess for improvedtorque transmission*.

2 Synthes Dynamic Locking Screw System Technique Guide

Features

Cobalt chromium molybdenumalloy (CoCrMo) enables DLS to beused with all Synthes stainless steelor titanium locking large and smallfragment plates.

Laserwelded. For stable fixationbetween pin and sleeve.

*Testing on file at Synthes.

Dynamic Locking Screw System Technique Guide Synthes 3

Principle of Dynamic Locking Screw (DLS)

New screw tip. Roundedtip with self-tapping flutedesign.

Standard lockinghead. Compatiblewith all Synthes largeand small fragment locking plates.

Pin-sleeve design.Micro-motion withinthe screw.

Fully threadedshaft. With lockingscrew profile.

DLS allows surgeons to modulate therigidity of the locking plate construct.

DLS construct can deliver nearly parallelfracture site motion.


Locking Compression Plate (LCP)

The Synthes Locking CompressionPlate:– Provides angular stable support of

fragments regardless of bone quality– Is designed to reduce risk of primary

and secondary loss of reductioneven under high dynamic loading

– Is designed to reduce impairment ofperiosteal blood supply due to limitedplate-periosteum contact

– Is designed to maintain a favorablehold in osteoporotic bone and multi-ple fragment fractures

c

d

Locking Compression Plates havecombination locking andcompression holes (Combi holes).The Combi holes allow placement ofstandard cortex and cancellous bonescrews on one side or threaded conicallocking screws on the opposite side ofeach hole.a. Threaded hole section for locking

screwsb. Dynamic compression unit (DCU)

hole section for standard screwsc. Locking screw in threaded side of

plate holed. Cortex screw in compression side

of plate hole

Note: Holes in straight and reconstruc-tion plates are oriented so that thecompression component of the hole isalways directed toward the middle ofthe plate.

a

b


AO Principles

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

Anatomic reductionFracture reduction and fixation to restore anatomicalrelationships.

Stable fixationStability by fixation or splintage, as the personality of thefracture and injury requires.

Preservation of blood supplyPreservation of the blood supply to soft tissue and boneby careful handling.

Early, active mobilizationEarly and safe mobilization of the part and the patient.

1. M.E. Muller, M. Allgöwer, R. Schneider, and H. Willenegger: Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991.


Indications and Contraindications

IndicationsSynthes Dynamic Locking Screws (DLS) in combination withSynthes Locking Compression Plates (LCP) are intended foruse in long bone fractures, the fixation of osteopenic bone,the fixation of osteotomies, and for the fixation of nonunionsand malunions.

Contraindications– Severe muscular, neural or vascular diseases that endanger

the extremities involved– Lack of bone substance or poor bone quality which makes

stable seating of the implant impossible – Acute or chronic, local or systemic infections, and allergy

to the implanted material

The Synthes Dynamic Locking Screws are not approved for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic, or lumbar spine. The adverse events that could occur are infection*, cardiovasculardisorder*, hematoma*, malunion or nonunion.

* These risks can also be associated with general risks of surgery.


Preparation

Synthes offers a wide selection of LCP plates, which cover a variety of indications. For this reason, this technique guidedoes not cover specific indications or the selection of a platetype for specific clinical situations. For these subjects, pleaserefer to “AO Principles of Fracture Management” courses offered by the AO Foundation (www.aofoundation.org), and the corresponding professional literature.

For general purposes, the following techniques for handlingthe implants and instruments will be demonstrated with astraight 3.5 mm LCP plate and 3.7 mm DLS.

Important: The 3.7 mm DLS has a 0.2 mm larger diametercompared to the standard 3.5 mm locking screw. Therefore,dedicated instruments for 3.7 mm DLS (drill bit and drillsleeve) have to be used. All other instruments are the sameas standard locking small fragment technique.

Note: The 5.0 mm DLS is inserted per standard 5.0 mm locking screw technique.

Required sets are dependent on the plates used. For smallfragment plates: 105.434 Small Fragment LCP Instrument and Implant

Set, with self-tapping screwsor

145.434 Small Fragment LCP Instrument and TitaniumImplant Set, with self-tapping screws or

01.212.005 Small Fragment LCP Instrument and ImplantSet, with 3.5 mm StarDrive Cortex Screws or

01.212.006 Small Fragment LCP Instrument and ImplantSet, with 3.5 mm Hex Drive Cortex Screws or

01.212.007 Small Fragment LCP Instrument and ImplantSet, with 4.0 mm Cannulated Screws or

01.212.008 Small Fragment LCP Instrument and TitaniumImplant Set, with 3.5 mm StarDrive CortexScrews or

01.212.009 Small Fragment LCP Instrument and TitaniumImplant Set, with 3.5 mm Hex Drive CortexScrews and

01.213.003 3.7 mm DLS Instrument Set

Note: The 3.7 mm DLS requires the use of:03.213.001 3.1 mm Drill Guide, for 3.7 mm Dynamic Locking Screw and03.213.002 3.1 mm Drill Bit, quick coupling, 165 mm length, for 3.7 mm Dynamic Locking Screw

Do not insert the 3.7 mm DLS using the 2.8 mm Drill Bitused for 3.5 mm Locking Screws.


2Contour plate

Instruments

329.04 Bending Iron, for 2.7 mm and 3.5 mmplates, 150 mm length (for use with329.05)

329.05 Bending Iron, for 2.7 mm and 3.5 mmplates, 150 mm length (for use with329.04)

329.15 Bending Pliers, for 2.7 mm and 3.5 mmplates, 230 mm length

329.29 Bending Pliers, for 2.7 mm and 3.5 mmReconstruction Plates, 246 mm length

Adapt the LCP plate to the anatomy using the appropriatebending instruments (as for standard plates).

Note: The LCP Combi holes are asymmetrical in the plate. In straight plates, the hole alignment changes in the middleof the plate. This asymmetry enables exertion of unidirectionaldynamic compression.

Dynamic Locking Screw Technique

1Reduce fracture Reduce the fracture under image intensification and, as needed,provide fixation with a Kirschner wire or reduction forceps.



3Position platePosition and fix the plate on the bone.

Important:Before setting the first dynamic locking screw, verify that theplate is provisionally fixed in place. Otherwise, the plate mayrotate during final tightening and cause damage to surround-ing soft tissue.

4Insert DLS drill sleeve

Instrument

03.213.001 3.1 mm Drill Guide, for 3.7 mm DynamicLocking Screw

Carefully thread the drill guide into the desired LCP hole untilit is secure. The drill sleeve ensures that the DLS is correctlyaligned with the locking hole in the plate. Angular stability is reduced if a locking screw is inserted obliquely.

Technique tip: If alignment is difficult, it may be useful toslightly rotate the drill sleeve counterclockwise.

Note: In precontoured plates, the threaded hole is typicallynot perpendicular to the plate surface due to the anatomy.

Important: Only use the white color-coded DLS drill guidewith the white color-coded drill bit for 3.7 mm DLS. The 5.0 mm DLS uses the same instruments as the 5.0 mm LCP.



5Predrill screw hole

Instrument

03.213.002 3.1 mm Drill Bit, quick coupling, 165 mm length, for 3.7 mm DynamicLocking Screw

Carefully drill the screw hole using an appropriate drill.Remove the drill sleeve.

Important: Only use the white color-coded DLS drill bit to ensure the correct drill hole.

6Determine screw length

Instrument

319.01 Depth Gauge

Determine screw length with the depth gauge.


7Insert Dynamic Locking Screw

Instruments

311.43 Handle, with quick coupling

314.116 StarDrive Screwdriver Shaft, T15,self-retaining, quick coupling

511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling

Prior to insertion of the first DLS, anatomical reconstructionmust have occurred. After insertion of the DLS, additional reduction can no longer occur without removing the DLS.The DLS can either be inserted with power (without finallocking) or manually.

Technique tip: To ease insertion into very hard bone, the DLScan be turned counterclockwise a few turns and reinserted.

Important:Always insert the DLS with the appropriate Torque LimitingAttachment (TLA).

Three or more dynamic locking screws must be inserted foreach segment / fragment.

Do not combine standard locking screws and/or standardcortex screws with DLS in the same segment / fragment. Thiswill nullify the dynamization and overload the standard lockingscrew; however, one fragment can be fixed with all standardlocking screws and another with all DLS.



7aScrew insertion with powerTo insert the DLS using power, attach the appropriate TLA to the power tool. Insert the screwdriver shaft into the TLA.

Pick up the DLS and insert it into the plate hole. To insert thescrew, start the power tool slowly, increasing speed and thenreducing it again before the screw is fully tightened.

Uncouple the power tool and mount the appropriate handleto manually tighten the screw. After one click, the optimumtorque is reached.

Notes:DLS should be inserted under power using the TLA. After the screw insertion using the TLA, always hand tighten to ensure the screws are fully inserted

For long screws and thick cortical bone, ensure sufficient cooling during insertion

Important:Insert the DLS with the appropriate TLA: – For 3.7 mm DLS screws, use the 1.5 Nm TLA– For 5.0 mm DLS screws, use the 4.0 Nm TLA

7bManual insertionFor manual DLS insertion, attach the handle to the TLA andinsert a screwdriver shaft.

Insert the DLS, and lock it in the plate.

Important:Insert the DLS with the appropriate TLA: – For 3.7 mm DLS screws, use the 1.5 Nm TLA– For 5.0 mm DLS screws, use the 4.0 Nm TLA


Implant Removal

To remove the plate, first remove tissue and bone from allscrew heads and drive recesses. Insert a screwdriver in thescrew recess and unlock all screws manually. Then, completelyremove all of the screws.


Implants

3.7 mm Dynamic Locking Screws, self-tapping– CoCrMo– Sterile Length Length (mm) (mm)

09.213.022S 22 09.213.044S 44

09.213.024S 24 09.213.046S 46

09.213.026S 26 09.213.048S 48

09.213.028S 28 09.213.050S 50

09.213.030S 30 09.213.052S 52

09.213.032S 32 09.213.054S 54

09.213.034S 34 09.213.056S 56

09.213.036S 36 09.213.058S 58

09.213.038S 38 09.213.060S 60

09.213.040S 40 09.213.065S 65

09.213.042S 42 09.213.070S 70

5.0 mm Dynamic Locking Screws, self-tapping– CoCrMo– Sterile Length Length (mm) (mm)

09.223.032S 32 09.223.050S 50

09.223.034S 34 09.223.055S 55

09.223.036S 36 09.223.060S 60

09.223.038S 38 09.223.065S 65

09.223.040S 40 09.223.070S 70

09.223.042S 42 09.223.075S 75

09.223.044S 44 09.223.080S 80

09.223.046S 46 09.223.085S 85

09.223.048S 48 09.223.090S 90

Warning: Do not resterilize dynamic locking screws.


Instruments for use with 3.7 mm Dynamic Locking Screws (DLS)

03.213.001 3.1 mm Drill Guide, for 3.7 mm DynamicLocking Screw

03.213.002 3.1 mm Drill Bit, quick coupling, 165 mmlength, for 3.7 mm Dynamic Locking Screw

329.04* Bending Iron, for 2.7 mm to 3.5 mm plates,150 mm length (for use with 329.05)

329.05* Bending Iron, for 2.7 mm to 3.5 mm plates,150 mm length (for use with 329.04)

314.116* StarDrive Screwdriver Shaft, T15, self-retaining, quick coupling

311.43* Handle, with quick coupling

319.01* Depth Gauge

511.773* Torque Limiting Attachment, 1.5 Nm, quick coupling

* All instruments are found in Synthes Small Fragment LCP Sets (105.434,145.434, 01.212.005, 01.212.006, 01.212.007, 01.212.008, 01.212.009)


314.119 StarDrive Screwdriver Shaft, T25self-retaining, quick coupling, 165 mm

314.118 StarDrive Screwdriver, T25, self-retaining,245 mm

Instruments for use with 5.0 mm Dynamic Locking Screws*

310.431 4.3 mm Drill Bit, quick coupling, 180 mm

312.449 4.3 mm Threaded Drill Guide

323.021 Direct Measuring Device

314.11 Holding Sleeve, 121 mm

* All instruments are found in Synthes Large Fragment LCP Sets (115.400,146.400, 115.401, 115.405, 146.405)


397.706 Handle, for AO Reaming Coupler Connection

511.774 Torque Limiting Attachment, 4 Nm, for AO Reaming Coupler

323.46 4.5 mm Universal Drill Guide


3.7 mm and 5.0 mm Dynamic Locking Screw Set (01.213.006)

Module and Case60.213.001 3.7 mm Dynamic Locking Screw

Instrument Module

60.213.002 Case for 3.7 mm and 5.0 mm DynamicLocking Screws

Instruments03.213.001 3.1 mm Drill Guide, for 3.7 mm Dynamic

Locking Screw, 2 ea.

03.213.002 3.1 mm Drill Bit, quick coupling, 165 mmlength, for 3.7 mm Dynamic LockingScrew, 2 ea.

Implants3.7 mm Dynamic Locking Screws, self-tapping, 4 ea.

Length Length (mm) (mm)

09.213.022S 22 09.213.044S 44

09.213.024S 24 09.213.046S 46

09.213.026S 26 09.213.048S 48

09.213.028S 28 09.213.050S 50

09.213.030S 30 09.213.052S 52

09.213.032S 32 09.213.054S 54

09.213.034S 34 09.213.056S 56

09.213.036S 36 09.213.058S 58

09.213.038S 38 09.213.060S 60

09.213.040S 40 09.213.065S 65

09.213.042S 42 09.213.070S 70

5.0 mm Dynamic Locking Screws, self-tapping, 4 ea.

Length Length (mm) (mm)

09.223.032S 32 09.223.050S 50

09.223.034S 34 09.223.055S 55

09.223.036S 36 09.223.060S 60

09.223.038S 38 09.223.065S 65

09.223.040S 40 09.223.070S 70

09.223.042S 42 09.223.075S 75

09.223.044S 44 09.223.080S 80

09.223.046S 46 09.223.085S 85

09.223.048S 48 09.223.090S 90

Note: For additional information, please refer to package insert.

For detailed cleaning and sterilization instructions, please refer towww.synthes.com/cleaning-sterilization In Canada, the cleaning and sterilization instructions will be provided with the Loaner shipments.


Module 60.213.001 3.7 mm Dynamic Locking Screw

Instrument Module

Instruments03.213.001 3.1 mm Drill Guide, for 3.7 mm Dynamic

Locking Screw, 2 ea.

03.213.002 3.1 mm Drill Bit, quick coupling, 165 mm length, for 3.7 mm DynamicLocking Screw, 2 ea.

Also Available60.212.006 Instrument Tray, for LCP Small Fragment

Instrument and Implant Set

3.7 mm Dynamic Locking Screw Instrument Set (01.213.003)

60.213.001

Synthes USA1302 Wrights Lane EastWest Chester, PA 19380Telephone: (610) 719-5000To order: (800) 523-0322Fax: (610) 251-9056

Synthes (Canada) Ltd.2566 Meadowpine BoulevardMississauga, Ontario L5N 6P9Telephone: (905) 567-0440To order: (800) 668-1119Fax: (905) 567-3185

© 2011 Synthes, Inc. or its affiliates. All rights reserved. Combi, LCP and Synthes are trademarks of Synthes, Inc. or its affiliates. Printed in U.S.A. 4/13 J10966-B

www.synthes.com

Dynamic Locking Screw (DLS) System TG - …synthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North...

Documents

Transcript of Dynamic Locking Screw (DLS) System TG - …synthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North...