AAP LOQTEQ Distal Dorsolateral Humerus Plate... User manual

Locking Compression Technology by aap
Elbow lating System
Surgical Technique

1
Elbow lating System
Surgical Technique

Disclaimer
This surgical technique is exclusively intended for medical professionals, especially physicians, and the-
refore may not be regarded as a source of information for non-medical persons. The description of this
surgical technique does not constitute medical advice or medical recommendations nor does it convey
any diagnostic or therapeutic information on individual cases. Therefore, the attending physician is
fully responsible for providing medical advice to the patient and obtaining the informed consent of the
patient which this surgical technique does not supersede.
The description of this surgical technique has been compiled by medical experts and trained staff of
aap mplantate AG with utmost diligence and to the best of their knowledge. However, aap Implantate
AG excludes any liability for the completeness, accuracy, currentness, and quality of the information
as well as for material or immaterial damages arising from the use of this information.
Surgical Technique
Elbow lating System
aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
2

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
•aterial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
•Indications / Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
•Processing (Sterilization & Cleaning) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
•Features & Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Surgical Technique Distal Humerus lates 2.7/3.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
•Preoperative planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
•Patient positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
•Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
•Preparing the plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
•Reduction and primary fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
•Insertion of cortical screws (gold) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15
•Insertion of locking screws (blue) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
•Insertion of locking compression screws (red) without compression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
•Insertion of the Distal Dorsolateral Humerus Plate, 90° plate configuration . . . . . . . . . . . . . . . . . . . . . . .18
•Insertion of the Distal Lateral Humerus Plate, 180° plate configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Surgical Technique Olecranon late 2.7/3.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
•Preoperative planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
•Patient positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
•Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
•Preparing the plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
•Reduction and primary fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
•Insertion of cortical screws (gold) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
•Insertion of locking screws (blue) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
•Insertion of locking compression screws (red) without compression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Insertion of locking compression screws (red) with compression . . . . . . . . . . . . . . . . . .24
Explantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Assembly instructions aiming arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Assembly instructions compression drill guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
3Surgical Technique
Elbow ating System
Content

Surgical Technique
Elbow lating System
aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
4
Introduction
The LOQTEQ® Elbow Plating System combines the advantages of angular stability with anatomically preformed plates
for stable fixation of complex fractures of the distal humerus and the proximal ulna. When necessary, diaphyseal/
metaphyseal compression can be achieved using the gliding locking holes in the plate shaft.
The LOQTEQ® Elbow Plating System includes the following plates:
•LOQTEQ® Distal Dorsolateral Humerus Plate 2.7/3.5 •LOQTEQ® Distal Lateral Humerus Plate 2.7/3.5
•LOQTEQ® Distal edial Humerus Plate 2.7/3.5 •LOQTEQ® Olecranon Plate 2.7/3.5
Material
The LOQTEQ® implants and instruments are manufactured using high-quality materials, which have been proven to be
successful in medical technology for decades. The anatomical plates and bone screws are made of titanium alloy.
All materials employed comply with national and international standards. They are characterized by good biocompatibility,
a high degree of safety against allergic reactions and good mechanical properties. LOQTEQ® implants show an excellent
highly polished surface.
Indications/Contraindications
Indications
L QTEQ® Distal Humerus Plates
•Intra-articular fractures, supracondylar fractures, osteotomies and non-unions of the distal humerus.
L QTEQ® lecranon Plates
•Fixation of fractures, osteotomies and nonunions of the olecranon, particularly in osteopenic bone.
Contraindications
•Infection or inflammation (localized or systemic)
•Allergies against the implant material
•High anesthesia risk patients
•Severe soft tissue swelling impacting normal wound healing
•Insufficient soft tissue coverage
•Fractures in children and adolescents with epiphyseal plates not yet ossified
Processing (Sterilization & Cleaning)
The implants are supplied sterile and non-sterile.
Implants and instruments that are supplied in non-sterile condition must be sterilized before use.
For this purpose, please refer to the Instructions for Use that are enclosed with the plates, instruments, and trays.
Do not use (sterile) implants from damaged or open inner packaging.

aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
5Surgical Technique
Elbow lating System
Introduction
Distal Medial Humerus late 2.7/3.5
Features & Benefits
•The anatomical plate design minimizes the need for intraoperative plate contouring
•All plate holes, with the exception of the oblong hole, are compatible with locking as well as
non-locking cortical screws
•Fitted, radiolucent aiming devices are designed for the safe placement of drill guides at a preset angle
•inor contact undercuts may help to preserve the blood supply to the periosteum
•Available as left and right version
Gliding locking holes
in the shaft area allow
compression and
angular stability with
LOQTEQ® technology
•
The flattened end of the
plate is designed for
tissue-conserving,
sub-muscular insertion
•
The oblong hole allows
for easy adjustment
of the plate
•
Holes for K-wires for
temporary fixation of
bone fragments or of the
plate to the bone
•
Round locking holes in
the metaphyseal plate
area are suitable for
2.7 mm locking screws
(blue) as well as 2.5 mm
cortical screws (gold)
•
•In combination with the
dorsolateral (90°) or the
lateral plate (180°) a very
stable support for the medial
condyle is possible, which
can allow early recovery for
the patient
•
•2.7 mm screws as well
as offset holes in the
metaphyseal area of the
plate allow to catch even
very small fragments
•
•2.5 mm non-locking cortical
screws (gold) can angulate
in the plate hole
•

Surgical Technique
Elbow lating System
aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
6
Introduction
Distal Dorsolateral Humerus late 2.7/3.5
Features & Benefits
•The anatomical plate design minimizes the need for intraoperative plate contouring
•All plate holes, with the exception of the oblong hole, are compatible with locking as well as
non-locking cortical screws
•inor contact undercuts may help to preserve the blood supply to the periosteum
•Available as left and right version
Gliding locking holes
in the shaft area allow
compression and
angular stability with
LOQTEQ® technology
•
The flattened end of the
plate is designed for
tissue-conserving,
sub-muscular insertion
•
The oblong hole allows
for easy adjustment
of the plate
•
Holes for K-wires for
temporary fixation of
bone fragments or of the
plate to the bone
•
Round locking holes in
the metaphyseal plate
area are suitable for
2.7 mm locking screws
(blue) as well as 2.5 mm
cortical screws (gold)
•
•In combination with the
medial plate (90°) a very
stable support for the medial
condyle is possible, which
can allow early recovery for
the patient
•
•2.7 mm screws as well
as offset holes in the
metaphyseal area of the
plate allow to even catch
very small fragments
•
•2.5 mm non-locking cortical
screws (gold) can angulate
in the plate hole
•

aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
7Surgical Technique
Elbow lating System
Introduction
Distal Lateral Humerus late 2.7/3.5
Features & Benefits
•The anatomical plate design minimizes the need for intraoperative plate contouring
•All plate holes, with the exception of the oblong hole, are compatible with locking as well as
non-locking cortical screws
•Fitted, radiolucent aiming devices are designed for the safe placement of drill guides at a preset angle
•inor contact undercuts may help to preserve the blood supply to the periosteum
•Available as left and right version
Gliding locking holes
in the shaft area allow
compression and
angular stability with
LOQTEQ® technology
•
The flattened end of the
plate is designed for
tissue-conserving,
sub-muscular insertion
•
The oblong hole allows
for easy adjustment
of the plate
•
Holes for K-wires for
temporary fixation of
bone fragments or of the
plate to the bone
•
Round locking holes in
the metaphyseal plate
area are suitable for
2.7 mm locking screws
(blue) as well as 2.5 mm
cortical screws (gold)
•
•In combination with the
medial plate (180°) a very
stable support for the medial
condyle is possible, which
can allow early recovery for
the patient
•
•2.7 mm screws as well
as offset holes in the
metaphyseal area of the
plate allow to even catch
very small fragments
•
•2.5 mm non-locking cortical
screws (gold) can angulate
in the plate hole
•

Surgical Technique
Elbow lating System
aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
8
Introduction
Olecranon late 2.7/3.5
Features & Benefits
•The anatomical plate design minimizes the need for intraoperative plate contouring
•All plate holes, with the exception of the oblong hole, are compatible with locking as well as
non-locking cortical screws
•Fitted, radiolucent aiming devices are designed for the safe placement of drill guides at a preset angle
•inor contact undercuts may help to preserve the blood supply to the periosteum
•Available as left and right version
Gliding locking holes
in the shaft area allow
compression and
angular stability with
LOQTEQ® technology
•
The flattened end of the
plate is designed for
tissue-conserving,
sub-muscular insertion
•
The oblong hole allows
for easy adjustment
of the plate
•
Holes for K-wires for
temporary fixation of
bone fragments or of the
plate to the bone
•
Round locking holes in
the metaphyseal plate
area are suitable for
2.7 mm locking screws
(blue) as well as 2.5 mm
cortical screws (gold)
•
•2.7 mm screws as well
as offset holes in the
metaphyseal area of the
plate allow to even catch
very small fragments
•
•2.5 mm non-locking cortical
screws (gold) can angulate
in the plate hole
•
•Screws aim at and
stabilize the coronoid
•
•Bendable segments
allow additional
contouring
•

aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
9Surgical Technique
Elbow lating System
Surgical Technique
Distal Humerus lates
90°
plate placement
180°
plate placement
Preoperative planning
•Evaluate the fracture type on the basis of
the X-rays / CT and select the appropriate
plate length and screw positions.
Also insert lag screws, if necessary.
NTE:
To prevent extensive diaphyseal stress,
it is recommended that the medial and
lateral plates are not the same length,
with at least a two-hole difference
between the plates.
•LOQTEQ® Distal Humerus Plates are anato-
mically precontoured to fit to the anatomy
of an average distal humerus.
•In general, the articular block should be
reduced prior to repositioning the articular
block to the shaft.
•Bicolumn fractures are common, requiring
fixation via a dual plate construct.
LOQTEQ® Elbow Plating System allows for
90° and 180° plate placement.
Minimum 2 holes difference

Surgical Technique
Elbow lating System
aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
10
Surgical Technique
Distal Humerus lates 2.7/3.5
L QTEQ® Distal Medial
Humerus Plate 2.7/3.5
85 mm

98 mm

124 mm

150 mm

202mm

2 holes 11 holes7 holes5 holes3 holes11 holes 2 holes3 holes5 holes7 holes
L R
11 holes5 holes 7 holes
2 holes
11 holes 7 holes 5 holes 3 holes
LR
3 holes2 holes
89 mm

102 mm

128 mm

154 mm

206 mm

L QTEQ® Distal Dorsolateral
Humerus Plate 2.7/3.5
(90°)

aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
11Surgical Technique
Elbow lating System
Surgical Technique
Distal Humerus lates 2.7/3.5
11 holes5 holes 7 holes
2 holes
11 holes 7 holes 5 holes 3 holes 3 holes2 holes
86 mm
n
99 mm
n
125 mm
n
151 mm
n
205 mm
n
LR
L QTEQ® Distal
Lateral Humerus
Plate 2.7/3.5
(180°)

Surgical Technique
Elbow lating System
aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
12
Surgical Technique
Distal Humerus lates 2.7/3.5
Patient positioning
•Position the patient in lateral or prone
position with the arm supported over
bolsters.
Approach
•The posterior access is usually preferred,
with a longitudinal incision just radial to
the olecranon.
CAUTI N:
The ulnar nerve must be identified and
protected. When using longer plates, the
radial nerve may require exploration and
protection.
•Depending on the fracture pattern, the
triceps can be left intact (A), elevated off
the bone (B) or an olecranon osteotomy
(C) can be performed for adequate ex-
posure of the fracture.
ABC

aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
13Surgical Technique
Elbow lating System
Surgical Technique
Distal Humerus lates 2.7/3.5
1.5 mm

•Position the medial plate on the madial column at the distal humerus
using the aiming arm prefixing it in the most distal plate hole.
•Plate position: on the medial column, medial distal
•Orientation of distal screws: mediolateral
NTE:
Screw the drill guide in the most distal screw hole of the medial
plate and position the opposite tip of the aiming pointer in the
location of the desired screw penetration point on the lateral side.
In case of the pointer indicating a likely penetration of an area
within the joint, try one hole up.
CAUTI N:
To reduce the risk of glove perforation, care should be taken
when using the aiming pointer of the aiming arm.
NTE:
The offset of the twist drill / K-wire is 1.5 mm.
NTE:
If for example an angle stable screw fixation should not be possible
in the most distal plate hole, the cortical screws 2.5 mm (gold)
offer a draw-back with an option of slight angulation. In that
case the principle of internal fixation will be violated for that
particular hole.
Preparing the plate
INSTRUMENTS ART.-NO.
Aiming arm LOQTEQ® Distal edial Humerus Plate IU 8179-00

Surgical Technique
Elbow lating System
aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
14
Surgical Technique
Distal Humerus lates 2.7/3.5
•Ensure that the anatomy of the distal humerus is reconstructed.
•For reposition and temporary fixation of the fragments place K-wires
or reduction forceps. Ensure that the K-wires will not interfere with
later plate positioning. If necessary, use lag screws to secure intra-
articular fragments.
•The articular fragments of the distal block should be reduced prior to
reducing the distal block of the shaft.
NTE:
The shape of the L QTEQ® Distal Humerus Plates may assist in
anatomic reduction of the humerus.
•For temporary fixation of the plate, place the K-wire ø1.6 or a twist
drill ø2.0 (light blue) through the drill guide of the aiming arm for
the distal medial humerus plate.
Reduction and primary fixation
INSTRUMENTS ART.-NO.
K-wire with trocar point, ø1.6, L 150 NK 0016-15
Aiming arm LOQTEQ® Distal edial Humerus Plate IU 8179-00

aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
15Surgical Technique
Elbow lating System
Surgical Technique
Distal Humerus lates 2.7/3.5
Insertion of cortical screws
(gold)
INSTRUMENTS ø 2.5 ø 3.5
Drill guide IU 8169-20 IU 8116-60
Twist Drill, coil 50, quick coupling IU 7420-18 IU 7427-15
Depth gauge for locking screws IS 7903-20 IS 7904-20
Screwdriver, quick coupling IU 7815-56 IU 7825-56
Large handle, cannulated, quick coupling IU 7707-00 IU 7706-00
For locking/oblong hole only use cortical screws ø3.5!
For round hole only use cortical screws ø2.5!
•For the primary fixation of the plate shaft, a non-locking cortical
screw 3.5 mm (gold) can be inserted into the oblong hole. For this
purpose use a double drill guide and a twist drill ø2.7 and drill to
the desired depth.
•Then determine the length of the screw using the depth gauge and
insert a screw of appropriate length by using the screwdriver T15.
The plate can be pulled against the bone using this screw.
NTE:
Securing the oblong hole before inserting screws in other plate
holes can facilitate the positioning of the plate on the bone.
•To insert a non-locking cortical screw 3.5 mm (gold) in the gliding
hole, proceed as described above.
NTE:
If a combination of non-locking and locking screws is used, non-
locking screws must be inserted first.
•To improve handling the aiming arm can be removed leaving the drill /
K-wire in place providing necessary stability. The adjusting ring can then
be freely moved to allow more space for the subsequent surgical steps.
NTE:
To ensure the temporary stability of the reduction, do not remove
the K-wire or twist drill until at least one additional locking screw has
been inserted.
•To insert non-locking cortical screws 2.5mm (gold) in the metaphy-
seal area (round hole) of the plate, please follow the instructions on
page 16 (locking screws 2.7, light blue). The torque limiter is not
applicable for non-locking screws.
•Check the plate position using fluoroscopy and adjust if required.

Surgical Technique
Elbow lating System
aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
16
Surgical Technique
Distal Humerus lates 2.7/3.5
Insertion of locking screws
(light blue)
INSTRUMENTS ART.-NO.
Drill guide LOQTEQ® Elbow plates 2.7, light blue IU 8169-20
Twist drill ø2.0, L 180, coil 25, quick coupling IU 7420-18
Depth gauge for locking screws ø2.7, up to L 70 IS 7903-20
Screwdriver Duo, T8, quick coupling IU 7815-56
Large handle, cannulated, quick coupling IU 7706-00
Handle round with quick coupling, with torque limiter 1.5 Nm IU 7707-00
2
1
•Insert the drill guide (light blue) into the desired plate hole in the
metaphyseal portion of the plate and drill with the twist drill ø2.0
(light blue).
•easure for screw length with the depth gauge for screws ø2.7.
Alternatively, the penetration depth during drilling can be read off
from the drill guide (light blue/gold) to determine the required
screw length.
•The drill guide is marked with two very accurate measuring scales,
which must be observed during measuring.
easuring scale 10-42 mm, 2 mm steps
easuring scale 45-75 mm, 5 mm steps
•Insert the appropriate length LOQTEQ® locking screw 2.7 mm (light
blue) using the screwdriver T8 and finally tighten the screw with
the torque limiter 1.5 Nm. With an audible and sensible click of the
torque limiter the optimal locking is achieved. In addition, it is re-
commended to ensure correct fit of the screws, e.g. visually or using
fluoroscopy.
CAUTI N:
As soon as the head of the screw reaches the plate hole it is
compulsory to switch to the torque limiter.
•Secure the other metaphyseal plate holes in this way. Then remove
any remaining K-wires.
CAUTI N:
Screws in the metaphyseal area of the plate should never pene-
trate the articulating surface. A final control of movement
should be preformed.
1
2

aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
17Surgical Technique
Elbow lating System
Surgical Technique
Distal Humerus lates 2.7/3.5
•Screw the drill guide for gliding hole (red) into the desired plate
hole and drill using the twist drill ø2.7 (blue/red).
•Remove the drill guide for gliding hole (red) and determine the
required screw length using the depth gauge.
•Insert a LOQTEQ® locking compression screw 3.5 mm (red) of the
appropriate length using screwdriver T15 and finally tighten the
screw with the torque limiter 2.0 Nm. With an audible and sensible
click of the torque limiter the optimal locking is achieved. In addi-
tion, it is recommended to ensure correct fit of the screws, e.g. vi-
sually or using fluoroscopy.
CAUTI N:
As soon as the head of the screw reaches the plate hole it is com-
pulsory to switch to the torque limiter. In cases of very hard bone
in the diaphysis it is necessary to make sure that the screw head
is flush to the plate. Therefore, it is permissible in exceptionally
hard bone of the diaphysis to finish the screw without the torque
limiter.
•Secure the other proximal plate holes in this way. Then remove any
remaining K-wires.
•For optimal plate-to-screw connection, it is recommended to use
the threaded drill guide (red) to insert LOQTEQ® locking compression
screws (red). If the locking compression screw is inserted obliquely,
a secure connection between the screw and plate is not guaranteed!
Insertion of locking
compression screws (red)
without compression
INSTRUMENTS ART.-NO.
Drill guide for gliding hole LOQTEQ® 3.5, I-ø2.8, red IU 8166-10
Twist drill ø2.7, L 150, coil 50, quick coupling IU 7427-15
Depth gauge for locking screws ø3.5-4.0, up to L 90 IS 7904-20
Screwdriver Duo, T15, quick coupling IU 7825-56
Large handle, cannulated, quick coupling IU 7706-00
Handle round with quick coupling, with torque limiter 1.5 Nm IU 7707-00

Surgical Technique
Elbow lating System
aap Implantate AG
Lorenzweg 5 •12099 Berlin •Germany
18
Surgical Technique
Distal Humerus lates 2.7/3.5
•Plate position: on the lateral column, radial
•Orientation of distal screws: posteroanterior
•Temporarily fixate the plate with K-wires through the holes in the
plate that are intended for this purpose.
•As an alternative to the K-wires, a standard cortical screw 3.5 mm
(gold) can be inserted in the oblong hole. For this purpose, use a
double drill guide ø2.7/3.5 and a twist drill ø2.7 and drill to the
required depth. Then determine the screw length using the depth
gauge and insert a screw of the appropriate length. This screw can
simultaneously pull the plate towards the shaft.
•Check plate position using fluoroscopy and adjust if required.
•Please refer to the pages 15-17 for the detailed description of the
surgical steps.
•Plate position: lateral column, radial
•Orientation of distal screws: lateromedial
•The aiming arm assists in positioning the distal screws of both the
distal medial and lateral plates to help to ensure optimal support
for the articular block of the distal humerus.
•Please refer to the pages 13-17 for the detailed description of the
surgical steps.
Insertion of the Distal
Dorsolateral Humerus Plate
90° plate configuration
Insertion of the Distal
Lateral Humerus Plate
180° plate configuration
INSTRUMENTS ART.-NO.
K-wire with trocar point, ø1.6, L 150 NK 0016-15
Double drill guide ø2.7/ 3.5, with spring aided centuring IU 8116-60
Twist drill ø2.0, L 180, coil 50, quick coupling IU 7420-18
Depth gauge for locking screws ø2.7, up to L 70 IS 7903-20
Screwdriver Duo, T15, quick coupling IU 7825-56
Large handle, cannulated, quick coupling IU 7706-00
Drill guide LOQTEQ® Elbow plates 2.7, light blue IU 8169-20
Twist drill ø2.7, L 150, coil 50, quick coupling IU 7427-15