3.5 mm LCP Superior Anterior Clavicle Plates TGsynthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North...Synthes 9 DeterminePlateLengthandBendPlate 4 Determineplatelengthandbendplate

3.5 mm LCP Superior AnteriorClavicle Plates. Part of the Syntheslocking compression plate (LCP) system.

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

3.5 mm LCP Superior Anterior Clavicle Plates 2

AO Principles 4

Indications 5

Position Patient 6

Approach 7

Reduce 8

Determine Plate Length and Bend Plate 9

Insert Plate 10

Verify Screw Placement 10

Insert Screws 11

Confirm Reduction and Fixation 15

Wound Closure 16

Postoperative Treatment 16

Implant Removal 16

Implants 17

Instruments 20

Set List 24

Image intensifier control

Synthes

The 3.5 mm LCP Superior Anterior Clavicle Plate combineslocking screw technology with conventional plating techniques.

The plate is available in stainless steel and titanium andfeatures a limited-contact shaft profile. The Combi holesallow fixation with locking screws in the threaded section forangular stability, and cortex screws in the dynamic compressionunit (DCU) section for compression.

A fixed-angle construct provides advantages in osteopenicbone or multifragment fractures where screws do not relyon plate-to-bone compression to resist patient load, butfunction similarly to multiple, small, angled blade plates.

Features– Precontoured plate for anatomical shape

– Left and right plates

– Plates are available with 6, 7, or 8 holes; plates with lateralextension are available in six lengths with 3, 4, 5, 6, 7 or 8Combi holes in the shaft

– Notches in the plate allow any necessary plate contouring

– Compatible with current inventory

– Available in 316L stainless steel and titanium alloy(Ti-6Al-7Nb)

– Available sterile-packed

3.5 mm LCP Superior Anterior Clavicle Plates

2 Synthes 3.5 mm LCP Superior Anterior Clavicle Plates Technique Guide

Recon plate segmentsAllow contouring of platesto fit patient anatomy

Rounded plate profile andscrewheads seated flush in the plateMinimize the risk for soft tissue irritation

Synthes 3

Plates with lateral extension feature six distal locking holesthat accept 2.7 mm locking and 2.4 mm cortex screws.The Combi holes in the plate shaft accept 3.5 mm locking,3.5 mm cortex, and 4.0 mm cancellous bone screws.

Combi holesAccept 3.5 mm locking, 3.5 mm cortexand 4.0 mm cancellous bone screws

UndercutsReduce impairment of blood supply

Lateral extensionSix lateral holes accept2.7 mm locking and2.4 mm cortex screws.Small diverging screwsprovide fixation formultiple fracture patterns.

Positioning inscriptionsLateral arrow and signfor right or left

Tapered plate tipTapered end for submuscular plateinsertion preserves tissue viability

AO Principles


In 1958, the AO formulated four basic principles, whichhave become the guidelines for internal fixation.1 Thoseprinciples, as applied to the 3.5 mm LCP Superior AnteriorClavicle Plates, are:

Anatomic reductionPrecontoured plate assists in reduction of metaphysis todiaphysis and facilitates restoration of articular surface.

Stable fixationLocking screws create a fixed-angle construct providingangular stability.

Preservation of blood supplyTapered end facilitates submuscular plate insertion.Submuscular insertion may help to preserve tissue viability.

Early, active mobilizationEarly mobilization per standard AO technique creates anenvironment for bone healing, expediting a return tooptimal function.

1. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger: Manual of InternalFixation, 3rd Edition. Berlin: Springer-Verlag. 1991.

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Indications

The Synthes 3.5 mm LCP Clavicle Plate System is indicatedfor fixation of fractures, malunions, nonunions and osteotomiesof the clavicle.


Position Patient

1Position patient

A beach-chair or supine position on a radiolucent operatingtable is recommended to provide appropriate access to theclavicle. AP and lordotic visualization of the clavicle withfluoroscopy is recommended. A roll placed between thescapulas allows retraction of the shoulders and assists withreduction. The head of the patient should be turned awayfrom the operative side and may be supported with a headrest. Prepare the entire upper extremity, the upper chestwall and hemithorax. This includes the sternum andsternoclavicular articulation.

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Approach

2Approach

The horizontal incision is placed over the superior or inferiorclavicle, depending on stabilization method.

Subcutaneous dissection permits identification of thesupraclavicular sensory nerve branches. The major fibers ofthese nerves should be identified and protected with smallvessel loops throughout the case. The platysma is carefullydivided to expose the clavicle periosteum at the deltotrapezialfascia. Minimal periosteal dissection is carefully done to allowexposure of the fracture. It is critical to not further strip anycomminuted fragments.

Dissectedplatysma muscle

Dissected pectoralismuscle and inferiorplatysma muscle

Vessel loops identifysupraclavicularsensory nerve


Reduce

3Reduce

After fracture exposure, distract the two main fragments andrestore the length of the clavicle. If the bone ends are angledor oblique, reduction with a pointed or serrated reductionforceps is recommended. Normal length, axis angulation androtation should be restored. Any large comminuted fragmentsshould also be reduced and temporarily held with smallpointed bone clamps or K-wires. The temporary fixationshould be planned so as not to interfere with the placementof the definitive fixation.

K-wires can be placed through the distal end of the plateto assist with temporary maintenance of the reduction andfor plate placement.

Additional options for maintaining the reduction include:– Independent lag screws

– Lag screws through the plate

Technique tip: To estimate the amount of clavicular lengthto restore, measure the distance between the acromioclavicularjoint and the sternoclavicular joint on the contralateral side.

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Determine Plate Length and Bend Plate

4Determine plate length and bend plate

Required set

105.434 Small Fragment LCP Instrument and ImplantSet, with self-tapping screws

Instruments

329.04, Bending Irons329.05

329.29 Bending Pliers

329.291 Bending Pliers, for 3.5 mm Clavicle Plates,227 mm length

329.30 Plate Press

Select a plate length appropriate for the fracture.

Due to varying patient anatomy, slight plate bending may benecessary. Using bending irons, bending pliers, and/or theplate press, contour the plate as needed. For an optimum fit,the plate can be bent at each notch in the plane of the shaft.

To bend the plate, insert it into the jaws of the bendingpliers for 3.5 mm clavicle plates at the appropriate notch.

To adjust the superior bend, insert the plate all the waytoward the back of the jaws of the bending pliers (Figures 1and 2).

To adjust the S-curve, place the plate between the twonotches in the front of the jaws of the bending pliers(Figures 3 and 4).

For more leverage and control over bending, loosen theadjustment screw on the bending pliers so that the handlesare closer together. If more adjustment is needed, make aseries of small bends, threading the adjustment screwroughly half a turn at a time.

Figure 1 Figure 2

Figure 3 Figure 4


6Verify screw placement

Since the direction of the locking screw depends on thecontour of the plate, final screw position may be verified withK-wires before insertion. This becomes especially importantwhen the plate has been manually contoured, applied nearthe acromioclavicular joint, or for unusual anatomy.

Verify K-wire placement under image intensification todetermine if final screw placement will be acceptable.

Important: The K-wire position represents the final positionof the locking screw. Confirm that the K-wire does not enterthe joint.

Insert Plate and Verify Screw Placement

5Insert plate

Positioning from the lateral view, the lateral end of eitherplate sits superiorly and wraps around slightly anteriorapproaching the medial end of the clavicle.

Position the plate on the reduced bone, and attach ittemporarily with the plate holding forceps, push/pullreduction device or a 3.5 mm cortex screw. After plateinsertion, check alignment of the bone using fluoroscopy.

Note: This locking plate is precontoured to fit the clavicle.If the plate contour is changed, it is important to check theposition of the screws in relation to the joint, using screwplacement verification.

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Insert Screws

7Insert screws

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 ensure that the platehas appropriate bone contact.

Note: To secure the plate to the clavicle prior to locking screwinsertion, it is recommended to pull the plate to the boneusing a cortex screw.

It is necessary to avoid over-penetration of the inferiorclavicle, due to the close proximity of the subclavian arteryand brachial plexus.

Fixation with 3.5 mm cortex screws

Instruments

310.25 2.5 mm Drill Bit, quick coupling,110 mm, gold

314.02 Small Hexagonal Screwdriver withHolding Sleeve

or311.43 Handle, with quick couplingwith314.03 Small Hexagonal Screwdriver Shaft,

quick coupling

319.01 Depth Gauge

323.36 3.5 mm Universal Drill Guide

Use the 2.5 mm drill bit through the 3.5 mm universal drillguide to predrill the bone. For the neutral position, pressthe drill guide down in the nonthreaded end of the hole.To obtain compression, place the drill guide at the end ofthe nonthreaded hole away from the fracture (do not applydownward pressure on the spring-loaded tip).


7Insert screws continued

Fixation with 3.5 mm cortex screws continuedMeasure for screw length using the depth gauge.

Select and insert the appropriate length 3.5 mm cortexscrew using a small hexagonal screwdriver.

Insert Screws continued

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Locking screw insertion

Notes:The direction of the locking screws is predetermined basedon normal anatomy. If manual contouring in the metaphysealarea is necessary, verify new screw trajectories using the K-wireplacement. The use of image intensification is recommended.

If a locking screw will be used as the first screw, be sure thefracture is reduced and the plate is held securely to the bone.This prevents plate rotation as the screw is locked to the plate.

Fixation with 3.5 mm locking screws

Instruments

310.288 2.8 mm Drill Bit, quick coupling, 165 mm

312.648 2.8 mm Threaded Drill Guide

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

quick coupling

314.115 StarDrive Screwdriver, T15or314.116 StarDrive Screwdriver Shaft, quick coupling,

T15

319.01 Depth Gauge

Insert the 2.8 mm threaded drill guide into a 3.5 mm lockinghole until fully seated. Use the 2.8 mm drill bit to drill to thedesired depth. Remove the 2.8 mm threaded drill guide. Usethe depth gauge to determine screw length.

Insert the locking screw under power, using the torquelimiting attachment and the StarDrive screwdriver shaft, orinsert it manually, using the StarDrive screwdriver. Hold theplate securely on the bone to prevent plate rotation as thescrew is locked to the plate.


Insert Screws continued

7Insert screws continued

Fixation with 2.7 mm locking screws—lateral extension

Instruments

311.43 Handle, with quick coupling

314.467 StarDrive Screwdriver Shaft, T8, 105 mm

314.468 Holding Sleeve, for StarDrive ScrewdriverShaft, T8

319.006 Depth Gauge

323.061 2.0 mm Threaded Drill Guide,with Depth Gauge

or313.353 Drill Sleeve for 2.0 mm Drill Bit

323.062 2.0 mm Drill Bit with Depth Mark,quick coupling, 140 mm

511.776 Torque Limiting Attachment, 0.8 Nm,quick coupling

Screw the 2.0 mm threaded drill guide into a 2.7 mm lockinghole until fully seated. Use the 2.0 mm drill bit to drill to thedesired depth. Remove the 2.0 mm threaded drill guide.Use the depth gauge to determine screw length.

Optional techniqueFor direct measuring with a calibrated drill bit, determinewhere locking screws will be used. Screw the 2.0 mm threadeddrill guide into a threaded hole until fully seated. Use the2.0 mm drill bit with depth mark to drill to the desired depth.Determine the screw length directly from the drill bit.

The 2.7 mm locking screw can be inserted manually or withpower. For power insertion, use the T8 StarDrive screwdrivershaft attached to the 0.8 Nm torque limiting attachment.For manual insertion, use the handle with quick coupling.Use the holding sleeve for StarDrive screwdriver shaft, ifnecessary. Repeat for all lateral holes to be used.

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Confirm Reduction and Fixation

8Confirm reduction and fixation

Carefully assess the final reduction and fixation, by both directvisualization and image intensification. Confirm full range ofmotion and stability of the fixation with the shoulder. AP andlordotic fluoroscopic visualization should confirm reductionand appropriate positioning of the plate and screws.


Wound closure

A careful layered closure should be performed. The trapezial-deltoid fascia can often be approximated over the plate. Theplatysma and the subcutaneous tissue should be closed asseparate layers.

Postoperative treatment

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

Wound Closure, Postoperative Treatment and Implant Removal

Implant removal

Optional sets

01.240.001 Screw Removal Set

105.971 Screw Removal Set

Optional 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. Thisprevents 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 recesses of the lockingscrews are 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 counterclockwise.

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Screws Used with the 3.5 mm LCP Superior Anterior Clavicle Plates

3.5 mm Locking Screws– Used in the locking portion of the Combi holesor in round locking holes

– Create a locked, fixed-angle screw/plate construct

– Fully threaded shaft

– Self-tapping tip

– Available in stainless steel and titanium alloy*

4.0 mm Cancellous Bone Screws– May be used in the DCU portion of the Combi holes

– Compress the plate to the bone or create axial compression

– Fully or partially threaded shaft

– Available in stainless steel and titanium

3.5 mm Cortex Screws– May be used in the DCU portion of the Combi holes

– Compress the plate to the bone or create axial compression


– Available in stainless steel and titanium

* Ti-6Al-7Nb

Screws Used with the 3.5 mm LCP Superior Anterior Clavicle Plates continued


2.4 mm Cortex Screws– May be used in the distal locking holes

– Compress the plate to the bone




2.7 mm Locking Screws– Used in the distal locking holes




* Ti-6Al-7Nb

Synthes 19


3.5 mm LCP Superior Anterior Clavicle Plates,with lateral extension

Stainless LengthSteel Titanium Holes (mm)

02.112.006 04.112.006 3 69 right02.112.007 04.112.007 3 69 left02.112.010 04.112.010 4 81 right02.112.011 04.112.011 4 81 left02.112.012 04.112.012 5 94 right02.112.013 04.112.013 5 94 left02.112.008 04.112.008 6 108 right02.112.009 04.112.009 6 108 left02.112.018 04.112.018 7 123 right02.112.019 04.112.019 7 123 left02.112.020 04.112.020 8 135 right02.112.021 04.112.021 8 135 left



02.112.026 04.112.026 6 94 right02.112.027 04.112.027 6 94 left02.112.028 04.112.028 7 110 right02.112.029 04.112.029 7 110 left02.112.030 04.112.030 8 120 right02.112.031 04.112.031 8 120 left


Instruments

311.43 Handle, with quick coupling

313.353 Drill Sleeve for 2.0 mm Drill Bit



319.006 Depth Gauge, for 2.0 mm and 2.4 mm screws

323.061 2.0 mm Threaded Drill Guide, withDepth Gauge


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323.062 2.0 mm Drill Bit with Depth Mark,quick coupling, 140 mm





Selected Instruments from the Small Fragment LCP Instrumentand Implant Set (105.434)

310.25 2.5 mm Drill Bit, quick coupling, 110 mm, gold


312.648 2.8 mm Threaded Drill Guide

314.02 Small Hexagonal Screwdriver withHolding Sleeve

314.03 Small Hexagonal Screwdriver Shaft,quick coupling

314.115 StarDrive Screwdriver, T15

314.116 StarDrive Screwdriver Shaft, T15, quick coupling

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319.01 Depth Gauge




329.04 Bending Iron(used with 329.05)

329.05 Bending Iron(used with 329.04)


3.5 mm LCP Clavicle SystemStainless Steel (01.112.022) and Titanium (01.112.024)

Graphic Case60.112.012 3.5 mm LCP Clavicle System Graphic Case

Instruments310.510 1.8 mm Drill Bit, quick coupling, 100 mm,

2 ea.

311.43 Handle with quick coupling

313.353 Drill Sleeve for 2.0 mm Drill Bit



319.006 Depth Gauge for 2.0 mm and 2.4 mm screws

323.061 2.0 mm Threaded Drill Guide withDepth Gauge, 2 ea.

323.062 2.0 mm Drill Bit with Depth Mark,quick coupling, 140 mm, 2 ea.




Implants2.4 mm Cortex Screws, self-tapping, with T8 StarDriverecess, 2 ea.

Stainless Steel Titanium Length (mm)

201.758 401.758 8201.760 401.760 10201.762 401.762 12201.764 401.764 14201.766 401.766 16201.768 401.768 18201.770 401.770 20201.772 401.772 22

Synthes

Implants continued2.7 mm Locking Screws, self-tapping, with T8 StarDriverecess, 3 ea.

Stainless LengthSteel Titanium (mm)

202.208 402.208 8202.210 402.210 10202.212 402.212 12202.214 402.214 14202.216 402.216 16202.218 402.218 18202.220 402.220 20202.222 402.222 22

3.5 mm LCP Superior Anterior Clavicle Plates,with lateral extension


02.112.006 04.112.006 3 69 right02.112.007 04.112.007 3 69 left02.112.010 04.112.010 4 81 right02.112.011 04.112.011 4 81 left02.112.012 04.112.012 5 94 right02.112.013 04.112.013 5 94 left02.112.008 04.112.008 6 108 right02.112.009 04.112.009 6 108 left02.112.018 04.112.018 7 123 right02.112.019 04.112.019 7 123 left02.112.020 04.112.020 8 135 right02.112.021 04.112.021 8 135 left



02.112.026 04.112.026 6 94 right02.112.027 04.112.027 6 94 left02.112.028 04.112.028 7 110 right02.112.029 04.112.029 7 110 left02.112.030 04.112.030 8 120 right02.112.031 04.112.031 8 120 left

Required Set105.434 Small Fragment LCP Instrument and

Implant Set, with self-tapping screws

Also Available Sets01.112.010 3.5 mm LCP Clavicle Hook Templates

and Graphic Case Set

01.240.001 Screw Removal Set

105.971 Screw Removal Set

Also Available Implants3.5 mm LCP Clavicle Hook Plates, sterile

Stainless Hook DepthSteel Titanium Holes (mm)

241.072S 441.072S 4 12 right241.073S 441.073S 4 12 left241.074S 441.074S 4 15 right241.075S 441.075S 4 15 left241.076S 441.076S 4 18 right241.077S 441.077S 4 18 left241.082S 441.082S 5 12 right241.083S 441.083S 5 12 left241.084S 441.084S 5 15 right241.085S 441.085S 5 15 left241.086S 441.086S 5 18 right241.087S 441.087S 5 18 left241.094S 441.094S 6 15 right241.095S 441.095S 6 15 left241.096S 441.096S 6 18 right241.097S 441.097S 6 18 left241.104S 441.104S 7 15 right241.105S 441.105S 7 15 left241.106S 441.106S 7 18 right241.107S 441.107S 7 18 left

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

© 2008 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. 3/09 J8647-B

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Documents

3.5 mm LCP Superior Anterior Clavicle Plates TGsynthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North...Synthes 9 DeterminePlateLengthandBendPlate 4 Determineplatelengthandbendplate