distal medial humeral locking plate - double medical medial... · position the plate on the medial...

Distal Medial Humeral Locking Plate

990210005

Distal Medial Humeral Locking Plate Distal Medial Humeral Locking Plate

INDEX

Warning

Caution

This publication describes the recommended procedures for using Double Engine devices and instruments. It offers guidance that you should pay attention to. But as with any such technical guide, the guide alone does not provide sufficient background for direct use of the instrument set, each surgeon should also consider the particular needs of each patient and make appropriate adjustments when required. Instruction by experienced surgeon is still highly recommended.

All non-sterile devices must be cleaned and sterilized before use. Multi-component instruments must be disassembled for cleaning. Please follow the instructions provided in our Reprocessing, Care and Maintenance Guide (RCMG-2012).

Please refer to Package Insert for a complete list of potential adverse effects, contraindications, warnings and precautions. The surgeon must discuss all relevant risks, including the finite lifetime of the device, with the patient, when necessary.

The implants are designed for temporary fixation of fractured bone fragments until the bone heals. Therefore, if bone does not heal or bone consolidation is delayed or not sufficient, the system may break. Post-operative care under the guidance of the surgeon is also very important and it must be to ensure the promotion of bone consolidation.

Indications

Patient Position

Surgical Technique

– Step 1 Approach and Reduction

– Step 2 Plate Length Determination

– Step 3 Plate Placement

– Step 4 Drilling

– Step 5 Depth Determination

– Step 6 Locking Screw Insertion

– Step 7 Final Locking


It is recommended to choose a lateral decubitus position. For severe C3 fracture, position the patient fully prone on the operation table if the patient is fit. Rest the arm on a padded bar allowing elbow flexion of 120°.

Patient Position

3 4

Surgical Technique

STEP 1APPROACH AND REDUCTION

Make a slightly curved posterior incision just radial to the Olecranon. Identify the ulnar nerve and it may need to be either isolated or elevated at the ulnar epicondyle.

For C-type fractures, make reduction for the articular fragments of the distal block under image intensification and use guide wire and/or reduction forceps with points to perform temporary fixation. Provisionally fix the distal block to the shaft using guide wire and/or forceps so as to restore the anatomy of the distal humerus. The subsequent plate placement should not be affected by hindrance of the guide wire or forceps.

STEP 2PLATE LENGTH DETERMINE

STEP 3PLATE PLACEMENT

STEP 4DRILLING

In order to provide sufficient fixation proximal to the fractutre lines, take care in selecting the plate length. It is recommended that medial and lateral plates are not the same length in order to prevent extensive diaphyseal stress. For example, use a 5-hole medial plate with a 7-hole lateral plate.

Important: To achieve sufficient stability for early mobilization, use the medial and lateral plates at the same time. Two-plate fixation for distal humeral fracture can provide stronger stability.

110040500 Drill Bit, φ2.5110040300 Drill Sleeve, for drill bit

Screw the drill sleeve, for drill bit into the threaded hole of the plate. Insert the drill bit through drill sleeve to predrill the bone.

Indications Distal medial humeral fracture

110040600 Bending Iron, left110041800 Bending Iron, right110041600 Drill Sleeve, for Guide Wire, φ1.5110040100 Guide Wire, φ1.5

Use bending irons to bend the plate if necessary. But bending should be limited to the region of the combi-holes and avoid the plate back and forth.

Position the plate on the medial part of distal humerus. Screw the drill sleeve, for guide wire into the threaded hole of the plate. Insert the guide wire through the drill sleeve so as to fix the plate temporarily.

nerveRadialnerve

Radial

Ulnar

Incisionsite

nerve

Ulnarnerve


STEP 5DEPTH DETERMINATION

STEP 6LOCKING SCREW INSERTION

STEP 7FINAL LOCKING

DOUBLE MEDICAL DOUBLE MEDICAL

5 6

110040800 Torque Indicating Screwdriver, 1.5Nm

After screw insertion final tighten by using torque indicating screwdriver, always check that the screws are fully tightened by hand.

Note: Confirm screw placement and length with image intensification during movement of the elbow to ensure screws are not exiting in the joint.

110040400 Depth Gauge for Locking Screws

Check the depth of the drill bit under image intensification.

110040900 Screwdriver, hexagonal, φ2.5

Select and insert the appropriate 3.5mm cortex screw using the screwdriver, hexagonal, φ2.5.

Note: Once locking screws are inserted, further reduction is not possible without loosening the locking screws.

For cortex screw, use the 2.5mm drill bit through the double drill guide, φ2.5/φ3.5 to predrill the bone. To obtain compression, place the drill guide at the end of the nonthreaded hole away from the fracture. And importantly, the procedures must be operated before the locking screw insertion.

Instruments 110580000

110040100 Guide Wire, φ1.5, length 150mm

110040200 Drill Bit, φ2.8

110040300 Drill Sleeve for Drill Bits, φ2.8

110040400 Depth Gauge for Locking Screws

110040500 Drill Bit, φ2.5

110040600 Bending Iron, left

110040700 Tap for Cortex Screws φ3.5

110040800 Torque Indicating Screwdriver, 1.5Nm



7 8

110040900 Screwdriver, hexagonal, φ2.5

110041000 Holding Sleeve

110041100 Double Drill Guide, φ2.5/φ3.5

110041200 Extraction Screw for Screws, φ2.5

110041300 Broken Screw Extractor

110041400 T-Handle with Quick Coupling

110041500 Screw Forceps, self-holding

110041600 Drill Sleeve, for Guide Wire φ1.5, short

110041700 Screwdriver Shaft, hexagonal, φ2.5

110041800 Bending Iron, right

110041900 Reduction Forceps with Points

110042000 Bone Holding Forceps, self-centering

110042100 Periosteal Elevator, round edge

110042200 Periosteal Elevator, straight

110042300 Bone Lever, small



9 10

110042400 Bone Lever, large

110042500 Holding Sleeve for Torque Indicating Screwdriver

110580001 Instrument Case

distal medial humeral locking plate - double medical medial... · position the plate on the medial...

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