VA-LCP Distal Humerus Plates 2.7/3.5 The low-profile fixation system with variable angle locking technology. Technique Guide

Image intensier control Warning This description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling these instruments is highly recommended. Reprocessing, Care and Maintenance of Synthes Instruments For general guidelines, function control and dismantling of multi-part instruments, please contact your local sales representative or refer to: www.synthes.com/reprocessing

Introduction VA-LCP Distal Humerus Plates 2.7/3.5 2 Surgical Technique Preparation and Approach 6 Determination of Fixation Technique 10 Insert Lateral-Column Plate 14 Insert Distal Screws in Lateral-Column Plate 20 Insert Medial-Column Plate 25 Insert Distal Screws in Medial-Column Plate 28 Insert Plate-Shaft Screws 29 Fixation of Olecranon Osteotomy 32 Product Information Implants 34 VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes

VA-LCP Distal Humerus Plates 2.7/ 3.5. The low-profile fixation system with variable angle locking technology. Plate configurations The VA-LCP Elbow Plating System offers three main doubleplating configurations for the distal humerus: perpendicular, perpendicular with lateral support, and parallel. Variable angle locking Variable angle locking screws 2.7 mm give the surgeon the ability to create a fixed-angle construct with the freedom of up to 15° off-axis screw angulation. Plate design Optimized metaphyseal plate profile, together with rounded edges and an improved anatomical plate fit minimize...

VA-LCP Distal Humerus Plates The plates offer multiple screw configurations for the medial and lateral columns, and the articular block. 3 2 1 1 Medial Plate The standard medial column plate. 2 Medial Plate, with extension The extension buttresses the medial epicondyle and includes an ascending screw that stabilizes the medial column. 5 4 3 Lateral Plate The lateral plate for the parallel-plating configuration. 4 Dorsolateral Plate The dorsolateral plate for the perpendicular-plating configuration with distal screws targeting the capitellum. 5 Dorsolateral Plate, with lateral support The screws...

AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation1, 2. Anatomic reduction Fracture reduction and fixation to restore anatomical relationships. 1 4 Early, active mobilization Early and safe mobilization and rehabilitation of the injured part and the patient as a whole. 2 3 Copyright © 2007 by AO Foundation 1 Müller ME, Allgöwer M, Schneider R, Willenegger H: Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991. 2 Rüedi TP, Buckley RE, Moran CG. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York:...

Indications – – – – Intra-articular fractures of the distal humerus Supracondylar fractures of the distal humerus Nonunions of the distal humerus Osteotomies of the distal humerus (e.g. due to malunions, deformities) VA-LCP Distal Humerus Plates 2.7/ 3.5 Technique Guide Synthes 5

Preoperative planning Complete the preoperative radiographic assessment and prepare the preoperative plan. Use the x-ray templates for theVA-LCP Distal Humerus Plates (Art. No. 034.000.721, 034.000.722 and 034.000.723) to determine the plate type, length, and the position of the screws. 6 Synthes VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide

Position patient Position the patient in prone or in lateral decubitus with the arm on a radiolucent support, or a padded post. The forearm should be positioned such that it can be flexed to an angle greater than 120 degrees. Note: Please consult www.aosurgery.org for further infor- VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide Synthes

Fractures are approached through a slightly curved posterior ncision just radial to the olecranon. - Identify the ulnar nerve and elevate it at the ulnar epi- - When using longer plates, ensure that the radial nerve is carefully identified. The type of approach is determined by the character of the fracture, and the preference and experience of the surgeon. For comminuted fractures, a distally pointed chevron ole- cranon osteotomy exposes the fracture best. Note: Please consult www.aosurgery.org for further infor- 8 Synthes VA-LCP Distal Humerus Plates 2.7/3.5 Technique Guide

4 Reduce fracture and provide temporary fixation Instrument 03.118.001 Periarticular Reduction Forceps, with pointed ball tips л 6.5 mm, small For AO C-type fractures, first reduce the fragments of the articular block under image intensifier control and use Kirschner wires and/or reduction forceps for temporary fixation. Fix the articular block to the shaft using Kirschner wires and/or reduction forceps in both columns to ensure that the anatomy of the distal humerus is restored. Ensure that the Kirschner wires or reduction forceps will not interfere with subsequent plate placement. Notes: –...

Determination of Fixation Technique Select a plate type and length appropriate for the fracture. - Choose the plate lengths that offer sufficient fixation proximal to the fracture line. - To achieve sufficient stability for early mobilization in AO A-type and C-type fractures, use two plates: one for the medial and one for the lateral column. Determine lateral-column plate type and length 03.117.004 Trial Implants for VA-LCP Distal Humeral 03.1 17.104 with lateral support, right or left, 4 holes 03.1 17.802 Trial Implants for VA-LCP Distal Humeral or Plate 2.7/3.5, lateral, right or left, 2 holes...

Use of the trial implants and/or the descriptions and illustrations below is recommended to aid implant selection for the lateral column. 1a Perpendicular plating VA-LCP Distal Humerus Plate, dorsolateral – Plate position: lateral column, dorsal – Orientation of distal screws: posteroanterior VA-LCP Distal Humerus Plate, dorsolateral with lateral support – Plate position: lateral column, dorsal – Orientation of distal screws: posteroanterior and lateromedial Note: On very small humeri, the lateral support may protrude extensively over the lateral epicondyle, in which case the use of the plate...