Synthes LCP User manual

Part of the DePuy Synthes Locking Compression Plate (LCP®) System
3.5 mm LCP®Extra-articular
Distal Humerus Plate
Surgical Technique

3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 1
Introduction
Surgical Technique
Product Information
Table of Contents
3.5 mm LCP Extra-articular Distal Humerus Plate 2
AO Principles 4
Indications 5
Preparation 6
Approach 7
Reduce Fracture 8
Preliminary Fixation 9
Insert Two Most Distal Locking Screws 10
Insert Locking Screws 13
Implants 15
Instruments 16
Set List 19
Image intensifier control
MR Information
The 3.5 mm LCP Distal Humerus Plates System has not been evaluated for safety and
compatibility in the MR environment. It has not been tested for heating, migration or
image artifact in the MR environment. The safety of the 3.5 mm LCP Distal Humerus
Plates System in the MR environment is unknown. Scanning a patient who has this
device may result in patient injury.

2 DePuy Synthes 3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique
3.5 mm LCP Extra-articular Distal Humerus Plate
Plate head tapered to
minimize soft tissue irritation
Two most distal holes are angled toward
the capitulum and trochlea
Features
– Left and right plates are anatomically contoured to match
the posterolateral distal humerus
– Locking screws engaged in the plate create a fixed-angle
construct that enhances fixation in osteopenic bone
– Combi holes combine a dynamic compression unit (DCU)
hole with a threaded hole, providing the flexibility of axial
compression and locking capability throughout the plate shaft
– Available with 4, 6, 8, 10, 12 or 14 elongated Combi
holes to allow greater adjustment of plate placement
on the humerus
– Available in 316L stainless steel and titanium
Five locking holes in plate head
are angled medially to maximize
screw purchase in bone

3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 3
Elongated Combi holes accept 3.5 mm
locking screws, 3.5 mm cortex screws
and 4.0 mm cancellous bone screws
Limited-contact design

4 DePuy Synthes 3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique
AO Principles
1
4
2
3
4_Priciples_03.pdf 1 05.07.12 12:08
4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique
AO PRINCIPLES
In 1958, the AO formulated four basic principles, which
have become the guidelines for internal fixation1, 2.
1Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal
Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.
2Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management.
2nd ed. Stuttgart, New York: Thieme. 2007.
Anatomic reduction
Fracture reduction and fixation to
restore anatomical relationships.
Early, active mobilization
Early and safe mobilization and
rehabilitation of the injured part
and the patient as a whole.
Stable fixation
Fracture fixation providing abso-
lute or relative stability, as
required by the patient, the injury,
and the personality of the
fracture.
Preservation of blood supply
Preservation of the blood supply
to soft tissues and bone by
gentle reduction techniques and
careful handling.
In 1958, the AO formulated four basic principles, which
have become the guidelines for internal fixation.1, 2
Anatomic reduction
Fracture reduction and fixation to
restore anatomical relationships.
Early, active mobilization
Early and safe mobilization and
rehabilitation of the injured part
and the patient as a whole.
Stable xation
Fracture fixation providing absolute
or relative stability, as required by
the patient, the injury, and the
personality of the fracture.
Preservation of blood supply
Preservation of the blood supply
to soft tissues and bone by gentle
reduction techniques and
careful handling.
1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation.
3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; 1991.
2.
Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management.
2nd ed. Stuttgart New York: Thieme; 2007.

3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 5
Indications
The 3.5 mm LCP®Extra-articular Distal Humerus Plate
is indicated for fractures of the distal humerus.

6 DePuy Synthes 3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique
Preparation
1
Preoperative planning
Required sets
01.104.010/ 3.5 mm LCP Extra-articular Distal Humerus
01.104.020 Plate Set (stainless steel or titanium)
105.434/ Small Fragment LCP Instrument and
145.434 Implant Set (stainless steel or titanium)
Optional sets
01.104.000 3.5 mm LCP Elbow System
01.104.004 3.5 mm LCP Titanium Elbow System
Complete the preoperative radiographic assessment and
prepare the preoperative plan. Use the x-ray template for
3.5 mm LCP Extra-articular Distal Humerus Plate to determine
the length of the plate and the position of the screws.

3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 7
Approach
2
Position patient
Positioning is by surgeon preference. However, the lateral
decubitus position is frequently chosen. Rest the arm on a
padded bar allowing elbow flexion of 120°.
3
Approach
Possible approaches include a triceps split approach or a
posterolateral approach, where the triceps are elevated off
the back of the humerus from lateral to medial. Distally, this
is the posterior side of a standard Kocher approach. Proximally,
one can identify the radial nerve in the manner described by
Gerwin, et al.2
Precaution: If the plate is long, the radial nerve must be
elevated off the back of the humerus and the plate placed
underneath. Otherwise, the radial nerve rarely needs to be
identified by more than palpation and almost never needs
to be isolated or elevated with these fractures.
Note: An olecranon osteotomy is not necessary for
plate placement.
2. Gerwin, Michelle, et al. “Alternative Operative Exposures of the Posterior Aspect
of the Humeral Diaphysis. With Reference to the Radial Nerve.” The Journal of
Bone and Joint Surgery, 78:1690-5. (1996).

8 DePuy Synthes 3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique
3
Position plate on bone
Instruments
329.02* Bending Iron, for 4.5 mm plates (2 required)
329.30* Plate-Bending Press
399.121* Bone Holding Forceps, 14 mm, serrated jaw,
soft ratchet
Position the plate so that the shaft portion of the plate is
located centrally on the posterior aspect of the bone while
the distal end curves along the back of the lateral column.
Ensure that the plate is at a safe distance from the olecranon
fossa so that complete elbow extension is not impeded.
The position of the plate should allow distal screw insertion
through the lateral flange to reach far into the trochlea.
Due to varying patient anatomy, slight bending may be
necessary. Contour the plate as needed using the bending
irons or the plate-bending press.
Reduce Fracture
1
Reduce fracture and fix temporarily
Use pointed forceps for temporary fixation in restoring
the anatomy. Ensure that forceps will not interfere with
subsequent plate placement.
2
Determine plate length
Choose a plate length that offers sufficient fixation proximal
to the fracture.
* Also available

3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 9
Preliminary Fixation
4
Preliminary fixation and compression
Instruments
310.25 2.5 mm Drill Bit, quick coupling
311.43 Handle, with quick coupling
314.02 Small Hexagonal Screwdriver with Holding
Sleeve
314.03 Small Hexagonal Screwdriver Shaft
323.36 3.5 mm Universal Drill Guide
399.121* Bone Holding Forceps, 14 mm, serrated jaw,
soft ratchet
Alternative instrument
314.116 StarDriveTM Screwdriver Shaft, T15
After reducing the fracture, apply the plate and insert a
nonlocking screw through the center of the DCU portion
of an elongated Combi hole proximal to the fracture.
Use the 2.5 mm drill bit through the 3.5 mm universal drill
guide to predrill the bone. For the neutral position, press the
drill guide down in the nonthreaded hole. Use the depth
gauge to determine screw length.
Select and insert an appropriate length 3.5 mm cortex screw.
Do not completely tighten the screw. Make any final
adjustments to plate placement. Manually tighten the screw to
maintain plate placement and compress the plate to the bone.
* Also available