Technique Guide. VA-LCP Distal Humerus Plates 2.7/3.5. The low-profile fixation system with variable angle locking technology.

Transcription

1 Technique Guide VA-LCP Distal Humerus Plates 2.7/3.5. The low-profile fixation system with variable angle locking technology.

2 Image intensifier control Warning This description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling these instruments is highly recommended. Reprocessing, Care and Maintenance of Synthes Instruments For general guidelines, function control and dismantling of multi-part instruments, please contact your local sales representative or refer to:

3 Table of Contents Introduction VA-LCP Distal Humerus Plates 2.7/ AO Principles 4 Indications 5 Surgical Technique Preparation and Approach 6 Determination of Fixation Technique 10 Insert Lateral-Column Plate 14 Insert Distal Screws in Lateral-Column Plate 20 Insert Medial-Column Plate 25 Insert Distal Screws in Medial-Column Plate 28 Insert Plate-Shaft Screws 29 Fixation of Olecranon Osteotomy 32 Implant Removal 33 Product Information Implants 34 Instruments 39 Sets 42 Bibliography 43 VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 1

4 VA-LCP Distal Humerus Plates 2.7/ 3.5. The low-profile fixation system with variable angle locking technology. Plate configurations The VA-LCP Elbow Plating System offers three main doubleplating configurations for the distal humerus: perpendicular, perpendicular with support, and parallel. Variable angle locking Variable angle locking screws 2.7 mm give the surgeon the ability to create a fixed-angle construct with the freedom of +/-15 off-axis screw angulation. Plate design Optimized metaphyseal plate profile, together with rounded edges and an improved anatomical plate fit minimize the prominence of the construct without compromising stability. 1 2 Cross-section of the VA-LCP Distal Humerus Plate, medial (1) and the LCP Distal Humerus Plate, medial (2) at the level of the medial epicondyle. 2 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

5 VA-LCP Distal Humerus Plates The plates offer multiple screw configurations for the medial and lateral columns, and the articular block Medial Plate The standard medial column plate. 2 Medial Plate, with extension The extension buttresses the medial epicondyle and includes an ascending screw that stabilizes the medial column. 3 Lateral Plate The lateral plate for the parallel-plating configuration. 4 Dorsolateral Plate The dorsolateral plate for the perpendicular-plating configuration with screws targeting the capitellum. 5 Dorsolateral Plate, with lateral support The screws from the lateral support target the articular block. VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 3

6 AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation. 1,2 Those principles, as applied to the VA-LCP Elbow System are: Anatomic reduction Precontoured plates assist in anatomic reduction. Stable fixation Variable angle locking screws create a fixed-angle construct providing angular stability. Preservation of blood supply Plates designed with limited plate-to-bone contact helps to preserve the periosteal blood supply. Optimized plate profiles reduce the risk of implant-related soft tissue irritation. Early, active mobilization Locking screws create a fixed-angle construct providing angular stability to maintain the anatomical reduction, especially in osteoporotic bone. 3 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme Schuster I, J Korner, M Arzdorf, K Schwieger, G Diederichs, B Linke. Mechanical Comparison in Cadaver Specimens of Three Different 90-Degree Double-Plate Osteosyntheses for Simulated C2-Type Distal Humerus Fractures with Varying Bone Densities. J Orthop Trauma 2008, 22: Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

7 Indications Intra-articular fractures of the distal humerus Supracondylar fractures of the distal humerus Nonunions of the distal humerus Osteotomies of the distal humerus (e.g. due to malunions, deformities) VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide Synthes 5

8 Preparation and Approach 1 Preoperative planning Complete the preoperative radiographic assessment and prepare the preoperative plan. Use the x-ray templates for the VA-LCP Distal Humerus Plates (Art. No , and ) to determine the plate type, length, and the position of the screws. 6 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

9 2 Position patient Position the patient in prone or in lateral decubitus with the arm on a radiolucent support, or a padded post. The forearm should be positioned such that it can be flexed to an angle greater than 120 degrees. Note: Please consult for further infor - mation. VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide Synthes 7

10 Preparation and Approach 3 Approach Fractures are approached through a slightly curved posterior incision just radial to the olecranon. Important: Identify the ulnar nerve and elevate it at the ulnar epicondyle if necessary. When using longer plates, ensure that the radial nerve is carefully identified. The type of approach is determined by the character of the fracture, and the preference and experience of the surgeon. For comminuted fractures, a distally pointed chevron ole - cranon osteotomy exposes the fracture best. Note: Please consult for further infor - mation. 8 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

11 4 Reduce fracture and provide temporary fixation Instrument Periarticular Reduction Forceps, with pointed ball tips 6.5 mm, small For AO C-type fractures, first reduce the fragments of the articular block under image intensifier control and use Kirschner wires and/or reduction forceps for temporary fixation. Fix the articular block to the shaft using Kirschner wires and/or reduction forceps in both columns to ensure that the anatomy of the distal humerus is restored. Ensure that the Kirschner wires or reduction forceps will not interfere with subsequent plate placement. Notes: If necessary, reduce the articular block using independent screws. When using the dorsolateral plate without lateral support, it is important to reduce and fix the articular block with screws according to the AO Principles of Fracture Management (lag screw for simple articular fracture or position screw for comminuted fracture). Please consult for further information. VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide Synthes 9

12 Determination of Fixation Technique Select a plate type and length appropriate for the fracture. Notes: Choose the plate lengths that offer sufficient fixation proximal to the fracture line. To achieve sufficient stability for early mobilization in AO A-type and C-type fractures, use two plates: one for the medial and one for the lateral column. 1 Determine lateral-column plate type and length Instruments Trial Implants for VA-LCP Distal Humeral or Plate 2.7/3.5, dorsolateral, with lateral support, right or left, 4 holes Trial Implants for VA-LCP Distal Humeral or Plate 2.7 / 3.5, lateral, right or left, 2 holes Notes: Do not bend trial implants. For full trial implant details, see pages 37 and Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

13 Use of the trial implants and/or the descriptions and illustrations below is recommended to aid implant selection for the lateral column. 1a Perpendicular plating VA-LCP Distal Humerus Plate, dorsolateral Plate position: lateral column, dorsal Orientation of distal screws: posteroanterior VA-LCP Distal Humerus Plate, dorsolateral with lateral support Plate position: lateral column, dorsal Orientation of distal screws: posteroanterior and latero - medial Note: On very small humeri, the lateral support may protrude extensively over the lateral epicondyle, in which case the use of the plate without lateral support is recommended. 1b Parallel plating VA-LCP Distal Humerus Plate, lateral Plate position: lateral column, lateral Orientation of distal screws: lateromedial VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 11

14 Determination of Fixation Technique 2 Determine medial-column plate type and length Instruments Trial Implants for VA-LCP Distal Humeral Plate 2.7 / 3.5, medial, with lateral support, right or left, 2 holes Notes: Do not bend trial implants. For full trial implant details, see pages 37 and 38. Important: To prevent extensive diaphyseal stress, it is recommended that the medial and lateral plates are not the same length. For example, use a short medial plate with a medium dorsolateral / lateral plate. 12 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

15 Use of the trial implants and/or the descriptions and illustrations below is recommended to aid implant selection for the medial column. VA-LCP Distal Humerus Plate, medial Plate position: medial column, medial Orientation of distal screws: mediolateral VA-LCP Distal Humerus Plate, medial, with Extension Plate position: medial column, medial Orientation of distal screws: mediolateral and ascending VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 13

16 Insert Lateral-Column Plate 1 Position lateral-column plate 1a Perpendicular plating: Position dorsolateral plate with or without support Position the plate on the dorsolateral aspect of the distal humerus with the distal spoon-shape portion covering the nonarticulating part of the capitulum, and with the lateral support extending over the most protruding tip of the lateral epicondyle, just proximal to the lateral collateral ligament insertion. Ensure that the shaft portion is positioned at a safe distance from the olecranon fossa. For the dorsolateral plate with support, the position of the plate should allow distal screw insertion through the lateral support to reach into the trochlea. Important: The distal plate position has to be carefully chosen to avoid impingement of the radial head and thus a loss of extension. The distance between the plate and the cartilage should not normally be less than 3 mm. 14 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

17 1b Parallel plating: Position lateral plate Position the plate on the lateral ridge of the distal humerus. The most distal screw hole should lay on or close to the anatomical joint axis. VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 15

18 Insert Lateral-Column Plate Note: Steps 2 and 3 are applicable for all three plate types for the lateral column. 2 Bend plate Instruments Bending Pliers for Plates 2.4 to 4.0, length 230 mm Bending Pliers for Clavicular Plates, length 227 mm Bending Press, length 400 mm Due to varying patient anatomy, slight plate bending may be necessary. Use the bending pliers to contour the plate around the axis of the undercuts. Important: Contour the plate precisely at the level of the undercuts to avoid deformation of the plate holes. 16 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

19 Use the bending pliers for clavicular plates or the bending press to contour the plate around the axis of the reconstruction notches. Important: Contour the plate precisely at the level of the reconstruction notches to avoid deformation of the plate holes. VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 17

20 Insert Lateral-Column Plate 3 Temporary plate fixation Instruments Drill Bit 2.5 mm, length 110 / 85 mm, 2-flute, for Quick Coupling Screwdriver, hexagonal, small, 2.5 mm, with Groove Depth Gauge for Screws 2.7 to 4.0 mm, measuring range up to 60 mm Universal Drill Guide 3.5 Note: The plate can be temporarily fixed with 1.6 mm Kirschner wires inserted through the suture holes. Insert a 3.5 mm cortex screw through the DCU portion of the elongated hole. Use the 2.5 mm drill bit with the 3.5 universal drill guide to predrill the bone through both cortices. To set the screws in a neutral position, press the drill guide down. Determine the required length of the cortex screw using the depth gauge. 18 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

21 Insert the appropriate 3.5 mm cortex screw using the hexagonal screwdriver. Do not tighten the screw. VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 19

22 Insert Distal Screws in Lateral- Column Plate Determine the combination of screws to be used for distal fixation. If a combination of locking and non-locking screws is used, non-locking screws must be inserted first. 1 Optional: Fixation with low-profile metaphyseal compression screws 2.7 mm Use the same instrumentation as per the insertion of variable angle locking screws 2.7 mm. Follow the instructions in step 3. Important: The low-profile metaphyseal compression screw 2.7 mm can be used to pull the plate to the bone. However, the screw can not be used to create interfragmentary compression. The 1.2 Nm torque limiter is recommended for use during insertion of low-profile metaphyseal compression screws 2.7 mm to avoid potential screw damage as a result of excessive torque, for example due to screw collisions. As the low-profile metaphyseal screws 2.7 mm are nonlocking, final tightening must be performed carefully, as with conventional cortical screws. Do not wait for the TLA to click during final tightening. This is not required and could result in the screw thread stripping out of the bone. 2 Optional: Fixation with 2.4 mm cortex screws Use the 2.4 universal drill guide and the 1.8 mm drill bit for insertion of 2.4 mm cortex screws. Determine the length of the screw by using the depth gauge. 20 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

23 3 Fixation with 2.7 mm variable angle locking screws Instruments VA-LCP Drill Sleeve 2.7, for Drill Bits 2.0 mm Drill Bit 2.0 mm, with double marking, length 140 /115 mm, 3-flute, for Quick Coupling Depth Gauge, percutaneous Screwdriver Shaft, Stardrive, T8, self-holding Torque Limiter, 1.2 Nm, with AO / ASIF Quick Coupling Handle for Torque Limiters 0.4 / 0.8 / 1.2 Nm Notes: When inserting screws at the nominal angle, screws should not collide with other screws in the same plate. Using variable angle in close proximity to another plate increases the risk of drill and screw collisions. Do not use any threaded drill guide in the variable angle locking holes, as it could damage the threads in the hole. If 2.7 mm locking screws (non-va) are used, use the VA-LCP drill sleeve 2.7. Always drill and insert at nominal angle. VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 21

24 Insert Distal Screws in Lateral-Column Plate Insert screw at nominal angle Insert the VA-LCP drill sleeve 2.7 into the variable angle locking hole, ensuring that the drill sleeve tip keys into the cloverleaf portion of the hole. The fixed-angle end of the drill sleeve ensures that the drill bit follows the nominal trajectory of the locking hole. Use the 2.0 mm drill bit to drill to the desired depth. Determine the required length of the screw by using the scale on the drill sleeve. If a single marking is visible on the drill bit, the scale from 0 30 mm applies; if a double marking is visible, the scale from mm applies. Alternative technique: Remove the drill sleeve and use the depth gauge ( ) to measure the screw length. Note: If the depth gauge is used for 2.7 mm screws, subtract 4 mm from the indicated length to obtain the correct screw length. 22 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

25 Use the T8 Stardrive screwdriver shaft attached to the 1.2 Nm torque limiter to insert the 2.7 mm variable angle locking screw. For manual insertion, use the handle for torque limiters. Important: Use of the torque limiter ensures maximum strength of the plate-to-screw interface. VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 23

26 Insert Distal Screws in Lateral-Column Plate Optional: Variable angle Use the funnel-shaped end of the drill sleeve to drill variable angle holes at the desired angle. The funnel allows the drill bit a total of ±15 off-axis angulation. Use the 2.0 mm drill bit to drill at the desired angle and to the desired depth. Verify the drill bit angle under image intensifier control to ensure the desired angle has been achieved. Remove the drill sleeve and use the depth gauge to measure the screw length. Important: It is important not to angulate more than 15 from the central axis of the screw hole. Screws can only be removed and inserted at different angles prior to final tightening with the 1.2 Nm torque limiter. Use the T8 Stardrive screwdriver shaft attached to the 1.2 Nm torque limiter to insert the 2.7 mm variable angle locking screw. For manual insertion, use the handle for torque limiters. Repeat for all distal holes to be used. Important: Ensure that the screws do not protrude in the olecranon or coronoid fossa. 24 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

27 Insert Medial-Column Plate 1 Position medial plate or medial plate with extension Position the medial plate on the medial ridge slightly dorsal to the intermuscular septum. The medial plate with extension will wrap around the medial epicondyle. Distal screws should reach as far as possible into the bone. Choose a plate position that allows the longest possible screws. If necessary, bend the plate to ensure optimal plate fit and position of the long screws through the articular block (see pages 16 and 17). VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 25

28 Insert Medial-Column Plate 2 Temporary plate fixation Instruments Drill Bit 2.5 mm, length 110 / 85 mm, 2-flute, for Quick Coupling Screwdriver, hexagonal, small, 2.5 mm, with Groove Depth Gauge for Screws 2.7 to 4.0 mm, measuring range up to 60 mm Universal Drill Guide 3.5 Insert a 3.5 mm cortex screw through the DCU portion of the elongated hole. Use the 2.5 mm drill bit with the 3.5 universal drill guide to predrill the bone through both cortices. To set screws in a neutral position, press the drill guide down. 26 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

29 Determine the required length of the cortex screw using the depth gauge. Insert the appropriate 3.5 mm cortex screw using the hexagonal screwdriver. Do not tighten the screw. VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 27

30 Insert Distal Screws in Medial- Column Plate For variable angle locking and low-profile metaphyseal screw insertion, use a similar procedure to the dorsolateral plate (see pages 20 to 24 for details). Notes: When inserting screws distally in the medial distal humerus plate with extension, insert the most distal screw (ascending screw) first to avoid collision with other screws. Using variable angle in close proximity to another plate increases the risk of drill and screw collisions. Important: Careful drilling is necessary, as interference with screws in the dorsolateral plate is possible. In case of interference, stop drilling and use a screw of appropriate length. 28 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

31 Insert Plate-Shaft Screws After fixing the distal portion of the lateral and medial plates, determine where locking or cortex screws will be used in the shaft. Note: If a combination of cortex and locking screws is used, cortex screws must be inserted first to pull the plate to the bone. 1a Fixation with 3.5 mm cortex screws Instruments Drill Bit 2.5 mm, length 110 / 85 mm, 2-flute, for Quick Coupling Universal Drill Guide Depth Gauge for Screws 2.7 to 4.0 mm, measuring range up to 60 mm Screwdriver, hexagonal, small, 2.5 mm, with Groove Optional instrument Tap for Cortex Screws 3.5 mm, length 110/50 mm Use the 2.5 mm drill bit with the 3.5 universal drill guide to predrill the bone through both cortices. To set screws in a neutral position, press the drill guide down in the non-threaded hole. To obtain compression, place the drill guide at the end of the non-threaded hole away from the fracture, avoiding downward pressure on the spring-loaded tip. Determine the required length of the cortex screw using the depth gauge. Insert the appropriate 3.5 mm cortex screw using the hexagonal screwdriver. VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 29

32 Insert Plate-Shaft Screws 1b Fixation with 3.5 mm locking screws Instruments LCP Drill Sleeve 3.5, for Drill Bits 2.8 mm LCP Drill Bit 2.8 mm with Stop, length 165 mm, 2-flute, for Quick Coupling Depth Gauge for Screws 2.7 to 4.0 mm, measuring range up to 60 mm Screwdriver Shaft, hexagonal, small, 2.5 mm or Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO / ASIF Quick Coupling Torque Limiter, 1.5 Nm, for AO / ASIF Quick Coupling Handle with Quick Coupling Insert the 3.5 mm drill sleeve into the locking hole until fully seated. Drill through both cortices with the 2.8 mm drill bit and use the scale to read-off the screw length. Alternative technique: Remove the drill guide. Use the depth gauge to determine the screw length. Insert the locking screw with the appropriate screwdriver shaft (hexagonal or Stardrive recess) mounted on the 1.5 Nm torque limiter. Insert the screw manually or with the use of a power tool until a click is heard. If a power tool is used, reduce the speed when tightening the head of the locking screw into the plate. 30 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

33 Repeat the above steps for all required shaft holes. VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 31

34 Fixation of Olecranon Osteotomy If the olecranon has been osteotomized for approaching the distal humerus, reduce the olecranon and fix the osteotomy. Notes: Irrigate prior to closure. Please consult and for further information on olecranon osteotomy fixation. 32 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

35 Implant Removal Instruments Screwdriver Shaft, hexagonal, small, 2.5 mm or Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO / ASIF Quick Coupling Screwdriver Shaft, Stardrive, T8, self-holding Handle with Quick Coupling Extraction Screw for Screws 3.5 mm Extraction Screw, conical, for Screws 1.5 and 2.0 mm To remove the implants, unlock all locking screws before removing them completely. Failure to unlock all locking screws may cause plate rotation while the last screw is being removed, which may damage the soft tissue. If the locking screws can not be removed with the screwdriver (e.g. the recess of the screw is damaged or the locking screw is stuck in the plate), use an extraction screw with left-handed thread. Loosen the screw by turning the handle counterclockwise. Important: Ensure that the correct instrumentation is available to enable trouble-free implant removal. The use of the correct screwdrivers (hexagonal or Stardrive) and extraction screws is important. VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 33

36 Implants Plates VA-LCP Distal Humeral Plate 2.7/3.5, dorsolateral Holes Length Right Left 3 (short) 75 mm 0X X (medium) 88 mm 0X X (long) 127 mm 0X X (extra-long) 153 mm 0X X mm 0X S* 0X S* mm 0X S* 0X S* VA-LCP Distal Humeral Plate 2.7/3.5, dorsolateral, with lateral support Holes Length Right Left 3 (short) 75 mm 0X X (medium) 88 mm 0X X (long) 127 mm 0X X (extra-long) 153 mm 0X X mm 0X S* 0X S* mm 0X S* 0X S* VA-LCP Distal Humeral Plate 2.7/3.5, lateral Holes Length Right Left 1 (short) 69 mm 0X X (medium) 82 mm 0X X (long) 121 mm 0X X (extra-long) 147 mm 0X X mm 0X S* 0X S* mm 0X S* 0X S* X=2: Stainless steel X=4: Titanium All plates and screws are also available sterile packed. For sterile implants, add suffix S to article number. *Only available sterile 34 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

37 VA-LCP Distal Humeral Plate 2.7/3.5, medial Holes Length Right Left 1 (short) 69 mm 0X X (medium) 82 mm 0X X (long) 108 mm 0X X (extra-long) 134 mm 0X X mm 0X S* 0X S* mm 0X S* 0X S* VA-LCP Distal Humeral Plate 2.7/3.5, medial, with Extension Holes Length Right Left 1 (short) 72 mm 0X X (medium) 85 mm 0X X (long) 111 mm 0X X (extra-long) 137 mm 0X X mm 0X S* 0X S* mm 0X S* 0X S* X=2: Stainless steel X=4: Titanium All plates and screws are also available sterile packed. For sterile implants, add suffix S to article number. *Only available sterile VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 35

38 Implants Screws Distal screws 0X X VA Locking Screw Stardrive 2.7 mm (head 2.4), self-tapping, length mm 0X X Low Profile Metaphyseal Compression Screw Stardrive 2.7 mm, self-tapping, length mm X Cortex Screw Stardrive 2.4 mm, X self-tapping, length mm Shaft screws X Locking Screw Stardrive 3.5 mm, X self-tapping, length mm or X Locking Screw 3.5 mm, self-tapping, X length mm X Cortex Screw 3.5 mm, self-tapping, X length mm or 0X Cortex Screw Stardrive 3.5 mm, 0X self-tapping, length mm X=2: Stainless steel X=4: Titanium All plates and screws are also available sterile packed. For sterile implants, add suffix S to article number. 36 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

39 Trial Implants Trial Implant for VA-LCP Distal Humeral Plate 2.7/ 3.5, dorsolateral, with lateral support, right, medium, 4 holes, length 88 mm, Stainless Steel Trial Implant for VA-LCP Distal Humeral Plate 2.7/3.5, dorsolateral, with lateral support, left, medium, 4 holes, length 88 mm, Stainless Steel Trial Implant for VA-LCP Distal Humeral Plate 2.7 / 3.5, lateral, right, medium, 2 holes, length 82 mm, Stainless Steel Trial Implant for VA-LCP Distal Humeral Plate 2.7 / 3.5, lateral, left, medium, 2 holes, length 82 mm, Stainless Steel VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 37

40 Implants Trial Implant for VA-LCP Distal Humeral Plate 2.7/3.5, medial, with lateral support, right, medium, 2 holes, length 85 mm, Stainless Steel Trial Implant for VA-LCP Distal Humeral Plate 2.7/3.5, medial, with lateral support, left, medium, 2 holes, length 85 mm, Stainless Steel 38 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

41 Instruments Extraction Screw for Screws 3.5 mm Extraction Screw, conical, for Screws 1.5 and 2.0 mm Drill Bit 2.5 mm, length 110 / 85 mm, 2-flute, for Quick Coupling Handle with Quick Coupling LCP Drill Bit 2.8 mm with Stop, length 165 mm, 2-flute, for Quick Coupling Screwdriver Shaft, Stardrive, T8, self-holding Depth Gauge for Screws 2.7 to 4.0 mm, measuring range up to 60 mm Screwdriver Shaft, hexagonal, small, 2.5 mm Drill Bit 2.0 mm, with double marking, length 140 /115 mm, 3-flute, for Quick Coupling Tap for Cortex Screws 3.5 mm, length 110 /50 mm VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 39

42 Instruments Screwdriver Shaft Stardrive 3.5, T15, self-holding, for AO / ASIF Quick Coupling LCP Drill Sleeve 3.5, for Drill Bits 2.8 mm Universal Drill Guide Handle for Torque Limiters 0.4 / 0.8 / 1.2 Nm Torque Limiter, 1.2 Nm, with AO / ASIF Quick Coupling Periarticular Reduction Forceps, with pointed ball tips 6.5 mm, small 40 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

43 Bending Pliers for Plates 2.4 to 4.0, length 230 mm Screwdriver, hexagonal, small, 2.5 mm, with Groove Depth Gauge, percutaneous VA-LCP Drill Sleeve 2.7, for Drill Bits 2.0 mm Torque Limiter, 1.5 Nm, for AO/ASIF Quick Coupling Bending Pliers for Clavicular Plates, length 227 mm Bending Press, length 400 mm VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide Synthes 41

44 Sets Vario Cases X01 Or X02 Or X03 Or X04 VA-LCP Elbow Plates 2.7/3.5, Complete Set, in Modular Tray, Vario Case System VA-LCP Elbow 2.7/3.5, Distal Humeral Plates for Perpendicular Arrangement and Olecranon Plates VA-LCP Elbow 2.7/3.5, Distal Humeral Plates for Parallel Arrangement and Olecranon Plates VA-LCP Elbow 2.7/3.5, Distal Humeral Plates for Perpendicular and Parallel Arrangement and Olecranon Plates Screw Insertion Instruments for Locking and Cortex Screws 2.7, in Modular Tray Small Fragment Basic Instruments, in Modular Tray, Vario Case System Screw Insertion Instruments 3.5/4.0, in Modular Tray, Vario Case System Optional sets Trial Implants for VA-LCP Elbow Plates 2.7/3.5, in Modular Tray, Vario Case System Small Fragment Reduction Instruments, in Modular Tray, Vario Case System X = 0: Stainless steel X = 1: Titanium 42 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

45 Bibliography Kaiser T, Brunner A, Hohendorff B, Ulmar B, Babst R. Treatment of supra- and intra-articular fractures of the distal humerus with the LCP Distal Humerus Plate: a 2-year followup. J Shoulder Elbow Surg 2011; 20: Schuster I, Korner J, Arzdorf M, Schwieger K, Diederichs G, Linke B. Mechanical Comparison in Cadaver Specimens of Three Different 90-Degree Double-Plate Osteosyntheses for Simulated C2-Type Distal Humerus Fractures With Varying Bone Densities. J Orthop Trauma 2008; 22(2): Stoffel K, Cunneen S, Morgan R, Nicholls R, Stachowiak G. Comparative stability of perpendicular versus parallel doublelocking plating systems in osteoporotic comminuted distal humerus fractures. J Orthop Res 2008; 26(6): Sanchez-Sotelo J, Torchia ME, O Driscoll SW. Complex Distal Humeral Fractures: Internal Fixation with a Principle-Based Parallel-Plate Technique. J Bone Joint Surg Am 2007; 89: VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes 43

46 44 Synthes VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide

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48 All technique guides are available as PDF files at / lit Ö öAAPä version AA 05 / Synthes, Inc. or its affiliates Subject to modifications Synthes, LCP, Stardrive and Vario Case are trademarks of Synthes, Inc. or its affiliates