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

3.5 mm LCP Extra-articular ®

Distal Humerus Plate

Surgical Technique
Table of Contents

Introduction 3.5 mm LCP Extra-articular Distal Humerus Plate 2

AO Principles 4

Indications 5

Surgical Technique Preparation 6

Approach 7

Reduce Fracture 8

Preliminary Fixation 9

Insert Two Most Distal Locking Screws 10

Insert Locking Screws 13

Product Information Implants 15

Instruments 16

Set List 19

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.

Image intensifier control

3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique  DePuy Synthes    1

3.5 mm LCP Extra-articular Distal Humerus Plate

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

Plate head tapered to Two most distal holes are angled toward
minimize soft tissue irritation the capitulum and trochlea

2    DePuy Synthes  3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique

Elongated Combi holes accept 3.5 mm
locking screws, 3.5 mm cortex screws
and 4.0 mm cancellous bone screws

Limited-contact design­

3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique  DePuy Synthes    3

 AO Principles

AO PRINCIPLES

In 1958, the AO formulated four basic principles, which

have become the guidelines for internal fixation.1, 2
In 1958, the AO formulated four basic principles, which
have become the guidelines for internal fixation1, 2.

4_Priciples_03.pdf 1 05.07.12 12:08

Anatomicreduction
Anatomic reduction Stable
Stablefixation
fixation
Fracture reduction and fixation
Fracture reduction and fixation to
to Fracture
Fracturefixation
fixationproviding
providingabsolute
abso-
restore anatomical relationships.
restore anatomical relationships. or relative stability, as required
lute or relative stability, as by
the patient,
required by the
theinjury, and
patient, thetheinjury,
1 2 personality of the fracture.
and the personality of the
fracture.

Early,
Early,active
active mobilization Preservationof ofblood
bloodsupply
supply
Early
Early and
and safe
mobilization
safe mobilization
mobilization andand 4 3 Preservation
Preservationofofthe
Preservation theblood
bloodsupply
supply
rehabilitation
rehabilitation of the injured part
of the injured part to soft tissues and bone by
to soft tissues and bone by gentle
and
andthe
the patient
patient as
as aa whole.
whole. gentle reduction
reduction techniques
techniques and and
careful handling.
careful handling.

1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation.

3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; 1991.
1
2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management.
Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal
2nd ed. Stuttgart New York: Thieme; 2007.
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.
4    DePuy Synthes  3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique
Indications

The 3.5 mm LCP® Extra-articular Distal Humerus Plate

is indicated for fractures of the distal humerus.

3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique  DePuy Synthes    5

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.

6    DePuy Synthes  3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique

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).

3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique  DePuy Synthes    7

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.

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.

* Also available

8    DePuy Synthes  3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique

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

3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique  DePuy Synthes    9

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

11    DePuy Synthes  3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique
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.

3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique  DePuy Synthes    11

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.

11    DePuy Synthes  3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique
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.

3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique  DePuy Synthes    11

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.

11    DePuy Synthes  3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique
Screws Used with the 3.5 mm LCP Extra-articular Distal Humerus Plate
Stainless Steel and Titanium

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

3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique  DePuy Synthes    11

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

11    DePuy Synthes  3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique
312.648 2.8 mm Threaded Drill Guide

314.02 Small Hexagonal Screwdriver with

Holding Sleeve

314.03 Small Hexagonal Screwdriver Shaft,

quick coupling

314.115 StarDrive Screwdriver, T15

314.116 StarDrive Screwdriver Shaft, T15,

quick coupling

319.01 Depth Gauge, for small screws

323.023 1.6 mm Wire Sleeve

3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique  DePuy Synthes    11

Selected Instruments from the Small Fragment LCP Instrument and Implant Sets
Stainless Steel (105.434) and Titanium (145.434) continued

323.025 Direct Measuring Device

323.36 3.5 mm Universal Drill Guide

324.024 Push-Pull Reduction Device

324.031 Threaded Plate Holder, long, for 3.5 mm

locking hole

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

* Also available

11    DePuy Synthes  3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique
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.

3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique  DePuy Synthes    11

Also Available

Sets
01.104.000 3.5 mm LCP Elbow System
01.104.004 3.5 mm LCP Titanium Elbow System

Instruments
03.122.001 2.8 mm LCP Drill Guide, long, for 3.5 mm
LCP plates
03.122.002 2.8 mm Drill Bit, quick coupling, 248 mm,
95 mm calibration
329.02 Bending Iron, for 4.5 mm plates (2 required)
329.30 Plate-Bending Press
398.81 Self-Centering Bone Forceps, size 1, 240 mm
length, 14 mm, small serrated jaw, speed lock
399.121 Bone Holding Forceps, soft ratchet, for plates
to 14 mm wide
511.770 Torque Limiting Attachment, 1.5 Nm

22    DePuy Synthes  3.5 mm LCP® Extra-articular Distal Humerus Plate  Surgical Technique
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.

Manufactured or distributed by:

Synthes USA Products, LLC Synthes USA, LLC
1302 Wrights Lane East 1101 Synthes Avenue
West Chester, PA 19380 Monument, CO 80132

To order (USA): 800-523-0322

To order (Canada): 855-946-8999

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

www.depuysynthes.com

© DePuy Synthes 2009–2017. All rights reserved.

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