VA-LCP DISTAL RADIUS SYSTEM Your choice for a consistent outcome

Literature review

Aim of this presentation

� Summarize the benefits of our distal radius system

� Provide clinical and biomechanical evidence to support our portfolio

VA-LCP DISTAL RADIUS SYSTEMSystem Overview

VA-LCP DISTAL RADIUS SYSTEMA LONG HERITAGE IN PLATING SOLUTIONS

� DePuy Synthes launched its first locking distal radius plate in the nineties.

� Long plating heritage with over 2 milliondistal radius plates implanted.

� Strong collaboration with the AO which focuses on research and education.

Launched in 1996

> 2 Million sold

VA-LCP DISTAL RADIUS SYSTEMSIMPLE AND VERSATILE

� A few common instruments allow to utilize a broad range of implants

Two-Column PlateVersatile choice for

various fracture patterns

Volar Rim PlateDesigned for difficult-to-

treat distal fractures

Dorsal PlatesFor fragment specific treatment of dorsally displaced fractures

Extra-Articular PlateCore option for extra-

articular fractures

VA-LCP DISTAL RADIUS SYSTEMYOUR OPTIONS FOR A SUCCESSFUL OUTCOME

� A lot of options beyond the standard plates, screws and instruments

CHOICES FOR DRILLING

MATERIAL CHOICESADDITIONAL SCREW OPTIONS

CONVENIENCE IN REDUCTION

VA-LCP DISTAL RADIUS SYSTEMIN A NUTSHELL

� One complementary plating system

� Simple and versatile

� Built on a long clinical history in distal radius plating

� Offers a lot of options

VA-LCP DISTAL RADIUS SYSTEMClinical and biomechanical evidence

VA-LCP Two-Column Plate

Anatomical fit of seven different palmar distal radius plates(Oppermann et al, 2014)

► Intent: Compare the anatomical fit of different, pre-contoured palmar distal radius

plates.

► Methods: The anatomical fit of seven different types of palmar distal radius plates from

Medartis, Synthes and Königsee were investigated in 25 embalmed human

cadaveric radii.

► Results: ‘In our study, ‘…’, the Synthes 2-column implant yielded the best fitting

result. A low profile and optimized anatomical pre-contouring

minimizes irritation of the surrounding soft tissues and should be

considered with plate design and implant choice.’

The VA-LCP Two-Column Plate offers the best anatomical fit of the sample

group.

Pictures taken from : Oppermann et al, 2014

VA-LCP Volar Rim Plate

► Intent: Determine the percentage of AO B3 distal radius fractures [volar shearing]

that lose reduction after volar plate fixation.

► Methods: AO B3.3 fractures were treated either with DePuy Synthes VA-LCP TCP,

Stryker VariAx or Biomet DVR distal radius plates.

► Results: ‘Patients with AO B3.3 fractures with less than 15 mm of lunate facet

available for fixation, or greater than 5 mm of Initial lunate subsidence, are

at risk for failure even if a volar plate is properly placed.’

‘We recommend additional fixation to maintain reduction of the small volar

lunate facet fracture fragments ‘…’.

Standard volar distal radius plates bear some risk for loss of reduction in volar

shearing fractures. The Volar Rim plate is particularly designed for the

treatment of such fracture patterns.

Pictures taken from : Beck, 2013, Stryker, 2014, Biomet, 2014

Volar plate fixation failure for volar shearing distal radius

fractures with small lunate facet fragments (Beck, 2014)

VA-LCP Extra-Articular Plate

► Intent: Compare fixed-angle single-row plates with variable-angle multi-row plates

to clarify the optimal number of locking screws.

► Methods: Five different plate-screw combinations of three manufacturers (Stryker,

DePuy Synthes, Hofer) underwent a cyclic and load-to-failure testing on a

bone with an AO type C2 fracture.

► Results: ‘The results of our study showed no significant differences between volar

locking distal radius plates which have a single distal screw row and

plates which incorporate two distal screw rows, regardless of whether one

or both screw rows have been filled.’

One-row angular stable plates are equivalent to double-row plates in terms

of construct rigidity and resistance against loss of reduction. If the fracture

pattern allows for it, single-row plates like the VA-LCP Extra-articular Plate

provide sufficient construct strength.

Pictures taken from : Drobetz, 2012

More is not necessarily better. A biomechanical study on distal

screw numbers in volar locking distal radius plates (Drobetz, 2012)

VA-LCP Dorsal Plates

► Intent: Determine, in a simple intra-articular fracture model, whether dorsal or

volar constructs would be more stable.

► Methods: The biomechanical properties of a VA-LCP Two-Column Plate and two VA-

LCP Dorsal Distal Radius Plates (double plate technique) were evaluated.

► Results: ‘Biomechanically, volar plating with a modern variable angle plate [ VA-LCP

Two-Column Plate] is equivalent to dorsal plating with two modern variable

angle plates [VA-LCP Dorsal Distal Radius Plates].’

VA-LCP Dorsal Distal Radius Plates applied as a double plate construct are

as stable as a VA-LCP Two-Column Plate.

Pictures taken from : Rausch, 2011

Volar versus dorsal latest-generation variable- angle locking

plates for the fixation of AO type 23 C2.1 distal radius fractures:

A biomechanical study in cadavers (Rausch, 2011)

Variable Angle Technology

► Intent: Investigate the strength of polyaxial locking interfaces of distal radius plates.

► Methods: The strength of 0˚ and 10˚ screw locking angle was determined for three

polyaxial distal radius plates (Synthes VA-LCP TCP , Stryker VariAx, Königsee

Palmar Classic).

► Results: ‘‘…’ the Locking mechanism of the Two-Column Plate from the Company

Synthes which is based on a interlocking of various treaded columns in the plate

hole with the conical screw head seems to be the most sufficient. The failure

mode was always screw breakage and not failure of the locking mechanism as

observed with the other systems.’

The thread-to-thread locking mechanism as in the VA-LCP Two-Column Plate is

superior to competitive variable angle technology.

Pictures taken from : Rausch, 2011, Stryker, 2014, Königsee, 2014

Comparative study on the strength of different mechanisms of

operation of multidirectionally angle-stable distal radius plates (Rausch, 2011)

VA-LCP Distal Radius System

► Intent: Analysis of single case of DRUJ dysfunction following volar plate fixation.

► Methods: The outcome of a patient that underwent bilateral distal radius ORIF by

identical approach and implant choice.

► Results: ‘Volar Locking plates are not a panacea to all distal radius fractures. Plate

selection and fixation technique must include consideration of patient

anatomy.’ Restoration of patient-specific anatomy is crucial to the

management of distal radius fractures.

A broad portfolio of different plate shapes and sizes allows to account for the

varying wrist anatomies and fracture patterns. DePuy Synthes offers the

broadest VA-LCP distal radius portfolio with a variety of different plates.

Pictures taken from : Jones, 2014

One size does not fit all: Distal radioulnar joint

dysfunction after volar locking plate fixation (Jones, 2014)

Summary

► VA-LCP Two-Column Plate offers the best anatomical fit of the sample group.

► Standard volar distal radius plate bear some risk for loss of reduction in volar shearing

fractures which emphasizes the need for a Volar Rim Plate to treat these fractures.

► One-row angular stable plates are equivalent to double-row plates in terms of construct rigidity

and resistance against loss of reduction. Hence, single-row plates like the VA-LCP Extra-

articular Plate provide sufficient construct strength.

► VA-LCP Dorsal Distal Radius Plates applied as a double plate construct are as stable as a

VA-LCP Two-Column Plate.

► The thread-to-thread locking mechanism as in the VA-LCP Two-Column Plate is superior

to competitive variable angle technology in strength.

► One plate does not fit all. Hence, a broad portfolio of different plate shapes and sizes allows

to account for the varying wrist anatomies and fracture patterns of the patients.

Bibliography

► Beck, J.D. et al (2014) Volar Plate Fixation Failure for Volar Shearing Distal Radius

Fractures With Small Lunate Facet Fragments. J Hand Surg Am. 39 (4), 670-678

► Jones, C.W. Lawson, R.D. (2014) One Size does not fit all: Distal Radioulnar Joint

Dysfunction after Volar Locking Plate Fixation. J Wrist Surg. 3, 42-45

► Drobetz, H. et al (2013) More is not necessarily better. A biomechanical study on distal

screw numbers in volar locking distal radius plates. Injury. 44 (4), 535-539

► Oppermann, J., et al (2014) Anatomical fit of seven different palmar distal radius plates.

Arch Orthop Trauma Surg. 134 (10), 1483-1489 .

► Rausch S. et al (2011) Comparative Study of the Strength of Different Mechanisms of

Operation of Multidirectionally Angle-Stable Distal Radius Plates. Z Orthop Unfall. 149,

694-698

Bibliography

► Rausch S. et al (2013) Volar versus dorsal latest-generation variable-angle locking plates

for the fixation of AO type 23C 2.1 distal radius fractures: A biomechanical study in

cadavers. Injury Int J Care Injured. 44, 523-526.

Pictures

► Stryker (2014) Variax Distal Radius Plating System. [Online] Available from:

http://www.stryker.com/stellent/groups/public/documents/web_prod/058336.pdf

[Accessed 14th October 2014].

► Biomet (2014) DVR Anatomic Volar Plating System [Online] Available from:

http://www.stryker.com/stellent/groups/public/documents/web_prod/058336.pdf

[Accessed 14th October 2014].

► Königsee (2014) Produkte für die Humanmedizin [Online] Available from:

http://www.koenigsee-implantate.de/human_de.php?id=127&=Weitere-

Kleinfragment-Radiusplatten-fuer-Schrauben-D-35-mm [Accessed 14th October

2014].

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