Synthes LCP Distal Humerus Plates User manual

LCP Distal Humerus Plates. The
anatomic fixation system for the
distal humerus with angular stability.
Technique Guide

Synthes 1
Contents
Warning
This description is not sufficient for immediate application
of the instrumentation. Instruction by a surgeon experienced in
handling this instrumentation is highly recommended.
LCP Distal Humerus Plates
Indications and contraindications 2
Implants 3
Instruments 5
Preparation 6
Dorsolateral plate with support 9
Medial Plate 14
Fixing the shaft 16
Option: Dorsolateral plate without support 17
Option: Positioning and compression device PCD 19
Implant removal 24

2
Indications and contraindications
LCP Distal Humerus Plates
Indications
– Intraarticular fractures of the distal humerus
– Supracondylar fractures of the distal humerus
– Non-unions of the distal humerus
Contraindications
– Acute infections
– Children in the growth phase

Synthes 3
Implants
Distal humerus plates
Distal Humerus Plate, dorsolateral, right
Art. No. Holes
X41.262 3
X41.264 5
X41.266 7
X41.268 9
X41.300 14
Distal Humerus Plate, dorsolateral, left
Art. No. Holes
X41.263 3
X41.265 5
X41.267 7
X41.269 9
X41.301 14
Distal Humerus Plate, dorsolateral with support, right
Art. No. Holes
X41.272 3
X41.274 5
X41.276 7
X41.278 9
X41.302 14
Distal Humerus Plate, dorsolateral with support, left
Art. No. Holes
X41.273 3
X41.275 5
X41.277 7
X41.279 9
X41.303 14
Distal Humerus Plate, medial, right
Art. No. Holes
X41.282 3
X41.284 5
X41.286 7
X41.288 9
X41.304 14
Distal Humerus Plate, medial, left
Art. No. Holes
X41.283 3
X41.285 5
X41.287 7
X41.289 9
X41.305 14
LCP Distal Humerus Plates
All plates are available sterile packed.

4
Implants
LCP Distal Humerus Plates
LCP locking screws
X02.214–260 LCP Locking Screw 2.7 mm
(head LCP 2,4), length 14–60 mm,
self-tapping, with Stardrive®recess
X12.102–124 LCP Locking Screw 3.5 mm,
length 12–60 mm, self-tapping,
with Stardrive®recess
X13.012–060 LCP Locking Screw 3.5 mm,
length 12–60 mm, self-tapping
with hexagonal recess
Standard screws
X01.764–790 Cortex Screw 2.4 mm, length 14–40 mm,
self-tapping with Stardrive®recess
X04.814–860 Cortex Screw 3.5 mm, length 14–60 mm,
self-tapping, with hexagonal recess
X-ray template
034.000.450 Distal Humerus Plate, dorsolateral,
with support
034.000.451 Distal Humerus Plate,
dorsolateral
034.000.452 Distal Humerus Plate,
medial
All screws are available sterile packed.

Instruments
LCP Distal Humerus Plates
Torque Limiters
511.776 Torque Limiter 0.8 Nm, for LCP locking screws 2.4/2.7 mm
with AO/ASIF quick coupling for power tool/handle
511.773 Torque Limiter 1.5 Nm, for LCP locking screws 3.5 mm
with AO/ASIF quick coupling for power tool/handle
511.770 Torque Limiter 1.5 Nm, for LCP locking screws 3.5 mm
with CAD coupling for power tool/handle
Important: always use TLA when inserting LCP screws,
otherwise plate and/or screws might be damaged
Drilling instruments for LCP locking screws 2.7 mm
323.061 LCP Drill Sleeve 2.7 (head LCP2.4), with scale up to 60 mm
323.062 Drill Bit 2.0 mm,
with double markings, L 140/115
313.351– Positioning and Compression Device (PCD) for the
313.357 dorso-lateral plate with support, with length markings
Note: The PCD can also be used without plate to implement 3.5mm
cortex screws.
Length measurement devices
319.005 Depth Gauge for Screws 2.0 and 2.4 mm,
measuring range up to 40 mm
319.010 Depth Gauge for Screws 2.7 to 4.0 mm,
measuring range up to 60 mm
Synthes 5

6
Preparation
LCP Distal Humerus Plates
Note: Experience in the use of the Locking Compression Plate
System LCP (see surgical technique 036.000.019) or instruction
by a surgeon with corresponding experience is recommended.
1
Position patient
The lateral decubitus position is usually chosen. In severe C3
fractures, the fully prone position can be used, if the patient is
otherwise fit. The arm is rested on a padded bar allowing
elbow flexion of 120°. In rare cases bone graft may be needed
and it is wise to prepare a donor site. The use of a tourniquet,
preferably sterile, is not essential, but can make it easier to
identify the ulnar nerve.
2
Surgical approach
All fractures are approached through a slightly curved
posterior incision just radial to the olecranon. The ulnar nerve
is gently identified and may need to be isolated and elevated
at the ulnar epicondyle.
For supracondylar fractures or simple articular fractures it may
be sufficient to expose the nerves on both sides of the triceps.
For comminuted fractures a distally pointed chevron olecranon
osteotomy exposes the fracture best.
When using longer plates the radial nerve has to be carefully
identified.

Synthes 7
3
Reduce fracture and fix temporarily
For C-type fractures, reduce the articular fragments of the
distal block under direct vision or image intensifier and fix them
temporarily, using Kirschner wires and/or pointed reduction
forceps.
Fix the distal block temporarily to the shaft using K-wires in
both columns and/or forceps and make sure that the anatomy
of the distal humerus is restored.
Note: LCP locking screws are not suitable for reduction, since
they cannot effect compression.The fracture must therefore be
reduced before inserting locking screws.
When using longer plates the radial nerve has to be carefully
identified.
4
Choose dorsolateral plate (with or without support)
For the dorsolateral side, choose the type of implant to be
used. The dorsolateral plates allow for screw insertion in a
posterior-anterior direction. The plate with support allows for
additional screw insertion through the lateral epicondyle in a
lateral-medial direction.
Note: On very small humeri the support may protrude
extensively over the lateral epicondyle, in which case the use
of a plate without support is recommended.

8
LCP Distal Humerus Plates
Preparation
5
Determine the length of the plates
Choose plate lengths that offer sufficient fixation proximal to
the fracture lines. To prevent extensive diaphyseal stress, the
medial and dorsolateral plates may not have the same length.
Sample: medial 5 holes, dorsolateral 7 holes.
Important: To reach sufficient stability for early mobilization
both plates dorsolateral and medial have to be used in case of
severe fractures. Application of single plates should be limited
to simple fractures where one column is still intact.
Important: For fractures extending into the shaft always use
both dorsolateral and medial plates to have sufficient strength,
especially when using 9 or 14 hole plates.
6
Prepare plates, bending
Required instruments
Bending Pliers for Plates 2.4 to 4.0, length 230 mm 329.150
Bending Iron for Plates 2.4 to 3.5, length 145 mm 329.040/329.050
LCP Drill Sleeve 2,7 (head LCP 2,4), with scale up to 60 mm 323.061
The form of the distal humerus can vary between individuals.
Bending might be required to adapt the plate form. Use
bending pliers and irons to shape the plates.
Be careful to observe the LCP locking screw direction of the
distal screws during the bending. Use drill guide to check.
Note: If only cortex screws are used, the plates need to be
congruent with the surface of the bone and bending or
torquing may be required. Normally only minimal bending is
necessary when using LCP locking screws.