MatrixRIB. Stable fixation of normal and osteoporotic ribs.

Transcription

1 MatrixRIB. Stable fixation of normal and osteoporotic ribs. Technique Guide CMF Matrix

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3 Table of Contents Introduction MatrixRIB 2 AO Principles 4 Indications 5 Surgical Technique Patient Positioning 5 Plating Rib 6 Splint Insertion 16 Product Information Implants 24 Instruments 25 Sets 29 Bibliography 37 Synthes In the Service of Health 38 Warning This description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling this product is highly recommended. Reprocessing, Care and Maintenance of Synthes Instruments For general guidelines, function control and dismantling of multipart instruments please refer to: Synthes 1

4 MatrixRIB. Stable fixation of normal and osteoporotic ribs. The Synthes MatrixRIB Fixation System consists of precontoured locking plates, locking screws, and intramedullary splints for the fixation and stabilization of ribs. Although some rib fractures are treated with pain management and bracing, as well as endotracheal intubation and mechanical ventilation if necessary, some patients could benefit from surgical stabilization (osteosynthesis). There are several potential benefits of surgical stabilization of rib fractures. These include reduced mortality and increased cost effectiveness due to a reduced duration of mechanical ventilation support, shortened ICU stays, and less complications. Patients could also benefit from preserved pulmonary function, improved pain control, better clearance of secretions through efficient cough, minimized chest wall deformities resulting from trauma and shorter back to work time. 1,2,3,4 Right plates Locking holes In-plane radius R3 R4-5 R6-7 Longitudinal Twist R8-9 Features Designed to be used without removing periosteum, to maximize blood supply to the bone All implants are manufactured from titanium alloy* for flexibility and strength Drill bit with stop to prevent over-drilling Self-retaining screwdriver blades Locking screws Screws work with self-retaining screwdriver blades to reduce camout Locking design for stable construct One screw diameter for use with all plates and splints * Ti-6Al-7Nb 1 Ahmed Z, Mohyuddin Z, 1995, Engel C, et al., 2005, Lardinois D, et al., 2001, Tanaka H, et al., 2002, Synthes MatrixRIB Technique Guide

5 Locking plates Plates are precontoured to fit an average rib shape, which minimizes intraoperative bending 5 Locking plate construct provides stable fixation Low-profile 1.5 mm thick plates Plates are color-coded to distinguish left and right designs Plates are etched on medial end to indicate the corresponding rib A universal plate with 8 holes is available R3 rib 3 rib 4 rib 3 rib 4 L3 R4-5 rib 5 rib 5 L4-5 rib 6 R6-7 rib 7 rib 8 R8-9 rib 9 rib 6 rib 7 rib 8 rib 9 L6-7 L8-9 Left plates L3 Etching Out of plane radius L4-5 L6-7 Tubular radius L8-9 Intramedullary splints Intramedullary splints allow less invasive procedures Three widths available (3 mm, 4 mm, 5 mm) Only one screw needed to secure splint 5 Mohr M, et al., 2007, Synthes 3

6 AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation. 6 These principles, as applied to the MatrixRIB Fixation system, are: Anatomic reduction Fracture reduction and fixation to restore anatomical relationships. A comprehensive implant and instrument selection addresses most simple and complex fixation needs. Stable fixation Stability by rigid fixation or splintage, as the personality of the fracture and the injury requires. The MatrixRIB plate and screw locking technology are optimized to achieve stable bone fixation. Preservation of blood supply Preservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques. Instrumentation, with rounded plate profiles and edges, preserve vascular blood flow for bone healing. Early, active mobilization Early and safe mobilization of the body part and patient. The MatrixRIB implants, combined with AO technique, provide stable fixation to allow functional aftercare. 6 Müller ME, Allgöwer M, Schneider R, Willenegger H, Synthes MatrixRIB Technique Guide

7 Indications The Synthes MatrixRIB Fixation System is indicated for the fixation and stabilization of rib fractures, fusions and osteotomies of normal and osteoporotic bone. Patient Positioning Position the patient to optimize access to the rib to be repaired. For pure lateral chest injuries, a lateral thoracotomy may be used with the patient in a lateral decubitus position, and the arms abducted 90 on padded arm rests. Anterolateral chest injuries may be approached with an anterolateral thoracotomy with the patient in a supine position, with both arms abducted 90. Synthes 5

8 Plating Rib 1 Expose fractured rib Make an incision over the fracture area. Expose the rib to allow a minimum of three screws on each side of the fracture. Remove any nonviable bone. Caution: Avoid significant muscle division to preserve as much respiratory function as possible. The serratus anterior muscle insertions on the chest wall are generally the only muscle fibers that are divided for anterolateral injuries. Notes For lateral chest wall injuries, the anterior aspect of the latissimus dorsi can be dissected to gain access to the fracture. Removal of the periosteum is not required. 6 Synthes MatrixRIB Technique Guide

9 2 Determine rib thickness Instrument Calliper Optional instrument Universal Calliper Make a small incision in the intercostal space at the superior border of the rib to allow insertion of the calliper tip. Insert the calliper tip through the incision and determine the rib thickness. Note: If an existing access into the intercostal space is available for determining the rib thickness, it is recommended to insert the calliper tip using the existing access. To select the appropriate drill bit with stop and the appropriate screw length, add 2 mm to allow for the plate thickness. Caution: Take care to avoid damaging the nerve and vessel bundle at the inferior border of the rib. Synthes 7

10 Plating Rib 3 Approximate broken rib segments Instrument Reduction Forceps with Points, narrow, ratchet lock, length 132 mm Use the forceps to approximate the broken rib segments. 4 Cut and contour plate template Instrument MatrixRIB Bending Template for Rib Plates Cut the bending template to a length that allows placement of a minimum of three screws on each side of the fracture. Contour the template to the rib. 8 Synthes MatrixRIB Technique Guide

11 5 Select and cut plate Instrument Plate and Rod Cutter Use the plate template contoured in step 4 to select the best matching plate. Notes Position the precontoured plate with the etching toward the sternum. A universal plate is available for use in place of a precontoured plate (see implants on page 24). If necessary, cut the plate to the desired length. Caution: Use a minimum of three screws on each side of the fracture, to properly secure the plate. Synthes 9

12 Plating Rib 6 Contour plate Instrument Bending Pliers with Nose, for Pure Titanium Plates 2.4 and 2.7 If contouring is necessary, use the bending pliers, contour the plate to match the template. Caution: Avoid sharp bends, reverse bends, or bending the implant at a screw hole. Avoid notching or scratching the implant. These factors may produce internal stresses which may become the focal point for eventual breakage of the implant. 10 Synthes MatrixRIB Technique Guide

13 7 Position plate Instrument MatrixRIB Plate Holding Forceps, small Optional instruments MatrixRIB Plate Holding Forceps, small, with ball tip MatrixRIB Plate Holding Forceps, large, with ball tip Position the plate on the rib over the fracture, allowing a minimum of three screws on each side of the fracture. Verify the contour of the plate matches the rib. Using the plate holding forceps, hold the plate on the rib. Caution: It is recommended to insert the forceps from the superior border of the rib to avoid damaging the nerve and vessel bundle located at the inferior border of the rib. Synthes 11

14 Plating Rib 8 Drill Instruments MatrixRIB Drill Guide 2.2 for Plates MatrixRIB Drill Bits 2.2 mm with stop, length 135, 6 mm to 14 mm, 2 flute, for J-latch Coupling Thread the drill guide into the plate. This will help ensure safe drilling and alignment of the drill hole with the plate hole. Select the drill bit with stop as determined in step 2 and drill. Drill bits with stop are available with stop lengths ranging from 6 mm to 14 mm, in 2 mm increments, matching the locking screw lengths. Note: Irrigate during drilling to avoid thermal damage to the bone. Caution: Do not drill any deeper than necessary, to avoid the risk of pneumothorax. Remove the 2.2 drill guide after drilling. 12 Synthes MatrixRIB Technique Guide

15 9 Select and insert first screw Instruments Depth Gauge for Sternal Cable Screwdriver Shaft MatrixMANDIBLE, medium, self-holding, for Hexagonal Coupling Ratcheting Screwdriver Handle, with Hexagonal Coupling Optional instrument Screwdriver Shaft MatrixMANDIBLE, long, self-holding, for Hexagonal Coupling Use the depth gauge through the plate to confirm the appropriate screw length determined in step 2. Caution: Do not extend the tip of the depth gauge too far beyond the posterior cortex of the rib. Synthes 13

16 Plating Rib Select the proper length screw. Caution: The screw should be no longer than necessary to engage the posterior cortex, to avoid deeper injury. The tip of the screw should not extend more than 1 mm beyond the posterior cortex. The screw length indicator on the module can be used to select the appropriate screws. Insert the locking screw through the plate and tighten until secure. Optionally, a 6 mm nonlocking screw is available to ensure the plate sits flush with the bone. This nonlocking screw is a temporary fixation and will need to be replaced with a locking screw before closure. 14 Synthes MatrixRIB Technique Guide

17 10 Drill and place remaining screws Verify proper reduction of the fracture. Insert a second screw on the opposite side of the fracture following steps 8 and 9. Insert remaining screws in the same manner. Synthes 15

18 Splint Insertion Intramedullary splints improve the ability to fix posterior rib fractures. The intramedullary splints have a rectangular profile for rotational stability within the canal, and a locking feature to prevent migration and rotation of the implant. Intramedullary splints Intramedullary splints allow less invasive procedures Three widths available (3 mm, 4 mm, 5 mm) Only one screw needed to secure splint 1 Expose fractured rib Make incisions over the fractured area. Expose the fractured rib to allow splint head placement. A minimum of 50 mm on the medial side of the fracture is recommended. Remove any nonviable bone. Notes It is recommended to minimize the dissection of the soft tissue on the lateral side of the fracture. Removal of the periosteum is not recommended. Caution: Avoid significant muscle division to preserve as much respiratory function as possible. 16 Synthes MatrixRIB Technique Guide

19 Determine rib thickness Instrument Calliper Optional instrument Universal Calliper Make a small incision in the intercostal space at the superior border of the rib to allow insertion of the calliper tip. Insert the calliper tip through the incision and determine the rib thickness. Note: If an existing access into the intercostal space is available for determining the rib thickness, it is recommended to insert the calliper tip using the existing access. To select the appropriate drill bit with stop and the appropriate screw length, add 1 mm to allow for the plate thickness. Caution: Take care to avoid damaging the nerve and vessel bundle at the inferior border of the rib. Synthes 17

20 Splint Insertion 3 Prepare splint insertion hole Instruments MatrixRIB Drill Guide 5.5 for Intramedullary Splint Insertion MatrixRIB Drill Bit 5.5 mm with Stop, length 125 mm, 2-flute, for J-Latch Coupling MatrixRIB Plate Holding Forceps, small Optional instruments MatrixRIB Intramedullary Splint Driver Drill Guide 5.5, for MatrixRIB Intramedullary Splints, without Handle Insert the hook end of the drill guide into the intramedullary canal of the medial segment until it is seated fully on the rib. Notes It is recommended to insert the hook near the superior edge of the rib, and to drill an entry hole in the upper 2 3 of the rib. The small plate holding forceps can be used to clamp down the 5.5 splint drill guide during drilling. Caution: If the drill guide without handle is used, ensure the tapered end, labeled Fracture, is aligned with the fracture to ensure the hole is approximately 30 mm from the fracture line. Note: The splint driver may be threaded into the drill guide to act as handle, as needed. Ensure the medial end of the drill guide contacts the bone. Using the 5.5 mm drill bit with stop, drill monocortically. 18 Synthes MatrixRIB Technique Guide

21 Remove the drill guide and verify the hole is approximately 30 mm from the fracture line. Notes Ensure the lateral fracture segment is long enough to accommodate the insertion length of the splint before drilling. Irrigate during drilling to avoid thermal damage to the bone. Synthes 19

22 Splint Insertion 4 Select splint Instruments MatrixRIB Intramedullary Splint Driver MatrixRIB Template for Intramedullary Splint, small MatrixRIB Template for Intramedullary Splint, medium Mallet Reduction Forceps with Points, narrow, ratchet lock, length 132 mm The splint template is used to prepare the canal and select the correct size of splint. It is recommended to start with the small template before using the medium template. Thread the splint driver into the splint template and fully insert the template into the insertion hole prepared in step 3. Remove the splint template. Fully insert the template into the canal of the lateral fracture segment. Remove the splint template. Notes If the small template fits snugly, use the 3 mm wide splint. If the medium template fits snugly, use the 4 mm wide splint. If the medium template fits loosely, use the 5 mm wide splint. The mallet can be used to assist insertion of the splint template, if needed. Use bone reduction forceps to hold the rib segment during splint template insertion. 20 Synthes MatrixRIB Technique Guide

23 5 Insert splint Instruments MatrixRIB Intramedullary Splint Driver Mallet Reduction Forceps with Points, narrow, ratchet lock, length 132 mm Thread the splint driver into the splint selected in step 4 with the splint markings facing up towards the handle. Insert the splint through the insertion hole prepared in step 3. Drive the splint across the fracture line and into the canal of the lateral segment. The splint is fully inserted when the head of the splint rests flush on the outside of the rib. Remove the splint driver after the splint is fully seated. Caution: To prevent additional injuries to the rib, do not insert the splint head further once it is seated in the insertion hole. Note: The mallet can be used to assist insertion of the splint, if needed. Synthes 21

24 Splint Insertion 6 Drill screw hole Instruments MatrixRIB Drill Guide 2.2 for Plates MatrixRIB Drill Bits 2.2 mm with Stop, length 135, 6 mm to 14 mm, 2 flute, for J-latch Coupling Thread the drill guide into the splint. This will help ensure safe drilling and alignment of the screw with the splint locking hole. Select the drill bit with stop as determined in step 2 and drill. Drill bits with stop are available with stop lengths ranging from 6 mm to 14 mm, in 2 mm increments, matching the locking screw lengths. Note: Irrigate during drilling to avoid thermal damage to the bone. Caution: Do not drill any deeper than necessary, to avoid the risk of pneumothorax. Remove the 2.2 drill guide after drilling. 22 Synthes MatrixRIB Technique Guide

25 7 Select and insert screw Instruments Depth Gauge Screwdriver Shaft MatrixMANDIBLE, medium, self-holding, for Hexagonal Coupling Ratcheting Screwdriver Handle Optional instruments Screwdriver Shaft MatrixMANDIBLE, long, self-holding, for Hexagonal Coupling Universal Calliper Use the depth gauge through the splint to confirm the screw length determined in step 2. Caution: Do not extend the tip of the depth gauge too far beyond the posterior cortex of the rib. Select the proper length screw. Caution: The screw should be no longer than necessary to engage the posterior cortex, to avoid deeper injury. The tip of the screw should not extend more than 1 mm beyond the posterior cortex. The screw length indicator on the module can be used to select the appropriate screws. Insert the locking screw through the splint and tighten until secure. Synthes 23

26 Implants MatrixRIB Pre-Contoured Plates, Titanium Alloy (TAN)* holes, for left rib holes, for right rib holes, for left ribs 4 and holes, for right ribs 4 and holes, for left ribs 6 and holes, for right ribs 6 and holes, for left ribs 8 and holes, for right ribs 8 and 9 Left plate (light blue) Right plate (rose red) MatrixRIB Universal Plate, 8 holes, Titanium Alloy (TAN)* MatrixRIB Intramedullary Splints, Titanium Alloy (TAN)* Small, 3 mm width Medium, 4 mm width Large, 5 mm width MatrixRIB LOCK Screws, 2.9 mm, self-tapping, Titanium Alloy (TAN)** (in 2 mm increments) mm 14 mm MatrixRIB NON-LOCK Screw 2.9 mm**, self-tapping, length 6 mm, Titanium Alloy (TAN) ** For sterile plates and splints add suffix S ** For screws in packs of 5, add suffix.05 ; for sterile screws add suffix.01s 24 Synthes MatrixRIB Technique Guide

27 Instruments Depth Gauge for Sternal Cable MatrixRIB Plate Holding Forceps, small, with ball tip MatrixRIB Plate Holding Forceps, large, with ball tip MatrixRIB Intramedullary Splint Driver MatrixRIB Drill Guide 2.2 for Plates MatrixRIB Drill Bits 2.2 mm with stop, length 135, 6 mm to 14 mm, 2 flute, for J-latch coupling Synthes 25

28 Instruments MatrixRIB Drill Guide 5.5 for Intramedullary Splint Insertion MatrixRIB Template for Intramedullary Splint, small MatrixRIB Template for Intramedullary Splint, medium Calliper Mallet MatrixRIB Drill Bit 5.5 mm with Stop, length 125 mm, 2-flute, for J-Latch Coupling MatrixRIB Plate Holding Forceps, small 26 Synthes MatrixRIB Technique Guide

29 MatrixRIB Bending Template for Rib Plates Universal Calliper Drill Guide 5.5, for MatrixRIB Intramedullary Splints, without Handle Screwdriver Shaft MatrixMANDIBLE, self-holding, for Hexagonal Coupling medium long Ratcheting Screwdriver Handle, with Hexagonal Coupling Bending Pliers with Nose, for Pure Titanium Plates 2.4 and 2.7 Synthes 27

30 Instruments Cutting Pliers for Plates and Rods Reduction Forceps with Points, narrow, ratchet lock, length 132 mm 28 Synthes MatrixRIB Technique Guide

31 MatrixRIB Fixation System Set ( ) Graphic Case Graphic Case, with Lid, for MatrixRIB Fixation System Length Marker, black Type Type Type Type Type 14 Art. No. Quantity Depth Gauge MatrixRIB Plate Holding Forceps, 2 small, with ball tip MatrixRIB Plate Holding Forceps, 2 large, with ball tip MatrixRIB Intramedullary Splint Driver MatrixRIB Drill Guide 2.2 for Plates MatrixRIB Drill Bit 2.2 mm with 2 Stop, length 135/6 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm with 2 Stop, length 135/8 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm with 2 Stop, length 135/10 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm with 2 Stop, length 135/12 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm with 2 Stop, length 135/14 mm, 2-flute, MatrixRIB Drill Guide 5.5 for 1 Intramedullary Splint Insertion Art. No. Quantity MatrixRIB Template for 1 Intramedullary Splint, small MatrixRIB Template for 1 Intramedullary Splint, medium Calliper Mallet MatrixRIB Drill Bit 5.5 mm with 2 Stop, length 125 mm, 2-flute, MatrixRIB Plate Holding Forceps, small MatrixRIB Bending Template 2 for Rib Plates Screwdriver Shaft MatrixMANDIBLE, 2 medium, self-holding, for Hexagonal Coupling Screwdriver Shaft MatrixMANDIBLE, 2 long, self-holding, for Hexagonal Coupling Ratcheting Screwdriver Handle, 2 with Hexagonal Coupling Bending Pliers with Nose 1 for Pure Titanium Plates 2.4 and Cutting Pliers for Plates and Rods Reduction Forceps with Points, 2 narrow, ratchet lock, length 132 mm Synthes 29

32 MatrixRIB Fixation System Set ( ) Art. No. Quantity MatrixRIB Precontoured Plate, 2 left, for Rib No. 3, 15 holes, Titanium Alloy (TAN)* MatrixRIB Precontoured Plate, 2 right, for Rib No. 3, 15 holes, Titanium Alloy (TAN)* MatrixRIB Precontoured Plate, 2 left, for Ribs No. 4 and 5, 16 holes, Titanium Alloy (TAN)* MatrixRIB Precontoured Plate, 2 right, for Ribs No. 4 and 5, 16 holes, Titanium Alloy (TAN)* MatrixRIB Precontoured Plate, 2 left, for Ribs No. 6 and 7, 17 holes, Titanium Alloy (TAN)* MatrixRIB Precontoured Plate, right, 2 for Ribs No. 6 and 7, 17 holes, Titanium Alloy (TAN)* MatrixRIB Precontoured Plate, left, 2 for Ribs No. 8 and 9, 18 holes, Titanium Alloy (TAN)* MatrixRIB Precontoured Plate, right, 2 for Ribs No. 8 and 9, 18 holes, Titanium Alloy (TAN)* MatrixRIB Universal Plate, 8 holes, 4 Titanium Alloy (TAN)* MatrixRIB Intramedullary Splint, 6 small, width 3 mm, Titanium Alloy (TAN)* MatrixRIB Intramedullary Splint, 6 medium, width 4 mm, Titanium Alloy (TAN)* Art. No. Quantity MatrixRIB Intramedullary Splint, large, 6 width 5 mm, Titanium Alloy (TAN)* MatrixRIB LOCK Screw 2.9 mm, 15 self-tapping, length 6 mm, Titanium Alloy (TAN) ** MatrixRIB LOCK Screw 2.9 mm, 35 self-tapping, length 8 mm, Titanium Alloy (TAN) ** MatrixRIB LOCK Screw 2.9 mm, 35 self-tapping, length 10 mm, Titanium Alloy (TAN) ** MatrixRIB LOCK Screw 2.9 mm, 15 self-tapping, length 12 mm, Titanium Alloy (TAN) ** MatrixRIB LOCK Screw 2.9 mm, 10 self-tapping, length 14 mm, Titanium Alloy (TAN) ** MatrixRIB NON-LOCK Screw mm, self-tapping, length 6 mm, Titanium Alloy (TAN) ** Also available MatrixMANDIBLE Screwdriver, 1 self-holding * For sterile plates and splints add suffix S ** For screws in a pack of 5, add suffix.05 ; for sterile screws, add suffix.01s 30 Synthes MatrixRIB Technique Guide

33 MatrixRIB Compact Plate and Splint System ( ) Compact Graphic Case MatrixRIB Compact Graphic Case (without Inserts) MatrixRIB Compact Splint System Art. No. Quantity MatrixRIB Plate Holding Forceps, 2 small, with ball tip MatrixRIB Intramedullary Splint Driver MatrixRIB Drill Guide 2.2 for Plates MatrixRIB Drill Bit 2.2 mm with 2 Stop, length 135/6 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm with 2 Stop, length 135/8 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm with 2 Stop, length 135/10 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm with 2 Stop, length 135/12 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm with 2 Stop, length 135/14 mm, 2-flute, Drill Guide 5.5, for MatrixRIB 1 Intramedullary Splints, without Handle MatrixRIB Template for 1 Intramedullary Splint, small MatrixRIB Template for 1 Intramedullary Splint, medium Universal Calliper Mallet MatrixRIB Compact Graphic Case, without tray MatrixRIB Compact Insert Tray, plate and splint Synthes 31

34 MatrixRIB Compact Plate and Splint System ( ) Art. No. Quantity MatrixRIB Drill Bit 5.5 mm 2 with Stop, length 125 mm, 2-flute, MatrixRIB Plate Holding Forceps, small Ratcheting Screwdriver Handle, 1 with Hexagonal Coupling Reduction Forceps with Points, 2 narrow, ratchet lock, length 132 mm MatrixRIB Bending Template 1 for Rib Plates MatrixRIB Universal Plate, 8 holes, 6 Titanium Alloy (TAN) MatrixRIB Intramedullary Splint, small, 2 width 3 mm, Titanium Alloy (TAN) MatrixRIB Intramedullary Splint, medium, 2 width 4 mm, Titanium Alloy (TAN) MatrixRIB Intramedullary Splint, large, 2 width 5 mm, Titanium Alloy (TAN) MatrixRIB LOCK Screw 2.9 mm, 2 self-tapping, length 6 mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 4 self-tapping, length 8 mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 4 self-tapping, length 10 mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 4 self-tapping, length 12mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 2 self-tapping, length 14mm, Titanium Alloy (TAN), pack of 5 units 32 Synthes MatrixRIB Technique Guide

35 MatrixRIB Compact Plate System ( ) Compact Graphic Case MatrixRIB Compact Graphic Case (without Inserts) MatrixRIB Compact Plate Only Insert Tray Art. No. Quantity MatrixRIB Plate Holding Forceps, 2 small, with ball tip MatrixRIB Drill Guide 2.2 for Plates MatrixRIB Drill Bit 2.2 mm 2 with Stop, length 135/6 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm 2 with Stop, length 135/8 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm 2 with Stop, length 135/10 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm 2 with Stop, length 135/12 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm 2 with Stop, length 135/14 mm, 2-flute, Universal Calliper Ratcheting Screwdriver Handle, 1 with Hexagonal Coupling Reduction Forceps with Points, 2 narrow, ratchet lock, length 132 mm MatrixRIB Bending Template 1 for Rib Plates MatrixRIB Compact Graphic Case, without tray MatrixRIB Compact Insert Tray, plate only Synthes 33

36 MatrixRIB Compact Plate System ( ) Art. No. Quantity MatrixRIB Universal Plate, 8 holes, 6 Titanium Alloy (TAN) MatrixRIB LOCK Screw 2.9 mm, 2 self-tapping, length 6 mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 4 self-tapping, length 8 mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 4 self-tapping, length 10 mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 4 self-tapping, length 12 mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 2 self-tapping, length 14 mm, Titanium Alloy (TAN), pack of 5 units 34 Synthes MatrixRIB Technique Guide

37 MatrixRIB Compact Splint System ( ) Compact Graphic Case MatrixRIB Compact Graphic Case (without Inserts) MatrixRIB Compact Splint System Art. No. Quantity MatrixRIB Intramedullary Splint Driver MatrixRIB Drill Guide 2.2 for Plates MatrixRIB Drill Bit 2.2 mm 2 with Stop, length 135/6 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm 2 with Stop, length 135/8 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm 2 with Stop, length 135/10 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm 2 with Stop, length 135/12 mm, 2-flute, MatrixRIB Drill Bit 2.2 mm 2 with Stop, length 135/14 mm, 2-flute, Drill Guide 5.5, for MatrixRIB 1 Intramedullary Splints, without Handle MatrixRIB Template for 1 Intramedullary Splint, small MatrixRIB Template for 1 Intramedullary Splint, medium Universal Calliper Mallet MatrixRIB Compact Graphic Case, without tray MatrixRIB Compact Insert Tray, plate and splint Synthes 35

38 MatrixRIB Compact Splint System ( ) Art. No. Quantity MatrixRIB Drill Bit 5.5 mm 2 with Stop, length 125 mm, 2-flute, MatrixRIB Plate Holding Forceps, small Ratcheting Screwdriver Handle, 1 with Hexagonal Coupling Reduction Forceps with Points, 2 narrow, ratchet lock, length 132 mm MatrixRIB Bending Template 1 for Rib Plates MatrixRIB Intramedullary Splint, small, 4 width 3 mm, Titanium Alloy (TAN) MatrixRIB Intramedullary Splint, medium, 4 width 4 mm, Titanium Alloy (TAN) MatrixRIB Intramedullary Splint, large, 4 width 5 mm, Titanium Alloy (TAN) MatrixRIB LOCK Screw 2.9 mm, 1 self-tapping, length 6 mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 2 self-tapping, length 8 mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 2 self-tapping, length 10 mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 2 self-tapping, length 12mm, Titanium Alloy (TAN), pack of 5 units MatrixRIB LOCK Screw 2.9 mm, 1 self-tapping, length 14mm, Titanium Alloy (TAN), pack of 5 units 36 Synthes MatrixRIB Technique Guide

39 Bibliography Ahmed Z, Mohyuddin Z (1995) Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 110(6): Engel C, Krieg JC, Madey SM, Long WB, Bottlang M (2005) Operative chest wall fixation with osteosynthesis plates. J Trauma. 58(1):181 6 Lardinois D, Krueger T, Dusmet M, Ghisleta N, Gugger M, Ris H (2001) Pulmonary function testing after operative stabilization of the chest wall for flail chest. Eur J Cardiothorac Surg, 20(3): Mohr M, Abrams E, Engel C, Long WB, Bottlang M (2007) Geometry of Human Ribs Pertinent to Orthopaedic Chest-Wall Reconstruction. J Biomech. 40(6): Müller ME, Allgöwer M, Schneider R, Willenegger H (1995) AO Manual of Internal Fixation. 3rd expandet and completly revised ed Berlin: Springer Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H, Matsuda H, Shimazaki S (2002) Surgical stabilization of internal pneumatic stabilization. A prospective randomized study of management of severe flail chest patients. J Trauma. 52(4):727 32; discussion 32 Synthes 37

40 Synthes In the Service of Health Synthes is an internationally leading company in medical technology. Over 10,000 Synthes employees worldwide are involved in serving the needs of surgeons, surgical support staff and patients. Synthes a company specializing in the field of osteosynthesis develops, produces and markets surgical instruments, implants, and biomaterials for the surgical treatment of bone fractures and reconstructions of the human skeleton and its associated soft tissue. The main goal of Synthes is to provide safe and highly advanced implants, surgical instruments and technologies that enable reliable operations, fast healing and a complaint-free life after surgery. We gua rantee high quality, continuous innovation and a focused customer orientation. AO A medically oriented nonprofit organization in the service of surgeons and patients Synthes works closely with the AO Foundation, and is licensee of the products bearing the brand name Synthes. AO stands for Arbeitsgemeinschaft für Osteosynthesefragen (Association for the Study of Internal Fixation). The foundation boasts more than 5,000 surgeons who participate in AO activities throughout the world one of the largest networks in the field of medicine. In the professional world, this surgeon-led, scientific nonprofit organization focused on treating bone fractures and diseases of the musculoskeletal system is a pioneer in research, documentation and development. The Technical Commission of the AO monitors the implementation of medical studies of new products, as a fully independent institution administered by health professionals. Only when it confirms the effectiveness and quality of a product does it award the seal of quality of the Synthes brand. Surgeons throughout the world place great trust in Synthes products because they know they have been carefully evaluated and tested. Yet even the best implants and instruments are useless if they are not used properly. AO International, the arm of the foundation responsible for training, annually organizes more than 160 AO courses throughout the world that offer practical exercises and discussions. Since the beginnings of the AO, experienced AO physicians have provided theoretical and practical training for more than 500,000 surgeons and more than 150,000 surgical support staff members. Synthes products are a familiar sight in nearly every operating room in the world. AO Foundation, Davos, Switzerland. The AO Foundation offers numerous training courses worldwide. 38 Synthes MatrixRIB Technique Guide

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44 All technique guides are available as PDF files at Ö öABöä AB /2010 Synthes, Inc. or its affiliates All rights reserved Synthes is a trademark of Synthes, Inc. or its affiliates