2.4 mm LCP Radial Head Plates Technique Guide · Robert N. Hotchkiss, MD: ... 10 Synthes 2.4 mm LCP Radial Head Plates Insert Shaft Screws 4 Insert screws in the shaft of the plate

Instruments and Implantsapproved by the AO Foundation

2.4 mm LCP™ Radial Head Plates.Part of the Synthes LCP Distal RadiusPlate System.

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

2.4 mm LCP Radial Head Plates 2

AO ASIF Principles of Internal Fixation 4

Indications 5

Preparation 6

Reduce Fracture 8

Insert Proximal Screws 9

Insert Shaft Screws 10

General Notes on Technique 11

Postoperative Treatment 14

Implant Removal 14

Screws 15

Instruments 16

Set Lists 17

Sterilization Parameters 17

Image intensifier control

Synthes

2.4 mm LCP Radial Head Plates

2 Synthes 2.4 mm LCP Radial Head Plates

Plate features– Nine (9) Radial Head Plates available to address various

fracture patterns of the proximal radius

– Plates are precontoured for anatomical fit

– Combi holes allow fixation with locking screws in thethreaded section for angular stability, and cortex screws in the Dynamic Compression Unit (DCU) section for distraction. A fixed-angle construct provides advantages in osteopenic bone or multifragment fractures, where traditional screw purchase is compromised.

Additional features– Limited-contact design shaft with 2, 3, and 4 Combi holes

– The holes in the head of the plate accept 2.4 mm LockingScrews and 2.0 mm Cortex Screws

– The shaft holes accept 2.4 mm Locking Screws in thethreaded portion or 2.7 mm Cortex Screws and 2.4 mmCortex Screws in the distraction portion

– Radial Head Rim Plates available in right and left plateswith a 5º tilt to match the anatomy of the radial head

– Radial Head Neck Plates fit both right and left proximalradii

Synthes 3

Rim plates

Neck plates

2-hole plates

3-hole plates

4-hole plates

2-hole plate

3-hole plate

4-hole plate

AO ASIF Principles of Internal Fixation

In 1958, the AO ASIF (Association for the Study of InternalFixation) formulated four basic principles,1 which have be-come the guidelines for internal fixation. These principles, as applied to the 2.4 mm LCP Radial Head Plates, are:

Anatomic Reduction Multiple, nonparallel metaphyseal screw holes provide fixationoptions for a variety of fracture patterns. Precontoured platesassist reduction of metaphysis to diaphysis.

Stable FixationLocking screws create a fixed-angle construct, providing angular stability.

Preservation of Blood SupplyTapered end allows submuscular plate insertion, preserving tissue viability.

Limited-contact plate design reduces plate-to-bone contact,limiting vascular trauma and insult to bone.

Early, Active MobilizationEarly mobilization per standard AO technique creates an environment for bone healing, expediting a return to optimal function.


1. M.E. Müller, M. Allgöwer, R. Schneider, H. Willenegger: AO Manualof Internal Fixation, 3rd Edition. Berlin; Springer-Verlag. 1991.

Indications

Extra-articular and intra-articular fractures of the proximal radius andmultifragmented radial neck fractures.

Synthes 5


Preparation

Patient position

Position the patient supine on the table. Prepare the extrem-ity from the axilla to the hand. This allows rotation of theforearm and flexion and extension of the elbow during theoperative fixation.

Approach

A lateral approach is most commonly used. Take care toavoid the deep branch of the radial nerve, which runs anteriorto the capsule and the radial head. To minimize the risk ofoperative disruption of the lateral collateral ligament, thecapsular incision should remain in the front of the anteriormargin of the anconeus muscle and parallel to the fasciallimit of the extensor carpi ulnaris. The annular ligament, atrue thickening of the capsule, is opened laterally or slightlyanteriorly to allow full inspection of the fragments. In selectedcases, an osteotomy of the lateral epicondyle will allow anextensile approach.

Illustrations on this page are reproduced from Rüedi/Murphy, AO Principles of Fracture Management by permission of AO Publishing, Copyright © 2000 AO Publishing, Switzerland.

Synthes 7

2. Robert N. Hotchkiss, MD: “Displaced Fractures of the Radial Head: Internal Fixation or Excision?” AAOS, Vol. 5, No. 1, January/February 1997.

Safe zone

Both plates fit within the Hotchkiss safe zone2 which is described as an area of 105° on the radial head that is free of impingement between ulna and radius. The Hotchkiss safezone is located on the opposite side of the radial tuberosity.

Required Set

105.515 2.4 mm LCP Distal Radius Plate Instrument and Implant Set

or

145.515 2.4 mm Titanium LCP Distal Radius PlateInstrument and Implant Set

= Safe zone

Neutral Supination Pronation

Reduce Fracture


1Reduce fracture

Instruments

292.12 1.25 mm Kirschner Wire (stainless steel)492.12 1.25 mm Titanium Kirschner Wire

292.16 1.6 mm Kirschner Wire (stainless steel)492.16 1.6 mm Titanium Kirschner Wire

399.97 Reduction Forceps, with points

Obtain reduction and temporary fixation with pointed Reduction Forceps. Gentle rotation of the forearm allows inspection of the circumference of the radial head and neck. Perform preliminary fixation with K-wires.

2Apply Radial Head Plate

Instruments

311.43 Handle, with quick coupling

314.467 StarDrive Screwdriver Shaft, T8

329.12 Bending Pliers

After reducing the fracture, apply the plate and insert a preliminary cortex screw through the DCU portion of one of the elongated Combi Holes.

Note: The plates are precontoured to fit the anatomy of theradial head. There are no undercuts on the plates to protectthe threaded holes from distortion during bending. If it is necessary to bend the plate, use the Bending Pliers.

Synthes 9

Insert Proximal Screws

3Insert proximal screws

Instruments



For 2.0 mm cortex screws

310.16 1.5 mm Drill Bit


For 2.4 mm locking screws

310.509 1.8 mm Drill Bit with depth mark, quickcoupling, 110 mm

323.029 Threaded LCP Drill Guide

Use the 2.0 mm Cortex Screws and the 2.4 mm LockingScrews in the head of the plate.

Important: Careful drilling is necessary, as interference withscrews in the proximal portion of the plate is possible. In caseof interference, stop drilling and use a screw of appropriatelength.

See General Notes on Technique for additional information.


Insert Shaft Screws

4Insert screws in the shaft of the plate

Instruments




310.509 1.8 mm Drill Bit, with depth mark, quickcoupling, 110 mm


323.202 2.4 mm Universal Drill Guide





For 2.4 mm locking screws

310.509 1.8 mm Drill Bit with depth mark, quickcoupling, 110 mm


Use 2.4 mm and 2.7 mm Cortex Screws and 2.4 mm LockingScrews in the shaft of the plate.

Synthes 11

General Notes on Technique

Determine screw choice

– If planning a combination of locking and cortex screws, first use a cortex screw to pull the plate to the bone.

– If using a locking screw first, ensure that the plate is held securely to the bone, to avoid spinning of the plate as thescrew locks into the plate.

Insert cortex screws

Instruments






319.006 Depth Gauge, for 2.0 mm and 2.4 mm screws




– Use the 2.0 mm Universal Drill Guide for insertion of 2.0 mmCortex Screws. For the proximal 2.0 mm Cortex Screw, usethe 1.5 mm Drill Bit for the threaded hole and the 2.0 mmDrill Bit for the gliding hole. Determine the length of screwby using the Depth Gauge.

– Use the 2.4 mm Universal Drill Guide or the 2.7 mm Universal Drill Guide for an eccentric (distraction) or neutral (buttress) insertion of cortex screws.

– For the 2.4 mm Cortex Screw, use the 1.8 mm Drill Bit for the threaded hole and the 2.4 mm Drill Bit for the gliding hole. Determine the length of the screw by usingthe Depth Gauge. For 2.7 mm Cortex Screws, use the 2.0 mm Drill Bit for the threaded hole and the 2.7 mm Drill Bit for the gliding hole.

Note: The 2.0 mm Cortex Screws are also available in the Modular Foot System, Modular Hand System, and Mini Fragment sets.


Insert locking screws

Instruments

310.509 1.8 mm Drill Bit with depth mark, quickcoupling



319.006 Depth Gauge, for 2.0 mm and 2.4 mm screws


– Screw the Threaded LCP Drill Guide into a hole until fully seated.

– For the 2.4 mm Locking Screws, use the 1.8 mm Drill Bitwith depth mark, quick coupling, to drill to the desireddepth. Determine the screw length directly from the markon the drill bit and scale on the threaded drill guide. Thismay be verified using a Depth Gauge for 2.0 mm and 2.4 mm screws.

– Insert the locking screw manually with the T8 StarDrive Screwdriver Shaft and Handle. Carefully tighten the lock-ing screw, as excessive force is not necessary to produceeffective plate-to-screw locking.

General Notes on Technique continued

Synthes 13

Alternate method

Locking screw insertion with holding sleeve

Instruments



314.468 Holding Sleeve

An alternate method may be used for insertion of lockingscrews, using the locking screw to pull the plate to the bone.Place the Holding Sleeve onto the StarDrive ScrewdriverShaft. Pick up the locking screw with the Holding Sleeve, and insert the screw. With the locking screw still held by theHolding Sleeve, tighten the screw until the plate is drawn tothe bone. Pull up on the Holding Sleeve to release the screwhead, and tighten the locking screw into the plate.

Take care to hold the plate securely on the bone to avoid spinning the plate as the screw locks to the plate.


Postoperative Treatment and Implant Removal

Postoperative treatment

Postoperative treatment with locking compression platesdoes not differ from conventional internal fixation procedures.

Implant removal

To remove locking screws, first unlock all screws from theplate and then remove the screws completely from the bone.This avoids rotation of the plate when removing the last locking screw.

ReferencesT. Rüedi, W. Murphy: AO Principles of Fracture Management. Thieme, New York, 2000.

M.E. Müller, M. Allgöwer, R. Schneider, H. Willenegger: AO Manual of Internal Fixation,3rd Edition. Berlin; Springer-Verlag. 1991.

Robert N. Hotchkiss, MD: “Displaced Fractures of the Radial Head: Internal Fixation or Excision?” AAOS, Vol. 5, No. 1, January/February 1997.

Synthes 15

Screws Used with 2.4 mm LCP Radial Head PlatesStainless Steel and Titanium

2.0 mm Cortex Screws, self-tapping (Also available in the Modular Hand Set, Modular Foot Set,and the Mini Fragment Set)– For use in round holes in plate head, to provide

compression or neutral fixation– Low-profile head in the plate holes

– 10 mm to 26 mm lengths

2.4 mm Cortex Screws, self-tapping, with T8 StarDrive recess (Available in the 2.4 mm LCP Distal Radius Set)– For use in Combi holes in plate shaft, to provide

distraction or neutral fixation

– Low-profile head in the plate holes

– StarDrive recess mates with self-retaining screwdriver and provides improved torque transmission


2.4 mm Locking Screws, self-tapping, with T8 StarDrive recess (Available in the 2.4 mm LCP Distal Radius Set)– Threaded, conical head locks securely into the plate

to provide angular stability– Locked screws allow unicortical screw fixation and

load transfer to the near cortex– StarDrive recess mates with self-retaining screwdriver

and provides improved torque transmission– 6 mm to 30 mm lengths

2.7 mm Cortex Screws, self-tapping, with T8 StarDrive recess (Available in the 2.4 mm LCP Distal Radius Set)– For use in Combi holes in plate shaft, to provide

distraction or neutral fixation

– Low-profile head in the plate holes

– StarDrive recess mates with self-retaining screwdriver and provides improved torque transmission


Note: For information on fixation principles using conven-tional and locked plating techniques, please refer to the SmallFragment Locking Compression Plate (LCP) Technique Guide.

Stainless steel screws are made of implant quality 316L stainless steel.Titanium screws are made of titanium alloy, Ti-6Al-7Nb.

Instruments

310.16 1.5 mm Drill Bit, quick coupling, 110 mm

310.972 Countersink, for 2.0 mm and 2.4 mm screws

311.03.96 Handle, with mini quick coupling, small

314.67.96 1.5 mm/2.0 mm Cruciform Screwdriver Blade,with holding sleeve



Synthes 17

2.4 mm LCP Radial Head Plate Instrument and Implant SetsStainless Steel (141.682) and Titanium (141.684)

Modules304.215 2.4 mm LCP Radial Head Plate

Graphic Case Module

304.216 2.4 mm Titanium LCP Radial Head PlateGraphic Case Module

Implants2.4 mm LCP Radial Head Rim PlatesStainless Steel Titanium Description Length (mm)241.680 441.680 2 holes, right 34241.681 441.681 2 holes, left 34 241.682 441.682 3 holes, right 46241.683 441.683 3 holes, left 46241.684 441.684 4 holes, right 56 241.685 441.685 4 holes, left 56

2.4 mm LCP Radial Head Neck PlatesStainless Steel Titanium241.690 441.690 2 holes 28241.691 441.691 3 holes 40241.692 441.692 4 holes 50

2.0 mm Cortex Screws, self-tapping, 2 ea.Stainless Steel Titanium Length (mm)201.810 401.810 10 201.811 401.811 11 201.812 401.812 12201.813 401.813 13 201.814 401.814 14 201.816 401.816 16201.818 401.818 18201.820 401.820 20201.822 401.822 22201.824 401.824 24 201.826 401.826 26

Instruments

310.16 1.5 mm Drill Bit, quick coupling, 110 mm, 2 ea.

310.972 Countersink, for 2.0 mm and 2.4 mm screws

311.03.96 Handle, with mini quick coupling, small

314.67.96 1.5 mm/2.0 mm Cruciform Screwdriver Blade,with holding sleeve


Sterilization Parameters for Sets (141.682 and 141.684)These Synthes sets with all additionally available items, as marked in the case, can be sterilized by the following parameters. For more information, please seegraphic case package insert.

Method Cycle Temperature Exposure Time

Steam Prevacuum 132°–135°C 8 Minutes(Wrapped) (270°–275°F)

Steam Gravity Displacement 132°–135°C 22 Minutes(Wrapped) (270°–275°F)

Required Additional Set105.515 2.4 mm LCP Distal Radius Plate Instrument

and Implant Set or

145.515 2.4 mm Titanium LCP Distal Radius PlateInstrument and Implant Set

Synthes (USA)1302 Wrights Lane EastWest Chester, PA 19380Telephone: (610) 719-5000To order: (800) 523-0322Fax: (610) 251-9056

Synthes (Canada) Ltd.2566 Meadowpine BoulevardMississauga, Ontario L5N 6P9Telephone: (905) 567-0440To order: (800) 668-1119Fax: (905) 567-3185

© 2006 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. 12/06 J5946-B

www.synthes.com

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2.4 mm LCP Radial Head Plates Technique Guide · Robert N. Hotchkiss, MD: ... 10 Synthes 2.4 mm LCP Radial Head Plates Insert Shaft Screws 4 Insert screws in the shaft of the plate