2.4 mm LCPRadial Head Plates TGsynthes.vo.llnwd.net/o16/Mobile/Synthes North... · Apply Radial Head Plate 8 Synthes 2.4 mm LCP Radial Head Plates Technique Guide 2 Apply radial head

Instruments and Implantsapproved by the AO Foundation

2.4 mm LCP Radial Head Plates.Contoured plates to address variousfracture patterns of the proximal radius.

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

2.4 mm LCP Radial Head Plates 2

AO Principles 3

Indications 4

Preparation 5

Reduce Fracture 7

Apply Radial Head Plate 8

Insert Proximal Screws 9

Insert Shaft Screws 10

General Notes on Technique 11

Alternative Method 13

Postoperative Treatment 14

Implant Removal 14

Implants 15

Instruments 17

Set List 20

Image intensifier control

Synthes

2.4 mm LCP Radial Head Plates

2 Synthes 2.4 mm LCP Radial Head Plates Technique Guide

Plate features– Nine (9) radial head plates available to address various

fracture patterns of the proximal radius

– Plates are precontoured for anatomical fit

– Combi holes allow fixation with locking screws in thethreaded section for angular stability, and cortex screws inthe dynamic compression unit (DCU) section for distraction.A fixed-angle construct provides advantages in osteopenicbone or multifragment fractures, where traditional screwpurchase is compromised.

Additional features– Limited-contact design shaft with 2, 3, and 4 Combi holes

– The holes in the head of the plate accept 2.4 mm lockingscrews and 2.0 mm cortex screws

– The shaft holes accept 2.4 mm locking screws in thethreaded portion or 2.7 mm cortex screws and 2.4 mmcortex screws in the distraction portion

– Radial head rim plates available in right and left plates with a 5º tilt to match the anatomy of the radial head

– Radial head neck plates fit both right and left proximal radii

– Available in 316L stainless steel and commercially pure (CP) titanium

AO Principles

Synthes 3

In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation.1 These principles, as applied to the 2.4 mm LCP Radial Head Plates, are:

Anatomic reduction Multiple, nonparallel metaphyseal screw holes provide fixationoptions for a variety of fracture patterns. Precontoured platesassist reduction of metaphysis to diaphysis.

Stable fixationLocking screws create a fixed-angle construct, providing angular stability.

Preservation of blood supplyTapered end allows submuscular plate insertion, preserving tissue viability.

Limited-contact plate design reduces plate-to-bone contact,limiting vascular trauma and insult to bone.

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

1. M.E. Müller, M. Allgöwer, R. Schneider, H. Willenegger: Manual of Internal Fixation, 3rd Edition. Berlin; Springer-Verlag. 1991.

Indications


Extra-articular and intra-articular fractures of the proximal radius andmultifragmented radial neck fractures.

Preparation

Synthes 5

Patient position

Position the patient supine on the table. Prepare the extremityfrom the axilla to the hand. This allows rotation of the forearm and flexion and extension of the elbow during theoperative fixation.

Approach

A lateral approach is most commonly used. Take care to avoidthe deep branch of the radial nerve, which runs anterior to the capsule and the radial head. To minimize the risk ofoperative disruption of the lateral collateral ligament, thecapsular incision should remain in the front of the anteriormargin of the anconeus muscle and parallel to the fasciallimit of the extensor carpi ulnaris. The annular ligament, atrue thickening of the capsule, is opened laterally or slightlyanteriorly to allow full inspection of the fragments. In selectedcases, an osteotomy of the lateral epicondyle will allow anextensile approach.

Illustrations on this page are reproduced from Rüedi /Murphy, AO Principles ofFracture Management by permission of AO Publishing, Copyright © 2000 AOPublishing, Switzerland.

Preparation continued


Safe zone

Both plates fit within the Hotchkiss safe zone2 which is described as an area of 105° on the radial head that is free of impingement between ulna and radius. The Hotchkiss safezone is located on the opposite side of the radial tuberosity.

= Safe zone

Neutral Supination Pronation

2. Robert N. Hotchkiss, MD: “Displaced Fractures of the Radial Head: Internal Fixation or Excision?” AAOS, Vol. 5, No. 1, January/February 1997.

Reduce Fracture

Synthes 7

Required set

01.111.120/ LCP Modular Mini Fragment Instrument and01.111.140 Implant Set (stainless or titanium)or01.110.045/ 2.4 mm LCP Distal Radius System 01.110.046 (stainless or titanium)

1Reduce fracture

Instruments

292.12 1.25 mm Kirschner Wire (stainless steel)or492.12 1.25 mm Titanium Kirschner Wire

292.16 1.6 mm Kirschner Wire (stainless steel)or492.16 1.6 mm Titanium Kirschner Wire

399.97 Reduction Forceps, with points

Obtain reduction and temporary fixation with pointed reduction forceps. Gentle rotation of the forearm allows inspection of the circumference of the radial head and neck. Perform preliminary fixation with K-wires.

Apply Radial Head Plate


2Apply radial head plate

Instruments

310.19 2.0 mm Drill Bit

310.26 2.7 mm Drill Bit, quick coupling

310.509 1.8 mm Drill Bit with depth mark, quick coupling, 110 mm

310.530 2.4 mm Drill Bit, quick coupling, 100 mm

311.43 Handle, with quick coupling

314.467 StarDrive Screwdriver Shaft, T8

319.006 Depth Gauge, for 2.0 mm and 2.4 mm screws

323.202 2.4 mm Universal Drill Guide


329.12 Bending Pliers

After reducing the fracture, apply the plate and insert a preliminary cortex screw through the DCU portion of one of the elongated Combi holes.

For 2.4 mm cortex screws, use the 1.8 mm drill bit for thethreaded hole and the 2.4 mm drill bit for the gliding hole.

For 2.7 mm cortex screws, use the 2.0 mm drill bit for thethreaded hole and the 2.7 mm drill bit for the gliding hole.

Note: The plates are precontoured to fit the anatomy of theradial head. There are no undercuts on the plates to protectthe threaded holes from distortion during bending. If it is necessary to bend the plate, use the bending pliers.

Insert Proximal Screws

Synthes 9

3Insert proximal screws

Instruments



For 2.0 mm cortex screws



313.843 2.0 mm Screwdriver Blade, self-retaining,StarDrive, long

For 2.4 mm locking screws



323.029 Threaded LCP Drill Guide

323.035 1.8 mm Threaded Drill Guide, short

Use the 2.0 mm cortex screws and the 2.4 mm locking screwsin the head of the plate.

Important: Careful drilling is necessary, as interference with screws in the proximal portion of the plate is possible. Incase of interference, stop drilling and use a screw of appropriate length.

See General Notes on Technique (page 11) for additional information.

Insert Shaft Screws


4Insert screws in the shaft of the plate

Instruments











319.01 Depth Gauge


For 2.4 mm locking screws




Use 2.4 mm and 2.7 mm cortex screws and 2.4 mm lockingscrews in the shaft of the plate.

General Notes on Technique

Synthes 11

Determine screw choice

– If planning a combination of locking and cortex screws, first use a cortex screw to pull the plate to the bone.

– If using a locking screw first, ensure that the plate is held securely to the bone, to avoid spinning of the plate as thescrew locks into the plate.

Insert cortex screws

Instruments










– Use the 2.0 mm universal drill guide for insertion of 2.0 mmcortex screws. For the proximal 2.0 mm cortex screw, usethe 1.5 mm drill bit for the threaded hole and the 2.0 mmdrill bit for the gliding hole. Determine the length of screwby using the depth gauge.

– Use the 2.4 mm universal drill guide or the 2.7 mm universaldrill guide for an eccentric (distraction) or neutral (buttress)insertion of cortex screws.

– For the 2.4 mm cortex screw, use the 1.8 mm drill bit for thethreaded hole and the 2.4 mm drill bit for the gliding hole.Determine the length of the screw using the depth gauge.

– For 2.7 mm cortex screws, use the 2.0 mm drill bit for thethreaded hole and the 2.7 mm drill bit for the gliding hole.Determine the length of the screw using the depth gauge.

General Notes on Technique continued


Insert locking screws

Instruments

310.509 1.8 mm Drill Bit with depth mark, quick coupling






Screw the threaded LCP drill guide into a hole until full seated.

For the 2.4 mm locking screws, use the 1.8 mm drill bit with depth mark, quick coupling, to drill to the desireddepth. Determine the screw length directly from the mark on the drill bit and scale on the threaded drill guide. Thismay be verified using a depth gauge for 2.0 mm and 2.4 mm screws.

Insert the locking screw manually with the T8 StarDrive screwdriver shaft and handle. Carefully tighten the lockingscrew, as excessive force is not necessary to produce effective plate-to-screw locking.

Alternative Method

Synthes 13

Alternative method

Locking screw insertion with holding sleeve

Instruments



314.468 Holding Sleeve

An alternative method may be used for insertion of lockingscrews, using the locking screw to pull the plate to the bone.Place the holding sleeve onto the StarDrive screwdrivershaft. Pick up the locking screw with the holding sleeve, and insert the screw. With the locking screw still held by theholding sleeve, tighten the screw until the plate is drawn tothe bone. Pull up on the holding sleeve to release the screwhead, and tighten the locking screw into the plate.

Take care to hold the plate securely on the bone to avoid spinning the plate as the screw locks to the plate.

Postoperative Treatment and Implant Removal


Implant removal

To remove locking screws, unlock all screws from the plateand then begin to remove the screws completely from thebone. This avoids rotation of the plate when removing thelast locking screw.

Postoperative treatment

Postoperative treatment with locking compression plates doesnot differ from conventional internal fixation procedures.

2.4 mm LCP Radial Head Plates

Synthes 15

Rim plates

Stainless Steel Titanium Holes241.680 441.680 2 right241.681 441.681 2 left241.682 441.682 3 right241.683 441.683 3 left241.684 441.684 4 right241.685 441.685 4 left

Neck plates

Stainless Steel Titanium Holes241.690 441.690 2241.691 441.691 3241.692 441.692 4

Screws Used with the 2.4 mm LCP Radial Head PlatesStainless steel and titanium


2.0 mm Cortex Screws, self-tapping, with T6 StarDrive recess– For use in round holes in plate head, to provide

compression or neutral fixation– Low-profile head in the plate holes

– 10 mm to 26 mm lengths

2.4 mm Cortex Screws, self-tapping, with T8 StarDrive recess* – For use in Combi holes in plate shaft, to provide

distraction or neutral fixation

– Low-profile head in the plate holes

– StarDrive recess mates with self-retaining screwdriver and provides improved torque transmission


2.4 mm Locking Screws, self-tapping, with T8 StarDrive recess* – Threaded, conical head locks securely into the plate

to provide angular stability– Locked screws allow unicortical screw fixation and

load transfer to the near cortex– StarDrive recess mates with self-retaining screwdriver

and provides improved torque transmission– 6 mm to 30 mm lengths

2.7 mm Cortex Screws, self-tapping, with T8 StarDrive recess* – For use in Combi holes in plate shaft, to provide

distraction or neutral fixation

– Low-profile head in the plate holes

– StarDrive recess mates with self-retaining screwdriver and provides improved torque transmission


Note: For information on fixation principles using conventionaland locked plating techniques, please refer to the Small Fragment Locking Compression Plate (LCP) Technique Guide.

*Available in the 2.4 mm LCP Distal Radius Set and Modular Mini Fragment LCP Set.Screws are made of implant-quality 316L stainless steel, or titanium alloy, Ti-6Al-7Nb.

Instruments

Synthes 17



310.509 1.8 mm Drill Bit with depth mark, quick coupling


310.16 1.5 mm Drill Bit, quick coupling, 110 mm

310.972 Countersink, for 2.0 mm and 2.4 mm screws

311.03.96 Handle, with mini quick coupling, small

Instruments continued



313.843 2.0 mm Screwdriver Blade, self retaining,StarDrive, long


319.01 Depth Gauge

319.006 Depth Gauge, for 2.0 mm and 2.4 mm Cortex Screws



Synthes 19



329.12 Bending Pliers

399.97 Reduction Forceps, with points


2.4 mm LCP Radial Head Plate Instrument and Implant Sets Stainless Steel (141.682) and Titanium (141.684)


Required Additional Set01.110.045/ 2.4 mm LCP Distal Radius Plate System01.110.046 (stainless steel or titanium)or

01.111.120/ LCP Modular Mini Fragment Instrument and01.111.140 Implant Set (stainless steel or titanium)

Module60.110.040 Small Module for LCP Radial Head Instruments

and Implants

Instruments

310.16 1.5 mm Drill Bit, quick coupling, 110 mm, 2 ea.

310.972 Countersink, for 2.0 mm and 2.4 mm screws

311.03.96 Handle, with mini quick coupling, small

313.843 2.0 mm Screwdriver Blade, self-retaining,StarDrive, long


Implants2.4 mm LCP Radial Head Rim PlatesStainless Steel Titanium Description Length (mm)241.680 441.680 2 holes, right 34241.681 441.681 2 holes, left 34 241.682 441.682 3 holes, right 46241.683 441.683 3 holes, left 46241.684 441.684 4 holes, right 56 241.685 441.685 4 holes, left 56

2.4 mm LCP Radial Head Neck PlatesStainless Steel Titanium Description Length (mm)241.690 441.690 2 holes 28241.691 441.691 3 holes 40241.692 441.692 4 holes 50

2.0 mm Cortex Screws, self-tapping, with StarDrive recess, 2 ea.Stainless Steel Titanium Length (mm)201.360.97 401.360.97 10 201.361.97 401.361.97 11 201.362.97 401.362.97 12201.363.97 401.363.97 13 201.364.97 401.364.97 14 201.366.97 401.366.97 16201.368.97 401.368.97 18201.370.97 401.370.97 20201.372.97 401.372.97 22201.374.97 401.374.97 24 201.375.97 401.375.97 26

Note: For additional information, please refer to package insert.

Synthes (USA)1302 Wrights Lane EastWest Chester, PA 19380Telephone: (610) 719-5000To order: (800) 523-0322Fax: (610) 251-9056

Synthes (Canada) Ltd.2566 Meadowpine BoulevardMississauga, Ontario L5N 6P9Telephone: (905) 567-0440To order: (800) 668-1119Fax: (905) 567-3185

© 2006 Synthes Inc., or its affiliates. All rights reserved. Combi, LCP and Synthes are trademarks of Synthes Inc., or its affiliates. Printed in U.S.A. 1/10 J5946-F

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2.4 mm LCPRadial Head Plates TGsynthes.vo.llnwd.net/o16/Mobile/Synthes North... · Apply Radial Head Plate 8 Synthes 2.4 mm LCP Radial Head Plates Technique Guide 2 Apply radial head