2.4 mm LCP Radial Head Plates. Contoured plates to address various fracture patterns of the proximal radius.

Transcription

1 2.4 mm LCP Radial Head Plates. Contoured plates to address various fracture patterns of the proximal radius. Technique Guide Instruments and Implants approved by the AO Foundation

2 Table of Contents Introduction 2.4 mm LCP Radial Head Plates 2 AO Principles 3 Indications 4 Surgical Technique Preparation 5 Reduce Fracture 7 Apply Radial Head Plate 8 Insert Proximal Screws 9 Insert Shaft Screws 10 General Notes on Technique 11 Alternative Method 13 Postoperative Treatment 14 Implant Removal 14 Product Information Implants 15 Instruments 17 Set List 20 Image intensifier control Synthes

3 2.4 mm LCP Radial Head Plates Plate features Nine (9) radial head plates available to address various fracture patterns of the proximal radius Plates are precontoured for anatomical fit Combi holes allow fixation with locking screws in the threaded section for angular stability, and cortex screws in the dynamic compression unit (DCU) section for distraction. A fixed-angle construct provides advantages in osteopenic bone or multifragment fractures, where traditional screw purchase is compromised. Additional features Limited-contact design shaft with 2, 3, and 4 Combi holes The holes in the head of the plate accept 2.4 mm locking screws and 2.0 mm cortex screws The shaft holes accept 2.4 mm locking screws in the threaded portion or 2.7 mm cortex screws and 2.4 mm cortex screws in the distraction portion Radial head rim plates available in right and left plates with a 5º tilt to match the anatomy of the radial head Radial head neck plates fit both right and left proximal radii Available in 316L stainless steel and commercially pure (CP) titanium 2 Synthes 2.4 mm LCP Radial Head Plates Technique Guide

4 AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation. 1 These principles, as applied to the 2.4 mm LCP Radial Head Plates, are: Anatomic reduction Multiple, nonparallel metaphyseal screw holes provide fixation options for a variety of fracture patterns. Precontoured plates assist reduction of metaphysis to diaphysis. Stable fixation Locking screws create a fixed-angle construct, providing angular stability. Preservation of blood supply Tapered end allows submuscular plate insertion, preserving tissue viability. Limited-contact plate design reduces plate-to-bone contact, limiting vascular trauma and insult to bone. Early, active mobilization Early mobilization per standard AO technique creates an environment for bone healing, expediting a return to optimal function. 1. M.E. Müller, M. Allgöwer, R. Schneider, H. Willenegger: Manual of Internal Fixation, 3rd Edition. Berlin; Springer-Verlag Synthes 3

5 Indications Extra-articular and intra-articular fractures of the proximal radius and multifragmented radial neck fractures. 4 Synthes 2.4 mm LCP Radial Head Plates Technique Guide

6 Preparation Patient position Position the patient supine on the table. Prepare the extremity from the axilla to the hand. This allows rotation of the forearm and flexion and extension of the elbow during the operative fixation. Approach A lateral approach is most commonly used. Take care to avoid the deep branch of the radial nerve, which runs anterior to the capsule and the radial head. To minimize the risk of operative disruption of the lateral collateral ligament, the capsular incision should remain in the front of the anterior margin of the anconeus muscle and parallel to the fascial limit of the extensor carpi ulnaris. The annular ligament, a true thickening of the capsule, is opened laterally or slightly anteriorly to allow full inspection of the fragments. In selected cases, an osteotomy of the lateral epicondyle will allow an extensile approach. Illustrations on this page are reproduced from Rüedi/Murphy, AO Principles of Fracture Management by permission of AO Publishing, Copyright 2000 AO Publishing, Switzerland. Synthes 5

7 Preparation continued Safe zone Both plates fit within the Hotchkiss safe zone 2 which is described as an area of 105 on the radial head that is free of impingement between ulna and radius. The Hotchkiss safe zone is located on the opposite side of the radial tuberosity. Neutral Supination Pronation = Safe zone 2. Robert N. Hotchkiss, MD: Displaced Fractures of the Radial Head: Internal Fixation or Excision? AAOS, Vol. 5, No. 1, January/February Synthes 2.4 mm LCP Radial Head Plates Technique Guide

8 Reduce Fracture Required set / LCP Modular Mini Fragment Instrument and Implant Set (stainless or titanium) or / 2.4 mm LCP Distal Radius System (stainless or titanium) 1 Reduce fracture Instruments mm Kirschner Wire (stainless steel) or mm Titanium Kirschner Wire mm Kirschner Wire (stainless steel) or mm Titanium Kirschner Wire Reduction Forceps, with points Obtain reduction and temporary fixation with pointed reduction forceps. Gentle rotation of the forearm allows inspection of the circumference of the radial head and neck. Perform preliminary fixation with K-wires. Synthes 7

9 Apply Radial Head Plate 2 Apply radial head plate Instruments mm Drill Bit mm Drill Bit, quick coupling mm Drill Bit with depth mark, quick coupling, 110 mm mm Drill Bit, quick coupling, 100 mm Handle, with quick coupling StarDrive Screwdriver Shaft, T Depth Gauge, for 2.0 mm and 2.4 mm screws mm Universal Drill Guide mm Universal Drill Guide Bending Pliers After reducing the fracture, apply the plate and insert a preliminary cortex screw through the DCU portion of one of the elongated Combi holes. For 2.4 mm cortex screws, use the 1.8 mm drill bit for the threaded hole and the 2.4 mm drill bit for the gliding hole. For 2.7 mm cortex screws, use the 2.0 mm drill bit for the threaded hole and the 2.7 mm drill bit for the gliding hole. Note: The plates are precontoured to fit the anatomy of the radial head. There are no undercuts on the plates to protect the threaded holes from distortion during bending. If it is necessary to bend the plate, use the bending pliers. 8 Synthes 2.4 mm LCP Radial Head Plates Technique Guide

10 Insert Proximal Screws 3 Insert proximal screws Instruments Handle, with quick coupling Depth Gauge, for 2.0 mm and 2.4 mm screws For 2.0 mm cortex screws mm Drill Bit mm Drill Bit mm Screwdriver Blade, self-retaining, StarDrive, long For 2.4 mm locking screws mm Drill Bit with depth mark, quick coupling, 110 mm StarDrive Screwdriver Shaft, T Threaded LCP Drill Guide mm Threaded Drill Guide, short Use the 2.0 mm cortex screws and the 2.4 mm locking screws in the head of the plate. Important: Careful drilling is necessary, as interference with screws in the proximal portion of the plate is possible. In case of interference, stop drilling and use a screw of appropriate length. See General Notes on Technique (page 11) for additional information. Synthes 9

11 Insert Shaft Screws 4 Insert screws in the shaft of the plate Instruments Handle, with quick coupling StarDrive Screwdriver Shaft, T8 For 2.4 mm cortex screws mm Drill Bit with depth mark, quick coupling, 110 mm mm Drill Bit, quick coupling Depth Gauge, for 2.0 mm and 2.4 mm screws mm Universal Drill Guide For 2.7 mm cortex screws mm Drill Bit, quick coupling mm Drill Bit, quick coupling Depth Gauge mm Universal Drill Guide For 2.4 mm locking screws mm Drill Bit with depth mark, quick coupling, 110 mm Threaded LCP Drill Guide mm Threaded Drill Guide, short Use 2.4 mm and 2.7 mm cortex screws and 2.4 mm locking screws in the shaft of the plate. 10 Synthes 2.4 mm LCP Radial Head Plates Technique Guide

12 General Notes on Technique Determine screw choice If planning a combination of locking and cortex screws, first use a cortex screw to pull the plate to the bone. If using a locking screw first, ensure that the plate is held securely to the bone, to avoid spinning of the plate as the screw locks into the plate. Insert cortex screws Instruments mm Drill Bit, quick coupling mm Drill Bit, quick coupling mm Drill Bit, quick coupling mm Drill Bit with depth mark, quick coupling, 110 mm mm Drill Bit, quick coupling Depth Gauge, for 2.0 mm and 2.4 mm screws mm Universal Drill Guide mm Universal Drill Guide mm Universal Drill Guide Use the 2.0 mm universal drill guide for insertion of 2.0 mm cortex screws. For the proximal 2.0 mm cortex screw, use the 1.5 mm drill bit for the threaded hole and the 2.0 mm drill bit for the gliding hole. Determine the length of screw by using the depth gauge. Use the 2.4 mm universal drill guide or the 2.7 mm universal drill guide for an eccentric (distraction) or neutral (buttress) insertion of cortex screws. For the 2.4 mm cortex screw, use the 1.8 mm drill bit for the threaded hole and the 2.4 mm drill bit for the gliding hole. Determine the length of the screw using the depth gauge. For 2.7 mm cortex screws, use the 2.0 mm drill bit for the threaded hole and the 2.7 mm drill bit for the gliding hole. Determine the length of the screw using the depth gauge. Synthes 11

13 General Notes on Technique continued Insert locking screws Instruments mm Drill Bit with depth mark, quick coupling Handle, with quick coupling StarDrive Screwdriver Shaft, T Depth Gauge, for 2.0 mm and 2.4 mm screws Threaded LCP Drill Guide mm Threaded Drill Guide, short Screw the threaded LCP drill guide into a hole until full seated. For the 2.4 mm locking screws, use the 1.8 mm drill bit with depth mark, quick coupling, to drill to the desired depth. Determine the screw length directly from the mark on the drill bit and scale on the threaded drill guide. This may be verified using a depth gauge for 2.0 mm and 2.4 mm screws. Insert the locking screw manually with the T8 StarDrive screwdriver shaft and handle. Carefully tighten the locking screw, as excessive force is not necessary to produce effective plate-to-screw locking. 12 Synthes 2.4 mm LCP Radial Head Plates Technique Guide

14 Alternative Method Alternative method Locking screw insertion with holding sleeve Instruments Handle, with quick coupling StarDrive Screwdriver Shaft, T Holding Sleeve An alternative method may be used for insertion of locking screws, using the locking screw to pull the plate to the bone. Place the holding sleeve onto the StarDrive screwdriver shaft. Pick up the locking screw with the holding sleeve, and insert the screw. With the locking screw still held by the holding sleeve, tighten the screw until the plate is drawn to the bone. Pull up on the holding sleeve to release the screw head, and tighten the locking screw into the plate. Take care to hold the plate securely on the bone to avoid spinning the plate as the screw locks to the plate. Synthes 13

15 Postoperative Treatment and Implant Removal Postoperative treatment Postoperative treatment with locking compression plates does not differ from conventional internal fixation procedures. Implant removal To remove locking screws, unlock all screws from the plate and then begin to remove the screws completely from the bone. This avoids rotation of the plate when removing the last locking screw. 14 Synthes 2.4 mm LCP Radial Head Plates Technique Guide

16 2.4 mm LCP Radial Head Plates Rim plates Stainless Steel Titanium Holes right left right left right left Neck plates Stainless Steel Titanium Holes Synthes 15

17 Screws Used with the 2.4 mm LCP Radial Head Plates Stainless steel and titanium 2.0 mm Cortex Screws, self-tapping, with T6 StarDrive recess For use in round holes in plate head, to provide compression or neutral fixation Low-profile head in the plate holes 10 mm to 26 mm lengths 2.4 mm Cortex Screws, self-tapping, with T8 StarDrive recess* For use in Combi holes in plate shaft, to provide distraction or neutral fixation Low-profile head in the plate holes StarDrive recess mates with self-retaining screwdriver and provides improved torque transmission 6 mm to 30 mm lengths 2.4 mm Locking Screws, self-tapping, with T8 StarDrive recess* Threaded, conical head locks securely into the plate to provide angular stability Locked screws allow unicortical screw fixation and load transfer to the near cortex StarDrive recess mates with self-retaining screwdriver and provides improved torque transmission 6 mm to 30 mm lengths 2.7 mm Cortex Screws, self-tapping, with T8 StarDrive recess* For use in Combi holes in plate shaft, to provide distraction or neutral fixation Low-profile head in the plate holes StarDrive recess mates with self-retaining screwdriver and provides improved torque transmission 10 mm to 30 mm lengths Note: For information on fixation principles using conventional and locked plating techniques, please refer to the Small Fragment Locking Compression Plate (LCP) Technique Guide. *Available in the 2.4 mm LCP Distal Radius Set and Modular Mini Fragment LCP Set. Screws are made of implant-quality 316L stainless steel, or titanium alloy, Ti-6Al-7Nb. 16 Synthes 2.4 mm LCP Radial Head Plates Technique Guide

18 Instruments mm Drill Bit, quick coupling, 110 mm mm Drill Bit, quick coupling mm Drill Bit, quick coupling mm Drill Bit with depth mark, quick coupling mm Drill Bit, quick coupling Countersink, for 2.0 mm and 2.4 mm screws Handle, with mini quick coupling, small Synthes 17

19 Instruments continued Handle, with quick coupling mm Screwdriver Blade, self retaining, StarDrive, long StarDrive Screwdriver Shaft, T Depth Gauge, for 2.0 mm and 2.4 mm Cortex Screws Depth Gauge Threaded LCP Drill Guide mm Threaded Drill Guide, short 18 Synthes 2.4 mm LCP Radial Head Plates Technique Guide

20 mm Universal Drill Guide mm Universal Drill Guide mm Universal Drill Guide Bending Pliers Reduction Forceps, with points Synthes 19

21 2.4 mm LCP Radial Head Plate Instrument and Implant Sets Stainless Steel ( ) and Titanium ( ) Module Small Module for LCP Radial Head Instruments and Implants Instruments mm Drill Bit, quick coupling, 110 mm, 2 ea Countersink, for 2.0 mm and 2.4 mm screws Handle, with mini quick coupling, small mm Screwdriver Blade, self-retaining, StarDrive, long mm Universal Drill Guide Implants 2.4 mm LCP Radial Head Rim Plates Stainless Steel Titanium Description Length (mm) holes, right holes, left holes, right holes, left holes, right holes, left 56 Required Additional Set / 2.4 mm LCP Distal Radius Plate System (stainless steel or titanium) or / LCP Modular Mini Fragment Instrument and Implant Set (stainless steel or titanium) 2.4 mm LCP Radial Head Neck Plates Stainless Steel Titanium Description Length (mm) holes holes holes mm Cortex Screws, self-tapping, with StarDrive recess, 2 ea. Stainless Steel Titanium Length (mm) Note: For additional information, please refer to package insert. 20 Synthes 2.4 mm LCP Radial Head Plates Technique Guide

22 Synthes (USA) 1302 Wrights Lane East West Chester, PA Telephone: (610) To order: (800) Fax: (610) Synthes (Canada) Ltd Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) To order: (800) Fax: (905) Synthes Inc., or its affiliates. All rights reserved. Combi, LCP and Synthes are trademarks of Synthes Inc., or its affiliates. Printed in U.S.A. 1/10 J5946-F