skeletal dynamics DISTAL ELBOW SET User manual

As described by:
Jorge L. Orbay, M.D.
Miami Hand & Upper
Extremity Institute
Miami, Florida
SURGICAL TECHNIQUE GUIDE
DISTAL ELBOW SET
proximal ulna plate

Indications for Use
The proximal ulna plates are intended for xation of fractures, fusions, osteotomies
and non unions of the ulna, particulary in osteopenic bone.
Please refer to the Distal Elbow Plating Set Instructions for Use to review the warnings, precautions and contraindications for this system.
DISTAL ELBOW SET
proximal ulna plate

1
2
SUPERFICIAL EXPOSURE
Locate the ulnar nerve.
Release and protect the
nerve, considering the
possibility of transposition.
With the elbow exed 900,
make a posterior incision
extending distally, curving
around the olecranon and
over the subcutaneous
border of the ulna.
NOTE:
The incision can be curved
slightly lateral or medial to
the tip of the olecranon
based on your preferred
method.
Warning:
Take care to avoid injury to
the ulnar nerve.
DISTAL ELBOW SET
proximal ulna plate
RELEASING THE ULNAR NERVE

4
3 DEEP EXPOSURE
ACCESSING THE JOINT
Expose the proximal ulna
sub-periosteally.
For olecranon fractures,
enter the joint through the
fracture plane by releasing
the capsular attachments
on the proximal fragment as
needed.
The articular surfaces can be
evaluated at this time.

5
6
Debride the fracture site.
NOTE:
It is necessary to remove
callus, clot and brous tissue
in order to achieve a proper
reduction.
DEBRIDING THE FRACTURE
DISTAL TRICEPS RELEASE
Starting distal to proximal,
split the triceps insertion
longitudinally for approximately
1 cm.
Elevate the triceps along a
narrow longitudinal strip to
provide space for the “Home
Run” (HR) tab.

7
8
PLATE SELECTION
PROVISIONAL PLATE FIXATION
Select the appropriate
length of plate that provides
at least six cortices of xation
distal to the fracture line.
NOTE:
The shaft of the 151mm
length plate can be bent
using the Bending Irons. If
plate bending is necessary,
please refer to step 29 in this
surgical technique guide.
WARNING:
Bending may weaken or
break the plate. Be sure
to inspect the plate for
damage prior to use.
Apply the plate to the
proximal fragment conrming
that the plate is centered on
the unla shaft and that the HR
tab is ush to the olecranon.
Secure the plate to the
proximal fragment using a
2mm K-wire through the hole
at the base of the HR tab.
K-wire, 2.0mm

9
10
FRACTURE REDUCTION
Reduce the fracture by
levering the shaft of the
plate to the distal fragment.
Conrm fracture reduction
and plate alignment using
uoroscopy.
DISTAL FRAGMENT FIXATION
Using the 2.7mm x 40mm bit,
drill bicortical through the
distal end of an oblong hole
that is distal to the fracture
line. This will allow for dynamic
compression of the fracture.
Measure screw length using
the appropriate scale on the
50mm Depth Gauge, then
insert a 3.5mm compression
screw (PANL series) using the
T-10 Driver while applying
interfragmentary compression.
NOTE:
The depth gauge has a dual
scale to reect measurements
through the PDG’s (top scale)
or directly through the plate
(bottom scale).
Drill, 2.7mm x 40mm Compression
Screw
(3.5mm PANL)
Driver, T-10
Depth Gauge, 50mm

11
12
PROXIMAL FIXATION OPTIONS
The two proximal holes
containing PDG’s are for
xation to the olecranon (A).
The adjacent two distal holes
containing PDG’s are for
xation to the coronoid (B).
All of the PDG’s can accept
an A.I.M.ing Guide 2.0 (C) if
provisional K-wire xation is
necessary using 2.0mm K-wires.
If it is necessary to vary a screw
trajectory, remove the PDG
and drill free-hand. A tissue
protector is provided in the
system.
If a 3.0mm Cannulated
Polyaxial Locking Screw (PLS)
is needed, please refer to steps
22 through 25 in this surgical
technique guide.
PROVISIONAL K-WIRE FIXATION
A B
C
Tissue Protector
A.I.M.ing Guide, 2.0mm
K-wire, 2.0mm
If provisional plate xation is
needed, insert an A.I.M.ing
Guide 2.0 into the desired
PDG, then drive a 2.0mm
K-wire through the A.I.M.ing
Guide taking care to avoid
the articular surfaces of the
joint.
Using the 2.7mm bit, drill
through the PDG. If a K-wire
obstructs drilling, bend it out
of the way.

13
14
FLUOROSCOPIC CONFIRMATION
Repeat steps 12 and 13 for
the remaining olecranon
screw hole using a 3.5mm
Multi-Thread Locking Screw.
Conrm proper plate
positioning, fracture
reduction and screw lengths
using uoroscopic imaging.
OLECRANON FIXATION
Measure the screw length
using the appropriate scale
on the 50mm Depth Gauge.
Using the T-10 Driver, remove
the PDG and insert the
correct length 3.5mm Multi-
Thread Compression Screw
until the screw head contacts
the plate.
Remove the 2.0mm K-wire at
the base of the HR tab, then
fully seat the Compression
Screw until the plate is
reduced to the olecranon.
NOTE:
It is recommended to
subtract ~ 2mm from the
measured screw lengths to
avoid compromising the
articular surfaces and/or soft
tissue irritation.
Multi-Thread Compression Screw
Multi-Thread Locking Screw

15
16
PREPARING THE HOME RUN TAB
Conrm that the HR tab is ush
to the tip of the olecranon. If
necessary, you can bend the
tab as described in step 30 of
this surgical technique guide.
Using the 2.7mm x 80mm
bit, drill through the PDG,
then measure and record
the screw length using the
appropriate scale on the
80mm Depth Gauge.
NOTE:
If the HR tab was bent,
conrm that the new
trajectory will avoid contact
with the articular surfaces of
the joint.
WARNING:
Bending may weaken or
break the tab. Be sure to
inspect the tab for damage
prior to use.
OVERDRILLING THE HOME RUN TAB
Using the T-10 driver, remove
the PDG in the HR tab.
Drill up to the fracture
line using the 3.5mm bit.
Fluoroscopic imaging is
helpful during this step.
Drill, 3.5mm x 70mm
Drill, 2.7mm x 80mm
Depth Gauge, 80mm

17
18
FLUOROSCOPIC CONFIRMATION
Conrm proper plate positioning,
fracture reduction and screw
lengths using luoroscopic imaging.
LAGGING THE PROXIMAL FRAGMENT
Loosen the screw previously
placed in the oblong hole of the
shaft.
Insert the recorded length
3.5mm Multi-Threaded
Compression Screw through
the HR tab to further reduce
the fracture.
Retighten the screw in the
oblong hole of the shaft.
Multi-Thread Compression Screw

19
20
CORONOID PREPARATION
CORONOID FIXATION
Using the 2.7mm bit, drill
through a PDG.
Measure the screw length
using the appropriate scale
on the 50mm Depth Gauge.
NOTE:
If the HR Tab has been
repositioned, consider the
use of a Polyaxial Locking
Screw if impingement
occurs.
Using the T-10 Driver, remove
the PDG and insert the
correct length 3.5mm Multi-
Thread screw until fully
tightened.
Repeat steps 19 and 20 for
the remaining coronoid
screw hole.

21
22
CANNULATED 3.0 PLS SETUP (OPTIONAL)
If a Polyaxial Locking Screw
is needed in any of the
threaded holes, use the T-10
driver to remove the PDG if
present and insert the 1.1mm
PLS A.I.M.ing Guide.
Insert a 1.1mm guidewire
through the PLS A.I.M.ing
Guide in the desired
trajectory until the far cortex
is reached.
NOTE:
Fluoroscopy is helpful to
conrm the trajectory of the
guidewire.
DISTAL PLATE FIXATION
If xed angled xation
through any of the threaded
holes is desired, secure the
appropriate Thread-In Drill
Guide into the selected hole.
Using the 2.7mm bit, drill to
the proper depth. Read the
length directly from the drill or
by removing the Thread-In Drill
Guide and using the 50mm
Depth Gauge.
Insert and fully tighten the
desired screw using the T-10
Driver. Repeat this step for
the remaining distal threaded
holes.
For oblong holes, drill free-
hand, then measure and insert
a compression screw until fully
seated to the plate.
Thread-In Drill Guide
PLS A.I.M.ing Guide, 1.1mm x 100
K-wire, 1.1mm
Tissue Protector

23
24
FLUOROSCOPIC CONFIRMATION
CANNULATED 3.0 PLS PREPARATION
After conrming that the
guidewire is tacked to
the far cortex, use the
cannulated 3.0 PLS T-10
Driver to remove the PLS
A.I.M.ing Guide leaving the
guidewire in place.
Slide the cannulated Depth
Gauge over the guidewire
to measure the appropriate
length of screw.
Using the 2.4mm Cannulated
PLS bit, drill over the guidewire
to the proper depth.
3.0 PLS Driver (cannulated)
Depth Gauge, PLS 3.0
PLS Drill (cannulated) 2.4mm x 40mm

25
26
FLUOROSCOPIC CONFIRMATION
Using uoroscopic imaging,
conrm that proper reduction
has been maintained and
that all screws are of proper
length and fully engaged to
the plate.
Conrm that all PDG’s have
been removed.
CANNULATED 3.0 PLS FIXATION
Using the Cannulated 3.0
PLS T-10 Driver, thread the
screw down the guidewire
until the head of the screw
contacts the plate.
Remove the guidewire
and fully lock the screw to
the plate using the non-
cannulated T-10 driver.
PLS Screw, 3.0mm
T-10 Driver

27
28
SOFT TISSUE ATTACHMENT POINTS (OPTIONAL)
WOUND CLOSURE
All plates incorporate two
suture attachment points
proximal and distal to the
olecranon screw holes that
will accommodate a curved
needle.
The triceps attachment
points (A) are benecial
to augment plate xation
when the triceps insertion is
avulsed and osteoporotic
or comminuted olecranon
fractures are evident.
The fascia attachments
points (B) are benecial
for re-attaching the fascia
when necessary.
Conrm that the ulnar nerve
is free of any impingement.
Close deep to supercial in
your normal fashion. Apply
a standard long-arm post-op
dressing as necessary.
AB

1
3
29
30
HR TAB BENDING (OPTIONAL)
If it is necessary to modify the
HR tab, rmly hold the plate,
then grip the round node of the
HR tab using the Bending Pliers
and shape as intended.
A. Vertical Plane: Secure
the Bending Plier to bend
up to 300
B. Transverse Plane: Secure the
Bending Plier to bend up to 450
Conrm that the new trajectory
avoids contact with the
articular surfaces and other
screw trajectories using
uoroscopy.
NOTE:
Do not exceed the maximum
bend angles as described
above.
WARNING:
Bending may weaken or break
the plate. Be sure to inspect
the plate for damage prior to
use.
PLATE BENDING (OPTIONAL)
If it is necessary to modify the
shaft of the 151mm plate,
attach the Bending Irons to
bend the plate in any plane
up to 100.
A. Vertical Plane:
Use section 1 of the
Bending Irons.
B. Horizontial Plane:
Use section 2 of the
Bending Irons. This plate
manipulation can also
be performed in-situ.
C. Transverse Plane:
Use section 3 of the
Bending Irons.
NOTE:
Do not exceed the respective
maximum bend angles as
described above.
WARNING:
Bending may weaken or break
the plate. Be sure to inspect the
plate for damage prior to use.
2
1
3
A-1
B-2
C-3

Plate Catalog # Description
APL-PUP-3HL Proximal Ulna Plate, 73mm, Left
APL-PUP-3HR Proximal Ulna Plate, 73mm, Right
APL-PUP-6HL Proximal Ulna Plate, 108mm, Left
APL-PUP-6HR Proximal Ulna Plate, 108mm, Right
APL-PUP-9HL Proximal Ulna Plate, 151mm, Left
APL-PUP-9HR Proximal Ulna Plate, 151mm, Right
73mm
108mm
151mm
10mm
5.7mm
10mm
Proximal Ulna Plate Dimensions
Proximal Ulna Plates

APL-PUP-3HL Proximal Ulna Plate, 73mm, Left
APL-PUP-3HR Proximal Ulna Plate, 73mm, Right
APL-PUP-6HL Proximal Ulna Plate, 108mm, Left
APL-PUP-6HR Proximal Ulna Plate, 108mm, Right
APL-PUP-9HL Proximal Ulna Plate, 151mm, Left
APL-PUP-9HR Proximal Ulna Plate, 151mm, Right
Catalog # Description
MTLS-35080-TS Screw, Multi-Thread Locking, 3.5mm x 8mm, Ti
MTLS-35100-TS Screw, Multi-Thread Locking, 3.5mm x 10mm, Ti
MTLS-35120-TS Screw, Multi-Thread Locking, 3.5mm x 12mm, Ti
MTLS-35140-TS Screw, Multi-Thread Locking, 3.5mm x 14mm, Ti
MTLS-35160-TS Screw, Multi-Thread Locking, 3.5mm x 16mm, Ti
MTLS-35180-TS Screw, Multi-Thread Locking, 3.5mm x 18mm, Ti
MTLS-35200-TS Screw, Multi-Thread Locking, 3.5mm x 20mm, Ti
MTLS-35220-TS Screw, Multi-Thread Locking, 3.5mm x 22mm, Ti
MTLS-35240-TS Screw, Multi-Thread Locking, 3.5mm x 24mm, Ti
MTLS-35260-TS Screw, Multi-Thread Locking, 3.5mm x 26mm, Ti
MTLS-35280-TS Screw, Multi-Thread Locking, 3.5mm x 28mm, Ti
MTLS-35300-TS Screw, Multi-Thread Locking, 3.5mm x 30mm, Ti
MTLS-35320-TS Screw, Multi-Thread Locking, 3.5mm x 32mm, Ti
MTLS-35340-TS Screw, Multi-Thread Locking, 3.5mm x 34mm, Ti
MTLS-35360-TS Screw, Multi-Thread Locking, 3.5mm x 36mm, Ti
MTLS-35380-TS Screw, Multi-Thread Locking, 3.5mm x 38mm, Ti
MTLS-35400-TS Screw, Multi-Thread Locking, 3.5mm x 40mm, Ti
MTLS-35450-TS Screw, Multi-Thread Locking, 3.5mm x 45mm, Ti
MTLS-35500-TS Screw, Multi-Thread Locking, 3.5mm x 50mm, Ti
MTLS-35550-TS Screw, Multi-Thread Locking, 3.5mm x 55mm, Ti
MTLS-35600-TS Screw, Multi-Thread Locking, 3.5mm x 60mm, Ti
MTLS-35700-TS Screw, Multi-Thread Locking, 3.5mm x 70mm, Ti
MTNL-35080-TS Screw, Multi-Thread Compression, 3.5mm x 8mm, Ti
MTNL-35100-TS Screw, Multi-Thread Compression, 3.5mm x 10mm, Ti
MTNL-35120-TS Screw, Multi-Thread Compression, 3.5mm x 12mm, Ti
MTNL-35140-TS Screw, Multi-Thread Compression, 3.5mm x 14mm, Ti
MTNL-35160-TS Screw, Multi-Thread Compression, 3.5mm x 16mm, Ti
MTNL-35180-TS Screw, Multi-Thread Compression, 3.5mm x 18mm, Ti
MTNL-35200-TS Screw, Multi-Thread Compression, 3.5mm x 20mm, Ti
MTNL-35220-TS Screw, Multi-Thread Compression, 3.5mm x 22mm, Ti
MTNL-35240-TS Screw, Multi-Thread Compression, 3.5mm x 24mm, Ti
MTNL-35260-TS Screw, Multi-Thread Compression, 3.5mm x 26mm, Ti
MTNL-35280-TS Screw, Multi-Thread Compression, 3.5mm x 28mm, Ti
MTNL-35300-TS Screw, Multi-Thread Compression, 3.5mm x 30mm, Ti
MTNL-35320-TS Screw, Multi-Thread Compression, 3.5mm x 32mm, Ti
MTNL-35340-TS Screw, Multi-Thread Compression, 3.5mm x 34mm, Ti
MTNL-35360-TS Screw, Multi-Thread Compression, 3.5mm x 36mm, Ti
MTNL-35380-TS Screw, Multi-Thread Compression, 3.5mm x 38mm, Ti
MTNL-35400-TS Screw, Multi-Thread Compression, 3.5mm x 40mm, Ti
MTNL-35450-TS Screw, Multi-Thread Compression, 3.5mm x 45mm, Ti
MTNL-35500-TS Screw, Multi-Thread Compression, 3.5mm x 50mm, Ti
MTNL-35550-TS Screw, Multi-Thread Compression, 3.5mm x 55mm, Ti
MTNL-35600-TS Screw, Multi-Thread Compression, 3.5mm x 60mm, Ti
MTNL-35700-TS Screw, Multi-Thread Compression, 3.5mm x 70mm, Ti
Screw Options

Screw Options
Catalog # Description
PANL-35080-TS Screw, Cortical Non Locking, 3.5mm x 8mm, Ti
PANL-35100-TS Screw, Cortical Non Locking, 3.5mm x 10mm, Ti
PANL-35120-TS Screw, Cortical Non Locking, 3.5mm x 12mm, Ti
PANL-35140-TS Screw, Cortical Non Locking, 3.5mm x 14mm, Ti
PANL-35160-TS Screw, Cortical Non Locking, 3.5mm x 16mm, Ti
PANL-35180-TS Screw, Cortical Non Locking, 3.5mm x 18mm, Ti
PANL-35200-TS Screw, Cortical Non Locking, 3.5mm x 20mm, Ti
PANL-35220-TS Screw, Cortical Non Locking, 3.5mm x 22mm, Ti
PANL-35240-TS Screw, Cortical Non Locking, 3.5mm x 24mm, Ti
PANL-35260-TS Screw, Cortical Non Locking, 3.5mm x 26mm, Ti
PANL-35280-TS Screw, Cortical Non Locking, 3.5mm x 28mm, Ti
PANL-35300-TS Screw, Cortical Non Locking, 3.5mm x 30mm, Ti
PANL-35320-TS Screw, Cortical Non Locking, 3.5mm x 32mm, Ti
PANL-35340-TS Screw, Cortical Non Locking, 3.5mm x 34mm, Ti
PANL-35360-TS Screw, Cortical Non Locking, 3.5mm x 36mm, Ti
PANL-35380-TS Screw, Cortical Non Locking, 3.5mm x 38mm, Ti
PANL-35400-TS Screw, Cortical Non Locking, 3.5mm x 40mm, Ti
PANL-35420-TS Screw, Cortical Non Locking, 3.5mm x 42mm, Ti
PANL-35440-TS Screw, Cortical Non Locking, 3.5mm x 44mm, Ti
PALS-30200-CC Screw, Polyaxial Locking, 3.0mm x 20mm Cannulated, CoCr
PALS-30220-CC Screw, Polyaxial Locking, 3.0mm x 22mm Cannulated, CoCr
PALS-30240-CC Screw, Polyaxial Locking, 3.0mm x 24mm Cannulated, CoCr
PALS-30260-CC Screw, Polyaxial Locking, 3.0mm x 26mm Cannulated, CoCr
PALS-30280-CC Screw, Polyaxial Locking, 3.0mm x 28mm Cannulated, CoCr
PALS-30300-CC Screw, Polyaxial Locking, 3.0mm x 30mm Cannulated, CoCr
PALS-30320-CC Screw, Polyaxial Locking, 3.0mm x 32mm Cannulated, CoCr
PALS-30340-CC Screw, Polyaxial Locking, 3.0mm x 34mm Cannulated, CoCr
PALS-30360-CC Screw, Polyaxial Locking, 3.0mm x 36mm Cannulated, CoCr
PALS-30380-CC Screw, Polyaxial Locking, 3.0mm x 38mm Cannulated, CoCr
PALS-30400-CC Screw, Polyaxial Locking, 3.0mm x 40mm Cannulated, CoCr
Single Use Instruments Catalog Number Dimensions
PDG-AIM-020 AIMing Guides, 2.0mm
KWIR-STD-20152 K-Wire, 2.0 mm x 152 mm
DRVR-UQC-T10 Driver, Universal Quick Connect, T10
DRLL-SSC-27080 Drill, 2.7mm x 80mm
DRLL-SSC-27040 Drill, 2.7mm x 40mm
DRLL-SSC-35070 Drill, 3.5mm x 70mm
PDG-AIM-011 PLS AIMing Guide, 1.1mm x 10°
KWIR-PLS-11152 K-Wire,1.1 mm x 152 mm
DRLL-PLS-24 Drill, Cannulated, PLS, 2.4mm x 40mm