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
postoperative
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3 months
6 months
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Locked Plating. Clinical Problem.
Delayed Union
postoperative
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3 months
8 months
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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
-
Stiff plating constructs limit fracture motion
-
Non-union rates in distal femur fractures have
been reported up to 19%1:
-
Imperfect reduction
-
Lack of compression
-
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
NEW
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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
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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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