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OHL OLECRANON HOOK LOCKING PLATE emergency team for broken bones®

CONTENTS Preface 03 2.5mm Olecranon Hook Locking Plate 04 Properties 05 Indications & Contraindications 06 Time of operation 06 Fracture 07 Positioning of the patient 08 Access 09 Implantation 10 Implantation of single fragment fractures 11 Implantation of multi fragment fractures 13 Case Studies 16 Postoperative treatment Information 03 Elbow System Surgical Technique Preface 17 Locking 18 Dotize® 19 Sterilization Guidelines 20 Notes 22

Preface Preface: The main advantages of the locking osteosynthesis plate lie in early functional postoperative treatment, as conventional fracture treatment with tension bands and subsequent immobilisation leads to heterotopic ossifications and subsequent limitation of movement, predominantly in the elbow. Part of the Elbow System Elbow System: • • • • Distal Humeral locking Plate dorsolateral Distal Humeral locking Plate medial Olecranon Hook locking Plate Olecranon locking Plate 03

Olecranon Hook Locking Plate • Optimum reconstruction of the joint surfaces • Simple positioning due to sliding hole • Sliding hole with compression option Multidirectional locking: • Re-setting of screw (up to 3 times) 81273-1CO Spiral Drill, D=2.7mm, L=100mm, AO Connector self-holding sleeve 37351-xx-N Cortical Screw, locking, D=3.5mm, SH 61273-100 Spiral Drill, D=2,7mm, L=100mm, AO Connector self-holding sleeve 37422-XX-N Cancellous Screw, locking, D-4.2mm, SH 51253-18Q Spiral Drill, D=2.5mm, L=180mm, AO Connector self-holding sleeve

• Multidirectional locking • Anatomically contoured • Plate lengths: 5 - hole left/right • Plate material: Titanium Grade 2 • Easier removal of implant after fracture has healed • Improved fatigue strength of implant • Redcued risk of inflammation and allergy All I.T.S. locking plates are anatomically pre-contoured. In the unlikely eyent that the plate has to be formed to the bone please notice that slight contouring is possible. ATTrNTION. Sign neurit bending a: the looking -ides will reduce lock -:g elect ver ess and if bend more than once in bci'i drectisi's it ìihht weaker the titaniun-...

Indications, Contraindications Indications: • All dislocated fractures of the olecranon Contraindications: • • • • • General problems with blood clotting Critical general condition Diabetes Damage to soft tissue Pre-existing arthrosis of the elbow Time of operation: • Primary on the first day after the trauma • Secondary after detumescence, temporary fixation in an upper arm plastercast or with an external fixing device 06

Positioning of the patient • Under a general anaesthetic or plexus anaesthesia with pneumatic partial deprivation of blood supply • Supine position or optionally abdominal position 08

Access A slightly bow-shaped skin incision should be made in radial direction, deviating from the ulnar edge, in order to achieve a nice soft tissue flap which finally covers the plate well. The scar should not extend directly above the plate. However, in individual cases pre-existing scars or deep excoriations can compel access to be changed. 09

Implantation The bone is skilfully prepared with the knife. The fracture segments should be exposed as carefully as possible in order not to further decrease blood flow. The elbow joint should be radially exposed as far as necessary to enable a good view of the joint surface of the olecranon and thus of the reduction result. 10

Implantation of single fragment fractures Single fragment fractures can simply be reduced directly with the olecranon hook plate which is implanted like a reduction hook and is initially screwed to the ulna in the sliding hole. When the compression principle of the sliding hole is fully utilised, compression of up to 4mm can occur. In this case, it is vital also to seize the ventral ulna corticalis in order to attain a stable hold of the screw used for compression. Subsequently, the necessary remaining screws are inserted at a fixed angle where required in order to stably seize all parts of...

Implantation of multi fragment fractures In the case of multi fragment fractures, K-wires can be used to fix intermediate fragments temporarily. Depending on the fracture, the sliding hole can initially be loosely engaged and the olecranon fragments screwed at a fixed angle in the first instance before the main fracture is definitively fixed by tightening the screw in the sliding hole. 13

Subsequently, the necessary remaining screws are inserted at a fixed angle where required in order to stably seize all parts of the fracture. The objective of operative treatment is to achieve the stable fixation of the fragments. 15

Case studies Case 1: Pre- and intraoperative radiographs following fixed angle fixation of a multi fragment fracture of the olecranon AO 21 B1.2. 16

Postoperative treatment Postoperative treatment: • Dependent on swelling and the condition of the soft tissue, application of an upper arm longuette until wound is completely healed • Physiotherapy • Free early functional therapy following removal of the sutures 17

Locking Locking: Locking works because of: • Screw material (TiAl6V4 ELI) is slightly harder than plate material (Titanium Grade 2) • Screw head forms thread into the plate (no cutting) Benefits: • • • • • ± 15° and Locking No pre threading No cold welding No debris Re-setting of screw (up to 3 times) 30° 18

Dotize® Dotize®: Chemical process - anodization in a strong alkaline solution* Type III anodization Layer thickness 60-200nm Type II anodization Layer thickness 2000-10 000nm + Different colors + Film become an interstitial part of the titanium - Implant surface remains sensitive to: Chipping Peeling Discoloration - No visible cosmetical effect Anodization Type II leads to following benefits* • • • • • • • • Oxygen and silicon absorbing conversion layer Decrease in protein adsorption Closing of micro pores and micro cracks Reduced risk of inflammation and allergy Hardened titanium surface...