Cannulated Angled Blade Plate 3.5 and 4.5, 90.

Cannulated Angled Blade Plate 3.5 and 4.5, 90. Technique Guide This publication is not intended for distribution in the USA. Instruments and implants approved by the AO Foundation.

Table of Contents Introduction Cannulated Angled Blade Plates 3.5 and 4.5, 90 2 Indications 4 Surgical Technique Surgical Technique 5 Implant Removal 12 Cleaning of Instruments 13 Product Information Implants 14 Instruments 15 Image intensifier control Warning This description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling these instruments is highly recommended. Processing, Reprocessing, Care and Maintenance For general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: www.synthes.com/reprocessing For general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to: www.synthes.com/reprocessing Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 1

Cannulated Angled Blade Plates 3.5 and 4.5, 90 Cannulated Angled Blade Plate 3.5, 90 The cannulated blade allows accurate insertion and exact positioning of the plate Blade geometry and the oblique lag screw provide high rotational stability Available blade lengths: 30, 35, 40 and 45 mm Number of screw holes: 4, 5, 6, 8 or 10 The three round screw holes next to the blade are suitable for cortex screws B 3.5 mm or cancellous bone screws B 4.0 mm LC-DCP holes for cortex screws B 3.5 mm LC-DCP undercuts allow good periosteal blood supply Available in Pure Titanium or Stainless Steel 2 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

Cannulated Angled Blade Plate 4.5, 90 The cannulated blade allows accurate insertion and exact positioning of the plate Blade geometry and the oblique lag screw provide high rotational stability Available blade lengths: 30, 40, 50, and 60 mm Number of screw holes: 4, 5, 6, 8, 10, or 12 The three round screw holes next to the blade are suitable for cortex screws B 4.5 mm or cancellous bone screws B 6.5 mm LC-DCP holes for cortex screws B 4.5 mm LC-DCP undercuts allow good periosteal blood supply Available in Pure Titanium or Stainless Steel Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 3

Indications The Cannulated Angled Blade Plate 3.5 and 4.5, 90 has the following indications: Humerus 2-part fractures of the proximal humerus Non-unions of the proximal humerus Tibia Metaphyseal fractures of the proximal and distal tibia Metaphseal non-union and malunion Metaphyseal/diaphyseal hinged tibia osteotomies 4 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

Surgical Technique A proximal humeral fracture is used to demonstrate the following surgical technique for the Cannulated Angled Blade Plate 3.5 and 4.5, 90. Important: Use the guide wire to determine the blade length intraoperatively. X-ray templates are not required. 1 Patient positioning Position the patient in a beach chair position. 2 Fracture reduction Reduce the fracture under image intensifier control. 3 Approach Use a deltopectoral approach. Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 5

Surgical Technique 4 Determine blade entry point and insert guide wire 332.015 Drill Guide for Cannulated Angled Blade Plate 3.5 or 332.401 Drill Guide for Cannulated Angled Blade Plate 4.5 292.650 Guide Wire B 2.0 mm with threaded tip with trocar, length 230 mm, Stainless Steel Place the drill guide on the lateral metaphysis of the proximal humerus. Insert the guide wire through the central hole of the drill guide. Place the tip of the guide wire in the subchondral position. Use the image intensifier to check the position of the guide wire. The position of the guide wire indicates the final position of the blade at a 90 angle to the diaphysis. Note: The drill guide does not need to be used to insert the guide wire. Check position with the image intensifier. 6 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

5 Determine blade length Instruments 50 40 30 319.210 Direct Measuring Device for Cannulated Screws B 7.0 mm Remove the drill guide. Slide the direct measuring device onto the guide wire and use the markings to read the blade length. The extent of the fracture will determine the plate shaft length. Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 7

Surgical Technique 6 Open blade entry point Instruments 332.015 Drill Guide for Cannulated Angled Blade Plate 3.5 or 332.401 Drill Guide for Cannulated Angled Blade Plate 4.5 315.690 Drill Bit B 4.5/2.1 mm, cannulated, calibrated, length 230/210 mm, 3-flute, for Jacobs Chuck 1 3 2 4 Slide the drill guide again onto the guide wire and align with the humeral metaphysis. Use a B 3.5 or 4.5 mm drill bit to drill a hole through the near cortical bone to the left and to the right of the guide wire hole (1;2). Then use a B 2.5 or 3.2 mm drill bit to drill through the near cortical bone through the two oblique holes of the drill guide from distal to proximal (3;4). Remove the drill guide. Slide the cannulated drill bit onto the guide wire and drill through the remaining cortical bone. Note: All cortical bone at the blade entry point must be removed in order to facilitate blade insertion and achieve optimal fit of the plate to the metaphysis. 8 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

7 Contour plate Instruments 332.017 Bending Template for Cannulated Angled Blade Plate 3.5, 4 holes, length 80 mm 332.019 Bending Template for Cannulated Angled Blade Plate 3.5, 10 holes, length 158 mm or 329.905 Bending Template for Cannulated Angled Blade Plate 4.5, 5 holes, length 94 mm 329.908 Bending Template for Cannulated Angled Blade Plate 4.5, 8 holes, length 148 mm 329.912 Bending Template for Cannulated Angled Blade Plate 4.5, 12 holes, length 220 mm 329.040 Bending Iron for Plates 2.4 to 3.5, length 145 mm and 329.050 Bending Iron for Plates 2.4 to 3.5, length 145 mm Place the bending template distally under the blade entry point to adapt it to the bone. Use bending pliers or a bending iron to contour the plate to match the template. Ensure a snug fit of plate shaft and bone. Important: The angle between the guide wire and the humeral metaphysis must identically match the angle between the blade and the plate shaft. Note: Avoid bending the plate back and forth. Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 9

Surgical Technique 8 Insert plate Slide the plate onto the guide wire. Press the blade manually through the cortical and the cancellous bone until its final position is reached. Remove and dispose of the guide wire. Dense bone procedure Instruments 332.016 Inserter/Extractor for Cannulated Angled Blade Plates 3.5 and 4.5 332.403 Slotted Hammer, small, for Cannulated Angled Blade Plates 3.5 and 4.5 Optional 321.120 Tension Device, articulated, span 20 mm Attach the inserter/extractor as close to the plate angle as possible. Slide the blade onto the guide wire. Press it manually through the opening in the cortical bone. Use slight taps of slotted hammer onto the inserter/extractor to move the plate into its final position and complete the insertion. Note: Use the tension device to achieve additional compression between the proximal fragment of the humeral head and the metaphysis. 10 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

9 Attach plate Insert a cortex screw B 3.5 or 4.5 mm or a cancellous bone screw B 4.0 or 6.5 mm as a lag screw obliquely through the hole in the angle of the plate. Increase the drill hole width up to the fracture line to the same size as the outer diameter of the screw thread. This will act as a gliding hole. To achieve compression between the proximal fragment of the humeral head and the metaphysis, seat the lag screw in the far cortical bone distal to the fracture. Insert cortex screws B 3.5 or 4.5 mm or cancellous bone screws B 4.0 or 6.5 mm into the proximal round holes and cortex screws B 3.5 or 4.5 mm into the distal LC-DCP holes to secure the plate in its final position. Ensure the screws are firmly seated in both cortices to achieve stable fixation. Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 11

Implant Removal Remove plate Instruments 332.016 Inserter/Extractor for Cannulated Angled Blade Plates 3.5 and 4.5 332.403 Slotted Hammer, small, for Cannulated Angled Blade Plates 3.5 and 4.5 After removing all screws, attach the inserter/extractor close to the angle between the plate shaft and the blade and extract the plate with slight taps of the slotted hammer. 12 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

Cleaning of Instruments Instrument 319.360 Cleaning Stylet B 2.0 mm, for Cannulated Instruments Carefully clean the instruments to maintain proper function. Clean the cannulation of the drill bit B 4.5/2.1 mm intraoperatively with the cleaning stylet. Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 13

Implants Cannulated Angled Blade Plates 3.5* X32.006 Cannulated Angled Blade Plate 3.5, 90, 10 holes, blade length 30 mm X32.007 Cannulated Angled Blade Plate 3.5, 90, 10 holes, blade length 35 mm X32.008 Cannulated Angled Blade Plate 3.5, 90, 10 holes, blade length 40 mm X32.009 Cannulated Angled Blade Plate 3.5, 90, 10 holes, blade length 45 mm X32.046 Cannulated Angled Blade Plate 3.5, 90, 4 holes, blade length 30 mm X32.047 Cannulated Angled Blade Plate 3.5, 90, 4 holes, blade length 35 mm X32.048 Cannulated Angled Blade Plate 3.5, 90, 4 holes, blade length 40 mm X32.049 Cannulated Angled Blade Plate 3.5, 90, 4 holes, blade length 45 mm X32.056 Cannulated Angled Blade Plate 3.5, 90, 5 holes, blade length 30 mm X32.057 Cannulated Angled Blade Plate 3.5, 90, 5 holes, blade length 35 mm X32.058 Cannulated Angled Blade Plate 3.5, 90, 5 holes, blade length 40 mm X32.059 Cannulated Angled Blade Plate 3.5, 90, 5 holes, blade length 45 mm X32.066 Cannulated Angled Blade Plate 3.5, 90, 6 holes, blade length 30 mm X32.067 Cannulated Angled Blade Plate 3.5, 90, 6 holes, blade length 35 mm X32.068 Cannulated Angled Blade Plate 3.5, 90, 6 holes, blade length 40 mm X32.069 Cannulated Angled Blade Plate 3.5, 90, 6 holes, blade length 45 mm X32.086 Cannulated Angled Blade Plate 3.5, 90, 8 holes, blade length 30 mm X32.087 Cannulated Angled Blade Plate 3.5, 90, 8 holes, blade length 35 mm X32.088 Cannulated Angled Blade Plate 3.5, 90, 8 holes, blade length 40 mm X32.089 Cannulated Angled Blade Plate 3.5, 90, 8 holes, blade length 45 mm Cannulated Angled Blade Plates 4.5* X37.043 Cannulated Angled Blade Plate 4.5, 90, 4 holes, blade length 30 mm X37.044 Cannulated Angled Blade Plate 4.5, 90, 4 holes, blade length 40 mm X37.053 Cannulated Angled Blade Plate 4.5, 90, 5 holes, blade length 30 mm X37.054 Cannulated Angled Blade Plate 4.5, 90, 5 holes, blade length 40 mm X37.063 Cannulated Angled Blade Plate 4.5, 90, 6 holes, blade length 30 mm X37.064 Cannulated Angled Blade Plate 4.5, 90, 6 holes, blade length 40 mm X37.083 Cannulated Angled Blade Plate 4.5, 90, 8 holes, blade length 30 mm X37.084 Cannulated Angled Blade Plate 4.5, 90, 8 holes, blade length 40 mm X37.085 Cannulated Angled Blade Plate 4.5, 90, 8 holes, blade length 50 mm X37.104(s) Cannulated Angled Blade Plate 4.5, 90, 10 holes, blade length 40 mm X37.105 Cannulated Angled Blade Plate 4.5, 90, 10 holes, blade length 50 mm X37.106 Cannulated Angled Blade Plate 4.5, 90, 10 holes, blade length 60 mm X37.123 Cannulated Angled Blade Plate 4.5, 90, 12 holes, blade length 30 mm X37.124 Cannulated Angled Blade Plate 4.5, 90, 12 holes, blade length 40 mm X37.125 Cannulated Angled Blade Plate 4.5, 90, 12 holes, blade length 50 mm X37.126 Cannulated Angled Blade Plate 4.5, 90, 12 holes, blade length 60 mm * X = 2: Stainless Steel X = 4: Pure Titanium All implants are available sterile packed. For sterile implants add suffix "S" to article number. 14 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

Instruments General Instruments 332.015 Drill Guide for Cannulated Angled Blade Plate 3.5 332.401 Drill Guide for Cannulated Angled Blade Plate 4.5 292.650 Guide Wire B 2.0 mm with threaded tip with trocar, length 230 mm, Stainless Steel 319.210 Direct Measuring Device for Cannulated Screws B 7.0 mm 332.016 Inserter/Extractor for Cannulated Angled Blade Plates 3.5 and 4.5 332.403 Slotted Hammer, small, for Cannulated Angled Blade Plates 3.5 and 4.5 315.690 Drill Bit B 4.5/2.1 mm, cannulated, calibrated, length 230/210 mm, 3-flute, for Jacobs Chuck 332.405 Impactor for Cannulated Angled Blade Plate 4.5 332.406 Insert for Impactor No. 332.405 332.407 Impactor for Cannulated Angled Blade Plate 3.5 332.408 Insert for Impactor No. 332.407, single Cleaning Instruments 319.360 Cleaning Stylet B 2.0 mm, for Cannulated Instruments Bending Irons 329.040 Bending Iron for Plates 2.4 to 3.5, length 145 mm 329.050 Bending Iron for Plates 2.4 to 3.5, length 145 mm Bending Templates 329.905 Bending Template for Cannulated Angled Blade Plate 4.5, 5 holes, length 94 mm 329.908 Bending Template for Cannulated Angled Blade Plate 4.5, 8 holes, length 148 mm 329.912 Bending Template for Cannulated Angled Blade Plate 4.5, 12 holes, length 220 mm 332.017 Bending Template for Cannulated Angled Blade Plate 3.5, 4 holes, length 80 mm 332.019 Bending Template for Cannulated Angled Blade Plate 3.5, 10 holes, length 158 mm Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide Synthes 15

16 Synthes Cannulated Angled Blade Plate 3.5 and 4.5, 90 Technique Guide

Synthes GmbH Eimattstrasse 3 CH-4436 Oberdorf www.depuysynthes.com Ö036.000.111öACQä This publication is not intended for distribution in the USA. All surgical techniques are available as PDF files at www.synthes.com/lit 0123 Synthes GmbH 2014. All rights reserved. 036.000.111 AC DSEM/TRM/0714/0112 07/2014