0x6.001.067_AB 15.11.12 07:00 Seite Cvr1
DLS Dynamic Locking Screw.
Combined with LCP Locking
Compression Plate.
Instructions for Use
0x6.001.067_AB 15.11.12 07:00 Seite Cvr2
0x6.001.067_AB 15.11.12 07:00 Seite 1
Table of Contents
Introduction
Instructions for Use
Product Information
DLS Dynamic Locking Screw
2
Indications
5
Dynamic Locking Screw Technique
6
Compatibility with the LCP Percutaneous
Instrument System 3.5
13
Implant Removal
14
Technical Information
15
Implants
16
Instruments for DLS 3.7 mm
18
Instruments for DLS 5.0 mm
20
Image intensifier 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
Dynamic Locking Screw
Instructions for Use
Synthes
1
0x6.001.067_AB 15.11.12 07:00 Seite 2
DLS Dynamic Locking Screw.
Combined with LCP Locking
Compression Plate.
DLS Dynamic Locking Screw
Stardrive recess. For better
torque transmission.
Angular stable screw
Locking screws can be placed in each
threaded hole of the appropriate LCP.
Screws lock tightly in the plate to:
– eliminate tension on the bone
– eliminate compression between
plate and bone
– protect periosteum from potential
damage and retain circulation
Pin-sleeve design of the DLS allows
micro-motion within the angular stable
system.
DLS can be used with all Synthes’ titanium or stainless steel locking plates.
Cobalt chromium
molybdenum alloy (CoCrMo)
enables DLS to be as strong as
standard locking screws.
CoCrMo encourages less ingrowth and facilitates screw
removal – similar to stainless
steel screws.
Laserwelded. For stable fixation between pin and sleeve.
2
Synthes
Dynamic Locking Screw
Instructions for Use
0x6.001.067_AB 15.11.12 07:00 Seite 3
Principle of
Dynamic Locking Screw (DLS)
Standard
locking head.
Compatible with
all Synthes’
locking plates.
DLS allows surgeons to modulate the
rigidity of the locked plate construct for
better load distribution.
Pin-sleeve design.
Micro-motion within
the screw.
DLS construct can deliver nearly parallel
fracture site motion.
Standard thread in
the shaft. For strong
anchorage in bone.
Boosting biological bone healing:
Micro-motions on the plate-side of the
locking construct improve circumferential callus formation.
New screw tip. Rounded
tip and five flute design.
Dynamic Locking Screw
Instructions for Use
Synthes
3
0x6.001.067_AB 15.11.12 07:00 Seite 4
LCP Locking Compression Plate
– Provides angular stable support of
fragments regardless of bone quality
– Reduces risk of primary and secondary loss of reduction even under
high dynamic loading
– Reduces impairment of periosteal
blood supply due to limited plateperiosteum contact
– Maintains favorable hold in osteoporotic bone and multiple fragment
fractures
LCP combi-hole
A
B
DLS – Self-tapping dynamic
locking screw
– Requires precise measurement of
length (diaphysis and metaphysis)
– Bicortical use in the shaft
– Not necessary to separately tap
thread
4
Synthes
Dynamic Locking Screw
A. Stable plate-screw connection
– Locking screws reduce screw loosening
– Excessive torque is not applied to
the cortical bone
– The conical screw head facilitates
screw insertion
B. Compatibility
– The proven dynamic compression
hole allows for use of all standard
screws
Standard screw
– Dynamic compression is created
by the eccentric insertion of the
standard screw (analogous to
LC-DCP)
Self-tapping locking screw
– Requires precise measurement of
length (metaphysis)
– Monocortical or bicortical use
– Not necessary to separately tap
thread
Instructions for Use
0x6.001.067_AB 15.11.12 07:00 Seite 5
Indications
Synthes Dynamic Locking Screws (DLS) in combination with
Synthes Locking Compression Plates (LCP) are intended for
the fixation of metaphyseal and diaphyseal shaft fractures
of long bones (humerus, femur and tibia). The DLS allows
micro-motion within the angular stable system.
Synthes offers a wide selection of LCP plates, which covers
a correspondingly extensive variety of indications. For this
reason, this technical guide does not cover specific indications
or the selection of a plate type for specific clinical situations.
For treatment of these subjects, please refer to ”AO Principles
of Fracture Management,” courses offered by the AO
(www.aofoundation.org), and the corresponding professional literature.
For general purposes, the following techniques for handling
the implants and instruments will be demonstrated with a
straight 3.5 mm LCP and DLS 3.7 mm.
Important: The DLS 3.7 mm has a 0.2 mm larger shaft
thread diameter compared to the standard locking screw
3.5 mm. Therefore dedicated instruments for DLS 3.7 mm
(drill bit and drill sleeve) have to be used. The other instruments stay the same.
Standard locking screw 5.0 instrumentation can be used for
the DLS 5.0 (see pages 19 and 20).
Dynamic Locking Screw
Instructions for Use
Synthes
5
0x6.001.067_AB 15.11.12 07:00 Seite 6
Dynamic Locking Screw Technique
1
Reduce and fix fracture
Reduce the fracture under image intensification. As needed,
provide fixation with a Kirschner wire or reduction forceps.
2
Bend plate
Instruments
329.040
Bending Iron for Plates 2.4 to 3.5
length 145 mm (for use with 329.050)
329.050
Bending Iron for Plates 2.4 to 3.5
length 145 mm (for use with 329.040)
329.150
Bending Pliers for Plates 2.4 to 4.0,
length 230 mm
329.290
Bending Pliers for Reconstruction Plates
2.7 and 3.5
Adapt the LCP plate to the anatomy using the appropriate
bending instruments (as for standard plates), especially in the
case of joint fractures.
Notes
– Do not bend the plate back and forth.
– The LCP combi-holes are asymmetrical in the plate. In
straight plates, the hole alignment changes in the middle
of the plate. This asymmetry enables exertion of unidirectional dynamic compression.
6
Synthes
Dynamic Locking Screw
Instructions for Use
0x6.001.067_AB 15.11.12 07:00 Seite 7
3
Position and fix plate
Position and fix the plate on the bone.
Important: Before setting the first dynamic locking screw,
ensure that the plate is provisionally well fixed in place.
Otherwise the plate may rotate during screw locking, causing
damage to surrounding soft tissue.
Dynamic Locking Screw
Instructions for Use
Synthes
7
0x6.001.067_AB 15.11.12 07:00 Seite 8
Dynamic Locking Screw Technique
4
Prepare DLS drill sleeve
Instrument
03.213.001
DLS Drill Sleeve 3.7, for Drill Bits ⭋ 3.1 mm
Carefully screw the DLS drill sleeve into the desired LCP hole
until it is gripped completely by the thread. The DLS drill
sleeve ensures that the dynamic locking screw is correctly
locked in the plate. Angular stability is reduced if a locking
screw is inserted obliquely.
Technique tip: To make it easier for the drill sleeve to locate
the start of the thread, it may be useful to slightly rotate the
drill sleeve counterclockwise.
Note: In precontoured plates, the threaded holes might not
be perpendicular to the plate surface due to the anatomy.
Important: Only use the white color-coded DLS drill sleeve
with the white color coded drill bit for DLS 3.7 mm. For
the DLS 5.0 mm the standard drill sleeve and drill bit as for
standard locking screws can be used.
8
Synthes
Dynamic Locking Screw
Instructions for Use
0x6.001.067_AB 15.11.12 07:00 Seite 9
5
Predrill screw hole and determine screw length
Instrument
03.213.002
DLS Drill Bit ⭋ 3.1 mm with Stop, length
165 mm, 2-flute, for Quick Coupling
Carefully drill the screw hole using an appropriate drill bit.
Remove the drill sleeve.
Important: Only use the white color-coded DLS drill bit for
DLS 3.7 mm to ensure the correctly sized drill hole.
Example showing measured length of 24 mm.
6
Option: Determine screw length
Instrument
319.010
Depth Gauge
Determine the screw length with the depth gauge.
Example showing measured length of 24 mm.
Dynamic Locking Screw
Instructions for Use
Synthes
9
0x6.001.067_AB 15.11.12 07:00 Seite 10
Dynamic Locking Screw Technique
7
Insert Dynamic Locking Screw
Instruments
511.770
Torque Limiter, 1.5 Nm
511.773
Torque Limiter, 1.5 Nm, for AO/ASIF Quick
Coupling
314.116
Screwdriver Shaft T15, self-holding
397.705
Handle for Torque Limiter
Nos. 511.770 and 511.771
311.431
Handle with Quick Coupling
Before insertion of the first dynamic locking screw, anatomical reconstruction must have occurred. After insertion of the
dynamic locking screws, additional reduction cannot be
achieved without removing the dynamic locking screws. The
dynamic locking screws can either be inserted with a power
tool (without final locking) or manually and always with a
torque limiter.
Important
– Always insert the dynamic locking screw with the dedicated torque limiter.
– 3 or more dynamic locking screws must be inserted for
each segment / fragment.
– Do not combine standard locking screws and/or standard
screws with DLS in the same segment/fragment. This will
nullify the dynamization and might overload the standard
locking screw; however, one fragment can be fixed with
a standard locking screw and another with DLS.
Note: Do not press the plate onto the bone. This will nullify
the dynamization.
10
Synthes
Dynamic Locking Screw
Instructions for Use
0x6.001.067_AB 15.11.12 07:00 Seite 11
7a
Insertion with power tool
To insert the dynamic locking screw using a power tool, fit a
torque limiter to the power tool. Then insert the screwdriver
shaft into the torque limiter.
Pick up the dynamic locking screw and insert it into the plate
hole. To insert the screw, start the power tool slowly, increasing the speed and then reducing it again before the dynamic
locking screw is fully tightened. Uncouple the power tool
and mount the handle for torque limiter or the handle with
quick coupling and manually tighten the screw. After one
click, the optimum torque is reached.
Notes
– To reduce the risk of stripping the screw head, do not lock
dynamic locking screws at full speed. Screw head stripping can cause difficulty in removing the implant.
– For long screws and thick cortical bone, ensure sufficient
cooling during insertion.
Important: Always insert the dynamic locking screw with
the dedicated torque limiter:
DLS 3.7 mm → TLA 1.5 Nm
DLS 5.0 mm → TLA 4.0 Nm
Dynamic Locking Screw
Instructions for Use
Synthes
11
0x6.001.067_AB 15.11.12 07:00 Seite 12
Dynamic Locking Screw Technique
7b
Manual insertion
To insert the dynamic locking screw manually, attach the
torque limiter handle to the torque limiter and insert a screwdriver shaft. Screw in the dynamic locking screw, and lock it
in the plate.
Important
– Always insert and lock the dynamic locking screw with the
dedicated torque limiter:
DLS 3.7mm → TLA 1.5 Nm
DLS 5.0mm → TLA 4.0 Nm
– The dynamic locking screw is only available with Stardrive
recess and should only be used with the appropriate
Stardrive screwdriver. Do not use the hexagonal screwdriver.
Note: Under image intensification you can identify the pinsleeve design of the DLS.
12
Synthes
Dynamic Locking Screw
Instructions for Use
0x6.001.067_AB 15.11.12 07:00 Seite 13
Compatibility with the
LCP Percutaneous Instrument System
3.5 mm
The LCP Percutaneous Instrument Set 3.5 mm consists of a
comprehensive series of aiming arms and instrumentation to
facilitate the percutaneous, submuscular insertion of various
plates.
The DLS 3.7 mm is compatible with the LCP Percutaneous
Instrument System 3.5 mm.
For the use of the DLS 3.7 with LCP Percutaneous Instrument
System 3.5 the LCP Small Fragment Percutaneous Instrument
Set 3.5 needs to be upgraded with the following instruments:
03.113.030
Drill Bit ⭋ 3.1 mm with Stop, calibrated,
length 250/225 mm, for Quick Coupling
03.113.031
Locking Drill Sleeve ⭋ 3.1 mm,
percutaneous
For the complete instruction and technique details of the use
of the LCP Percutaneous Instrument System 3.5 please refer
to technique guide “LCP Low Bend Medial Distal Tibia Plate
Aiming Instruments 3.5 mm” 036.001.045 and “LCP
Percutaneous Aiming System 3.5 for PHILOS” 036.001.024.
Dynamic Locking Screw
Instructions for Use
Synthes
13
0x6.001.067_AB 15.11.12 07:00 Seite 14
Implant Removal
To remove the plate, first remove tissue and bone from all
screw heads and drives. Insert a screwdriver in the screw
recess and unlock all screws manually. Then completely remove all screws.
If the screws cannot be removed with the screwdriver, consult the separate Synthes publication “Screw Extraction Set:
Instruments for removing Synthes screws” (Art. No.
036.000.918: pages 27–31 (Situation B) and pages 44 – 47),
which explains how broken screws can be removed.
These are the specific instruments for the extraction
of the dynamic locking screws:
DLS 3.7 mm:
309.035
Hollow Reamer, complete, anticlockwise
cutting, for Screws ⭋ 3.5 and 4.0 mm
309.038
Spare Reamer Tube, for No. 309.035
309.039
Extraction Bolt,
for Screws ⭋ 3.5 and 4.0 mm
309.510
Extraction Screw, conical,
for Screws ⭋ 1.5 and 2.0 mm
309.520
Extraction Screw, conical, for Screws
⭋ 2.7, 3.5 and 4.0 mm
DLS 5.0 mm:
309.450
Hollow Reamer, complete, anticlockwise
cutting, for Screws ⭋ 4.5 mm
309.480
Spare Reamer Tube, for No. 309.450
309.490
Extraction Bolt,
for Screws ⭋ 4.5 and 5.0 mm
309.520
Extraction Screw, conical, for Screws
⭋ 2.7, 3.5 and 4.0 mm
309.521
Extraction Screw for Screws ⭋ 3.5 mm
14
Dynamic Locking Screw
Synthes
Instructions for Use
0x6.001.067_AB 15.11.12 07:00 Seite 15
Technical Information
Screw and pin lengths
*
38 – 90 mm
Long Pin
*
32 – 36 mm
*
DLS 5.0
The three shortest screws (32 – 36 mm) have a shorter pin,
and all longer screws (38 – 90 mm) have the same longer
length pin. The result is a comparable elastic behavior across
all screw lengths.
Short Pin
*
26 – 70 mm
Long Pin
*
22 and 24 mm
Short Pin
DLS 3.7
The two shortest screws (22 and 24 mm) have a shorter pin,
and all longer screws (26 – 70 mm) have the same longer
length pin. The result is a comparable elastic behavior across
all screw lengths.
*
* Maximum deflection 0.2 mm
* Maximum deflection 0.35 mm
Dynamic Locking Screw
Instructions for Use
Synthes
15
0x6.001.067_AB 15.11.12 07:00 Seite 16
Implants
DLS 3.7 – Dynamic Locking Screw ⭋ 3.7 mm, self-tapping
– CoCrMo
– Sterile
Art no.
Length (mm)
09.213.022S
22
09.213.024S
24
09.213.026S
26
09.213.028S
28
09.213.030S
30
09.213.032S
32
09.213.034S
34
09.213.036S
36
09.213.038S
38
09.213.040S
40
09.213.042S
42
09.213.044S
44
09.213.046S
46
09.213.048S
48
09.213.050S
50
09.213.052S
52
09.213.054S
54
09.213.055S
55
09.213.056S
56
09.213.058S
58
09.213.060S
60
09.213.065S
65
09.213.070S
70
Warning: Do not resterilize the Dynamic Locking Screw.
16
Synthes
Dynamic Locking Screw
Instructions for Use
0x6.001.067_AB 15.11.12 07:00 Seite 17
DLS 5.0 – Dynamic Locking Screw ⭋ 5.0 mm, self-tapping
– CoCrMo
– Sterile
Art no.
Length (mm)
09.223.032S
32
09.223.034S
34
09.223.036S
36
09.223.038S
38
09.223.040S
40
09.223.042S
42
09.223.044S
44
09.223.046S
46
09.223.048S
48
09.223.050S
50
09.223.055S
55
09.223.060S
60
09.223.065S
65
09.223.070S
70
09.223.075S
75
09.223.080S
80
09.223.085S
85
09.223.090S
90
Warning: Do not resterilize the Dynamic Locking Screw.
Dynamic Locking Screw
Instructions for Use
Synthes
17
0x6.001.067_AB 15.11.12 07:01 Seite 18
Instruments for DLS 3.7 mm
Dedicated instruments for DLS 3.7 mm
03.213.001
DLS Drill Sleeve 3.7, for Drill Bits ⭋ 3.1 mm
03.213.002
DLS Drill Bit ⭋ 3.1 mm with Stop, length
165 mm, 2-flute, for Quick Coupling
Small fragment instruments
329.040
Bending Iron for Plates 2.4 to 3.5,
length 145 mm (for use with 329.050)
329.050
Bending Iron for Plates 2.4 to 3.5,
length 145 mm (for use with 329.040)
329.150
Bending Pliers for Plates 2.4 to 4.0,
length 230 mm
329.290
Bending Pliers for Reconstruction Plates
2.7 and 3.5
319.010
Depth Gauge for Screws ⭋ 2.7 to 4.0 mm,
measuring range up to 60 mm
511.770
Torque Limiter, 1.5 Nm,
for Compact Air Drive and for Power Drive
511.773
Torque Limiter, 1.5 Nm,
for AO/ASIF Quick Coupling
18
Dynamic Locking Screw
Synthes
Instructions for Use
0x6.001.067_AB 15.11.12 07:01 Seite 19
314.116
Screwdriver Shaft Stardrive 3.5, T15,
self-holding, for AO/ASIF Quick Coupling
397.705
Handle for Torque Limiter Nos. 511.770
and 511.771
311.431
Handle with Quick Coupling
Dynamic Locking Screw
Instructions for Use
Synthes
19
0x6.001.067_AB 15.11.12 07:01 Seite 20
Instruments for DLS 5.0 mm
Large fragment instruments
310.430
LCP Drill Bit ⭋ 4.3 mm with Stop, length
221 mm, 2-flute, for Quick Coupling
323.042
LCP Drill Sleeve 5.0, for Drill Bits ⭋ 4.3 mm
323.460
Universal Drill Guide 4.5/3.2, for neutral
and load position
323.500
LCP Universal Drill Guide 4.5/5.0
314.119
Screwdriver Shaft Stardrive 4.5/5.0, T25,
self-holding, for AO/ASIF Quick Coupling
314.164
Screwdriver Stardrive 4.5/5.0, T25,
with Groove, length 240 mm
20
Dynamic Locking Screw
Synthes
Instructions for Use
0x6.001.067_AB 15.11.12 07:01 Seite Cvr3
314.163
Torque-limiting Screwdriver Stardrive, T25,
self-holding, for Locking Screws ⭋ 5.0 mm
314.281
Holding Sleeve for Screws, for LCP 4.5/5.0
397.705
Handle for Torque Limiter Nos. 511.770
and 511.771
511.771
Torque Limiter, 4 Nm,
for Compact Air Drive and Power Drive
Dynamic Locking Screw
Instructions for Use
Synthes
21
All technique guides are available as PDF files at
www.synthes.com/lit
0123
version AB
Ö036.001.067öABNä
036.001.067
10/2012
30101298
© Synthes, Inc. or its affiliates
Subject to modifications
Synthes is a trademark of Synthes, Inc. or its affiliates
0x6.001.067_AB 15.11.12 07:01 Seite Cvr4