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LCP Extra-articular Distal Humerus Plate. The anatomically ...

LCP Extra-articular Distal Humerus plate . The anatomically shaped and angular stable fixation system for extra - articular fractures of the Distal Humerus . Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation. Image intensi er control Warning This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of m ulti-part instruments, as well as processing guidelines for i mplants, please contact your local sales representative or refer to: For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: Table of Contents Introduction LCP Extra-articular Distal Humerus plate 2.

LCP Extra-articular Distal Humerus Plate. The anatomically shaped and angular stable fixation system for extra-articular fractures of the distal humerus.

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Transcription of LCP Extra-articular Distal Humerus Plate. The anatomically ...

1 LCP Extra-articular Distal Humerus plate . The anatomically shaped and angular stable fixation system for extra - articular fractures of the Distal Humerus . Surgical Technique This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation. Image intensi er control Warning This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of m ulti-part instruments, as well as processing guidelines for i mplants, please contact your local sales representative or refer to: For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: Table of Contents Introduction LCP Extra-articular Distal Humerus plate 2.

2 AO Principles 4. Indications 5. Surgical Technique Preparation and Approach 6. Surgical Technique 8. Implant Removal 16. Product Information Implants 17. Instruments 18. Bibliography 19. MRI Information 20. LCP Extra-articular Distal Humerus plate Surgical Technique DePuy Synthes 1. LCP Extra-articular Distal Humerus plate . The anatomically shaped and angular stable fixation system for extra - articular fractures of the Distal Humerus . Indications E xtra- articular fractures of the Distal Humerus Malunions of the Distal Humerus Non-unions of the Distal Humerus Features Tapered end designed Hole density is increased Elongated combi-holes to minimize soft tissue distally and mm accept mm screws irritation locking screws are and facilitate plate accepted positioning Thickness of the plate is Two most Distal screw Undercuts designed based on LCP , holes angled toward the to reduce impair- narrow, and allows capitellum and trochlea ment of blood stand-alone application supply 2 DePuy Synthes LCP Extra-articular Distal Humerus plate Surgical Technique anatomically pre-contoured LCP.

3 Selection for the Distal Humerus LCP Extra-articular Distal LCP Distal Humerus Plates LCP Metaphyseal Distal Medial Humerus plate Humerus plate Primary Indication Primary Indication Primary Indication Extra-articular fractures of the Distal Intra- articular fractures of the Distal Juxta- articular Distal Humerus Humerus Humerus , especially for osteoporotic fractures bone Features Features Supracondylar fractures of the Distal plate thickness based on LCP Notches on plate shaft Humerus , narrow Tapered plate end near the joint Designed angles of Distal screw Features Aiming block for guided screw holes 90 plating technique possible insertion Tapered plate end near the joint Small Distal screws for multiple Portfolio fixation options for the Distal block Portfolio One plate for left and right Position and compression device Plates in six lengths Plates in five lengths available Aiming block for guided screw insertion Portfolio Dorsolateral plates with or without support All plates in five lengths LCP Locking Compression plate LCP combi-hole Angular stable fixation of fragments Intraoperative choice between com- regardless of bone quality pression and angular stable locking Minimised risk of primary and With standard screws: secondary loss of reduction, even interfragmental or dynamic-axial under high dynamic loading compression Reduced impairment of periosteal With locking screws.

4 Blood supply due to the limited plate stable plate -screw connection without contact loss of reduction, regardless of plate modelling Good purchase also in osteoporotic bone and in multifragment fractures LCP Extra-articular Distal Humerus plate Surgical Technique DePuy Synthes 3. AO Principles AO PRINCIPLES. In 1958, the AO formulated four basic principles, which have In 1958, the guidelines become AO formulated four basic for internal principles, fixation1,2.. which have become the guidelines for internal xation1, 2. 1 12:08. Anatomic Anatomic reduction fixation Stable fixation Fracture reduction Fracture reduction and and fixation xation to Fracture Fracture fixation xationproviding providingabsolute abso- to restore restore anatomical anatomical relationships. relationships. or relative lute stability, or relative as required stability, as by the prequired atient, theby injury, and thethe the patient, personality injury, 1 2 of andthethe fracture.

5 Personality of the fracture. Early, Early, active mobilization mobilization Preservationof Preservation of blood blood supply supply Early and Early and safe mobilization mobilizationand and 4 3 Preservation Preservationof ofthe theblood bloodsupply supply rehabilitation the injured partand rehabilitation of the injured part to to soft tissues and bone bygentle soft tissues and bone by the patient and as a whole. the patient as a whole. reduction techniques gentle reduction and careful techniques and handling. careful handling. 1. M ller ME, M Allg wer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991. 2. R edi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007. 1. M ller ME, Allg wer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer. 1991. 2.

6 R edi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007. 4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique 4 DePuy Synthes LCP Extra-articular Distal Humerus plate Surgical Technique Indications Extra-articular fractures of the Distal Humerus Malunions of the Distal Humerus Non-unions of the Distal Humerus LCP Extra-articular Distal Humerus plate Surgical Technique DePuy Synthes 5. Preparation and Approach Note: For information on fixation principles using conven . tional and locked plating techniques, please refer to the LCP Locking Compression plate Surgical Technique (DSEM/TRM/0115/0278). 1 LCP Extra-articular Distal Humerus plate Preoperative planning 20 20. Complete the preoperative radiographic assessment and pre- . 40 40. pare the preoperative plan. Use the x-ray template for LCP. Extra-articular Distal Humerus plate (Art. No. Synthes is a trademark of Synthes, Inc.)

7 Or its affiliates Right for right and for left Humerus ) to determine the length of the 14 holes 12 holes 10 holes 8 holes 6 holes 4 holes plate and the position of the screws. Left Right Left All rights reserved Titanium St. Steel Holes Length (mm) Titanium St. Steel Holes Length (mm). 4 122 4 122. 6 158 6 158. 8 194 8 194. 02/2009 Synthes, Inc. or its affiliates 10 230 10 230. 12 266 12 266. 14 302 14 302. Magnification 30090003. Synthes GmbH. 0 10 20 30 40 50 60 70 80 90 100mm Eimattstrasse 3. For use only with the Original AO System of CH-4436 Oberdorf Instruments and Implants X-ray template for LCP Extra-articular Distal Humerus plate 2. Position patient Positioning is by surgeon preference. However, the lateral decubitus position is frequently chosen. The arm is rested on a padded bar allowing elbow flexion of 120 . 6 DePuy Synthes LCP Extra-articular Distal Humerus plate Surgical Technique 3. Approach Possible approaches include a triceps split approach or a pos- terolateral approach; where the triceps are elevated off the back of the Humerus from lateral to medial.

8 Distally, this is the posterior side of a standard Kocher approach. Proximally, one can identify the radial nerve in the manner described by Gerwin et Precaution: If the plate is long, the radial nerve needs to be elevated off the back of the Humerus and the plate placed underneath. Also consider the nerve when inserting screws. Otherwise, the ulnar nerve rarely needs to be identified by more than palpation and almost never needs to be isolated or elevated with these fractures. An olecranon osteotomy is not necessary for plate place- ment. Gerwin, Michelle, et al. Alternative Operative Exposures of the Posterior 2. Aspect of the Humeral Diaphysis. With Reference to the Radial Nerve.. The Journal of Bone and Joint Surgery 78:1690-5 (1996). LCP Extra-articular Distal Humerus plate Surgical Technique DePuy Synthes 7. Surgical Technique 1. Reduce fracture and fix temporarily Use pointed forceps for temporary fixation in restoring the anatomy.

9 Ensure that forceps will not interfere with subse- quent plate placement. 2. Determine plate length Choose a plate length that offers sufficient fixation proximal to the fracture. 8 DePuy Synthes LCP Extra-articular Distal Humerus plate Surgical Technique 3. Position plate on the bone Optional instruments Bending Iron for LC-DCP and DCP , length 250 mm Bending Press, length 400 mm Position the plate so that the shaft portion of the plate is lo- cated centrally on the posterior aspect of the bone while the Distal end curves along the back of the lateral column. En- sure that the plate is at a safe distance from the olecranon fossa so that complete elbow extension is not impeded. The position of the plate should allow Distal screw insertion through the lateral flange to reach far into the trochlea. Due to varying patient anatomy, slight bending may be nec- essary. Contour plate as needed using the bending irons or the plate -bending press.

10 LCP Extra-articular Distal Humerus plate Surgical Technique DePuy Synthes 9. Surgical Technique 4. Preliminary fixation and compression Instruments Universal Drill Guide Drill Bit B mm, length 110/85 mm, 2-flute, for Quick Coupling Handle with Quick Coupling Screwdriver Shaft, hexagonal, small, B mm Screwdriver, hexagonal, small, with Holding Sleeve After reducing the fracture, apply the plate and insert a non-locking screw through the center of the DCU portion of an elongated combi-hole proximal to the fracture. Use the mm drill bit through the mm universal drill guide to predrill the bone. For the neutral position, press the drill guide down in the non-threaded hole. Use the depth gauge to determine screw length. Select and insert a mm cortex screw of appropriate length. Do not completely tighten the screw. Make any final adjustments to plate placement. Manually tighten the screw to maintain the plate placement and compress the plate to the bone.


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