DLS Dynamic Locking Screw.synthes.vo.llnwd.net/o16/LLNWMB8/INT Mobile/Synthes... · Prepare DLS...

DLS Dynamic Locking Screw.Combined with LCP LockingCompression Plate.

Instructions for Use

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Dynamic Locking Screw Instructions for Use Synthes 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 13Instrument System 3.5

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

WarningThis description alone does not provide sufficient background for direct use ofthe product. Instruction by a surgeon experienced in handling this product ishighly recommended.

Reprocessing, Care and Maintenance of Synthes InstrumentsFor general guidelines, function control and dismantling of multi-part instruments,please refer to: www.synthes.com/reprocessing

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Angular stable screwLocking screws can be placed in eachthreaded 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 stablesystem.

DLS can be used with all Synthes’ tita-nium or stainless steel locking plates.

Cobalt chromiummolybdenum alloy (CoCrMo)enables DLS to be as strong asstandard locking screws.

CoCrMo encourages less in-growth and facilitates screw removal – similar to stainlesssteel screws.

Laserwelded. For stable fixa-tion between pin and sleeve.

2 Synthes Dynamic Locking Screw Instructions for Use

DLS Dynamic Locking Screw.Combined with LCP LockingCompression Plate.

DLS Dynamic Locking Screw

Stardrive recess. For bettertorque transmission.

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New screw tip. Roundedtip and five flute design.

Standardlocking head.Compatible withall Synthes’ locking plates.

Pin-sleeve design.Micro-motion withinthe screw.

Standard thread inthe shaft. For stronganchorage in bone.

DLS allows surgeons to modulate therigidity of the locked plate construct forbetter load distribution.

DLS construct can deliver nearly parallelfracture site motion.

Boosting biological bone healing: Micro-motions on the plate-side of thelocking construct improve circumferen-tial callus formation.


Principle of Dynamic Locking Screw (DLS)

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A

B


LCP Locking Compression Plate

– Provides angular stable support offragments regardless of bone quality

– Reduces risk of primary and second-ary loss of reduction even underhigh dynamic loading

– Reduces impairment of periostealblood supply due to limited plate-periosteum contact

– Maintains favorable hold in osteo-porotic bone and multiple fragmentfractures

A. Stable plate-screw connection– Locking screws reduce screw loosen-

ing– Excessive torque is not applied to

the cortical bone– The conical screw head facilitates

screw insertion

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

Self-tapping locking screw– Requires precise measurement of

length (metaphysis)– Monocortical or bicortical use– Not necessary to separately tap

thread

Standard screw– Dynamic compression is created

by the eccentric insertion of thestandard screw (analogous to LC-DCP)

LCP combi-hole

B. Compatibility– The proven dynamic compression

hole allows for use of all standardscrews

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Indications

Synthes Dynamic Locking Screws (DLS) in combination withSynthes Locking Compression Plates (LCP) are intended forthe fixation of metaphyseal and diaphyseal shaft fractures of long bones (humerus, femur and tibia). The DLS allowsmicro-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 indicationsor the selection of a plate type for specific clinical situations.For treatment of these subjects, please refer to ”AO Principlesof Fracture Management,” courses offered by the AO(www.aofoundation.org), and the corresponding profes-sional literature.

For general purposes, the following techniques for handlingthe implants and instruments will be demonstrated with astraight 3.5 mm LCP and DLS 3.7 mm.

Important: The DLS 3.7 mm has a 0.2 mm larger shaftthread 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 instru-ments stay the same.

Standard locking screw 5.0 instrumentation can be used forthe DLS 5.0 (see pages 19 and 20).

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Dynamic Locking Screw Technique

1Reduce and fix fracture

Reduce the fracture under image intensification. As needed,provide fixation with a Kirschner wire or reduction forceps.

2Bend 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 appropriatebending instruments (as for standard plates), especially in thecase 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 middleof the plate. This asymmetry enables exertion of uni-directional dynamic compression.

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3Position 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, causingdamage to surrounding soft tissue.

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4Prepare 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 holeuntil it is gripped completely by the thread. The DLS drillsleeve ensures that the dynamic locking screw is correctlylocked in the plate. Angular stability is reduced if a lockingscrew is inserted obliquely.

Technique tip: To make it easier for the drill sleeve to locatethe start of the thread, it may be useful to slightly rotate thedrill sleeve counterclockwise.

Note: In precontoured plates, the threaded holes might notbe perpendicular to the plate surface due to the anatomy.

Important: Only use the white color-coded DLS drill sleevewith 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 forstandard locking screws can be used.

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5Predrill 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 forDLS 3.7 mm to ensure the correctly sized drill hole.

6Option: Determine screw length

Instrument

319.010 Depth Gauge

Determine the screw length with the depth gauge.

Example showing measured length of 24 mm.

Example showing measured length of 24 mm.

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7Insert 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, anatomi-cal reconstruction must have occurred. After insertion of thedynamic locking screws, additional reduction cannot beachieved without removing the dynamic locking screws. The dynamic locking screws can either be inserted with a powertool (without final locking) or manually and always with atorque limiter.

Important– Always insert the dynamic locking screw with the dedi-

cated 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 willnullify the dynamization and might overload the standardlocking 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 nullifythe dynamization.

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7aInsertion with power tool

To insert the dynamic locking screw using a power tool, fit atorque limiter to the power tool. Then insert the screwdrivershaft into the torque limiter.

Pick up the dynamic locking screw and insert it into the platehole. To insert the screw, start the power tool slowly, increas-ing the speed and then reducing it again before the dynamiclocking screw is fully tightened. Uncouple the power tooland mount the handle for torque limiter or the handle withquick coupling and manually tighten the screw. After oneclick, 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 strip-ping can cause difficulty in removing the implant.

– For long screws and thick cortical bone, ensure sufficientcooling during insertion.

Important: Always insert the dynamic locking screw withthe dedicated torque limiter: DLS 3.7 mm → TLA 1.5 Nm DLS 5.0 mm → TLA 4.0 Nm

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7bManual insertion

To insert the dynamic locking screw manually, attach thetorque limiter handle to the torque limiter and insert a screw-driver shaft. Screw in the dynamic locking screw, and lock itin 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 Stardriverecess and should only be used with the appropriateStardrive screwdriver. Do not use the hexagonal screw-driver.

Note: Under image intensification you can identify the pin-sleeve design of the DLS.


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Compatibility with the LCP Percutaneous Instrument System3.5 mm

The LCP Percutaneous Instrument Set 3.5 mm consists of acomprehensive series of aiming arms and instrumentation tofacilitate the percutaneous, submuscular insertion of variousplates.

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 InstrumentSystem 3.5 the LCP Small Fragment Percutaneous InstrumentSet 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 useof the LCP Percutaneous Instrument System 3.5 please referto technique guide “LCP Low Bend Medial Distal Tibia PlateAiming Instruments 3.5 mm” 036.001.045 and “LCP Per cutaneous Aiming System 3.5 for PHILOS” 036.001.024.

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To remove the plate, first remove tissue and bone from allscrew heads and drives. Insert a screwdriver in the screw recess and unlock all screws manually. Then completely re-move all screws.

If the screws cannot be removed with the screwdriver, con-sult 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

Implant Removal

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** * *

* *

Shor

t Pi

n

Shor

t Pi

n

Long

Pin

Long

Pin

26 –

70 m

m

22 a

nd 2

4 m

m

32 –

36 m

m

38 –

90 m

m


DLS 3.7The two shortest screws (22 and 24 mm) have a shorter pin,and all longer screws (26 – 70 mm) have the same longerlength pin. The result is a comparable elastic behavior acrossall screw lengths.

DLS 5.0The three shortest screws (32 – 36 mm) have a shorter pin,and all longer screws (38 – 90 mm) have the same longerlength pin. The result is a comparable elastic behavior acrossall screw lengths.

Technical Information

Screw and pin lengths

* Maximum deflection 0.2 mm

* Maximum deflection 0.35 mm

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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.

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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.

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Instruments for DLS 3.7 mm

03.213.001 DLS Drill Sleeve 3.7, for Drill Bits � 3.1 mm

Dedicated instruments for DLS 3.7 mm

03.213.002 DLS Drill Bit � 3.1 mm with Stop, length165 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 Plates2.7 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

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314.116 Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO/ASIF Quick Coupling

397.705 Handle for Torque Limiter Nos. 511.770and 511.771

311.431 Handle with Quick Coupling

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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

323.460 Universal Drill Guide 4.5/3.2, for neutraland load position

Instruments for DLS 5.0 mm

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

Large fragment instruments

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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. 511.770and 511.771

511.771 Torque Limiter, 4 Nm, for Compact Air Drive and Power Drive


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All technique guides are available as PDF files at www.synthes.com/lit

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