Synthes LISS DF Technique Manual
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Synthes LISS DF Technique Manual

Synthes LISS DF Technique Manual

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

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Summary of Contents for Synthes LISS DF

  • Page 1 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...

  • Page 3: Table Of Contents

    Instruction by a surgeon experienced in handling this instrumentation is highly recommended. Processing, Reprocessing, 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 DePuy Synthes...
  • Page 4 LISS DF. The less invasive stabilization system for distal femur fractures. Less invasive procedure Anatomically precontoured low Angular stability − A radiolucent handle facilitates the profile plates – Prevents screw loosening as well insertion of the plate as well as accu- –...
  • Page 5 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. DePuy Synthes...

  • Page 6: Ao Principles

    This helps improve the environment for bone healing, accelerating the patient’s return to previous mobility and function. Müller ME, Allgöwer M, Schneider R, Willenegger H (1991) AO Manual of Internal Fixation. 3rd Edition. Berlin: Springer DePuy Synthes LISS DF Technique Guide...

  • Page 7: Indications

    Indications 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 DePuy Synthes...

  • Page 8: Clinical Cases

    Clinical Cases Case 1 Male, 20 years old, poly- trauma, fracture 33-C3 Preoperative Follow-up after 6 weeks Follow-up after 3 months Follow-up after 5 months DePuy Synthes LISS DF Technique Guide...
  • Page 9 Case 2 Male, 76 years old, isolated fracture 33-B2 Preoperative Postoperative Follow-up after 4 weeks DePuy Synthes...

  • Page 10: Preoperative Planning

    04.124.031S 02.124.031S For use only with the Original AO System of 04.124.035S 02.124.035S Instruments and Implants 04.124.039S 02.124.039S Synthes GmbH Eimattstrasse 3 CH-4436 Oberdorf www.synthes.com DePuy Synthes LISS DF Technique Guide...
  • Page 11 6. Determine the screw lengths for the screw holes A to G using the table below. The positions A to G are indicated on the x-ray template and on the LISS DF insertion guide. Length of locking screws (mm) Hole...
  • Page 12 The real condyle width (RCW) is therefore 83 mm. The screw lengths are therefore: Screw hole Screw length (mm) Important: The proper placement of the plate on the condyle is essential to ensure the correct screw length. DePuy Synthes LISS DF Technique Guide...

  • Page 13: Preparation

    Modular Insert, for Modular Screw Rack, for Screws 6.5 mm, size 1/3, without Contents, Vario Case System 68.122.054 Modular Screw Rack, with Drawer, Measuring Block and Lid, length 200 mm, height 115 mm, size 1/2, without Contents, Vario Case System DePuy Synthes...
  • Page 14 In very short distal fragments, it is recommended to flex the lower leg to approximately 60°. This also reduces the traction force of the gastrocnemius muscle. DePuy Synthes LISS DF Technique Guide...
  • Page 15 LISS instruments. Then, screws can be inserted by applying the technique described in the LCP Instructions for Use 036.000.019. Insert the fixation bolt in hole A of the insertion guide. Place the insertion guide on the three-point locking mechanism of the plate. DePuy Synthes...
  • Page 16 Note: To prevent tissue ingrowth and facilitate implant removal, close the unoccupied screw holes with screw hole inserts prior to inserting the plate. Use the torque-limiting screwdriver. The optimum torque is reached after one click. DePuy Synthes LISS DF Technique Guide...
  • Page 17 Intra-articular fractures In intra-articular fractures, an anterolateral arthrotomy provi- ding good control of the reduction is recommended. This arthrotomy also allows a subsequent insertion of the plate and can be used to insert lag screws from medially. DePuy Synthes...

  • Page 18: Plate Insertion

    Consequently, the insertion guide shows an internal rotation of about 10°. This occurrence is also visible in the AP view of an image intensifier. The plate must lie flat up against the condyle to ensure an optimal fit on the bone. DePuy Synthes LISS DF Technique Guide...
  • Page 19 Option: Check plate position with a Kirschner Wire Instrument 292.699 Kirschner Wire 2.0 mm with threaded tip Use a Kirschner wire to check the correct position of the proximal part of the plate on the bone. DePuy Synthes...
  • Page 20 Carefully check the position of the plate and the length of the reduced injured limb. Once the reduction has been successfully completed and the plate has been positioned correctly, the locking screws can be inserted. DePuy Synthes LISS DF Technique Guide...
  • Page 21 Once the correct position is deter- mined, the plate can be locked temporarily with a Kirschner wire through the fixation bolt. Note: The aiming device can be used from hole 3 to hole 13. DePuy Synthes...

  • Page 22: Option A Insertion Of Self-Drilling Monocortical Screws

    Then insert a screw in the proximal fragment. Important: If a screw has to be removed and reinserted, use the torque-limiting screwdriver and not the power tool. DePuy Synthes LISS DF Technique Guide...
  • Page 23 (324.033) or the drill bit 4.3 mm (310.423). − The insertion of the initial screw tends to push the bone medially, especially in case of dense bone and/or unstable reductions. The pulling device helps to solve this problem (see page 32). DePuy Synthes...
  • Page 24 Kirschner wires, leaving the centering sleeve in place, and round down to the nearest screw length. This will ensure that the tip of the screw will not protrude through the me- dial cortex. DePuy Synthes LISS DF Technique Guide...
  • Page 25 LISS insertion guide. To insert the screw, start the power tool slowly, increase the speed and then reduce it again before the screw is fully tightened. Advance the screws into the bone until the second bulge of the screwdriver dis- appears in the drill sleeve. DePuy Synthes...
  • Page 26 − Should the screwdriver be difficult to remove after insertion, disconnect it from the power tool and remove the drill sleeve. After reconnecting the screwdriver to the power tool, withdraw the screwdriver from the screw. DePuy Synthes LISS DF Technique Guide...
  • Page 27 Drill Bit 4.3 mm, length 280 mm Remove the trocar and thread the drill sleeve 7.2/4.3 into the plate hole through the drill sleeve for LISS insertion guide. Carefully drill the screw hole using the 4.3 mm drill bit. DePuy Synthes...
  • Page 28 Option: The insertion of the initial screw tends to push the bone medially, especially in the case of dense bone and/or unstable reductions. The pulling device helps to solve this problem (see page 32). DePuy Synthes LISS DF Technique Guide...
  • Page 29 LISS insertion guide. To insert the screw, start the power tool slowly, increase the speed and then reduce it again before the screw is fully tightened. Advance the screws into the bone until the second bulge of the screwdriver dis- appears in the drill sleeve. DePuy Synthes...
  • Page 30 Torque-limiting Screwdriver Stardrive, T25 324.019 Stopper Insert and lock the screw with the torque-limiting screwdriver through the drill sleeve for LISS insertion guide. Insert a stopper into the LISS insertion guide after screw insertion. DePuy Synthes LISS DF Technique Guide...
  • Page 31 324.022 Drill Sleeve for LISS Insertion Guide 324.027 Trocar, length 162 mm, for No. 324.022 Make a stab incision for plate holes requiring a periprosthetic screw and insert the drill sleeve for LISS insertion guide and the trocar. DePuy Synthes...
  • Page 32 Read the drilled depth directly from the laser mark on the drill bit. Remove both drill bit and drill sleeve 7.2/4.3. Note: Replacement stop rings can be ordered from the local Synthes representative. DePuy Synthes LISS DF Technique Guide...
  • Page 33 – If the measured drill depth is shorter than 8 mm, do not use periprosthetic screws. – Never place a screw which is longer than the measured length, as this will result in stripping of the thread in the bone and loss of screw anchoring. DePuy Synthes...

  • Page 34: Option: Pulling Device ("Whirly Bird")

    Note: It is important to monitor the advance of the screw tip carefully when inserting the pulling device. Stop the power tool before the pulling device is seated on the plate. Failure to do so may result in stripping the thread in the bone. DePuy Synthes LISS DF Technique Guide...

  • Page 35: Implant Removal

    (see step 1 on page 16). Make stab incisions and use the torque-limiting screwdriver to unlock all screws manually. In a second step, completely remove all screws with a power tool. DePuy Synthes...
  • Page 36 If the screws cannot be removed with the screwdriver, please consult the separate Synthes publication “Screw Extraction Set. Instruments for removing Synthes screws.” (Art. No. 036.000.918), which explains in detail how screws with a damaged recess as well as how broken and jammed screws can be removed.

  • Page 37: Tips

    To ensure stability of the construct, the most proximal screw should be inserted last, just before removing the insertion DePuy Synthes...
  • Page 38 − Adjustable blade for free choice of insertion angle and blade length − Available in two sizes: for small and large fragment plates For additional information see the separate Synthes publica- tion on the Soft tissue retractor (Art. No. 036.000.127). DePuy Synthes...

  • Page 39: Implants

    02.124.031S 04.124.031S left 02.124.034S 04.124.034S right 02.124.035S 04.124.035S left 02.124.038S 04.124.038S right 02.124.039S 04.124.039S left Note: Long LCP DF plates from 15–19 holes are available in sterile only. Add suffix ”S” to article number to order sterile product. DePuy Synthes...
  • Page 40 0X.221.518 X = 2: stainless steel X = 4: TAN 422.390 Screw Hole Insert 5.0 mm All screws are available nonsterile and sterile packed. For sterile implants add suffix “S” to the article number. DePuy Synthes LISS DF Technique Guide...
  • Page 41 324.044 Stabilization Bolt for LISS Insertion Guide, length 156 mm 324.027 Trocar, length 162 mm, for No. 324.022 324.033 Pulling Device 4.0 mm, length 240 mm, for LISS 310.423 Drill Bit 4.3 mm, length 280 mm, for LISS DePuy Synthes...
  • Page 42 161 mm, for No. 324.022 324.019 Stopper for LISS Insertion Guide 324.056 X-ray Calibrator, length 50 mm 324.053 Cleaning Instrument for Screw Head, length 202 mm 324.253 Cleaning Instrument for Screw Head Stardrive, T25, length 202 mm DePuy Synthes LISS DF Technique Guide...
  • Page 43 Kirschner Wire 2.0 mm with threaded tip, length 280 mm, Stainless Steel 324.037 LISS Measuring Device for Kirschner Wires 2.0 mm, length 121 mm, for No. 292.699 324.007 Drill Sleeve 7.2/4.3, length 130 mm, for LISS Periprosthetic Screws DePuy Synthes...

  • Page 44: Sets

    Note on long plates: The LCP DF plates with 15 to 19 holes are available in sterile only and not part of a set. Therefore these articles have to be ordered as single items (for article numbers refer to page 37). DePuy Synthes LISS DF Technique Guide...
  • Page 45 Screw Rack, size ⁄ , without Contents, Vario Case System 68.000.128 Auxiliary Module, size ⁄ , height 14 mm, for Screw Rack, size ⁄ 68.000.129 Auxiliary Module, size ⁄ , height 28 mm, for Screw Rack, size ⁄ DePuy Synthes...
  • Page 46 Schandelmaier P et al. (2001) Internal Fixation of Distal Fe- mur Fractures with the Less Invasive Stabilizing System (LISS). Orthopedics and Traumatology 9:166–184 Schütz M et al. (2003) Revolution in plate osteosynthesis: new internal fixator systems. Journal of Orthopedic Science 8:252–258 DePuy Synthes LISS DF Technique Guide...
  • Page 48 Synthes GmbH Eimattstrasse 3 4436 Oberdorf Switzerland This publication is not intended for distribution in the USA. Tel: +41 61 965 61 11 Fax: +41 61 965 66 00 All surgical techniques are available as PDF files at 0123 www.depuysynthes.com...

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