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Part of the DePuy Synthes Locking Compression Plate (LCP®) System

3.5 mm LCP® Olecranon PlatesSurgical Technique

3.5 mm LCP® Olecranon Plates Surgical Technique DePuy Synthes 1

Introduction

Surgical Technique

Product Information

Table of Contents

3.5 mm LCP Olecranon Plates 2

AO Principles 3

Indications 3

Clinical Cases 4

Preparation 5

Implantation 7

Insert Distal Screws 12

Implant Removal 14

Implants 15

Instruments 17

Set List 20

Image intensifier control

MR Information The 3.5 mm LCP Olecranon 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 Olecranon Plates System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury.

1 DePuy Synthes 3.5 mm LCP® Olecranon Plates Surgical Technique

3.5 mm LCP Olecranon Plates. Part of the DePuy Synthes locking compression plate (LCP) System.

Features– Anatomically precontoured

– Left and right plates

– Head holes accept 3.5 mm locking screws, and 2.7 mm and 3.5 mm cortex screws

– Shaft holes accept 3.5 mm locking screws and 3.5 mm cortex screws

– Choice of six lengths with 2, 4, 6, 8, 10 or 12 Combi holes in the shaft

– Guide block for easy and correct insertion of proximal screws

Combi holes: combination locking and compression holesThe dual-purpose Combi hole allows placement of conventional cortex screws on one side, or threaded conical locking screws on the opposite side of the same hole.

Fixed-angle stabilityThe locking screws mate with the threaded plate holes to form a fi xed-angle construct.

Unicortical fi xation optionUnicortical locking screws provide stability and load transfer only at the near cortex due to the threaded connection between the plate and the screw. Because the screw is locked to the plate, fi xation does not rely solely on the pullout strength of the screw or on the frictional force between the plate and the bone.


AO Principles and Indications

IndicationsThe 3.5 mm LCP Olecranon Plates are indicated for fixation of fractures, osteotomies and nonunions of the olecranon, particularly in osteopenic bone.

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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.

1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.

2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007.

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation 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 reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation 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.


Clinical Cases

Case 2– Male patient, 41 years old

– Olecranon fracture: 21-C2, right arm

– Implant: LCP Olecranon Plate with 4 holes

Case 1– Male patient, 79 years old

– Olecranon fracture: 21-B1, right arm

– Implant: LCP® olecranon plate with 8 holes

Preoperative, lateral view Image intensifier during surgery, lateral view Postoperative (one day after surgery), PA view

Preoperative, lateral view Postoperative (ten days after surgery), lateral view Postoperative (ten days after surgery), PA view


Preparation

1Position patient

Place the patient either in the lateral or the prone positionwith the elbow fl exed over a side rest. Depending on thefracture, use a posterior access up to approximately 5 cmdistal from the supracondylar region.

The supine position with the forearm placed across the chest is also an acceptable option, especially with extended approaches to the lateral pillar or column.


Preparation

2Surgical approach

The incision runs posterior from the supracondylar area to a point 4 cm–5 cm distal to the fracture. It can be slightly curved to the radial side to protect the ulnar nerve.

3Reduce fracture and provide temporary fixation

Reduce the fracture directly or indirectly depending on the type of fracture. Ensure that the coronoid is properly reduced before fixation.

Examine the reduction of the coronoid process to determine if it is correct before fixation.

Use Kirschner wires for temporary fixation.

Triceps

Ulna

Common extensor tendon

Anconeus

Chevron

Olecranon

Ulnar nerve


1Determine plate length and adapt plate

Required set

105.434 Small Fragment LCP Instrument and Implant Set, with self-tapping screwsor 145.434 Small Fragment Titanium LCP Instrument

and Implant Set, with self-tapping screws

Instruments

329.04, Bending Irons329.05

329.29* Bending Pliers, for 2.7 mm and 3.5 mm Reconstruction Plates

Select a plate length appropriate for the fracture.

Due to varying patient anatomy, slight bending might be necessary. Using bending irons, contour plates as needed.

The triceps tendon may have to be split in order to apply the plate.

Evaluate whether or not the hole in the proximal tab should be used. If necessary, remove the tab.

Precaution: If bending the tab, take care that the screw in the tab does not collide with the other proximal screws.

Implantation

* Also available


Implantation

2Position plate

Instruments

310.25 2.5 mm Drill Bit

312.910 Guiding Block for 3.5 mm LCP Olecranon Plate, right

312.911 Guiding Block for 3.5 mm LCP Olecranon Plate, left

314.02 Small Hexagonal Screwdriver with Holding Sleeve

314.03 Small Hexagonal Screwdriver Shaft

323.053 3.5 mm Locking Screw Sleeve

323.054 2.8 mm Drill Sleeve

323.055 1.6 mm Wire Sleeve

323.36 3.5 mm Universal Drill Guide

324.024 Push-Pull Reduction Device

After adapting the plate, attach the guiding block, drill sleeves and wire sleeve on the proximal part of the plate. Position the plate on the reduced bone, and attach it temporarily with a 3.5 mm cortex screw or push-pull reduction device.

Note: Determine the combination of screws to be used for fixation. If a combination of locking and cortex screws will be used, cortex screws should be inserted first to pull the plate to the bone.


3Proximal locking screw insertion

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

312.910 Guiding Block for 3.5 mm LCP Olecranon or Plate, right or left 312.911

314.115 StarDrive Screwdriver, T15

314.116 StarDrive Screwdriver Shaft, T15

319.01 Depth Gauge

323.025 Direct Measuring Device

323.053 3.5 mm Locking Screw Sleeve



511.770* Torque Limiting Attachment, 1.5 Nm or 511.773 Torque Limiting Attachment, 1.5 Nm,

quick coupling

To determine screw length needed, insert a Kirschner wire through the sleeve assembly. Stop when increased resistance from the subchondral bone is felt. Since it may not always be possible to feel resistance, the use of image intensification is recommended. Slide the direct measuring device over the K-wire to determine the length of screw.

Precaution: All three sleeves must be present. The direct measuring device provides an approximate screw length. Screws longer than 30 mm in the proximal part will collide with the shaft screws.

max. 30 mm

* Also available


Implantation

3. Proximal locking screw insertion continued

Remove the K-wire and K-wire centering sleeve. Drill through the 2.8 mm drill sleeve and then remove it.

Insert an appropriate length locking screw through the 3.5 mm locking screw sleeve using the StarDriveTM Screwdriver shaft.

Whenever possible, locking screws should be inserted under power using the torque limiting attachment. The audible ‘click’ will notify the surgeon that the maximum torque value has been reached and the power insertion is completed.

After screw insertion using the torque limiting attachment, always check that the screws are fully inserted by hand tightening them.

Precaution: Always use the torque limiter to restrict the maximum torque.


Alternative technique Insert the 2.8 mm threaded drill guide into a locking hole or Combi hole until fully seated. Drill to the desired depth. Remove the drill guide and use the depth gauge to determine screw length. Insert the appropriate screw.


Insert Distal Screws

1Fixation with 3.5 mm cortex screws

Instruments



311.43 Handle, with quick coupling

314.02 Small Hexagonal Screwdriver with Holding Sleeve or 314.03 Small Hexagonal Screwdriver Shaft

319.01 Depth Gauge


For lag screw fixation, use the 2.5 mm drill bit through the 3.5 mm universal drill guide to drill for the threaded hole and the 3.5 mm drill bit to drill for the gliding hole.

Determine the required length of the cortex screw with the depth gauge.

Insert the self-tapping 3.5 mm cortex screw using the small hexagonal screwdriver shaft connected to a power tool or use the small hexagonal screwdriver with holding sleeve.


2Fixation with 3.5 mm locking screws

Instruments




314.116 StarDrive Screwdriver Shaft, T15

319.01 Depth Gauge

511.770* Torque Limiting Attachment, 1.5 Nm or 511.773 Torque Limiting Attachment, 1.5 Nm,

quick coupling

Insert the 2.8 mm threaded drill guide into a locking hole or Combi hole until fully seated.

Use the 2.8 mm drill bit to drill to the desired depth. Remove the drill guide and use the depth gauge to determine screw length.

Insert the self-tapping 3.5 mm locking screw using the StarDrive Screwdriver shaft.

Whenever possible, locking screws should be inserted under power using the torque limiting attachment. The audible ‘click’ will notify the surgeon that the maximum torque value has been reached and the power insertion is completed.

After screw insertion using the torque limiting attachment, always check that the screws are fully inserted by hand tightening them.

Precaution: Always use the torque limiter to restrict the maximum torque.

* Also available


Implant Removal

Implant removal

Optional set

01.240.001 Screw Removal Set

Instruments

309.520 Conical Extraction Screw


To remove locking screws, unlock all screws from the plate, then remove the screws completely from the bone. This prevents simultaneous rotation of the plate when unlocking the last locking screw.

If the screws cannot be removed with the screwdriver (e.g. if the hexagonal or StarDrive Recess of the locking screw is damaged or if the screws are stuck in the plate), insert the conical extraction screw with left-handed thread into the screwhead, using the handle with quick coupling, and loosen the locking screw by turning it counterclockwise.


Screws Used with the 3.5 mm LCP Olecranon PlateStainless Steel and Titanium

3.5 mm Locking Screws†

– Create a locked, fi xed-angle screw-plate construct

– Self-tapping tip

– Used in the locking portion of the Combi holes or in round locking holes

3.5 mm Cortex Screws*– May be used in the DCU portion of the Combi holes

in the plate shaft or in round locking holes

– Compress the plate to the bone or create axial compression

2.7 mm Cortex Screws*– May be used in the proximal locking holes

– Compress the plate to the bone

† Screws made of implant quality 316L stainless steel or titanium alloy (Ti-6Al-7Nb)

* Screws made of implant quality 316L stainless steel or commercially pure (CP) titanium


3.5 mm LCP Olecranon Plates

Implants3.5 mm LCP Olecranon Plates, right*Stainless Steel Titanium Holes Length (mm)236.502 436.502 2 86236.504 436.504 4 112236.506 436.506 6 138236.508 436.508 8 164236.510 436.510 10 189236.512 436.512 12 215

3.5 mm LCP Olecranon Plates, left*Stainless Steel Titanium Holes Length (mm)236.503 436.503 2 86236.505 436.505 4 112236.507 436.507 6 138236.509 436.509 8 164236.511 436.511 10 189236.513 436.513 12 215

* Plates are made of implant quality 316L stainless steel or commercially pure (CP) titanium



Instruments

Instruments from the 3.5 mm LCP Olecranon Plate Set (01.104.015/01.104.016)

312.910 Guiding Block for 3.5 mm LCP Olecranon Plate, right





Selected Instruments from the Small Fragment LCP Instrument and Implant Set (105.434/145.434)

292.71 1.6 mm Kirschner Wire with thread, 150 mm, trocar point


Selected Instruments from the Small Fragment LCP Instrument and Implant Set (105.434/145.434)


314.02 Small Hexagonal Screwdriver with Holding Sleeve

314.03 Small Hexagonal Screwdriver Shaft


314.116 StarDrive Screwdriver Shaft, T15, quick coupling

319.01 Depth Gauge

323.023 1.6 mm Wire Sleeve, 55 mm


323.025 Direct Measuring Device




511.770* Torque Limiting Attachment, 1.5 Nmor511.773 Torque Limiting Attachment, 1.5 Nm,

quick coupling

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

* Also available


3.5 mm LCP Olecranon Plate Set Stainless Steel (01.104.015) and Titanium (01.104.016)

Graphic Case60.104.015 3.5 mm LCP Olecranon Plate Graphic Case

Instruments312.910 Guiding Block for 3.5 mm LCP Olecranon

Plate, right


Implants3.5 mm LCP Hook Plates, 2 ea.Stainless Steel Titanium Holes 02.113.103 04.113.103 3

3.5 mm LCP Olecranon Plates, rightStainless Steel Titanium Holes Length (mm)236.502 436.502 2 86236.504 436.504 4 112236.506 436.506 6 138236.508 436.508 8 164236.510 436.510 10 189236.512 436.512 12 215

3.5 mm LCP Olecranon Plates, leftStainless Steel Titanium Holes Length (mm)236.503 436.503 2 86236.505 436.505 4 112236.507 436.507 6 138236.509 436.509 8 164236.511 436.511 10 189236.513 436.513 12 215

Required Set105.434 Small Fragment LCP Instrument and

Implant Set, with self-tapping screws

or 145.434 Small Fragment Titanium LCP Instrument

and Implant Set, with self-tapping screws

Note: For additional information, please refer to package insert.

For detailed cleaning and sterilizationinstructions, please refer towww.synthes.com/cleaning-sterilization orsterilization instructions, if provided.


Also Available01.104.000 3.5 mm LCP Elbow System

01.104.004 3.5 mm Titanium LCP Elbow System

01.240.001 Screw Removal Set

60.104.016 3.5 mm LCP Olecranon Graphic Case Tray

329.29 Bending Pliers, for 2.7 mm and 3.5 mm Reconstruction Plates

511.770 Torque Limiting Attachment, 1.5 Nm

690.419 Retrofit Kit for 3.5 mm LCP Elbow System Graphic Case

690.479 Retrofit Kit for 3.5 mm Titanium LCP Elbow System Graphic Case

Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed.

Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information.

CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.

Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada.

Not all products may currently be available in all markets.

© DePuy Synthes 2007–2017. All rights reserved.DSUS/TRM/0916/1096 4/17 DV

Synthes USA, LLC 1101 Synthes AvenueMonument, CO 80132

Manufactured or distributed by:Synthes USA Products, LLC 1302 Wrights Lane EastWest Chester, PA 19380

To order (USA): 800-523-0322 To order (Canada): 855-946-8999

Note: For recognized manufacturer, refer to the product label.

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