DLS – Dynamic Locking Screw

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Index. Dynamic Locking Screw. – Introduction. – Key Indications. – X-ray Case Example. – Product Details. – Features & Benefits. – Surgical Technique.

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Introduction. Locked Plating and the New Synthes Solution.

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Locked Plating. Synthes LCP. LCP - Locking Compression Plate Angular stable / locked plating technique – Rigid angular stable plate-screw construct, especially beneficial in osteopenic bone – The locking construct enables pre-contoured plates to be fully effective – Minimally invasive technique (MIPO) is easy to perform – Reduced impairment of periosteal blood supply due to limited plate-periosteum contact

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Locked Plating. Synthes LCP. LCP - Locking Compression Plate – The stable plate-screw connection reduces the risk of primary and secondary loss of reduction even under high load – The screws are locked in the plate, and the physiological load is transferred from the bone to the plate – Stable bridging / plating construct

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Locked Plating. Synthes LCP. LCP - Locking Compression Plate – The stable plate-screw connection reduces the risk of primary and secondary loss of reduction even under high load – The screws are locked in the plate, and the physiological load is transferred from the bone to the plate – Stable plating construct  too rigid  too stiff …for bridging technique???

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Locked Plating. Clinical Problem. Delayed Union

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3 months

6 months 7

Locked Plating. Clinical Problem. Delayed Union

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3 months

8 months 8

Locked Plating. Clinical Problem. Almost anatomical reduction, but slight distraction gap Rigid construct maintains gap

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Locked Plating. Clinical Problem. -

Bridge Plating: Anatomic reduction in the zone of comminution is challenging, and not required for comminuted fractures

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Stiff plating constructs limit fracture motion

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Non-union rates in distal femur fractures have been reported up to 19%1: -

Imperfect reduction

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Lack of compression

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Stiff constructs (plate-side)

Henderson CE, Kuhl L, Fitzpatrick DC, et al. Locking Plates for Distal Femur Fractures: Is There a Problem With Fracture Healing? J Orthop Trauma. 2011; 25 (Suppl 2): S8—S14

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Locked Plating. Clinical Need. – Less rigid solution for the angular stable plate system (LCP). – System which allows axial micro-motion, and increases plate-side motion – Reduction of the axial stiffness, without reducing the bending strength of the plate. – No changes in the plate-screw interface and bone-screw interface  surgical technique remains the same, and is compatible with existing small and large fragment systems.

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Locked Plating. Clinical Need. The following publications support this clinical need and demonstrate attempts to clinically solve this problem: – Gardner MJ et al. Stiffness Modulation of Locking Plate Constructs Using Near Cortical Slotted Holes: A Preliminary Study. J Ortho Trauma. 2009; 23: 281– 287. – Bottlang M et al. Far Cortical Locking Can Reduce Stiffness of Locked Plating Constructs While Retaining Construct Strength. J Bone Joint Surg Am. 2009; 91: 1985-94.

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Locked Plating. Current Solutions. Current clinical solutions to modulate stiffness

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Synthes Solution. DLS. The Dynamic Locking Screw - DLS  Modulates the rigidity of existing locking screw-plate systems –The micro-motion between implant construct, without compromising the screw-bone interface  The motion is within the screw  No compromise to the screwbone interface

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Synthes Solution. DLS. – Pin-sleeve design allows for micro-motion within the screw to modulate axial stiffness of locking screw-plate systems. – Screw-bone interface as well as screw-plate interface remains unchanged.

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Indications and Contraindications. DLS.

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DLS. Indications. The Synthes Dynamic Locking Screws (DLS) in combination with Synthes Locking Compression Plates (LCP) are intended for use in long bone fractures, the fixation of osteopenic bone, the fixation of osteotomies, and for the fixation of nonunions and malunions.

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DLS. 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*, cardiovascular disorder*, hematoma*, malunion or nonunion.

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

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DLS. Indications. The Key Application of DLS is bridge plating of lower extremity fractures -Diaphyseal and distal femur fractures -Proximal, diaphyseal and distal tibia fractures

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DLS. Indications. It is important to emphasize that each time a plate is used the surgeon determines how the plate will function. Plates can used in five different ways: – compression

 Compression plate

– protection

 Protection plate

– buttress

 Buttress/anti-glide plate

– tension band

 Tension band plate

– bridging

 Bridge plating

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DLS. Indications. It is important to emphasize that each time a plate is used the surgeon determines how the plate will function. Plates can used in five different ways: – compression

 Compression plate

– protection

 Protection plate

– buttress

 Buttress/anti-glide plate

– tension band

 Tension band plate

– bridging

 Bridge plating

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 Focus

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DLS. Indications. Bridge plating In order to respect the biology of a fracture and to minimize any additional soft-tissue injury, the bridge plating principle may be applied. Bridge plates provide relative stability and fracture healing occurs with callus formation. The key concept of bridge plating is that the plate is fixed only to the two main fragment leaving the fracture zone untouched to maximize the blood supply.

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DLS. Indications. Bridge plating To maximize implant stability in this flexible fixation, long plates with few screws should be used to increase the lever arm and distribute the bending forces.

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Today’s issue with bridge plating…

…motion only in the far cortex stimulates fracture healing only on the far cortex

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Bridge plating. How can we improve? The goal is to stimulate fracture healing in a simple fracture, treated with bridge plating osteosynthesis by: - controlled micro-motion over the entire fracture area - Increasing relative motion between the plate and bone

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Bridge plating. How can we improve? Induce relative motion between screw head and screw shaft - enabling micro-motion at the entire fracture area

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DLS. The basic concept.

CrCoMo Pin is laser welded to CrCoMo sleeve

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DLS. The basic concept.

Working Principle: Locking Screw versus DLS

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DLS. X-ray Case Example.

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3.7 mm DLS. Case # 1 – simple fracture. preop

2 months

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6 months

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3.7 mm DLS. Case # 2 – simple fracture. preop

3 months

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6 months

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3.7 mm DLS. Case # 3 – simple fracture. preop

postop

3 months

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6 months

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3.7 mm DLS. Case # 4 – simple fracture. preop

postop

1 month

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6 months

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3.7 mm DLS. Case # 5 – complex fracture. preop

3 months

6 months

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12 months

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DLS. Product details.

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3.7 mm DLS. Product Description. 3.7 mm Dynamic Locking Screw – 09.213.022S – 09.213.070S  only available in sterile, do not resterilize! – Material:

Cobalt-chromium-molybdenum alloy (CoCrMo)

– Length:

22 – 70 mm

– Recess:

Stardrive T15

– Thread diameter:

Ø 3.7 mm

– Core diameter:

Ø 3.1 mm

– Max. deflection:

0.2 mm

– TLA:

1.5 Nm

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3.7 mm DLS. Product Description. Additional instruments for 3.7 DLS: – 3.1mm Drill Guide for 3.7mm Dynamic Locking Screw (03.213.001)

– 3.1mm Drill Bit, Quick Coupling, 165mm for 3.7mm Dynamic Locking Screw (03.213.002)

 Diameter 3.1mm color coded white.

60.213.001: 3.7mm Dynamic Locking Screw Instrument Module 60.212.006: Instrument Tray for LCP Small Fragment

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5.0 mm DLS. Product Description. 5.0 mm Dynamic Locking Screw – 09.223.032S – 09.223.090S  only available in sterile, do not resterilize! – Material:

Cobalt-chromium-molybdenum alloy (CoCrMo)

– Length:

32 - 90 mm

– Recess:

Stardrive T25

– Thread diameter:

Ø 5.0 mm

– Core diameter:

Ø 4.4 mm

– Max. deflection:

0.35 mm

– TLA:

4.0 Nm

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DLS. New Packaging Solutions. New sterile packaging for 3.7 mm & 5.0 mm DLS Since DLS is only available in sterile, an optimized sterile package concept was developed: - Reduced size (about 1/3 vs. previous solutions) - Less waste

Previous

- Easier opening - Full product visibility

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DLS. Case Configurations. – 60.213.001

3.7mm Dynamic Locking Screw Instrument Module

Module fits in bottom of LCP Small Fragment Graphic Case

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DLS. Case Configurations. – 60.212.006

Instrument Tray for LCP Small Fragment Instrument and Implant Set

Spot for 3.7mm DLS instruments: -03.213.001 3.1mm Drill Guide for 3.7mm DLS, -03.213.002 3.1mm Drill Bit, Quick Coupling, 165mm for 3.7mm DLS In-Service / Dec 2011 / DJ7351-A / For Sales Consultant Use Only-Do not Distribute

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DLS. Case Configurations. – 60.213.002

Carrying Case for 3.7mm and 5.0mm Dynamic Locking Screws

 4 screws per screw length

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DLS. Features & Benefits.

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DLS Features & Benefits. Main Focus. Features

Benefits

DLS – Motion occurs within the screw

• Fully engaged shaft threads • Standard locking screw head & shaft threads: - No changes in the plate-screwinterface - No changes in the bone-screwinterface

DLS – CoCrMo screw is compatible with stainless steel and titanium plates

• One screw type upgrades the complete LCP system • Screw removal is similar to Stainless Steel • Eliminates duplicate inventory

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DLS. Features & Benefits. Features

Benefits

1. Standard locking head with Stardrive recess

3a. Compatible with all Synthes’ locking plates 3b. Improved torque transmission

2. Blunt screw tip

4a. Minimizes soft tissue irritations

3. Only available in sterile, with optimized packaging solution

5a. Reduces screw portfolio and therefore storage area & costs 5b. No loss of time: Resterilization for next surgery not needed

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DLS Surgical Technique. Tips & Tricks.

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DLS. Surgical Technique. Technique Guide J10966-A Since the DLS is compatible with LCP, the surgical technique does not differ to the standard LCP technique. But there are some important things to know.  Tip & Tricks

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DLS. Tips and Tricks. Insertion of Dynamic Locking Screws Important – 3 or more dynamic locking screws must be inserted for each segment or fragment. – Do not combine standard locking screws and/or standard screws with DLS in the same segment or fragment. This will nullify the dynamization and overload the standard locking screw; however, one fragment can be fixed with a standard locking screw and another with DLS.

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DLS. Tips and Tricks. Surgical Technique - Dynamic Locking Screw Instrumentation: 3.7mm DLS: – 3.1mm drill bit and sleeve (white) must be used. – Due to larger thread diameter

5.0mm DLS: – Use instruments from LCP Large Fragment

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DLS. Tips and Tricks. Insertion with power tool Notes – To reduce the risk of stripping the screw head, do not lock dynamic locking screws at full speed. – For long screws and thick cortical bone, ensure sufficient cooling during insertion. Important: – Always insert the dynamic locking screw with the dedicated torque limiter: 3.7 mm DLS → TLA 1.5 Nm 5.0 mm DLS → TLA 4.0 Nm

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DLS. Tips and Tricks. Manual insertion Important – Always insert and lock the dynamic locking screw with the dedicated torque limiter: 3.7 mm DLS → TLA 1.5 Nm 5.0 mm DLS → TLA 4.0 Nm – The dynamic locking screw is only available with Stardrive recess. Use the appropriate Stardrive screwdriver.

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DLS. Tips and Tricks. Note: Under image intensification you can see the pin-sleeve design of the DLS

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Thank you!

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