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.

Synthes 9
Dorsolateral plate with support
LCP Distal Humerus Plates
Position and fix the dorsolateral plate with support
Normally a transolecranon approach is used and the plate
fixation starts on the dorsolateral side of the distal humerus.
1
Position the plate
The plate is to be positioned on the dorsolateral aspect of the
distal humerus, with its distal spoon-shape portion covering
the non-articulating part of the capitellum, and with the lateral
support reaching over the most protruding tip of the lateral
epicondyle, just proximal to the lateral collateral ligament inser-
tion. Make sure that the shaft portion of the plate is positioned
at safe distance from the olecranon fossa.
The position of the plate should allow for distal screw insertion
through the lateral support to reach through the articular
block to the medial side. The direction of the screw to be used
can be visualised with the LCP Drill Sleeve 2.7 and a K-Wire
or with the Positioning and Compression Device, PCD.
Important: The plate distal position has to be carefully chosen
to ensure no impingement of the radius head and thus loss
of extension. The distance between the plate and the cartilage
should normally not be less than 3 mm.
Note: In contrast to conventional plating, plating with LCP
locking screws do not rely on a congruent contact of plate-to-
bone.
3 mm

10
3
Determine screw length
Required instruments
Depth Gauge for Screws 2.7 to 4.0 mm 319.010
Determine the required length of the cortex screw with the
depth gauge.
2
Preliminary fixation of the plate
Required instruments
Universal Drill Guide 3.5 323.360
Drill Bit 2.5 mm, length 110/85 mm, for Quick Coupling 310.250
After correct placement of the plate use the drill guide and the
drill bit 2.5 mm to pre-drill both cortices.

Synthes 11
5
Pre-drill distal hole
Required instruments
LCP Drill Sleeve 2.7 (head LCP 2.4), with scale up to 60 mm 323.061
Drill Bit 2.0 mm, with double markings 323.062
Screw the LCP Drill Sleeve into one of the threaded holes
of the distal part of the plate and pre-drill a hole with the drill
bit  2.0 mm. Check the depth of the drill bit under image
intensifier.
4
Insert cortex screw
Required instruments
Screwdriver Shaft, hex small, 2.5 mm 314.030
Use the screwdriver shaft mounted on a power tool or on a
handle to insert the self-tapping cortex screw 3.5 mm. Do
not tighten the screw.
LCP Distal Humerus Plates
Dorsolateral plate with support

12
6
Determine length of screw
Required instruments
LCP Drill Sleeve 2.7 (head LCP 2.4), with Scale up to 60 mm,
for Drill Bits 2.0 mm 323.061
Drill Bit 2.0 mm, with double marking, length 140/115 mm,
3-flute, for Quick Coupling 323.062
Depth Gauge for Screws 2.0 and 2.4 mm, measuring range
up to 40 mm 319.005
Depth Gauge for Screws 2.7 to 4.0 mm, measuring range
up to 60 mm 319.010
Determine the required length of the screw by using the scale
on the drill guide. If a single marking is visible on the drill bit,
the scale from 0–30 mm applies; if a double marking is visible,
the scale from 30–60 mm applies.
Option: Use a Depth Gauge 319.005 to check length.
Note: For all screw types: using the exact length indication
will lead to a screw which ends exactly at the exit point of the
bone for all measuring devices contained in the set. Thus for
bicortical screws (shaft), the chosen screw must be a little
longer than the indication. Screws in the joint must be a little
shorter.
If Depth Gauge 319.010 is used for 2.7 mm screws, subtract
4 mm from the indication to obtain a correctly comparable
screw length.

Synthes 13
7
Insert distal screws LCP 2,7 mm
Required instruments
Holding Sleeve for LCP Screw Stardrive 2.4/2.7 mm 313.301
Screwdriver Shaft Stardrive, T8, cylindrical, with groove 313.304
Torque Limiter, 0.8 Nm, with AO/ASIF Quick Coupling 511.776
The LCP locking screw can be inserted manually or by power
tool.
Use the screwdriver shaft, attached to the torque limiter.
Use the holding sleeve if necessary.
A “click” indicates that the screw is locked into the plate.
Important: always use TLA when inserting LCP locking
screws, otherwise plate and/or screws might be damaged
Option: Use cortex screw 2.4 mm
Repeat the above steps for all distal holes to be used.
Important: It is recommended to use minimum one screw on
the lateral side which crosses the distal block. Screw length
should be 40–60mm depending on the size of the humerus.
The recommended screw length for the capitellum is
16–24 mm.
Important: When inserting the screws into the capitellum, be
careful not to damage the joint due to the length of the
screws. It is recommended to check the position of the screws
with the image intensifier during movement of the elbow.
LCP Distal Humerus Plates
Dorsolateral plate with support

14
Medial Plate
LCP Distal Humerus Plates
1
Position and adaption of the plate
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 position of the medial plate is on the medial ridge and on,
or slightly dorsal to the inter-muscular septum, with the distal
tip reaching down to the insertion of the medial collateral
ligament.
Use the drill guide with double scale and a Kirschner wire to
determine the optimal position of the plate.
If needed, check the position under image intensifier.
Distal screws should reach into the bone, as far as possible.
Therefore, choose a plate position that allows for longest
possible screws.
Bending of the distal part is recommended to adjust the optimal
position of the long screws through the articular block.
Situation after bending.

Synthes 15
2
Preliminary fixation of the plate to the bone
Required instruments
Drill Bit Ø 2,5 mm, length 110/85 mm, for Quick Coupling 310.250
Universal Drill Guide 3.5 (2.5/3.5) 323.360
LCP Drill Sleeve 2.7 (head LCP 2.4), with scale up to 60 mm 323.061
Use a K-wire through the drill sleeve in the distal hole to
fix the distal plate position. Make sure no collision with the
already implemented screws occurs.
Use the drill guide and the drill bit 2.5 mm to pre-drill both
cortices. Insert a 3.5 mm cortex screw through the long hole
of the plate.
3
Fix the distal part of the plate to the bone
Use a similar procedure as for the dorsolateral plate to insert
the LCP locking or cortex screws (see dorsolateral plate with
support).
Important: Careful drilling is necessary as collision with the
screws of the dorsolateral plate may occur. In case of collision
stop drilling and use adequate screw for fixation. Use other
available holes for application of more screws.
Important: It is recommended to use minimum one screw on
the medial side and one screw on the lateral side which cross
the distal block. Screw length should be 40–60mm depending
on the size of the humerus.

16
1
Attach LCP drill sleeve
Required instruments
LCP Drill Sleeve 3.5 for Drill Bits 2,7 323.027
Carefully screw the LCP drill sleeve (323.027) into the threaded
central hole of the plate.
2
Predrill the screw hole
Required instruments
LCP Drill Bit 2.8 mm, length 165 mm 310.284
Predrill the screw hole with a LCP drill bit 2.8 mm through
both cortices. Read the required screw length directly from the
drill bit.
Option: Use depth gauge to check length of screw.
Fixing the shaft
LCP Distal Humerus Plates
Fix the shafts of the dorsolateral and medial plate
Use LCP locking screws 3.5 mm to fix the proximal part of
the plate to the bone.

Synthes 17
3
Insert LCP locking screw
Required instruments
Screwdriver Shaft, hex, small, 2.5 mm 314.030
Screwdriver Shaft Stardrive 3.5 T15 314.116
Handle for Torque Limiter 1.5 Nm (511.770/511.773) 397.705
Handle with Quick Coupling 311.431
Insert the LCP locking screw with the screwdriver for hexagonal
or for Stardrive®recess, mounted on torque limiter 1.5 Nm.
Insert the screw manually or by machine until a click is heard.
If a power tool is used, reduce speed when screwing the head
of the locking screw into the plate.
Repeat the procedure until all required shaft holes are used.
Final check the locking of the screws.
Note: Use 3 screws bicortical per plate for optimal fixation to
the shaft.

18
Option: Dorsolateral plate
without support
LCP Distal Humerus Plates
1
Position the plate
Fix the distal part of the bone temporarily to the shaft with
Kirschner wires and reduction forceps.
Fix and compress it with minimum one 3.5 mm cortex screw
according to the AO Manual.
Position the plate on the dorsolateral aspect of the distal
humerus, with its distal spoon shape portion covering the non-
articulating part of the capitellum.
Note: The positioning and compression device (PCD) can be
used for easy insertion of the 3.5 mm cortex screw.
2
Preliminary fixation of the plate to the bone
Required instruments
Universal Drill Guide 3.5 (2.5/3.5) 323.360
Drill Bit 2,5 mm, length 110/85 mm, for Quick Coupling 310.250
Depth Gauge for Screws 2.7 to 4.0 mm 319.010
After determining the correct position of the plate, fix it to
the bone with a 3.5 mm cortex screw through the long hole in
the shaft portion of the plate.