AAP LOQTEQ Distal Dorsolateral Humerus Plate 2.7/3.5, LOQTEQ Olecranon Plate 2.7/3.5, LOQTEQ Distal Medial Humerus Plate 2.7/3.5, LOQTEQ Elbow Plating System, LOQTEQ Distal Lateral Humerus Plate 2.7/3.5 User Manual

Elbow Plating System

Surgical Technique

Locking Compression Technology by aap

Elbow Plating System

Surgical Technique

1

Disclaimer

This surgical technique is exclusively intended for medical professionals, especially physicians, and the-

refore may not be regarded as a source of information for non-medical persons. The description of this

surgical technique does not constitute medical advice or medical recommendations nor does it convey

any diagnostic or therapeutic information on individual cases. Therefore, the attending physician is

fully responsible for providing medical advice to the patient and obtaining the informed consent of the

patient which this surgical technique does not supersede.

The description of this surgical technique has been compiled by medical experts and trained staff of

aap mplantate AG with utmost diligence and to the best of their knowledge. However, aap Implantate

AG excludes any liability for the completeness, accuracy, currentness, and quality of the information

as well as for material or immaterial damages arising from the use of this information.

Surgical Technique

2

Elbow Plating System

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Content

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

• Material . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

• Indications / Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

• Processing (Sterilization & Cleaning) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

• Features & Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Surgical Technique Distal Humerus Plates 2.7/3.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

• Preoperative planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

• Patient positioning

• Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

• Preparing the plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

• Reduction and primary fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

• Insertion of cortical screws (gold) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

• Insertion of locking screws (blue) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

• Insertion of locking compression screws (red) without compression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

• Insertion of the Distal Dorsolateral Humerus Plate, 90° plate configuration . . . . . . . . . . . . . . . . . . . . . . .18

• Insertion of the Distal Lateral Humerus Plate, 180° plate configuration . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Surgical Technique Olecranon Plate 2.7/ 3.5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

• Preoperative planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19

• Patient positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

• Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20

• Preparing the plate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

• Reduction and primary fixation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

• Insertion of cortical screws (gold) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

• Insertion of locking screws (blue) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

• Insertion of locking compression screws (red) without compression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Insertion of locking compression screws (red) with compression . . . . . . . . . . . . . . . . . .24

Explantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Assembly instructions aiming arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

Assembly instructions compression drill guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28

Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Case Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .34

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Pating System

3Surgical Technique

Introduction

The LOQTEQ® Elbow Plating System combines the advantages of angular stability with anatomically preformed plates for stable fixation of complex fractures of the distal humerus and the proximal ulna. When necessary, diaphyseal/ metaphyseal compression can be achieved using the gliding locking holes in the plate shaft.

The LOQTEQ® Elbow Plating System includes the following plates:

• LOQTEQ® Distal Dorsolateral Humerus Plate 2.7/3.5 • LOQTEQ® Distal Lateral Humerus Plate 2.7/3.5

• LOQTEQ® Distal Medial Humerus Plate 2.7/3.5 • LOQTEQ® Olecranon Plate 2.7/3.5

Material

The LOQTEQ® implants and instruments are manufactured using high-quality materials, which have been proven to be successful in medical technology for decades. The anatomical plates and bone screws are made of titanium alloy.

All materials employed comply with national and international standards. They are characterized by good biocompatibility, a high degree of safety against allergic reactions and good mechanical properties. LOQTEQ® implants show an excellent highly polished surface.

Indications/Contraindications

Indications LOQTEQ® Distal Humerus Plates

• Intra-articular fractures, supracondylar fractures, osteotomies and non-unions of the distal humerus.

LOQTEQ® Olecranon Plates

• Fixation of fractures, osteotomies and nonunions of the olecranon, particularly in osteopenic bone.

Contraindications

• Infection or inflammation (localized or systemic)

• Allergies against the implant material

• High anesthesia risk patients

• Severe soft tissue swelling impacting normal wound healing

• Insufficient soft tissue coverage

• Fractures in children and adolescents with epiphyseal plates not yet ossified

Processing (Sterilization & Cleaning)

The implants are supplied sterile and non-sterile.

Implants and instruments that are supplied in non-sterile condition must be sterilized before use. For this purpose, please refer to the Instructions for Use that are enclosed with the plates, instruments, and trays.

Do not use (sterile) implants from damaged or open inner packaging.

Surgical Technique

4

Elbow Plating System

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Introduction

Distal Medial Humerus Plate 2.7/3.5

Features & Benefits

• The anatomical plate design minimizes the need for intraoperative plate contouring

• All plate holes, with the exception of the oblong hole, are compatible with locking as well as

non-locking cortical screws

• Fitted, radiolucent aiming devices are designed for the safe placement of drill guides at a preset angle

• Minor contact undercuts may help to preserve the blood supply to the periosteum

• Available as left and right version

The flattened end of the

plate is designed for

tissue-conserving,

sub-muscular insertion

Gliding locking holes

in the shaft area allow

compression and

angular stability with

LOQTEQ® technology

The oblong hole allows

for easy adjustment

of the plate

Holes for K-wires for

temporary fixation of

bone fragments or of the

plate to the bone

•

• In combination with the

dorsolateral (90°) or the

lateral plate (180°) a very

•

stable support for the medial

condyle is possible, which

can allow early recovery for

the patient

• 2.7 mm screws as well

as offset holes in the

metaphyseal area of the

plate allow to catch even

very small fragments

•

Round locking holes in

the metaphyseal plate

area are suitable for

2.7 mm locking screws

(blue) as well as 2.5 mm

cortical screws (gold)

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

•

• 2.5 mm non-locking cortical

screws (gold) can angulate

in the plate hole

•

5Surgical Technique

Elbow Plating System

Introduction

Distal Dorsolateral Humerus Plate 2.7/3.5

Features & Benefits

• The anatomical plate design minimizes the need for intraoperative plate contouring

• All plate holes, with the exception of the oblong hole, are compatible with locking as well as

non-locking cortical screws

• Minor contact undercuts may help to preserve the blood supply to the periosteum

• Available as left and right version

The flattened end of the

plate is designed for

tissue-conserving,

sub-muscular insertion

Holes for K-wires for

temporary fixation of

bone fragments or of the

plate to the bone

Gliding locking holes

in the shaft area allow

compression and

angular stability with

LOQTEQ® technology

The oblong hole allows

for easy adjustment

of the plate

Round locking holes in

the metaphyseal plate

area are suitable for

2.7 mm locking screws

(blue) as well as 2.5 mm

cortical screws (gold)

•

• In combination with the

medial plate (90°) a very

stable support for the medial

•

condyle is possible, which

can allow early recovery for

the patient

• 2.7 mm screws as well

as offset holes in the

metaphyseal area of the

plate allow to even catch

very small fragments

• 2.5 mm non-locking cortical

screws (gold) can angulate

in the plate hole

•

Surgical Technique

6

Elbow Plating System

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Introduction

Distal Lateral Humerus Plate 2.7/ 3.5

Features & Benefits

• The anatomical plate design minimizes the need for intraoperative plate contouring

• All plate holes, with the exception of the oblong hole, are compatible with locking as well as

non-locking cortical screws

• Fitted, radiolucent aiming devices are designed for the safe placement of drill guides at a preset angle

• Minor contact undercuts may help to preserve the blood supply to the periosteum

• Available as left and right version

The flattened end of the

plate is designed for

tissue-conserving,

sub-muscular insertion

Gliding locking holes

in the shaft area allow

compression and

angular stability with

LOQTEQ® technology

The oblong hole allows

for easy adjustment

of the plate

Holes for K-wires for

temporary fixation of

bone fragments or of the

plate to the bone

•

• In combination with the

medial plate (180°) a very

stable support for the medial

condyle is possible, which

can allow early recovery for

the patient

• 2.7 mm screws as well

as offset holes in the

metaphyseal area of the

plate allow to even catch

very small fragments

•

Round locking holes in

the metaphyseal plate

area are suitable for

2.7 mm locking screws

(blue) as well as 2.5 mm

cortical screws (gold)

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

•

• 2.5 mm non-locking cortical

screws (gold) can angulate

in the plate hole

•

7Surgical Technique

Elbow Plating System

Introduction

Olecranon Plate 2.7/3.5

Features & Benefits

• The anatomical plate design minimizes the need for intraoperative plate contouring

• All plate holes, with the exception of the oblong hole, are compatible with locking as well as

non-locking cortical screws

• Fitted, radiolucent aiming devices are designed for the safe placement of drill guides at a preset angle

• Minor contact undercuts may help to preserve the blood supply to the periosteum

• Available as left and right version

Holes for K-wires for

temporary fixation of

bone fragments or of the

plate to the bone

Round locking holes in

the metaphyseal plate

area are suitable for

2.7 mm locking screws

(blue) as well as 2.5 mm

cortical screws (gold)

The oblong hole allows

for easy adjustment

of the plate

Gliding locking holes

in the shaft area allow

compression and

angular stability with

LOQTEQ® technology

•

• 2.7 mm screws as well

as offset holes in the

metaphyseal area of the

•

plate allow to even catch

very small fragments

• Screws aim at and

stabilize the coronoid

• 2.5 mm non-locking cortical

screws (gold) can angulate

in the plate hole

• Bendable segments

allow additional

contouring

•

The flattened end of the

plate is designed for

tissue-conserving,

sub-muscular insertion

Surgical Technique

8

Elbow Plating System

•

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Distal Humerus Plates

Preoperative planning

• Evaluate the fracture type on the basis of

the X-rays / CT and select the appropriate plate length and screw positions. Also insert lag screws, if necessary.

OTE:

 N To prevent extensive diaphyseal stress,

it is recommended that the medial and lateral plates are not the same length, with at least a two-hole difference between the plates.

Surgical Technique

Minimum 2 holes difference

• LOQTEQ® Distal Humerus Plates are anato-

mically precontoured to fit to the anatomy of an average distal humerus.

• In general, the articular block should be

reduced prior to repositioning the articular block to the shaft.

• Bicolumn fractures are common, requiring

fixation via a dual plate construct. LOQTEQ® Elbow Plating System allows for 90° and 180° plate placement.

plate placement

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

90°

180°

plate placement

9Surgical Technique

Elbow Plating System

Surgical Technique

Distal Humerus Plates 2.7/3.5

LOQTEQ® Distal Medial Humerus Plate 2.7/3.5

L R

202mm



150 mm



124 mm



98 mm



85 mm



LOQTEQ® Distal Dorsolateral Humerus Plate 2.7/3.5 (90°)

LR

206 mm



154 mm



128 mm



102mm



89 mm



2 holes 11 holes7 holes5 holes3 holes11 holes 2 holes3 holes5 holes7 holes

11 holes 7 holes 5 holes 3 holes

Surgical Technique

10

Elbow Plating System

2 holes

3 holes2 holes

aap Implantate AG

Lorenzweg 5 • 12099 Berlin • Germany

11 holes5 holes 7 holes

Distal Humerus Plates 2.7/3.5

Surgical Technique

LOQTEQ® Distal Lateral Humerus Plate 2.7/3.5 (180°)

LR

205 mm

n

151 mm

n

125 mm

n

99 mm

n

86 mm

n

11 holes 7 holes 5 holes 3 holes 3 holes2 holes

2 holes

11 holes5 holes 7 holes

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

11Surgical Technique

Surgical Technique

Patient positioning

• Position the patient in lateral or prone

position with the arm supported over bolsters.

Approach

• The posterior access is usually preferred,

with a longitudinal incision just radial to the olecranon.

Distal Humerus Plates 2.7/3.5

 CAUTION:

The ulnar nerve must be identified and

protected. When using longer plates, the

radial nerve may require exploration and protection.

• Depending on the fracture pattern, the

triceps can be left intact (A), elevated off the bone (B) or an olecranon osteotomy (C) can be performed for adequate exposure of the fracture.

ABC

Surgical Technique

12

Elbow Plating System

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Distal Humerus Plates 2.7/3.5

Surgical Technique

Preparing the plate



1.5 mm

INSTRUMENTS

Aiming arm LOQTEQ® Distal Medial Humerus Plate IU 8179-00

• Position the medial plate on the madial column at the distal humerus

using the aiming arm prefixing it in the most distal plate hole.

• Plate position: on the medial column, medial distal

• Orientation of distal screws: mediolateral

OTE:

 N Screw the drill guide in the most distal screw hole of the medial

plate and position the opposite tip of the aiming pointer in the location of the desired screw penetration point on the lateral side. In case of the pointer indicating a likely penetration of an area within the joint, try one hole up.

ART.-NO.

 CA UT IO N:

To reduce the risk of glove perforation, care should be taken

when using the aiming pointer of the aiming arm.

 NOTE: The offset of the twist drill / K-wire is 1.5mm.

 NOTE: If for example an angle stable screw fixation should not be possible

in the most distal plate hole, the cortical screws 2.5mm (gold) offer a draw-back with an option of slight angulation. In that case the principle of internal fixation will be violated for that particular hole.

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

13Surgical Technique

Surgical Technique

Distal Humerus Plates 2.7/3.5

Reduction and primary fixation

INSTRUMENTS

K-wire with trocar point, ø1.6, L 150 NK 0016-15 Aiming arm LOQTEQ® Distal Medial Humerus Plate IU 8179-00

ART.-NO.

• Ensure that the anatomy of the distal humerus is reconstructed.

• For reposition and temporary fixation of the fragments place K-wires

or reduction forceps. Ensure that the K-wires will not interfere with later plate positioning. If necessary, use lag screws to secure intraarticular fragments.

• The articular fragments of the distal block should be reduced prior to

reducing the distal block of the shaft.

OTE:

 N The shape of the LOQTEQ® Distal Humerus Plates may assist in

anatomic reduction of the humerus.

Surgical Technique

14

Elbow Plating System

• For temporary fixation of the plate, place the K-wire ø1.6 or a twist

drill ø2.0 (light blue) through the drill guide of the aiming arm for the distal medial humerus plate.

aap Implantate AG

Lorenzweg 5 • 12099 Berlin • Germany

Distal Humerus Plates 2.7/3.5

Surgical Technique

Insertion of cortical screws (gold)

INSTRUMENTS

Drill guide IU 8169-20 IU 8116-60 Twist Drill, coil 50, quick coupling IU 7420-18 IU 7427-15 Depth gauge for locking screws IS 7903-20 IS 7904-20 Screwdriver, quick coupling IU 7815-56 IU 7825-56 Large handle, cannulated, quick coupling IU 7707-00 IU 7706-00

ø 2.5 ø 3.5

 For locking/oblong hole only use cortical screws ø3.5!  For round hole only use cortical screws ø2.5!

• For the primary fixation of the plate shaft, a non-locking cortical

screw 3.5 mm (gold) can be inserted into the oblong hole. For this purpose use a double drill guide and a twist drill ø2.7 and drill to the desired depth.

• Then determine the length of the screw using the depth gauge and

insert a screw of appropriate length by using the screwdriver T15. The plate can be pulled against the bone using this screw.

OTE:

 N

Securing the oblong hole before inserting screws in other plate holes can facilitate the positioning of the plate on the bone.

• To insert a non-locking cortical screw 3.5mm (gold) in the gliding

hole, proceed as described above.

 NOTE: If a combination of non-locking and locking screws is used, non-

locking screws must be inserted first.

• To improve handling the aiming arm can be removed leaving the drill /

K-wire in place providing necessary stability. The adjusting ring can then be freely moved to allow more space for the subsequent surgical steps.

 NOTE:

To ensure the temporary stability of the reduction, do not remove

the K-wire or twist drill until at least one additional locking screw has been inserted.

• To insert non-locking cortical screws 2.5 mm (gold) in the metaphy-

seal area (round hole) of the plate, please follow the instructions on page 16 (locking screws 2.7, light blue). The torque limiter is not applicable for non-locking screws.

• Check the plate position using fluoroscopy and adjust if required.

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

15Surgical Technique

Surgical Technique

Distal Humerus Plates 2.7/3.5

Insertion of locking screws (light blue)

INSTRUMENTS

Drill guide LOQTEQ® Elbow plates 2.7, light blue IU 8169-20 Twist drill ø2.0, L 180, coil 25, quick coupling IU 7420-18 Depth gauge for locking screws ø2.7, up to L 70 IS 7903-20 Screwdriver Duo, T8, quick coupling IU 7815-56 Large handle, cannulated, quick coupling IU 7706-00 Handle round with quick coupling, with torque limiter 1.5Nm IU 7707-00

ART.-NO.

• Insert the drill guide (light blue) into the desired plate hole in the

metaphyseal portion of the plate and drill with the twist drill ø2.0 (light blue).

• Measure for screw length with the depth gauge for screws ø2.7.

Alternatively, the penetration depth during drilling can be read off from the drill guide (light blue/gold) to determine the required screw length.

• The drill guide is marked with two very accurate measuring scales,

which must be observed during measuring.

2

Measuring scale 10-42mm, 2 mm steps Measuring scale 45-75 mm, 5 mm steps

1

2

• Insert the appropriate length LOQTEQ® locking screw 2.7mm (light

1

blue) using the screwdriver T8 and finally tighten the screw with the torque limiter 1.5 Nm. With an audible and sensible click of the torque limiter the optimal locking is achieved. In addition, it is recommended to ensure correct fit of the screws, e.g. visually or using fluoroscopy.

AU TI ON :

 C As soon as the head of the screw reaches the plate hole it is

compulsory to switch to the torque limiter.

• Secure the other metaphyseal plate holes in this way. Then remove

any remaining K-wires.

Surgical Technique

16

Elbow Plating System

 CA UT IO N: Screws in the metaphyseal area of the plate should never pene-

trate the articulating surface. A final control of movement should be preformed.

aap Implantate AG

Lorenzweg 5 • 12099 Berlin • Germany

Distal Humerus Plates 2.7/3.5

Surgical Technique

Insertion of locking compression screws (red)

without compression

INSTRUMENTS

Drill guide for gliding hole LOQTEQ® 3.5, I-ø2.8, red IU 8166-10 Twist drill ø2.7, L 150, coil 50, quick coupling IU 7427-15 Depth gauge for locking screws ø3.5-4.0, up to L 90 IS 7904-20 Screwdriver Duo, T15, quick coupling IU 7825-56 Large handle, cannulated, quick coupling IU 7706-00 Handle round with quick coupling, with torque limiter 1.5Nm IU 7707-00

ART.-NO.

• Screw the drill guide for gliding hole (red) into the desired plate

hole and drill using the twist drill ø2.7 (blue/red).

• Remove the drill guide for gliding hole (red) and determine the

required screw length using the depth gauge.

• Insert a LOQTEQ® locking compression screw 3.5mm (red) of the

appropriate length using screwdriver T15 and finally tighten the screw with the torque limiter 2.0Nm. With an audible and sensible click of the torque limiter the optimal locking is achieved. In addition, it is recommended to ensure correct fit of the screws, e.g. visually or using fluoroscopy.

AU TI ON :

 C As soon as the head of the screw reaches the plate hole it is com-

pulsory to switch to the torque limiter. In cases of very hard bone in the diaphysis it is necessary to make sure that the screw head is flush to the plate. Therefore, it is permissible in exceptionally hard bone of the diaphysis to finish the screw without the torque limiter.

• Secure the other proximal plate holes in this way. Then remove any

remaining K-wires.

• For optimal plate-to-screw connection, it is recommended to use

the threaded drill guide (red) to insert LOQTEQ® locking compression screws (red). If the locking compression screw is inserted obliquely, a secure connection between the screw and plate is not guaranteed!

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

17Surgical Technique

Surgical Technique

Distal Humerus Plates 2.7/3.5

Insertion of the Distal Dorsolateral Humerus Plate

90° plate configuration

INSTRUMENTS

K-wire with trocar point, ø1.6, L 150 NK 0016-15 Double drill guide ø2.7/3.5, with spring aided centuring IU 8116-60 Twist drill ø2.0, L 180, coil 50, quick coupling IU 7420-18 Depth gauge for locking screws ø2.7, up to L 70 IS 7903-20 Screwdriver Duo, T15, quick coupling IU 7825-56 Large handle, cannulated, quick coupling IU 7706-00 Drill guide LOQTEQ® Elbow plates 2.7, light blue IU 8169-20 Twist drill ø2.7, L 150, coil 50, quick coupling IU 7427-15

ART.-NO.

• Plate position: on the lateral column, radial

• Orientation of distal screws: posteroanterior

• Temporarily fixate the plate with K-wires through the holes in the

plate that are intended for this purpose.

• As an alternative to the K-wires, a standard cortical screw 3.5mm

(gold) can be inserted in the oblong hole. For this purpose, use a double drill guide ø2.7/3.5 and a twist drill ø2.7 and drill to the required depth. Then determine the screw length using the depth gauge and insert a screw of the appropriate length. This screw can simultaneously pull the plate towards the shaft.

Insertion of the Distal Lateral Humerus Plate

180° plate configuration

• Check plate position using fluoroscopy and adjust if required.

• Please refer to the pages 15-17 for the detailed description of the

surgical steps.

• Plate position: lateral column, radial

• Orientation of distal screws: lateromedial

• The aiming arm assists in positioning the distal screws of both the

distal medial and lateral plates to help to ensure optimal support for the articular block of the distal humerus.

Surgical Technique

18

Elbow Plating System

• Please refer to the pages 13-17 for the detailed description of the

surgical steps.

aap Implantate AG

Lorenzweg 5 • 12099 Berlin • Germany

Olecranon Plate 2.7/3.5

Surgical Technique

Preoperative planning

• Evaluate the fracture type on the basis

of the X-rays / CT and select the appropriate plate length and screw positions.

• LOQTEQ® Olecranon Plates are anatomically

precontoured to fit to normal ulna anatomy. Although not usually necessary, the plates may be contoured to the individual patient anatomy. The plates (except the short, 2-hole plates) feature bending elements to facilitate the bending process. Use bending irons to contour the plates as needed.

INSTRUMENTS

Bending iron 1 for small fragment plates, closed IP 8405-00 Bending iron 2 for small fragment plates, closed IP 8405-50

2 holes 8 holes6 holes4 holes 10 holes10 holes 4 holes6 holes8 holes 2 holes

o

ART.-NO.

86 mm

o

112mm

o

138 mm

o

164 mm

o

190 mm

AUTION:

 C Observe the following while bending the

plates, avoid repeatedly or excessevely bending the plates as it may result in implant failure. Bend the plate between the holes to prevent the loss of locking function. Avoid any sharp-edged damage by instruments.

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

19Surgical Technique

Surgical Technique

Patient positioning

• Position the patient in lateral or prone

position with the arm supported over bolsters.

Olecranon Plate 2.7/3.5

Approach

• The posterior access lateral to the elbow

is usually preferred, with a skin incision about 5 cm distally over the supracondylar area. The incision may be slightly curved radially to protect the ulnar nerve.

 CAUTION:

The ulnar nerve must be identified

and protected.

Surgical Technique

20

Elbow Plating System

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Olecranon Plate 2.7/3.5

Surgical Technique

Preparing the plate

Reduction and primary fixation

INSTRUMENTS

Aiming device LOQTEQ® Olecranon Plate, R / L IU 8178-01/ -02 Drill guide LOQTEQ® Elbow plates 2.7, light blue IU 8169-20

• Place the aiming device on the plate and fixate it using the drill

guide LOQTEQ® Elbow Plates 2.7 (light blue) in the most distal hole of the targeting device.

• Ensure that the anatomy of the proximal ulna is reconstructed.

• For temporary reposition and fixation of the fragments place K-wires

or reduction forceps. Ensure that the K-wires will not interfere with later plate positioning. If necessary, use lag screws to secure intraarticular fragments.

ART.-NO.

• The articular fragments of the distal block (humerus) should be

reduced prior to reducing the fragments of the olecranon.

• When repositioning the olecranon, ensure appropriate reconstruction

of the coronoid process.

OTE:

 N The shape of the LOQTEQ® Olecranon Plates may assist in anatomic

reduction of the humerus.

• For temporary fixation of the plate place K-wires through the cor-

responding holes in the plate.

 NOTE: Position the plate on the dorsal aspect of the proximal ulna.

Proximally, the plate does not need necessarily to center on the olecranon.

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

21Surgical Technique

Surgical Technique

Olecranon Plate 2.7/3.5

Insertion of cortical screws (gold)

Insertion of locking screws (light blue)

• Please follow instructions on page 15.

 NOTE:

Avoid placing the cortical screw (gold) in oblique lateral direction

to prevent screw collision with the two most proximal 2.7 mm locking screws (light blue). Alternatively, shorter 2.7mm cortical screws can be chosen.

INSTRUMENTS

Drill guide LOQTEQ® Elbow plates 2.7, light blue IU 8169-20 Twist drill ø2.0, L 110, coil 25, quick coupling IU 7420-10 Depth gauge for locking screws ø2.7, up to L 70 IS 7903-20 Screwdriver Duo, T8, quick coupling IU 7815-56 Large handle, cannulated, quick coupling IU 7706-00 Handle round with quick coupling, with torque limiter 1.5Nm IU 7707-00

ART.-NO.

• Insert the drill guide (light blue) into the desired plate hole in the

metaphyseal portion of the plate and drill with the twist drill ø2.0 (light blue).

• Measure for screw length with the depth gauge for screws ø2.7.

Alternatively, the penetration depth during drilling can be read off from the drill guide (light blue) to determine the required screw length.

AU TI ON :

 C

The drill giude for fixating the aiming device of the LOQTEQ®

Olecranon Plate must remain in the distal round hole 2.7 until all

other screws 2.7mm have been placed. Then the aiming device can be removed and a 2.7 mm screw can be inserted in the distal round hole.

Surgical Technique

22

Elbow Plating System

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Olecranon Plate 2.7/3.5

Surgical Technique

• Insert the appropriate length LOQTEQ® locking screw 2.7mm (light

blue) using the screwdriver T8 and finally tighten the screw with the torque limiter 1.5Nm. With an audible and sensible click of the torque limiter the optimal locking is achieved. In addition, it is recommended to ensure correct fit of the screws, e.g. visually or using fluoroscopy.

AU TI ON :

 C As soon as the head of the screw reaches the plate hole it is

compulsory to switch to the torque limiter.

• Secure the other metaphyseal plate holes in this way. Then remove

any remaining K-wires.

compression screws (red)

without compression

 CA UT IO N: Screws in the metaphyseal area of the plate should never pene-

trate the articulating surface. A final control of movement should be preformed.

• Please follow instructions on page 17.Insertion of locking

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

23Surgical Technique

Surgical Technique

Insertion of locking compression screws (red)

with compression

INSTRUMENTS

Basic Insert for load drill guide LOQTEQ® 3.5 IU 8166-05 Load Drill guide LOQTEQ® 3.5, compression 1 mm IU 8166-01 Load Drill guide LOQTEQ® 3.5, compression 2mm IU 8166-02 Twist Drill ø2.7, L 150, coil 50, quick coupling IU 7427-15 Depth gauge for locking screws ø3.5-4.0, up to L 90 IS 7904-20 Screwdriver duo, T15, quick coupling IU 7825-56 Large handle, cannulated, quick coupling IU 7706-00 Handle with quick coupling, with torque limiter, 2.0Nm IU 7707-20

OPTIONAL

Load drill guide LOQTEQ® 3.5, adjustable up to 2mm

ART.-NO.

IU 8166-03

• If required, fracture compression can be achieved by inserting a

non-locking cortical screw 3.5 mm (gold) or LOQTEQ® locking compression screw 3.5mm (red) into the compression position.

• Screw the basic insert for load drill guide (IU 8166-05) into a shaft

hole near the fracture line or, if necessary, above the fracture line. Choose a load drill guide in accordance with the compression distance (1 mm or 2 mm) and position on the basic insert away from the fracture gap.

• Alternatively, the adjustable load drill guide (IU 8166-03) can be used.

The fracture gap serves as orientation in setting the compression distance (max. 2 mm). For this purpose, turn the wheel of the load drill guide until an appropriate gap forms in the upper part of the instrument and position the drill guide on the basic insert for load drill guide away from the fracture gap.

Surgical Technique

24

Elbow Plating System

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Surgical Technique

• Drill to the desired depth using a twist drill ø2.7 (blue/red) and

determine the depth with the depth gauge.

• Loosely insert a LOQTEQ® locking compression screw 3.5mm (red) of

the appropriate length with screwdriver T15 and finally tighten the screw with the torque limiter 2.0Nm. With an audible and sensible click of the torque limiter the optimal locking is achieved. In addition, it is recommended to ensure correct fit of the screws, e.g. visually or using fluoroscopy.

AUTION:

 C

Care should be taken to select the proper compression distance

(1 or 2 mm). If the fracture gap is too small and the bone very hard, excessive compression may prevent full locking of the angle stable screw.



 CAUTION: As soon as the head of the screw reaches the plate hole it is

compulsory to switch to the torque limiter. In cases of very hard bone in the diaphysis it is necessary to make sure that the screw head is flush to the plate. With such conditions, it is permissible to finish the screw without the torque limiter.

• Alternatively, a non-locking cortical screw (gold) can be placed as a

compression screw. For this purpose, use the double drill guide in offset position (do not apply pressure on the drill guide) and drill using a twist drill ø2.7.

• When all required screws have been inserted, perform final check

using fluoroscopy, AP and lateral, and close the wound.

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

25Surgical Technique

Explantation

INSTRUMENTS

Explantation screwdriver, T8, round handle IU 7811-08 Explantation screwdriver, T15, round handle IU 7811-15

ART.-NO.

 NOTE: Use the appropriate explantation screwdriver T8/ T15 (IU 7811-08/

IU 7811-15) for a safe screw removal. The explantation screwdrivers are not self-retaining and allow for higher torque transmission during screw removal. They should be ordered separately.

The screwdrivers T8/T15 in the set (IU 7815-56/IU 7825-56) are

self-retaining and should not be used for screw explantation.

• Place an incision on the old scar. Manually undo all screws and

sequentially remove them.

OTE:

 N After manually unlocking all screws, the removal can be

performed using a power tool.

Surgical Technique

26

Elbow Plating System

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Assembly instructions aiming arm

• The aiming arm for the distal medial humerus plate consists of

four individual parts:

1

4

3

2

Aiming arm made of radiolucent PEEK material

1

2

Metal drill guide with external thread

3

Metal adjusting ring with internal thread

4

Pointer

AUTION:

 C To reduce the risk of glove perforation, care should be taken

when using the aiming pointer of the aiming arm.

a

Screw the adjusting ring onto the guiding sleeve.

Click the drill guide with the assembled adjusting

b

ring onto the PEEK aiming arm.

b

c

Click the pointer onto the PEEK aiming arm.

c

a

 CAUTION: The aiming arm must be disassembled prior to cleaning

and sterilization.

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

27Surgical Technique

Assembly instructions load drill guide

• The load drill guide facilitates setting a variable compression path.

It can be disassembled and reassembled in only a few steps.

 NOTE: When ordering the adjustable load drill guide LOQTEQ® 3.5

(IU 8166-03), please add a screwdriver hexagonal 2.5

(IU 7825-00) to your order.

Disassembly

2

4.1

5

Assembly

2

4.2

1

• Remove screws (items 4.1 and 4.2) using a

hexagonal screwdriver 2.5

• Unscrew the set screw (item 3)

3

• Pull the compression block apart (items 1 and 2)

1

• Fit together the compression block (items 1 and 2)

4.1

Surgical Technique

28

Elbow Plating System

4.2

• Insert the set screw (item 3) into the compression block,

middle hole

3

• Insert the retaining screws (items 4.1 and 4.2)

using a hexagonal screwdriver 2.5

aap Implantate AG

Lorenzweg 5 • 12099 Berlin • Germany

Implants and Instruments

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

29Surgical Technique

Implants

Plates Elbow Plating System

LOQTEQ® Distal Medial Humerus Plate 2.7/3.5

HOLES LENGTH LEFT RIGHT

(mm)

2 85 PH 3522-02-2 PH 3521-02-2 3 98 PH 3522-03-2 PH 3521-03-2 5 124 PH 3522-05-2 PH 3521-05-2 7 150 PH 3522-07-2 PH 3521-07-2

11 202 PH 3522-11-2 PH 3521-11-2

Aiming device LOQTEQ® Distal Medial Humerus Plate, R IU 8177-01 Aiming device LOQTEQ® Distal Medial Humerus Plate, L IU 8177-02

LOQTEQ® Distal Dorsolateral Humerus Plate 2.7/3.5

HOLES LENGTH LEFT RIGHT

(mm)

2 89 PH 3532-02-2 PH 3531-02-2 3 102 PH 3532-03-2 PH 3531-03-2 5 128 PH 3532-05-2 PH 3531-05-2 7 154 PH 3532-07-2 PH 3531-07-2

11 206 PH 3532-11-2 PH 3531-11-2

LOQTEQ® Distal Lateral Humerus Plate 2.7/3.5

HOLES LENGTH LEFT RIGHT

(mm)

2 3 99 PH 3542-03-2 PH 3541-03-2 5 125 PH 3542-05-2 PH 3541-05-2 7 151 PH 3542-07-2 PH 3541-07-2

11 205 PH 3542-11-2 PH 3541-11-2

Aiming device LOQTEQ® Distal Lateral Humerus Plate, R IU 8182-01 Aiming device LOQTEQ® Distal Lateral Humerus Plate, L IU 8182-02

86

PH 3542-02-2 PH 3541-02-2

LOQTEQ® Olecranon Plate 2.7/3.5

HOLES LENGTH LEFT RIGHT

(mm)

2 86 PU 3532-02-2 PU 3531-02-2 4 112 PU 3532-04-2 PU 3531-04-2 6 138 PU 3532-06-2 PU 3531-06-2 8 164 PU 3532-08-2 PU 3531-08-2

10 190 PU 3532-10-2 PU 3531-10-2

Aiming device LOQTEQ® Olecranon Plate, R IU 8178-01 Aiming device LOQTEQ® Olecranon Plate, L IU 8178-02

Surgical Technique

30

Elbow Plating System

For ordering of the sterile plates please add „S“ to the article number,

e.g. PU 3532-02-2S

aap Implantate AG

Lorenzweg 5 • 12099 Berlin • Germany

Implants

Elbow Plating System Screws

Cortical Screw 2.5,

small head, T8, self-tapping

-L 14 SK 2512-14-2 L 16 SK 2512-16-2 L 18 SK 2512-18-2 L 20 SK 2512-20-2 L 22 SK 2512-22-2 L 24 SK 2512-24-2 L 26 SK 2512-26-2 L 28 SK 2512-28-2 L 30 SK 2512-30-2 L 32 SK 2512-32-2 L 34 SK 2512-34-2 L 36 SK 2512-36-2 L 38 SK 2512-38-2 L 40 SK 2512-40-2 L 42 SK 2512-42-2 L 45 SK 2512-45-2 L 50 SK 2512-50-2 L 55 SK 2512-55-2 L 60 SK 2512-60-2 L 65 SK 2512-65-2 L 70 SK 2512-70-2

LOQTEQ® Cortical Screw 2.7, small head, T8, self-tapping

-L 14 SK 2726-14-2 L 16 SK 2726-16-2 L 18 SK 2726-18-2 L 20 SK 2726-20-2 L 22 SK 2726-22-2 L 24 SK 2726-24-2 L 26 SK 2726-26-2 L 28 SK 2726-28-2 L 30 SK 2726-30-2 L 32 SK 2726-32-2 L 34 SK 2726-34-2 L 36 SK 2726-36-2 L 38 SK 2726-38-2 L 40 SK 2726-40-2 L 42 SK 2726-42-2 L 45 SK 2726-45-2 L 50 SK 2726-50-2 L 55 SK 2726-55-2 L 60 SK 2726-60-2 L 65 SK 2726-65-2 L 70 SK 2726-70-2

Cortical Screw 3.5,

T15, self-tapping

L 12 SK 3514-12-2 L 14 SK 3514-14-2 L 16 SK 3514-16-2 L 18 SK 3514-18-2 L 20 SK 3514-20-2 L 22 SK 3514-22-2 L 24 SK 3514-24-2 L 26 SK 3514-26-2 L 28 SK 3514-28-2 L 30 SK 3514-30-2 L 32 SK 3514-32-2 L 34 SK 3514-34-2 L 36 SK 3514-36-2 L 38 SK 3514-38-2 L 40 SK 3514-40-2 L 42 SK 3514-42-2 L 45 SK 3514-45-2 L 50 SK 3514-50-2 L 55 SK 3514-55-2 L 60 SK 3514-60-2 L 65 SK 3514-65-2 L 70 SK 3514-70-2

LOQTEQ® Cortical Screw 3.5,

T15, self-tapping

L 12 SK 3525-12-2 L 14 SK 3525-14-2 L 16 SK 3525-16-2 L 18 SK 3525-18-2 L 20 SK 3525-20-2 L 22 SK 3525-22-2 L 24 SK 3525-24-2 L 26 SK 3525-26-2 L 28 SK 3525-28-2 L 30 SK 3525-30-2 L 32 SK 3525-32-2 L 34 SK 3525-34-2 L 36 SK 3525-36-2 L 38 SK 3525-38-2 L 40 SK 3525-40-2 L 42 SK 3525-42-2 L 45 SK 3525-45-2 L 50 SK 3525-50-2 L 55 SK 3525-55-2 L 60 SK 3525-60-2 L 65 SK 3525-65-2 L 70 SK 3525-70-2

For ordering of the sterile screws please add „S“ to the article number,

e.g. SK 3525-12-2S*

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

31Surgical Technique

Instruments

Small Fragment

Bending iron 1 for small fragment plates, closed IP 8405-00 Bending iron 2 for small fragment plates, closed IP 8405-50

Depth gauge for screws, ø2.7, up to L 70 IS 7903-20

Depth gauge for screws, ø3.5-4.0, up to L 90 IS 7904-20

Twist drill ø2.0, L 180, coil 25, quick coupling IU 7420-18* Twist drill ø2.7, L 150, coil 50, quick coupling IU 7427-15* Twist drill ø3.5, L 110, coil 50, quick coupling IU 7435-00*

* For ordering single use drill guides please add „-1U“ to the article number

(e.g. IU 7420-10-1U)

Large handle, cannulated, quick coupling IU 7706-00

Handle with quick coupling, with torque limiter 1.5 Nm IU 7707-00

Surgical Technique

32

Elbow Plating System

Handle with quick coupling, with torque limiter 2.0Nm IU 7707-20

Screwdriver Duo, T8, quick coupling IU 7815-56

aap Implantate AG

Lorenzweg 5 • 12099 Berlin • Germany

Screwdriver Duo, T15, quick coupling IU 7825-56

Double drill guide ø2.7/3.5, with spring aided centering IU 8116-60

Instruments

Small Fragment

Load drill guide LOQTEQ® 3.5, compression 1mm IU 8166-01 Load drill guide LOQTEQ® 3.5, compression 2mm IU 8166-02 Load drill guide LOQTEQ® 3.5, adjustable up to 2mm IU 8166-03 Basic insert for load drill guide LOQTEQ® 3.5 IU 8166-05

Drill guide for gliding hole LOQTEQ® 3.5, I-ø 2.8, red IU 8166-10

Drill guide LOQTEQ® Elbow plates 2.7, light blue IU 8169-20

Aiming arm LOQTEQ® Distal Medial Humerus Plate IU 8179-00

K-wire with trocar point, ø1.6, L 150 NK 0016-15

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

33Surgical Technique

Case Study

Preoperative

Surgical Technique

34

Elbow Plating System

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Postoperative

Case Study

Postoperative

Clinical case and CT images with the kind permission of Univ.-Prof. Dr. Dr. Dr. h.c. Reinhard Schnettler, Trauma University Hospital Giessen and Marburg GmbH, Germany.

aap Implantate AG Lorenzweg 5 • 12099 Berlin • Germany

Elbow Plating System

35Surgical Technique

Notes

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Surgical Technique

36

Elbow Plating System

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lorenzweg 5 • 12099 Berlin • Germany

aap Implantate AG

Subject to technical modifications,

errors and misprints.

aap Implantate AG

©

WP 4OP030 EN / 1707

Layout, typesetting: deSIGN graphic - Wolfram Passlack

Illustrations: Karen Hilberg

aap Implantate AG

Lorenzweg 5

• 12099 Berlin

Germany

Phone +49 30 75019-0 Fax +49 30 75019-111

customer.service@aap.de

www.aap.de

aap Implantate AG

Lorenzweg 5

• 12099 Berlin

Germany

Phone +49 30 75019-0 Fax +49 30 75019-111

customer.service@aap.de www.aap.de

WP 4OP030 EN / 1707

AAP LOQTEQ Distal Dorsolateral Humerus Plate 2.7/3.5, LOQTEQ Olecranon Plate 2.7/3.5, LOQTEQ Distal Medial Humerus Plate 2.7/3.5, LOQTEQ Elbow Plating System, LOQTEQ Distal Lateral Humerus Plate 2.7/3.5 User Manual

Specifications and Main Features

Frequently Asked Questions

User Manual