Synthes LISS DF User manual

LISS DF. The less invasive stabilization
system for distal femur fractures.
Technique Guide
This publication is not intended for
distribution in the USA.
Instruments and implants
approved by the AO Foundation

Introduction
Surgical Technique
Product Information
Bibliography 44
Less Invasive Stabilization System LISS 2
AO Principles 4
Indications 5
Clinical Cases 6
Preoperative Planning 8
Preparation 11
Plate Insertion 16
– Option A Insertion of Self-Drilling Monocortical Screws 20
– Option B Insertion of Self-Tapping Bicortical Screws 25
– Option C Insertion of Periprosthetic Screws 29
– Option: Pulling Device (“Whirly Bird”) 32
Implant Removal 33
Tips 35
Instruments for Minimally Invasive Surgery 36
Implants 37
Instruments 39
Sets 42
Image intensifier control
Warning
This description is not sufficient for immediate application of the instrumentation.
Instruction by a surgeon experienced in handling this instrumentation is highly
recommended.
Processing, eprocessing, Care and Maintenance
For general guidelines, function control and dismantling of multi-part instruments,
as well as processing guidelines for implants, please contact your local sales
representative or refer to: www.synthes.com/reprocessing
Table of Contents
DePuy Synthes 1
Stardrive
Hex drive

2 DePuy Synthes LISS DF Technique Guide
LISS DF. The less invasive stabilization
system for distal femur fractures.
Less invasive procedure
− A radiolucent handle facilitates the
insertion of the plate as well as accu-
rate and hassle-free percutaneous
placement of the screws.
− Additional instrumentation facilitate
indirect reduction.
Anatomically precontoured low
profile plates
–Intended to reduce soft tissue
problems
– No need for plate contouring
Note: Excessive and repetitive bending is not
recommended as it may weaken the plate.
Angular stability
– Prevents screw loosening as well
as primary and secondary loss
of reduction
– Allows early functional mobilization
– As an internal fixator the plate
preserves bone vascularization
– Offers improved purchase in osteo-
porotic bone
Wide variety of screws
– Self-tapping or self-drilling locking
screws
– Periprosthetic locking screws with
blunt tip for periprosthetic fractures
– Cortex screws
– Available in stainless steel and
titanium
Wide variety of anatomically
precontoured plates
– LCP DF and PLT plates
– Available in stainless steel and
titanium alloy (TAN)
– Left and right versions
– LCP DF plates in eight lengths with
5 to 19 holes in the shaft
– Long LCP DF plates (15 to 19 holes)
available in sterile only

DePuy Synthes 3
LISS instrumentation for Stardrive
and Hex drive
The torque-limiting screwdriver, the
screwdriver shaft and the cleaning
instrument are available for screws with
Stardrive and Hex drive.

4 DePuy Synthes LISS DF Technique Guide
In 1958, the AO formulated four basic principles, which have
become the guidelines for internal fixation:1
Anatomic reduction
Fixation of extra- and intra-articular distal femur fractures
with the precontoured LCP DF plates allows for anatomic
reduction.
Stable fixation
Locking holes allow fixation with locking screws for angular
stability. A fixed-angle construct is advantageous in osteo-
porotic bone and multifragment fractures where traditional
screw purchase is compromised.
Preservation of blood supply
The LISS approach with its proven success preserves the
blood supply through a minimally invasive surgical technique
and minimal bone-to-plate contact.
Early, active mobilization
LISS provides stable fracture fixation with minimal trauma to
the vascular supply. This helps improve the environment for
bone healing, accelerating the patient’s return to previous
mobility and function.
AO Principles
1Müller ME, Allgöwer M, Schneider R, Willenegger H (1991) AO Manual of
Internal Fixation. 3rd Edition. Berlin: Springer

DePuy Synthes 5
Indications
LCP DF is indicated for the stabilization of fractures of the
distal femur. These include:
− Distal shaft fractures
−Supracondylar fractures
− Intra-articular fractures
− Periprosthetic fractures
Indications

6 DePuy Synthes LISS DF Technique Guide
Case 1
Male, 20 years old, poly-
trauma, fracture 33-C3
Clinical Cases
Preoperative Follow-up after 6 weeks
Follow-up after 3 months Follow-up after 5 months

DePuy Synthes 7
Case 2
Male, 76 years old, isolated
fracture 33-B2
Preoperative Postoperative
Follow-up after 4 weeks

LCP Distal Femur, right
Titanium St. Steel Holes Length (mm)
422.250 222.250 5 156
422.252 222.252 7 196
422.254 222.254 9 236
422.256 222.256 11 276
422.258 222.258 13 316
04.124.030S 02.124.030S 15 356
04.124.034S 02.124.034S 17 396
04.124.038S 02.124.038S 19 436
ED/F AC/G B
12345678910 11 12 13
FE/A/B
GC
D
034.000.315 AB 30100466 © 09/2010 Synthes, Inc. or its affiliates All rights reserved Synthes is trademark of Synthes, Inc. or its affiliates Ö034.000.315öAB{ä
Synthes GmbH
Eimattstrasse 3
CH-4436 Oberdorf
www.synthes.com
14 15 16 17 18 19
18 19
16 17
14 15
1213
11
10
89
67
45
23
B
1
E
DF
A
CG
0 10 20 30 40 50 60 70 80 90 100 mm
1.10 Magnification
Caution: Due to variable magnification factors in x-rays,
this template should be used for general pre-operative planning only.
For use only with the Original AO System of
Instruments and Implants
LCP Distal Femur, left
ED/F AC/G B
12345678910 11 12 13
DB/A/E
CG
F
Titanium St. Steel Holes Length (mm)
422.251 222.251 5 156
422.253 222.253 7 196
422.255 222.255 9 236
422.257 222.257 11 276
422.259 222.259 13 316
04.124.031S 02.124.031S 15 356
04.124.035S 02.124.035S 17 396
04.124.039S 02.124.039S 19 436
034.000.320 AB 30100466 ©06/2010 Synthes, Inc. or its affiliates All rights reserved Synthes is trademark of Synthes, Inc. or its affiliates Ö034.000.320öABNä
Synthes GmbH
Eimattstrasse 3
CH-4436 Oberdorf
www.synthes.com
14 15 16 17 18 19
1819
16 17
14 15
12 13
10 11
89
67
45
23
CG
B
1
E
DF
A
010 20 30 40 50 60 70 80 90 100 mm
1.10 Magnification
Caution: Due to variable magnification factors in x-rays,
this template should be used for general pre-operative planning only.
For use only with the Original AO System of
Instruments and Implants
8 DePuy Synthes LISS DF Technique Guide
Preoperative Planning
Use the x-ray templates for LCP DF (Art. No. 034.000.315 for
right and 034.000.320 for left femur) to determine the
length of the plate and the position of the screws.
Preoperative planning of lag screws may be necessary.