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

Transcription

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

2 Table of Contents Introduction 4.5 mm LCP Proximal Tibia Plates 2 AO Principles 4 Indications 5 Surgical Technique Preparation 6 Make Incision 7 Reduce Articular Surface 7 Attach Wire Guides 8 Determine Plate Position 9 Insert Proximal Screws 10 Reduce Shaft to Tibial Plateau 12 Insert Cortex Screws in Plate Shaft 14 Insert Locking Screws in Plate Shaft 15 Insert Locking Screw into Angled Plate Hole 16 Postoperative Treatment 18 Implant Removal 18 Product Information Implants 19 Set Lists 21 Image intensifier control Synthes

3 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. 2 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

4 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 Angled locking hole accepts the 5.0 mm cannulated locking screw and supports the medial fragment Three locking screw holes accept 5.0 mm cannulated locking or 5.0 mm cannulated conical screws 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 3

5 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 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

6 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 Synthes 5

7 Preparation 1 Preparation Required set Periarticular LCP Plating System with 5.0 mm Locking Screws or Periarticular LCP Plating System with 4.0 mm Locking Screws Optional sets 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 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. 6 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

8 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 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 7

9 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. 4 Attach wire guides Instruments mm Drill Tip Guide Wire, 200 mm 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. 8 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

10 Determine Plate Position 5 Determine plate position Instruments mm Non-Colored Threaded Guide Wire 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 9

11 Insert Proximal Screws 6 Insert proximal screws Instruments 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. 10 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

12 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 11

13 Reduce Shaft to Tibial Plateau 7 Reduce shaft to tibial plateau Instrument 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. 12 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

14 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 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 Incorrect Synthes 13

15 Insert Cortex Screws in Plate Shaft 8 Insert 4.5 mm cortex screws in plate shaft Instruments Star/HexDrive Screwdriver, T25/3.5 mm hexagonal Star/ HexDrive Screwdriver Shaft, T25/ 3.5 mm hexagonal mm Drill Bit, quick coupling Depth Gauge mm Universal Drill Guide 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 ( and ) are not compatible with the LCP plates. Neutral Compression Measure for screw length using the depth gauge. Select and insert the appropriate length 4.5 mm cortex screw using the large hexagonal screwdriver. 14 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

16 Insert Locking Screws in Plate Shaft 9 Insert 4.0 mm or 5.0 mm locking screws in plate shaft Instruments Star/HexDrive Screwdriver, T25/3.5 mm hexagonal Star/ HexDrive Screwdriver Shaft, T25/ 3.5 mm hexagonal mm Drill Bit or mm Drill Bit Depth Gauge, for large screws mm Drill Guide, for 4.0 mm screws or mm Threaded Drill Guide Torque Limiting Attachment, 4 Nm or Torque Limiting Attachment, 4 Nm, for AO Reaming Coupler 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 15

17 Insert Locking Screw into Angled Plate Hole 10 Insert the 5.0 mm cannulated locking screw into the angled hole Instruments mm Drill Tip Guide Wire Cannulated Hexagonal Screwdriver Cannulated Screw Measuring Device 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. 16 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

18 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 mm Cleaning Brush 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 17

19 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. 18 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

20 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 Synthes 19

21 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. 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 4.4 mm core diameter 1.0 mm thread pitch 5.0 mm thread profile Threaded conical screw head 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. 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. 20 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

22 4.5 mm LCP Proximal Tibia Plate Implant Sets Stainless Steel ( ) and Titanium ( ) Graphic Case mm LCP Proximal Tibia Plate Set Graphic Case mm Titanium LCP Proximal Tibia Plate Set Graphic Case Implants in set mm LCP Proximal Tibia Plates Holes Length (mm) right left right left right left right left right left right left Implants in set mm Titanium LCP Proximal Tibia Plates Holes Length (mm) 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 21

23 4.5 mm LCP Proximal Tibia Plate Implant Sets Stainless Steel ( ) and Titanium ( ) continued Required Set Periarticular LCP Plating System with 5.0 mm Locking Screws or Periarticular LCP Plating System with 4.0 mm Locking Screws Recommended Additional Sets 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 General Instrument Set Interchangeable Gouge, Chisel and Impactor Set mm Cannulated Screw Instrument and Implant Set mm/ 7.3 mm Combined Cannulated Screw Instrument and Implant Set Bone Forceps Set Periarticular Reduction Forceps Set Large Fragment LCP Instrument and Implant Set, with 4.0 mm and 5.0 mm locking screws Large Distractor Set Pelvic Reduction Instrument Set mm/7.3 mm Combined Titanium Cannulated Screw Instrument and Implant Set 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) S right S left S right S left S right S left 22 Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

24 Periarticular LCP Plating System, with 5.0 mm Locking Screw ( ) Graphic Cases and Screw Racks Locking Periarticular Plating System Graphic Case Screw Rack, for 4.5 mm Cortex Screws Screw Rack, for 5.0 mm Locking Screws, with T25 StarDrive Recess Screw Rack, for 5.0 mm and 7.3 mm Cannulated Locking Screws and 7.3 mm Conical Screws Screw Rack, for 5.0 mm Cannulated Conical Screws Locking Periarticular Plating System Instrument Tray Instruments 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 mm Drill Tip Guide Wire, 200 mm, 10 ea mm Drill Bit, quick coupling, 145 mm mm Drill Bit, quick coupling, 180 mm, for 5.0 mm Locking Screws mm Drill Bit, quick coupling, 145 mm mm Cannulated Drill Bit, quick coupling, 200 mm (short flute) 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 mm Threaded Drill Guide, 4 ea 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

25 Periarticular LCP Plating System, with 5.0 mm Locking Screw ( ) continued Instruments continued Depth Gauge, for 4.5 mm and 6.5 mm screws mm Cleaning Brush mm Cleaning Stylet Cannulated Screw Measuring Device Articulated Tension Device Combination Wrench, 11 mm width across flats mm Universal Drill Guide mm Wire Guide, for 5.0 mm screws, 5 ea mm Wire Guide, for 7.3 mm screws, 2 ea mm Drill Guide, for 4.0 mm screws, 2 ea Large Quick Coupling Handle, for AO Reaming Coupler Connection Torque Limiting Attachment, 4 Nm, for AO Reaming Coupler Implants 4.5 mm Cortex Screws, self-tapping Length Length (mm) Qty. (mm) Qty Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

26 Implants continued 5.0 mm Periprosthetic Locking Screws, self-tapping, with T25 StarDrive recess Length (mm) Length (mm) mm Locking Screws, self-tapping, with T25 StarDrive recess Length Length (mm) Qty. (mm) Qty Available nonsterile or sterile-packed. Add S to catalog number to order sterile product. Synthes 25

27 Periarticular LCP Plating System, with 5.0 mm Locking Screw ( ) continued Implants continued 5.0 mm Cannulated Locking Screws Length Length (mm) Qty. (mm) Qty mm Cannulated Conical Screws, 2 ea. Length (mm) Length (mm) mm Cannulated Locking Screws, 2 ea. Length (mm) Length (mm) Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

28 Implants continued 7.3 mm Cannulated Conical Screws Length (mm) Length (mm) 7.3 mm Cannulated Conical Screws, partially threaded Length (mm) Length (mm) mm Screw Nut, 2 ea. Also Available 5.0 mm Periprosthetic Locking Screws, self-tapping, with T25 StarDrive recess Length (mm) mm Kirschner Wire, 150 mm, trocar point Tap for 6.5 mm Cancellous Bone Screws 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

29 Periarticular LCP Plating System Instrument and Titanium Screw Set ( ) Graphic Case and Screw Racks Graphic Case, for Titanium LCP Periarticular Plating System Screw Rack, for 4.0 mm Titanium StarDrive Locking Screws Screw Rack, for 5.0 mm Titanium Cannulated Conical and Locking Screws Screw Rack, for 5.0 mm Titanium StarDrive Locking Screws Screw Rack, for 4.5 mm Titanium and Stainless Steel Cortex Screws Instruments mm Drill Tip Guide Wire, 200 mm, 8 ea mm Cannulated Drill Bit, quick coupling, 200 mm, 2 ea mm Cannulated Drill Bit, quick coupling, 200 mm, 2 ea Solid Hexagonal Screwdriver Cannulated Hexagonal Screwdriver, 2 ea Cannulated Hexagonal Screwdriver Shaft mm Cleaning Brush mm Cleaning Stylet Cannulated Screw Measuring Device mm Wire Guide, for 5.0 mm screws, 4 ea mm Drill Guide, for 4.0 mm screws, 2 ea Large Quick Coupling Implants 4.0 mm Titanium Locking Screws, self-tapping, with T25 StarDrive recess Length Length (mm) Qty. (mm) Qty Synthes 4.5 mm LCP Proximal Tibia Plates Technique Guide

30 Implants continued 5.0 mm Titanium Cannulated Locking Screws Length Length (mm) Qty. (mm) Qty mm Titanium Cannulated Conical Screws Length Length (mm) Qty. (mm) Qty mm Titanium Locking Screws, self-tapping, with T25 StarDrive recess Length Length (mm) Qty. (mm) Qty mm Titanium Screw Nut, 2 ea. Also Available mm Drill Tip Guide Wire with 12 mm thread, 300 mm mm Titanium Locking Screws, mm 90 mm (5 mm increments) Synthes

31 Synthes (USA) 1302 Wrights Lane East West Chester, PA Telephone: (610) To order: (800) Fax: (610) Synthes (Canada) Ltd Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) To order: (800) Fax: (905) Synthes, Inc. or its affiliates. All rights reserved. Combi, DCP, LC-DCP, LCP and Synthes are trademarks of Synthes, Inc. or its affiliates. Printed in U.S.A. 11/08 J4053-G