3.5 Mm LCP Proximal Humerus Plate

3.5 mmLCP ProximalHumerus Plate Stainless Steel and TitaniumTECHNIQUE GUIDEPart of the SynthesSmall FragmentLCP SystemOriginal Instruments and Implants of the Associationfor the Study of Internal Fixation — AO ASIF

The 3.5 mm LCP Proximal Humerus Plate The 3.5 mm LCP Proximal Humerus Plate is part of the SmallFragment LCP System. This plate addresses complex fracturesof the proximal humerus.IndicationsThe 3.5 mm LCP Proximal Humerus Plate is indicated for fracturesand fracture dislocations, osteotomies and nonunions of the proximalhumerus, particularly for patients with osteopenic bone.Preoperative X-ray of a proximalhumerus fracturePostoperative X-ray of a proximalhumerus fracture treated with the3.5 mm LCP Proximal Humerus PlateNote: For information on fixation principles using conventionaland locked plating techniques, please refer to the Small FragmentLocking Compression (LCP ) Technique Guide.

FeaturesSuture holes Anatomically-shapedInsertionGuide holes Ten suture holes around the perimeter of the proximal endProximal locking holes accept 3.5 mm LockingScrewsLocked construct in humeral head (levels A–E)Distal shaft consists of three or five lockingcompression holes in the shaft, including oneelongated hole to aid in plate positioning. Theseholes accept 3.5 mm Locking Screws in thethreaded portion, and 3.5 mm Cortex Screws,4.0 mm Cortex Screws, and 4.0 mm CancellousBone Screws in the compression portion.Available in stainless steel and titaniumABCDEFProximal locking holes Provide flexibility in screw placement, allowingfor different constructs Permit multiple points of fixation to supportthe humeral headA, C, D and E levelscrews for a “diverging”screw patternA, B, and D level screwsfor a “converging”screw patternClinical exampleusing A, B, C, andE level screws1

Surgical Technique1Patient positionA beach-chair position is recommended to provide easyaccess to the shoulder with imaging equipment.2ApproachA deltopectoral approach is suggested. Care should betaken to avoid damaging the vasculature of the fragments.Note: For information on open reductionapproaches for proximal humerus, please referto T.P. Rüedi and W.M. Murphy: AO Principlesof Fracture Management. Stuttgart, New York;Thieme, 2000, pp. 274-277.A deltopectoral approach is suggested.2

3Reduce the fractureReduce the fracture fragments and confirm the reduction underimage intensification.The humeral head and tuberosity fragments may be manipulatedand provisionally fixed with sutures and/or Kirschner wires.However, K-wires should be placed where they will not interferewith plate application.Note: The locking screws do not provide any compression for a lagscrew effect. Therefore, humeral head fragments must be reduced, andany desired interfragmentary compression must be obtained prior toapplying the 3.5 mm LCP Proximal Humerus Plate with locking screws.Insertion Guide: top view (left) andbottom view (right).4Attach the Insertion Guide [323.050] to the plate toinsert the proximal locking screws.Attach the insertion guide to the plateTo facilitate insertion of the proximal locking screws,place the Insertion Guide [323.050] against the plateand tighten the guide’s attachment screw with theSmall Hexagonal Screwdriver [314.02], to lock theguide against the plate.Note: The stability of the construct can be increasedby the insertion of sutures. If sutures are to be usedin conjunction with the plate, they should be passedthrough the plate prior to attaching the insertion guide.Lock the Insertion Guide to the plate by tighteningthe attachment screw with the Small HexagonalScrewdriver [314.02].3

Surgical Technique (continued)5Apply plate to bonePositioning from AP viewThe plate should be placed approximately 8 mmdistal to the rotator cuff attachment on the upperedge of the greater tuberosity. Care should be takento avoid placing the plate too high because thiscould increase the risk of subacromial impingement.However, care should also be taken to avoid placing the plate too low which could prevent optimalscrew placement in the humeral head.SuturesDetermine plate position by placing a 1.6 mm K-wirethrough the proximal guide hole of the insertionguide so that the K-wire rests on top of the humeralhead and aims at the proximal joint surface.Positioning from a lateral viewThe plate should be centered against the lateralaspect of the greater tuberosity, ensuring that asufficient gap is maintained between the plate andthe long biceps tendon (arterial blood supply).To check the placement of the plate, 1.6 mm K-wiresand two sleeve assemblies [323.053, 323.054, and323.055] can be used: one in the hole for the mostproximal screw to be placed and one in the holefor the most distal screw to be placed in the humeralhead. If possible, the distal K-wire should bepositioned approximately 5 mm above the calcar.The plate should becentered against thelateral aspect of thegreater tuberosity(sutures have beenomitted for clarity).Note: To maintain proper alignment between theinsertion guide and the plate, intraoperative bendingof the plate is not recommended.Check placement of plate by inserting a K-wireand sleeve assembly as shown.4

6Insert screwsThe placement of the initial screw will dependon the fracture type and the reduction achieved.There are two options for the order of screwinsertion:ABCDOption 1: Insertion of a proximal screw firstEThis technique permits fixation of the proximalfragments first and then fixation with or withoutcompression distally.FIt is necessary to control the height of the platein the AP view under image intensificationbefore insertion of the screws.Option 2: Insertion of a distal screw firstThis technique permits reduction of the distalshaft fragment against the plate and a final heightadjustment prior to the insertion of the otherscrews in the shaft.Insert a standard cortex screw into the compression portion of hole F (elongated hole); theninsert proximal locking screws.5

Surgical Technique (continued)6Insert screws (continued)Proximal locking screw insertionInsert the 3.5 mm Locking Screw Sleeve [323.053], the2.8 mm Drill Sleeve [323.054], and the 1.6 mm WireSleeve [323.055] into the Insertion Guide [323.050].Insert a 1.6 mm K-Wire, 150 mm [292.71] through thesleeve assembly. Stop when increased resistance fromthe subchondral bone is felt. Since it may not alwaysbe possible to feel this resistance, the use of imageintensification is recommended.323.053323.054323.055Sleeve assemblyNote: The K-wire tip should come as close as possibleto the subchondral bone, approximately 5–8 mm fromthe joint surface.Slide the Direct Measuring Device [323.025] overthe K-wire and push it against the sleeve assembly.Note: All three sleeves must be present. The DirectMeasuring Device provides an approximate screw length.Important: When selecting the appropriate screw length,the possibility of bone resorption at the fracture site mustbe taken into account. Care should be taken to ensurethat the screw tip is a sufficient distance from the jointsurface. Check that the plate supports the lateral aspectof the greater tuberosity.Measure screw length by sliding the DirectMeasuring Device [323.025] over the K-wire.Remove the K-wire and the K-wire centering sleeve.Drill the near cortex with the 2.8 mm Drill Bit[310.288] through the Drill Sleeve. Remove theDrill Sleeve.Drill the near cortex with the 2.8 mm Drill Bit[310.288] through the drill sleeve.6

Insert the appropriate length locking screwthrough the 3.5 mm Locking Screw Sleeve.Use the StarDrive Screwdriver, T15, [314.115] toinsert the locking screw through the 3.5 mmLocking Screw Sleeve [323.053].Note: The Depth Gauge for 2.7 mm and smallscrews [319.01] may also be used to determinescrew length. This depth gauge will give an approximate measurement for the proximal screws whenused through the Insertion Guide and will givean approximate measurement for the distal screwswhen placed against the plate. To ensure thatthe screw tip is a sufficient distance from the jointsurface, 10 mm should be deducted from depthgauge readings for the proximal screw.Alternatively, screw length can be measuredusing the Depth Gauge for 2.7 mm and smallscrews [319.01].7

Surgical Technique (continued)6Insert screws (continued)Distal locking screw insertionFor proper drilling of the shaft holes, the 2.8 mmThreaded Drill Guide [312.648] must be used.Thread the Drill Guide into the threaded partof the shaft holes.Drill with the 2.8 mm Drill Bit and remove theDrill Guide.Measure screw length with the Depth Gauge [319.01].Use the 2.8 Threaded Drill Guide when drillingholes for the 3.5 mm locking screws in the shaftholes of the plate.Note: For more stable fixation, insertion of the lockingscrew through both cortices is recommended.Distal standard screw insertionFor nonlocking screws, use the standard AO screwinsertion technique.7Remove Insertion Guide8Implant removalTo remove locking screws, unlock all screws from theplate, then remove the screws completely from thebone. This prevents simultaneous rotation of the platewhen removing the last locking screw.Final construct8

Product Information3.5 mm LCP Proximal Humerus PlatesMust be used with a Synthes Small Fragment LCP Instrument and Implant Set [105.434] or [145.434].Implants241.901241.9033.5 mm LCP Proximal Humerus Plate–standard, 3 hole shaft, 90 mm3.5 mm LCP Proximal Humerus Plate–standard, 5 hole shaft, 114 mm441.901441.9033.5 mm Titanium LCP Proximal Humerus Plate–standard, 3 hole shaft, 90 mm3.5 mm Titanium LCP Proximal Humerus Plate–standard, 5 hole shaft, 114 mmInstruments323.050323.053323.054323.055Insertion Guide3.5 mm Locking Screw Sleeve2.8 mm Drill Sleeve1.6 mm Wire quired Set105.434145.434Small Fragment LCP Instrument and Implant SetorSmall Fragment LCP Instrument and Titanium Implant Set

SYNTHES (USA)1690 Russell RoadPaoli, PA 19301- 1262Telephone: (610 ) 647- 9700Fax: (610 ) 251- 9056To order: (800 ) 523 -0322SYNTHES (CANADA) LTD.2566 Meadowpine BoulevardMississauga, Ontario L5N 6P9Telephone: (905) 567-0440Fax: (905) 567-3185To order: (800) 668-1119Original Instruments and Implants of the Associationfor the Study of Internal Fixation — AO ASIF 2002 SYNTHES (USA)DCP, LC-DCP, LCP, SYNTHES and ASIF are registered trademarks of SYNTHES (USA) and SYNTHES AG Chur.Printed in U.S.A. GP2067-D Rev. 6/04 J4029-D

Must be used with a Synthes Small Fragment LCP Instrument and Implant Set [105.434] or [145.434]. 323.050 323.053 323.054 323.055 241.901 241.903 Product Information Required Set 105.434 Small Fragment LCP Instrument and Implant Set or 145.434 Small Fragment LCP Instrument and Titanium Implant Set