Locking Trochanter Stabilizing Plate for DHS . Supplement to DHS/DCS Surgical Technique. ®
Surgical Technique– Anatomisches Design
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Contents
Introduction
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Indications
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Features and benefits
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Description ............................................................................................ 6 Advantages of angular stability .............................................................. 6 Improvement to the conventional TSP .................................................... 6 Additional features ................................................................................ 6
Surgical technique
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Adjusting the plate ................................................................................ 7 Placing the antirotation screw ................................................................ 9 Fixing the locking head screws ............................................................ 10 Advantages of angular stability .............................................................11 Wound closure .....................................................................................11 Implant removal ................................................................................... 12 Special surgical considerations ............................................................. 12
Implants/Case
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Instruments
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Warning This description is not sufficient for immediate application of the instrumentation. Instruction by a surgeon experienced in handling this instrumentation is highly recommended.
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Introduction
In unstable trochanteric fractures, varus deformation of the proximal fragment, with „cut out“ of the screw and medialisation of the distal femoral fragment, are possible complications after treatment with the dynamic hip screw. Placing a trochanter stabilizing plate reduces these complications and enhances the clinical result.
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The Locking Trochanter Stabilizing Plate for DHS (no. 281.871) has been ® designed as an extension to the DHS plate and serves the following functions:
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1
It limits diaphyseal medialisation by fastening onto the greater trochanter.
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It enables the insertion of an additional cranial and parallel antirotation screw, which acts as a superolateral tension band. When used, the atirotation screw imposes a slightly more caudal ® positioning of the DHS screw compared to the standard technique.
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It allows for an additional proximal internal fixation of the greater trochanter with locking head screws.
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It maintains the dynamization capacity of the DHS .
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Indications
Unstable A2 and A3 fractures, especially multifragmentary ones with a separated greater trochanter. Excessive secondary fracture impact and medialization of the femoral ® shaft can be avoided by combining the DHS with the locking trochanter stabilizing plate. Fixation of the greater trochanter with locking head screws reduces varus angulation and limb shortening. Stabilizing the greater trochanter can reduce internal bleeding and restores the function of the gluteus medius. This results in less postoperative pain and a faster mobilization of the patient.
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Features and benefits
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Description
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A B C D
C
E
Threaded holes for the insertion of 3.5 mm locking head screws Arms that can be cut easily with the Calcaneal Plate Cutter (329.151) A hole for the antirotation screw (6.5 mm cannulated or cancellous bone screw) ® Two screw holes to fix the plate through the DHS plate to the femur The second proximal hole acts as a „window“ and has a larger diameter than the 4.5 mm cortex screw head allowing for ® previous fixation of the DHS plate to the femur
Advantages of angular stability
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Locked angle-stable screws can be fixed monocortically, even in „soft“ bone without any risk of screw loosening. Due to the high stability of the screws in the plate, the greater trochanter can be secured as a functional entity without using cerclage wires. Fix the plate over or through the gluteus medius muscle without compressing the bone. As an internal fixator, the plate preserves bone vascularity.
E Improvement to the conventional TSP F
The new version of the trochanter stabilizing plate has the same functions as the conventional TSP (nos. 281.869, 281.870): – –
It limits diaphyseal medialization by fastening onto the greater trochanter In addition to the possibility of using locking head screws, it provides the advantages of angular stability and allows a simple screw fixation of the trochanter
Additional features – – –
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Instead of a cerclage, use locking head screws to achieve an additional proximal internal fixation (cerclage is still possible) Only one size is required (plate can be cut) It is easy to bend the plate and adapt it to the individual anatomical conditions
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Surgical Technique
Adjusting the plate When fixing the DHS® plate with cortex screws, do not occupy the first and the third proximal hole so that the Locking Trochanter Stabilizing Plate can be secured through these two holes. The guide wire remains in the DHS® screw during the entire procedure. Before fixing the Locking Trochanter Stabilizing Plate over the DHS® plate, use the appropriate instruments to cut and bend the plate to adapt it to the specific anatomical configurations. Temporarily position the bending template over the greater trochanter to verify both length and contour of the plate.
Important note Keep the first and the third stem hole ® of the DHS unoccupied for the Locking Trochanter Stabilizing Plate.
Cutting: to avoid sharp edges, use the Calcaneal Plate Cutter (329.151). Place the plate into the jaws of the cutter as shown.
Bending: the area around the hole for the antirotation screw is bent best with bending irons. Use the Bending Template (329.513) to preshape the Locking TSP.
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Insert self-tapping 4.5 mm cortex screws through the two remaining ® open holes of the DHS plate to fix the Locking Trochanter Stabilizing ® Plate over the DHS .
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Placing the antirotation screw ®
Use the DHS Parallel Drill Guide (338.750) and the required drill sleeves to place the antirotation screw cranially and parallel to the DHS® screw.
6.5 mm Cancellous Bone Screw Drill Bit
Drill Sleeves
Guide Wire
3.2 mm Drill Bit (310.310)
Drill Sleeve 4.5/3.2 (338.730) Drill Sleeve 6.0/4.5 (338.740) DHS® Parallel Drill Guide (338.750)
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6.5 mm Cannulated Screw Drill Bit
Drill Sleeves
Guide Wire
Cannulated 5.0 mm Drill Bit (310.630)
2.8 mm Parallel Wire Guide (312.010) or Drill Sleeve 4.5/2.8 (338.731) Drill Sleeve 6.0/4.5 (338.740) DHS® Parallel Drill Guide (338.750)
Threaded 2.8 mm Guide Wire with spade point (292.680)
Note Alternate between tightening the antirotation screw and – if used – the ® DHS/ DCS Compression Screw (280.990) to ensure an even compression of the fracture.
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Minimize any interference between the plate and the gluteus medius. If the Locking Trochanter Stabilizing Plate crosses the insertion point of the gluteus medius, pull apart the muscle fibres with a scalpel to obtain an optimal contact between the plate and the trochanter. This prevents a possible conflict between the muscle and the plate. Fine bending may be achieved in situ with the threaded Plate Holder (324.023) or with the threaded LCP Drill Guide (323.027). Apply small incremental force to achieve the required bending. Warning Be careful to avoid overbending, as the benders may become dislodged from the plate hole and damage the threaded holes.
Note Highly comminuted trochanteric fractures should be fixed as functional entity rather than attempting a reduction of every single fragment. The objective of the cranial and oblique locking head screws of the trochanter stabilizing plate is twofold: to counteract the tension forces of the gluteus medius and to gather and impact the various fragments of the trochanteric fracture into one another.
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Fixing the locking head screws To fix the trochanter fragments with 3.5 mm locking screws, thread the threaded LCP Drill Guide (323.027) into the threaded plate hole until seated. To ensure that the locking head screw seats fully in the threaded hole, the threaded drill guide must be used to guarantee the proper drilling angle. Use the 2.8 mm Drill Bit (310.284) through the threaded drill guide to drill through the cortex. As the screws are used monocortically, a screw length between 20 and 25 mm is sufficient.
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Advantages of angular stability – – – –
Avoids screw loosening Improved purchase in osteoporotic bone Monocortical screw insertion is possible As an internal fixator, the plate preserves bone vascularisation
Note The locking head screws should not be too long to avoid any impaired dynamisation of the lag screw
Wound closure Close the vastus lateralis muscle by suturing the two proximal flaps around the „neck“ of the Locking Trochanter Stabilizing Plate, and along its longitudinal incision. Then perform a simple closure of the tensor fasciae latae muscle over a suction drain. Suture the subcutaneous fat and the skin over the suction drain.
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Implant removal Remove the implants in the following sequence: – All fixation elements (screws, wire, cable, suture) attached to the LTSP – Antirotation screw (if used) – Locking Trochanter Stabilizing Plate – Compression screw DHS® plate – DHS® screw –
Special surgical considerations Note that particularly in young patients with a tight tensor fasciae latae muscle, the protrusion of both the Locking Trochanter Stabilizing Plate and the proximal fixation system sometimes requires an early removal of the implants as soon as consolidation has occurred. ®
The DHS plate combined with the Locking Trochanter Stabilizing Plate offers the possibility of covering a wide range of fractures of the upper femur, especially in osteoporotic bone.
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Implants
3.5 mm Locking Head Screw, ST, length 24 mm St. steel 213.024 212.108
TAN 413.024 412.108
Sterile X13.024 S X12.108 S
3.5 mm Locking Head Screw, ST, length 20 mm St. steel 213.020 212.106
TAN 413.020 412.106
Sterile X13.020 S X12.106 S
3.5 mm Locking Head Screw, ST, length 16 mm St. steel 213.016 212.104
TAN 413.016 412.104
Sterile X13.016 S X12.104 S
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Locking Trochanter Stabilizing Plate for DHS , adjustable St. steel 281.871
TAN 481.871
Sterile X81.871 S
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Case
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Locking Trochanter Stabilizing Plate for DHS Instrument and Implant Set (01.102.802)
68.102.000 VARIO Case for Locking Trochanter Stabilizing Plate ® for DHS 213.016 3.5 mm Locking Head Screw, self-tapping, length 16 mm, stainless steel, 6 units 213.020 3.5mm Locking Head Screw, self-tapping, length 20 mm, stainless steel, 12 units 213.024 3.5mm Locking Head Screw, self-tapping, length 24 mm, stainless steel, 12 units ® 281.871 Locking Trochanter Stabilizing Plate for DHS , stainless steel, 2 units 310.284 Drill Bit, 2.8 mm dia., length 165 mm 314.070 Screwdriver hexagonal, small, length 200 mm 323.027 LCP Drill Guide for 2.8 mm Drill Bit 329.050 Bending Iron for Plates 2.7 and 3.5, 2 units 329.513 Bending Template for Locking Trochanter Stabilizing Plate
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Locking Trochanter Stabilizing Plate for DHS Instrument and Implant Set Stardrive (01.102.812) 68.102.000 VARIO Case for Locking Trochanter ® Stabilizing Plate for DHS ® 212.104 LCP Locking Screw Stardrive Ø3.5 mm, self tapping, length 16 mm, stainless steel ® 212.106 LCP Locking Screw Stardrive Ø3.5 mm, self tapping, length 20 mm, stainless steel ® 212.108 LCP Locking Screw Stardrive Ø3.5 mm, self tapping, length 24 mm, stainless steel ® 281.871 Locking Trochanter Stabilizing Plate for DHS , stainless steel, 2 units 310.284 Drill Bit, 2.8 mm dia., length 165 mm ® 314.041 Screwdriver Stardrive 3.5, T15, small, length 200 mm 323.027 LCP Drill Guide for 2.8 mm Drill Bit 329.050 Bending Iron for Plates 2.7 and 3.5, 2 units 329.513 Bending Template for Locking Trochanter Stabilizing Plate
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Locking Trochanter Stabilizing Plate for DHS Supplement to DHS/DCS Surgical Technique ®
Instruments
Bending Template for Locking Trochanter Stabilizing Plate (329.513)
LCP Drill Guide for 2.8 mm Drill Bit (323.027)
Drill Bit, 2.8 mm dia., length 165 mm (310.284)
Screwdriver hexagonal, small, length 200 mm (314.070) ®
Screwdriver Stardrive 3.5, T15, small, length 200 mm (314.041)
Bending Iron for Plates 2.7 and 3.5, 2 units (329.050)
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Presented by:
036.000.092 SM_707480 AB © Synthes 2006 Printed in Switzerland LAG Subject to modifications.
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