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

10 DePuy Synthes 3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique
Insert Two Most Distal Locking Screws
5
Insert two most distal locking screws
Instruments
292.71 1.6 mm Kirschner Wire with Thread
310.288 2.8 mm Drill Bit, quick coupling
312.648 2.8 mm Threaded Drill Guide
314.03 Small Hexagonal Screwdriver Shaft
or
314.116 StarDrive Screwdriver Shaft, T15
323.023 1.6 mm Wire Sleeve
323.025 Direct Measuring Device
399.121* Bone Holding Forceps, soft ratchet, for plates
to 14 mm wide
511.773 Torque Limiting Attachment, 1.5 Nm,
quick coupling
Insert the 1.6 mm wire sleeve into the threaded drill guide.
Insert the threaded drill guide assembly into the most distal
locking hole until fully seated.
Insert a 1.6 mm threaded K-wire through the wire sleeve
and drill to the desired depth.
Verify K-wire placement under image intensification to
determine if final screw placement will be acceptable. This
wire should be at, or slightly distal to, the equator of the
capitellum for plate placement to be correct.
Precaution: The K-wire position represents the final position
of the locking screw. Confirm that the K-wire does not enter
the joint.
* Also available

3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 11
Measure for screw length by sliding the tapered end of
the direct measuring device over the K-wire down to the
wire sleeve.
Remove the direct measuring device, K-wire and 1.6 mm
wire sleeve, leaving the threaded drill guide in place.
Under image intensification, predrill for the screw with
the 2.8 mm drill bit.
Remove the threaded drill guide.

12 DePuy Synthes 3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique
Insert Two Most Distal Locking Screws
5
Insert two most distal locking screws continued
Select a locking screw of the appropriate length.
Insert the locking screw with the appropriate screwdriver
shaft (hexagonal or StarDrive Recess) attached to the 1.5 Nm
torque limiting attachment (TLA).
Insert the screw manually or by power until a click is heard.
If a power tool is used, reduce speed when inserting the head
of the locking screw into the plate.
Repeat this process for the second-most-distal locking screw.
Note: If additional compression of the distal fragment to
the plate is needed, insert a 4.0 mm cancellous screw before
inserting the locking screws. This screw may be inserted into
one of the proximal locking holes in the head of the plate
(but not one of the two most distal holes). After fixation with
locking screws through the remaining holes, this screw can
be replaced with a locking screw.
Insert locking screws into the remaining head holes.

3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 13
Insert Locking Screws
6
Insert locking screws
Instruments
310.288 2.8 mm Drill Bit, quick coupling
312.648 2.8 mm Threaded Drill Guide
314.03 Small Hexagonal Screwdriver Shaft
or
314.116 StarDrive Screwdriver Shaft, T15
319.01 Depth Gauge, for small screws
511.773 Torque Limiting Attachment, 1.5 Nm,
quick coupling
Determine where locking screws will be used in the shaft
portion of the plate. Working from the fracture up the shaft,
insert locking screws into the preferred holes until the desired
fixation is achieved.
Insert the 2.8 mm threaded drill guide into the locking portion
of the Combi hole until fully seated.
Use the 2.8 mm drill bit to drill to the desired depth.
Remove the drill guide.
Use the depth gauge to determine screw length.

14 DePuy Synthes 3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique
Insert Locking Screws
6
Insert locking screws continued
Insert the locking screw with the appropriate screwdriver
shaft (hexagonal or StarDrive Recess) attached to the
1.5 Nm TLA.
Insert the screw manually or by power until a click is heard.
If a power tool is used, reduce speed when inserting the
head of the locking screw into the plate.
If desired, the cortex screw used for preliminary fixation and
compression may be removed.

3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 15
4.0 mm Cancellous Bone Screws
Found in the Small Fragment LCP Instrument Set
– May be used in the DCU portion of the Combi holes
in the plate shaft
– Compress the plate to the bone or create
axial compression
– Fully or partially threaded shaft
3.5 mm Locking Screws
Found in the Small Fragment LCP Instrument Set
– Used in the locking portion of the Combi holes or
in round locking holes
– Create a locked, fixed-angle screw/plate construct
– Fully threaded shaft
– Self-tapping tip
3.5 mm Cortex Screws
Found in the Small Fragment LCP Instrument Set
– May be used in the DCU portion of the Combi holes
– Compress the plate to the bone or create
axial compression
– Fully threaded shaft
Screws Used with the 3.5 mm LCP Extra-articular Distal Humerus Plate
Stainless Steel and Titanium

16 DePuy Synthes 3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique
Selected Instruments from the Small Fragment LCP Instrument and Implant Sets
Stainless Steel (105.434) and Titanium (145.434)
03.122.001* 2.8 mm LCP Drill Guide, long, for 3.5 mm
LCP plates, for use with 03.122.002
03.122.002* 2.8 mm Drill Bit, quick coupling, 248 mm,
95 mm calibration, for use with 03.122.001
292.20 2.0 mm Kirschner Wire, 150 mm, trocar point
292.71 1.6 mm Kirschner Wire with Thread,
150 mm, trocar point, 5 mm thread length
310.25 2.5 mm Drill Bit, quick coupling, 110 mm
310.288 2.8 mm Drill Bit, quick coupling, 165 mm
311.43 Handle, with quick coupling
* Also available

3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 17
314.115 StarDrive Screwdriver, T15
314.03 Small Hexagonal Screwdriver Shaft,
quick coupling
314.116 StarDrive Screwdriver Shaft, T15,
quick coupling
319.01 Depth Gauge, for small screws
323.023 1.6 mm Wire Sleeve
312.648 2.8 mm Threaded Drill Guide
314.02 Small Hexagonal Screwdriver with
Holding Sleeve

18 DePuy Synthes 3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique
Selected Instruments from the Small Fragment LCP Instrument and Implant Sets
Stainless Steel (105.434) and Titanium (145.434) continued
329.04 Bending Iron, for 2.7 mm and 3.5 mm plates,
150 mm length, used with 329.05
329.05 Bending Iron, for 2.7 mm and 3.5 mm plates,
150 mm length, used with 329.04
511.770* Torque Limiting Attachment, 1.5 Nm
or
511.773 Torque Limiting Attachment, 1.5 Nm,
quick coupling
323.36 3.5 mm Universal Drill Guide
323.025 Direct Measuring Device
324.024 Push-Pull Reduction Device
324.031 Threaded Plate Holder, long, for 3.5 mm
locking hole
* Also available

3.5 mm LCP®Extra-articular Distal Humerus Plate Surgical Technique DePuy Synthes 19
3.5 mm LCP Extra-articular Distal Humerus Plate Sets
Stainless Steel (01.104.010) and Titanium (01.104.020)
Graphic Case
60.104.010 3.5 mm LCP Extra-articular Distal Humerus
Plate Graphic Case
Implants◊
3.5 mm LCP Extra-articular Distal Humerus Plates, right
Stainless Length
Steel Titanium Holes (mm)
02.104.004 04.104.004S 4 122
02.104.006 04.104.006S 6 158
02.104.008 04.104.008S 8 194
02.104.010 04.104.010S 10 230
02.104.012 04.104.012S 12 266
02.104.014 04.104.014S 14 302
3.5 mm LCP Extra-articular Distal Humerus Plates, left
Stainless Length
Steel Titanium Holes (mm)
02.104.024 04.104.024S 4 122
02.104.026 04.104.026S 6 158
02.104.028 04.104.028S 8 194
02.104.030 04.104.030S 10 230
02.104.032 04.104.032S 12 266
02.104.034 04.104.034S 14 302
Required Set
105.434 Small Fragment LCP Instrument and
Implant Set, with self-tapping screws
or
145.434 Small Fragment LCP Instrument and Titanium
Implant Set, with self-tapping screws
◊Stainless steel plates are available nonsterile or sterile-packed.
Add “S” to catalog number to order sterile product.
Titanium plates are available sterile only.
Note: For additional information, please refer to package insert.
For detailed cleaning and sterilization
instructions, please refer to
www.synthes.com/cleaning-sterilization or
sterilization instructions, if provided.