3.5 mm LCP
Medial Distal
Tibia Plate
TECHNIQUE GUIDE
Original Instruments and Implants of the Association
for the Study of Internal Fixation — AO ASIF
®
3.5 mm LCP® Medial Distal Tibia Plate
Foreword
The 3.5 mm LCP® Medial Distal Tibia Plate is part of
the Synthes Small Fragment LCP System that merges
locking screw technology with conventional plating
techniques. The plate is stainless steel and features
a limited-contact shaft profile, locking compression
plate (LCP) holes in the shaft, and locking screw
holes in the head. The LCP holes in the plate shaft
combine a dynamic compression unit (DCU) hole
with a locking screw hole. The LCP hole provides
the flexibility of axial compression and locking
capability throughout the length of the plate shaft.
Fixation with the 3.5 mm LCP Medial Distal Tibia
Plate has many similarities to traditional plate fixation
methods, with a few important improvements. The
technical innovation of locking screws provides the
ability to create a fixed-angle construct while using
familiar AO plating techniques. Locking capability
is important for fixed-angle constructs in osteopenic
bone or multifragmentary fractures where screw
purchase is compromised. These screws do not
rely on plate-to-bone compression to resist patient
load, but function similarly to multiple, small, angled
blade plates.
Note: For information on fixation principles using conventional
and locked plating techniques, please refer to the Small Fragment
Locking Compression Plate (LCP) Technique Guide.
Indications
• Extra-articular and intra-articular distal tibia fractures
• Osteotomies of the distal tibia
1
Plate Features
• Anatomically contoured; plate is twisted
20° and bent to fit the distal tibia
• Available for left and right tibias
• Limited-contact shaft design
with 4 to 14 combination locking/
compression holes
• Eight distal locking holes accept
2.7 mm Cortex, 3.5 mm Locking,
3.5 mm Cortex, or 4.0 mm
Cancellous Bone Screws
• Proximal and distal holes for
1.6 mm or 2.0 mm Kirschner wires
• 316L stainless steel
• Locking holes in distal region
are parallel to the joint
• Elongated hole in shaft aids in initial
plate positioning
• The shaft holes accept 3.5 mm Locking
Screws in the threaded portion and
3.5 mm Cortex Screws, 4.0 mm Cortex
Screws and 4.0 mm Cancellous Bone
Screws in the compression portion
• Distal tab for optional medial malleolus
screw accepts 3.5 mm Locking, 2.7 mm
Cortex, 3.5 mm Cortex, 4.0 mm Cortex
or 4.0 mm Cancellous Bone Screws
3.5 mm Locking 2.7 mm Cortex 3.5 mm Cortex 4.0 mm Cancellous
Bullet-nose
tipSuture/
K-wire hole
Combination
hole
Locking
hole
Medial
malleolus
tab
Distal Screw Profile
Limited-
contact
design
in shaft
Thin distal
region
2
The AO ASIF Principles of Internal Fixation
Anatomic Reduction
Facilitates restoration of the articular surface by
exact screw placement utilizing wire sleeves.
Precontoured plate assists reduction of metaphysis
to diaphysis.
Stable Fixation
Locking screws create a fixed-angle construct,
providing angular stability.
Preservation of Blood Supply
Tapered end for submuscular plate insertion,
preserving tissue viability.
Limited-contact plate design reduces plate-to-bone
contact, limiting vascular trauma and insult to bone.
Early Mobilization
Early mobilization per standard AO technique
creates an environment for bone healing,
expediting a return to optimal function.
3
Surgical Technique
Preparation
Complete the radiographic assessment and prepare
the preoperative plan. For a minimally invasive
procedure, use the AO ASIF preoperative planning
template to determine plate length and screw posi-
tions. Position the patient supine on a radiolucent
operating table. Visualization of the distal tibia
under fluoroscopy in both the lateral and AP views
is necessary.
Required Sets:
The Small Fragment LCP Set [105.434] is required when
implanting the 3.5 mm LCP Medial Distal Tibia Plates.
1
Reduce articular surface
Reduce the fracture fragments and confirm
reduction using image intensification. Reduction
may be stabilized using the following methods:
1. Independent Kirschner Wires
2. K-wires through the plate
3. Independent lag screws
4. Lag screws through the plate
5. Locking screws through the plate
The locking screws do not provide interfragmentary
compression; therefore, any desired compression
must be achieved with standard lag screws. The
articular fractures must be reduced and compressed
prior to fixation of the 3.5 mm LCP Medial Distal
Tibia Plate with locking screws.
2.7 mm or 3.5 mm Cortex Screws may also be used
as lag screws through the plate by overdrilling the
near fragment.
Technique Tip: Prior to reduction, application of
an external fixator or Large Distractor [394.35] may
facilitate visualization and reduction of the joint.
Technique Tip: To verify that independent lag screws
will not interfere with plate placement, evaluate place-
ment on the preoperative plan or intraoperatively with
AP and lateral fluoroscopic images.
2
Locking Small Fragment
Instrument and Implant Set–LCP,
with self-tapping screws
105.434
Insert independent K-wires to reduce
fracture fragments.
4
Insert plate
For minimally invasive insertion, make a
single incision distally and carefully push
the plate under the soft tissue. Make stab
incisions to insert screws into the shaft.
Technique Tip: Use a Threaded Plate Holder
[324.031] in one of the distal holes as a handle
for percutaneous insertion.
Technique Tip: Prior to placing the plate against
the bone, thread the 2.8 mm Threaded Drill Guides
[312.648] into the distal holes. It is easier to thread
these guides into the plate when the plate is off
the bone.
4
Surgical Technique (continued)
Bend distal tab (optional)
Contour the distal tab as necessary with
the Universal Bending Pliers [391.963].
3
Bend the distal tab to fit the medial malleolus
using the Universal Bending Pliers.
Saphenous
Vein
Saphenous
Nerve
5
Position plate and fix provisionally
The plate may be temporarily held in place with
standard plate holding forceps or the Push-Pull
Reduction Device [324.024], to prevent plate
rotation while inserting the first locking screw.
K-wires may be used through the plate for
provisional fixation.
Assure proper reduction prior to insertion
of the first locking screw. Locking
screw insertion may prevent
any further reduction.
5
Hold the plate to the bone using the
Push-Pull Reduction Device.
Insert screws
Determine the combination of 2.7 mm, 3.5 mm
and 4.0 mm Cortex, 4.0 Cancellous Bone
Screws, and 3.5 mm Locking Screws that will
be used for fixation.
If a combination of cortex and locking screws
will be used, cortex screws should be inserted
first to pull the plate to the bone.
If using a locking screw as the first screw,
be sure the plate is held securely to the
bone to prevent plate rotation as the screw
is locked to the plate.
Reminder: The locking screw is not a lag screw.
Use standard screws when requiring a precise
anatomical reduction (e.g. joint surfaces) or
interfragmentary compression. Before inserting
the first locking screw, perform anatomical reduction
and fix the fracture with lag screws, if necessary.
After the insertion of locking screws, an anatomical
reduction will no longer be possible without
loosening the locking screws.
6
Insertion of a lag screw through the elongated hole.
324.024
324.024
6
Surgical Technique (continued)
Insert screws (continued)
Distal locking screw insertion
• Screw the 2.8 mm Threaded Drill Guide
[312.648] into an LCP plate hole until
fully seated.
• Use the 2.8 mm Drill Bit [310.288]
to drill to the desired depth.
• Remove the drill guide.
• Use the Depth Gauge [319.01] to
determine screw length.
• Insert the locking screw under power, using
the Torque Limiting Attachment [511.770
or 511.773] and the StarDrive Screwdriver
Shaft [314.116], or insert manually, using the
StarDrive Screwdriver [314.115].
Note: When using the Torque Limiting
Attachment, the screw is securely locked
to the plate when a“click” is heard.
Warning: Never use the StarDrive shaft directly
with power equipment unless using a Torque
Limiting Attachment.
6
When inserting 3.5 mm Locking Screws, screw the
2.8 mm Threaded Drill Guide into the hole and
then drill with the 2.8 mm Drill Bit.
Measure for screw length using the Depth Gauge.
Insert a 3.5 mm Locking Screw using the StarDrive
Screwdriver Shaft and Torque Limiting Attachment.
Screws may also be inserted manually using the
StarDrive Screwdriver. To prevent plate rotation, be
sure the plate is secured to the bone before inserting
the first lag screw.
7
Insert screws (continued)
Shaft screw insertion
If using the threaded portion of the LCP holes,
repeat the steps for distal locking screw insertion.
For nonlocking screws, use the standard
AO screw insertion technique.
6
Optional Techniques
Medial malleolus screw insertion
If the tab for the medial malleolus screw is to
be utilized, insert either a 3.5 mm Locking Screw
or a nonlocking 2.7 mm, 3.5 mm, or 4.0 mm
Cortex Screw, or a 4.0 mm Cancellous Bone
Screw through the screw hole for malleolus
fixation. Use the screw insertion techniques
previously described.
Depending on the bone quality, screws through the
plate shaft can be either bicortical or unicortical.
Insert a screw through the distal tab to secure the
medial malleolus.
Screw placement verification
Final position of the locking screws may be
verified under image intensification with a K-wire
prior to insertion. This is especially important
when changing the contour of the plate, or in
metaphyseal regions close to joint surfaces.
Please refer to the Small Fragment LCP Technique
Guide for screw placement verification technique.
8
Optional Procedures
Inserting bone graft
If desired, fill any metaphyseal bone defect with
autogenous bone graft or bone graft substitute.
When using bone graft substitute, follow the
manufacturer’s directions for use.
Implant removal
To remove locking screws, unlock all screws
from the plate, then remove the screws
completely from the bone. This prevents
simultaneous rotation of the plate when
unlocking the last locking screw.
Apply bone graft if necessary.
Implants
3.5 mm LCP® Medial Distal Tibia Plates
Right Left Holes Length
239.900 239.901 4 holes 116 mm
239.904 239.905 6 holes 142 mm
239.908 239.909 8 holes 168 mm
239.912 239.913 10 holes 194 mm
239.916 239.917 12 holes 220 mm
239.920 239.921 14 holes 246 mm
Instrument
391.963 Universal Bending Pliers
Required Set
105.434 Locking Small Fragment Instrument
and Implant Set—LCP®
3.5 mm LCP® Medial Distal Tibia Plate
Instrument and Implant Set [115.358]
239.912
(right)
239.913
(left)
3.5 mm LCP® Medial Distal
Tibia Plate Set Graphic Case
690.376
Sterilization Parameters for Set [115.358]
For more information, please see graphic case package insert.
Method Cycle Temperature Exposure Time
Steam Gravity 132°–135°C 22 Minutes
Displacement (270°– 275°F)
(Wrapped)
Steam Prevacuum 132°– 135°C 8 Minutes
(Wrapped) (270°– 275°F)
Original Instruments and Implants of the Association
for the Study of Internal Fixation — AO ASIF
© 2003 SYNTHES (USA) LCP is a trademark and SYNTHES and ASIF are registered trademarks of SYNTHES (USA) and SYNTHES AG Chur. Printed in U.S.A. 8/03 J4492-A
SYNTHES (USA)
1690 Russell Road
Paoli, PA 19301-1262
Telephone: (610) 647-9700
Fax: (610 ) 251-9056
To order: (800) 523-0322
SYNTHES (CANADA) LTD.
111 Brunel Road, Suite 110
Mississauga, Ontario L4Z 1X3
Telephone: (905) 568 -1711
Fax: (905) 568-1662
To order: (800) 668-1119
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