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
•