Elbow Plating System Surgical Technique

Transcription

1 Locking Compression Technology by aap

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4 Disclaimer This surgical technique is exclusively intended for medical professionals, especially physicians, and therefore may not be regarded as a source of information for non-medical persons. The description of this surgical technique does not constitute medical advice or medical recommendations nor does it convey any diagnostic or therapeutic information on individual cases. Therefore, the attending physician is fully responsible for providing medical advice to the patient and obtaining the informed consent of the patient which this surgical technique does not supersede. The description of this surgical technique has been compiled by medical experts and trained staff of aap Implantate AG with utmost diligence and to the best of their knowledge. However, excludes any liability for the completeness, accuracy, currentness, and quality of the information as well as for material or immaterial damages arising from the use of this information. 2

5 Content Introduction Description Materials Indications / Contraindications Processing (Sterilization & Cleaning) Preoperative Planning Distal Humerus Plates Preoperative Planning Olecranon Plate Positioning Access Distal Humerus Access Olecranon Repositioning and primary fixation Inserting the Distal Medial Humerus Plate Inserting the Distal Dorsolateral Humerus Plate Inserting the Olecranon Plate Inserting screws Inserting standard screws (gold) Inserting locking screws (light blue) Compression-free locking with a LOQTEQ cortical screw 3.5mm (red) Interfragmentary compression with a LOQTEQ cortical screw 3.5mm (red) Explantation Assembly instructions, aiming arm Trays LOQTEQ Elbow Plates 2.7/3.5, Set of Implants LOQTEQ Small Fragment Set, Set of Instruments LOQTEQ Small Fragment, screw set, basic Case Study

6 Introduction The LOQTEQ combines the advantages of angular stability with anatomically preformed plates for stable fixation of complex fractures of the distal humerus and the proximal ulna. When necessary, diaphyseal/metaphyseal compression can be achieved using the gliding locking holes in the plate shaft. The LOQTEQ includes the following plates: - LOQTEQ Distal Dorsolateral Humerus Plate 2.7/3.5 - LOQTEQ Distal Medial Humerus Plate 2.7/3.5 - LOQTEQ Olecranon Plate 2.7/3.5 Description The anatomic plate design minimizes the need for intraoperative plate contouring and can act as a reduction aid for reconstruction of complex fractures Locking and non-locking screw option in every hole for custom screw configurations 3.5mm locking screws (red) for gliding locking hole enable optional diaphyseal/metaphyseal compression Low-profile plates with 2.7mm locking screws for round locking holes in the metaphyseal plate area may reduce the risk of soft tissue irritation Holes for K-wires and an oblong hole facilitate the primary fixation of the plate The flattened end of the plate shaft enables the tissue-conserving, submuscular insertion of the plate Minor contact undercuts shall minimize the reduction in blood supply to the periosteum The aiming arm assists in positioning the metaphyseal screws of the medial plate to help to ensure optimal support for the articular block of the distal humerus The aiming device assists in precisely inserting the distal screws in the olecranon plate Left and right distal humerus plates available in 2, 3, 5, 7 and 11 hole designs Left and right olecranon plate available in 2, 4, 6, 8 and 10 hole designs 4

7 Introduction Material For the manufacture of angle stable plate systems materials are used which have been proven to be successful in medical technology for decades. The anatomical preformed plates and screws are made of titanium alloy. All materials employed comply with national and international standards. They are characterized by good biocompatibility, a high degree of safety against allergic reactions and optimal mechanical properties. Indications / Contraindications Indikationen LOQTEQ Distal Humerus Plates Intra-articular fractures of the distal humerus Supracondylar fractures of the distal humerus Osteotomies and non-unions of the distal humerus LOQTEQ Olecranon Plates Fractures Osteotomies and non-unions of the Olecranon Contraindications Infection or inflammation (localized or systemic) Allergies against the implant material High risk patients for anesthesia Severe soft tissue swelling impacting normal wound healing Insufficient soft tissue coverage Fractures in children and adolescents with epiphyseal plates not yet ossified Processing (Sterilization & Cleaning) The implants are supplied sterile and non-sterile. Implants and instruments that are supplied in non-sterile condition must be sterilized before use. For this purpose, please refer to the Instructions for Use that are enclosed with the plates, instruments, and trays. Do not use (sterile) implants from damaged or open inner packaging. Implant components that have come or might have come into contact with infectious fluids (e.g. blood) must not be resterilized and reused in another surgery. They must be returned to the manufacturer. Resterilization is prohibited in this case (see Instructions for Use). 5

8 Preoperative Planning Distal Humerus Plates Evaluate the fracture type on the basis of the X-rays / CT and select the appropriate plate length and screw positions. Also insert lag screws, if necessary. Minimum 2 holes difference N NOTE: To prevent extensive diaphyseal stress, it is recommended that the medial and lateral plates are not the same length, with at least a two-hole difference between the plates. LOQTEQ Distal Humerus Plates are anatomically preformed to fit to the anatomy of an average distal humerus. In general, the articular block should be reduced prior to repositioning the articular block to the shaft. Bicolumn fractures are common, requiring fixation via a dual plate construct. LOQTEQ allows for 90 plate placement. 6

9 Distal Medial Humerus Plate L R 202mm n 150 mm n 124 mm n 98 mm n 85 mm n 11 holes 7 holes 5 holes 3 holes 2 holes 2 holes 3 holes 5 holes 7 holes 11 holes Distal Dorsolateral Humerus Plate L 206 mm n R 154 mm n 128 mm n 102 mm n 89 mm n 11 holes 7 holes 5 holes 3 holes 2 holes 2 holes 3 holes 5 holes 7 holes 11 holes 7

10 Preoperative Planning Olecranon Plate INSTRUMENTS ART.-NO. Bending iron 1 for small fragment plates, closed IP Bending iron 2 for small fragment plates, closed IP Evaluate the fracture type on the basis of the X-rays/CT and select the appropriate plate length and screw positions. Also insert lag screws, if necessary. 10 holes 8 holes 6 holes 4 holes 2 holes 2 holes 4 holes 6 holes 8 holes 10 holes LOQTEQ Olecranon Plates are anatomically preformed to fit to normal ulna anatomy. Although not usually necessary, the plates may be contoured to individual patient anatomy. The plates (except the short, 2-hole plates) feature bending elements to facilitate the bending process. Use bending irons to contour the plates as needed. o 86 mm o 112 mm o 138 mm o 164 mm L o 190 mm R N CAUTION: Observe the following while bending the plates, avoid repeatedly or excessevely beinding the plates as it may result in implant failure. Bend the plate between the holes to prevent the loss of locking function. Avoid any sharp-edged damage by instruments. 8

11 Positioning Position the patient in lateral decubitus or prone position with the arm supported over bolsters. Access Distal Humerus The posterior access is usually preferred, with a longitudinal incision just radial to the olecranon. N CAUTION: The ulnar nerve must be identified and protected. When using longer plates, the radial nerve may require exploration and protection. Depending on the fracture pattern, the triceps can be left intact (A), elevated off the bone (B) or an olecranon osteotomy (C) can be performed for adequate exposure of the fracture. A B C 9

12 Access Olecranon The posterior access lateral to the elbow is usually preferred, with a skin incision about 5cm distally over the supracondylar area. The incision may be slightly curved radially to protect the ulnar nerve. N CAUTION: The ulnar nerve must be identified and protected. Repositioning and primary fixation INSTRUMENTS ART.-NO. K-wire with trocar point, ø1.6, L 150 NK Ensure that the anatomy of the distal humerus/proximal ulna is reconstructed. For temporary reposition and fixation of the fragments place K-wires or reduction forceps. Ensure that the K-wires will not interfere with later plate positioning. If necessary, use lag screws to secure intraarticular fragments. The articular fragments of the distal block should be reduced prior to reducing the distal block of the shaft. When repositioning the olecranon, ensure appropriate reconstruction of the coronoid process. N NOTE: The shape of the LOQTEQ Distal Humerus Plates/Olecranon Plates may assist in anatomic reduction of the humerus. 10

13 Inserting the Distal Medial Humerus Plate INSTRUMENTS ART.-NO. K-wire with trocar point, ø1.6, L 150 NK Screwdriver hexagonal, ø2.5, quick coupling IU Large handle, cannulated, quick coupling IU Double drill guide, ø2.5 / 3.5, with spring aided centering IU Twist drill ø2.5, L 110, coil 50, quick coupling IU Depth gauge for screws IS Screw forceps, self-holding IU Aiming arm LOQTEQ Distal Medial Humerus Plate IU Twist drill ø2.0, L 180, coil 50, quick coupling IU Drill guide LOQTEQ Elbow plates 2.7, light blue/gold IU The aiming arm assists in positioning the distal screws of the medial plate to help to ensure optimal support for the articular block of the distal humerus. N NOTE: The offset of the twist drill / K-wire is 1.5mm. Plate position: on the medial column, medial distal Orientation of distal screws: mediolateral N NOTE: Screw the drill guide in the most distal screw hole of the medial plate and position the opposite tip of the aiming pointer in the desired location of the screw s ending point on the lateral side. N CAUTION: To reduce the risk of glove perforation, care should be taken when using the aiming pointer of the aiming arm. 11

14 For temporary fixation, place the K-wire ø1.6 or a twist drill ø2.0 (light blue / gold) through the drill guide of the aiming arm for the distal medial humerus plate. Insert a standard cortical screw 3.5mm (gold) into the oblong hole. For this purpose, use a double drill guide ø2.5/3.5 and a twist drill ø2.5 and drill to the required depth. Then determine the screw length using the depth gauge and insert a standard cortical screw 3.5mm (gold) of the appropriate length. This screw can simultaneously pull the plate towards the shaft. The aiming arm can be removed to improve handling. The adjusting ring can then be freely moved to allow more space for the subsequent surgical steps. N CAUTION: To ensure the stability of the reduction, do not remove the K- wire or twist drill until at least one additional locking screw has been inserted. Check the plate position using fluoroscopy and adjust if required. 12

15 The drill guide is marked with two very accurate measuring scales, which must be observed during measuring. Measuring scale Measuring scale mm, 2 mm steps mm, 5 mm steps 2 1 To determine the required screw length, the penetration depth of the twist drill in the bone can be read off from the drill guide (light blue/gold) or using the depth gauge for screws. After at least one other locking screw 2.7mm has been inserted for securing, insert a locking screw 2.7mm into the most distal hole. Alternatively, a standard screw 2.5mm can be used. N NOTE: The steps for inserting screws are described starting on page 16, Inserting screws. 13

16 Inserting the Distal Dorsolateral Humerus Plate INSTRUMENTS ART.-NO. K-wire with trocar point, ø1.6, L 150 NK Screwdriver hexagonal, ø2.5, quick coupling IU Large handle, cannulated, quick coupling IU Double drill guide, ø2.5 / 3.5, with spring aided centering IU Twist drill ø2.5, L 110, coil 50, quick coupling IU Depth gauge for screws IS Screw forceps, self-holding IU Plate position: on the lateral column, dorsal Orientation of distal screws: posteroanterior Temporarily fixate the plate with K-wires through the holes in the plate that are intended for this purpose. As an alternative to the K-wires, a standard cortical screw 3.5mm can be inserted in the oblong hole. For this purpose, use a double drill guide ø2.5/3.5 and a twist drill ø2.5 and drill to the required depth. Then determine the screw length using the depth gauge and insert a screw of the appropriate length. This screw can simultaneously pull the plate towards the shaft. Check plate position using fluoroscopy and adjust if required. 14

17 Inserting the Olecranon Plate INSTRUMENTS ART.-NO. Aiming device LOQTEQ Olecranon Plate, R / L IU /02 Handle round with quick coupling, with torque limiter 1.5 Nm IU Drill guide LOQTEQ Elbow plates 2.7, light blue/gold IU Double drill guide, ø2.5/3.5, with spring aided centering IU Twist drill ø2.5, L 110, coil 50, quick coupling IU Depth gauge for screws IS Screw forceps, self-holding IU Place the aiming device on the plate and fixate it using the drill guide LOQTEQ Elbow Plates 2.7 (light blue / gold) in the most distal hole of the targeting device. For temporarily fixation place the K-wires through the corresponding holes in the plate. Alternatively, a standard cortical screw 3.5mm can be inserted in the oblong hole. For this purpose, use a double drill guide ø2.5/3.5 and a twist drill ø2.5 and drill to the required depth. Then determine the screw length using the depth gauge and insert a screw of the appropriate length. This screw can simultaneously pull the plate towards the shaft. N NOTE: Avoid placing the standard screw in oblique lateral direction to prevent screw collision with the two most proximal 2.7mm screws. Alternatively, shorter 2.7mm cortical screws can be chosen. N NOTE: Position the plate on the dorsal aspect of the proximal ulna. Proximally, the plate does not need necessarily to center on the olecranon. Check plate position using fluoroscopy and adjust if required. N CAUTION: Correct plate position can be verified using a drill placed through the drill guide in the distal round hole. For this purpose, drill through one of the drill guides under fluoroscopy. The two screws meet in the tip of the coronoid process. If the screw tip is too far proximal and risks to perforate the articular surface, monocortical locking screws or standard screws should be chosen. 15

18 Inserting screws Determine the combination of screws to be used for fixation. If a combination of locking and non-locking screws will be used, non-locking screws must be inserted first to pull the bone to the plate. Inserting standard screws (gold) N NOTE: The following surgical steps (page 16-22) apply to all three plate types and are graphically illustrated using the example of the LOQTEQ Distal Medial Humerus Plate. INSTRUMENTS ART.-NO. Double drill guide ø2.0/2.5 IU Twist drill ø2.0, L 180, coil 50, quick coupling IU Depth gauge for screws IS Screwdriver T8, quick coupling IU Screwdriver Duo, T8, quick coupling IU Large handle, cannulated, quick coupling IU mm cortical screw in the metaphyseal part of the plate Insert the double drill guide ø2.0 / 2.5 into the desired plate hole in the metaphyseal portion of the plate and drill to the desired depth with the twist drill ø2.0 (light blue / gold). Measure for screw length with the depth gauge for screws ø Insert the appropriate length cortical screw 2.5 mm using screwdriver T8. 16

19 INSTRUMENTS ART.-NO. Double drill guide, ø2.5 / 3.5, with spring aided centering IU Twist drill ø2.5, L 110, coil 50, quick coupling IU Depth gauge for screws IS Screwdriver hexagonal, ø2.5, quick coupling IU Large handle, cannulated, quick coupling IU mm cortical screw in the plate shaft N NOTE: Only two types of screws are used from the small fragment set (SK 3510-xx-2 and SK 3525-xx-2). The screws SK 3512-xx-2 and SK 3526-xx-2 are not compatible and must not be used with the three plates types. Insert the double drill guide ø2.5/3.5 into the desired screw hole in the shaft portion of the plate and drill to the desired depth with the twist drill ø2.5. Measure for screw length with the depth gauge for screws ø Insert the appropriate length cortical screw 3.5mm using screwdriver hexagonal SW

20 Inserting locking screws (light blue) INSTRUMENTS ART.-NO. Drill guide LOQTEQ Elbow plates 2.7, light blue/gold IU Twist drill ø2.0, L 180, coil 50, quick coupling IU Depth gauge for screws IS Handle with quick coupling, with torque limiter 1.5 Nm IU Screwdriver T8, quick coupling IU Screwdriver Duo, T8, quick coupling IU mm locking screw in the metaphyseal part of the plate Insert the drill guide IU (light blue / gold) into the desired plate hole in the metaphyseal portion of the plate and drill with the twist drill ø2.0 (light blue / gold). N CAUTION: Use the targeting device when inserting screws ø2.7mm in the LOQTEQ Olecranon Plate. Measure for screw length with the depth gauge for screws ø Alternatively, the penetration depth during drilling can be read off from the drill guide IU (light blue / gold) to determine the required screw length. N CAUTION: The drill for fixating the aiming device of the LOQTEQ Olecranon Plate must remain in the distal round hole 2.7 until all other screws 2.7mm have been placed. Then the targeting device can be removed and a 2.7mm screw can be inserted in the distal round hole. Insert the appropriate length LOQTEQ cortical screw 2.7mm using the torque limiter, 1.5Nm. Optimal fixation is reached once an audible click is heard. N NOTE: As soon as the head of the screw reaches the plate hole, it is compulsory to switch to the torque limiter. Secure the other metaphyseal plate holes in this way. Then remove any remaining K-wires. 18

21 Compression-free locking with a LOQTEQ cortical screw 3.5mm (red) INSTRUMENTS ART.-NO. Drill guide for gliding hole LOQTEQ 3.5, I-ø 2.8, red IU Twist drill ø2.7, L 150, coil 50, quick coupling IU Depth gauge for screws IS Screwdriver T15, short, quick coupling IU Screwdriver Duo, T15, quick coupling IU Handle with quick coupling, with torque limiter, 2.0 Nm IU Large handle, cannulated, quick coupling IU mm locking screw in the plate shaft Screw the drill guide for gliding hole (red) into the desired plate hole and drill using the twist drill ø2.7 (blue / red). Remove the drill guide for gliding hole (red) and determine the required screw length using the depth gauge. Then loosely insert a LOQTEQ cortical screw 3.5 mm (red) of the appropriate length using screwdriver T15 and finally tighten the screw with the torque limiter 2.0Nm. Optimal fixation is reached once an audible click is heard. Secure the other proximal plate holes in this way. Then remove any remaining K-wires. N NOTE: As soon as the head of the screw reaches the plate hole, it is compulsory to switch to the torque limiter. In cases of very hard diaphyseal bone, make sure that the screw head is flush with the plate. Therefore it is permissible in exceptionally hard diaphyseal bone to finish tightening the screw without the torque limiter. For optimal plate-to-screw connection, it is recommended to use the threaded drill guide (red) to insert LOQTEQ locking screws. If the locking screw is inserted obliquely, a secure connection between the screw and plate is not guaranteed! 19

22 Interfragmentary compression with a LOQTEQ cortical screw 3.5mm (red) INSTRUMENTS ART.-NO. Basic Insert for load drill guide LOQTEQ 3.5 IU Load drill guide LOQTEQ 3.5, compression 1 mm IU Load drill guide LOQTEQ 3.5, compression 2 mm IU Load drill guide LOQTEQ 3.5, adjustable up to 2 mm IU Twist drill ø2.7, L 150, coil 50, quick coupling IU Depth gauge for screws IS Screwdriver T15, short, quick coupling IU Screwdriver Duo, T15, quick coupling IU Handle with quick coupling, with torque limiter, 2.0 Nm IU Large handle, cannulated, quick coupling IU For combined shaft fractures, the required fracture compression can be achieved by inserting a LOQTEQ cortical screw 3.5mm (red) into the compression position. Screw the basic insert for load drill guide above the fracture line. Choose a load drill guide in accordance with the compression distance (1mm or 2mm) and position on the basic insert away from the fracture gap. Drill with a twist drill ø2.7 (blue/red) and determine the screw length using the depth gauge. Loosely insert a LOQTEQ cortical screw 3.5mm (red) with screwdriver T15 and finally tighten the screw with the torque limiter 2.0Nm. Optimal fixation is reached once an audible click is heard. N NOTE: As soon as the head of the screw reaches the plate hole, it is compulsory to switch to the torque limiter. In cases of very hard diaphyseal bone it is necessary to make sure that the screw head is flush with the plate. Therefore it is permissible in exceptionally hard diaphyseal bone to finish the screw without the torque limiter. 20

23 Alternatively, the adjustable load drill guide (adjustable up to 2mm) can be used. The fracture gap serves as orientation in setting the compression distance (max. 2mm). For this purpose, turn the wheel of the load drill guide until an appropriate gap forms in the upper part of the instrument, and position the drill guide on the basic insert for load drill guide away from the fracture gap. The marking on the load drill guide can help orientation. 21

24 Explantation INSTRUMENTS ART.-NO. Screwdriver, hexagonal, ø2.5, blue handle IU Screwdriver, T15, Round Handle IU Screwdriver T8, round handle IU N NOTE: The screwdrivers (T8, T15) in the set are self-retaining. To achieve maximum torque during screw removal, use the appropriate explantation screwdriver (IU /IU ). It allows deeper penetration into the screw head and hence safe screw removal. It can be ordered separately. Place an incision on the old scar. Manually undo all screws and sequentially remove them. N NOTE: After manually undoing all screws, the removal can be performed in automated mode in the second step. 22

25 Assembly instructions, aiming arm The aiming arm for the distal medial humerus plate consists of four individual parts: 1 1 Aiming arm made of radiolucent PEEK material 2 Metal drill guide with external thread 3 Metal adjusting ring with internal thread 4 Aiming pointer N CAUTION: To reduce the risk of glove perforation, care should be taken when using the aiming pointer of the aiming arm. a Screw the adjusting ring onto the guiding sleeve. b b c Click the drill guide with the assembled adjusting ring onto the PEEK aiming arm. Click the aiming pointer onto the PEEK aiming arm. c a N CAUTION: The aiming arm must be disassembled prior to cleaning and sterilization. 23

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27 Trays LOQTEQ Elbow Plates 2.7/3.5, Implants IC LOQTEQ Small Fragment Set, Set of Instruments IC LOQTEQ Small Fragment Set, Screw Rack, complete IC

28 Trays LOQTEQ Elbow Plates 2.7/ 3.5, Set of Implants IC * ARTICLE ART.-NO. Tray for implants LOQTEQ Elbow Plates 2.7/3.5 IC Lid for trays, large IC Depth gauge for screws IS Twist drill ø2.0, L 180, coil 50, quick coupling IU Handle round with quick coupling, with torque limiter 1.5 Nm IU Screwdriver T8, quick coupling IU Screwdriver Duo, T8, quick coupling IU Double drill guide ø2.0/2.5 IU Drill guide LOQTEQ Elbow plates 2.7, light blue/gold IU Aiming device LOQTEQ Olecranon Plate, R IU Aiming device LOQTEQ Olecranon Plate, L IU Aiming arm LOQTEQ Distal Medial Humerus Plate IU LOQTEQ Distal Medial Humerus Plate, 2 holes, L 85, R Titanium PH LOQTEQ Distal Medial Humerus Plate, 3 holes, L 98, R, Titanium PH LOQTEQ Distal Medial Humerus Plate, 5 holes, L 124, R, Titanium PH LOQTEQ Distal Medial Humerus Plate, 2 holes, L 85, L, Titanium PH LOQTEQ Distal Medial Humerus Plate, 3 holes, L 98, L, Titanium PH LOQTEQ Distal Medial Humerus Plate, 5 holes, L 124, L, Titanium PH LOQTEQ Distal Dorsolat. Humerus Plate, 2 holes, L 89, R, Titanium PH LOQTEQ Distal Dorsolat. Humerus Plate, 3 holes, L 102, R, Titanium PH LOQTEQ Distal Dorsolat. Humerus Plate, 5 holes, L 128, R, Titanium PH LOQTEQ Distal Dorsolat. Humerus Plate, 2 holes, L 89, L, Titanium PH LOQTEQ Distal Dorsolat. Humerus Plate, 3- holes, L 102, L, Titanium PH LOQTEQ Distal Dorsolat. Humerus Plate, holes, L 128, L, Titanium PH LOQTEQ Olecranon Plate, 2 holes, L 86, R, Titanium PU LOQTEQ Olecranon Plate, 4 holes, L 112, R, Titanium PU LOQTEQ Olecranon Plate, 2 holes, L 86, L, Titanium PU LOQTEQ Olecranon Plate, 4 holes, L 112, L, Titanium PU

29 Trays LOQTEQ Elbow Plates 2.7/ 3.5, Set of Implants IC * AVAILABLE ON REQUEST ARTICLE ART.-NO. Screwdriver T8, round handle IU LOQTEQ Distal Medial Humerus Plate, 7 holes, L 150, R, Titanium PH LOQTEQ Distal Medial Humerus Plate, 11 holes, L 202, R, Titanium PH LOQTEQ Distal Medial Humerus Plate, 7 holes, L 150, L, Titanium PH LOQTEQ Distal Medial Humerus Plate, 11 holes, L 202, L, Titanium PH LOQTEQ Distal Dorsolat. Humerus Plate, 7 holes, L 154, R, Titanium PH LOQTEQ Distal Dorsolat. Humerus Plate, 11 holes, L 206, R, Titanium PH LOQTEQ Distal Dorsolat. Humerus Plate, 7 holes, L 154, L, Titanium PH LOQTEQ Distal Dorsolat. Humerus Plate, 11 holes, L 206, L, Titanium PH LOQTEQ Olecranon Plate, 6 holes, L 138, R, Titanium PU LOQTEQ Olecranon Plate, 8 holes, L 164, R, Titanium PU LOQTEQ Olecranon Plate, 10 holes, L 190, R, Titanium PU LOQTEQ Olecranon Plate, 6 holes, L 138, L, Titanium PU LOQTEQ Olecranon Plate, 8 holes, L 164, L, Titanium PU LOQTEQ Olecranon Plate, 10 holes, L 190, L, Titanium PU * 2.5/2.7 instruments only! Please complete with Small Fragment Set Set IC /IC or IC and IC /IC

30 Trays LOQTEQ Elbow Plates 2.7/ 3.5, screw set, basic ARTICLE ART.-NO. Screw rack LOQTEQ Elbow for extensions screw set, empty IC Standard screws 2.5 Titanium ARTICLE ART.-NO. Cortical Screw 2.5, small head T8, self-tapp., L 14 SK Cortical Screw 2.5, small head T8, self-tapp., L 16 SK Cortical Screw 2.5, small head T8, self-tapp., L 18 SK Cortical Screw 2.5, small head T8, self-tapp., L 20 SK Cortical Screw 2.5, small head T8, self-tapp., L 22 SK Cortical Screw 2.5, small head T8, self-tapp., L 24 SK Cortical Screw 2.5, small head T8, self-tapp., L 26 SK Cortical Screw 2.5, small head T8, self-tapp., L 28 SK Cortical Screw 2.5, small head T8, self-tapp., L 30 SK Cortical Screw 2.5, small head T8, self-tapp., L 32 SK Cortical Screw 2.5, small head T8, self-tapp., L 34 SK Cortical Screw 2.5, small head T8, self-tapp., L 36 SK Cortical Screw 2.5, small head T8, self-tapp., L 38 SK Cortical Screw 2.5, small head T8, self-tapp., L 40 SK Cortical Screw 2.5, small head T8, self-tapp., L 42 SK Cortical Screw 2.5, small head T8, self-tapp., L 45 SK Cortical Screw 2.5, small head T8, self-tapp., L 50 SK Cortical Screw 2.5, small head T8, self-tapp., L 55 SK Cortical Screw 2.5, small head T8, self-tapp., L 60 SK Cortical Screw 2.5, small head T8, self-tapp., L 65 SK Cortical Screw 2.5, small head T8, self-tapp., L 70 SK

31 Trays Screws for round locking hole 2.7 Titanium ARTICLE ART.-NO. LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 14 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 16 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 18 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 20 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 22 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 24 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 26 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 28 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 30 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 32 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 34 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 36 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 38 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 40 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 42 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 45 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 50 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 55 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 60 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 65 SK LOQTEQ Cortical Screw 2.7, small head T8, self-tapp. L 70 SK

32 Trays LOQTEQ Small Fragment Set, Set of Instruments IC ARTICLE ART.-NO. Tray for instruments LOQTEQ Small Fragment, empty IC Lid for trays, large IC Bending iron 1 for small fragment plates, closed IP Bending iron 2 for small fragment plates, closed IP Depth gauge for locking screws, small IS Twist drill ø2.5, L 110, coil 50, quick coupling IU Twist drill ø2.5, L 180, coil 50, quick coupling IU Twist drill ø2.7, L 150, coil 50, quick coupling IU Twist drill ø2.7, L 220, coil 50, quick coupling IU Twist drill ø3.5, L 110, coil 50, quick coupling IU Large handle, cannulated, quick coupling IU Handle with quick coupling, with torque limiter, 2.0 Nm IU Screwdriver T15, short, quick coupling IU Screwdriver hexagonal, ø2.5, quick coupling IU Screwdriver Duo, T15, quick coupling IU Screw forceps, self-holding IU Double drill guide, ø2.5 / 3.5, with spring aided centering IU Load drill guide LOQTEQ 3.5, compression 1 mm IU Load drill guide LOQTEQ 3.5, compression 2 mm IU Basic Insert for load drill guide LOQTEQ 3.5 IU Drill guide for gliding hole LOQTEQ 3.5, I-ø 2.8, red IU Reduction sleeve for K-wire ø1.6 IU Drill guide for round hole LOQTEQ 3.5, I-ø 2.8, blue IU K-wire with trocar point, ø1.6, L 150 NK OPTIONAL Load drill guide LOQTEQ 3.5, adjustable up to 2 mm IU

33 Trays LOQTEQ Small Fragment Set, Screw Rack, complete IC ARTICLE ART.-NO. Screw rack LOQTEQ Small Fragment, empty IC Screws for gliding locking hole 3.5 ARTICLE ART.-NO. LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 12 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 14 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 16 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 18 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 20 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 22 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 24 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 26 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 28 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 30 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 32 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 34 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 36 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 38 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 40 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 45 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 50 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 55 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 60 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 65 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 70 SK

34 Trays Standard screws 3.5 ARTICLE ART.-NO. Cortical Screw 3.5, self-tapping, L 12 SK Cortical Screw 3.5, self-tapping, L 14 SK Cortical Screw 3.5, self-tapping, L 16 SK Cortical Screw 3.5, self-tapping, L 18 SK Cortical Screw 3.5, self-tapping, L 20 SK Cortical Screw 3.5, self-tapping, L 22 SK Cortical Screw 3.5, self-tapping, L 24 SK Cortical Screw 3.5, self-tapping, L 26 SK Cortical Screw 3.5, self-tapping, L 28 SK Cortical Screw 3.5, self-tapping, L 30 SK Cortical Screw 3.5, self-tapping, L 32 SK Cortical Screw 3.5, self-tapping, L 34 SK Cortical Screw 3.5, self-tapping, L 36 SK Cortical Screw 3.5, self-tapping, L 38 SK Cortical Screw 3.5, self-tapping, L 40 SK Cortical Screw 3.5, self-tapping, L 45 SK Cortical Screw 3.5, self-tapping, L 50 SK Cortical Screw 3.5, self-tapping, L 55 SK Cortical Screw 3.5, self-tapping, L 60 SK Cortical Screw 3.5, self-tapping, L 65 SK Cortical Screw 3.5, self-tapping, L 70 SK

35 33

36 Case Study Preoperative 34

37 Case Study Postoperative Clinical case and CT images with the kind permission of Univ.-Prof. Dr. Dr. Dr. h.c. Reinhard Schnettler, Trauma University Hospital Giessen and Marburg GmbH, Germany. 35

38 36 Notes

39 Subject to technical modifications, errors and misprints. WP 2OP030 EN / 1405 Layout, typesetting: design graphic - Wolfram Passlack Illustrations: Karen Hilberg Lorenzweg Berlin Germany Phone Fax customer.service@aap.de

40 Lorenzweg Berlin Germany Phone Fax customer.service@aap.de WP 2OP030 EN / 1405