skeletal dynamics DISTAL ELBOW SET Manual de usuario
As described by:
Jorge L. Orbay, M.D.
Miami Hand & Upper
Extremity Institute
Miami, Florida
SURGICAL TECHNIQUE GUIDE
DISTAL ELBOW SET
proximal ulna plate
Indications for Use
The proximal ulna plates are intended for xation of fractures, fusions, osteotomies
and non unions of the ulna, particulary in osteopenic bone.
Please refer to the Distal Elbow Plating Set Instructions for Use to review the warnings, precautions and contraindications for this system.
DISTAL ELBOW SET
proximal ulna plate
1
2
SUPERFICIAL EXPOSURE
Locate the ulnar nerve.
Release and protect the
nerve, considering the
possibility of transposition.
With the elbow exed 900,
make a posterior incision
extending distally, curving
around the olecranon and
over the subcutaneous
border of the ulna.
NOTE:
The incision can be curved
slightly lateral or medial to
the tip of the olecranon
based on your preferred
method.
Warning:
Take care to avoid injury to
the ulnar nerve.
DISTAL ELBOW SET
proximal ulna plate
RELEASING THE ULNAR NERVE
4
3 DEEP EXPOSURE
ACCESSING THE JOINT
Expose the proximal ulna
sub-periosteally.
For olecranon fractures,
enter the joint through the
fracture plane by releasing
the capsular attachments
on the proximal fragment as
needed.
The articular surfaces can be
evaluated at this time.
5
6
Debride the fracture site.
NOTE:
It is necessary to remove
callus, clot and brous tissue
in order to achieve a proper
reduction.
DEBRIDING THE FRACTURE
DISTAL TRICEPS RELEASE
Starting distal to proximal,
split the triceps insertion
longitudinally for approximately
1 cm.
Elevate the triceps along a
narrow longitudinal strip to
provide space for the “Home
Run” (HR) tab.
7
8
PLATE SELECTION
PROVISIONAL PLATE FIXATION
Select the appropriate
length of plate that provides
at least six cortices of xation
distal to the fracture line.
NOTE:
The shaft of the 151mm
length plate can be bent
using the Bending Irons. If
plate bending is necessary,
please refer to step 29 in this
surgical technique guide.
WARNING:
Bending may weaken or
break the plate. Be sure
to inspect the plate for
damage prior to use.
Apply the plate to the
proximal fragment conrming
that the plate is centered on
the unla shaft and that the HR
tab is ush to the olecranon.
Secure the plate to the
proximal fragment using a
2mm K-wire through the hole
at the base of the HR tab.
K-wire, 2.0mm
9
10
FRACTURE REDUCTION
Reduce the fracture by
levering the shaft of the
plate to the distal fragment.
Conrm fracture reduction
and plate alignment using
uoroscopy.
DISTAL FRAGMENT FIXATION
Using the 2.7mm x 40mm bit,
drill bicortical through the
distal end of an oblong hole
that is distal to the fracture
line. This will allow for dynamic
compression of the fracture.
Measure screw length using
the appropriate scale on the
50mm Depth Gauge, then
insert a 3.5mm compression
screw (PANL series) using the
T-10 Driver while applying
interfragmentary compression.
NOTE:
The depth gauge has a dual
scale to reect measurements
through the PDG’s (top scale)
or directly through the plate
(bottom scale).
Drill, 2.7mm x 40mm Compression
Screw
(3.5mm PANL)
Driver, T-10
Depth Gauge, 50mm
11
12
PROXIMAL FIXATION OPTIONS
The two proximal holes
containing PDG’s are for
xation to the olecranon (A).
The adjacent two distal holes
containing PDG’s are for
xation to the coronoid (B).
All of the PDG’s can accept
an A.I.M.ing Guide 2.0 (C) if
provisional K-wire xation is
necessary using 2.0mm K-wires.
If it is necessary to vary a screw
trajectory, remove the PDG
and drill free-hand. A tissue
protector is provided in the
system.
If a 3.0mm Cannulated
Polyaxial Locking Screw (PLS)
is needed, please refer to steps
22 through 25 in this surgical
technique guide.
PROVISIONAL K-WIRE FIXATION
A B
C
Tissue Protector
A.I.M.ing Guide, 2.0mm
K-wire, 2.0mm
If provisional plate xation is
needed, insert an A.I.M.ing
Guide 2.0 into the desired
PDG, then drive a 2.0mm
K-wire through the A.I.M.ing
Guide taking care to avoid
the articular surfaces of the
joint.
Using the 2.7mm bit, drill
through the PDG. If a K-wire
obstructs drilling, bend it out
of the way.
13
14
FLUOROSCOPIC CONFIRMATION
Repeat steps 12 and 13 for
the remaining olecranon
screw hole using a 3.5mm
Multi-Thread Locking Screw.
Conrm proper plate
positioning, fracture
reduction and screw lengths
using uoroscopic imaging.
OLECRANON FIXATION
Measure the screw length
using the appropriate scale
on the 50mm Depth Gauge.
Using the T-10 Driver, remove
the PDG and insert the
correct length 3.5mm Multi-
Thread Compression Screw
until the screw head contacts
the plate.
Remove the 2.0mm K-wire at
the base of the HR tab, then
fully seat the Compression
Screw until the plate is
reduced to the olecranon.
NOTE:
It is recommended to
subtract ~ 2mm from the
measured screw lengths to
avoid compromising the
articular surfaces and/or soft
tissue irritation.
Multi-Thread Compression Screw
Multi-Thread Locking Screw
15
16
PREPARING THE HOME RUN TAB
Conrm that the HR tab is ush
to the tip of the olecranon. If
necessary, you can bend the
tab as described in step 30 of
this surgical technique guide.
Using the 2.7mm x 80mm
bit, drill through the PDG,
then measure and record
the screw length using the
appropriate scale on the
80mm Depth Gauge.
NOTE:
If the HR tab was bent,
conrm that the new
trajectory will avoid contact
with the articular surfaces of
the joint.
WARNING:
Bending may weaken or
break the tab. Be sure to
inspect the tab for damage
prior to use.
OVERDRILLING THE HOME RUN TAB
Using the T-10 driver, remove
the PDG in the HR tab.
Drill up to the fracture
line using the 3.5mm bit.
Fluoroscopic imaging is
helpful during this step.
Drill, 3.5mm x 70mm
Drill, 2.7mm x 80mm
Depth Gauge, 80mm
