3.5 mm LCP Olecranon Plates

Transcription

1 Part of the DePuy Synthes Locking Compression Plate (LCP ) System 3.5 mm LCP Olecranon Plates Surgical Technique

2 Table of Contents Introduction 3.5 mm LCP Olecranon Plates 2 AO Principles 3 Indications 3 Clinical Cases 4 Surgical Technique Preparation 5 Implantation 7 Insert Distal Screws 12 Implant Removal 14 Product Information Implants 15 Instruments 17 Set List 20 MR Information The 3.5 mm LCP Olecranon 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 Olecranon 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 Olecranon Plates Surgical Technique DePuy Synthes 1

3 3.5 mm LCP Olecranon Plates. Part of the DePuy Synthes locking compression plate (LCP) System. Features Anatomically precontoured Left and right plates Head holes accept 3.5 mm locking screws, and 2.7 mm and 3.5 mm cortex screws Shaft holes accept 3.5 mm locking screws and 3.5 mm cortex screws Choice of six lengths with 2, 4, 6, 8, 10 or 12 Combi holes in the shaft Guide block for easy and correct insertion of proximal screws Combi holes: combination locking and compression holes The dual-purpose Combi hole allows placement of conventional cortex screws on one side, or threaded conical locking screws on the opposite side of the same hole. Fixed-angle stability The locking screws mate with the threaded plate holes to form a fixed-angle construct. Unicortical fixation option Unicortical locking screws provide stability and load transfer only at the near cortex due to the threaded connection between the plate and the screw. Because the screw is locked to the plate, fixation does not rely solely on the pullout strength of the screw or on the frictional force between the plate and the bone. 1 DePuy Synthes 3.5 mm LCP Olecranon Plates Surgical Technique

4 AO Principles and Indications 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. Indications The 3.5 mm LCP Olecranon Plates are indicated for fixation of fractures, osteotomies and nonunions of the olecranon, particularly in osteopenic bone. 1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; Müller Rüedi ME, TP, RE M Buckley, Allgöwer, CG R Moran. Schneider, AO Principles H Willenegger. of Fracture Manual Management. of Internal Fixation. 2nd ed. 3rd Stuttgart ed. Berlin New Heidelberg York: Thieme; New York: Springer Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme mm LCP Olecranon Plates Surgical Technique DePuy Synthes 3

5 Clinical Cases Case 1 Male patient, 79 years old Olecranon fracture: 21-B1, right arm Implant: LCP olecranon plate with 8 holes Preoperative, lateral view Image intensifier during surgery, lateral view Postoperative (one day after surgery), PA view Case 2 Male patient, 41 years old Olecranon fracture: 21-C2, right arm Implant: LCP Olecranon Plate with 4 holes Preoperative, lateral view Postoperative (ten days after surgery), lateral view Postoperative (ten days after surgery), PA view 4 DePuy Synthes 3.5 mm LCP Olecranon Plates Surgical Technique

6 Preparation 1 Position patient Place the patient either in the lateral or the prone position with the elbow flexed over a side rest. Depending on the fracture, use a posterior access up to approximately 5 cm distal from the supracondylar region. The supine position with the forearm placed across the chest is also an acceptable option, especially with extended approaches to the lateral pillar or column. 3.5 mm LCP Olecranon Plates Surgical Technique DePuy Synthes 5

7 Preparation 2 Surgical approach The incision runs posterior from the supracondylar area to a point 4 cm 5 cm distal to the fracture. It can be slightly curved to the radial side to protect the ulnar nerve. Ulnar nerve Triceps Olecranon Chevron Anconeus Common extensor tendon Ulna 3 Reduce fracture and provide temporary fixation Reduce the fracture directly or indirectly depending on the type of fracture. Ensure that the coronoid is properly reduced before fixation. Examine the reduction of the coronoid process to determine if it is correct before fixation. Use Kirschner wires for temporary fixation. 6 DePuy Synthes 3.5 mm LCP Olecranon Plates Surgical Technique

8 Implantation 1 Determine plate length and adapt plate Required set Small Fragment LCP Instrument and Implant Set, with self-tapping screws or Small Fragment Titanium LCP Instrument and Implant Set, with self-tapping screws Instruments , Bending Irons * Bending Pliers, for 2.7 mm and 3.5 mm Reconstruction Plates Select a plate length appropriate for the fracture. Due to varying patient anatomy, slight bending might be necessary. Using bending irons, contour plates as needed. The triceps tendon may have to be split in order to apply the plate. Evaluate whether or not the hole in the proximal tab should be used. If necessary, remove the tab. Precaution: If bending the tab, take care that the screw in the tab does not collide with the other proximal screws. * Also available 3.5 mm LCP Olecranon Plates Surgical Technique DePuy Synthes 7

9 Implantation 2 Position plate Instruments mm Drill Bit Guiding Block for 3.5 mm LCP Olecranon Plate, right Guiding Block for 3.5 mm LCP Olecranon Plate, left Small Hexagonal Screwdriver with Holding Sleeve Small Hexagonal Screwdriver Shaft mm Locking Screw Sleeve mm Drill Sleeve mm Wire Sleeve mm Universal Drill Guide Push-Pull Reduction Device After adapting the plate, attach the guiding block, drill sleeves and wire sleeve on the proximal part of the plate. Position the plate on the reduced bone, and attach it temporarily with a 3.5 mm cortex screw or push-pull reduction device. Note: Determine the combination of screws to be used for fixation. If a combination of locking and cortex screws will be used, cortex screws should be inserted first to pull the plate to the bone. 8 DePuy Synthes 3.5 mm LCP Olecranon Plates Surgical Technique

10 3 Proximal locking screw insertion Instruments mm Kirschner Wire with thread mm Drill Bit, quick coupling mm Threaded Drill Guide Guiding Block for 3.5 mm LCP Olecranon or Plate, right or left StarDrive Screwdriver, T StarDrive Screwdriver Shaft, T Depth Gauge Direct Measuring Device mm Locking Screw Sleeve mm Drill Sleeve mm Wire Sleeve * Torque Limiting Attachment, 1.5 Nm or Torque Limiting Attachment, 1.5 Nm, quick coupling max. 30 mm To determine screw length needed, insert a Kirschner wire through the sleeve assembly. Stop when increased resistance from the subchondral bone is felt. Since it may not always be possible to feel resistance, the use of image intensification is recommended. Slide the direct measuring device over the K-wire to determine the length of screw. Precaution: All three sleeves must be present. The direct measuring device provides an approximate screw length. Screws longer than 30 mm in the proximal part will collide with the shaft screws. * Also available 3.5 mm LCP Olecranon Plates Surgical Technique DePuy Synthes 9

11 Implantation 3. Proximal locking screw insertion continued Remove the K-wire and K-wire centering sleeve. Drill through the 2.8 mm drill sleeve and then remove it. Insert an appropriate length locking screw through the 3.5 mm locking screw sleeve using the StarDrive TM Screwdriver shaft. Whenever possible, locking screws should be inserted under power using the torque limiting attachment. The audible click will notify the surgeon that the maximum torque value has been reached and the power insertion is completed. After screw insertion using the torque limiting attachment, always check that the screws are fully inserted by hand tightening them. Precaution: Always use the torque limiter to restrict the maximum torque. 11 DePuy Synthes 3.5 mm LCP Olecranon Plates Surgical Technique

12 Alternative technique Insert the 2.8 mm threaded drill guide into a locking hole or Combi hole until fully seated. Drill to the desired depth. Remove the drill guide and use the depth gauge to determine screw length. Insert the appropriate screw. 3.5 mm LCP Olecranon Plates Surgical Technique DePuy Synthes 11

13 Insert Distal Screws 1 Fixation with 3.5 mm cortex screws Instruments mm Drill Bit, quick coupling mm Drill Bit, quick coupling Handle, with quick coupling Small Hexagonal Screwdriver with Holding Sleeve or Small Hexagonal Screwdriver Shaft Depth Gauge mm Universal Drill Guide For lag screw fixation, use the 2.5 mm drill bit through the 3.5 mm universal drill guide to drill for the threaded hole and the 3.5 mm drill bit to drill for the gliding hole. Determine the required length of the cortex screw with the depth gauge. Insert the self-tapping 3.5 mm cortex screw using the small hexagonal screwdriver shaft connected to a power tool or use the small hexagonal screwdriver with holding sleeve. 11 DePuy Synthes 3.5 mm LCP Olecranon Plates Surgical Technique

14 2 Fixation with 3.5 mm locking screws Instruments mm Drill Bit, quick coupling mm Threaded Drill Guide StarDrive Screwdriver, T StarDrive Screwdriver Shaft, T Depth Gauge * Torque Limiting Attachment, 1.5 Nm or Torque Limiting Attachment, 1.5 Nm, quick coupling Insert the 2.8 mm threaded drill guide into a locking hole or Combi hole until fully seated. Use the 2.8 mm drill bit to drill to the desired depth. Remove the drill guide and use the depth gauge to determine screw length. Insert the self-tapping 3.5 mm locking screw using the StarDrive Screwdriver shaft. Whenever possible, locking screws should be inserted under power using the torque limiting attachment. The audible click will notify the surgeon that the maximum torque value has been reached and the power insertion is completed. After screw insertion using the torque limiting attachment, always check that the screws are fully inserted by hand tightening them. Precaution: Always use the torque limiter to restrict the maximum torque. * Also available 3.5 mm LCP Olecranon Plates Surgical Technique DePuy Synthes 11

15 Implant Removal Implant removal Optional set Screw Removal Set Instruments Conical Extraction Screw Handle, with quick coupling To remove locking screws, unlock all screws from the plate, then remove the screws completely from the bone. This prevents simultaneous rotation of the plate when unlocking the last locking screw. If the screws cannot be removed with the screwdriver (e.g. if the hexagonal or StarDrive Recess of the locking screw is damaged or if the screws are stuck in the plate), insert the conical extraction screw with left-handed thread into the screwhead, using the handle with quick coupling, and loosen the locking screw by turning it counterclockwise. 11 DePuy Synthes 3.5 mm LCP Olecranon Plates Surgical Technique

16 Screws Used with the 3.5 mm LCP Olecranon Plate Stainless Steel and Titanium 3.5 mm Locking Screws Create a locked, fixed-angle screw-plate construct Self-tapping tip Used in the locking portion of the Combi holes or in round locking holes 3.5 mm Cortex Screws* May be used in the DCU portion of the Combi holes in the plate shaft or in round locking holes Compress the plate to the bone or create axial compression 2.7 mm Cortex Screws* May be used in the proximal locking holes Compress the plate to the bone Screws made of implant quality 316L stainless steel or titanium alloy (Ti-6Al-7Nb) * Screws made of implant quality 316L stainless steel or commercially pure (CP) titanium 3.5 mm LCP Olecranon Plates Surgical Technique DePuy Synthes 15

17 3.5 mm LCP Olecranon Plates Implants 3.5 mm LCP Olecranon Plates, right* Stainless Steel Titanium Holes Length (mm) mm LCP Olecranon Plates, left* Stainless Steel Titanium Holes Length (mm) * Plates are made of implant quality 316L stainless steel or commercially pure (CP) titanium 11 DePuy Synthes 3.5 mm LCP Olecranon Plates Surgical Technique

18 Instruments Instruments from the 3.5 mm LCP Olecranon Plate Set ( / ) Guiding Block for 3.5 mm LCP Olecranon Plate, right Guiding Block for 3.5 mm LCP Olecranon Plate, left Selected Instruments from the Small Fragment LCP Instrument and Implant Set ( / ) mm Kirschner Wire with thread, 150 mm, trocar point mm Drill Bit mm Drill Bit mm Drill Bit Handle, with quick coupling 3.5 mm LCP Olecranon Plates Surgical Technique DePuy Synthes 17

19 Selected Instruments from the Small Fragment LCP Instrument and Implant Set ( / ) mm Threaded Drill Guide Small Hexagonal Screwdriver with Holding Sleeve Small Hexagonal Screwdriver Shaft StarDrive Screwdriver, T StarDrive Screwdriver Shaft, T15, quick coupling Depth Gauge mm Wire Sleeve, 55 mm 18 DePuy Synthes 3.5 mm LCP Olecranon Plates Surgical Technique

20 Direct Measuring Device mm Drill Sleeve mm Wire Sleeve mm Universal Drill Guide 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 3.5 mm LCP Olecranon Plates Surgical Technique DePuy Synthes 19

21 3.5 mm LCP Olecranon Plate Set Stainless Steel ( ) and Titanium ( ) Graphic Case mm LCP Olecranon Plate Graphic Case Instruments Guiding Block for 3.5 mm LCP Olecranon Plate, right Guiding Block for 3.5 mm LCP Olecranon Plate, left Implants 3.5 mm LCP Hook Plates, 2 ea. Stainless Steel Titanium Holes mm LCP Olecranon Plates, right Stainless Steel Titanium Holes Length (mm) mm LCP Olecranon Plates, left Stainless Steel Titanium Holes Length (mm) Required Set Small Fragment LCP Instrument and Implant Set, with self-tapping screws or Small Fragment Titanium LCP Instrument and Implant Set, with self-tapping screws Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer to or sterilization instructions, if provided. 22 DePuy Synthes 3.5 mm LCP Olecranon Plates Surgical Technique

22 Also Available mm LCP Elbow System mm Titanium LCP Elbow System Screw Removal Set mm LCP Olecranon Graphic Case Tray Bending Pliers, for 2.7 mm and 3.5 mm Reconstruction Plates Torque Limiting Attachment, 1.5 Nm Retrofit Kit for 3.5 mm LCP Elbow System Graphic Case Retrofit Kit for 3.5 mm Titanium LCP Elbow System Graphic Case 3.5 mm LCP Olecranon Plates Surgical Technique DePuy Synthes 22

23 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/0916/1096 4/17 DV