Surgical Technique. Targeter Systems Overview

Transcription

1 Surgical Technique Targeter Systems Overview

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3 PERI-LOC Locked Plating System Targeter Systems Overview Table of contents Product overview... 2 Introduction... 2 Indications... 2 Design features and benefits... 3 Large Fragment Targeter Systems Implant overview... 5 Surgical technique Fracture reduction... 7 Ball Spike Reduction Clamp mm Lateral Distal Femur Locking Plate mm Lateral Proximal Tibia Locking Plate Screw insertion mm Cortex Screws/4.5mm Locking Screws/ 6.5mm Partially Threaded Cancellous Screws mm Cannulated Screws Small Fragment Targeter Systems Implant overview Surgical technique Fracture reduction Ball Spike Reduction Clamp mm Lateral Proximal Tibia Locking Plate mm Medial Distal Tibia Locking Plate Screw insertion mm Cortex Screws/3.5mm Locking Screws/ 4.0mm Cancellous Screws Catalog information Nota Bene The technique description herein is made available to the healthcare professional to illustrate the treatment for the uncomplicated procedure. In the final analysis, the preferred treatment is the individual surgeon s decision, which addresses the needs of the specific patient. 1

4 Product overview Introduction The PERI-LOC Periarticular Locked Plating System from Smith & Nephew offers the advantages of locked plating with the flexibility and the benefits of traditional plating in one system. Offering both locking and non-locking screw options, the PERI-LOC system can provide a construct that resists angular (eg, varus/ valgus, rotational and axial) collapse while simultaneously acting as an effective aid to fracture reduction. A simple and straightforward instrument set features standardized drill bits and color-coded instrumentation, making PERI-LOC efficient and easy to use. Radiolucent Targeter Systems are available for the following four plates in the PERI-LOC system: 4.5mm Lateral Distal Femur Locking Plate 4.5mm Lateral Proximal Tibia Locking Plate 3.5mm Lateral Proximal Tibia Locking Plate 3.5mm Medial Distal Tibia Locking Plate These targeters allow surgeons to use percutaneous, or minimally invasive, techniques to preserve the soft tissue envelope during the surgical procedure. Indications The PERI-LOC Periarticular Locked Plating System can be used for adult and pediatric patients, as well as patients with osteopenic bone. PERI-LOC plates and screws are indicated for fixation of pelvic, small and long bone fractures, including those of the tibia, fibula, femur, pelvis, acetabulum, metacarpals, metatarsals, humerus, ulna, radius, calcaneus and clavicle. Disposable components and implants in the PERI-LOC Locked Plating System are for single use only. 2

5 Design features and benefits Radiolucent base The targeters in the PERI-LOC Periarticular Locked Plating System feature a radiolucent base that allows for a clear lateral view under fluoroscopy. Unique, versatile screw hole design All plates in the PERI-LOC system feature a unique screw hole that was designed to be used in a variety of applications at the surgeon s discretion. Each screw hole accepts both locking and non-locking screw options and allows for up to 1mm of axial compression, distraction or translation per hole. The unique design of our screw hole supports customized screw configurations to optimally treat each specific fracture. This drawing illustrates the radiolucency of the PERI-LOC Targeter. Streamlined, color-coded instrumentation The PERI-LOC Targeter systems have been designed to minimize confusion during the procedure. Side specific instruments are color-coded to reduce the chance of misuse. Coordinating drill guides and drill bits are color-coded for ease of use. 3

6 Large Fragment Targeter Systems Radiolucent Targeters are available for the following two large fragment plates: 4.5mm Lateral Distal Femur Locking Plate 4.5mm Lateral Proximal Tibia Locking Plate

7 Implant overview 4.5mm Lateral Distal Femur Locking Plate Beveled tip assists with submuscular insertion Radiolucent targeter available for percutaneous technique Anatomically designed with 90 inch (2.28 meter) radius anterior bow Periarticular recesses allow for easy placement of lag screws in strategic locations around and independent of the implant for reduction of the articular surface Available in 6, 8, 10, 13, 16 and 19 hole configurations ( mm) Specification overview Plate dimensions Profile thickness of head 3.6mm Width of head 36.0mm Profile thickness of shaft 4.8mm Width of shaft 17.6mm Shaft hole spacing 18.0mm 5

8 4.5mm Lateral Proximal Tibia Locking Plate Beveled tip assists with submuscular insertion Radiolucent targeter available for percutaneous technique Plate head has 5 posterior tilt and is contoured to match the lateral proximal tibia Plate shaft has 3 bend to match diaphysis of tibia Proximal suture holes for meniscal repair or K-wire placement for positioning Proximal periarticular recesses allow for easy placement of independent lag screws for reduction of the articular surface in subchondral fashion Available in 4, 6, 8, 10, 13 and 16 hole configurations (94-309mm) Specification overview Plate dimensions Profile thickness of head 3.0mm Width of head 32.5mm Profile thickness of shaft 3.7mm Width of shaft 12.7mm Shaft hole spacing 18.0mm 6

9 Surgical technique Fracture reduction Articular fracture components must be anatomically reduced prior to plate application and screw insertion. Reduction aids should be placed so as not to interfere with final plate placement. Reduce and provisionally secure fragments using: K-wires 2.0mm x 350mm for Targeter Note If K-wires are to be inserted through the K-wire holes on a PERI-LOC Large Fragment Plate for the purpose of provisional fixation, it is recommended that 2.0mm wires be used. The Targeter K-wire can be placed through a Large Fragment Targeter K-wire Guide ( ). Provisional Fixation Pins 3.5mm x 18mm for Targeter mm x 40mm for Targeter Note Provisional Fixation Pins may be inserted on power, but should always be seated manually in order to avoid stripping of the threads and loss of purchase. Bicortical purchase of the provisional fixation pin will decrease the chance of stripping and pull-out. Reduction Forceps* Reduction Forceps with Ratchet, 205mm Reduction Forceps with Ratchet-Bowed, 205mm Reduction Forceps with Points, Broad Reduction Forceps with Serrated Jaw Ball Spike Reduction Clamp, Medium Ball Spike Reduction Clamp, Large * Located in the PERI-LOC Forceps Set and the PERI-LOC VLP Periarticular Reduction Forceps Set 7

10 Ball Spike Reduction Clamp* Assemble either the 15mm or 25mm Spiked Washer ( , ) to the Ball Spike Reduction Clamp by pushing the tip of the clamp into the washer until it snaps on. Care should be taken when handling the clamps and spiked washers to avoid the sharpened tips. If the Ball Spike Reduction Clamp is to be used with a plate, insert one of the tips into the desired plate hole and engage the other tip with the bone on the opposite cortex. If using a spiked washer on the far-side clamp tip, ensure that the spikes are against bone. Consideration for the spiked washer should be given in osteopenic or comminuted bone. 15mm Spiked Washer Medium Ball Spike Reduction Clamp * Located in the PERI-LOC VLP Periarticular Reduction Forceps Set 8

11 4.5mm Lateral Distal Femur Locking Plate Plate selection Following fracture reduction, select the 4.5mm Lateral Distal Femur Locking Plate that best accommodates patient anatomy and fracture pattern. In general, a longer plate allows for better mechanical advantage over a shorter plate. An allowance for five screw holes above the most proximal aspect of the fracture is recommended when selecting a plate length. Note The PERI-LOC 4.5mm Lateral Distal Femur Locking Plate Preoperative Template ( ) is available to assist with preoperative radiographic planning. 4.5mm Distal Femur Targeter assembly Assemble to targeter base, handle and plate on the back table as shown below. Check the plate alignment by inserting a screw guide through the base, targeting the most proximal hole of the plate. Insert a drill guide through the screw guide and ensure that it threads into the plate. Remove this drill guide and screw guide and proceed with plate insertion. 9

12 Plate insertion Insert the plate between the muscle and the periosteum keeping the proximal end of the plate against the femur during insertion. Use intraoperative image intensifier or direct visualization to confirm plate balance on the femoral shaft. Plate positioning Position the plate by matching the contour of the plate to the distal portion of the lateral femur. Insert a Large Fragment Targeter Screw Guide ( ) with the red color-coded 3.5mm Drill Guide ( ) into one of the distal holes. Tighten the screw guide to the base and tighten the red drill guide to the plate. Insert a 3.5mm x 40mm Targeter Provisional Fixation Pin ( ) through the drill guide. Be careful not to over tighten the Provisional Fixation Pin as extreme torque may cause the threads to strip. 10

13 Obtain sagittal alignment of fracture and confirm with a lateral radiograph. To access the most proximal hole, insert a screw guide with a Targeter Trocar ( ) through a small stab incision until the screw guide reaches the plate and locks into the base. Remove the trocar and insert a red drill guide, threading it into the plate. Center the plate on the lateral aspect of the femur and apply a 3.5mm x 18mm Targeter Provisional Fixation Pin ( ) in the most proximal hole. If further reduction of the distal portion of the diaphyseal fracture is required, center the plate on the distal diaphyseal fracture fragment and provisionally fix the plate close to the fracture by repeating the previous step. Obtain final confirmation of fracture alignment and implant position. Insert a screw guide through any of the distal holes, securing it to the base. Insert the blue color-coded 2.0mm K-wire Locking Guide Insert ( ) which accepts the 2.0mm x 350mm K-wire ( ). This K-wire can be redirected if necessary until it is parallel to the joint in the AP view. Loosening of the Provisional Fixation Pins may be necessary to redirect the K-wire parallel to the joint. For correct coronal alignment, the K-wire (guide wire) must be parallel to the joint in the AP view. 11

14 4.5mm Lateral Proximal Tibia Locking Plate Plate selection Following fracture reduction, select the 4.5mm Lateral Proximal Tibia Locking Plate that best accommodates patient anatomy and fracture pattern. In general, a longer plate allows for better mechanical advantage over a shorter plate. An allowance for five screw holes below the most distal aspect of the fracture is recommended when selecting a plate length. Note The PERI-LOC 4.5mm Lateral Proximal Tibia Locking Plate Preoperative Template ( ) is available to assist with preoperative radiographic planning. Use caution when using the 16 hole version of this plate to not damage the superficial peroneal nerve. 4.5mm Lateral Proximal Targeter assembly Assemble to targeter base, handle and plate on the back table as shown below. Check the plate alignment by inserting a screw guide through the base, targeting the most distal hole of the plate. Insert a drill guide through the screw guide and ensure that it threads into the plate. Remove this drill guide and screw guide and proceed with plate insertion. 12

15 Plate insertion Insert the plate between the muscle and the periosteum keeping the distal end of the plate against the tibia during insertion. Plate positioning Position the plate by matching the contour of the plate to the proximal portion of the lateral tibia. Insert a Large Fragment Targeter Screw Guide ( ) with the red color-coded 3.5mm Drill Guide ( ) into one of the proximal holes. Tighten the screw guide to the base and tighten the red drill guide to the plate. Insert a 3.5mm x 40mm Targeter Provisional Fixation Pin ( ) through the drill guide. Be careful not to over tighten the Provisional Fixation Pin as extreme torque may cause the threads to strip. 13

16 Obtain sagittal alignment of fracture and confirm with a lateral radiograph. When a sagittal split is present, reduction can be obtained with either clamps or lag screws, outside or through the plate. To access the distal hole, insert a screw guide with a Targeter Trocar ( ) through a small stab incision until the screw guide reaches the plate and locks into the base. Remove the trocar and insert a red drill guide, threading it into the plate. Center the plate on the lateral aspect of the tibia and apply a 3.5mm x 18mm Targeter Provisional Fixation Pin ( ) in the most proximal hole. If further reduction of the proximal portion of the diaphyseal fracture is required, center the plate on the proximal diaphyseal fracture fragment and provisionally fix the plate close to the fracture by repeating the previous step. Obtain final confirmation of fracture alignment and implant position. Insert a screw guide through any of the proximal holes, securing it to the base. Insert the blue color-coded 2.0mm K-wire Locking Guide Insert ( ) which accepts the 2.0mm x 350mm K-wire ( ). This K-wire can be redirected if necessary until it is parallel to the joint in the AP view. Loosening of the Provisional Fixation Pins may be necessary to redirect the K-wire parallel to the joint. For correct coronal alignment, the K-wire (guide wire) must be parallel to the joint in the AP view. 14

17 Screw insertion The choice of screws, and their order and configuration, is a decision to be made by the individual surgeon depending on the patient s circumstances and needs. Smith & Nephew does not recommend any particular screw insertion order or configuration of the various types of screws available in the system. 15

18 4.5mm Cortex Screws/ 4.5mm Locking Screws/ 6.5mm Partially Threaded Cancellous Screws Insert the Large Fragment Targeter Screw Guide ( ) with Targeter Trocar ( ) through a small stab incision until the screw guide reaches the plate and locks into the base. Remove trocar and insert a red color-coded 3.5mm Drill Guide ( ) and thread into the plate. Drill Drill to the desired depth using a 3.5mm Targeter Drill Bit ( ). Measure Measure for screw length by reading the exposed calibrations off of the 3.5mm Targeter Drill Bit. Screw insertion Remove the drill guide and insert the appropriate length screw by hand using the T25 Self Retaining Screwdriver ( ) and the Large Screwdriver Handle ( ). 16

19 5.7mm Cannulated Screws Insert the Large Fragment Targeter Screw Guide ( ) with Targeter Trocar ( ) through a small stab incision until the screw guide reaches the plate and locks into the base. Remove trocar and insert a blue color-coded 2.0mm K-wire Guide ( ) and thread into the plate. Guide wire insertion Insert a 2.0mm x 350mm K-wire ( ) through the guide to the desired depth. Drill (optional) In areas of increased bone density, it may be beneficial to drill prior to screw insertion. This may be done with the 4.5mm Cannulated Drill Bit ( ) by drilling over the guide wire to the desired depth. Measure Slide the 5.7mm Cannulated Depth Gauge ( ) over the guide wire until it rests against the 2.0mm K-wire Guide. Measure for screw length by reading the calibrations on the depth gauge. Screw insertion Remove the K-wire Guide and insert the appropriate length 5.7mm Cannulated Screw using the 3.5mm Cannulated Hex Driver until just before the screw head engages with the plate. Remove and discard the guide wire. 17

20 Small Fragment Targeter Systems Radiolucent Targeters are available for the following two small fragment plates: 3.5mm Lateral Proximal Tibia Locking Plate 3.5mm Medial Distal Tibia Locking Plate 18

21 Implant overview 3.5mm Lateral Proximal Tibia Locking Plate Beveled tip assists with submuscular insertion Radiolucent targeter available for percutaneous technique Plate head has 5 posterior tilt and is contoured to match the lateral proximal tibia Plate shaft has 3 bend to match diaphysis of tibia Proximal periarticular recesses allow for easy placement of independent lag screws for reduction of the articular surface Proximal suture holes for meniscal repair or K-wire placement for positioning Available in 4, 6, 8, 10 and 13 hole configurations (73-187mm) Specification overview Plate dimensions Profile thickness of head 2.9mm Width of head 31.8mm Profile thickness of shaft 3.4mm Width of shaft 11.0mm Shaft hole spacing 12.7mm 19

22 3.5mm Medial Distal Tibia Locking Plate Beveled tip assists with submuscular insertion Distal K-wire holes for provisional fixation and to assist with joint surface reduction Radiolucent targeter available for percutaneous technique Anatomically contoured to match the distal tibia Available in 4, 6, 8, 10, 13 and 16 hole configurations ( mm) Specification overview Plate dimensions Profile thickness of head 2.7mm Width of head 19.2mm Profile thickness of shaft 3.7mm Width of shaft 11.0mm Shaft hole spacing 12.7mm 20

23 Surgical technique Fracture reduction Articular fracture components must be anatomically reduced prior to plate application and screw insertion. Reduction aids should be placed so as not to interfere with final plate placement. Reduce and provisionally secure fragments using: K-wires 1.6mm x 260mm for Targeter Note If K-wires are to be inserted through the K-wire holes on a PERI-LOC Small Fragment Plate for the purpose of provisional fixation, it is recommended that 1.6mm wires be used. The Targeter K-wire can be placed through a Small Fragment Targeter 1.6mm K-wire Guide ( ). Provisional Fixation Pins 2.7mm x 18mm for Targeter mm x 40mm for Targeter Note Provisional Fixation Pins may be inserted on power, but should always be seated manually in order to avoid stripping of the threads and loss of purchase. Bicortical purchase of the provisional fixation pin will decrease the chance of stripping and pull-out. Reduction Forceps* Reduction Forceps with Ratchet, 205mm Reduction Forceps with Ratchet-Bowed, 205mm Reduction Forceps with Points, Broad Reduction Forceps with Serrated Jaw Ball Spike Reduction Clamp, Medium Ball Spike Reduction Clamp, Large * Located in the PERI-LOC Forceps Set and the PERI-LOC VLP Periarticular Reduction Forceps Set 21

24 Ball Spike Reduction Clamp* Assemble either the 15mm or 25mm Spiked Washer ( , ) to the Ball Spike Reduction Clamp by pushing the tip of the clamp into the washer until it snaps on. Care should be taken when handling the clamps and spiked washers to avoid the sharpened tips. If the Ball Spike Reduction Clamp is to be used with a plate, insert one of the tips into the desired plate hole and engage the other tip with the bone on the opposite cortex. If using a spiked washer on the far-side clamp tip, ensure that the spikes are against bone. Consideration for the spiked washer should be given in osteopenic or comminuted bone. 15mm Spiked Washer Medium Ball Spike Reduction Clamp * Located in the PERI-LOC VLP Periarticular Reduction Forceps Set 22

25 3.5mm Lateral Proximal Tibia Locking Plate Plate selection Following fracture reduction, select the 3.5mm Lateral Proximal Tibia Locking Plate that best accommodates patient anatomy and fracture pattern. In general, a longer plate allows for better mechanical advantage over a shorter plate. An allowance for five screw holes below the most distal aspect of the fracture is recommended when selecting a plate length. Note The PERI-LOC 3.5mm Lateral Proximal Tibia Locking Plate Preoperative Template ( ) is available to assist with preoperative radiographic planning. 3.5mm Lateral Proximal Targeter assembly Assemble to targeter base, handle and plate on the back table as shown below. Check the plate alignment by inserting a screw guide through the base, targeting the most distal hole of the plate. Insert a drill guide through the screw guide and ensure that it threads into the plate. Remove this drill guide and screw guide and proceed with plate insertion. 23

26 Plate insertion Insert the plate between the muscle and the periosteum keeping the distal end of the plate against the tibia during insertion. Plate positioning Position the plate by matching the contour of the plate to the proximal portion of the lateral tibia. Insert a Small Fragment Targeter Screw Guide ( ) with the orange color-coded 2.7mm Drill Guide ( ) into one of the proximal holes. Tighten the screw guide to the base and tighten the orange drill guide to the plate. Insert a 2.7mm x 40mm Targeter Provisional Fixation Pin ( ) through the drill guide. Be careful not to over tighten the Provisional Fixation Pin as extreme torque may cause the threads to strip. 24

27 Obtain sagittal alignment of fracture and confirm with a lateral image or direct visualization. When a sagittal split is present, reduction can be obtained with either clamps or lag screws, outside or through the plate. To access the distal hole, insert a screw guide with a Targeter Trocar ( ) through a small stab incision until the screw guide reaches the plate and locks into the base. Remove the trocar and insert an orange drill guide, threading it into the plate. Center the plate on the lateral aspect of the tibia and apply a 2.7mm x 18mm Targeter Provisional Fixation Pin ( ) in the most proximal hole. If further reduction of the proximal portion of the diaphyseal fracture is required, center the plate on the proximal diaphyseal fracture fragment and provisionally fix the plate close to the fracture by repeating the previous step. Obtain final confirmation of fracture alignment and implant position. Insert a screw guide through any of the proximal holes securing it to the base. Insert the blue color-coded 1.6mm K-wire Locking Guide Insert ( ) which accepts the 1.6mm x 260mm K-wire ( ). This K-wire can be redirected if necessary until it is parallel to the joint in the AP view. Loosening of the Provisional Fixation Pins may be necessary to redirect the K-wire parallel to the joint. For correct coronal alignment, the K-wire must be parallel to the joint in the AP view. 25

28 3.5mm Medial Distal Tibia Locking Plate Plate selection Following fracture reduction, select the 3.5mm Medial Distal Tibia Locking Plate that best accommodates patient anatomy and fracture pattern. In general, a longer plate allows for better mechanical advantage over a shorter plate. An allowance for five screw holes above the most proximal aspect of the fracture is recommended when selecting a plate length. The plate should be balanced well with the proximal and distal holes over cortical bone. Note The PERI-LOC 3.5mm Medial Distal Tibia Locking Plate Preoperative Template ( ) is available to assist with preoperative radiographic planning. Additionally, there are left and right Medial Distal Tibia Titanium Templates ( , ) located in the PERI-LOC Template Tray to assist with intraoperative plate selection. 26

29 3.5mm Medial Distal Tibia Targeter assembly The Locking Post Assembly for the Medial Distal Tibia is designed with a special left-hand thread. To assemble the plate to the handle, first ensure that the outer sleeve of the locking post assembly is oriented in a way that it is resting against the back of the inner sleeve (away from the threads that thread into the plate). Next, insert the locking post assembly through the handle into the most distal anterior hole (superior to the two K-wire holes) using the 4.7mm Ball Hexdriver and turning to the right. Next, hand tighten the outer sleeve by turning it to the left as far as it will go, being careful not to disengage the inner sleeve threads from the plate. Ensure that the construct is still tight by using the 4.7mm Ball Hexdriver and turning the Locking Post Assembly to the right. Check the plate alignment by inserting a screw guide through the base, targeting the most proximal hole of the plate. Insert a drill guide through the screw guide and ensure that it threads into the plate. Remove this drill guide and screw guide and proceed with plate insertion. Locking Post Assembly 27

30 Plate insertion Insert the plate between the muscle and the periosteum keeping the proximal end of the plate against the tibia during insertion. Plate positioning Position the plate by matching the contour of the plate to the distal portion of the medial tibia. Insert a K-wire Guide ( ) in either of the holes proximal to the thumb screw and insert a 1.6mm x 260mm K-wire ( ). Check the alignment of the plate to the distal tibia and confirm with radiograph. 28

31 Obtain sagittal alignment of fracture and confirm with a lateral radiograph. Upon confirming alignment, insert the orange color-coded 2.7mm Drill Guide ( ) into adjacent hole in base and insert a 2.7mm x 40mm Provisional Fixation Pin ( ). To access the proximal hole, insert a Small Fragment Targeter Screw Guide ( ) with a Targeter Trocar ( ) through a small stab incision until the screw guide reaches the plate and locks into the base. Remove the trocar and insert an orange drill guide, threading it into the plate. Confirm a centered sagittal position of the plate with lateral fluoroscopic radiographs, and insert a 2.7mm x 18mm Provisional Fixation Pin ( ) through the drill guide into the most proximal hole. 29

32 Screw insertion The choice of screws, and the order and configuration is a decision to be made by the individual surgeon depending on the patient s circumstances and needs. Smith & Nephew does not recommend any particular screw insertion order or configuration of the various types of screws available in the system. 30

33 3.5mm Cortex Screws/ 3.5mm Locking Screws/ 4.0mm Cancellous Screws Insert the Small Fragment Targeter Screw Guide ( ) with Targeter Trocar ( ) through a small stab incision until the screw guide reaches the plate and locks into the base. Remove trocar and insert an orange color-coded 2.7mm Drill Guide ( ) and thread into the plate. Drill Drill to the desired depth using a 2.7mm Targeter Drill Bit ( ). Measure Measure for screw length by reading the exposed calibrations off of the 2.7mm Drill Bit. Screw insertion Remove the drill guide and insert the appropriate length screw by hand using the T20 Self Retaining Screwdriver ( ) and the Large Screwdriver Handle ( ). Note Final seating of a 3.5mm Locking Screw should be performed using the 2.0Nm Torque Limiter Adapter ( ) found in the PERI-LOC Small Fragment Instrument Tray. 31

34 Catalog information Large fragment implants PERI-LOC 4.5mm Lateral Distal Femur Plate Set Set No Cat. No. Description Qty Hole, 155mm, Left Hole, 193mm, Left Hole, 230mm, Left Hole, 286mm, Left Hole, 342mm, Left Hole, 399mm, Left Hole, 155mm, Right Hole, 193mm, Right Hole, 230mm, Right Hole, 286mm, Right Hole, 342mm, Right Hole, 399mm, Right Small Outer Case Lid for Outer Case mm Lateral Distal Femur Plate Tray 1 PERI-LOC 4.5mm Lateral Proximal Tibia Plate Set Set No Cat. No. Description Qty Hole, 94mm, Left Hole, 130mm, Left Hole, 165mm, Left Hole, 201mm, Left Hole, 255mm, Left Hole, 309mm, Left Hole, 94mm, Right Hole, 130mm, Right Hole, 165mm, Right Hole, 201mm, Right Hole, 255mm, Right Hole, 309mm, Right Small Outer Case Lid for Outer Case mm Lateral Proximal Tibia Plate Tray 1 32

35 Catalog information Large fragment implants PERI-LOC Large Fragment Screw Set T25 Set No Cat. No. Description Qty Large Outer Case, 4.8mm Lid for Outer Cases mm OD Washer mm OD Washer mm Cannulated Locking Screw, Caddy Tray mm T25 Cortex Screw, Caddy mm T25 Locking Screw, Caddy mm T25 Cancellous Screw, Caddy 1 4.5mm Self-tapping T25 Cortex Screw Cat. No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm 4 Cat. No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm * 105mm * 110mm * 115mm * 120mm * 125mm * 130mm 0 *Sterile 33

36 Catalog information Large fragment implants PERI-LOC Large Fragment Screw Set T25 (continued) 4.5mm Self-tapping T25 Locking Screw Cat. No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm 4 Cat. No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm * 105mm * 110mm * 115mm * 120mm * 125mm * 130mm 0 5.7mm Cannulated Locking Screw Cat. No. Description Qty mm mm mm mm mm mm mm mm mm mm mm 5 Cat. No. Description Qty mm mm mm mm mm mm * 105mm * 110mm * 115mm * 120mm 0 *Sterile 34

37 6.5mm T25 Cancellous Screw, Partially Threaded Cat. No. Description Qty mm mm mm mm mm mm mm 2 Cat. No. Description Qty mm mm mm mm * 105mm * 110mm 0 Catalog information Large fragment instruments 5.7mm Cannulated Depth Gauge for Targeter Cat. No mm x 350mm K-wire for Targeter Cat. No Drill Guides for Targeter Cat. No. Description mm mm 2.0mm K-wire Guide for Targeter Cat. No Large Fragment Screw Guide for Targeter Cat. No mm Locking Post Assembly Cat. No mm Distal Femur Targeter Handles Cat. No. Description Left (Green) Right (Red) 35

38 Catalog information Large fragment instruments Drill Bits for Targeter Cat. No. Description mm mm mm Cannulated 4.5mm Trocar for Targeter Cat. No Provisional Fixation Pins for Targeter Cat. No. Description mm x 40mm mm x 18mm 4.7mm Hexdriver Shaft for Targeter Cat. No mm Cannulated Hexdriver Shaft Cat. No mm Base Hole Plug Cat. No mm Lateral Proximal Tibia Base Cat. No. Description Left Right Large Screwdriver Handle Cat. No T25 Self-retaining Screwdriver Shaft for Targeter Cat. No Lateral Distal Femur Targeter Base Cat. No. Description Left Right 4.5mm Lateral Proximal Tibia Handle Cat. No. Description Left Right 36

39 Catalog information Large fragment trays Distal Femur Targeter Set T25 Set No Cat. No. Description Qty Small Outer Case, 2.4mm Lid for Outer Cases mm Lateral Distal Femur Targeter Tray mm Targeter Over-Label Kit mm Cannulated Depth Gauge Targeter 3.5mm Drill Guide Targeter 4.5mm Drill Guide Targeter Large Fragment K-wire Guide Targeter Large Fragment Screw Guide mm Targeter Lock Post Assembly mm Targeter Medial Distal Tibia Handle, Right Targeter 4.5mm Distal Femur Handle, Left Targeter 4.5mm Distal Femur Handle, Right Targeter 4.5mm Trocar Targeter 4.7mm Hexdriver Shaft Targeter 3.5mm Large Fragment Can Hexdriver Targeter 4.5mm Base Plug Targeter 4.5mm Lateral Distal Femur Base, Left Targeter 4.5mm Lateral Distal Femur Base, Right Large Screwdriver Handle T25 Self-retaining Screwdriver with Quick Connect, 203mm 2 37

40 Catalog information Large fragment trays 4.5mm Lateral Proximal Tibia Targeter Set T25 Set No Cat. No. Description Qty Small Outer Case, Lid for Outer Cases mm Lateral Proximal Tibia Targeter Tray mm Targeter Over-Label Kit mm Cannulated Depth Gauge Targeter 3.5mm Drill Guide Targeter 4.5mm Drill Guide Targeter Large Fragment K-wire Guide Targeter Large Fragment Screw Guide mm Targeter Lock Post Assmbly Targeter 4.5mm Trocar Targeter 4.7mm Hexdriver Shaft Targeter 4.5mm Lateral Proximal Tibia Handle, Left Targeter 4.5mm Lateral Proximal Tibia Handle, Right Targeter 3.5mm Large Fragment Cannulated Hexdriver Targeter 4.5mm Base Plug Targeter 4.5mm Lateral Proximal Tibia Base, Left Targeter 4.5mm Lateral Proximal Tibia Base, Right Large Screwdriver Handle T25 Self-retaining Screwdriver with Quick Connect, 203mm 2 PERI-LOC Large Fragment Targeter Disposables Set Set No Cat. No. Description Qty mm x 350mm K-wire for Targeter mm Drill Bit for Targeter mm Drill Bit for Targeter mm x 40mm Provisional Fixation Pin for Targeter mm x 18mm Provisional Fixation Pin for Targeter mm Cannulated Drill Bit for Targeter 2 38

41 Catalog information Small fragment implants PERI-LOC Proximal Tibia Plate Set Set No mm Lateral Proximal Tibia Locking Plate Cat. No. Description Set Qty Hole, 73mm, Left Hole, 98mm, Left Hole, 123mm, Left Hole, 149mm, Left Hole, 187mm, Left Hole, 73mm, Right Hole, 98mm, Right Hole, 123mm, Right Hole, 149mm, Right Hole, 187mm, Right 0 Included in the 3.5mm Distal Tibia/Calcaneal Plates Set Set No mm Medial Distal Tibia Locking Plate Cat. No. Description Set Qty Hole, 134mm, Left Hole, 160mm, Left Hole, 185mm, Left Hole, 223mm, Left Hole, 134mm, Right Hole, 160mm, Right Hole, 185mm, Right Hole, 223mm, Right 1 39

42 Catalog information Small fragment implants Small Fragment Screw Set Set No mm T15 Cortex Screws, Self-tapping Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm 2 Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm 0 2.7mm T15 Locking Screws, Self-tapping Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm 3 Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm 3 40

43 Catalog information Small fragment implants 3.5mm T20 Cortex Screws, Self-tapping Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm 4 Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm 0 3.5mm T20 Locking Screws, Self-tapping Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm 4 Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm mm 0 Washer Cat. No. Description Qty mm Outer Diameter 6 41

44 Catalog information Small fragment implants 4.0mm Cancellous Screw Set Set No mm T20 Cancellous Screws, Fully Threaded Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm mm 2 Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm mm 0 4.0mm T20 Cancellous Screws, Partially Threaded Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm mm 2 Cat No. Description Qty mm mm mm mm mm mm mm mm mm mm mm mm 0 4.0mm Cancellous Screw Caddies Cat. No. Description Qty mm Cancellous Screw Caddy mm Cancellous Screw Caddy Lid 1 42

45 Catalog information Small fragment instruments 1.6mm x 260mm K-wire for Targeter Cat. No mm Hexdriver Shaft for Targeter Cat. No mm Drill Bit for Targeter Cat. No Small Fragment Screw Guide for Targeter Cat. No mm Drill Guide for Targeter Cat. No mm K-wire Guide for Targeter Cat. No mm Targeter Trocar Cat. No mm Locking Post Assembly Cat. No mm Lateral Proximal Tibia Targeter Base Cat. No. Description Left Right 3.5mm Medial Distal Tibia Targeter Handle Cat. No. Description Left (Green) Right (Red) 3.5mm Medial Distal Tibia Targeter Base Cat. No. Description Left Right 3.5mm Base Hole Plug Cat. No MDT Locking Post Assembly Cat. No

46 Catalog information Small fragment instruments Large Screwdriver Handle Cat. No T20 Self-retaining Screwdriver Shaft for Targeter Cat. No Provisional Fixation Pins for Targeter Cat. No. Description mm x 40mm mm x 18mm 3.5mm Lateral Proximal Tibia Targeter Handle Cat. No. Description Left (Green) Right (Red) 44

47 Catalog information Small fragment trays 3.5mm Lateral Proximal Tibia Targeter Set T20 Set No Cat. No. Description Qty Small Outer Case, 2.4mm Lid for Outer Cases mm Lateral Proximal Tibia Targeter Tray mm Targeter Over-Label Kit Targeter 4.7mm Hexdriver Shaft Targeter 3.5mm Screw Guide Targeter 3.5mm for 2.7mm Drill Guide Targeter 1.6mm K-wire Guide mm Targeter Trocar mm Targeter Lock Post Assembly mm Targeter Lateral Proximal Tibia Base, Left 1 Cat. No. Description Qty mm Targeter Lateral Proximal Tibia 1 Base, Right mm Targeter Lateral Proximal Tibia 1 Handle, Left mm Targeter Lateral Proximal Tibia 1 Handle, Right Targeter 3.5mm Base Plug mm Targeter 3.5mm 1 Self-retaining Hexdriver Large Screwdriver Handle T20 Self-retaining Screwdriver with Quick Connect, 165mm 2 Medial Distal Tibia Targeter Set T20 Set No Cat. No. Description Qty Small Outer Case, 2.4mm Lid for Outer Cases mm Distal Tibia Targeter Tray mm Targeter Over-Label Kit Targeter 4.7mm Hexdriver Shaft Targeter 3.5mm Screw Guide Targeter 3.5mm 2.7mm Drill Guide Targeter 1.6mm K-wire Guide Targeter 3.5mm Trocar mm Targeter Medial Distal Tibia 1 Handle, Left mm Targeter Medial Distal Tibia Handle, Right 1 Cat. No. Description Qty mm Targeter Medial Distal Tibia 1 Base, Left mm Targeter Medial Distal Tibia 1 Base, Right Targeter 3.5mm Base Plug MDT Locking Post Assembly mm Targeter Self-retaining Hexdriver Large Screwdriver Handle T20 Self-retaining Screwdriver with Quick Connect, 165mm 2 3.5mm Targeter Pin Wire Drill Set Set No Description Qty K-wire 1.6mm x 260mm mm PF Pin, 40mm 2 Description Qty mm Drill Bit mm PF Pin, 18mm 2 45

48 Orthopaedics Smith & Nephew, Inc Goodlett Farms Parkway Cordova, TN USA Telephone: Information: Orders/Inquiries: Trademark of Smith & Nephew. Reg. US Pat. & TM Off Smith & Nephew, Inc. All rights reserved REV0 04/11