Supracondylar Cable Plate - Zimmer Biomet

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Uncompromising, Intraoperative Surgical Latitude

Optimal Implant-To-Patient Fit

Quick…Simple…Precise!

Supr

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The VHS® Variable-Angle CHS System takes the time proventechnology of hipfixation to themillennium.

Optimal implant-to-patient fit. No longerare you limited by the pre-establishedintraoperativeconstraints of a fixed neck-shaft angle device.

The VHS® Systemallows forcompression andvalgus reduction of the fracture afterfixation is achieved.

• Reduced O.R. time• Reduced inventory

requirements—An 80% reduction means less storage

• Uncompromising surgical latitude


Summary

IntroductionThe VHS® Supracondylar Cable Plate isdesigned for treatment of your mostdifficult distal femur fractures includingperiprosthetic fractures. The combinationof the unique features of the variableangle of the barrel and the platecombined with BMP™ cable sleevesprovide for an extraordinary range oftreatment options. It is approved for anduseful in the treatment of T-Condylarfractures as well. Its major impact,however, will be on supracondylar andmore proximal fracture patterns.

Subtrochanteric and other proximalfemoral fractures can be treated with thisdevice. It is especially applicable tofractures proximal to or includingretrograde nails or long stem total knees.

The basic fracture treatment principlesof anatomic reduction and limitedweight bearing until union apply toVHS® Supracondylar Cable Plates aswith all load sharing devices.

In addition to the extraordinary range ofapplications, the Supracondylar VHS®

allows the unique ability to make a varusor valgus adjustment to the distal fragmentafter fracture fixation is complete.

The supracondylar plate was designedto provide strong and stable internalfixation of certain distal femoral andsubtrochanteric fractures.

Other Design FeaturesThe two screw holes closest to thebarrel accept 6.5mm cancellous bonescrews. This enhances stability byallowing:

• Fixation of the most distal condylar fracture fragments with two integralscrews

• Fixation of the most proximal subtrochanteric fracture fragments with two integral screwsSu

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Step OneReduce the fracture with provisionalfixation ensuring that the provisionalfixation does not obstruct the applicationof the screw and side plate. It isimportant that these pins do notinterfere and that a point for lag screwinsertion is selected along the lateralfemur approximately 4cm proximal tothe joint line and in line with the shaftof the femur.

Surgical Technique for 105° Supracondylar Cable Plate

105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°

Step TwoUsing the VHS® Supracondylar DrillGuide, insert a 2.5mm guide pin (P/N 328010) through the 105° hole,approximately 4cm proximal to the jointline. NOTE: The 105° hole is 4cm fromthe tip of the guide. Under imagecontrol, this pin should be orientedparallel to the distal femur and parallelto the anterior aspect of the femur.Placement ofthe centralguide pin inthis positionallows for theside plate tofit flush tothe lateralaspect of thefemoralshaft.

Step FourCalculate the reaming depth, tappingdepth and lag screw length by subtracting10mm from the reading of the depthgauge. A lag screw of that length maybe opened.

NOTE: Reamer setting mustbe 10mm less than readingfrom depth gauge.

Step FiveSet the reamer and ream the distalfemur over the guide pin. Check theposition of the reamer relative to theguide pin. If the pin is inadvertentlyremoved, insert the shaft end of the lag screw to relocate the pin.

Step SixThe cannulated lag screw tap is thenused if the bone is particularly dense.In osteoporotic bone, the tap can beomitted.

Step ThreeAdvance the guide pin through theguide. Because of the trapezoidal shapeof the distal femur, it is important toremember that a guide pin, which onimage intensifier appears cortex tocortex, has most likely penetratedthrough the medial cortex.Through image controland palpation, confirmthat the pin is at themedial cortex.

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Surgical Technique for the 105° Supracondylar Cable Plate (continued)

105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°

Step EightOn occasion, a rongeur may be neededto ensure intimate fit just proximal tothe lag screw hole. A table top platebender may be utilized to furtherconformity.

Step SevenAssemble lag screw inserter and connector to lag screw. Slide this assembly into thesafety inserter/T-handle. Insert into reamed cortex until tip of thread is at medialcortex. Please note that the near (lateral) end of the lag screw will be countersunkapproximately 10mm into the lateral cortex. This allows for later fracture compression,

if needed. Slide T-handle/safety inserter out, leaving hexangularinserter with connector in place. The VHS® Supracondylar Cable Plateis now advanced over the assembly and onto the lag screw. The plateis adjusted with a 3.5mm hex screwdriver to bring the proximal end ofplate to the lateral aspect of the femur.

Step NineA barrel/plate impactor is available toseat the side plate upon the lag screw.

Step TenThe barrel/plate is clamped to the lateralshaft of the femur with the bone clamp.

Step ElevenThe plate is then fixed to the lateralfemur with the 4.5mm self-tappingcortical screws which can be fixed in aneutral or eccentric/load position (Loadequals gold bushing; neutral equalsgreen bushing).

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Cable Technique

Step FourteenOnce the plate and lag screw are inplace, varus/valgus adjustments underimage control are made with a 3.5mmhex screwdriver if required.

NOTE: The VHS®

Supracondylar Cable Plateranges from approximately110° to 85°.

If comminution existswithin the fracture, usuallymedially, then autogenousbone grafting should beperformed.

105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°• 105°

*This portion of the technique will requirethe BMP™ Cable Instruments. SeeTechnique Y-BMT-540.


Step OneHook the passer around the bone andfeed the cable through the cannulationof the passer.* Remove the passer whileleaving the cable in place.

Step TwoPass the cable through the sleeve andmanually pull out the slack. Place thecam bar at the yoke end of thetensioner. This will hold the cams opento accept the cable. Thread the cablethrough the yoke and back through thecams. Turn the T-handle clockwise toclose the cams and tension the cable.

Step TwelveA screw depth gauge is used to measure for correct 4.5mm screw length. 2.0mmstainless steel BMP™ Cables areinstalled, as needed.

Step ThirteenOnce the side plate is applied, thelocking compression screw may beinserted into the lag screw, therebylocking the lag screw within the barrelplate, and compressing fractures, ifneeded.

The distal two holes of theside plate are designed toaccept 6.5mm cancellousbone screws to improve therigidity of the reduction.

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Surgical Technique for 95° Supracondylar Cable Plate

Step ThreeOnce the guide pin is seated, then use the depth gauge to measure theappropriate length. Because of thetrapezoidal shape of the distal femur, it is important to remember that a guidepin, which on image intensifier appearscortex to cortex, has mostlikely penetrated throughthe medial cortex.Therefore, to calculatethe reamer setting andlag screw length,10mm should besubtracted from thedepth gauge reading.

95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°•

Cable Technique (continued)

Step FourSlide the cable cutter over the cable,placing the cutter as close to the crimp as possible. Cut the cable bycompressing the cutter handles.

Step ThreeCenter the crimper jaws over the cablesleeve. Fully compress the handles, onetime to crimp the cable sleeve. It is onlynecessary to crimp once. Additionalcrimping may cause sleeve damage.

Step OneReduce the fracture with provisionalfixation ensuring that the provisionalfixation does not obstruct the applicationof the screw and side plate. It isimportant that these pins do notinterfere and that a point for lag screwinsertion is selected along the lateralfemur approximately 2cm proximal tothe joint line and in line with the shaftof the femur.

Step TwoUsing the VHS® Supracondylar drillguide, insert a 2.5mm guide pin (PartNo. 328010) through the 95° hole,approximately 2cm proximal to the jointline. NOTE: The 95° hole is 2cm fromthe tip of the guide. Under imagecontrol, this pin should be orientedparallel to the distal femur and parallel

to the anterior aspectof the femur.

Placement ofthe centralguide pin

in this positionallows for theside plate to fitflush to thelateral aspectof the femoralshaft.

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Step SevenOccasionally, a small notch has to berongeured in the lateral cortex of thefemoral condyle to allow the plate to lieflush with the bone.


Step EightIf needed, use a plate bending press tobend this plate.

Step NineInsert the lag screw with its insertionassembly and seat it so that it is at thereamer depth approximately 10mm fromthe medial cortex of the distal femur.

The barrel/side plate is now placed overthe lag screw, using the lag screwinserter as a guide.

Step FourUtilize the depth gauge to determine theappropriate length of the lag screw. Withthe guide pin placed to subchondralbone but not through, calculate thereaming depth, tapping depth and lagscrew length by subtracting 10mm fromthe reading of the depth gauge.

NOTE: Reamer setting must be10mm less than reading fromdepth gauge.

Step FiveSet the reamer at 10mm less than themeasured length and ream the distalfemur over the guide pin using imageintensification. Check the position ofthe reamer relative to the guide pin.

Step SixThe cannulated lag screw tap is thenused if the bone is particularly dense.In osteoporotic bone, the tap can beomitted.

95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°•

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Step ThirteenThe screws are applied to the side plateand may be inserted utilizing the hexhandle screw driver, or the powerscrewdriver.

Step FifteenOnce the side plate is applied, thelocking compression screw may beinserted into the lag screw, therebylocking the lag screw within the barrelplate. Install cables, as needed.

Step FourteenImproved valgus reduction can beachieved by adjusting the screw/plateangle without removing the corticalscrew fixation.

95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°• 95°•

The distal two holes ofthe side plate aredesigned to accept6.5mm cancellous bonescrews to improve therigidity of the reduction.

Step TenA barrel/plate impactor is available toseat the side plate upon the lag screw.

Step ElevenThe barrel/plate is clamped to thelateral shaft of the femur with the boneclamp. The plate is then fixed to thelateral femur with the 4.5mm self-tapping cortical screws which can be

fixed in a neutral or eccentric/loadposition. (Load equals gold bushing;neutral equals green bushing).

Step TwelveA screw depth gauge is used to measurefor correct 4.5mm screw length.


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Step OnePredrill lateral femoral cortex with 3/8"diameter twist drill.

Using the VHS® for Subtrochanteric Fractures

Step TwoInsert guide pin using imageintensification. Ideal position is in the inferior-posterior quadrant of thefemoral head and neck. VHS® PinGuide allows for 95° placement.

Step ThreeLength of the guide pin is read directlyoff the measuring depth gauge.

Step FourSet reamer at 10mm LESS THANmeasured length of guide pin. The setvalue is the last number visible when the knurled nut is fully tightened. Usingimage intensification, INSERT THEREAMER UNTIL ALL CUTTING EDGESHAVE PENETRATED THE LATERALFEMORAL CORTEX.

Step FiveTap, if necessary, using the tap and T-Handle. Use centering sleeve.

NOTE: Step 7 uses the safety lag screwinserter. This ensures that during theinsertion of the lag screw, the regularlag screw inserter connection does notstrip its articulation with the lag screw.

Step SixLength of lag screw is 10mm LESS THANmeasured length of guide pin (Step 4,pg. 7). Example: If guide wire length is90mm, use 80mm lag screw. Assemblelag screw on the inserter, held by theconnecting piece. Use safety lag screwinserter and T-Handle inserted throughthe centering sleeve.

Subtrochanteric • Subtrochanteric • Subtrochanteric • Subtrochanteric

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Step TenInstall cables as needed..

Using the VHS for Subtrochanteric Fractures (continued)

Step SevenFollowing removal of the T-Handle, safetylag screw inserter and centering sleeve(leaving the hexagonal inserter andconnector attached to the lag screw),slide the barrel of the plate over thehexagonal inserter until it is well engagedwith the lag screw. Reinsert the T-Handleand safety lag screwinserter over thehexagonalinserter toadjust the plateto the long axisof the femur.Then removeall instrumentsfrom the lagscrew.

Step EightUse a 3.5mm hexagonal screwdriver toadjust the plate flush with the femur.Impact the plate with the plate impactorplaced in the most proximal side platehole—NOT the barrel.

Step NineHold plate to femur with a clamp and fixthe plate with appropriate cortical orcancellous screws. Use the drill guide tocenter the drill in the holes in the plate.

Subtrochanteric • Subtrochanteric • Subtrochanteric • Subtrochanteric

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Compression & Valgus Reduction

The VHS® System allows for compression and

reduction of the fracture after fixation is achieved.

Simply adjust the screw/plate angle without removing

the cortical screw fixation. Then, compress the

fracture with the compression screw.


Adjustment of the Plate

Why not 85°…95°…110°; with the VHS® Supracondylar

System, you are no longer limited by the pre-

established constraints of a fixed neck-shaft angle

device. The plate is positioned and adjusted

intraoperatively to become flush with the femur.


This brochure is presented to demonstrate the surgical technique utilized by Walter Abendschein, M.D., Chevy Chase, Maryland.Biomet, as the distributor of this device, does not practice medicine and does not recommend this or any other surgical technique foruse on a specific patient. The surgeon who performs any implant procedure is responsible for determining and utilizing theappropriate techniques for implanting the prosthesis in each individual patient. Biomet is not responsible for selection of theappropriate surgical technique to be utilized for an individual patient.

VHS® is a trademark of Implant Distribution Network.BMP™ is a trademark of Biomet, Inc. U

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Stainless Steel Cable

VHS® Lag Screw w/Compression Screw

PART. NO. DESCRIPTION

220000115500 12.7 x 50mm

220000115555 12.7 x 55mm

220000116600 12.7 x 60mm

220000116655 12.7 x 65mm

220000117700 12.7 x 70mm

220000117755 12.7 x 75mm

220000118800 12.7 x 80mm

220000118855 12.7 x 85mm

220000119900 12.7 x 90mm

220000119955 12.7 x 95mm

220000220000 12.7 x 100mm

220000220055 12.7 x 105mm

220000221100 12.7 x 110mm

220000222200 12.7 x 120mm

P.O. Box 587, Warsaw, IN 46581-0587 • 219.267.6639 • ©2000 Biomet, Inc. All Rights Reservedweb site: http://www.biomet.com • eMail: [email protected]

Form No. Y-BMT-700/123100/K

4.5 SS Cortical Screw S/TPART NO. DESCRIPTION

1166--223355112200 20mm

1166--223355112222 22mm

1166--223355112244 24mm

1166--223355112266 26mm

1166--223355112288 28mm

1166--223355113300 30mm

1166--223355113322 32mm

1166--223355113344 34mm

1166--223355113366 36mm

1166--223355113388 38mm

1166--223355114400 40mm

1166--223355114422 42mm

1166--223355114444 44mm

1166--223355114466 46mm

1166--223355114488 48mm

1166--223355115500 50mm

1166--223355115522 52mm

1166--223355115544 54mm

1166--223355115566 56mm

1166--223355115588 58mm

1166--223355116600 60mm

6.5 SS Cancellous ScrewPART NO. DESCRIPTION

1166--223355223355 16mm x 35mm

1166--223355224400 16mm x 40mm

1166--223355224455 16mm x 45mm

1166--223355225500 16mm x 50mm

1166--223355225555 16mm x 55mm

1166--223355226600 16mm x 60mm

1166--223355226655 16mm x 65mm

1166--223355227700 16mm x 70mm

1166--223355227755 16mm x 75mm

1166--223355228800 16mm x 80mm

InstrumentsVHS® Super C Drill Guide35-463151Measuring Sleeve35-463100

Lag Screw Inserter35-463102

Power Screwdriver w/Hudson End35-463104

T-Handle35-463106

Reamer35-463108

Plate Impactor35-463110

Tap35-463112

11mm Centering Sleeve35-463114 for #35-463110

Lag Screw Connector35-463116

Safety Lag Screw Inserter35-463118

Parallel Pin Placer35-463120

3.5mm Hex Screwdriver 35-463122

Depth Gauge35-463124

Neutral + Load Drill Guide 35-463125

Replacement Tip 35-463128 for #35-463110

DisposablesDrill Bit Quick Release 35-463018 3.2mm x 5 1/2"35-463020 4.5mm x 5"

Threaded Tip Guide Pin 328010 2.5mm x 9"

Ordering Information

Supracondylar Cable PlatePART NO. DESCRIPTION

220000332255 248mm

*The BMP™ Cable System instruments will be required forthe cerclage portion of the procedure.

PART NO. DESCRIPTION

335500880000 2.0mm x 750mm

Supracondylar Cable Plate - Zimmer Biomet

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