3.5 mm LCP Extra-articular Distal Humerus Plate TGsynthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North America...Introduction Surgical Technique Product Information Table of Contents

3.5 mm LCP Extra-articular DistalHumerus Plate. Part of the Syntheslocking compression plate (LCP) system.

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

3.5 mm LCP Extra-articular Distal Humerus Plate 2

AO Principles 4

Indications 5

Preparation 6

Approach 7

Reduce Fracture 8

Preliminary Fixation 9

Insert Two Most Distal Locking Screws 10

Insert Locking Screws 13

Implants 15

Instruments 16

Set List 19

Image intensifier control

Synthes

2 Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Technique Guide

3.5 mm LCP Extra-articular Distal Humerus Plate

Plate head tapered to minimize soft tissue irritation

Two most distal holes are angled toward the capitulum and trochlea

Features– Left and right plates are anatomically contoured to match

the posterolateral distal humerus

– Locking screws engaged in the plate create a fixed-angleconstruct that enhances fixation in osteopenic bone

– Combi holes combine a dynamic compression unit (DCU)hole with a threaded hole, providing the flexibility of axialcompression and locking capability throughout the plate shaft

– Available with 4, 6, 8, 10, 12 or 14 elongated Combi holes to allow greater adjustment of plate placement on the humerus

– Available in 316L stainless steel and titanium

Five locking holes in plate headare angled medially to maximizescrew purchase in bone

Synthes 3

Elongated Combi holes accept 3.5 mmlocking screws, 3.5 mm cortex screws and 4.0 mm cancellous bone screws

Limited-contact design

AO Principles

In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation.1 These principles,as applied to the 3.5 mm LCP Extra-articular Distal HumerusPlate, are:

Anatomic reductionMultiple Combi holes and plate lengths provide fixation options for various fracture patterns. Precontoured plates assist reduction of metaphysis segment to diaphysis.

May be used in combination with the medial distal humerusplate for intra-articular distal humerus fractures.

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

Preservation of blood supplyLimited-contact plate design reduces plate-to-bone contact.Reduced plate-to-bone contact may minimize vasculartrauma 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, and H. Willenegger: Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991.

Indications

The 3.5 mm LCP Extra-articular Distal Humerus Plate is indicated for fractures of the distal humerus.

Synthes 5

Preparation

1Preoperative planning

Required sets

01.104.010/ 3.5 mm LCP Extra-articular Distal Humerus01.104.020 Plate Set (stainless steel or titanium)

105.434/ Small Fragment LCP Instrument and 145.434 Implant Set (stainless steel or titanium)

Optional sets

01.104.000 3.5 mm LCP Elbow System

01.104.004 3.5 mm LCP Titanium Elbow System

Complete the preoperative radiographic assessment and prepare the preoperative plan. Use the x-ray template for 3.5 mm LCP extra-articular distal humerus plate to determinethe length of the plate and the position of the screws.


Approach

2Position patient

Positioning is by surgeon preference. However, the lateral decubitus position is frequently chosen. Rest the arm on apadded bar allowing elbow flexion of 120°.

3Approach

Possible approaches include a triceps split approach or a posterolateral approach, where the triceps are elevated offthe back of the humerus from lateral to medial. Distally, thisis the posterior side of a standard Kocher approach. Proximally,one can identify the radial nerve in the manner described byGerwin, et al.2

Caution: If the plate is long, the radial nerve must be elevatedoff the back of the humerus and the plate placed underneath.Otherwise, the radial nerve rarely needs to be identified bymore than palpation and almost never needs to be isolatedor elevated with these fractures.

Note: An olecranon osteotomy is not necessary for plateplacement.

Synthes 7

2. Gerwin, Michelle, et al. “Alternative Operative Exposures of the Posterior Aspectof the Humeral Diaphysis. With Reference to the Radial Nerve.” The Journal ofBone and Joint Surgery, 78:1690-5. (1996).

3Position plate on bone

Instruments

329.02* Bending Iron, for 4.5 mm plates (2 required)

329.30* Plate-Bending Press

399.121* Bone Holding Forceps, 14 mm, serrated jaw,soft ratchet

Position the plate so that the shaft portion of the plate is located centrally on the posterior aspect of the bone whilethe distal end curves along the back of the lateral column.Ensure that the plate is at a safe distance from the olecranonfossa so that complete elbow extension is not impeded.

The position of the plate should allow distal screw insertionthrough the lateral flange to reach far into the trochlea.

Due to varying patient anatomy, slight bending may be necessary. Contour the plate as needed using the bendingirons or the plate-bending press.

Reduce Fracture

1Reduce fracture and fix temporarily

Use pointed forceps for temporary fixation in restoring the anatomy. Ensure that forceps will not interfere with subsequent plate placement.

2Determine plate length

Choose a plate length that offers sufficient fixation proximalto the fracture.


* Also available

Preliminary Fixation

4Preliminary fixation and compression

Instruments

310.25 2.5 mm Drill Bit, quick coupling

311.43 Handle, with quick coupling

314.02 Small Hexagonal Screwdriver with HoldingSleeve

314.03 Small Hexagonal Screwdriver Shaft

323.36 3.5 mm Universal Drill Guide

399.121* Bone Holding Forceps, 14 mm, serrated jaw,soft ratchet

Alternative instrument

314.116 StarDrive Screwdriver Shaft, T15

After reducing the fracture, apply the plate and insert a nonlocking screw through the center of the DCU portion of an elongated Combi hole proximal to the fracture.

Use the 2.5 mm drill bit through the 3.5 mm universal drillguide to predrill the bone. For the neutral position, press thedrill guide down in the nonthreaded hole. Use the depthgauge to determine screw length.

Select and insert an appropriate length 3.5 mm cortex screw.Do not completely tighten the screw. Make any final adjust-ments to plate placement. Manually tighten the screw tomaintain plate placement and compress the plate to the bone.

Synthes 9

* Also available

Insert Two Most Distal Locking Screws

5Insert two most distal locking screws

Instruments

292.71 1.6 mm Kirschner Wire with Thread


312.648 2.8 mm Threaded Drill Guide

314.03 Small Hexagonal Screwdriver Shaft or314.116 StarDrive Screwdriver Shaft, T15

323.023 1.6 mm Wire Sleeve

323.025 Direct Measuring Device

399.121* Bone Holding Forceps, soft ratchet, for platesto 14 mm wide

511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling

Insert the 1.6 mm wire sleeve into the threaded drill guide.

Insert the threaded drill guide assembly into the most distallocking hole until fully seated.

Insert a 1.6 mm threaded K-wire through the wire sleeve and drill to the desired depth.

Verify K-wire placement under image intensification to determine if final screw placement will be acceptable. Thiswire should be at, or slightly distal to, the equator of thecapitellum for plate placement to be correct.

Important: The K-wire position represents the final positionof the locking screw. Confirm that the K-wire does not enterthe joint.


* Also available

Measure for screw length by sliding the tapered end of the direct measuring device over the K-wire down to thewire sleeve.

Remove the direct measuring device, K-wire and 1.6 mmwire sleeve, leaving the threaded drill guide in place.

Under image intensification, predrill for the screw with the 2.8 mm drill bit.

Remove the threaded drill guide.

Synthes 11

Insert Two Most Distal Locking Screws

5Insert two most distal locking screws continued

Select a locking screw of the appropriate length.

Insert the locking screw with the appropriate screwdrivershaft (hexagonal or StarDrive recess) attached to the 1.5 Nmtorque limiting attachment (TLA).

Insert the screw manually or by power until a click is heard. If a power tool is used, reduce speed when inserting the headof the locking screw into the plate.

Repeat this process for the second-most-distal locking screw.

Tip: If additional compression of the distal fragment to theplate is needed, insert a 4.0 mm cancellous screw before inserting the locking screws. This screw may be inserted intoone of the proximal locking holes in the head of the plate(but not one of the two most distal holes). After fixation withlocking screws through the remaining holes, this screw canbe replaced with a locking screw.

Insert locking screws into the remaining head holes.


Insert Locking Screws

6Insert locking screws

Instruments



314.03 Small Hexagonal Screwdriver Shaftor314.116 StarDrive Screwdriver Shaft, T15

319.01 Depth Gauge, for small screws

511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling

Determine where locking screws will be used in the shaftportion of the plate. Working from the fracture up the shaft,insert locking screws into the preferred holes until the desiredfixation is achieved.

Insert the 2.8 mm threaded drill guide into the locking portionof the Combi hole until fully seated.

Use the 2.8 mm drill bit to drill to the desired depth.

Remove the drill guide.

Use the depth gauge to determine screw length.

Synthes 13

Insert Locking Screws

6Insert locking screws continued

Insert the locking screw with the appropriate screwdrivershaft (hexagonal or StarDrive recess) attached to the 1.5 Nm TLA.

Insert the screw manually or by power until a click is heard. If a power tool is used, reduce speed when inserting thehead of the locking screw into the plate.

If desired, the cortex screw used for preliminary fixation andcompression may be removed.


Synthes 15

4.0 mm Cancellous Bone ScrewsFound in the Small Fragment LCP Set– May be used in the DCU portion of the Combi holes

in the plate shaft

– Compress the plate to the bone or create axial compression

– Fully or partially threaded shaft

3.5 mm Locking ScrewsFound in the Small Fragment LCP Set– Used in the locking portion of the Combi holes or

in round locking holes

– Create a locked, fixed-angle screw/plate construct

– Fully threaded shaft

– Self-tapping tip

3.5 mm Cortex ScrewsFound in the Small Fragment LCP Set– May be used in the DCU portion of the Combi holes

– Compress the plate to the bone or create axial compression

– Fully threaded shaft

Screws Used with the 3.5 mm LCP Extra-articular Distal Humerus Plate Stainless Steel and Titanium


Selected Instruments from the Small Fragment LCP Instrument and Implant SetsStainless Steel (105.434) and Titanium (145.434)

03.122.001* 2.8 mm LCP Drill Guide, long, for 3.5 mmLCP plates, for use with 03.122.002

03.122.002* 2.8 mm Drill Bit, quick coupling, 248 mm,95 mm calibration, for use with 03.122.001

292.20 2.0 mm Kirschner Wire, 150 mm, trocar point

292.71 1.6 mm Kirschner Wire with Thread, 150 mm, trocar point, 5 mm thread length

310.25 2.5 mm Drill Bit, quick coupling, 110 mm

310.288 2.8 mm Drill Bit, quick coupling, 165 mm

311.43 Handle, with quick coupling

* Also available

Synthes 17

314.115 StarDrive Screwdriver, T15

314.03 Small Hexagonal Screwdriver Shaft, quick coupling

314.116 StarDrive Screwdriver Shaft, T15, quick coupling

319.01 Depth Gauge, for small screws

323.023 1.6 mm Wire Sleeve


314.02 Small Hexagonal Screwdriver with Holding Sleeve


Selected Instruments from the Small Fragment LCP Instrument and Implant SetsStainless Steel (105.434) and Titanium (145.434) continued

329.04 Bending Iron, for 2.7 mm and 3.5 mm plates,150 mm length, used with 329.05

329.05 Bending Iron, for 2.7 mm and 3.5 mm plates,150 mm length, used with 329.04

511.770* Torque Limiting Attachment, 1.5 Nmor511.773 Torque Limiting Attachment, 1.5 Nm,

quick coupling

323.36 3.5 mm Universal Drill Guide

323.025 Direct Measuring Device

324.024 Push-Pull Reduction Device

324.031 Threaded Plate Holder, long, for 3.5 mm locking hole

* Also available

Synthes 19

3.5 mm LCP Extra-articular Distal Humerus Plate Sets Stainless Steel (01.104.010) and Titanium (01.104.020)

Graphic Case60.104.010 3.5 mm LCP Extra-articular Distal Humerus

Plate Graphic Case

Implants◊

3.5 mm LCP Extra-articular Distal Humerus Plates, right

Stainless LengthSteel Titanium Holes (mm)02.104.004 04.104.004S 4 12202.104.006 04.104.006S 6 15802.104.008 04.104.008S 8 19402.104.010 04.104.010S 10 23002.104.012 04.104.012S 12 26602.104.014 04.104.014S 14 302

3.5 mm LCP Extra-articular Distal Humerus Plates, leftStainless LengthSteel Titanium Holes (mm)02.104.024 04.104.024S 4 12202.104.026 04.104.026S 6 15802.104.028 04.104.028S 8 19402.104.030 04.104.030S 10 23002.104.032 04.104.032S 12 26602.104.034 04.104.034S 14 302

Required Set105.434 Small Fragment LCP Instrument and

Implant Set, with self-tapping screws

or

145.434 Small Fragment LCP Instrument and TitaniumImplant Set, with self-tapping screws

◊ Stainless steel plates are available nonsterile or sterile-packed. Add “S” to catalog number to order sterile product. Titanium plates are available sterile only.

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

Also Available


Sets

01.104.000 3.5 mm LCP Elbow System

01.104.004 3.5 mm LCP Titanium Elbow System

Instruments

03.122.001 2.8 mm LCP Drill Guide, long, for 3.5 mmLCP plates

03.122.002 2.8 mm Drill Bit, quick coupling, 248 mm, 95 mm calibration

329.02 Bending Iron, for 4.5 mm plates (2 required)

329.30 Plate-Bending Press

398.81 Self-Centering Bone Forceps, size 1, 240 mmlength, 14 mm, small serrated jaw, speed lock

399.121 Bone Holding Forceps, soft ratchet, for platesto 14 mm wide

511.770 Torque Limiting Attachment, 1.5 Nm

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

© 2009 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. 10/09 J8913-A

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3.5 mm LCP Extra-articular Distal Humerus Plate TGsynthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North America...Introduction Surgical Technique Product Information Table of Contents