3.5 mm LCP Extra-articular Distal Humerus Plate

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1 Part of the DePuy Synthes Locking Compression Plate (LCP ) System 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

2 Table of Contents Introduction 3.5 mm LCP Extra-articular Distal Humerus Plate 2 AO Principles 4 Indications 5 Surgical Technique Preparation 6 Approach 7 Reduce Fracture 8 Preliminary Fixation 9 Insert Two Most Distal Locking Screws 10 Insert Locking Screws 13 Product Information Implants 15 Instruments 16 Set List 19 MR Information The 3.5 mm LCP Distal Humerus Plates System has not been evaluated for safety and compatibility in the MR environment. It has not been tested for heating, migration or image artifact in the MR environment. The safety of the 3.5 mm LCP Distal Humerus Plates System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury. Image intensifier control 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 1

3 3.5 mm LCP Extra-articular Distal Humerus Plate Features Left and right plates are anatomically contoured to match the posterolateral distal humerus Locking screws engaged in the plate create a fixed-angle construct that enhances fixation in osteopenic bone Combi holes combine a dynamic compression unit (DCU) hole with a threaded hole, providing the flexibility of axial compression 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 head are angled medially to maximize screw purchase in bone Plate head tapered to minimize soft tissue irritation Two most distal holes are angled toward the capitulum and trochlea 2 DePuy Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

4 Elongated Combi holes accept 3.5 mm locking screws, 3.5 mm cortex screws and 4.0 mm cancellous bone screws Limited-contact design 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 3

5 AO Principles AO PRINCIPLES In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation. 1, 2 In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation 1, 2. 4_Priciples_03.pdf :08 Anatomic Anatomic reduction reduction Fracture Fracture reduction reduction and and fixation fixation to to restore restore anatomical anatomical relationships. relationships. 1 2 Stable Stable fixation fixation Fracture Fracture fixation fixation providing providing absolute absolute or relative or relative stability, stability, as required as by the required patient, by the the injury, patient, and the the injury, personality and the personality of the fracture. of the fracture. Early, Early, active mobilization Early Early and and safe safe mobilization and rehabilitation of of the injured part and and the the patient as as a whole. 4 3 Preservation Preservation of of blood blood supply supply Preservation Preservation of of the the blood blood supply supply to to soft soft tissues tissues and and bone bone by by gentle reduction gentle reduction techniques techniques and and careful careful handling. handling. 1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal 2nd ed. Stuttgart New York: Thieme; 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 DePuy Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

6 Indications The 3.5 mm LCP Extra-articular Distal Humerus Plate is indicated for fractures of the distal humerus. 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 5

7 Preparation 1 Preoperative planning Required sets / 3.5 mm LCP Extra-articular Distal Humerus Plate Set (stainless steel or titanium) / Small Fragment LCP Instrument and Implant Set (stainless steel or titanium) Optional sets mm LCP Elbow System 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 determine the length of the plate and the position of the screws. 6 DePuy Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

8 Approach 2 Position patient Positioning is by surgeon preference. However, the lateral decubitus position is frequently chosen. Rest the arm on a padded bar allowing elbow flexion of Approach Possible approaches include a triceps split approach or a posterolateral approach, where the triceps are elevated off the back of the humerus from lateral to medial. 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 al. 2 Precaution: If the plate is long, the radial nerve must be elevated off the back of the humerus and the plate placed underneath. Otherwise, the radial nerve rarely needs to be identified by more than palpation and almost never needs to be isolated or elevated with these fractures. Note: An olecranon osteotomy is not necessary for plate placement. 2. Gerwin, Michelle, et al. Alternative Operative Exposures of the Posterior Aspect of the Humeral Diaphysis. With Reference to the Radial Nerve. The Journal of Bone and Joint Surgery, 78: (1996). 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 7

9 Reduce Fracture 1 Reduce fracture and fix temporarily Use pointed forceps for temporary fixation in restoring the anatomy. Ensure that forceps will not interfere with subsequent plate placement. 2 Determine plate length Choose a plate length that offers sufficient fixation proximal to the fracture. 3 Position plate on bone Instruments * Bending Iron, for 4.5 mm plates (2 required) * Plate-Bending Press * 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 while the distal end curves along the back of the lateral column. Ensure 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 necessary. Contour the plate as needed using the bending irons or the plate-bending press. * Also available 8 DePuy Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

10 Preliminary Fixation 4 Preliminary fixation and compression Instruments mm Drill Bit, quick coupling Handle, with quick coupling Small Hexagonal Screwdriver with Holding Sleeve Small Hexagonal Screwdriver Shaft mm Universal Drill Guide * Bone Holding Forceps, 14 mm, serrated jaw, soft ratchet Alternative instrument StarDrive TM 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 drill guide to predrill the bone. For the neutral position, press the drill guide down in the nonthreaded hole. Use the depth gauge to determine screw length. Select and insert an appropriate length 3.5 mm cortex screw. Do not completely tighten the screw. Make any final adjustments to plate placement. Manually tighten the screw to maintain plate placement and compress the plate to the bone. * Also available 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 9

11 Insert Two Most Distal Locking Screws 5 Insert two most distal locking screws Instruments mm Kirschner Wire with Thread mm Drill Bit, quick coupling mm Threaded Drill Guide Small Hexagonal Screwdriver Shaft or StarDrive Screwdriver Shaft, T mm Wire Sleeve Direct Measuring Device * Bone Holding Forceps, soft ratchet, for plates to 14 mm wide 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 distal locking 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. This wire should be at, or slightly distal to, the equator of the capitellum for plate placement to be correct. Precaution: The K-wire position represents the final position of the locking screw. Confirm that the K-wire does not enter the joint. * Also available 11 DePuy Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

12 Measure for screw length by sliding the tapered end of the direct measuring device over the K-wire down to the wire sleeve. Remove the direct measuring device, K-wire and 1.6 mm wire 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. 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 11

13 Insert Two Most Distal Locking Screws 5 Insert two most distal locking screws continued Select a locking screw of the appropriate length. Insert the locking screw with the appropriate screwdriver shaft (hexagonal or StarDrive Recess) attached to the 1.5 Nm torque 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 head of the locking screw into the plate. Repeat this process for the second-most-distal locking screw. Note: If additional compression of the distal fragment to the plate is needed, insert a 4.0 mm cancellous screw before inserting the locking screws. This screw may be inserted into one of the proximal locking holes in the head of the plate (but not one of the two most distal holes). After fixation with locking screws through the remaining holes, this screw can be replaced with a locking screw. Insert locking screws into the remaining head holes. 11 DePuy Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

14 Insert Locking Screws 6 Insert locking screws Instruments mm Drill Bit, quick coupling mm Threaded Drill Guide Small Hexagonal Screwdriver Shaft or StarDrive Screwdriver Shaft, T Depth Gauge, for small screws Torque Limiting Attachment, 1.5 Nm, quick coupling Determine where locking screws will be used in the shaft portion of the plate. Working from the fracture up the shaft, insert locking screws into the preferred holes until the desired fixation is achieved. Insert the 2.8 mm threaded drill guide into the locking portion of 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. 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 11

15 Insert Locking Screws 6 Insert locking screws continued Insert the locking screw with the appropriate screwdriver shaft (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 the head of the locking screw into the plate. If desired, the cortex screw used for preliminary fixation and compression may be removed. 11 DePuy Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

16 Screws Used with the 3.5 mm LCP Extra-articular Distal Humerus Plate Stainless Steel and Titanium 4.0 mm Cancellous Bone Screws Found in the Small Fragment LCP Instrument 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 Screws Found in the Small Fragment LCP Instrument 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 Screws Found in the Small Fragment LCP Instrument 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 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 11

17 Selected Instruments from the Small Fragment LCP Instrument and Implant Sets Stainless Steel ( ) and Titanium ( ) * 2.8 mm LCP Drill Guide, long, for 3.5 mm LCP plates, for use with * 2.8 mm Drill Bit, quick coupling, 248 mm, 95 mm calibration, for use with mm Kirschner Wire, 150 mm, trocar point mm Kirschner Wire with Thread, 150 mm, trocar point, 5 mm thread length mm Drill Bit, quick coupling, 110 mm mm Drill Bit, quick coupling, 165 mm Handle, with quick coupling * Also available 11 DePuy Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

18 mm Threaded Drill Guide Small Hexagonal Screwdriver with Holding Sleeve Small Hexagonal Screwdriver Shaft, quick coupling StarDrive Screwdriver, T StarDrive Screwdriver Shaft, T15, quick coupling Depth Gauge, for small screws mm Wire Sleeve 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 11

19 Selected Instruments from the Small Fragment LCP Instrument and Implant Sets Stainless Steel ( ) and Titanium ( ) continued Direct Measuring Device mm Universal Drill Guide Push-Pull Reduction Device Threaded Plate Holder, long, for 3.5 mm locking hole Bending Iron, for 2.7 mm and 3.5 mm plates, 150 mm length, used with Bending Iron, for 2.7 mm and 3.5 mm plates, 150 mm length, used with * Torque Limiting Attachment, 1.5 Nm or Torque Limiting Attachment, 1.5 Nm, quick coupling * Also available 11 DePuy Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

20 3.5 mm LCP Extra-articular Distal Humerus Plate Sets Stainless Steel ( ) and Titanium ( ) Graphic Case mm LCP Extra-articular Distal Humerus Plate Graphic Case Implants 3.5 mm LCP Extra-articular Distal Humerus Plates, right Stainless Length Steel Titanium Holes (mm) S S S S S S mm LCP Extra-articular Distal Humerus Plates, left Stainless Length Steel Titanium Holes (mm) S S S S S S Required Set Small Fragment LCP Instrument and Implant Set, with self-tapping screws or Small Fragment LCP Instrument and Titanium Implant 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. For detailed cleaning and sterilization instructions, please refer to or sterilization instructions, if provided. 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 11

21 Also Available Sets mm LCP Elbow System mm LCP Titanium Elbow System Instruments mm LCP Drill Guide, long, for 3.5 mm LCP plates mm Drill Bit, quick coupling, 248 mm, 95 mm calibration Bending Iron, for 4.5 mm plates (2 required) Plate-Bending Press Self-Centering Bone Forceps, size 1, 240 mm length, 14 mm, small serrated jaw, speed lock Bone Holding Forceps, soft ratchet, for plates to 14 mm wide Torque Limiting Attachment, 1.5 Nm 22 DePuy Synthes 3.5 mm LCP Extra-articular Distal Humerus Plate Surgical Technique

22 Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed. Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information. CAUTION: Federal Law restricts these devices to sale by or on the order of a physician. Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada. Not all products may currently be available in all markets. Manufactured or distributed by: Synthes USA Products, LLC 1302 Wrights Lane East West Chester, PA Synthes USA, LLC 1101 Synthes Avenue Monument, CO To order (USA): To order (Canada): Note: For recognized manufacturer, refer to the product label. DePuy Synthes All rights reserved. DSUS/TRM/1016/1131 4/17 DV

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