Related Manuals for Synthes DHS
Summary of Contents for Synthes DHS
- Page 1 DHS/DCS Standard System Surgical Technique Original Instruments and Implants of the Association for the Study of Internal Fixation – AO/ASIF...
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Page 2: Table Of Contents
DHS/DCS Standard System Table of contents Implants Indications/Contraindications ® Plate ® Trochanter Stabilizing Plate ® Plate 95° Assembling the insertion instruments Implant removal Bibliography 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. - Page 3 (a), an aperture for an anti-rotation screw (b), an oval aperture for the DHS/DCS screw (c) and holes for fixation to the DHS plate (d). The scooped section can be adapted to the anatomical contours of the greater trochanter using bending irons or flat-nosed pliers.
- Page 4 It is used in pertrochanteric fractures to compress the femoral fragments on the proximal and distal sides of the fracture. The DHS/DCS compression screw must be used if a DCS plate is applied to the distal femur. – Steel – Inner hexagon for Hexagonal Screwdriver 314.120 and 314.270...
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Page 5: Indications/Contraindications
– Group 31-A2 and A3 fractures, particularly multifragment fractures. The DHS Trochanter Stabilizing Plates (281.869 and 281.870) are viewed as an extension of the DHS plate for stabilizing the greater trochanter and for accepting an anti-rotation screw. Where telescoping is present in the fracture zone, the... - Page 6 Contraindications for DCS plates – Pertrochanteric fractures or trochanteric fractures extending to the subtrochanter. Indications for the DHS locking device The locking device is used if there is a risk of severe shortening of the femoral neck due to telescoping of the head fragment.
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Page 7: Dhs Plate
Fix the fracture temporarily with Kirschner wires. Position the Kirschner wires so that they do not hamper insertion of the DHS/DCS screw and DHS plate. Access The proximal femur is approached laterally. Make a 15–20 cm straight incision starting two fingerwidths proximal... - Page 8 Implants with CCD angles from 130° to 150° are available. Depending on the angle of the implant, the entry point for the DHS/DCS screw is approx. 2.5 – 6.0 cm distal to the innominate tubercle. Locate the DHS angled guide and drill the outer cortex using the Drill Bit 2.0 mm (310.190).
- Page 9 If the guide wire is pulled out during reaming it must be replaced. Push the short DHS Centering Sleeve (338.180) into the drill hole and insert a DHS/DCS screw with the shaft foremost into the centering sleeve. The guide wire can now easily be reinserted back in its original position.
- Page 10 DHS/DCS screw against the femoral shaft. Note: Do not use the DHS/DCS wrench to reduce the fracture as this only allows limited transmission of forces. Remove the DHS/DCS wrench and the long centering sleeve.
- Page 11 The DHS Locking Device (280.960) is used to temporarily block the sliding mechanism. In order to fully countersink the DHS locking device in the DHS plate barrel, the selected DHS/DCS screw must be 10 mm shorter (step 8, page 9) than the reaming depth (in this example 100 mm).
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Page 12: Dhs Trochanter Stabilizing Plate
Insert the DHS/DCS screw and DHS plate as described in steps 1 to 10. If an anti-rotation screw is to be used, the DHS/DCS screw must be inserted in a slightly more caudal direction than for the standard technique. Fix the DHS plate by inserting a cortex screw 4.5 mm... -
Page 13: Dcs Plate 95
DHS/DCS Standard System DCS plate 95° The following surgical technique is illustrated using the example of a fracture of the distal femur. The DCS plate 95° can also be used on the proximal femur using the same technique. To determine the entry point on the proximal femur see step 4, page 13. - Page 14 Determine entry point for the DHS/DCS screw and insert guide wire The entry point for the DHS/DCS screw is on the femoral shaft axis approx. 2 cm from the knee joint. 2 cm Using two Kirschner wires determine the correct alignment of the DHS/DCS screw.
- Page 15 Secure the reamer by tightening the Knurled Nut (338.120). Ream down to the stop. The appropriate DHS/DCS screw is 5 mm shorter than the reaming depth (in this example the DHS/DCS screw is 65 mm long). Remove the DCS triple reamer.
- Page 16 Set the drill to reverse operation to remove the guide wire. Dispose of the guide wire. Tap DCS plate Tap the DCS plate into the predrilled channel using the DHS/DCS Impactor (388.140). Compress the fracture by gentle hammer taps against the impactor. Achieve compression using cancellous bone screws 6.5 mm...
- Page 17 First fix the plate to the femoral shaft with screws. Insert and tighten the compression screw. Particularly if the bone is osteoporotic, insert the compression screw carefully and ensure that the DHS/DCS screw thread is not stripped. Reduce metaphyseal fracture component...
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Page 18: Assembling The Insertion Instruments
Assembling the insertion instruments Insert the short Connecting Screw (338.200) in the Guide Shaft (338.210) and screw into the inner thread of the DHS/DCS screw. The cam and slot must interlock correctly and firmly. Slide the long Centering Sleeve (338.190) over the DHS/DCS Wrench (338.060). -
Page 19: Implant Removal
DHS/DCS Standard System Implant removal First remove the DHS or DCS plate. Advance the DHS/DCS Wrench (338.060) over the DHS/DCS screw. The outer thread of the long Connecting Screw (338.220) must be securely held by the inner thread of the DHS/DCS screw. -
Page 20: Bibliography
Babst R, Renner N, Biedermann M, Rosso R, Heberer M, Harder F, Regazzoni P (1998) Clinical results using the trochanter stabilizing plate (TSP): the modular extension of the dynamic hip screw (DHS) for internal fixation of selected unstable intertrochanteric fractures. J Orthop Trauma 12: 392–9...