Part of the Synthes Locking Compression Plate (LCP ...

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

3.5 mm LCP® Clavicle Hook PlatesSurgical Technique

3.5 mm LCP® Clavicle Hook Plates Surgical Technique DePuy Synthes 1

Introduction

Surgical Technique

Product Information

Table of Contents

3.5 mm LCP Clavicle Hook Plates 2

AO Principles 4

Indications 5

Lateral Clavicle Fractures 6

Dislocation of the Acromioclavicular Joint 13

Implant Removal 20

Implants 21

Set List 22

Image intensifier control

MR Information The 3.5 mm LCP Clavicle Hook Plates have 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 Clavicle Hook Plates in the MR environment is unknown. Scanning a patient who has this device may result in patient injury.

2 DePuy Synthes 3.5 mm LCP® Clavicle Hook Plates Surgical Technique

3.5 mm LCP Clavicle Hook Plates

The 3.5 mm LCP® Clavicle Hook Plate provides fixation for lateral clavicle fractures and for acromioclavicular joint injuries.

12º bend in shaft eases implant placementUndercuts in shaft reduce

impairment of blood supply

Anatomically precontouredThe plate facilitates optimal implant placement and surgery to provide an improved outcome.

Rounded shaft profile helps minimize the risk of soft tissue irritation between the plate and surrounding soft tissue, the acromioclavicular joint and the rotator cuff

Lateral clavicle fracture Acromioclavicular joint dislocation


Intraoperative choice of hook size– 6 sizing templates help in selection

of the proper hook size

Locking compression plate (LCP Plates) – Locking screws provide ability

to create a fixed-angle construct while utilizing familiar AO plating techniques

– Reduced impairment of periosteal blood supply due to the limited plate contact

– Fixed-angle construct provides advantages in osteopenic bone or multifragmentary fractures where traditional screw purchase is compromised

Optimized implant selection– Left and right plates

– 4, 5, 6 and 7 hole plates

– 3 hook depths: 12 mm, 15 mm and 18 mm

– Stainless steel and titanium

Combi hole– Intraoperative choice between

compression and angular stable locking

– With standard screws: interfragment or dynamic-axial compression

– With locking screws: stable plate-screw connection without loss of reduction, regardless of plate modeling

3 different hook depths12 mm, 15 mm and 18 mm

Smooth hook design and posterior hook offset

3.5 mm LCP Clavicle Hook Plates


AO Principles

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4_Priciples_03.pdf 1 05.07.12 12:08

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique

AO PRINCIPLES

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

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

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing abso-lute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

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

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixatioFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.

1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; 1991.

2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart New York: Thieme; 2007.


Indications

Fixation of lateral clavicle fractures and dislocations of the acromioclavicular joint.


Lateral Clavicle Fractures

1Position the patient

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

Place the patient in the beach-chair position and tilt the head away from the affected side. Use a sandbag under the thoracic spine to allow the scapula to fall backward. This aids in realignment and reduction of the fracture and assists regaining length. Excessive extension of the neck should be avoided.

Note: For information on fixation principles using conventional and locked plating techniques, please refer to the Small Fragment Locking Compression Plate (LCP) Technique Guide.


2Approach

If image intensification is to be used, determine that access for the C-arm is sufficient for the anteroposterior and cephalic tilt views.

Through either a superior or transacromial incision, expose the deltotrapezial fascia. Take care to avoid injury to the lateral supraclavicular nerves.

3Reduce the fracture and provide temporary fixation

Perform temporary fixation of the fracture with Kirschner wires or pointed reduction forceps.

Identify the posterior aspect of the acromioclavicular joint capsule. Perform a 5 mm detachment of the extracapsular fibers of the trapezius from the medial border of the acromion, to allow passage of the hook of the plate under the acromion.



4Determine hook size and plate length

Instruments

329.930 Sizing Template for LCP Clavicle Hook Plate, 12 mm hook depth, left

329.931 Sizing Template for LCP Clavicle Hook Plate, 12 mm hook depth, right





Sizing templates aid in determining the appropriate hook size. To determine hook size, start by passing the 12 mm hook sizing template under the acromion. Place the shaft of the sizing template onto the superior aspect of the clavicle. If it is difficult to lower the shaft onto the reduced clavicle, try the 15 mm hook template or the 18 mm hook template. After determining the correct size, choose the appropriate implant. Once the plate shaft is placed on the clavicle, the end of the hook should be in contact with the underside of the acromion.

Confirm that the correct anatomic alignment of the clavicle and acromion has been restored without impinging on the rotator cuff. Use the C-arm to verify that full shoulder motion, particularly in abduction and external rotation, can be achieved without the hook impinging on the humeral head. The plate length must be appropriate for fixation on the medial side of the fracture. Check plate positioning with AP and axial C-arm views.

Note: Do not bend or implant the sizing templates.



5Adapt plate to the patient’s anatomy (optional)

Optional instruments

329.04 Bending Iron, for 2.7 mm and 3.5 mm plates and 329.05

329.15 Bending Pliers, for 2.7 mm and 3.5 mm plates

Note: Since the plate shaft is anatomically precontoured (12°), bending or twisting of the plate is not generally necessary, but may be needed in some cases.

Contour the plate using the appropriate bending instruments. The Combi holes should not be deformed excessively during bending, as this may interfere with the insertion of locking screws. If possible, bend the plate between the Combi holes.

Precautions: – The Combi holes should not be deformed excessively during bending, as this may hinder the subsequent insertion of

locking screws. If possible, bend the plate between the Combi holes.

– Do not bend the shaft between the holes more than 20 to 25°.

– Do not bend the hook more than 10 to 15°. – Do not bend the plate and hook back and forth. – Take care that the plate surface does not get scratched. – Sharp edges can irritate soft tissue.



6Fix the plate temporarily

Instruments

292.71 1.6 mm Kirschner Wire with Thread

323.054 2.8 mm Drill Sleeve

323.055 1.6 mm Wire Sleeve

Position the implant and confirm the correct plate position under the image intensifier, using a K-wire for temporary fixation. Drill the K-wire through the drill sleeve in the distal hole to fix the distal part of the plate.

By aligning the medial and lateral fracture fragments with the plate using reduction forceps, indirect reduction and definitive fixation can be performed.



7Screw insertion

Instruments

310.25 2.5 mm Drill Bit, quick coupling, gold, 110 mm

310.35 3.5 mm Drill Bit, quick coupling, 110 mm

311.43 Handle, with quick coupling, small

314.02 Small Hexagonal Screwdriver with Holding Sleeve

or314.03 Small Hexagonal Screwdriver Shaft

319.01 Depth Gauge, for 2.7 mm and smaller screws

323.36 3.5 mm Universal Drill Guide

Determine whether cortex screws, locking screws, or a combination of both will be used.

Note: When treating lateral clavicle fractures, it is recommended to begin fixation in the most lateral hole with a 3.5 mm locking screw or 3.5 mm cortex screw.

Fixation with 3.5 mm cortex screwsUse the 2.5 mm drill bit through the 3.5 mm drill guide to drill for the threaded hole and the 3.5 mm drill bit to drill for the gliding hole.

Determine the required length of the cortex screw with the depth gauge.

Insert the self-tapping 3.5 mm cortex screw using the small hexagonal screwdriver shaft connected to a power tool, or use the small hexagonal screwdriver with holding sleeve.

Note: The screw length should be carefully observed in order to avoid neurovascular injuries.



7Screw insertion continued

Instruments



312.648 2.8 mm Threaded Drill Guide

314.116 StarDrive Screwdriver Shaft, quick coupling, T15

319.01 Depth Gauge, for 2.7 mm and small screws

511.773 Torque Limiting Attachment, 1.5 Nm

Fixation with 3.5 mm locking screws Carefully screw the 2.8 mm threaded drill guide into a threaded hole of the plate.

Use a 2.8 mm drill bit to predrill the screw hole through both cortices. Use the depth gauge to check the length of screw.

Insert the locking screw using the StarDrive™ Screwdriver Shaft manually, or under power with the torque limiting attachment (TLA). When using power, reduce speed when tightening the head of the screw into the plate, and insert until a click is heard.

Repeat the procedure until all predetermined holes are used. Perform a final check to confirm all screws are locked.

It is recommended that final tightening is done manually.

Precaution: Always use a TLA when using power to fully insert screws.

Notes:– Do not mix titanium and stainless steel implants.– To ensure a stable fixation of the implant, use at least

two screws in the medial part of the plate. One or two screws can be used to fix the lateral fragments.

– The screw length should be carefully observed in order to avoid neurovascular injuries.



Dislocation of the Acromioclavicular Joint

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

1Position the patient

Place the patient in the beach-chair position and tilt the head away from the affected side. Use a sandbag under the thoracic spine to allow the scapula to fall backward. This aids in realignment and reduction of the fracture and assists regaining length. Excessive extension of the neck should be avoided.

Note: For information on fixation principles using conventional and locked plating techniques, please refer to the Small Fragment Locking Compression Plate (LCP) Technique Guide.



2Approach

If image intensification is to be used, determine that access for the C-arm is sufficient for the anteroposterior and cephalic tilt views.

Through either a superior or transacromial incision, expose the deltotrapezial fascia. Take care to avoid injury to the lateral supraclavicular nerves.

3Reduce the dislocation and provide temporary fixation

Elevate the arm and scapula toward the clavicle. Reduce the acromion to the clavicle in the horizontal and vertical planes. Temporary fixation may be achieved by a transacromial K-wire passed into the distal clavicle.

Identify the posterior aspect of the acromioclavicular joint capsule. Perform a 5 mm detachment of the extracapsular fibers of the trapezius from the medial border of the acromion, to allow passage of the hook of the plate under the acromion.


4Determine hook size and plate length

Instruments







Sizing templates aid in determining the appropriate hook size. To determine hook size, start by passing the 12 mm hook sizing template under the acromion. Place the shaft of the sizing template onto the superior aspect of the clavicle. If it is difficult to lower the shaft onto the reduced clavicle, try the 15 mm hook template or the 18 mm hook template. After determining the correct size, choose the appropriate implant. Once the plate shaft is placed on the clavicle, the end of the hook should be in contact with the underside of the acromion.

Confirm that the correct anatomic alignment of the clavicle and acromion has been restored without impinging on the rotator cuff. Use the C-arm to verify that full shoulder motion, particularly in abduction and external rotation, can be achieved without the hook impinging on the humeral head. The plate length must be appropriate for fixation on the medial side of the fracture. Check plate positioning with AP and axial C-arm views.

Note: Do not bend or implant the sizing templates.



5Adapt plate to the patient’s anatomy (optional)

Optional instruments

329.04 Bending Iron, for 2.7 mm and 3.5 mm plates and 329.05

329.15 Bending Pliers, for 2.7 mm and 3.5 mm plates

Note: Since the plate shaft is anatomically precontoured (12°), bending or twisting of the plate is not generally necessary, but may be needed in some cases.

Contour the plate using the appropriate bending instruments. The Combi holes should not be deformed excessively during bending, as this may interfere with the insertion of locking screws. If possible, bend the plate between the Combi holes.

Precautions: – The Combi-holes should not be deformed excessively during

bending, as this may hinder the subsequent insertion of locking screws. If possible, bend the plate between the Combi holes.

– Do not bend the shaft between the holes more than 20 to 25°.

– Do not bend the hook more than 10 to 15°. – Do not bend the plate and hook back and forth. – Take care that the plate surface does not get scratched. – Sharp edges can irritate soft tissue.



6Fix the plate temporarily

Instruments

292.71 1.6 mm Kirschner Wire with Thread

323.054 2.8 mm Drill Sleeve

323.055 1.6 mm Wire Sleeve

Position the implant and confirm the correct plate position under the image intensifier, using a K-wire for temporary fixation. Drill the K-wire through the wire sleeve in the distal hole to fix the distal part of the plate.



7Screw insertion

Instruments

310.25 2.5 mm Drill Bit, quick coupling, gold, 110 mm



314.02 Small Hexagonal Screwdriver with Holding Sleeve

or314.03 Small Hexagonal Screwdriver Shaft

319.01 Depth Gauge, for 2.7 mm and smaller screws

323.36 3.5 mm Universal Drill Guide

Determine whether cortex screws, locking screws, or a combination of both will be used.

Fixation with 3.5 mm cortex screws Use the 2.5 mm drill bit through the 3.5 mm drill guide to drill for the threaded hole and the 3.5 mm drill bit to drill for the gliding hole.

Determine the required length of the cortex screw with the depth gauge.

Insert the self-tapping 3.5 mm cortex screw using the small hexagonal screwdriver shaft connected to a power tool, or use the small hexagonal screwdriver with holding sleeve.

Note: The screw length should be carefully observed in order to avoid neurovascular injuries.



Instruments

310.288 2. 8 mm Drill Bit, quick coupling, 165 mm


312.648 2.8 mm Threaded Drill Guide

314.116 StarDrive Screwdriver Shaft, quick coupling, T15

319.01 Depth Gauge, for 2.7 mm and small screws

511.773 Torque Limiting Attachment, 1.5 Nm

Fixation with 3.5 mm locking screws Carefully screw the 2.8 mm threaded drill guide into a threaded hole of the plate.

Use a 2.8 mm drill bit to predrill the screw hole through both cortices. Use the depth gauge to check the length of screw.

Insert the locking screw using the StarDrive Screwdriver Shaft manually, or under power with the torque limiting attachment (TLA). When using power, reduce speed when tightening the head of the screw into the plate, and insert until a click is heard.

Repeat the procedure until all predetermined shaft holes are used. Perform a final check to confirm all screws are locked.

It is recommended that final tightening is done manually.

Precaution: Always use a TLA when using power to fully insert screws.

Notes:– Do not mix titanium and stainless steel implants. – To ensure a stable fixation of the implant, use at least two

screws in the medial part of the plate. One or two screws can be used to fix the lateral fragments.

– The screw length should be carefully observed in order to avoid neurovascular injuries.



Implant Removal

Required instruments


314.03 Small Hexagonal Screwdriver Shaft

314.116 StarDrive Screwdriver Shaft, T15, quick coupling

Warning: It is recommended that the 3.5 mm LCP Clavicle Hook Plate is removed after healing to prevent potential irritation of the acromion or impinging on the rotator cuff.

Implant removal is usually done three months after implantation.

To remove the implants, unlock all locking screws before removing them completely. The plate may otherwise rotate while the last screw is being removed, causing soft tissue damage.


Implants

3.5 mm LCP Clavicle Hook PlatesAvailable in:– 4 lengths

– 3 hook sizes

– Left and right versions

– Stainless steel and titanium

– Sterile packed

Stainless Length* Hook depth Steel Titanium (mm) (mm)241.072S 441.072S 4 holes, right 70 12241.073S 441.073S 4 holes, left 70 12241.074S 441.074S 4 holes, right 70 15241.075S 441.075S 4 holes, left 70 15241.076S 441.076S 4 holes, right 70 18241.077S 441.077S 4 holes, left 70 18241.082S 441.082S 5 holes, right 85 12241.083S 441.083S 5 holes, left 85 12241.084S 441.084S 5 holes, right 85 15241.085S 441.085S 5 holes, left 85 15241.086S 441.086S 5 holes, right 85 18241.087S 441.087S 5 holes, left 85 18241.094S 441.094S 6 holes, right 99 15241.095S 441.095S 6 holes, left 99 15241.096S 441.096S 6 holes, right 99 18241.097S 441.097S 6 holes, left 99 18241.104S 441.104S 7 holes, right 112 15241.105S 441.105S 7 holes, left 112 15241.106S 441.106S 7 holes, right 112 18241.107S 441.107S 7 holes, left 112 18

3.5 mm Locking Screws, self tapping, with StarDrive Recess

212.101– 412.101– 10 mm–60 mm212.124 412.124

3.5 mm Cortex Screws, self-tapping

204.810– 404.810– 10 mm–50 mm

204.850 404.850

*Hook length of 26 mm is included in full length measurementNote: 3.5 mm locking screws are available in 316L stainless steel and titanium alloy (Ti-6Al-7Nb)


3.5 mm LCP Clavicle Hook Templates and Graphic Case Set (01.112.010)

Graphic Case 60.112.010 3.5 mm LCP Clavicle Hook Plate Graphic Case

InstrumentsSizing Templates for LCP Clavicle Hook Plate

329.930 12 mm, left329.931 12 mm, right329.932 15 mm, left329.933 15 mm, right329.934 18 mm, left329.935 18 mm, right

Required Set105.434 Small Fragment LCP Instrument and Implant

Set, with self-tapping screwsor

145.434 Small Fragment LCP Instrument and Titanium Implant Set, with self-tapping screws

Note: For additional information, please refer to the package insert or www.e-ifu.com.

For detailed cleaning and sterilization instructions, please refer to www.depuysynthes.com/hcp/cleaning-sterilization or sterilization instructions, if provided in the instructions for use.

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 technique guide 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.

© DePuy Synthes 2007–2021. All rights reserved. DSUS/TRM/1016/1127 Rev B 05/21 DV

Synthes USA, LLC 1101 Synthes AvenueMonument, CO 80132

Manufactured or distributed by:Synthes USA Products, LLC 1302 Wrights Lane EastWest Chester, PA 19380

To order (USA): 800-523-0322 To order (Canada): 844-243-4321

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

www.depuysynthes.com

Synthes GmbHLuzernstrasse 214528 Zuchwil, Switzerland

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