Synthes Dorsal User manual

Distal Radius Plate
Instrument and Implant Set
Surgical Technique

1 DePuy Synthes Distal Radius Plate Instrument and Implant Set Surgical Technique
Indications
For xation of fractures and osteotomies,
including carpal fusions involving the
distal radius.
e Distal Radius Plates
Unique distal articular plate arms:
•Accept 1.8 mm threaded buttress pins that lock into
the threaded plate holes, providing a xed-angle
construct to buttress the articular surface
•2.4 mm self-tapping cortex screws can be used as an
alternative to, or in conjunction with, the 1.8 mm
buttress pins for increased hold and to lag together
dorsal and volar articular fragments
•Provide multiple points of xation and the
ability to buttress small fragments, allowing the
articular surface to be more easily reconstructed
readed holes in the
distal arms accept
1.8 mm buttress pins or
2.4 mm self-tapping
cortex screws.
Features
•Dorsal and volar plates available in right and
left designs
•Ramped edges and low prole plate/screw construct
minimize tendon and soft tissue irritation
•Precontoured for anatomical t
•Cut-to-length design to minimize inventory
•Elongated holes in the proximal shaft allow
for compression
•Available in stainless steel and titanium alloy

Distal Radius Plate Instrument and Implant Set Surgical Technique DePuy Synthes 2
Dorsal Distal Radius Plate
•Precise anatomical contour minimizes the
need to remove Lister’s tubercle
•Two proximal legs allow independent planes
of xation
Volar Distal Radius Plate
•20° AP bend ts the volar surface of
the distal radius
•18° angulation of distal plate arm provides
anatomic t for radial inclination
•10° angulation of threaded holes allows
more distal placement of the plate
10°
Titanium alloy
Titanium alloy

3 DePuy Synthes Distal Radius Plate Instrument and Implant Set Surgical Technique
Implants (stainless steel and titanium)
1.8 mm Buttress Pin
•For use in the distal plate arms in multifragmented
articular fractures, or in poor quality bone
where screw purchase may be compromised
•readed head locks into plate hole to
provide a xed pin-plate construct and
a buttress for the articular surface
•Smooth shaft inserts into bone without
displacing fragments
2.4 mm Self-Tapping Cortex Screw
•For use in the distal plate arms to
provide xation for restoration of the
articular surface
•Used when bone quality is good,
lag screw technique is required,
or large fragments of poor quality
bone are present
•Small cruciform head provides a low
prole when seated into the plate hole
2.7 mm Self-Tapping Cortex Screw
•For use in the proximal plate legs
•Standard self-tapping screws also available
in the DePuy Synthes Mini Fragment Instrument
and Implant Sets [105.488] and [125.488]
201.962–201.980
201.612–201.630
202.810–202.826
402.810–402.826
401.962–401.980
401.612–401.630
MR Information
The Distal Radius Plate Instrument and Implant Set System has not been evaluated for
safety and compatibility in the MR environment. It has not been tested for heating,
migration or image artifact in the MR environment. The safety of the Distal Radius
Plate Instrument and Implant Set System in the MR environment is unknown. Scanning
a patient who has this device may result in patient injury.

Distal Radius Plate Instrument and Implant Set Surgical Technique DePuy Synthes 4
Dorsal Surgical Approach
Place the patient in the supine position with
the hand and arm on a hand table, preferably
radiolucent for uoroscopic imaging.
Make a straight longitudinal incision over the
dorsal radius, between the second and third
extensor compartments, extending 7 to 12 cm.
Open the extensor retinaculum using a
longitudinal incision between the rst and
second extensor compartments as shown below.
Extensor retinaculum
Incision
Compartment 2
Compartment 1

5 DePuy Synthes Distal Radius Plate Instrument and Implant Set Surgical Technique
Dorsal Surgical Approach (continued)
Elevate the second and fourth dorsal
compartments subperiosteally
(as shown in cross-sectional view)
to preserve the integrity of these
compartments.
Note: If the fracture morphology dictates, use
of the additionally available mini lengthening
apparatus [394.08] will provide gentle indirect
reduction of complex fractures and minimize
soft tissue dissection.
Extensor retinaculum
Compartment 4
Compartment 6
Ulna
Cross-sectional view
Compartment 1
Compartment 3
Extensor pollicis longus
Extensor retinaculum
Compartment 5
Mini Lengthening Apparatus
394.08
Radius
Compartment 2
Compartment 3
Extensor pollicis longus
Extensor retinaculum
Take care to elevate and mobilize the third compartment (extensor pollicis
longus tendon) proximally and distally, and translocate it radially for better
access to the fracture site.

Distal Radius Plate Instrument and Implant Set Surgical Technique DePuy Synthes 6
Dorsal Plate Technique
Cut plate
Place the pliers in the right hand. To cut the plate,
open the pliers and slide the plate into the cutting
slot from the left side as shown. e underside
of the plate must be oriented toward the tip
of the pliers. Cut the plate between the holes by
aligning the plate in the center of the cutting slot.
Do not cut through a plate hole. Squeeze the
pliers closed to cut the plate.
Note: Most cases will require removing holes from
each arm and leg of the plate in order to t patient
anatomy and provide sucient stability without
increasing tissue dissection.
Shape template
Temporarily position the bending template [329.599]
over the distal radius. Verify plate length and contour,
then compare it to the distal radius plate.
Note: e bending template
can be used for either
right- or left-hand plates.
Note: If a more proximal plate
placement is desired, it may be
necessary to remove 1–2 mm
of the distal portion of
Lister’s tubercle.
1
2
Bending/
Cutting Pliers
391.962
With pliers open,
insert plate into
left side of
cutting slot
CORRECT: Underside of plate
towards tip of pliers. Cut between
plate holes where handles
interface.
INCORRECT: Top of plate towards
tip of pliers.
Underside
of plate
Cutting slot
Underside
of plate
must be
UP

7 DePuy Synthes Distal Radius Plate Instrument and Implant Set Surgical Technique
#
Dorsal Plate Technique (continued)
Contour distal plate arms
If required, use the bending irons to contour
the plate’s articular arms to t the distal radius.
read a bending iron into a distal-arm plate
hole. read another bending iron into the
adjacent hole and gently spread the irons
apart to create a convex bend.
Note: Contour the plate in small increments
to avoid over-bending and the need to
re-bend. Excessive back-and-forth bending
may weaken or fracture the plate.
3
Contour proximal plate legs
If needed, use the bending pliers to gently
contour the proximal legs to better t the
distal shaft of the radius.
4
Universal
Bending Pliers
391.963
Bending Iron
329.09

Distal Radius Plate Instrument and Implant Set Surgical Technique DePuy Synthes 8
Apply plate
Place the plate on the distal radius and
determine which holes will be used for
xation. e fracture pattern and clinical
situation will determine the specic order
of xation (proximal leg or distal arm).
5
Secure distal arms
6
1.8 mm Threaded
Drill Guide
312.92
6A: To secure the plate with 1.8 mm buttress
pins, screw a 1.8 mm threaded drill guide into
the threaded plate hole until seated.
Note: e threaded drill guide must be used to ensure
the proper drilling angle. Otherwise, the buttress pins
may not thread into the plate holes.
Determine whether 1.8 mm buttress pins
or 2.4 mm self-tapping cortex screws will
be used for xation. A combination of both
implants may be used.

9 DePuy Synthes Distal Radius Plate Instrument and Implant Set Surgical Technique
Dorsal Plate Technique (continued)
Remove the drill guide and use the depth gauge
[319.006] to measure and select the appropriate
length buttress pin.
Note: Be sure to consider the width of any gap between
the bone and plate when determining pin length.
Tightening the screws will close this gap and result in
pin tip protrusion beyond the far cortex, potentially
causing soft tissue irritation.
Using the cruciform screwdriver, push the buttress
pin through the hole and turn until the threaded
portion of the pin head locks into the plate.
Cruciform Screwdriver Shaft
with Holding Sleeve
314.67.97
Secure distal arms (continued)
Using the 1.8 mm drill bit and guide, drill through
both cortices. Buttress pins should be used
bicortically. Exercise caution to avoid excessive
protrusion through the far cortex.
1.8 mm Threaded
Drill Guide
312.92
Handle with
Mini Quick Coupling
311.01
6
1.8 mm Drill Bit
310.510

Distal Radius Plate Instrument and Implant Set Surgical Technique DePuy Synthes 10
Note: Caution should be used in determining the
placement and angulation of the screws so that
they do not interfere with each other or disrupt
the articular surface.
Note: 2.4 mm drill bits are available for use
when AO lag screw technique is desired.
Cruciform Screwdriver Shaft
with Holding Sleeve
314.67.97
Secure distal arms (continued)
6B: To secure the plate with 2.4 mm self-tapping
cortex screws, insert the 1.8 mm end of the 2.4 mm/
1.8 mm drill guide into the plate hole. Using the
1.8 mm drill bit and guide, drill through both cortices.
Measure for screw length using
the depth gauge [319.006].
Note: Correct measurement for
proximal and distal screw lengths
require dierent depth gauges.
Select and insert the appropriate 2.4 mm
self-tapping cortex screw using the
cruciform screwdriver.
Note: As with the buttress pins, be sure to
consider the width of any gap between the
bone and plate when determining screw
length. Tightening the screws will close
this gap and result in screw tip protrusion
beyond the far cortex, potentially causing
soft tissue irritation.
2.4 mm/1.8 mm Drill Guide
312.181
Handle with
Mini Quick Coupling
311.01
6
1.8 mm Drill Bit
310.510

11 DePuy Synthes Distal Radius Plate Instrument and Implant Set Surgical Technique
Drill through both cortices with a 2.0 mm
drill bit. Use the depth gauge [319.06] to
measure for screw length.
Insert the appropriate length 2.7 mm
self-tapping cortex screw using the
small hexagonal screwdriver.
Dorsal Plate Technique (continued)
Secure proximal legs
Place the 2.7 mm universal drill guide
in the plate hole.
7
2.7 mm
Universal Drill Guide
323.26
Small Hexagonal
Screwdriver with
Holding Sleeve
314.02
Load or Buttress Position:
Place the drill guide at either
end of the plate hole without
applying downward pressure
on the spring-loaded tip.
Neutral Position: Fully
press the spring-loaded sleeve
down into the plate hole.
Press
down
Note: 2.7 mm drill bits are available for use when
AO lag screw technique is desired.
2.0 mm Drill Bit
310.19

Distal Radius Plate Instrument and Implant Set Surgical Technique DePuy Synthes 12
Dorsal Closure
Leave compartments 2 and 3 (the extensor pollicis longus,
extensor carpi radialis brevis and extensor carpi radialis
longus tendons) above the extensor retinaculum at the
time of wound closure, to protect soft tissues (see below).
8
Figure 15
Compartment 5
Extensor retinaculum
Compartment 3
Extensor pollicis longus
Compartment 2
Extensor carpi radialis brevis
Extensor carpi radialis longus
Compartment 1
Compartment 6
Ulna
Radius
Compartment 3
Compartment 2
Cross-sectional view
Extensor retinaculum
Extensor retinaculum
Compartment 4

13 DePuy Synthes Distal Radius Plate Instrument and Implant Set Surgical Technique
Volar Surgical Approach
Place the patient in the supine position with the hand
and arm on a hand table, preferably radiolucent for
uoroscopic imaging.
Make a longitudinal incision along the radial border
of the distal forearm. e fracture can then be accessed
between the exor carpi radialis and the radial artery.
e fracture is then exposed through a radial incision
of the pronator quadratus muscle. Its bers are detached
from the surface of the bone and retracted to the ulnar
side. It is imperative not to open the volar wrist capsule,
in order to avoid devascularization of the fracture
fragments and destabilization of the volar wrist ligaments.
When direct visualization is required, it is accomplished
by a dorsal arthrotomy or arthroscopy.

Distal Radius Plate Instrument and Implant Set Surgical Technique DePuy Synthes 14
Follow dorsal surgical technique outlined in steps
1– 7. Use appropriate method for surgical closure
of the incision.
Volar Plate Technique

15 DePuy Synthes Distal Radius Plate Instrument and Implant Set Surgical Technique
Distal Radius Plate Instrument
and Implant Sets:
Stainless Steel [105.505]
Titanium [145.505]
Instruments
Drill Bits, quick coupling, 2 ea.
310.19 2.0 mm, 100 mm
310.26 2.7 mm, 100 mm
310.510 1.8 mm, 100 mm
310.530 2.4 mm, 100 mm
311.01 Handle with mini quick coupling
312.181 2.4 mm/1.8 mm Drill Guide,
for Distal Radius Plates
312.92 1.8 mm Threaded Drill Guide,
for Buttress Pins, 4 ea.
314.02 Small Hexagonal Screwdriver with
Holding Sleeve
314.67.97 Cruciform Screwdriver Shaft with Holding Sleeve
319.006 Depth Gauge, for 2.0 mm and 2.4 mm screws
319.06 Depth Gauge (for
use with 2.7 mm Cortex Screws)
323.26 2.7 mm Universal Drill Guide
329.09 Bending Irons, for Distal Radius Plates, 4 ea.
329.598 Bending Template for Volar Distal Radius Plate
329.599 Bending Template for Distal Radius Plate, 2 ea.
391.962 Bending/Cutting Pliers
391.963 Universal Bending Pliers, 2 ea.
Implants
Stainless
Steel Titanium
201.612 – 401.612 – 2.4 mm Cortex Screws, self-tapping,
201.630 401.630 12 mm–30 mm,* 4 ea.
201.962 – 401.962 – 1.8 mm Buttress Pins, 12 mm–30 mm,*
201.980 401.980 4 ea.
202.810 – 402.810 – 2.7 mm Cortex Screws, self-tapping,
202.826 402.826 10 mm– 26 mm,* 6 ea.
242.472 442.472 Dorsal Distal Radius Plate, right, 2 ea.
242.473 442.473 Volar Distal Radius Plate, right, 2 ea.
242.482 442.482 Dorsal Distal Radius Plate, left, 2 ea.
242.483 442.483 Volar Distal Radius Plate, left, 2 ea.
292.12 492.12 Kirschner Wires, 1.25 mm, pkg. of 10
292.16 492.16 Kirschner Wires, 1.60 mm, pkg. of 10
* 2 mm increments
Also Available
304.563 Titanium Distal Radius Implant Module with lid
305.801 Distal Radius Implant Module with lid
394.08 Mini Lengthening Apparatus
Distal Radius Plate Set
Graphic Case
690.342 (Titanium shown)
690.343 (Stainless Steel)
Tray insert for plates fits
into module; drill bits and
bending irons are stored
underneath.
Note: For additional information, please refer to package insert.
For detailed cleaning and sterilization
instructions, please refer to
www.synthes.com/cleaning-sterilization or
sterilization instructions, if provided.

Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship
and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed.
Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information.
CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.
Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada.
Please contact your sales consultant for items approved for sale in Canada.
Not all products may currently be available in all markets.
© DePuy Synthes 1999–2017. All rights reserved.
DSUS/TRM/0916/1063 4/17 DV
Synthes USA, LLC
1101 Synthes Avenue
Monument, CO 80132
Manufactured or distributed by:
Synthes USA Products, LLC
1302 Wrights Lane East
West Chester, PA 19380
To order (USA): 800-523-0322
To order (Canada): 855-946-8999
Note: For recognized manufacturer, refer to the product label.
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