Technique Guide 3.5 mm LCP Olecranon Plates. Part of the Synthes locking compression plate (LCP) system.
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 Image intensifier control Synthes
3.5 mm LCP Olecranon Plates. Part of the 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. 2 Synthes 3.5 mm LCP Olecranon Plates Technique Guide
AO Principles and Indications In 1958, the AO formulated four basic principles which have become the guidelines for internal fixation. 1 Those principles, as applied to the 3.5 mm LCP Olecranon Plate, are: Anatomic reduction Precontoured plate assists reduction of metaphysis to diaphysis and facilitates restoration of the articular surface. Stable fixation Locking screws create a fixed-angle construct providing angular stability. Preservation of blood supply Tapered end facilitates submuscular plate insertion. Early, active mobilization Early mobilization per standard AO technique creates an environment for bone healing, expediting a return to optimal function. 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. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger. Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag, 1991. Synthes 3
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 Synthes 3.5 mm LCP Olecranon Plates Technique Guide
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. Synthes 5
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 Synthes 3.5 mm LCP Olecranon Plates Technique Guide
Implantation 1 Determine plate length and adapt plate Required set 105.434 Small Fragment LCP Instrument and Implant Set, with self-tapping screws or 145.434 Small Fragment Titanium LCP Instrument and Implant Set, with self-tapping screws Instruments 329.04, Bending Irons 329.05 329.29* 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. Note: If bending the tab, take care that the screw in the tab does not collide with the other proximal screws. * Also available Synthes 7
Implantation 2 Position plate Instruments 310.25 2.5 mm Drill Bit 312.910 Guiding Block for 3.5 mm LCP Olecranon Plate, right 312.911 Guiding Block for 3.5 mm LCP Olecranon Plate, left 314.02 Small Hexagonal Screwdriver with Holding Sleeve 314.03 Small Hexagonal Screwdriver Shaft 323.053 3.5 mm Locking Screw Sleeve 323.054 2.8 mm Drill Sleeve 323.055 1.6 mm Wire Sleeve 323.36 3.5 mm Universal Drill Guide 324.024 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 Synthes 3.5 mm LCP Olecranon Plates Technique Guide
3 Proximal locking screw insertion Instruments 292.71 1.6 mm Kirschner Wire with thread 310.288 2.8 mm Drill Bit, quick coupling 312.648 2.8 mm Threaded Drill Guide 312.910 Guiding Block for 3.5 mm LCP Olecranon or Plate, right or left 312.911 314.115 StarDrive Screwdriver, T15 314.116 StarDrive Screwdriver Shaft, T15 319.01 Depth Gauge 323.025 Direct Measuring Device 323.053 3.5 mm Locking Screw Sleeve 323.054 2.8 mm Drill Sleeve 323.055 1.6 mm Wire Sleeve 511.770* Torque Limiting Attachment, 1.5 Nm or 511.773 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. Note: 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 Synthes 9
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 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. Warning: Never insert locking screws under power unless using a torque limiting attachment. 10 Synthes 3.5 mm LCP Olecranon Plates Technique Guide
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. Synthes 11
Insert Distal Screws 1 Fixation with 3.5 mm cortex screws Instruments 310.25 2.5 mm Drill Bit, quick coupling 310.35 3.5 mm Drill Bit, quick coupling 311.43 Handle, with quick coupling 314.02 Small Hexagonal Screwdriver with Holding Sleeve or 314.03 Small Hexagonal Screwdriver Shaft 319.01 Depth Gauge 323.36 3.5 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. 12 Synthes 3.5 mm LCP Olecranon Plates Technique Guide
2 Fixation with 3.5 mm locking screws Instruments 310.288 2.8 mm Drill Bit, quick coupling 312.648 2.8 mm Threaded Drill Guide 314.115 StarDrive Screwdriver, T15 314.116 StarDrive Screwdriver Shaft, T15 319.01 Depth Gauge 511.770* Torque Limiting Attachment, 1.5 Nm or 511.773 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. Warning: Never insert locking screws under power unless using a torque limiting attachment. * Also available Synthes 13
Implant Removal Implant removal Optional set 01.240.001 Screw Removal Set Instruments 309.520 Conical Extraction Screw 311.43 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. 14 Synthes 3.5 mm LCP Olecranon Plates Technique Guide
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 Synthes 15
3.5 mm LCP Olecranon Plates Implants 3.5 mm LCP Olecranon Plates, right* Stainless Steel Titanium Holes Length (mm) 236.502 436.502 2 86 236.504 436.504 4 112 236.506 436.506 6 138 236.508 436.508 8 164 236.510 436.510 10 189 236.512 436.512 12 215 3.5 mm LCP Olecranon Plates, left* Stainless Steel Titanium Holes Length (mm) 236.503 436.503 2 86 236.505 436.505 4 112 236.507 436.507 6 138 236.509 436.509 8 164 236.511 436.511 10 189 236.513 436.513 12 215 * Plates are made of implant quality 316L stainless steel or commercially pure (CP) titanium 16 Synthes 3.5 mm LCP Olecranon Plates Technique Guide
Instruments Instruments from the 3.5 mm LCP Olecranon Plate Set (01.104.015/01.104.016) 312.910 Guiding Block for 3.5 mm LCP Olecranon Plate, right 312.911 Guiding Block for 3.5 mm LCP Olecranon Plate, left Selected Instruments from the Small Fragment LCP Instrument and Implant Set (105.434/145.434) 292.71 1.6 mm Kirschner Wire with thread, 150 mm, trocar point 310.25 2.5 mm Drill Bit 310.288 2.8 mm Drill Bit 310.35 3.5 mm Drill Bit 311.43 Handle, with quick coupling Synthes 17
Selected Instruments from the Small Fragment LCP Instrument and Implant Set (105.434/145.434) 312.648 2.8 mm Threaded Drill Guide 314.02 Small Hexagonal Screwdriver with Holding Sleeve 314.03 Small Hexagonal Screwdriver Shaft 314.115 StarDrive Screwdriver, T15 314.116 StarDrive Screwdriver Shaft, T15, quick coupling 319.01 Depth Gauge 323.023 1.6 mm Wire Sleeve, 55 mm 18 Synthes 3.5 mm LCP Olecranon Plates Technique Guide
323.025 Direct Measuring Device 323.054 2.8 mm Drill Sleeve 323.055 1.6 mm Wire Sleeve 323.36 3.5 mm Universal Drill Guide 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 Nm or 511.773 Torque Limiting Attachment, 1.5 Nm, quick coupling * Also available Synthes 19
3.5 mm LCP Olecranon Plate Set Stainless Steel (01.104.015) and Titanium (01.104.016) Graphic Case 60.104.015 3.5 mm LCP Olecranon Plate Graphic Case Instruments 312.910 Guiding Block for 3.5 mm LCP Olecranon Plate, right 312.911 Guiding Block for 3.5 mm LCP Olecranon Plate, left Implants 3.5 mm LCP Hook Plates, 2 ea. Stainless Steel Titanium Holes 02.113.103 04.113.103 3 3.5 mm LCP Olecranon Plates, right Stainless Steel Titanium Holes Length (mm) 236.502 436.502 2 86 236.504 436.504 4 112 236.506 436.506 6 138 236.508 436.508 8 164 236.510 436.510 10 189 236.512 436.512 12 215 3.5 mm LCP Olecranon Plates, left Stainless Steel Titanium Holes Length (mm) 236.503 436.503 2 86 236.505 436.505 4 112 236.507 436.507 6 138 236.509 436.509 8 164 236.511 436.511 10 189 236.513 436.513 12 215 Required Set 105.434 Small Fragment LCP Instrument and Implant Set, with self-tapping screws or 145.434 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 http://us.synthes.com/medical+community/cleaning+and+sterilization.htm or to the below listed inserts, which will be included in the shipping container: Processing Synthes Reusable Medical Devices Instruments, Instrument Trays and Graphic Cases DJ1305 Processing Non-sterile Synthes Implants DJ1304 20 Synthes 3.5 mm LCP Olecranon Plates Technique Guide
Also Available 01.104.000 3.5 mm LCP Elbow System 01.104.004 3.5 mm Titanium LCP Elbow System 01.240.001 Screw Removal Set 60.104.016 3.5 mm LCP Olecranon Graphic Case Tray 329.29 Bending Pliers, for 2.7 mm and 3.5 mm Reconstruction Plates 511.770 Torque Limiting Attachment., 1.5 Nm 690.419 Retrofit Kit for 3.5 mm LCP Elbow System Graphic Case 690.479 Retrofit Kit for 3.5 mm Titanium LCP Elbow System Graphic Case Synthes
Synthes (USA) 1302 Wrights Lane East West Chester, PA 19380 Telephone: (610) 719-5000 To order: (800) 523-0322 Fax: (610) 251-9056 Synthes (Canada) Ltd. 2566 Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) 567-0440 To order: (800) 668-1119 Fax: (905) 567-3185 www.synthes.com 2007 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. 7/10 J6645-D