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LCP Compact Hand. The modularhand system.

Technique Guide

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Image intensifier control

WarningThis description alone does not provide sufficient background for direct use ofthe instrument set. Instruction by a surgeon experienced in handling theseinstruments is highly recommended.

Reprocessing, Care and Maintenance of Synthes InstrumentsFor general guidelines, function control and dismantling of multi-part instruments,please refer to: www.synthes.com/reprocessing

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Table of Contents

Introduction

Surgical Techniques

Product Information

LCP Compact Hand 2

AO Principles 4

Indications 5

Preparation 6

Fracture Reduction and Plate Contouring 7

Screw Insertion 11– Cortex Screws 12– Locking Screws 18

Implant Removal 23

Tips 24

Implants Compact Hand 1.0/1.3 25

Instruments Compact Hand 1.0/1.3 27

Implants LCP Compact Hand 1.5 28

Instruments LCP Compact Hand 1.5 32





Sets 42

Standard Instrument Set for LCP Compact Hand 43

LCP Compact Hand Technique Guide Synthes 1

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2 Synthes LCP Compact Hand Technique Guide

Low profile plates andfully countersunk screws

Anatomicallyprecontoured Rotation Correction Plate LCP combi-hole

Minimizes soft tissue irritation.

Minimizes need for bending. Allows intraoperative inspec-tion of the reduction andcorrection of the rotationalaxis.

Intraoperative choice between compression andangular stable locking.

LCP Compact Hand. The modularhand system.

Adaptable Locking Plates forVarious Indications

The modular LCP Compact Hand System offers a wide rangeof anatomical and adaptable plates. All implants are availablein titanium and stainless steel.

LCP Compact Hand implants are intended for the followingindications:

Compact Hand 1.0/1.3– Fixation of small fragments– Avulsion fractures and fractures of distal and middle

phalanges

LCP Compact Hand 1.5– Fractures, osteotomies and arthrodeses of the phalanges

and metacarpals– Replantations and reconstructions of the phalanges and

metacarpals

LCP Compact Hand 2.0– Fractures of the phalanges, metacarpals, wrist bones and

distal radius (double-plate technique)– Osteotomies and arthrodeses of the interphalangeal joints

LCP Compact Hand 2.4– Fractures of the metacarpals, wrist bones and distal radius

(double-plate technique)– Osteotomies and arthrodeses on the hand

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Part of the LCP Compact Hand System

4 modules, 5 dimensions:– Adaptable plates for different indications – Complete range of implants

1.0 mm1.3 mm1.5 mm (new locking)2.0 mm (locking)2.4 mm (locking)

– Broad range of non-locking, locking and LCP plates to address various fracture patterns.

– The use of locking screws allows creating a fixed-angle construct, which is particularly advantageous in osteopenicbone or in fractures near the joint.

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AO Principles

In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation.1,2 Those principles, as applied to the LCP Compact Hand system, are:

Anatomic reductionAnatomic plate profile assists in reduction and facilitatesrestoration anatomical relationships.

Stable fixationThe combination of conventional and locking screws offersoptimum fixation regardless of bone density. Locking screwscreate a fixed-angle construct, providing angular stability.

Preservation of blood supplyLimited-contact plate design reduces plate-to-bone contactand helps to preserve the periosteal blood supply. Taperedends for submuscular plate insertion preserve tissue viability.

Early, active mobilizationEarly mobilization per standard AO technique creates an environment for bone healing, expediting a return to optimalfunction.

1 Müller ME, Allgöwer M, Schneider R, Willenegger H (1995) Manual of InternalFixation. 3rd, expanded and completely revised ed. 1991. Berlin, Heidelberg,New York: Springer

2 Rüedi TP, Buckley RE, Moran CG (2007) AO Principles of Fracture Management.2nd expanded ed. 2002. Stuttgart, New York: Thieme

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Indications

Compact Hand 1.0/1.3General:– Fixation of small fragments– Avulsion fractures and fractures of the distal and

middle phalangesStraight plate:– Shaft fractures of phalanges Strut plate:– Comminuted fractures and replantations of middle or

proximal phalanges T-plate and Y-plate:– Condylar fractures of phalanges Single cortex screws:– Capturing of fragments with lag screw technique

LCP Compact Hand 1.5– Fracture fixation of the phalanges and metacarpals– Osteotomies– Arthrodeses– Replantations and reconstructions of phalanges and

metacarpals, particularly in osteopenic bone

LCP Compact Hand 2.0– Fractures of the phalanges, metacarpals and wrist bones– Osteotomies and arthrodeses of the interphalangeal joints– Fractures of distal radius (double-plate technique)– Subcapital radial head fractures

LCP Compact Hand 2.4– Fractures of the metacarpal and wrist bones– Fractures of distal radius (double-plate technique)– Osteotomies and arthrodeses on the hand– Subcapital radial head fractures


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1Select implant

Select the plates according to the fracture pattern andanatomy of the bone.

Notes– This surgical technique describes the application of the

LCP Compact Hand system using a Locking CondylarPlate 1.5.

– The plates of the LCP Compact Hand Module 1.5 areavailable either with or without short drill sleeves preassembled to the plate. Plates with preassembled drillsleeves are available sterile only.

Preparation

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1Reduce fracture

Reduce the fracture under image intensification and, if necessary, fix with Kirschner wires or reduction forceps.The reduction method is fracture-specific.

2Trim plate

Instrument

391.962 Bending/Cutting Pliers

Trim the plate to the desired length using bending/cuttingpliers. Remove the burrs.

Fracture Reduction andPlate Contouring


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1

2


3Contour plate

Instruments

347.901 Pliers, flat-nosed, pointed, for Plates 1.0 to 2.4

For LCP Compact Hand 1.5

03.114.003 Bending Pin for LCP Plates 1.5, with thread


329.921 Bending Pin for LCP Plates 2.0, with thread


329.922 Bending Pin for LCP Plates 2.4 and 2.7, with thread

If necessary, contour the plate to suit the anatomical conditions.

Fracture Reduction and Plate Contouring

Standard platesUse bending pins for LCP Plates and thread the pins into thescrew holes to contour the plate. (1)

The plate can also be bent using two flat nosed pliers. (2)

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3Preassembled plates(LCP Compact Hand 1.5 only)Use the non-threaded ends of the bending pins over theshort threaded drill sleeves. (3)

Note: If possible, bend the plate between the locking/LCPholes. Do not deform the threaded part of the holes or over-bend the plate as this may adversely affect insertion of lock-ing screws. Avoid repetitive bending of the plate.


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1

2


4Position plate

Instrument

399.970 Reduction Forceps with Points, ratchet lock, length 130 mm

Position the plate over the reduced fracture and, if necessaryfix provisionally with Kirschner wires or reduction forceps. (1)

Preassembled plates(LCP Compact Hand 1.5 only)When using reduction forceps with points on a preassembledplate, insert one branch of the forceps in the cannulation ofthe short drill sleeve to secure the plate to the bone. (2)

Optional Instrument

398.819 Holding Forceps with Swivel Foot, for Plates 1.3 to 2.4, speed lock

When using the holding forceps with swivel foot to hold theplate, remove the drill sleeves from the surrounding holes sothat the holding forceps sit flush on the plate.

Fracture Reduction and Plate Contouring

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21

Locking screw Cortex screw

Screw Insertion

Determine screw typeDepending on the individual case, cortex and/or lockingscrews may be inserted. Determine where locking screws andwhere cortex screws will be used.

The final screw placement and the use of locking and cortexscrews are determined by the fracture pattern.

If a locking screw is inserted first, ensure that the plate isheld securely to the bone to prevent the plate from spinningas the screw locks into the plate.

OptionIf angularly-stable buttress pins are used, one screw per bonefragment must be inserted additionally.

Note: For further details regarding the application ofLCP systems consult the corresponding technique guide(036.000.019).

LCP combi-hole: Cortex screw in the com-pression portion (1), lockingscrew in the threaded portion of the hole (2)

Locking hole: Cortex or locking screw

Compression hole: Cortex screw only

Elongated compressionhole: Cortex screw only


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Screw InsertionCortex Screws


1Pre-drill screw hole for cortex screw

Instruments

For Compact Hand 1.0/1.3

312.133 Double Drill Guide 1.3/1.0

513.005 Drill Bit � 1.0 mm, length 46/34mm, 2-flute, for Mini Quick Coupling

513.035 Drill Bit � 1.3 mm, length 46/34 mm, 2-flute, for Mini Quick Coupling


312.140 Double Drill Guide 1.5/1.1, for No. 311.150

03.114.007 Drill Bit � 1.1 mm, length 75/61 mm, 2-flute, for Mini Quick Coupling

310.141 Drill Bit � 1.5 mm, length 65/50 mm, 2-flute, for Mini Quick Coupling, Stainless Steel


323.200 Universal Drill Guide 2.0

310.507 Drill Bit � 1.5 mm, with marking, length 96/82 mm, 2-flute, for Mini Quick Coupling






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1

2

Standard platesDrill the screw hole using the drill bit and the correspondingdrill guide /drill sleeve. (1)

Use the following drill diameter for the threaded respectivelythe gliding hole:

� Threaded hole � Gliding hole

Compact Hand 1.3 1.0 1.3




When using a LCP hole, drill the screw hole either neutrallyor off-centre (compression).

Preassembled plates (LCP Compact Hand 1.5 only)Drill the screw hole using the short LCP drill sleeves that arepreassembled to the plate. To drill for a cortex screw in anangle other than 90° to the plate, use the double drill guide.Before using the double drill guide, remove the short drillsleeve. (2)


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1


2Determine screw length of cortex screw

Instruments


319.003 Depth Gauge for Screws � 1.3 to 1.5 mm, measuring range up to 24mm


319.003 Depth Gauge for Screws � 1.3 to 1.5 mm, measuring range up to 24 mm


319.005 Depth Gauge for Screws � 2.0 and 2.4 mm, measuring range up to 40 mm


319.005 Depth Gauge for Screws � 2.0 and 2.4 mm, measuring range up to 40 mm

Standard platesDetermine the screw length with the corresponding depthgauge. (1)


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2

3

Preassembled plates (LCP Compact Hand 1.5 only)Screw length may be measured either with of without theshort drill sleeve assembled to the plate (2, 3). When meas-ured directly through the drill sleeve, subtract 5 mm from thereading to account for the drill sleeve. (3)


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1


3Insert cortex screw

Instruments


314.413 Screwdriver Shaft 1.3, cruciform, with Holding Sleeve, length 62 mm, for Mini Quick Coupling

311.012 Handle, medium, with Mini Quick Coupling


03.114.009 Screwdriver Shaft, Stardrive 1.5, with Holding Sleeve, length 66 mm, for Mini Quick Coupling



314.676 Screwdriver Shaft Stardrive 2.0, with Holding Sleeve, length 66 mm, for Mini Quick Coupling



314.467 Screwdriver Shaft, Stardrive, T8, self-holding

311.430 Handle with Quick Coupling, length 110 mm

Standard platesInsert the self-tapping cortex screw using the correspondingscrewdriver. (1)


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2

3

Preassembled plates (LCP Compact Hand 1.5 only)Remove preassembled short drill sleeves. A tray which canserve as a tool to help removing the short drill sleeves fromthe screwdriver is optionally available. (2)

Insert the self-tapping cortex screw using the correspondingscrewdriver. (3)

Notes– It is recommended to count the short LCP drill sleeves to

ensure they are all removed before closure.– Find tips regarding how to properly pick-up screws with

Stardrive recess on page 24.


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1

2


Screw InsertionLocking Screws

1Pre-drill screw hole for locking screw

Instruments


03.114.001 LCP Drill Sleeve 1.5, for Drill Bits � 1.1 mm

03.114.007 Drill Bit � 1.1 mm, length 75/61 mm, 2-flute, for Mini Quick Coupling


323.034 LCP Drill Sleeve 2.0, with Scale, for Drill Bits � 1.5 mm with marking



323.029 LCP Drill Sleeve 2.4, with Scale up to 30 mm, for Drill Bits � 1.8 mm


Standard platesDrill screw hole through the LCP drill sleeve using the appropriately sized drill bit. (1)

Preassembled plates(LCP Compact Hand 1.5 only)Drill the screw hole using the short LCP drill sleeves that arepreassembled to the plate. (2)

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1

2

2Determine screw length of locking screw

Instruments


319.003 Depth Gauge for Screws � 1.3 to 1.5 mm, measuring range up to 24 mm



319.005 Depth Gauge for Screws, � 2.0 and 2.4 mm, measuring range up to 40 mm


323.029 LCP Drill Sleeve 2.4, with Scale up to 30 mm, for Drill Bits � 1.8 mm

319.005 Depth Gauge for Screws, � 2.0 and 2.4 mm, measuring range up to 40 mm

Standard platesDetermine the screw length either with the correspondingdepth gauge (1) or with the LCP drill sleeve (LCP CompactHand 2.0/2.4, marking on drill bit). (2)

When using the LCP drill sleeve check the length directly onthe scale of the drill sleeve. Then remove the drill sleeve.


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3


Preassembled plates(LCP Compact Hand 1.5 only)Screw length may be measured either with of without theshort drill sleeve assembled to the plate. When measured directly through the drill sleeve, subtract 5 mm from thereading to account for the drill sleeve. (3)


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13Insert locking screw

Instruments


03.114.009 Screwdriver Shaft, Stardrive 1.5, with Holding Sleeve, length 66 mm, for Mini Quick Coupling



314.676 Screwdriver Shaft Stardrive 2.0, with Holding Sleeve, length 66 mm, for Mini Quick Coupling


511.777 Torque Limiter, 0.4 Nm, with AO/ASIF Quick Coupling


314.467 Screwdriver Shaft, Stardrive, T8, self-holding



Standard platesInsert the self-tapping locking screw using the correspondingscrewdriver shaft and the appropriate handle. (1)


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2


Preassembled plates (LCP Compact Hand 1.5 only)Remove preassembled short drill sleeves. Insert the self-tap-ping locking screw using the corresponding screwdriver. (2)

A tray which can serve as a tool to help removing the shortdrill sleeves from the screwdriver is optionally available.

Note: It is recommended to count the short LCP drill sleevesto ensure they are all removed before closure.

LCP Compact Hand 2.0/2.4For mechanical insertion use the corresponding torque limiting attachment.

The torque limiter prevents over-tightening and ensures thatthe locking screws are securely locked into the plate.

Use manual locking to perform the final locking step for2.0 mm and 2.4 mm locking screws. Mechanical insertion isnot recommended.


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Implant Removal

To remove the plate, first unlock all screws then definitely remove them in a second step. If the screws are not unlocked before removal the plate may rotate while the lastscrew is being removed and cause soft tissue damage.


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Pick-up screws with Stardrive recess without holding sleeveSelect the screw and position the corresponding screwdriverperpendicular to the screw.

Pick-up the screw by applying slight axial pressure.

Make sure that the screwdriver remains perpendicular duringscrew extraction.

Pick-up screws with holding sleeveAll screws can also be picked-up with help of the correspon-ding holding sleeves.

Slide the holding sleeve onto the screwdriver, until it clicksinto place. With the holding sleeve jaws open, mount the appropriate screw onto the screwdriver, then push the hold-ing sleeve until it secures the screw.

Note: The holding sleeve covers the head of the screw.

Tips

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Implants Compact Hand 1.0/1.3

Plates

Adaption Plate 1.3, straight

Art. No. Holes Length (mm)

X21.312 12 48

T-Adaption Plate 1.3


X21.333 Shaft 8, head 3 35.5

X21.334 Shaft 8, head 4 35.5

Y-Adaption Plate 1.3


X21.335 Shaft 8, head 3 37

Strut Plate 1.3


X21.320 8 19

X21.321 8 19

X=2: Stainless SteelX=4: Titanium

Implants are available non-sterile or sterile packed. Add suffix “S” to article number to order sterile product.


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Screws

Cortex Screws � 1.0 mm, self-tapping

Art. No. Length (mm)

X00.526 6

X00.527 7

X00.528 8

X00.529 9

X00.530 10

X00.531 11

X00.532 12

X00.534 13

X00.534 14

Cortex Screws � 1.3 mm, self-tapping


X00.686 6

X00.687 7

X00.688 8

X00.689 9

X00.690 10

X00.691 11

X00.692 12

X00.693 13

X00.694 14

X00.695 15

X00.696 16

X00.698 18

Implants Compact Hand 1.0/1.3



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Instruments Compact Hand 1.0/1.3

312.133 Double Drill Guide 1.3/1.0

316.385 Drill Bit � 0.8 mm, length 40/16 mm,2-flute, for Mini Quick Coupling



310.882 Countersink 1.3 to 2.0, length 50 mm,for Mini Quick Coupling

314.413 Screwdriver Shaft 1.3, cruciform,with Holding Sleeve, length 62 mm,for Mini Quick Coupling

314.481 Screwdriver Shaft 1.0, cruciform,with Holding Sleeve, length 62 mm,with Mini Quick Coupling


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Implants LCP Compact Hand 1.5

Plates

LCP Plate 1.5, straight


0X.114.002 4 23

0X.114.004 6 36

Locking Plate 1.5, straight


0X.114.003 6 29

0X.114.005 12 59

Locking T-Plate 1.5


0X.114.006 Shaft 8, head 3 44.5

0X.114.007 Shaft 8, head 4 44.5

Locking Strut Plate 1.5


0X.114.010 Right 8 23

0X.114.009 Left 8 23

Locking Y-Plate 1.5


0X.114.013 Shaft 8, head 3 47

Locking Condylar Plate 1.5


0X.114.014 Shaft 6, head 2 36



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Plates, with Preassembled Short Drill Sleeves



0X.114.502S 4 23

0X.114.504S 6 36

Locking Plate 1.5, straight


0X.114.503S 6 29

0X.114.505S 12 59

Locking T-Plate 1.5


0X.114.506S Shaft 8, head 3 44.5

0X.114.507S Shaft 8, head 4 44.5

Locking Strut Plate 1.5


0X.114.510S Right 8 23

0X.114.509S Left 8 23

Locking Y-Plate 1.5


0X.114.513S Shaft 8, head 3 47

Locking Condylar Plate 1.5


0X.114.514S Shaft 6, head 2 36

Note: The plates with preassembled short drill sleeves areavailable sterile only.



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Screws

Cortex Screw Stardrive, � 1.5 mm,self-tapping


0X.214.106 6

0X.214.107 7

0X.214.108 8

0X.214.109 9

0X.214.110 10

0X.214.111 11

0X.214.112 12

0X.214.113 13

0X.214.114 14

0X.214.115 15

0X.214.116 16

0X.214.118 18

0X.214.120 20

0X.214.122 22

0X.214.124 24




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Locking Screw Stardrive, � 1.5 mm,self-tapping


0X.214.006 6

0X.214.007 7

0X.214.008 8

0X.214.009 9

0X.214.010 10

0X.214.011 11

0X.214.012 12

0X.214.013 13

0X.214.014 14

0X.214.015 15

0X.214.016 16

0X.214.018 18

0X.214.020 20

0X.214.022 22

0X.214.024 24




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Instruments LCP Compact Hand 1.5

03.114.001 LCP Drill Sleeve 1.5, for Drill Bit � 1.1 mm

03.114.003 Bending Pin for LCP Plates 1.5, with thread

03.114.007 Drill Bit � 1.1 mm, lengths 75/61 mm,2-flute, for Mini Quick Coupling

310.141 Drill Bit � 1.5 mm, length 65/50 mm,2-flute, for Quick Coupling, Stainless Steel

310.971 Countersink for Screws � 1.3 and 1.5 mm,Stainless Steel

312.140 Double Drill Guide 1.5/1.1, for No. 311.150

03.114.009 Screwdriver Shaft Stardrive 1.5, with Holding Sleeve length 66 mm, for Mini Quick Coupling

Drill Bits are available non-sterile or sterile packed. Add suffix “S” to article number to order sterile product.

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Plates



X47.344 4 31

X47.345 5 38

X47.346 6 45

X47.347 7 52

X47.348 8 59

X47.360 10 73

Adaption Plate 2.0


X43.091 12 71

LCP Condylar Plate 2.0


X47.349 Shaft 7, head 2 54

LCP Rotation Correction Plate 2.0


X47.354 Shaft 4, head 2 34

X47.355 Shaft 5, head 2 40

LCP T-Plate 2.0


X47.615 Shaft 7, head 3 52.5




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LCP Adaption Plate

Art No. Holes Length (mm)

X47.362 12 81.26

LCP T-Adaption Plate 2.0

Art No. Shaft holes Head holes

X47.351 7 2

LCP Y-Adaption Plate 2.0

Art No. Shaft holes Head holes

X47.350 7 3

Mini Condylar Plate 2.0

Art No.

X43.610 pin left

X43.620 pin left

Mini H-Plate

Art No. Holes

X43.480 4




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Screws



X01.356 6

X01.357 7

X01.358 8

X01.359 9

X01.360 10

X01.361 11

X01.362 12

X01.363 13

X01.364 14

X01.366 16

X01.368 18

X01.370 20

X01.372 22

X01.374 24

X01.375 26

X01.376 28

X01.377 30

X01.378 32

X01.379 34

X01.381 38




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X01.876 6

X01.877 7

X01.878 8

X01.879 9

X01.880 10

X01.881 11

X01.882 12

X01.883 13

X01.884 14

X01.886 16

X01.888 18

X01.890 20

X01.892 22

X01.894 24

X01.896 26

X01.898 28

X01.900 30



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329.921 Bending Pin for LCP Plates 2.0, with thread



310.507 Drill Bit � 1.5 mm, with marking,length 96/82 mm, 2-flute, for Mini Quick Coupling


310.880 Countersink 1.5 to 2.4, length 52 mm,for Mini Quick Coupling

314.676 Screwdriver Shaft Stardrive 2.0,with Holding Sleeve, length 66 mm,for Mini Quick Coupling


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Plates





X47.364 10 83.6

X47.375 5 43.6

X47.377 7 59.6

X47.648 8 68

X47.674 4 36

X47.676 6 52

Adaption Plate 2.4


X49.912 12 72

LCP T-Plate 2.4


X49.615 Shaft 7, head 3 57

LCP Condylar Plate 2.4


X49.679 Shaft 7, head 2 59

LCP Adaption Plate 2.4


X47.366 12 87.9

LCP T-Adaption Plate 2.4

Art. No. Shaft holes Head holes

X49.670 7 2

LCP Y-Adaption Plate 2.4

Art. No. Shaft holes Head holes

X49.669 7 3

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Screws



X01.756 6

X01.757 7

X01.758 8

X01.759 9

X01.760 10

X01.761 11

X01.762 12

X01.763 13

X01.764 14

X01.766 16

X01.768 18

X01.770 20

X01.772 22

X01.774 24

X01.776 26

X01.778 28

X01.780 30

X01.782 32

X01.784 34

X01.786 36

X01.788 38

X01.790 40



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X12.806 6

X12.807 7

X12.808 8

X12.809 9

X12.810 10

X12.811 11

X12.812 12

X12.813 13

X12.814 14

X12.816 16

X12.818 18

X12.820 20

X12.822 22

X12.824 24

X12.826 26

X12.828 28

X12.830 30



Buttress Pin (head LCP 2.4) � 1.8 mm

Art No. Length (mm)

X00.190 12

X00.191 14

X00.192 16

X00.193 18

Optional

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323.029 LCP Drill Sleeve 2.4, with Scale up to30 mm, for Drill Bits � 1.8 mm

329.922 Bending Pin for LCP Plates 2.4 and 2.7,with thread


310.508 Drill Bit � 1.8 mm, with marking,length 96/82 mm, 2-flute, for Mini QuickCoupling


314.467 Screwdriver Shaft, Stardrive, T8,self-holding

310.880 Countersink 1.5 to 2.4, length 52 mm, forMini Quick Coupling

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Sets

01.114.104 LCP Compact Hand 1.5 (Titanium Implants)

01.114.102 LCP Compact Hand 1.5 (Stainless Steel Implants)

182.480 Compact Hand 1.0/1.3 (Titanium Implants)

182.483 Compact Hand 1.0/1.3 (Stainless Steel Implants)





01.110.003 Standard Instrument Set for LCP Compact Hand

182.475 Aditional Instrument Set for Compact Hand

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Standard Instrument Set for LCP Compact Hand



319.003 Depth Gauge for Screws � 1.3 to 1.5 mm,measuring range up to 24 mm

319.005 Depth Gauge for Screws � 2.0 and2.4 mm, measuring range up to 40 mm

347.901 Pliers, flat-nosed, pointed, for Plates 1.0 to 2.4

347.985 Holding Forceps for Cortex Screws � 1.0 to 2.4 mm

391.962 Bending/Cutting Pliers


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03.100.000 Handle, lockable, with Mini Quick Coupling

311.011 Handle, small, with Mini Quick Coupling

311.013 Handle, large, with Mini Quick Coupling

347.981 Holding Forceps for Plates 1.0 to 2.4



Optional

Standard Instrument Set for LCP Compact Hand

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0123All technique guides are available as PDF files at www.synthes.com/lit

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