DHS/DCS Dynamic Hip and Condylar
Screw System. Designed to provide
stable internal fixation.
Technique Guide
Table of Contents
Introduction
Surgical Technique
Special Techniques
Product Information
Dynamic Hip Screw (DHS)
2
Dynamic Condylar Screw (DCS)
3
Indications
4
DHS
5
DCS
14
Using the DHS / DCS One-Step Insertion Wrench
23
Using the DCS for Subtrochanteric Fractures
28
Assembling the Instrumentation
37
Reinserting the 2.5 mm Threaded Guide Wire
41
Implant Removal
42
Implants
43
Instruments
46
Set Lists
53
Image intensifier control
Synthes
Dynamic Hip Screw (DHS)
The Dynamic Hip Screw is designed to provide strong and
stable internal fixation of a variety of intertrochanteric,
subtrochanteric and basilar neck fractures, with minimal
soft tissue irritation.
Strong
The DHS plates are made of 316L stainless steel and are
cold-worked for strength.
Stable
The number of screw holes per plate length is maximized,
without compromising plate strength. This allows an increased
number of fixation points with a smaller incision.
DCP (dynamic compression plate) holes in the DHS side plate:
– Allow angulation of 4.5 mm cortex screws, for lag screw
fixation of medial fragments, and
– Allow axial compression and multiple-screw fixation
of the main fragment in subtrochanteric fractures with
shaft extension
Two flats within the DHS plate barrel correspond to the
two-flat design of the DHS/DCS lag screw, preventing rotation
of the lag screw within the barrel. The two-flat design also
eases insertion of the plate over the DHS / DCS lag screw.
Minimal soft tissue irritation
The DHS plates have a low-profile design, reducing the risk
of trochanteric bursitis.
The DHS plates are available in a wide range of sizes and
barrel angles, with standard or short barrels, for varied
clinical situations.
The DHS / DCS lag screw, available from 50 mm to 145 mm
lengths, easily glides within the DHS plate barrel for controlled
collapse and impaction of fragments. When the fracture
requires additional intraoperative compression, the DHS / DCS
compression screw can be used; only one size compression
screw is needed.
The DHS instruments provide direct measurements throughout
the DHS procedure, allowing proper reaming, tapping and
lag screw insertion depth. The built-in stop and locking nut
on the DHS triple reamer prevent over-reaming.
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Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
Dynamic Condylar Screw (DCS)
The Dynamic Condylar Screw is designed to provide strong
and stable internal fixation of certain distal femoral and
subtrochanteric fractures, with minimal soft tissue irritation.
Strong
The DCS plates are made of 316L stainless steel and are
cold-worked for strength.
Stable
The two holes closest to the barrel accept 6.5 mm cancellous
bone screws. This enhances stability by allowing additional
fixation of the most distal condylar fracture fragments or
fixation of the most proximal subtrochanteric fracture fragments.
DCP holes in the DCS side plate allow angulation of 4.5 mm
cortex screws and axial compression across a shaft fracture.
The number of screw holes per plate length is maximized,
without compromising plate strength. This allows an increased
number of fixation points with a smaller incision.
Two flats within the DCS plate barrel correspond to the
two-flat design of the lag screw, preventing rotation of the
DHS / DCS lag screw within the barrel. The two-flat design
also eases insertion of the plate over the DHS / DCS lag screw.
Minimal soft tissue irritation
The low-profile design reduces the risk of iliotibial band
irritation (distal femoral fractures) and trochanteric bursitis
(subtrochanteric fractures).
The DCS plates are available with 6 to 16 holes, for varied
clinical situations. The DHS / DCS lag screw is available in
50 mm to 145 mm lengths. The DHS / DCS compression
screw can be used for additional compression; only one
size compression screw is needed.
The DCS instruments also provide direct measurements
throughout the DCS procedure, allowing proper reaming,
tapping, and lag screw insertion depth. The built-in stop and
locking nut on the DCS triple reamer prevent over-reaming.
Synthes
3
Indications
DHS
The DHS is indicated for the following fractures
of the proximal femur:
– Intertrochanteric fractures
– Subtrochanteric fractures*
– Basilar neck fractures
The DHS is indicated for stable fractures, and unstable fractures
in which a stable medial buttress can be reconstructed. The
DHS provides controlled collapse and compression of fracture
fragments. This results in stable fixation and prevents undue
stress concentration on the implant.
* For certain subtrochanteric fractures, a 95° device is the
implant of choice (See “Using the DCS for Subtrochanteric
Fractures,” page 28).
DCS
The DCS is indicated for the following fractures of the
distal femur:
– Intercondylar fractures**
– Supracondylar fractures**
– Unicondylar fractures**
** The following anatomic conditions should exist:
– 4 cm of distal femur should remain intact to provide support
for the implant.
– A distal portion of the medial condyle should be intact for
the DHS/DCS lag screw to gain good purchase.
If these conditions do not exist, a Synthes 4.5 mm LCP
condylar plate or LCP distal femur plate should be considered.
The DCS is indicated for the following fractures of the
proximal femur:
– Transverse subtrochanteric fractures†
– Short oblique subtrochanteric fractures†
– Long oblique subtrochanteric fractures†
†
With the lesser trochanter avulsed or on the distal
fragment (femoral shaft).1
1. Roy Sanders and P. Regazzoni. “Treatment of Subtrochanteric Femur Fractures
Using the Dynamic Condylar Screw.” Journal of Orthopaedic Trauma, vol. 3,
no. 3. New York: Raven Press, 1989. 206-213.
4
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
Surgical Technique — DHS
Plate selection
Barrel length
The standard 38 mm barrel length is most commonly indicated.
The 25 mm short barrel is indicated for specific clinical
situations, including:
– Cases in which the standard barrel may not provide sufficient
glide for the lag screw; i.e., a long impaction distance
is expected
– A medial displacement osteotomy
– Unusually small femurs
Barrel angle
An evaluation of the angle subtended between the femoral
neck and shaft axes (CCD, or collum-center-diaphysis, angle)
of the uninjured femur will aid in the selection of the most
appropriate barrel angle. The 135° barrel angle is most
commonly indicated.
Note: Greater barrel angles may produce biomechanical
advantages in unstable cases; i.e., better gliding characteristics
and reduced bending stresses on the plate / barrel junction,
although correct placement of the implant becomes technically
more difficult as barrel angles increase.2
38 mm barrel
25 mm barrel
2. P. Regazzoni, Th. Rüedi, R. Winquist, and M. Allgöwer. The Dynamic Hip Screw
Implant System. Berlin: Springer-Verlag, 1985. 5.
Synthes
5
Surgical Technique — DHS continued
1
Reduce fracture
Instruments
338.01–
338.04
DHS Angle Guides
900.723
2.5 mm Threaded Guide Wire
Reduce the fracture. Determine anteversion by placing a
2.5 mm threaded guide wire anteriorly along the femoral
neck, using the appropriate DHS angle guide. Gently hammer
the wire into the femoral head. This anteversion wire will later
allow correct placement of the central guide wire in the
center of the femoral head.
6
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
2
Insert guide wire
Instruments
310.19
2.0 mm Drill Bit
338.01–
338.04
DHS Angle Guides
900.723
2.5 mm Threaded Guide Wire
Align the appropriate DHS angle guide along the axis of
the femoral shaft, and place it on the femur. Point the guide
tube toward the center of the femoral head. Predrilling of
the lateral cortex with the 2.0 mm drill bit is recommended
in dense bone. Insert a 2.5 mm threaded guide wire through
the appropriate DHS angle guide, parallel to the anteversion
wire and directed toward the center of the femoral head.
This point of introduction varies with barrel angle. When a
135° barrel angle is used, the guide wire enters the proximal
femur approximately 2.5 cm distal to the vastus ridge.
Notes:
Because it is designed for use with the DHS / DCS instruments
and implants, the 2.5 mm threaded guide wire, and not an
alternative wire, must be used.
This guide wire remains in place throughout the procedure.
If it is inadvertently withdrawn, reinsert it immediately (see
“Reinserting the 2.5 mm Threaded Guide Wire,” page 41).
Synthes
7
Surgical Technique — DHS continued
3
Confirm placement
Confirm placement of the 2.5 mm threaded guide wire
under image intensification. It must lie along the axis of the
femoral neck in both the AP and lateral views, and parallel
to the anteversion wire. If its position is incorrect, insert a
new guide wire. Remove and discard the anteversion wire.
4
Determine insertion depth
Instrument
338.05
DHS / DCS Direct Measuring Device
Slide the direct measuring device over the guide wire to
determine guide wire insertion depth. Calibration on the
measuring device provides a direct reading.
8
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
5
a.
Calculate reaming depth and lag screw length
To calculate reaming depth, tapping depth and lag screw
length, subtract 10 mm from the reading. For example:
a.
Direct reading
105 mm
b.
Reamer setting
95 mm
c.
Tapping depth (optional)
Lag screw length
95 mm
95 mm
b.
c.
6
Ream to predetermined depth
Instruments
338.13
or
338.43*
DHS Triple Reamer
DHS Triple Reamer (for short barrel plates)
532.010*
Small Battery Drive
532.015*
Large Quick Coupling
532.032*
Battery Casing
532.033*
14.4 V Battery
Assemble the appropriate DHS triple reamer (for either the
standard or short barrel DHS plate) (see “Assembling the
Instrumentation,” page 37). Set the reamer to the correct
depth. Insert the DHS triple reamer into the small battery
drive using the large quick coupling attachment. Slide the
reamer over the guide wire to simultaneously drill for the
lag screw, ream for the plate barrel, and countersink for the
plate / barrel junction to the preset depth. When reaming in
dense bone, continuously irrigate the DHS triple reamer to
prevent thermal necrosis.
* Also available
Synthes
9
Surgical Technique — DHS continued
7
Tap to predetermined depth (optional)
Instruments
95 mm
338.08
DHS / DCS T-Handle
338.17
Tap for DHS / DCS, 12.5 mm diameter
338.18
DHS / DCS Centering Sleeve, short
If necessary, tap to the predetermined depth using the tap
assembly (see “Assembling the Instrumentation,” page 38).
Tapping depth can be seen through the window in the short
centering sleeve.
8
Insert lag screw
Instruments
338.06
DHS / DCS Wrench
338.19
DHS / DCS Centering Sleeve, long
338.20
DHS / DCS Coupling Screw
338.21
DHS / DCS Guide Shaft
Select the DHS / DCS lag screw and assemble the lag screw
insertion assembly (see “Assembling the Instrumentation,”
page 39). Slide the assembly over the guide wire and into
the reamed hole. Seat the long centering sleeve in the hole
to center and stabilize the assembly. Insert the lag screw by
turning the handle clockwise, until the zero mark on the
assembly aligns with the lateral cortex. The threaded tip of
the lag screw now lies 10 mm from the joint surface. The lag
screw may be inserted an additional 5 mm in porotic bone,
for increased holding power and additional controlled collapse.
Note: Keep continuous forward pressure on the DHS / DCS
wrench while advancing the lag screw.
10
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
9
Align handle
Before removing the assembly, align the handle so it is in the
same plane as the femoral shaft (parallel to the femoral shaft
axis when viewed laterally). This allows proper placement of
the DHS plate onto the lag screw.
10
Remove wrench
Instruments
532.010*
Small Battery Drive
532.022*
Quick Coupling for K-Wires
Remove the DHS / DCS wrench and long centering sleeve.
Slide the appropriate DHS plate onto the guide shaft/lag
screw assembly until it contacts the lateral cortex. Loosen
and remove the coupling screw and guide shaft. Use the
small battery drive in reverse, with the quick coupling for
K-wires, to withdraw the 2.5 mm threaded guide wire.
* Also available
Synthes
11
Surgical Technique — DHS continued
11
Seat plate
Instrument
338.28
DHS / DCS Impactor
Gently seat the plate with the DHS / DCS impactor. The vastus
ridge may be chiseled to further seat the plate on bone.
12
Fix plate to femur
Using AO standard screw insertion technique, fix the DHS plate
to the femur with 4.5 mm cortex screws.
12
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
13
Insert compression screw (optional)
Instrument
314.27
Large Hexagonal Screwdriver
For further, intraoperative compression of the trochanteric
fracture, the DHS / DCS compression screw may be inserted
into the lag screw. The DHS / DCS compression screw may be
used in unstable fractures to prevent disengagement of the
lag screw from the plate barrel in non-weight-bearing patients.
Note: Use of the compression screw may cause stripping
of the lag screw thread in porotic bone.
Synthes
13
Surgical Technique — DCS
1
Reduce fracture
Instrument
900.723
2.5 mm Threaded Guide Wire
Reduce the fracture. The fracture can be temporarily stabilized
with 2.5 mm threaded guide wires or Steinmann pins. Place
these wires so they do not interfere with subsequent positioning
of the DCS implant assembly (see illustrations accompanying
Step 3 for proper implant positioning). In intercondylar
fractures, the wires should be replaced with independent
6.5 mm or 7.3 mm cannulated screws or 6.5 mm cancellous
bone screws with washers.
2
Determine direction of central guide wire
B
25º
Instrument
292.20
2.0 mm Kirschner Wire
To determine the direction of the central guide wire, flex the
knee to 90°, and mark the axis of the knee joint by placing
a K-wire distally over the condyles (A). Place a second K-wire
anteriorly over the condyles (B).
Note: Placement of the guide wire determines placement
of the DCS implant assembly. Misplacement of the guide
wire can result in varus/valgus or rotational malalignment
of the fracture fragments.
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Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
B
A
3
Insert central guide wire
Instruments
338.41
DCS Drill Guide
900.723
2.5 mm Threaded Guide Wire
Using the DCS drill guide, insert the central guide wire (C)
parallel to the distal K-wire (A) in the AP view, and parallel
to the anterior K-wire (B) in the axial view. Do not insert the
guide wire too far medially; consider the inclination of the
medial wall of the distal femur. In the sagittal plane, the
central guide wire enters the distal femur at a point anterior
to the midline between the condyles, and in line with the
shaft axis, approximately 2 cm from the knee joint.
AP view: C is parallel to A
Axial view: C is parallel to B
Confirm placement of the central guide wire under image
intensification. If it is not parallel to the knee joint axis, insert
a new 2.5 mm threaded guide wire.
Notes:
Because it is designed for use with the DHS / DCS instruments
and implants, the 2.5 mm threaded guide wire, and not an
alternative wire, must be used.
This guide wire remains in place throughout the procedure.
If it is inadvertently withdrawn, reinsert it immediately (see
“Reinserting the 2.5 mm Threaded Guide Wire,” page 41).
2 cm
2/3
1/3
Synthes
15
Surgical Technique — DCS continued
4
Determine guide wire insertion depth
Instrument
338.05
DHS / DCS Direct Measuring Device
Slide the direct measuring device over the guide wire, and
determine guide wire insertion depth. Calibration on the
measuring device provides a direct reading.
80 mm
5
a.
Calculate reaming depth and lag screw length
To calculate reaming depth, tapping depth and lag screw
length, subtract 10 mm from the reading. For example:
a
b
c
Direct reading
Reamer setting
Tapping depth (optional)
Lag screw length
80 mm
70 mm
70 mm
70 mm
c.
If the compression screw will be used, allow for additional
compression of the fracture by selecting a lag screw
5 mm shorter (in this case, 65 mm) and inserting it an
additional 5 mm.
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Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
b.
6
Ream to predetermined depth
Instruments
338.46*
DCS Triple Reamer, complete
(includes DCS Reaming Head (338.47),
8.0 mm Drill Bit (338.10) and Nut)
532.010*
Small Battery Drive
532.015*
Large Quick Coupling
532.032*
Battery Casing
532.033*
14.4 V Battery
Assemble the DCS triple reamer (see “Assembling the
Instrumentation,” page 37). Set the reamer to the correct
depth. Insert the DCS triple reamer into the small battery
drive using the large quick coupling attachment. Slide the
reamer over the guide wire to simultaneously drill for the
lag screw, ream for the plate barrel, and countersink for the
plate/barrel junction to the preset depth. When reaming in
dense bone, continuously irrigate the DCS triple reamer to
prevent thermal necrosis.
7
Tap to predetermined depth (optional)
Instruments
338.08
DHS / DCS T-Handle
338.17
Tap for DHS / DCS, 12.5 mm diameter
338.18
DHS / DCS Centering Sleeve, short
If necessary, use the tap assembly to tap to the predetermined
depth, which can be seen through the window in the short
centering sleeve (see “Assembling the Instrumentation,”
page 38).
* Also available
Synthes
17
Surgical Technique — DCS continued
8
Assemble lag screw insertion assembly
Instruments
338.06
DHS / DCS Wrench
338.19
DHS / DCS Centering Sleeve, long
338.20
DHS / DCS Coupling Screw
338.21
DHS / DCS Guide Shaft
Select the correct length DHS / DCS lag screw and assemble
the lag screw insertion assembly (see “Assembling the
Instrumentation,” page 39). Slide the assembly over the
guide wire and into the reamed hole. Seat the long centering
sleeve in the hole to center and stabilize the assembly.
Note: Keep continuous forward pressure on the DHS / DCS
wrench while advancing the lag screw.
9
Insert lag screw
Insert the lag screw by turning the handle clockwise until the
0 mark on the assembly aligns with the lateral cortex. The
threaded tip of the lag screw now lies 10 mm from the medial
cortex. The lag screw may be inserted an additional 5 mm in
porotic bone, for increased holding power.
Note: If a lag screw 5 mm shorter than reaming and tapping
depth is used (in this case, 65 mm), insert it an additional 5 mm,
until the 5 mark on the assembly aligns with the lateral cortex.
18
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
10
Align handle
Before removing the assembly, align the handle so it is parallel
with the femoral shaft axis when viewed laterally. This allows
proper placement of the DCS plate onto the lag screw.
11
Remove wrench
Instruments
532.010*
Small Battery Drive
532.022*
Quick Coupling for K-Wires
Remove the DHS / DCS wrench and long centering sleeve.
Slide the appropriate DCS plate onto the guide shaft / lag
screw assembly. Loosen and remove the coupling screw and
guide shaft. Use the small battery drive in reverse, with the
quick coupling for K-wires, to withdraw the guide wire.
* Also available
Synthes
19
Surgical Technique — DCS continued
12
Seat plate
Instrument
338.28
DHS / DCS Impactor
Gently seat the plate with the DHS / DCS impactor. The lateral
condylar cortex may be chiseled to further seat the plate
on bone.
13
Compress distal fragments with compression screw
Instrument
314.27
Large Hexagonal Screwdriver
If the joint fragments were not previously reduced with
independent 6.5 mm cancellous bone screws, the DHS / DCS
compression screw may be inserted into the lag screw. In
porotic bone, insert the screw very carefully to avoid stripping
the lag screw thread.
20
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
14
Insert 6.5 mm cancellous screws
Further interfragmentary compression can be achieved by
using two 6.5 mm cancellous bone screws through the distal
round holes of the DCS plate.
15
Compress to femoral shaft
Instrument
321.12*
Articulated Tension Device
Once an approximate anatomic reduction is achieved, use
the articulated tension device to produce final compression
between the femoral shaft and distal fragments. To facilitate
reduction of the diaphyseal fragment, particularly in cases of
medial comminution with shortening, the tension device can
also be used as a distractor.
* Also available
Synthes
21
Surgical Technique — DCS continued
16
Fix plate to femur
Using AO standard screw insertion technique, fix the
DCS plate to the femur with 4.5 mm cortex screws.
22
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
Special Techniques — Using the DHS/DCS One-Step Insertion Wrench
DHS/DCS One-Step Insertion Wrench Assembly
Wrench
338.302
DHS Plate
281.xxx
Coupling
Screw
338.31
Centering Sleeve
338.32
DHS / DCS One Step
Lag Screw
280.2xx
280.3xx
1
Insert guide wire
Instruments
338.047
Variable Angle Guide for DHS
338.05
DHS / DCS Direct Measuring Device
900.723
2.5 mm Threaded Guide Wire
Set the variable angle guide for DHS to the desired angle.
Insert the tip of the 2.5 mm threaded guide wire to the
subchondral bone in the femoral head.
Use the DHS / DCS direct measuring device to determine the
length of the guide wire.
To determine reaming depth and lag screw length, subtract
10 mm from the reading.
Synthes
23
Special Techniques — Using the DHS/DCS One-Step Insertion Wrench continued
2
Ream for lag screw and plate
Instruments
338.13
or
338.43*
DHS Triple Reamer
DHS Triple Reamer (for short barrel plates)
338.17
DHS / DCS Tap
338.18
Centering Sleeve
Ream the hole for the lag screw and plate over the correctly
positioned guide wire. (See “Assembling the Instrumentation,”
page 37.)
Tap using the DHS / DCS tap with centering sleeve.
(See “Assembling the Instrumentation,” page 38)
*Also available
24
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
3
Assemble wrench
Instruments
338.302
One-Step Insertion Wrench
338.31
Coupling Screw
338.32
Centering Sleeve
Insert the coupling screw into the one-step insertion wrench
and slide the DHS plate onto the shaft of the wrench.
Select the appropriate length lag screw and place on the end
of the wrench; the flats of the lag screw must be aligned with
the flats on the wrench. Thread the coupling screw into the
end of the lag screw.
Synthes
25
Special Techniques — Using the DHS/DCS One-Step Insertion Wrench continued
3
Assemble wrench continued
Place the centering sleeve onto the wrench between the lag
screw and the plate.
Slide the assembly over the 2.5 mm guide wire and into the
reamed hole.
26
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
4
Insert lag screw
Turn the wrench clockwise until the back of the lag screw is
seated in the lateral cortex (as observed through the window
on the centering sleeve).
Align the wrench handle with the long axis of the femoral
shaft. The tip will be 10 mm from the tip of the guide wire.
To remove the centering sleeve from the wrench, twist the
inner and outer sleeves in opposite directions.
10 mm
5
Insert plate
Instrument
338.28
DHS / DCS Impactor
Advance the side plate along the shaft of the wrench and
manually insert the barrel into the reamed hole.
Seat the plate with the DHS / DCS impactor. Make certain that
the wrench shaft lies in the channel of the impactor.
Affix the plate to the proximal femur with 4.5 mm cortex
screws, using standard AO technique.
Synthes
27
Special Techniques — Using the DCS for Subtrochanteric Fractures
The design of the DCS plate can enhance fixation of selected,
stable subtrochanteric fractures because it permits stable
fixation in the proximal fragment.3 The DCS plate has a 95°
barrel angle, allowing it to enter the femur more proximally
than the DHS plate and allowing insertion of independent
screws into the calcar. Further, its two round proximal plate
holes permit insertion of 6.5 mm cancellous bone screws,
for stable proximal fixation.
Stable transverse and short oblique subtrochanteric
fractures
When using the DCS plate for these fractures, the plate can act
as a tension band against normal medial compressive forces.4
Long oblique subtrochanteric fractures
When using the 135° DHS plate to treat long oblique
subtrochanteric fractures, use of the proximal plate screws
can prohibit compression. With the 95° DCS plate, however,
stable fixation can be achieved by lagging the fracture through
the plate, since controlled collapse is not anticipated.
Note: When used in the proximal femur, the DCS plate can
only be used to treat stable fractures; i.e., fractures that can
be directly reduced and anatomically reassembled to allow
restoration of the bony medial buttress. Because the DCS
plate has a 95° barrel angle, it does not allow for controlled
collapse and compression.
3. Roy Sanders and P. Regazzoni. “Treatment of Subtrochanteric Femur Fractures
Using the Dynamic Condylar Screw.” Journal of Orthopaedic Trauma, vol. 3,
no. 3. New York: Raven Press, 1989. 211.
4. Ibid., 212.
28
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
Preoperative considerations
Plate selection
Select the DCS plate so there are four screws (eight cortices)
distal to the fracture in hard diaphyseal bone, or five screws
(ten cortices) in porotic bone.
Insertion of the 2.5 mm threaded guide wire
Though the general insertion area of the guide wire is known,
the precise insertion point varies with the CCD angle, the
angle subtended between the femoral neck and shaft axes.
Assessment of the CCD angle will allow subsequent placement
of the lag screw in its optimal position — in the center of the
femoral neck and in the inferior half of the femoral head
(see illustration). This insertion point should be determined
preoperatively with the aid of planning templates.
Note: The insertion point of the guide wire will vary with
CCD angle (angle subtended between the femoral neck and
shaft axes), as depicted by the valgus femur in the figure
(dotted lines). Example is exaggerated for clarity.
Synthes
29
Special Techniques — Using the DCS for Subtrochanteric Fractures continued
1
Reduce fracture
Instrument
900.723
2.5 mm Threaded Guide Wire
Reduce the fracture. Determine anteversion by placing a
2.5 mm threaded guide wire anteriorly along the femoral
neck, gently hammering it into the femoral head. This
anteversion wire will ensure correct placement of the
central guide wire.
2
Insert guide wire
Instruments
310.19
2.0 mm Drill Bit
338.41
95º DCS Drill Guide
900.723
2.5 mm Threaded Guide Wire
Place the 95º DCS drill guide along the axis of the femoral
shaft so the central guide wire will enter the femur slightly
anterior to the midpoint of the greater trochanter, near
the vastus ridge. The precise level at which the guide wire
enters the femur should be determined preoperatively (see
“Preoperative considerations,” page 29). Insert the central
guide wire parallel to the anteversion wire in the lateral view.
Predrilling of the lateral cortex with the 2.0 mm drill bit is
recommended in dense bone.
Notes:
Because it is designed for use with the DHS / DCS instruments
and implants, the 2.5 mm threaded guide wire, and not an
alternative wire, must be used.
This guide wire remains in place throughout the procedure.
If it is inadvertently withdrawn, reinsert it immediately (see
“Reinserting the 2.5 mm Threaded Guide Wire,” page 41).
30
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
3
Confirm placement
Confirm placement of the central guide wire under image
intensification, in two views. In the AP view, the wire should
lie in the center of the neck and in the inferior half of the
femoral head. In the lateral view, it should lie in the middle
of the femoral head. The tip of the guide wire should just
engage the subchondral bone. If its position is incorrect, insert
a new guide wire. Remove and discard the anteversion wire.
4
95 mm
Determine insertion depth
Instrument
338.05
DHS / DCS Direct Measuring Device
Slide the direct measuring device over the guide wire to
determine guide wire insertion depth. Calibration on the
measuring device provides a direct reading.
5
Calculate reaming depth and lag screw length
a.
b.
To calculate reaming depth, tapping depth and lag screw
length, subtract 10 mm from the reading. For example:
a.
b.
c.
Direct reading
Reamer setting
Tapping depth (optional)
Lag screw length
95 mm
85 mm
85 mm
85 mm
c.
Synthes
31
Special Techniques — Using the DCS for Subtrochanteric Fractures continued
6
Ream to predetermined depth
Instruments
338.46*
DCS Triple Reamer, complete
(includes DCS Reaming Head (338.47),
8.0 mm Drill Bit (338.10) and Nut)
532.010*
Small Battery Drive
532.015*
Large Quick Coupling
532.032*
Battery Casing
532.033*
14.4 V Battery
Assemble the DCS triple reamer (see “Assembling the
Instrumentation,” page 37). Set the reamer to the correct
depth. Insert the DCS triple reamer into the small battery
drive using the large quick coupling attachment. Slide the
reamer over the guide wire to simultaneously drill for the
lag screw, ream for the plate barrel, and countersink for the
plate/barrel junction to the preset depth. When reaming in
dense bone, continuously irrigate the DCS triple reamer to
prevent thermal necrosis.
7
Tap to predetermined depth (optional)
Instruments
338.08
DHS / DCS T-Handle
338.17
Tap for DHS / DCS, 12.5 mm diameter
338.18
DHS / DCS Centering Sleeve, short
Secure the proximal fragment with a bone forceps to prevent
rotation in the sagittal plane. If necessary, tap to the predetermined depth using the tap assembly (see “Assembling
the Instrumentation,” page 38). Tapping depth can be seen
through the window in the short centering sleeve.
* Also available
32
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
85 mm
8
Insert lag screw
Instruments
338.06
DHS / DCS Wrench
338.19
DHS / DCS Centering Sleeve, long
338.20
DHS / DCS Coupling Screw
338.21
DHS / DCS Guide Shaft
Select the lag screw and assemble the lag screw insertion
assembly (see “Assembling the Instrumentation,” page 39).
Slide the assembly over the guide wire and into the reamed
hole. Seat the centering sleeve in the hole to center and
stabilize the assembly, and insert the lag screw by turning the
handle clockwise until the 0 mark on the assembly aligns
with the lateral cortex. The threaded tip of the lag screw
now lies 10 mm from the medial cortex. The lag screw may
be inserted an additional 5 mm in porotic bone, until the
5 mm mark aligns with the lateral cortex, for increased
holding power.
9
Align handle
Before removing the assembly, align the handle so it is in the
same plane as the femoral shaft (parallel with the femoral
shaft axis when viewed laterally). This allows correct placement
of the DCS plate onto the lag screw.
* Also available
Synthes
33
Special Techniques — Using the DCS for Subtrochanteric Fractures continued
10
Remove wrench
Remove the DHS / DCS wrench and long centering sleeve.
Slide the appropriate DCS plate onto the guide shaft / lag
screw assembly.
11
Seat plate
Instruments
338.28
DHS / DCS Impactor
532.010*
Small Battery Drive
532.022*
Quick Coupling for K-Wires
Loosen and remove the coupling screw and guide shaft. Use
the small battery drive in reverse, with the quick coupling for
K-wires, to withdraw the guide wire. Gently seat the plate
with the DHS / DCS impactor. The vastus ridge can be chiseled
to further seat the plate on bone.
* Also available
34
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
12
Insert cancellous bone screws
Instruments
310.31
3.2 mm Drill Bit, quick coupling
310.44
4.5 mm Drill Bit, quick coupling
312.48
4.5 mm / 3.2 mm Insert Drill Sleeve
Insert two 6.5 mm cancellous bone screws through the proximal
round holes of the DCS plate, using lag screw technique. To
do so, drill a hole through the near cortex with the 4.5 mm
drill bit. Fully seat the 4.5 mm / 3.2 mm insert drill sleeve into
the hole. Drill through the sleeve and penetrate the far cortex
with the 3.2 mm drill bit. Measure, tap and insert the 6.5 mm
cancellous bone screw. This technique will prevent the drill
bit from gliding along the calcar.
13
Insert compression screw
Instrument
314.27
Large Hexagonal Screwdriver
Insert the DHS / DCS compression screw into the lag screw.
This will prevent disengagement of the lag screw from the
plate barrel.
Synthes
35
Special Techniques — Using the DCS for Subtrochanteric Fractures continued
14
Compress to femoral shaft
Instrument
321.12*
Articulated Tension Device
Once an approximate anatomic reduction is achieved, the
articulated tension device may be used to produce final
compression of the fracture.
Note: Do not use the tension device if extensive
comminution exists.
15
Fix plate to femur
Using AO standard screw insertion technique, fix the DCS plate
to the femur with 4.5 mm cortex screws.
* Also available
36
Synthes DHS/DCS Dynamic Hip and Condylar Screw System
Special Techniques — Assembling the Instrumentation
Triple reamer assembly
Instruments
338.11
DHS Reaming Head, standard
338.13
DHS Triple Reamer, complete (includes 338.11)
338.44
DHS Reaming Head, short
338.47
DCS Reaming Head
Caution: The components of the triple reamers are sharp
and should be handled carefully.
Note: The triple reamers can be assembled preoperatively.
Reaming depth is set intraoperatively.
338.13
Select the reaming head that corresponds to the chosen plate
(DHS or DCS) and barrel length (DHS standard or DHS short).
Align the setscrew on the reaming head with the flat on the
drill bit. Slide the cutting end of the reaming head over the
coupling end of the drill bit.
Setscrew
Flat
Hold the coupling end of the drill bit with one hand, and
continue sliding the reaming head along the drill bit with
the other hand. The proper setting is attained when the
non-cutting end of the reaming head reaches the calculated
depth setting. In this example, the depth setting is 95 mm
(see inset).
Synthes
37
Special Techniques — Assembling the Instrumentation continued
Triple reamer assembly continued
Secure the reaming head into the appropriate notch,
and lock it in place with the locking nut.
Tap assembly
Instruments
338.17
Tap for DHS / DCS, 12.5 mm diameter
338.18
DHS / DCS Centering Sleeve, short
Slide the short centering sleeve over the tap.
Simultaneously push the quick coupling fitting on the T-handle
and insert the tap into the fitting.
38
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
Release the collar, and check to be sure the tap is securely
seated in the handle.
Lag screw insertion assembly
Instruments
338.06
DHS / DCS Wrench
338.19
DHS / DCS Centering Sleeve, long
338.20
DHS / DCS Coupling Screw, short
338.21
DHS / DCS Guide Shaft
Note: The lag screw insertion assembly must be assembled
intraoperatively after the proper length lag screw is chosen.
Insert the coupling screw into the DHS / DCS guide shaft.
Synthes
39
Special Techniques — Assembling the Instrumentation continued
Lag screw insertion assembly continued
Screw the coupling screw into the end of the lag screw.
The tabs of the guide shaft should seat into the slots of
the lag screw.
Slide the long centering sleeve over the wrench.
Firmly insert the guide shaft / lag screw assembly into the
wrench until it stops.
40
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
Special Techniques — Reinserting the 2.5 mm Threaded Guide Wire
If the guide wire is inadvertently withdrawn at any time during
the procedure, reinsert it immediately.
To reinsert guide wire if withdrawn upon removal
of triple reamer
Instruments
338.19
DHS / DCS Centering Sleeve, long
399.42*
Hammer, 500 grams
900.723
2.5 mm Threaded Guide Wire
Insert a lag screw backwards into the short centering sleeve.
Place this assembly into the bone, and use it as a guide
for reinsertion of the threaded guide wire. Cannulation in
the DHS / DCS lag screw centers the threaded guide wire
in the hole.
Use a hammer to gently reseat the threaded guide wire.
Caution: Do not continue the procedure without the
threaded guide wire, as the risk of misdirecting the triple
reamer, tap assembly, or DHS / DCS lag screw is too great.
* Also available
Synthes
41
Implant Removal
Implant removal
Instrument
338.06
DHS / DCS Wrench
Remove the plate.
Assemble the insertion wrench, using the long coupling
screw. The long coupling screw allows the surgeon to exert
traction while unscrewing the lag screw.
Align the flats inside the wrench with the flats of the lag
screw. Slide the wrench over the lag screw until it is well
over the end of the screw.
Pull on the wrench while turning it counterclockwise.
Instrument options for removal
System
Will remove:
DHS
– Wrench (338.06)
– Long Coupling Screw (338.22)
DHS
DHS
DHS One-Step
– Insertion Wrench (338.302)
– Coupling Screw (338.31)
DHHS
– Solid Coupling Screw with
internal threads (338.313)
– Hammer Guide (03.010.059)
– Side / Fixed Hammer, 400 grams
(03.010.058)
DHS One-Step
DHS One-Step
DHHS
DHHS
DHS One-Step
DHS One-Step
DHHS
DHHS
DHHS
DHHS
DHHS
Note: If the DHHS solid coupling screw has external threads on the back-end,
use the Inserter Extractor (356.49) and Slotted Hammer (332.20) for removal.
42
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
Implants
DHS Plates, standard barrel (38 mm barrel) ◊
Holes Shaft Length
(mm)
130°
135°
2
46
281.021
281.102
3
62
281.031
281.131
4
78
281.040
281.140
5
94
281.050
281.150
6
110
281.060
281.160
8
142
281.081
281.180
10
174
281.010
281.100
12
206
281.012
281.110
14
238
281.014
281.130
16
270
—
281.170
18
302
—
281.190
20
333
—
281.020
Barrel Angle
140°
281.220
281.230
281.240
281.250
281.260
281.280
281.200
281.212
281.214
281.216
—
—
145°
281.320
281.330
281.340
281.350
281.360
281.308
281.310
281.312
281.314
281.316
—
—
150°
281.402
281.430
281.440
281.450
281.460
281.480
281.400
281.410
281.414
281.416
281.418
281.421
DHS Plates, short barrel (25 mm barrel)◊
Holes Shaft Length
(mm)
130°
135°
2
46
281.502
281.520
3
62
281.503
281.530
4
78
281.504
281.540
5
94
281.505
281.550
6
110
281.506
281.560
Barrel Angle
140°
281.620
281.630
281.640
281.650
281.660
145°
281.720
281.730
281.740
281.750
281.760
150°
281.820
281.830
281.840
281.850
281.860
DCS Plates◊
Holes Shaft Length
(mm)
6
114
8
146
10
178
12
210
14
242
16
274
18
306
20
338
22
370
Barrel Angle
95°
281.960
281.980
281.900
281.925
281.930
281.940
281.950
281.970
281.990
◊ Available nonsterile and sterile-packed.
Add “S” to catalog number to order sterile product.
Synthes
43
Implants continued
DHS/DCS Lag Screws, 12.7 mm diameter thread◊
– Thread length: 22 mm
– Shaft diameter: 8 mm
– Pitch: 3.0 mm
– Diameter of cannulation: 2.7 mm
280.501
280.550
280.600
280.650
280.700
280.750
280.800
280.850
280.900
280.950
Length (mm)
50
55
60
65
70
75
80
85
90
95
280.000
280.050
280.100
280.150
280.200
280.250
280.300
280.350
280.400
280.451
Length (mm)
100
105
110
115
120
125
130
135
140
145
DHS/DCS Lag Screws, 14.0 mm diameter thread ◊
– Thread length: 22 mm
– Shaft diameter: 8 mm
– Pitch: 3.0 mm
– Diameter of cannulation: 2.7 mm
Length (mm)
Length (mm)
280.454
50
280.504
100
280.455
55
280.505
105
280.460
60
280.510
110
280.465
65
280.515
115
280.470
70
280.520
120
280.475
75
280.525
125
280.480
80
280.530
130
280.485
85
280.535
135
280.490
90
280.540
140
280.495
95
280.545
145
DHS/DCS Compression Screw ◊
280.990
36 mm
◊ Available nonsterile and sterile-packed.
Add “S” to catalog number to order sterile product.
44
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
DHS/DCS One-Step Lag Screws, 12.7 mm dia. thread ◊
Length (mm)
Length (mm)
280.251
50
280.301
100
280.255
55
280.305
105
280.260
60
280.310
110
280.265
65
280.315
115
280.270
70
280.320
120
280.275
75
280.325
125
280.280
80
280.330
130
280.285
85
280.335
135
280.290
90
280.340
140
280.295
95
280.345
145
DHS/DCS One-Step Lag Screws, 14.0 mm dia. thread
Length (mm)
Length (mm)
280.651S
50
280.701S
100
280.655S
55
280.705S
105
280.660◊
60
280.710◊
110
280.665S
65
280.715S
115
280.670◊
70
280.720◊
120
280.675S
75
280.725S
125
280.680◊
80
280.730◊
130
280.685S
85
280.735S
135
280.690◊
90
280.740◊
140
280.695S
95
280.745S
145
02.102.001*
281.869*
281.870*
Universal Locking Trochanter Stabilization
Plate, 131 mm
Trochanter Stabilization Plate, 138 mm◊
Trochanter Stabilization Plate, 148 mm◊
02.102.001
281.869
◊ Available nonsterile and sterile-packed.
Add “S” to catalog number to order sterile product.
* For trochanter stabilization plate techniques, please refer to the Universal
Locking Trochanter Stabilization Plate and Trochanter Stabilization Plate for
DHS Technique Guides
Synthes
45
Instruments
292.20
2.0 mm Kirschner Wire, 150 mm, trocar point
310.19
2.0 mm Drill Bit, 100 mm, quick coupling
310.31
3.2 mm Drill Bit, 145 mm, quick coupling
310.44
4.5 mm Drill Bit, 145 mm, quick coupling
311.44
T-Handle, with quick coupling
311.46
Tap for 4.5 mm Cortex and
4.5 mm Shaft Screws
312.46
4.5 mm / 3.2 mm Double Drill Sleeve
46
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
312.48
4.5 mm / 3.2 mm Insert Drill Sleeve
314.11
Holding Sleeve
314.15
Large Hexagonal Screwdriver Shaft
314.27
Large Hexagonal Screwdriver
319.10
Depth Gauge, for large screws
319.97
Screw Forceps
322.43
4.5 mm DCP Hip Drill Guide
Synthes
47
Instruments continued
338.01 –
338.04
DHS Angle Guides
(135°, 140°, 145° and 150°)
338.05
DHS / DCS Direct Measuring Device
338.06
DHS / DCS Wrench
338.08
DHS / DCS T-Handle
338.11
DHS Reaming head
338.13
DHS Triple Reamer, complete
(includes DHS Reaming Head, standard
(338.11), 8.0 mm Drill Bit (338.10) and Nut)
338.17
Tap for DHS / DCS, 12.5 mm diameter
48
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
338.18
DHS / DCS Centering Sleeve, short
338.19
DHS / DCS Centering Sleeve, long
338.20
DHS / DCS Coupling Screw, short
338.21
DHS / DCS Guide Shaft
338.22
DHS / DCS Coupling Screw, long
338.28
DHS / DCS Impactor
338.41
95° DCS Drill Guide
Synthes
49
Instruments continued
338.44
DHS Reaming Head, short
338.47
DCS Reaming Head
900.723
2.5 mm Threaded Guide Wire, spade point,
230 mm
50
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
One-Step Instruments
338.047
Variable Angle Guide
338.25
Small Impactor Tip
338.302
DHS / DCS One-Step Insertion Wrench
338.31
DHS / DCS Coupling Screw
338.32
DHS / DCS Centering Sleeve for
One-Step Insertion Wrench
338.730
4.5 mm / 3.2 mm Insert Drill Sleeve
Synthes
51
One-Step Instruments continued
338.740
6.0 mm / 4.5 mm Drill Sleeve
338.750
DHS Parallel Drill Guide
52
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
DHS/DCS Basic Set, with self-tapping screws (105.831) and
DHS/DCS Basic Set (105.31)
Graphic Cases
304.250
DHS / DCS Basic Set with self-tapping screws
Graphic Case (for set 105.831)
304.257
DHS / DCS Basic Set Graphic Case (for set
105.31)
Instruments (in both sets)
292.20
2.0 mm Kirschner Wire, 150 mm, trocar point,
1 pkg. of 10
310.19
2.0 mm Drill Bit, quick coupling, 100 mm, 2 ea.
310.31
3.2 mm Drill Bit, quick coupling, 145 mm, 2 ea.
310.44
4.5 mm Drill Bit, quick coupling, 145 mm, 2 ea.
311.44
T-Handle, with quick coupling
311.46
Tap for 4.5 mm Cortex and
4.5 mm Shaft Screws, 2 ea.
312.46
4.5 mm /3.2 mm Double Drill Sleeve
312.48
4.5 mm /3.2 mm Insert Drill Sleeve
314.11
Holding Sleeve
314.15
Large Hexagonal Screwdriver Shaft
314.27
Large Hexagonal Screwdriver
319.10
Depth Gauge, for large screws
319.97
Screw Forceps
322.43
4.5 mm DCP Hip Drill Guide
338.01
135° DHS Angle Guide
338.02
140° DHS Angle Guide
338.03
145° DHS Angle Guide
338.04
150° DHS Angle Guide
338.05
DHS / DCS Direct Measuring Device
338.06
DHS / DCS Wrench
338.08
DHS / DCS T-Handle
338.13
DHS Triple Reamer, complete
338.17
Tap for DHS / DCS, 12.5 mm diameter
338.18
DHS / DCS Centering Sleeve, short
338.19
DHS / DCS Centering Sleeve, long
338.20
DHS / DCS Coupling Screw, short
338.21
DHS / DCS Guide Shaft
338.22
DHS / DCS Coupling Screw, long
338.28
DHS / DCS Impactor
Note: For additional information, please refer to package insert.
338.41
95° DCS Drill Guide
For detailed cleaning and sterilization instructions, please refer to
338.44
DHS Reaming Head, short
http://www.synthes.com/sites/NA/MedicalCommunity/Pages/Cleaning_and_Sterilization.aspx
or to the below listed inserts which will be included in the shipping container:
338.47
DCS Reaming Head
—Processing Synthes Reusable Medical Devices—Instruments, Instrument Trays and Graphic
Cases—DJ1305
—Processing Non-sterile Synthes Implants—DJ1304
Synthes
53
DHS/DCS Basic Set, with self-tapping screws (105.831) and
DHS/DCS Basic Set (105.31) continued
Instruments (in both sets) continued
900.723
2.5 mm Threaded Guide Wire, spade point,
230 mm, 10 ea.
900.723LBL
Graphic Case Labels for 2.5 mm Threaded
Guide Wire (900.723)
Implants in set 105.831
4.5 mm Cortex Screws, self-tapping
Length (mm)
Qty.
214.828
28
3
214.830
30
3
214.832
32
8
214.834
34
8
214.836
36
8
214.838
38
8
214.840
40
10
214.842
42
8
214.844
44
6
214.846
46
6
214.848
48
3
214.850
50
3
214.852
52
3
214.854
54
3
Implants in set 105.31
4.5 mm Cortex Screws
Length (mm)
214.028
28
214.030
30
214.032
32
214.034
34
214.036
36
214.038
38
214.040
40
214.042
42
214.044
44
214.046
46
214.048
48
214.050
50
214.052
52
214.054
54
54
Qty.
3
3
8
8
8
8
10
8
6
6
3
3
3
3
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
DHS Basic Set, with self-tapping screws (105.837) and
DHS Basic Set (105.37)
Graphic Cases
304.250
DHS / DCS Basic Set with self-tapping screws
Graphic Case (for set 105.837)
304.257
DHS / DCS Basic Set Graphic Case
(for set 105.37)
Instruments (in both sets)
310.19
2.0 mm Drill Bit, quick coupling, 100 mm, 2 ea.
310.31
3.2 mm Drill Bit, quick coupling, 145 mm, 2 ea.
310.44
4.5 mm Drill Bit, quick coupling, 145 mm, 2 ea.
311.44
T-Handle, with quick coupling
311.46
Tap for 4.5 mm Cortex and
4.5 mm Shaft Screws, 2 ea.
312.46
4.5 mm / 3.2 mm Double Drill Sleeve
312.48
4.5 mm / 3.2 mm Insert Drill Sleeve
314.11
Holding Sleeve
314.15
Large Hexagonal Screwdriver Shaft
314.27
Large Hexagonal Screwdriver
319.10
Depth Gauge, for large screws
319.97
Screw Forceps
322.43
4.5 mm DCP Hip Drill Guide
338.01
135° DHS Angle Guide
338.02
140° DHS Angle Guide
338.03
145° DHS Angle Guide
338.04
150° DHS Angle Guide
338.05
DHS / DCS Direct Measuring Device
338.06
DHS / DCS Wrench
338.08
DHS / DCS T-Handle
338.13
DHS Triple Reamer, complete
338.17
Tap for DHS / DCS, 12.5 mm diameter
338.18
DHS / DCS Centering Sleeve, short
338.19
DHS / DCS Centering Sleeve, long
338.20
DHS / DCS Coupling Screw, short
338.21
DHS / DCS Guide Shaft
338.22
DHS / DCS Coupling Screw, long
338.28
DHS / DCS Impactor
338.44
DHS Reaming Head, short
900.723
2.5 mm Threaded Guide Wire, spade point,
230 mm, 10 ea.
900.723LBL
Graphic Case Labels for 2.5 mm Threaded
Guide Wire (900.723)
Note: For additional information, please refer to package insert.
Synthes
55
DHS Basic Set, with self-tapping screws (105.837) and
DHS Basic Set (105.37) continued
Implants in set 105.837
4.5 mm Cortex Screws, self-tapping
Length (mm)
Qty.
214.828
28
3
214.830
30
3
214.832
32
8
214.834
34
8
214.836
36
8
214.838
38
8
214.840
40
10
214.842
42
8
214.844
44
6
214.846
46
6
214.848
48
3
214.850
50
3
214.852
52
3
214.854
54
3
Implants in set 105.37
4.5 mm Cortex Screws
Length (mm)
214.028
28
214.030
30
214.032
32
214.034
34
214.036
36
214.038
38
214.040
40
214.042
42
214.044
44
214.046
46
214.048
48
214.050
50
214.052
52
214.054
54
56
Qty.
3
3
8
8
8
8
10
8
6
6
3
3
3
3
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
DHS Universal Implant Set (105.35)
Graphic Case
305.36
DHS Universal Implant Set Graphic Case
Implants
DHS / DCS Lag Screws, 12.7 mm diameter thread ◊
Length (mm)
Length (mm)
280.000
100
280.451
145
280.050
105
280.650
65
280.100
110
280.700
70
280.150
115
280.750
75
280.200
120
280.800
80
280.250
125
280.850
85
280.300
130
280.900
90
280.350
135
280.950
95
280.400
140
DHS / DCS Compression Screw, 3 ea.◊
Length (mm)
280.990
36
DHS Plates, standard barrel (38 mm) ◊
Angle Holes
Length (mm)
281.140
135°
4
78
281.150
135°
5
94
281.160
135°
6
110
281.240
140°
4
78
281.250
140°
5
94
281.260
140°
6
110
281.340
145°
4
78
281.350
145°
5
94
281.360
145°
6
110
281.440
150°
4
78
281.450
150°
5
94
281.460
150°
6
110
DHS Plates, short barrel (25 mm) ◊
Angle Holes
281.540
135°
4
281.840
150°
4
Length (mm)
78
78
◊ Available nonsterile and sterile-packed.
Add “S” to catalog number to order sterile product.
Note: For additional information, please refer to package insert.
Synthes
57
DCS Universal Implant Set (105.32)
Graphic Case
304.270
DCS Implant Set Graphic Case
Implants
DHS / DCS Lag Screws, 12.7 mm diameter thread ◊, 2 ea.
Length (mm)
280.501
50
280.550
55
280.600
60
280.650
65
280.700
70
280.750
75
DHS / DCS Compression Screws ◊, 6 ea.
Length (mm)
280.990
36
95° DCS Plates ◊
281.900
281.925
281.930
281.940
281.960
281.980
Holes
10
12
14
16
6
8
Length (mm)
178
210
242
274
114
146
Qty.
2
1
1
1
2
2
◊ Available nonsterile and sterile-packed.
Add “S” to catalog number to order sterile product.
Note: For additional information, please refer to package insert.
58
Synthes DHS/DCS Dynamic Hip and Condylar Screw System
DHS One-Step Basic Set (105.839) and
DHS/DCS One-Step Basic Set (105.833)
DHS One-Step Basic Set (105.839)
Graphic Case
690.348
DHS / DCS One-Step Basic Set Graphic Case
Instruments
292.20
2.0 mm Kirschner Wire, 150 mm, trocar point,
(10 / pkg.),1 pkg.
310.31
3.2 mm Drill Bit, quick coupling, 145 mm, 2 ea.
310.44
4.5 mm Drill Bit, quick coupling, 145 mm, 2 ea.
311.44
T-Handle with quick coupling
311.46
Tap for 4.5 mm Cortex and 4.5 mm Shaft
Screws, 130 mm, 57 mm tap depth, 2 ea.
312.46
4.5 mm / 3.2 mm Double Drill Sleeve
314.11
Holding Sleeve
314.15
Large Hexagonal Screwdriver Shaft
314.27
Large Hexagonal Screwdriver
319.10
Depth Gauge for large screws
319.97
Screw Forceps
322.43
4.5 mm DCP Hip Drill Guide, neutral and load,
60 mm
338.047
Variable Angle Guide for DHS
338.05
DHS / DCS Direct Measuring Device, 200 mm
length
338.08
DHS / DCS T-Handle, with quick coupling
338.13
DHS Triple Reamer, complete
338.17
Tap for DHS / DCS, 12.5 mm diameter, 220 mm
338.18
DHS / DCS Centering Sleeve, short
338.25
Small Impactor Tip
338.28
DHS / DCS Impactor
338.302
DHS / DCS One-Step Insertion Wrench
338.31
DHS / DCS Coupling Screw
(for One-Step Insertion Wrench)
338.32
DHS / DCS Centering Sleeve
(for One-Step Insertion Wrench)
338.44
DHS Reaming Head, for DHS Triple Reamer
(for short barrel plates)
338.730
4.5 mm / 3.2 mm Insert Drill Sleeve
338.740
6.0 mm / 4.5 mm Drill Sleeve
338.750
DHS Parallel Drill Guide
900.723
2.5 mm Threaded Guide Wire, 230 mm, 10 ea.
Note: For additional information, please refer to package insert.
Synthes
59
DHS One-Step Basic Set (105.839) and
DHS/DCS One-Step Basic Set (105.833) continued
DHS One-Step Basic Set (105.839) continued
Implants
4.5 mm Cortex Screws, self-tapping:
Length (mm)
Qty.
214.828
28
3
214.830
30
3
214.832
32
8
214.834
34
8
214.836
36
8
214.838
38
8
214.840
40
10
214.842
42
8
214.844
44
6
214.846
46
6
214.848
48
3
214.850
50
3
214.852
52
3
214.854
54
3
DHS/DCS One-Step Basic Set (105.833)
Includes all components of DHS One-Step Basic Set (105.839),
plus:
338.41
95° DCS Drill Guide
338.47
DCS Reaming Head
60
Synthes DHS/DCS Dynamic Hip and Condylar Screw System
DHS One-Step Implant Set (105.352)
Graphic Case
690.344
DHS One-Step Implant Set
Graphic Case
Implants
DHS / DCS One-Step Lag Screws, 12.7 mm thread
Length (mm)
Length (mm)
280.265
65
280.301
100
280.270
70
280.305
105
280.275
75
280.310
110
280.280
80
280.315
115
280.285
85
280.320
120
280.290
90
280.325
125
280.295
95
130° DHS Plates, standard barrel
Holes
281.040
4
281.050
5
281.060
6
135° DHS Plates, standard barrel
Holes
281.140
4
281.150
5
281.160
6
140° DHS Plates, standard barrel
Holes
281.240
4
281.250
5
281.260
6
145° DHS Plates, standard barrel
Holes
281.340
4 holes
281.350
5 holes
281.360
6 holes
280.990
281.440
281.540
281.869
281.870
DHS / DCS Compression Screw, 36 mm, 3 ea.
150° DHS Plate, standard barrel, 4 holes
135° DHS Plate, short barrel, 4 holes
Trochanter Stabilization Plate, 138 mm, 2 ea.
Trochanter Stabilization Plate, 148 mm, 2 ea.
Note: For additional information, please refer to package insert.
Synthes
61
DCS One-Step Implant Set (105.321)
Graphic Case
304.295
DCS One-Step Universal Implant Set
Graphic Case
Implants
DHS / DCS One-Step Lag Screws, 12.7 mm thread, 2 ea.
Length (mm)
280.251
50
280.255
55
280.260
60
280.265
65
280.270
70
280.275
75
280.990
DHS / DCS Compression Screw, 36 mm, 6 ea.
95° DCS Plates
281.960
281.980
281.900
281.925
281.930
281.940
Holes
6
8
10
12
14
16
Qty.
2
2
2
1
1
1
Note: For additional information, please refer to package insert.
62
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
Also Available
Sets
01.102.001
105.12
105.35S
105.352S
105.355
105.812
105.831J
and
105.31J
105.837J
and
105.37J
105.839J
105.954
Universal Locking Trochanter Stabilization
Plate Set
DHS / DCS Basic Screw Rack with screws
(not self-tapping)
DHS Universal Implant Set, sterile (without
graphic case)
DHS One-Step Implant Set, sterile,
without graphic case
DHS Supplemental Implant Set
DHS / DCS Basic Screw Rack with self-tapping
screws
DHS / DCS Basic Set with self-tapping screws
DHS / DCS Basic Set (with standard drill bits
310.20, 310.32 and 310.45 to fit Jacobs chuck)
DHS Basic Set with self-tapping screws
DHS Basic Set (with standard drill bits 310.20,
310.32 and 310.45 to fit Jacobs chuck)
DHS One-Step Basic Set with self-tapping
screws (with standard drill bits 310.32 and
310.45 to fit Jacobs chuck)
Small Battery Drive with 14.4 V Battery Pack Set
Implants
02.102.001
Universal Locking Trochanter Stabilization
Plate, 131 mm
DHS / DCS Lag Screws, 14.0 mm diameter thread ◊
Length (mm)
Length (mm)
280.454
50
280.504
100
280.455
55
280.505
105
280.460
60
280.510
110
280.465
65
280.515
115
280.470
70
280.520
120
280.475
75
280.525
125
280.480
80
280.530
130
280.485
85
280.535
135
280.490
90
280.540
140
280.495
95
280.545
145
◊ Available nonsterile and sterile-packed.
Add “S” to catalog number to order sterile product.
Synthes
63
Also Available continued
Implants continued
DHS / DCS One-Step Lag Screws, 12.7 mm dia. thread
Length (mm)
280.330
130
280.335
135
280.340
140
280.345
145
DHS / DCS One-Step Lag Screws, 14.0 mm dia. thread
Length (mm)
Length (mm)
280.651S
50
280.701S
100
280.655S
55
280.705S
105
◊
◊
280.660
60
280.710
110
280.665S
65
280.715S
115
280.670◊
70
280.720◊
120
280.675S
75
280.725S
125
280.680◊
80
280.730◊
130
280.685S
85
280.735S
135
280.690◊
90
280.740◊
140
280.695S
95
280.745S
145
Instruments
310.20
321.12
338.005
338.43
338.720
338.731
399.42
532.010
532.013
532.015
532.022
532.032
532.033
Graphic Case
690.371
DHS Supplemental Implant Set Graphic Case
◊ Available nonsterile and sterile-packed.
Add “S” to catalog number to order sterile product.
64
2.0 mm Drill Bit, 85 mm, Jacobs chuck
Articulated Tension Device
130° DHS Angle Guide
DHS Triple Reamer, complete (for short
barrel plates)
4.5 mm / 2.0 mm Insert Wire Sleeve
(for Parallel Drill Guide)
4.5 mm / 2.8 mm Insert Wire Sleeve
(for Parallel Drill Guide)
Hammer, 500 grams
Small Battery Drive
Quick Coupling for Drill Bits
Large Quick Coupling
Quick Coupling for K-Wires
Battery Casing for 14.4 V Battery
14.4 V Battery
Synthes DHS / DCS Dynamic Hip and Condylar Screw System Technique Guide
Synthes (USA)
1302 Wrights Lane East
West Chester, PA 19380
Telephone: (610) 719-5000
To order: (800) 523-0322
Fax: (610) 251-9056
© 1990 Synthes, Inc. or its affiliates. All rights reserved.
Synthes (Canada) Ltd.
2566 Meadowpine Boulevard
Mississauga, Ontario L5N 6P9
Telephone: (905) 567-0440
To order: (800) 668-1119
Fax: (905) 567-3185
DCS, DCP, DHS, LCP and Synthes are trademarks of Synthes, Inc. or its affiliates.
www.synthes.com
Printed in U.S.A.
3/12
J3045-G