3.5 mm LCP Olecranon Plates TG - synthes.vo.llnwd.netsynthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North America...3.5 mm LCP Olecranon Plates 2 AO Principles 3 Indications 3

3.5 mm LCP Olecranon Plates. Part of the Synthes locking compressionplate (LCP) system.

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

3.5 mm LCP Olecranon Plates 2

AO Principles 3

Indications 3

Clinical Cases 4

Preparation 5

Implantation 7

Insert Distal Screws 12

Implant Removal 14

Implants 15

Instruments 17

Set List 20

Synthes

Image intensifier control

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 lockingscrews, and 2.7 mm and 3.5 mm cortex screws

– Shaft holes accept 3.5 mm lockingscrews 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 lockingand compression holesThe dual-purpose Combi hole allowsplacement of conventional cortexscrews on one side, or threaded conicallocking screws on the opposite side ofthe same hole.

Fixed-angle stabilityThe locking screws mate with thethreaded plate holes to form a fixed-angle construct.

Unicortical fixation optionUnicortical locking screws provide stability and load transfer only at thenear cortex due to the threaded connection between the plate and thescrew. Because the screw is locked tothe plate, fixation does not rely solelyon the pullout strength of the screw or on the frictional force between theplate and the bone.

2 Synthes 3.5 mm LCP Olecranon Plates Technique Guide

Synthes 3

AO Principles and Indications

In 1958, the AO formulated four basic principles which havebecome the guidelines for internal fixation.1 Those principles,as applied to the 3.5 mm LCP Olecranon Plate, are:

Anatomic reductionPrecontoured plate assists reduction of metaphysis to diaphysis and facilitates restoration of the articular surface.

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

Preservation of blood supplyTapered end facilitates submuscular plate insertion.

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, and H. Willenegger. Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag, 1991.

IndicationsThe 3.5 mm LCP Olecranon Plates are indicated for fixationof fractures, osteotomies and nonunions of the olecranon,particularly in osteopenic bone.


Clinical Cases

Case 2– Male patient, 41 years old

– Olecranon fracture: 21-C2, right arm

– Implant: LCP olecranon plate with 4 holes

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

Preoperative, lateral view Postoperative (ten days after surgery), lateral view Postoperative (ten days after surgery), PA view

Synthes 5

Preparation

1Position patient

Place the patient either in the lateral or the prone positionwith the elbow flexed over a side rest. Depending on thefracture, use a posterior access up to approximately 5 cmdistal 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.

Preparation


2Surgical 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.

3Reduce fracture and provide temporary fixation

Reduce the fracture directly or indirectly depending on thetype of fracture. Ensure that the coronoid is properly reduced before fixation.

Examine the reduction of the coronoid process to determineif it is correct before fixation.

Use Kirschner wires for temporary fixation.

Triceps

Ulna

Common extensor tendon

Anconeus

Chevron

Olecranon

Ulnarnerve

Synthes 7

1Determine 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 Irons329.05

329.29* Bending Pliers, for 2.7 mm and 3.5 mmReconstruction Plates

Select a plate length appropriate for the fracture.

Due to varying patient anatomy, slight bending might benecessary. 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 shouldbe 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.

Implantation

* Also available

Implantation


2Position plate

Instruments

310.25 2.5 mm Drill Bit

312.910 Guiding Block for 3.5 mm LCP OlecranonPlate, right

312.911 Guiding Block for 3.5 mm LCP OlecranonPlate, left

314.02 Small Hexagonal Screwdriverwith 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, drillsleeves 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 forfixation. If a combination of locking and cortex screws will be used, cortex screws should be inserted first to pull theplate to the bone.

Synthes 9

3Proximal 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 left312.911

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



511.770* Torque Limiting Attachment, 1.5 Nmor511.773 Torque Limiting Attachment, 1.5 Nm,

quick coupling

To determine screw length needed, insert a Kirschner wirethrough the sleeve assembly. Stop when increased resistancefrom the subchondral bone is felt. Since it may not always be possible to feel resistance, the use of image intensificationis 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 measur-ing device provides an approximate screw length. Screwslonger than 30 mm in the proximal part will collide with theshaft screws.

max. 30 mm

* Also available

Implantation


3. Proximal locking screw insertion continued

Remove the K-wire and K-wire centering sleeve. Drill throughthe 2.8 mm drill sleeve and then remove it.

Insert an appropriate length locking screw through the 3.5 mmlocking screw sleeve using the StarDrive screwdriver shaft.

Whenever possible, locking screws should be inserted underpower using the torque limiting attachment. The audible‘click’ will notify the surgeon that the maximum torque valuehas 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 unlessusing a torque limiting attachment.

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 determinescrew length. Insert the appropriate screw.

Synthes 11


Insert Distal Screws

1Fixation with 3.5 mm cortex screws

Instruments



311.43 Handle, with quick coupling

314.02 Small Hexagonal Screwdriver with Holding Sleeve

or314.03 Small Hexagonal Screwdriver Shaft

319.01 Depth Gauge


For lag screw fixation, use the 2.5 mm drill bit through the3.5 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 thedepth gauge.

Insert the self-tapping 3.5 mm cortex screw using the smallhexagonal screwdriver shaft connected to a power tool oruse the small hexagonal screwdriver with holding sleeve.

Synthes 13

2Fixation with 3.5 mm locking screws

Instruments




314.116 StarDrive Screwdriver Shaft, T15

319.01 Depth Gauge

511.770* Torque Limiting Attachment, 1.5 Nmor 511.773 Torque Limiting Attachment, 1.5 Nm,

quick coupling

Insert the 2.8 mm threaded drill guide into a locking hole orCombi hole until fully seated.

Use the 2.8 mm drill bit to drill to the desired depth. Removethe drill guide and use the depth gauge to determine screw length.

Insert the self-tapping 3.5 mm locking screw using theStarDrive screwdriver shaft.

Whenever possible, locking screws should be inserted underpower using the torque limiting attachment. The audible‘click’ will notify the surgeon that the maximum torque valuehas 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 unlessusing a torque limiting attachment.

* Also available


Implant Removal

Implant removal

Optional set

01.240.001 Screw Removal Set

Instruments

309.520 Conical Extraction Screw


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 unlockingthe last locking screw.

If the screws cannot be removed with the screwdriver (e.g. if the hexagonal or StarDrive recess of the lockingscrew is damaged or if the screws are stuck in the plate), insert the conical extraction screw with left-handed threadinto the screwhead, using the handle with quick coupling,and loosen the locking screw by turning it counterclockwise.

Synthes 15

Screws Used with the 3.5 mm LCP Olecranon PlateStainless 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


Implants3.5 mm LCP Olecranon Plates, right*Stainless Steel Titanium Holes Length (mm)236.502 436.502 2 86236.504 436.504 4 112236.506 436.506 6 138236.508 436.508 8 164236.510 436.510 10 189236.512 436.512 12 215

3.5 mm LCP Olecranon Plates, left*Stainless Steel Titanium Holes Length (mm)236.503 436.503 2 86236.505 436.505 4 112236.507 436.507 6 138236.509 436.509 8 164236.511 436.511 10 189236.513 436.513 12 215

* Plates are made of implant quality 316L stainless steel or commercially pure (CP) titanium


Synthes 17

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 OlecranonPlate, right


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





Selected Instruments from the Small Fragment LCP Instrument and Implant Set (105.434/145.434)


314.02 Small Hexagonal Screwdriver with Holding Sleeve

314.03 Small Hexagonal Screwdriver Shaft


314.116 StarDrive Screwdriver Shaft, T15, quick coupling

319.01 Depth Gauge

323.023 1.6 mm Wire Sleeve, 55 mm

Synthes 19



323.025 Direct Measuring Device


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 Nmor511.773 Torque Limiting Attachment, 1.5 Nm,

quick coupling

* Also available


3.5 mm LCP Olecranon Plate Set Stainless Steel (01.104.015) and Titanium (01.104.016)

Graphic Case60.104.015 3.5 mm LCP Olecranon Plate Graphic Case

Instruments312.910 Guiding Block for 3.5 mm LCP Olecranon

Plate, right


Implants3.5 mm LCP Hook Plates, 2 ea.Stainless Steel Titanium Holes02.113.103 04.113.103 3

3.5 mm LCP Olecranon Plates, rightStainless Steel Titanium Holes Length (mm)236.502 436.502 2 86236.504 436.504 4 112236.506 436.506 6 138236.508 436.508 8 164236.510 436.510 10 189236.512 436.512 12 215

3.5 mm LCP Olecranon Plates, leftStainless Steel Titanium Holes Length (mm)236.503 436.503 2 86236.505 436.505 4 112236.507 436.507 6 138236.509 436.509 8 164236.511 436.511 10 189236.513 436.513 12 215

Required Set105.434 Small Fragment LCP Instrument and

Implant Set, with self-tapping screws

or145.434 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 tohttp://us.synthes.com/Medical+Community/Cleaning+and+Sterilization.htmor 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

Synthes

Also Available01.104.000 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 mmReconstruction Plates

511.770 Torque Limiting Attachment., 1.5 Nm

690.419 Retrofit Kit for 3.5 mm LCP Elbow SystemGraphic Case

690.479 Retrofit Kit for 3.5 mm Titanium LCP ElbowSystem Graphic Case

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

© 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

www.synthes.com

Documents

3.5 mm LCP Olecranon Plates TG - synthes.vo.llnwd.netsynthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North America...3.5 mm LCP Olecranon Plates 2 AO Principles 3 Indications 3