Read 4.5 mm LCP Proximal Tibia Plates TG text version

4.5 mm LCP Proximal Tibia Plates. Part of the Synthes LCP Periarticular Plating System.

Technique Guide

Table of Contents

Introduction

4.5 mm LCP Proximal Tibia Plates AO Principles Indications

2 4 5

Surgical Technique

Preparation Make Incision Reduce Articular Surface Attach Wire Guides Determine Plate Position Insert Proximal Screws Reduce Shaft to Tibial Plateau Insert Cortex Screws in Plate Shaft Insert Locking Screws in Plate Shaft Insert Locking Screw into Angled Plate Hole Postoperative Treatment Implant Removal

6 7 7 8 9 10 12 14 15 16 18 18

Product Information

Implants Set Lists

19 21

Image intensifier control

Synthes

4.5 mm LCP Proximal Tibia Plates

The Synthes 4.5 mm LCP Proximal Tibia Plate is part of the LCP Periarticular Plating System, which merges locking screw technology with conventional plating techniques. The LCP Periarticular Plating System is capable of addressing complex fractures of the distal femur with the 4.5 mm LCP Condylar Plates, complex fractures of the proximal femur with the 4.5 mm LCP Proximal Femur Plates and 4.5 mm LCP Proximal Femur Hook Plates, and complex fractures of the proximal tibia when using the 4.5 mm LCP Proximal Tibia Plates and 4.5 mm LCP Medial Proximal Tibia Plates. The locking compression plate (LCP) has Combi holes in the plate shaft that combine a dynamic compression unit (DCU) hole with a locking screw hole. The Combi hole provides the flexibility of axial compression and locking capability throughout the length of the plate shaft. Note: For information on fixation principles using conventional and locked plating techniques, please refer to the Synthes Large Fragment Locking Compression Plate (LCP) Technique Guide. The 4.5 mm LCP Proximal Tibia Plate has many similarities to traditional plate fixation methods, with a few important improvements. The technical innovation of locking screws provides the ability to create a fixed-angle construct while using familiar AO plating techniques. Locking capability is important for a fixed-angle construct in osteopenic bone or multifragment fractures where screw purchase is compromised. These screws do not rely on plate-to-bone compression to resist patient load, but function similarly to multiple, small angled blade plates.

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

­ Anatomically contoured to approximate the lateral aspect of the proximal tibia ­ Can be tensioned to create a load-sharing construct ­ Available in left and right configurations, in 316L stainless steel or commercially pure (CP) titanium Plate head ­ Three convergent threaded screw holes accept 5.0 mm cannulated locking or 5.0 mm cannulated conical screws ­ Two 2.0 mm holes for preliminary fixation with K-wires, or meniscal repair with sutures Plate shaft ­ Available with 4, 6, 8, 10, 12, 14, 16*, 18*, or 20* Combi holes in the plate shaft ­ The two round holes distal to the head accept 4.5 mm cortex screws and 6.5 mm cancellous bone screws for interfragmentary compression or to secure plate position ­ An angled, threaded hole, distal to the two round holes, accepts the 5.0 mm cannulated locking screw. The hole angle allows this locking screw to converge with the central locking screw in the plate head to support a medial fragment ­ Combi holes, distal to the angled locking hole, combine a DCU hole with a threaded locking hole ­ Limited-contact profile

Two 2.0 mm holes for K-wires and sutures

Three locking screw holes accept 5.0 mm cannulated locking or 5.0 mm cannulated conical screws

Angled locking hole accepts the 5.0 mm cannulated locking screw and supports the medial fragment

Two round holes accept 4.5 mm cortex screws and 6.5 mm cancellous bone screws

Combi holes accept 4.0 mm or 5.0 mm locking screws in the threaded portion or 4.5 mm cortex screws in the DCU portion Accepts articulated tension device (to provide compression or distraction)

*Plates with 16, 18, or 20 screw holes are only available in 316L stainless steel

Synthes

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AO Principles

In 1958, the AO formulated four basic principles which have become the guidelines for internal fixation.1 Those principles, as applied to the 4.5 mm LCP Proximal Tibia Plates, are: Anatomic reduction Facilitates restoration of the articular surface using guide wires for reduction and insertion of cannulated screws. Precontoured plate assists reduction of metaphysis to diaphysis. Stable fixation Locking screws create a fixed-angle construct, providing angular stability. Preservation of blood supply Tapered end simplifies submuscular plate insertion, improving tissue viability. Limited-contact design reduces plate-to-bone contact and vascular trauma. Early, active mobilization Plate features combined with AO technique create an environment for bone healing, expediting a return to optimal function.

1. M. E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger. AO Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991.

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Indications

The Synthes 4.5 mm LCP Proximal Tibia Plate is intended for treatment of osteopenic bone, tibial osteotomies, nonunions, malunions and fractures of the proximal tibia including: ­ ­ ­ ­ Simple, comminuted fractures Lateral wedge fractures Depression medial wedge fractures Bicondylar combination of lateral wedge and depression fractures ­ Periprosthetic fractures ­ Proximal fractures with associated shaft fractures

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Preparation

1

Preparation Required set 01.240.201 or 01.240.209 Periarticular LCP Plating System with 5.0 mm Locking Screws Periarticular LCP Plating System with 4.0 mm Locking Screws

Optional sets 01.223.604 Periarticular LCP Plating System Instrument and Titanium Screw Set Periarticular LCP Plating System, with 5.0 mm Titanium Locking Screws Periarticular LCP Plating System, with 4.0 mm Titanium Locking Screws

01.240.401

01.240.409

Complete the preoperative radiographic assessment and prepare the preoperative plan. Determine plate length and instruments to be used. Determine proximal screw placement and screw lengths to ensure proper screw placement in the metaphysis. Position the patient supine on a radiolucent operating table. Visualization of the proximal tibia under fluoroscopy in both the lateral and AP views is necessary.

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Make Incision and Reduce Articular Surface

2

Make incision Lateral incision A lateral "S" incision is recommended when a simple articular fracture (AO classification 41-C1) or extra-articular fracture (AO classification 42 or 41A) is present. Anterolateral incision In the presence of a complex intra-articular fracture (AO classification 41-C2 or C3), perform an anterolateral approach. Perform arthrotomy to expose the joint for reduction. Extend the incision for adequate exposure of the joint for reduction and anatomic fixation.

3

Reduce articular surface Instrument 394.35 Large Distractor Kirschner Wires

Technique tip: Prior to reduction, application of an external fixator or large distractor may facilitate reduction of the joint. Reduce the fracture fragments and confirm reduction using image intensification. Fragments may be reduced using independent Kirschner wires; however, K-wire holes are also provided on the plate to help achieve provisional reduction, plate position, or fixation.

Synthes

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Attach Wire Guides

3

Reduce articular surface continued The locking screws do not provide interfragment or plate-tobone compression; therefore, any desired compression must be achieved with traditional lag screws. The angular fragments must be reduced and compression must be obtained prior to applying the 4.5 mm LCP proximal tibia plate with locking screws. However, 5.0 mm cannulated conical screws can be used through the head of the plate to compress the plate to the bone. Technique tip: To verify that lag screws will not interfere with plate placement, hold the plate laterally to the bone.

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Attach wire guides Instruments 310.243 324.174 2.5 mm Drill Tip Guide Wire, 200 mm 2.5 mm Wire Guide, for 5.0 mm screws

Before placing the plate against the bone, thread 2.5 mm wire guides into the three (3) proximal holes. If desired, thread a wire guide into the angled hole of the shaft. Note: It is easier to thread these wire guides when the plate is off the bone, and the wire guides can be used as handles to facilitate positioning of the plate on the bone. Insert 2.5 mm drill tip guide wires into each of the wire guides to verify that the wire guides are properly threaded into the plate. The wires in the plate head should be parallel to each other in the transverse plane. The oblique or kickstand wire should buttress the central wire in the plate head.

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Determine Plate Position

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Determine plate position Instruments 292.652 310.243 2.0 mm Non-Colored Threaded Guide Wire 2.5 mm Drill Tip Guide Wire

Using anatomic landmarks and fluoroscopy, mount the plate on the intact or reconstructed plateau without attempting to reduce the distal portion of the fracture. Use the wire guides to help position the plate on the bone. Insert a 2.5 mm guide wire through the 2.5 mm wire guide. Readjust plate position, if necessary. Place a second guide wire to prevent rotation of the plate, and to secure provisional fixation of the plate to the tibial plateau. All three guide wires must be inserted through the 2.5 mm wire guides. Note: Additional 2.0 mm K-wires may be placed in the proximal K-wire holes to hold the plate in position. Confirm plate head placement. Use clinical examination and fluoroscopy to confirm that: ­ Screw trajectories in the proximal locking holes are parallel to the joint in the transverse plane, and the plate is oriented properly on the plateau; ­ Screw and plate placement are consistent with the preoperative plan; and ­ Alignment of the plate to the shaft of the tibia is correct in both the AP and lateral views. Placement of the plate at this point will determine final flexion/extension reduction.

Synthes

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Insert Proximal Screws

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Insert proximal screws Instruments 310.634 314.05 319.701 4.3 mm Cannulated Drill Bit Cannulated Hexagonal Screwdriver Cannulated Screw Measuring Device

Note: If required, lag screw reduction of a fragment must be accomplished before inserting locking screws into the fragment.

Before inserting the first screw, advance each guide wire until it reaches either the medial cortex or the desired screw tip location when placing convergent screws. If the plate shifts during screw insertion, the guide wires must be removed and reinserted using the wire guides for the screws to lock to the plate properly. Screw length considerations Central locking hole: The locking screw holes in the proximal portion of the plate create a converging screw pattern for improved pullout strength. When using locking screws longer than 60 mm in the anterior and posterior of the three head holes, a central locking screw greater than 70 mm in length may meet with these screws. Measure for screw length using the cannulated screw measuring device. The correct length measurement will place the screw at the tip of the guide wire. Note: The measuring device must contact the end of the wire guide for an accurate measurement. Technique tip: The self-drilling, self-tapping flutes of the 5.0 mm screws make predrilling and pretapping unnecessary in most cases. If necessary in dense bone, the lateral cortex can be predrilled with the 4.3 mm cannulated drill bit, for 5.0 mm screws.

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Remove the wire guide and insert the appropriate length screw over the 2.5 mm guide wire and into the bone, using the cannulated hexagonal screwdriver. Locking screws may be inserted using power equipment. However, DO NOT use power to seat these screws since this may cause screws to cross-thread in the plate holes. Important: Securely tighten all locking screws to lock them to the plate. Note: To compress the plate to the lateral tibial plateau, it is necessary to use a conical screw prior to any locking screws. Conical screws may be replaced with locking screws after reduction is complete.

Synthes

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Reduce Shaft to Tibial Plateau

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Reduce shaft to tibial plateau Instrument 321.12 Articulated Tension Device

Reduce the tibial plateau to the shaft of the tibia using indirect reduction techniques whenever possible. Using atraumatic technique, temporarily secure the plate shaft to the bone with plate holding forceps. Confirm rotation of the extremity by clinical examination. Once reduction is satisfactory, and if it is appropriate based on the fracture morphology, the plate should be loaded in tension using the articulated tension device. Note: With multifragment fractures, it may not always be possible or desirable to achieve anatomic reduction of the fracture. However, in simple fracture patterns, the articulated tension device may facilitate anatomic reduction. This device may be used to generate either compression or distraction. In addition to having threaded locking holes, the plate functions similarly to DCP plates which offer the ability to self-compress fracture fragments. Therefore, a combination of lag screws and locking screws may be used.

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Important: If a combination of cortex (1) and locking screws (2) is used, a cortex screw should be inserted first to pull the plate to the bone.

1

2

2

1

Correct

Important: If locking screws (1) have been used to fix the plate to a fragment, subsequent insertion of a cortex screw (2) in the same fragment without loosening and retightening the locking screw is not recommended.

2

1

1

2

Incorrect

Synthes

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Insert Cortex Screws in Plate Shaft

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Insert 4.5 mm cortex screws in plate shaft Instruments 03.010.150 Star / HexDrive Screwdriver, T25 / 3.5 mm hexagonal Star / HexDrive Screwdriver Shaft, T25 / 3.5 mm hexagonal 3.2 mm Drill Bit, quick coupling Depth Gauge 4.5 mm Universal Drill Guide

03.010.151

310.31 319.10 323.46

Insert as many standard 4.5 mm cortex screws as necessary into the distal portion of the plate. Important: All of the 4.5 mm cortex screws must be inserted prior to insertion of locking screws. Use the 4.5 mm universal drill guide to predrill for 4.5 mm cortex screws and drill through both cortices with the 3.2 mm drill bit. For the neutral position, press the drill guide down in the nonthreaded hole. To obtain compression, place the drill guide at the end of the nonthreaded hole away from the fracture. Do not apply downward pressure on the drill guide's springloaded tip. Note: The DCP and LC-DCP Drill Guides (322.44 and 323.45) are not compatible with the LCP plates. Measure for screw length using the depth gauge. Select and insert the appropriate length 4.5 mm cortex screw using the large hexagonal screwdriver.

Neutral

Compression

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Insert Locking Screws in Plate Shaft

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Insert 4.0 mm or 5.0 mm locking screws in plate shaft Instruments 03.010.150 Star / HexDrive Screwdriver, T25 / 3.5 mm hexagonal Star / HexDrive Screwdriver Shaft, T25 / 3.5 mm hexagonal 3.2 mm Drill Bit 4.3 mm Drill Bit Depth Gauge, for large screws 3.2 mm Drill Guide, for 4.0 mm screws 4.3 mm Threaded Drill Guide Torque Limiting Attachment, 4 Nm Torque Limiting Attachment, 4 Nm, for AO Reaming Coupler

03.010.151

310.31 or 310.431 319.10 324.176 or 312.449 511.771 or 511.774

Attach the appropriate drill guide to the locking portion of a Combi hole: ­ Use the 3.2 mm drill guide when inserting 4.0 mm locking screws ­ Use the 4.3 mm threaded drill guide when inserting 5.0 mm locking screws Note: Use of the drill guide is required. It will center the drill bit in the threaded portion of the Combi hole to create a screw trajectory that ensures the screw properly engages the plate. Use the appropriate drill bit to drill to the desired depth: ­ Use the 3.2 mm drill bit for 4.0 mm locking screws ­ Use the 4.3 mm drill bit for 5.0 mm locking screws Note: Holes for locking screws may be drilled unicortically or bicortically, depending on bone quality.

Synthes

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Insert Locking Screw into Angled Plate Hole

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Insert the 5.0 mm cannulated locking screw into the angled hole Instruments 310.243 314.05 319.701 324.174 511.771 2.5 mm Drill Tip Guide Wire Cannulated Hexagonal Screwdriver Cannulated Screw Measuring Device 2.5 mm Wire Guide, for 5.0 mm screws Torque Limiting Attachment, 4 Nm

Note: Use the oblique locking position to buttress a medial fragment. If not already done, thread a 2.5 mm wire guide, for 5.0 mm screws into the angled locking hole. Insert a 2.5 mm drill tip guide wire through the 2.5 mm wire guide. Advance the guide wire until it reaches the desired screw tip location. Measure for screw length using the cannulated screw measuring device. The correct length measurement will place the screw at the tip of the guide wire. Use the cannulated hexagonal screwdriver to remove the wire guide. Note: The measuring device must contact the end of the wire guide for an accurate measurement.

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Screw length considerations Angled locking hole: The oblique locking screw in the plate shaft converges with the central locking screw in the plate head for improved pullout strength and fixation. If the oblique locking screw exceeds 65 mm in length, it should contact the proximal locking screw. Technique tip: The self-drilling, self-tapping flutes of the 5.0 mm screws make predrilling and pretapping unnecessary in most cases. If necessary, in dense bone, the lateral cortex can be predrilled with the 4.3 mm cannulated drill bit. Insert the appropriate length cannulated locking screw over the 2.5 mm guide wire and into the bone using the cannulated hexagonal screwdriver. Locking screws may be inserted using power equipment. However, DO NOT use power to seat these screws since this may cause screws to cross-thread in the plate holes. Important: Securely tighten all locking screws to ensure they are locked to the plate. Always use the torque limiting attachment when using power to insert locking screws.

Cleaning tip Instruments 319.24 319.461 2.9 mm Cleaning Brush 2.5 mm Cleaning Stylet

Cleaning the cannulation in the threaded drill guides is imperative for proper function. Instruments should be cleared intraoperatively using the 2.5 mm cleaning stylet to prevent accumulation of debris in the cannulation. Instruments should be cleaned postoperatively using the stylet and the 2.9 mm cleaning brush.

Synthes

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Postoperative Treatment and Implant Removal

Postoperative treatment Postoperative treatment with locking compression plates does not differ from conventional internal fixation procedures.

Implant removal To remove locking screws, unlock all screws from the plate; then remove the screws completely from the bone. This prevents simultaneous rotation of the plate when removing the last locking screw.

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Screws Used with the 4.5 mm LCP Proximal Tibia Plate Stainless Steel and Titanium

4.0 mm Locking Screws Create a locked, fixed-angle screw/plate construct ­ Threaded conical head ­ Fully threaded shaft ­ Self-tapping tip 4.5 mm Cortex Screws Compress the plate to the bone or create axial compression ­ May be used in the DCU portion of the Combi holes in the plate shaft 5.0 mm Cannulated Locking Screws Create a locked, fixed-angle screw/plate construct ­ Threaded conical head ­ Fully threaded shaft ­ Self-drilling, self-tapping tip 5.0 mm Cannulated Conical Screws Compress the plate to the bone and provide interfragmentary compression ­ Smooth conical head ­ Partially threaded shaft ­ Self-drilling, self-tapping tip 5.0 mm Locking Screws Create a locked, fixed-angle screw/plate construct ­ Threaded conical head ­ Fully threaded shaft ­ Self-tapping tip 5.0 mm Screw Nut Offers additional fixation and compression options for complex fractures ­ Self-cutting, serrated tip ­ Inserted from the medial aspect of the proximal tibia ­ Internal threads mate with the 5.0 mm cannulated conical screws

Stainless steel screws and screw nut are made of implant quality 316L stainless steel Titanium screws and screw nut are made of titanium alloy (Ti-6Al-7Nb) or commercially pure (CP) titanium

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5.0 mm Cannulated Locking and Cannulated Conical Screws

The screw design enhances fixation and facilitates the surgical procedure. Conical screw head The conical head simplifies alignment in the plate hole. This is of particular importance when using locking screws. The threaded screw head must align with the plate hole threads to provide a secure screw/plate construct. To ensure proper alignment and prevent cross-threading, the appropriate threaded wire guide or drill guide must always be used. Large diameter screw core The large diameter screw core improves bending and shear strength, and distributes the load over a larger area in the bone.

Thread profile The shallow thread profile of the locking screws is necessary to provide a larger core. This is appropriate since locking screws do not rely on compression between the plate and the bone to maintain stability. When required, interfragmentary compression can be achieved with the partially threaded cannulated conical screws, especially when near the articular surface.

Nonthreaded conical screw head

Threaded conical screw head

4.4 mm core diameter 1.0 mm thread pitch 5.0 mm thread profile 5.0 mm cannulated conical screw 5.0 mm cannulated locking screw

Screw selection and configuration for the plate head The 5.0 mm cannulated locking screws provide a fixed-angle construct in the metaphysis, while the 5.0 mm cannulated conical screws can be used to gain interfragmentary compression through the plate. This plate can serve as a buttress for a medial wedge. This is accomplished by the convergence of the locking screws in the metaphyseal region and the oblique screw from below.

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

4.5 mm LCP Proximal Tibia Plate Implant Sets Stainless Steel (105.222) and Titanium (01.123.604)

Graphic Case 690.367 4.5 mm LCP Proximal Tibia Plate Set Graphic Case 690.467 4.5 mm Titanium LCP Proximal Tibia Plate Set Graphic Case Implants in set 105.222 4.5 mm LCP Proximal Tibia Plates Holes Length (mm) 240.036 4 82 240.037 4 82 240.038 6 118 240.039 6 118 240.040 8 154 240.041 8 154 240.042 10 190 240.043 10 190 240.044 12 226 240.045 12 226 240.046 14 262 240.047 14 262 Implants in set 01.123.604 4.5 mm Titanium LCP Proximal Tibia Plates Holes Length (mm) 440.036 4 82 440.037 4 82 440.038 6 118 440.039 6 118 440.040 8 154 440.041 8 154 440.042 10 190 440.043 10 190 440.044 12 226 440.045 12 226 440.046 14 262 440.047 14 262

right left right left right left right left right left right left

right left right left right left right left right left right left

Available nonsterile or sterile-packed. Add "S" to catalog number to order sterile product.

Synthes

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4.5 mm LCP Proximal Tibia Plate Implant Sets Stainless Steel (105.222) and Titanium (01.123.604) continued

Required Set 01.240.201 Periarticular LCP Plating System with 5.0 mm Locking Screws or 01.240.209 Periarticular LCP Plating System with 4.0 mm Locking Screws Recommended Additional Sets 01.223.604 Periarticular LCP Plating System Instrument and Titanium Screw Set 01.240.401 Periarticular LCP Plating System, with 5.0 mm Titanium Locking Screws 01.240.409 Periarticular LCP Plating System, with 4.0 mm Titanium Locking Screws 102.91 General Instrument Set 102.93 Interchangeable Gouge, Chisel and Impactor Set 105.04 4.5 mm Cannulated Screw Instrument and Implant Set 105.190 6.5 mm / 7.3 mm Combined Cannulated Screw Instrument and Implant Set 105.90 Bone Forceps Set 105.909 Periarticular Reduction Forceps Set 115.400 Large Fragment LCP Instrument and Implant Set, with 4.0 mm and 5.0 mm locking screws 115.700 Large Distractor Set 115.86 Pelvic Reduction Instrument Set 145.190 6.5 mm/7.3 mm Combined Titanium Cannulated Screw Instrument and Implant Set 145.400 Large Fragment LCP Instrument and Titanium Implant set, with 4.0 mm and 5.0 mm locking screws Also Available (sterile only) 4.5 mm LCP Proximal Tibia Plates Holes Length (mm) 240.048S 16 298 240.049S 16 298 240.052S 18 334 240.053S 18 334 240.054S 20 370 240.055S 20 370

right left right left right left

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Periarticular LCP Plating System, with 5.0 mm Locking Screw (01.240.201)

Graphic Cases and Screw Racks 60.240.201 Locking Periarticular Plating System Graphic Case 60.240.203 Screw Rack, for 4.5 mm Cortex Screws 60.240.204 Screw Rack, for 5.0 mm Locking Screws, with T25 StarDrive Recess 60.240.205 Screw Rack, for 5.0 mm and 7.3 mm Cannulated Locking Screws and 7.3 mm Conical Screws 60.240.206 Screw Rack, for 5.0 mm Cannulated Conical Screws 60.240.208 Locking Periarticular Plating System Instrument Tray Instruments 292.652 03.010.150 03.010.151 310.243 310.31 310.431 310.44 310.632 310.634 310.99 311.44 311.449 311.46 312.449 312.48 313.93 314.05 314.11 314.23

2.0 mm Non-Colored Threaded Guide Wire, 230 mm, spade point, 10 ea. Star / HexDrive Screwdriver, T25 / 3.5 mm hexagonal, self-retaining Star / HexDrive Screwdriver Shaft, T25 / 3.5 mm hexagonal, self-retaining, 165 mm 2.5 mm Drill Tip Guide Wire, 200 mm, 10 ea. 3.2 mm Drill Bit, quick coupling, 145 mm 4.3 mm Drill Bit, quick coupling, 180 mm, for 5.0 mm Locking Screws 4.5 mm Drill Bit, quick coupling, 145 mm 5.0 mm Cannulated Drill Bit, quick coupling, 200 mm (short flute) 4.3 mm Cannulated Drill Bit, quick coupling, 200 mm (long flute) Countersink, for 4.5 mm and 6.5 mm screws T-Handle, with quick coupling Push-Pull Reduction Device, for use with 4.5 mm LCP plates, 2 ea. Tap for 4.5 mm Screws 4.3 mm Threaded Drill Guide, 4 ea. 4.5 mm / 3.2 mm Insert Drill Sleeve Solid Hexagonal Screwdriver, 4.0 mm width across flats Cannulated Hexagonal Screwdriver, 4.0 mm width across flats Holding Sleeve Cannulated Hexagonal Screwdriver Shaft, 4.0 mm width across flats

Synthes 23

Periarticular LCP Plating System, with 5.0 mm Locking Screw (01.240.201) continued

Instruments continued 319.10 Depth Gauge, for 4.5 mm and 6.5 mm screws 319.24 2.9 mm Cleaning Brush 319.461 2.5 mm Cleaning Stylet 319.701 Cannulated Screw Measuring Device 321.12 Articulated Tension Device 321.16 Combination Wrench, 11 mm width across flats 323.46 4.5 mm Universal Drill Guide 324.174 2.5 mm Wire Guide, for 5.0 mm screws, 5 ea. 324.175 2.5 mm Wire Guide, for 7.3 mm screws, 2 ea. 324.176 3.2 mm Drill Guide, for 4.0 mm screws, 2 ea. 338.49 Large Quick Coupling 397.706 Handle, for AO Reaming Coupler Connection 511.774 Torque Limiting Attachment, 4 Nm, for AO Reaming Coupler Implants 4.5 mm Cortex Screws, self-tapping Length (mm) Qty. 214.814 14 4 214.844 214.816 16 4 214.846 214.818 18 4 214.848 214.820 20 4 214.850 214.822 22 4 214.852 214.824 24 4 214.854 214.826 26 6 214.856 214.828 28 6 214.858 214.830 30 6 214.860 214.832 32 6 214.862 214.834 34 6 214.864 214.836 36 6 214.866 214.838 38 6 214.868 214.840 40 6 214.870 214.842 42 6

Length (mm) 44 46 48 50 52 54 56 58 60 62 64 66 68 70

Qty. 4 2 2 2 2 2 2 2 2 2 2 2 2 2

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Implants continued 5.0 mm Periprosthetic Locking Screws, self-tapping, with T25 StarDrive recess Length (mm) Length (mm) 02.221.508 8 02.221.512 12 02.221.510 10 5.0 mm Locking Screws, self-tapping, with T25 StarDrive recess Length Length (mm) Qty. (mm) Qty. 212.201 14 4 212.215 42 6 212.202 16 4 212.216 44 2 212.203 18 4 212.217 46 2 212.204 20 4 212.218 48 2 212.205 22 4 212.219 50 2 212.206 24 4 212.220 55 2 212.207 26 6 212.221 60 2 212.208 28 6 212.222 65 2 212.209 30 6 212.223 70 2 212.210 32 6 212.224 75 2 212.211 34 6 212.225 80 2 212.212 36 6 212.226 85 2 212.213 38 6 212.227 90 2 212.214 40 6

Available nonsterile or sterile-packed. Add "S" to catalog number to order sterile product.

Synthes

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Periarticular LCP Plating System, with 5.0 mm Locking Screw (01.240.201) continued

Implants continued 5.0 mm Cannulated Locking Screws Length (mm) Qty. 02.205.025 25 2 02.205.090 02.205.030 30 2 02.205.095 02.205.035 35 2 02.205.100 02.205.040 40 2 02.205.105 02.205.045 45 2 02.205.110 02.205.050 50 2 02.205.115 02.205.055 55 4 02.205.120 02.205.060 60 4 02.205.125 02.205.065 65 4 02.205.130 02.205.070 70 4 02.205.135 02.205.075 75 4 02.205.140 02.205.080 80 4 02.205.145 02.205.085 85 4 5.0 mm Cannulated Conical Screws, 2 ea. Length (mm) 02.205.240 40 02.205.270 02.205.245 45 02.205.275 02.205.250 50 02.205.280 02.205.255 55 02.205.285 02.205.260 60 02.205.290 02.205.265 65 02.205.295 7.3 mm Cannulated Locking Screws, 2 ea. Length (mm) 02.207.020 20 02.207.085 02.207.025 25 02.207.090 02.207.030 30 02.207.095 02.207.035 35 02.207.100 02.207.040 40 02.207.105 02.207.045 45 02.207.110 02.207.050 50 02.207.115 02.207.055 55 02.207.120 02.207.060 60 02.207.125 02.207.065 65 02.207.130 02.207.070 70 02.207.135 02.207.075 75 02.207.140 02.207.080 80 02.207.145

Length (mm) 90 95 100 105 110 115 120 125 130 135 140 145

Qty. 2 2 2 2 2 2 2 2 2 2 2 2

Length (mm) 70 75 80 85 90 95

Length (mm) 85 90 95 100 105 110 115 120 125 130 135 140 145

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Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Implants continued 7.3 mm Cannulated Conical Screws Length (mm) 02.207.250 50 02.207.275 02.207.255 55 02.207.280 02.207.260 60 02.207.285 02.207.265 65 02.207.290 02.207.270 70 02.207.295

Length (mm) 75 80 85 90 95

7.3 mm Cannulated Conical Screws, partially threaded Length (mm) Length (mm) 02.207.450 50 02.207.475 75 02.207.455 55 02.207.480 80 02.207.460 60 02.207.485 85 02.207.465 65 02.207.490 90 02.207.470 70 02.207.495 95 222.578 5.0 mm Screw Nut, 2 ea.

Also Available 5.0 mm Periprosthetic Locking Screws, self-tapping, with T25 StarDrive recess Length (mm) 02.221.514 14 02.221.518 18 292.20 311.66 312.67 394.35 397.705 398.81 398.813 511.761 511.771 60.240.207 2.0 mm Kirschner Wire, 150 mm, trocar point Tap for 6.5 mm Cancellous Bone Screws 6.5 mm / 3.2 mm Double Drill Sleeve Large Distractor Handle, quick coupling, for ComPact Air Drive Connection Bone Forceps Plate Holding Forceps with swivel foot Large Quick Coupling Torque Limiting Attachment, 4 Nm Screw Rack for 6.5 mm Cancellous Bone Screws

Available nonsterile or sterile-packed. Add "S" to catalog number to order sterile product.

Synthes

27

Periarticular LCP Plating System Instrument and Titanium Screw Set (01.223.604)

Graphic Case and Screw Racks 690.401 Graphic Case, for Titanium LCP Periarticular Plating System 690.402 Screw Rack, for 4.0 mm Titanium StarDrive Locking Screws 690.403 Screw Rack, for 5.0 mm Titanium Cannulated Conical and Locking Screws 690.404 Screw Rack, for 5.0 mm Titanium StarDrive Locking Screws 690.407 Screw Rack, for 4.5 mm Titanium and Stainless Steel Cortex Screws Instruments 310.243 2.5 mm Drill Tip Guide Wire, 200 mm, 8 ea. 310.632 5.0 mm Cannulated Drill Bit, quick coupling, 200 mm, 2 ea. 310.634 4.3 mm Cannulated Drill Bit, quick coupling, 200 mm, 2 ea. 313.93 Solid Hexagonal Screwdriver 314.05 Cannulated Hexagonal Screwdriver, 2 ea. 314.23 Cannulated Hexagonal Screwdriver Shaft 319.24 2.9 mm Cleaning Brush 319.461 2.5 mm Cleaning Stylet 319.701 Cannulated Screw Measuring Device 324.174 2.5 mm Wire Guide, for 5.0 mm screws, 4 ea. 324.176 3.2 mm Drill Guide, for 4.0 mm screws, 2 ea. 338.49 Large Quick Coupling Implants 4.0 mm Titanium Locking Screws, self-tapping, with T25 StarDrive recess Length (mm) Qty. 04.204.014 14 2 04.204.038 04.204.016 16 2 04.204.042 04.204.018 18 2 04.204.046 04.204.022 22 3 04.204.050 04.204.026 26 3 04.204.054 04.204.030 30 3 04.204.058 04.204.034 34 3 04.204.062

Length (mm) 38 42 46 50 54 58 62

Qty. 3 3 3 3 3 2 2

28

Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

Implants continued 5.0 mm Titanium Cannulated Locking Screws Length Length (mm) Qty. (mm) 04.205.025 25 2 04.205.065 65 04.205.030 30 2 04.205.070 70 04.205.035 35 2 04.205.075 75 04.205.040 40 2 04.205.080 80 04.205.045 45 2 04.205.085 85 04.205.050 50 2 04.205.090 90 04.205.055 55 2 04.205.095 95 04.205.060 60 2 5.0 mm Titanium Cannulated Conical Screws Length (mm) Qty. 04.205.240 40 2 04.205.270 04.205.245 45 2 04.205.275 04.205.250 50 2 04.205.280 04.205.255 55 2 04.205.285 04.205.260 60 2 04.205.290 04.205.265 65 3 04.205.295

Qty. 4 4 4 4 4 3 3

5.0 mm Titanium Locking Screws, self-tapping, with T25 StarDrive recess Length (mm) Qty. 412.201 14 2 412.213 412.202 16 2 412.215 412.203 18 2 412.217 412.205 22 3 412.219 412.207 26 3 412.220 412.209 30 3 412.221 412.211 34 3 412.222 422.578

Length (mm) 38 42 46 50 55 60 65

Qty. 3 3 3 3 3 2 2

5.0 mm Titanium Screw Nut, 2 ea.

Length (mm) 70 75 80 85 90 95

Qty. 3 3 3 3 2 2

Also Available 338.002 2.5 mm Drill Tip Guide Wire with 12 mm thread, 300 mm 412.223 ­ 5.0 mm Titanium Locking Screws, 412.227 70 mm ­ 90 mm (5 mm increments)

Synthes

Synthes (USA) 1302 Wrights Lane East West Chester, PA 19380 Telephone: (610) 719-5000 To order: (800) 523-0322 Fax: (610) 251-9056

© 2005 Synthes, Inc. or its affiliates. All rights reserved.

Synthes (Canada) Ltd. 2566 Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) 567-0440 To order: (800) 668-1119 Fax: (905) 567-3185

www.synthes.com

Printed in U.S.A. 11/08 J4053-G

Combi, DCP, LC-DCP, LCP and Synthes are trademarks of Synthes, Inc. or its affiliates.

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4.5 mm LCP Proximal Tibia Plates TG

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