0x6.000.578_AC 13.09.10 15:04 Seite Cvr1 Variable Angle LCP Two-Column Volar Distal Radius Plate 2.4 mm. For fragment-specific fracture fixation with variable angle locking technology. Technique Guide

0x6.000.578_AC 13.09.10 15:04 Seite Cvr2 Image intensier control Warning This description alone does not provide sufficient background for direct use of the product. Instruction by a surgeon experienced in handling this product is highly recommended. Reprocessing, Care and Maintenance of Synthes Instruments For general guidelines, function control and dismantling of multi-part instruments, please refer to: www.synthes.com/reprocessing

0x6.000.578_AC 13.09.10 15:04 Seite 1 Table of Contents Introduction 2 AO Principles 4 Indications 5 Clinical Cases 6 Three Column Theory 7 Screw Insertion Techniques Surgical Technique VA-LCP Two-Column Distal Radius Plate 2.4 mm 8 Screw Angle Overview Approach 12 Implantation 14 Postoperative Treatment/Implant Removal 28 Tips 29 Screws 30 Plates 31 Optional: Trial Implants 32 Instruments 33 Synthes Biomaterials Overview Product Information 10 37 Bibliography 38 Synthes 1

0x6.000.578_AC 13.09.10 15:04 Seite 2 Variable Angle LCP Two-Column Volar Distal Radius Plate 2.4 mm. For fragment-specific fracture fixation with variable angle locking technology. Features and Benefits Anatomic fit close to the volar ridge with highly polished smooth edges for minimized soft tissue irritation Two columns for increased stability with excellent fine-contouring properties Dedicated screws for fixation of radial styloid (blue) and support of lunate facet and DRUJ (green) 2 Synthes VA-LCP Two-Column Volar Distal Radius Plate 2.4 mm Oblongue hole for plate positioning and radius...

0x6.000.578_AC 13.09.10 15:04 Seite 3 Variable angle Screw holes allow up to 15° off-axis screw angulation in all directions 15° 15° Unique drill sleeves Allowing to use both +/–15° angulation and pre-defined screw angles Easy x-ray control in pre-defined angle mode and 20° inclined lateral view Synthes 3

0x6.000.578_AC 13.09.10 15:04 Seite 4 AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1, 2 The principles as applied to the Variable Angle LCP Two-Column Volar Distal Radius Plates 2.4 mm are: Anatomic reduction The use of variable angle locking technology allows fragmentspecific fixation by providing the flexibility to lock screws in trajectories that can diverge from the central axis of the plate hole. Variable screw angles provide fixation options for a variety of fracture patterns. Stable fixation Variable angle locking...

0x6.000.578_AC 13.09.10 15:04 Seite 5 Indications Variable Angle LCP Two-Column Volar Distal Radius Plates 2.4 mm are indicated for the fixation of intra- and extra-articular fractures and osteotomies of the distal radius. Synthes 5

0x6.000.578_AC 13.09.10 15:04 Seite 6 Clinical Cases Case 1 24-year-old male with AO 23C2.1 fracture, fall from scaffold Preoperative, AP view Preoperative, lateral view Postoperative, AP view Postoperative, lateral view Postoperative, AP view Postoperative, lateral view, 20° inclined Case 2 77-year-old female with AO 23C1 fracture, fall Preoperative, AP view 6 Synthes Preoperative, lateral view VA-LCP Two-Column Volar Distal Radius Plate 2.4 mm Technique Guide

0x6.000.578_AC 13.09.10 15:04 Seite 7 Three Column Theory The treatment of distal radius fractures requires a meticulous reconstruction of the joint surface, as well as stable internal fixation and early functional post-operative treatment. Extra-articular fractures require both the restoration of the volar tilt and radial length to reduce the possibility of displacement. Any malalignment may result in limitations of movement, changes of load distribution, mid-carpal instability as well as the increased risk of osteoarthritis in the radiocarpal joint. Intra-articular fractures with articular...

0x6.000.578_AC 13.09.10 15:04 Seite 8 Screw Insertion Techniques Screws can be inserted using two different techniques: – Variable angle technique (see below) – Pre-defined nominal angle technique (refer to page 9) Use fixed-angle end for nominal angle drilling Use funnel-shaped end for off-axis drilling VA-LCP Drill Sleeve (03.110.000) 15° 15° Variable angle technique To drill variable angle holes at a +/- 15° deviation from the nominal trajectory of the locking hole, insert the tip of the VA-LCP Drill Sleeve (03.110.000) and key into the cloverleaf design of the VA-LCP hole. Use of funnel-shaped...

0x6.000.578_AC 13.09.10 15:04 Seite 9 Pre-defined nominal angle technique A) Use of fixed-angle end of VA-LCP Drill Sleeve The fixed-angle end of the drill sleeve only allows the drill bit to follow the nominal trajectory of the locking hole, which is equivalent to using guiding blocks (see below). Use of fixed-angle end of VA-LCP Drill Sleeve B) Use of Guiding Blocks Fixation at the nominal trajectories of the locking holes in the head of the plate (refer to reference charts on pages 10 and 11) may be facilitated by a Guiding Block attached to the plate prior to plate fixation. The Guiding Blocks...

0x6.000.578_AC 13.09.10 15:04 Seite 10 Screw Angle Overview VA-LCP Two-Column Volar Distal Radius Plates provide various locking screw options in the head of the plate to optimally support the articular surface: – Radial screws for the radial column – Ulnar screws for the intermediate column When planning the placement of screws, particularly if using the nominal angle of the trajectories (e.g., with the aid of the guiding block), refer to the screw angle overview below. Basis for the angles given is the plate shaft with screw angulation 0°. VA-LCP Two-Column Distal Radius Plates with 6 head...

0x6.000.578_AC 13.09.10 15:04 Seite 11 VA-LCP Two-Column Distal Radius Plates with 6 head holes: distal 27° radial 5° distal ulnar 21° 1° adistal 33° radial 15° distal ulnar 14° 6° distal 30° radial 9° distal ulnar 23° 1° Reference point: 0° VA-LCP Two-Column Distal Radius Plates 2.4 mm with 7 head holes: distal 25° radial 0° distal 30° radial 6° distal ulnar 19° 4° distal 33° radial 15° distal ulnar 16° 4° distal 30° radial 10° distal ulnar 23° 1° Reference point: 0° Synthes 11