• Reduce fracture under imaging using Kirschner wires or reduction forceps if necessary.

NOTE: The reduction method will depend on patient anatomy and fracture pattern.

1. Select a drill sleeve and drill bit

Lag screws may be inserted using the Reduction Forceps (03.130.291). The associated drill sleeves and drill bits use a color-coded stripe system. The colors on the drill sleeves and drill bits correspond to the screw size. A single stripe indicates that the drill sleeve or drill bit is used for a threaded hole; a double stripe indicates that the drill sleeve or drill bit is used for a gliding hole. 
 

2. Assemble drill sleeve to forceps

Press the drill sleeve into the barrel of the Reduction Forceps so that the sleeve is fully seated and a click is felt. 

3. Attach the reduction forceps to the bone

Once in place, close the Reduction Forceps to the desired tightness. The forceps is designed to remain in place after the handles are released.

4. Drill threaded and gliding hole

Threaded Hole: Using the drill sleeve, drill the far fragment using a drill bit for the threaded hole. 

Gliding Hole: Using the drill sleeve, drill the near cortex, so that the thread of the screw does not obtain purchase. Drill so that the lag screw is perpendicular to the fracture plane. An alternative technique is to drill for the gliding hole first and then drill for the threaded hole.

5. Countersink (optional)

Remove the Drill Sleeve from the forceps. Attach the Countersink (03.130.215) to the Screwdriver Handle. Countersink, if desired.

6. Measure

• Insert the Depth Gauge (03.130.250) through the barrel of the forceps, to determine the screw length needed. The Depth Gauge is designed for one-handed use. 

• The black line indicates the screw length. Optional Technique: Use the scale on the back of the Depth Gauge to measure for screw length.

NOTE: The depth gauge consists of 2 pieces and is designed to be disassembled for cleaning. Slide the tip of the hook so it is fully inside the black outer body. Press the tab on the back of the sliding hook and remove it from the black outer body. 
 

7. Insert Cortex Screw

Assemble the screwdriver shaft to the Screwdriver Handle. 
For 1.3 mm and 1.5 mm screws, use the T4 STARDRIVE Screwdriver Shaft (03.130.010, with yellow and red bands). 
The tip of the T4 screwdriver is gold-colored.

For 2.0 mm screws, use the T6 STARDRIVE Screwdriver Shaft (03.130.020, with blue band). 
 
The screwdriver and screws are designed to be self-retaining. To attach the screw to the screwdriver, position the screwdriver directly in line with the screw with no tilting. 
 
Ensure that the screwdriver tip engages the star-shaped recess in the screw. It may be necessary to rotate the screwdriver up to a quarter turn to fully align the star-shaped screwdriver tip into the screw recess.

NOTE: Prior to sterilization of the Reduction Forceps, Soft Lock, add one drop of DePuy Synthes Autoclavable Oil (519.97) to instrument joints and ratchet mechanisms.

Apply firm axial pressure downwards to ensure that the screw is fully seated before removing the screw from the implant module.

Remove the screw from the implant module in a straight vertical position.
Using the screwdriver, place the screw on the scale of the implant module, to confirm the length of the screw.

Insert the screw through the barrel of the reduction forceps.

Confirm screw placement under radiographic imaging.

Once the screw has been inserted, remove the forceps from the bone.

For 1.3 mm, 1.5 mm, and 2.0 mm cortex screws used as independent lag screws, use a double-ended drill sleeve and corresponding drill bit. Drill bits and drill guides are color-coded. Drill bits are available with several different couplings (see item listing). Etch lines on drill bits are spaced 5 mm apart. A K-wire may be used through the double drill sleeve. 
 

DISCLAIMER: The following steps are summarized and do not constitute full operative instruction. Please refer to the package insert(s) or other labeling associated with the devices identified in the full surgical technique for additional information.

For additional product information, please visit: Variable Angle Locking Hand System
To find related video content for Trauma, Hand & Wrist and Fixation Techniques, please visit: JnJ Institute Video Library

1. Trim Plate

If desired, plate cutters can be used to adjust the length of the plate. The Plate Cutter (03.130.271) is designed to cut all plates within the Variable Angle Locking Hand System.

Precaution: To prevent sharp edges from causing soft tissue irritation, place the plate top side up on the cutters to ensure any sharp edges will angle towards the underside of the plate. 

Trim the plate to the desired length using the cutters, and remove any burr by using the rasp on the side of the cutters.

• The Plate Cutter creates a straight cut. 

• The Plate Cutter, In-Line (03.130.270) is designed to cut plates with straight shafts within the Variable Angle Locking Hand System.

Note: When using the Plate Cutter, In-Line, insert the plate top side up in its respective color coded area on the cutter. This is to ensure that the plate holes are protected during cutting. Insert the plate so that the section of the plate to be implanted is located on the side that is color-coded. Ensure that the plate is correctly inserted on the post. 

• This cutter is designed to be used to cut straight shafts of plates within the Variable Angle Locking Hand System.

Note: The Plate Cutter is designed with 2 silicone inserts in the jaws to hold the cut segment of the plate after cutting. The Plate Cutter, In-Line, is designed with 1 silicone insert. Remove the silicone insert(s) prior to cleaning and sterilization.

The Plate Cutter, In-Line, creates a cut with a rounded profile. Remove any burr by using the rasp on the side of the cutters.

Precaution: Reverse bending or use of the incorrect instrumentation for bending may weaken the plate and lead to premature plate failure (e.g., breakage). Do not bend the plate beyond what is required to match the anatomy. 

• The Plate Bending Pins (03.130.140) are designed to be used with the 1.3 mm locking plates. 

Bend adjacent holes in the plates.

Precaution: Avoid reverse bends and sharp bends (sharp bends include a single out-of-plane bend between two adjacent holes of >30°). Reverse or sharp bends may weaken the plate and lead to premature plate failure.

3. Position Plate

Position the plate over the reduced fracture using the preferred positioning method. Either K-wires or forceps may be used to hold the plate in place. K-wires can be used in the plate K-wire holes if present. 

Optional Instrument

• As an alternative, the Plate Holding Forceps may be used to hold the plate to the bone. 
• Insert the ball portion through a plate hole to the bone. 
• The curved arm wraps around the underside of the bone through the incision. 
• Close the forceps to the desired tightness to hold the plate. 
• The forceps is designed to remain in place after the handles are released. 

Precaution: When using the Plate Holding Forceps, avoid the tendons and avoid applying excessive pressure.

Note: Prior to sterilization of the Plate Holding Forceps, Soft Lock, add one drop of DePuy Synthes Autoclavable Oil (519.97) to instrument joints and ratchet mechanisms. 

5. Drill

• Select a drill bit based on the size of the screw. 

TIP: Drill bits are color-coded to the size of the associated screw. 

Note: The fracture pattern will dictate the optimal screw placement. Fracture pattern will determine the order of screw insertion. 

• In all cases, make sure the plate is in the correct position and flush with the bone. 

• If placing a plate on the condyle, be cognizant of reducing and restoring the articular surface. 

REFERENCE CHART
 

6. Select a Drill Guide and Drilling Technique

• Variable Angle Locking Double Drill Guide—with Cone (03.130.220, 03.130.320) Variable Angle Locking Screws can be inserted using 2 different techniques, depending on which end of the drill guide is used

• Verify the drill bit angle and depth under radiographic imaging to ensure the desired angle has been achieved. 

• If necessary, drill at a different angle and verify again under imaging. 

Precaution: Avoid redrilling, especially in osteopenic bone. 

Variable Angle

• Fully insert the variable angle end of the drill guide into the Variable Angle Locking hole. 

When drilling, the tip of the drill guide should remain fully seated in the hole. 

Drill the hole with the drill bit at the desired angle within the cone by positioning the drill bit. 

Precaution: When using the variable angle end of the guide, it is important to not angulate more than 15° from the central axis of the screw hole. Over angulation could result in difficulty locking the screw. 

Nominal Angle (Coaxial)

• Fully insert the coaxial end of the drill guide into the Variable Angle Locking hole and drill.

Drill for Variable Angle Screws—Freehand

Variable Angle Locking Double Drill Guide— Freehand (03.130.221, 03.130.321) Variable Angle Locking Screws can be inserted using 2 different techniques, depending on which end of the drill guide is used

Fully insert the variable angle end of the drill guide into the Variable Angle Locking hole. 

Drill the hole with the drill bit at the desired angle by positioning the drill guide in the hole. 

Precaution: When using the variable angle end of the guide, it is important to not angulate more than 15° from the central axis of the screw hole. Over angulation could result in difficulty locking the screw. 

Nominal Angle

• Fully insert the coaxial end of the drill guide into the Variable Angle Locking hole and drill.
• A 1.0 mm Threaded Drill Guide (03.130.120) is available for use with only the 1.3 mm plates.

NOTE: The drill guide allows drilling in the nominal position in the locking hole.

Use a Double Drill Guide (03.130.125, 03.130.225, or 03.130.325) to drill for cortex screws through the plate.

7. Determine Screw Length

Use the Depth Gauge (03.130.250) to determine screw length. Screw length is indicated by the black line.

8. Insert Screw

• Assemble the screwdriver shaft to the screwdriver handle. 

• 1.3 mm and 1.5 mm Screws are inserted with a T4 STARDRIVE Screwdriver (yellow and red bands). 

• The tip of the screwdriver is gold-colored. 

• 2.0 mm Screws are inserted with a T6 STARDRIVE Screwdriver (blue band). 

Note: The screwdriver and screws are designed to be self-retaining. 

• To attach the screw to the screwdriver, position the screwdriver directly in line with the screw, with no tilting. 

• Ensure that the screwdriver tip engages the star-shaped recess in the screw. 

Note: It may be necessary to rotate the screwdriver up to a quarter turn to fully align the star-shaped screwdriver tip into the screw recess. In addition, a tactile sensation may be noticed when the screwdriver shaft is fully aligned with the screw recess. 

• Apply firm axial pressure downwards to ensure that the screw is fully seated before removing the screw from the implant module. 

• Remove the screw from the implant module in a straight vertical position.

Using the screwdriver, place the screw on the scale of the implant module, to confirm the length of the screw.

Insert Screw

When inserting screws, use a two-finger tightening technique.

For Variable Angle Locking and Locking Screws, confirm screw placement and length under radiographic imaging prior to final tightening.
 

For Variable Angle Locking and Locking Screws, screw insertion is complete when the screw is flush to the plate. 

Confirm screw position and depth under radiographic imaging.

Precaution: Avoid penetrating the articular surface. 

Postoperative Treatment

Postoperative treatment with locking plates or variable angle locking plates does not differ from conventional internal fixation procedures. 

Implant Removal 

If removal of the implant is necessary, the following instructions are suggested.

2. Clean recess

• Before removing screws, clean the screw recess. 
• Free the screw recess from ingrown bone and tissue using the sharp hook to ensure the screwdriver can be fully inserted. 
• Check the condition and the geometry of the recess of the exposed screwhead. 

• When implanting this plate, the following screw order placement is suggested. 

• Place a cortex screw in the elongated hole (1), leaving the screw slightly loose. Screw placement is at the midaxial line.

TIP: Place plate prior to the K-wire so that the cortex screw can be positioned at the midaxial line 

• Provisionally fix the condyles. 

• Place a K-wire in the center of the condyle, so the wire is located between the two distal holes (2). 

TIP: The K-wire should be placed in the center of the axis of the joint. K-wire placement is relative to the fan-shaped, central collateral ligament. 

NOTE: The footprint of the ligament is larger than the center of the axis. 

TIP: Make small adjustments to K-wire placement to avoid intra-articular placement of screws, while still creating a stable construct. 

NOTE: Variations in K-wire placement are at surgeon’s discretion, considering periarticular tissue and fracture size. For 1.3 mm plates, use a 0.6 mm K-wire. For 1.5 mm plates, use a 0.8 mm K-wire 

• Adjust the plate along the bone shaft, as necessary, so that the K-wire abuts the plate. 

• Tighten the cortex screw in the elongated hole 

• Place a screw in most distal hole (3)
• Place screw in most volar hole (4)

Confirm placement and depth of screws under radiographic imaging

Place remaining screws in the head and plate shaft, depending on fracture pattern

NOTE: Refer to surgical technique section for general plate and screw application techniques where this suggested screw insertion order can be applied.

• When implanting this plate, the following screw order placement is suggested. 

• Place cortex screw in elongated hole (1), leaving screw slightly loose. Check alignment and adjust plate as necessary.

• Tighten screw in the elongated hole. 
• Place a Variable Angle Locking Screw in one of the head holes (2). For 1.3 mm plates, place a locking screw. Confirm screw placement and depth under radiographic imaging.

Place remaining screws in the head and plate shaft as needed, depending on fracture pattern.

NOTE: Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

3. Condylar Plate Surgical Technique

SUMMARY: Straight plate with hole configuration designed to facilitate fixation of the middle and proximal phalanx, and the metacarpals. Designed for metaphyseal transverse, oblique, or comminuted fractures of the phalanx and metacarpals.

• Position the head of the plate on the condyles. 

NOTE: When implanting this plate, the following screw order placement is suggested. 

• Place a cortex screw in the elongated hole (1), leaving screw slightly loose. Check alignment and adjust plate, as necessary.
• Tighten the screw in the elongated hole. 

• Place a Variable Angle Locking Screw in one of the head holes (2). 

• Confirm screw placement and length using radiographic imaging. 

• Place remaining screws in the head and plate shaft as needed, depending on fracture pattern.

TIP: Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

• Position plate on the metacarpal

TIP: During plate placement, consider the curve in the base of the metacarpal. 

Place a K-wire in any of the three K-wire holes, if needed, to hold the plate in place and obtain provisional fixation of the fragments around the joint (1).

NOTE: When implanting this plate, the following screw order placement is suggested. 

Place cortex screw in the elongated hole (2), leaving the screw slightly loose. Adjust plate position, as necessary.

• Tighten cortex screw in the elongated hole. 
• Place a Variable Angle Locking Screw in the most proximal, metaphyseal head hole (3). 

NOTE: The screw in the most proximal head hole is placed first since it is closest to the joint. 

• Confirm screw placement and length under radiographic imaging. 
• Place remaining screws in the head and plate shaft as needed, depending on the fracture pattern. 

NOTE: Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied. 

NOTE: Placement of the plate is fracture-dependent. When implanting this plate, the following screw order and placement is suggested.

• Place a cortex screw in the elongated hole (1), leaving the screw slightly loose. 

• Adjust plate position, as necessary. 

• Tighten cortex screw in the elongated hole. 

• Place a Variable Angle Locking Screw in the arms of the plate (2). 

• Confirm screw placement and length under radiographic imaging.

• Place remaining screws in the plate, depending on fracture pattern. 

NOTE: Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

NOTE: When implanting this plate, the following screw order placement is suggested.

Place a cortex screw in the elongated hole (1), leaving the screw slightly loose. Adjust plate position, as necessary. Tighten cortex screw in the elongated hole. Additionally, a K-wire can be placed in the K-wire hole (2) in the distal portion of the plate to hold the plate in place, as necessary. Place a Variable Angle Locking Screw in either of the most distal holes of the plate head (3).

NOTE: Avoid wire and screw interference when placing screws in a variable angle hole. 

TIP: If necessary, the K-wire can be bent slightly to facilitate placement of the Variable Angle drill guide into a plate hole in the head of the plate.

Confirm screw placement and length under radiographic imaging.

Place remaining screws in the plate, depending on fracture pattern. Fracture pattern will dictate the order of screw placement.

NOTE: Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied.

NOTE: When implanting this plate, the following screw order placement is suggested.

• Position the plate with the T-shaped section of the plate near the joint.

• Insert 2 Variable Angle Locking Screws into the T-shaped section of the plate (1), ensuring that the elongated hole (2) is on the side of the osteotomy away from the joint, near a section of intact bone.

• Confirm screw placement and length under radiographic imaging. 
• Adjust the position of the bone. 
• Place a cortex screw into the elongated transverse hole (2), leaving the screw loose. 
• Release and tighten the cortex screw while adjusting plate position, as necessary.

• Check result of repositioning with the wrist at maximum extension. 

• Tighten cortex screw. 

• Place remaining screws distal or proximal to the elongated transverse hole.

• Confirm screw placement and depth using radiographic imaging. 

NOTE: Refer to surgical technique section for general plate and screw application techniques where this suggested order can be applied. 

NOTE: When implanting this plate, the following screw order placement is suggested.

Insert a cortex screw into the head of the plate (1) into the condyle, ensuring that the elongated hole (2) is on the side of the osteotomy away from the joint, near a section of intact bone.

TIP: Provisional fixation in either adjacent hole may be helpful. 

• Correct the position of the bone. Place a cortex screw in the elongated transverse hole (2).
• Continue to adjust the position of the bone, as necessary. 
• Check result of repositioning.

Place remaining screws distal or proximal to the elongated transverse hole.