MatrixRIB. Stable fixation of normal and osteoporotic ribs.

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

Table of Contents Introduction MatrixRIB 2 AO Principles 4 Indications 5 Surgical Technique Patient Positioning 5 Plating Rib 6 Splint Insertion 14 Product Information Implants 21 Instruments 22 Set Lists 26 References 31 MatrixRIB Technique Guide Synthes

MatrixRIB 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). Potential benefits of surgical stabilization of fractures include reduced duration of mechanical ventilation support, shortened ICU stays and hospitalization, better secretion management through efficient cough, and minimized chest wall deformities resulting from trauma. 1,2 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 Right plates Locking holes In-plane radius R3 R4-5 Longitudinal twist R6-7 R8-9 Locking screws Screws work with self-retaining screwdriver blades to reduce cam-out Locking design for increased stable fixation One screw diameter for use with all plates and splints * Ti-6Al-7Nb 2 Synthes MatrixRIB Technique Guide

Locking plates Plates are precontoured to fit an average rib shape, which minimizes intraoperative bending 3 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 curvature A universal plate with 8 holes is available R3 R4-5 R6-7 rib 3 rib 4 rib 5 rib 6 rib 7 rib 3 rib 4 rib 5 rib 6 rib 7 L3 L4-5 L6-7 rib 8 rib 8 R8-9 rib 9 rib 9 L8-9 Left plates L3 Etching Out of plane radius L4-5 L6-7 Tubular radius L8-9 Intramedullary splints Intramedullary splints allow minimally invasive procedures Three widths available (3 mm, 4 mm, 5 mm) Only one screw needed to secure splint MatrixRIB Technique Guide Synthes 3

AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.* Anatomic reduction Fracture reduction and fixation to restore functional anatomical relationships. Stable fixation Stability by rigid fixation or splintage, as the personality of the fracture and the injury requires. Preservation of blood supply Preservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques. Early, active mobilization Early and safe mobilization of the part and patient. * M. E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger. Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991. 4 Synthes MatrixRIB Technique Guide

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 patient 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. MatrixRIB Technique Guide Synthes 5

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. 2 Measure rib thickness Instrument 03.501.065 Caliper Optional instrument 03.501.074 Universal Caliper Make a small incision in the intercostal space at the superior border of the rib to allow insertion of the caliper tip. Insert the caliper tip through the incision and measure the rib thickness. Note: If an existing access into the intercostal space is available for measuring the rib thickness, it is recommended to insert the caliper tip using the existing access. To select the appropriate drill bit with stop and the appropriate screw length, add 2 mm to the measurement to allow for the plate thickness. Caution: Take care to avoid damaging the nerve and vessel bundle at the inferior border of the rib. 6 Synthes MatrixRIB Technique Guide

3 Approximate broken rib segments Instrument 398.40 Reduction Forceps with points, narrow, ratchet, 132 mm length Use the forceps to approximate the broken rib segments. 4 Cut and contour plate template (optional) Instrument 03.501.072 Bending Template for MatrixRIB Locking 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. MatrixRIB Technique Guide Synthes 7

Plating Rib continued 5 Select and cut plate (optional) Instrument 391.990 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 marking toward the sternum. A universal plate is available for use in place of a precontoured plate (see implants on page 21). 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. 8 Synthes MatrixRIB Technique Guide

6 Contour plate (optional) Instrument 329.142 Combination Bending Pliers Using the bending pliers, contour the plate to match the template. Caution: If contouring is necessary, 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. MatrixRIB Technique Guide Synthes 9

Plating Rib continued 7 Position plate Instrument 03.501.071 MatrixRIB Plate Holding Forceps, small Optional instruments 03.501.030 MatrixRIB Plate Holding Forceps, small, with ball tips 03.501.031 MatrixRIB Plate Holding Forceps, large, with ball tips Position the plate on the rib over the fracture, allowing a minimum of three screws on each side of the fracture. Verify that 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. 10 Synthes MatrixRIB Technique Guide

8 Drill Instruments 03.501.033 2.2 mm Threaded Drill Guide for MatrixRIB Locking Plates 03.501.036 2.2 mm Drill Bits with stop, Stryker J-latch 03.501.044 6 mm to 14 mm stop 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. 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 mm drill guide after drilling. MatrixRIB Technique Guide Synthes 11

Plating Rib continued 9 Select and insert screw Instruments 03.501.001 Depth Gauge for 2.7 mm and larger screws with zero offset 03.503.071 MatrixMANDIBLE/ THORAX Self-Retaining Screwdriver Blade, medium 311.023 Ratcheting Screwdriver Handle Optional instrument 03.503.072 MatrixMANDIBLE/ THORAX Self-Retaining Screwdriver Blade, long 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. 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. Screws can be measured using the screw length indicator on the module. Insert the locking screw through the plate and tighten until secure. Optionally, 10 and 12 mm nonlocking screws are available to ensure the plate sits flush with the bone. These nonlocking screws are for temporary fixation and will need to be replaced with locking screws before closure. 12 Synthes MatrixRIB Technique Guide

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. Note: If nonlocking screws were used, remember to replace with the proper locking screw. MatrixRIB Technique Guide Synthes 13

Splint Insertion Intramedullary splints require smaller incisions and 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 limit migration and rotation of the implant. Intramedullary splints Intramedullary splints allow minimally 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. 14 Synthes MatrixRIB Technique Guide

2 Measure rib thickness Instrument 03.501.065 Caliper Optional instrument 03.501.074 Universal Caliper Make a small incision in the intercostal space at the superior border of the rib to allow insertion of the caliper tip. Insert the caliper tip through the incision and measure the rib thickness. Note: If an existing access into the intercostal space is available for measuring the rib thickness, it is recommended to insert the caliper tip using the existing access. To select the appropriate drill bit with stop and the appropriate screw, add 1 mm to the measurement to allow for the splint thickness. Caution: Take care to avoid damaging the nerve and vessel bundle at the inferior border of the rib. MatrixRIB Technique Guide Synthes 15

Splint Insertion continued 3 Prepare splint insertion hole Instruments 03.501.055 5.5 mm Drill Guide for MatrixRIB Intramedullary Splints 03.501.070 5.5 mm Drill Bit with stop, Stryker J-latch 03.501.071 MatrixRIB Plate Holding Forceps, small Optional instruments 03.501.032 MatrixRIB Intramedullary Splint Driver 03.501.075 5.5 mm Drill Guide 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 hold the drill guide against the rib 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 a 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. Irrigate during drilling to avoid thermal damage to the bone. Remove the drill guide and verify the hole is approximately 30 mm from the fracture line. Note: Ensure the lateral fracture segment is long enough to accommodate the insertion length of the splint before drilling. 16 Synthes MatrixRIB Technique Guide

4 Select splint Instruments 03.501.032 MatrixRIB Intramedullary Splint Driver 03.501.061 MatrixRIB Intramedullary Splint Template, small 03.501.062 MatrixRIB Intramedullary Splint Template, medium 03.501.066 Mallet, 200 g 398.40 Reduction Forceps with points, narrow, ratchet, 132 mm length 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 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. Use the mallet to assist insertion of the splint template, if needed. Use bone reduction forceps to hold the rib segment during splint template insertion. MatrixRIB Technique Guide Synthes 17

Splint Insertion continued 5 Insert splint Instruments 03.501.032 MatrixRIB Intramedullary Splint Driver 03.501.066 Mallet, 200 g 398.40 Reduction Forceps with points, narrow, ratchet, 132 mm length Thread the splint driver into the splint selected in Step 4, with the splint marking facing up toward 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. 18 Synthes MatrixRIB Technique Guide

6 Drill screw hole Instruments 03.501.033 2.2 mm Threaded Drill Guide for MatrixRIB Locking Plates 03.501.036 2.2 mm Drill Bits with stop, Stryker J-latch 03.501.044 6 mm to 14 mm stop 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. 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 mm drill guide after drilling. MatrixRIB Technique Guide Synthes 19

Splint Insertion continued 7 Select and insert screw Instruments 03.501.001 Depth Gauge for 2.7 mm and larger screws with zero offset 03.503.071 MatrixMANDIBLE/THORAX Self Retaining Screwdriver Blade, medium 311.023 Ratcheting Screwdriver Handle Optional instruments 03.501.074 Universal Caliper 03.503.072 MatrixMANDIBLE/ THORAX Self-Retaining Screwdriver Blade, long 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. Screws can be measured using the screw length indicator on the module. Insert the locking screw through the splint and tighten until secure. 20 Synthes MatrixRIB Technique Guide

Implants Titanium MatrixRIB Pre-Contoured Plates 04.501.001 15 holes, for left rib 3 04.501.002 15 holes, for right rib 3 04.501.003 16 holes, for left ribs 4 and 5 04.501.004 16 holes, for right ribs 4 and 5 04.501.005 17 holes, for left ribs 6 and 7 04.501.006 17 holes, for right ribs 6 and 7 04.501.007 18 holes, for left ribs 8 and 9 04.501.008 18 holes, for right ribs 8 and 9 Left plate (light blue) 04.501.001 Right plate (rose red) 04.501.002 04.501.009 Titanium MatrixRIB Universal Plate, 8 holes Titanium MatrixRIB Intramedullary Splints 04.501.010 Small, 3 mm width 04.501.011 Medium, 4 mm width 04.501.012 Large, 5 mm width 2.9 mm Titanium MatrixRIB Locking Screws,* self-tapping 04.501.016.01 6 mm 04.501.018.01 8 mm 04.501.020.01 10 mm 04.501.022.01 12 mm 04.501.024.01 14 mm 2.9 mm Titanium MatrixRIB Non-locking Screws, * self-tapping 04.501.040.01 10 mm 04.501.042.01 12 mm *For screws in packs of 5, replace suffix.01 with.05. MatrixRIB Technique Guide Synthes 21

Instruments 03.501.001 Depth Gauge for 2.7 mm and larger screws with zero offset 03.501.030 MatrixRIB Plate Holding Forceps, small, with ball tips 03.501.031 MatrixRIB Plate Holding Forceps, large with ball tips 03.501.032 MatrixRIB Intramedullary Splint Driver 03.501.033 2.2 mm Threaded Drill Guide for MatrixRIB Locking Plates 03.501.036 2.2 mm Drill Bits with stop, Stryker J-latch 03.501.044 6 mm to 14 mm stops (2 mm increments) 22 Synthes MatrixRIB Technique Guide

03.501.055 5.5 mm Drill Guide for MatrixRIB Intramedullary Splints 03.501.061 MatrixRIB Intramedullary Splint Template, small 03.501.062 MatrixRIB Intramedullary Splint Template, medium 03.501.065 Caliper 03.501.066 Mallet, 200 g 03.501.070 5.5 mm Drill Bit with stop, Stryker J-latch, 125 mm MatrixRIB Technique Guide Synthes 23

Instruments continued 03.501.071 MatrixRIB Plate Holding Forceps, small 03.501.072 Bending Template for MatrixRIB Locking Plates 03.501.074 Universal Caliper 03.501.075* 5.5 mm Drill Guide for MatrixRIB Intramedullary Splints, without handle MatrixMANDIBLE/THORAX Self-Retaining Screwdriver Blades 03.503.071 Medium 03.503.072 Long In sets 01.501.010 and 01.501.011 * In set 01.501.010 24 Synthes MatrixRIB Technique Guide

311.023 Ratcheting Screwdriver Handle 329.142 Combination Bending Pliers 391.990 Plate and Rod Cutter 398.40 Reduction Forceps with points, narrow, ratchet, 132 mm length MatrixRIB Technique Guide Synthes 25

MatrixRIB Fixation System Set (01.501.005) Graphic Case 60.501.001 Graphic Case with Lid for MatrixRIB Fixation System Instruments 03.501.001 Depth Gauge for 2.7 mm and larger screws with zero offset 03.501.030 MatrixRIB Plate Holding Forceps, small, with ball tips, 2 ea. 03.501.031 MatrixRIB Plate Holding Forceps, large, with ball tips, 2 ea. 03.501.032 MatrixRIB Intramedullary Splint Driver 03.501.033 2.2 mm Threaded Drill Guide for MatrixRIB Locking Plates, 2 ea. 2.2 mm Drill Bits, Stryker J-latch, 135 mm, 2 ea. 03.501.036 with 6 mm stop 03.501.038 with 8 mm stop 03.501.040 with 10 mm stop 03.501.042 with 12 mm stop 03.501.044 with 14 mm stop 03.501.055 5.5 mm Drill Guide, for MatrixRIB Intramedullary Splints 03.501.061 MatrixRIB Intramedullary Splint Template, small 03.501.062 MatrixRIB Intramedullary Splint Template, medium 03.501.065 Caliper 03.501.066 Mallet, 200 g 03.501.070 5.5 mm Drill Bit with stop, Stryker J-latch, 125 mm, 2 ea. 03.501.071 MatrixRIB Plate Holding Forceps, small, 2 ea. 03.501.072 Bending Template, for MatrixRIB Locking Plates, 2 ea. 03.503.071 MatrixMANDIBLE/ THORAX Self-Retaining Screwdriver Blade, medium, 2 ea. 03.503.072 MatrixMANDIBLE/ THORAX Self-Retaining Screwdriver Blade, long, 2 ea. 311.023 Ratcheting Screwdriver Handle, 2 ea. 329.142 Combination Bending Pliers, for 2.0 mm 2.4 mm plates 391.990 Plate and Rod Cutter 398.40 Reduction Forceps with points, narrow, ratchet, 132 mm length, 2 ea. Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer to http://www.synthes.com/sites/na/medicalcommunity/pages/cleaning_and_ Sterilization.aspx or to the below listed inserts, which will be included in the shipping container: Processing Synthes Reusable Medical Devices Instruments, Instrument Trays and Graphic Cases DJ1305 Processing Non-sterile Synthes Implants DJ1304 26 Synthes MatrixRIB Technique Guide

Implants Titanium MatrixRIB Pre-Contoured Plates, 2 ea. 04.501.001 15 holes, for left rib 3 04.501.002 15 holes, for right rib 3 04.501.003 16 holes, for left ribs 4 and 5 04.501.004 16 holes, for right ribs 4 and 5 04.501.005 17 holes, for left ribs 6 and 7 04.501.006 17 holes, for right ribs 6 and 7 04.501.007 18 holes, for left ribs 8 and 9 04.501.008 18 holes, for right ribs 8 and 9 04.501.009 Titanium MatrixRIB Universal Plate, 8 holes, 4 ea. MatrixRIB Intramedullary Splints, 6 ea. 04.501.010 Small, 3 mm width 04.501.011 Medium, 4 mm width 04.501.012 Large, 5 mm width 2.9 mm Titanium MatrixRIB Locking Screws, self-tapping, 5/pkg. 04.501.016.05 6 mm, 6 pkgs. 04.501.018.05 8 mm, 10 pkgs. 04.501.020.05 10 mm, 10 pkgs. 04.501.022.05 12 mm, 10 pkgs. 04.501.024.05 14 mm, 6 pkgs. 04.501.040.05 2.9 mm Titanium MatrixRIB Non-Locking Screws, self-tapping, 10 mm, 2 pkgs. of 5 MatrixRIB Technique Guide Synthes 27

MatrixRIB Compact Plate and Splint System (01.501.010) Graphic Case 60.501.010 MatrixRIB Compact Graphic Case, without tray 60.501.012 MatrixRIB Compact Insert Tray, plate and splint Screw Length Markers 304.106 6 mm 304.108 8 mm 304.110 10 mm 304.112 12 mm 304.114 14 mm Instruments 03.501.030 MatrixRIB Plate Holding Forceps, small, with ball tips, 2 ea. 03.501.032 MatrixRIB Intramedullary Splint Driver 03.501.033 2.2 mm Threaded Drill Guide for MatrixRIB Locking Plates, 2 ea. 2.2 mm Drill Bits, Stryker J-latch, 135 mm, 2 ea. 03.501.036 with 6 mm stop 03.501.038 with 8 mm stop 03.501.040 with 10 mm stop 03.501.042 with 12 mm stop 03.501.044 with 14 mm stop 03.501.061 MatrixRIB Intramedullary Splint Template, small 03.501.062 MatrixRIB Intramedullary Splint Template, medium 03.501.066 Mallet, 200 g 03.501.070 5.5 mm Drill Bit with stop, Stryker J-latch, 125 mm, 2 ea. 03.501.071 MatrixRIB Plate Holding Forceps, small, 2 ea. 03.501.074 Universal Caliper 03.501.075 5.5 mm Drill Guide, for MatrixRIB Intramedullary Splints, without handle 03.503.071 MatrixMANDIBLE/THORAX Self-Retaining Screwdriver Blade, medium, 2 ea. 03.503.072 MatrixMANDIBLE/THORAX Self-Retaining Screwdriver Blade, long, 2 ea. 311.023 Ratcheting Screwdriver Handle, 2 ea. 398.40 Reduction Forceps with points, narrow, ratchet, 132 mm length, 2 ea. 60.501.010 60.501.012 28 Synthes MatrixRIB Technique Guide

Implants 04.501.009 Titanium MatrixRIB Universal Plate, 8 holes, 3 ea. Titanium MatrixRIB Intramedullary Splints, 4 ea. 04.501.010 small, 3 mm width 04.501.011 medium, 4 mm width 04.501.012 large, 5 mm width 2.9 mm Titanium MatrixRIB Locking Screws, self-tapping, 5/ pkg. 04.501.016.05 6 mm, 2 pkgs. 04.501.018.05 8 mm, 5 pkgs. 04.501.020.05 10 mm, 6 pkgs. 04.501.022.05 12 mm, 5 pkgs. 04.501.024.05 14 mm, 2 pkgs. MatrixRIB Technique Guide Synthes 29

MatrixRIB Compact Plate System (01.501.011) Graphic Case 60.501.010 MatrixRIB Compact Graphic Case, without tray 60.501.011 MatrixRIB Compact Insert Tray, plate only Screw Length Markers 304.106 6 mm 304.108 8 mm 304.110 10 mm 304.112 12 mm 304.114 14 mm Instruments 03.501.030 MatrixRIB Plate Holding Forceps, small, with ball tips, 2 ea. 03.501.033 2.2 mm Threaded Drill Guide for MatrixRIB Locking Plates, 2 ea. 2.2 mm Drill Bits, Stryker J-latch, 135 mm, 2 ea. 03.501.036 with 6 mm stop 03.501.038 with 8 mm stop 03.501.040 with 10 mm stop 03.501.042 with 12 mm stop 03.501.044 with 14 mm stop 60.501.010 60.501.011 03.501.071 MatrixRIB Plate Holding Forceps, small, 2 ea. 03.501.074 Universal Caliper 03.503.071 MatrixMANDIBLE/THORAX Self-Retaining Screwdriver Blade, medium, 2 ea. 03.503.072 MatrixMANDIBLE/THORAX Self-Retaining Screwdriver Blade, long, 2 ea. 311.023 Ratcheting Screwdriver Handle, 2 ea. 398.40 Reduction Forceps with points, narrow, ratchet, 132 mm length, 2 ea. Implants 04.501.009 Titanium MatrixRIB Universal Plate, 8 holes, 6 ea. 2.9 mm Titanium MatrixRIB Locking Screws, self-tapping, 5/ pkg. 04.501.016.05 6 mm, 2 pkgs. 04.501.018.05 8 mm, 5 pkgs. 04.501.020.05 10 mm, 6 pkgs. 04.501.022.05 12 mm, 5 pkgs. 04.501.024.05 14 mm, 2 pkgs. 30 Synthes MatrixRIB Technique Guide

Also Available 5.5 mm Drill Bit with stop, 03.501.085 AO Quick Coupling, 125 mm 2.2 mm Drill Bits, AO Quick Coupling, 135mm 03.501.606 with 6 mm stop 03.501.608 with 8 mm stop 03.501.610 with 10 mm stop 03.501.612 with 12 mm stop 03.501.614 with 14 mm stop 03.503.073 MatrixMANDIBLE/THORAX Self-Retaining Fixed Handle Screwdriver 2.9 mm Titanium MatrixRIB Locking Screws, self-tapping, 1/ pkg. 04.501.016.01 6 mm 04.501.018.01 8 mm 04.501.020.01 10 mm 04.501.022.01 12 mm 04.501.024.01 14 mm 2.9 mm Titanium MatrixRIB Non-Locking Screws, self-tapping, 1/pkg. 04.501.040.01 10 mm 04.501.042.01 12 mm 04.501.042.05 2.9 mm Titanium MatrixRIB Non-Locking Screws, self-tapping, 12 mm, 5/pkg. 05.000.007.01S Battery Pack, sterile, for Battery Powered Driver 05.000.008 Hand Piece, for Battery Powered Driver References 1. Z. Ahmed, Z. Mohyuddin. Management of flail chest injury: internal fixation versus endotracheal intubation and ventilation. J Thorac Cardiovasc Surg. 1995 Dec; 110(6):1676-80. 2. H. Tanaka, T. Yukioka, Y. Yamaguti, S. Shimizu, H. Goto, H. Matsuda, S. Shimazaki. Surgical stabilization of internal pneumatic stabilization. A prospective randomized study of management of severe flail chest patients. J Trauma. 2002;52(4): 727-32; discussion 32. 3. M. Mohr, E. Abrams, C. Engel, W.B. Long, M. Bottlang. Geometry of Human Ribs Pertinent to Orthopaedic Chest-Wall Reconstruction. J Biomech. 2007;40(6):1310-7. MatrixRIB Technique Guide Synthes 31

Synthes CMF 1302 Wrights Lane East West Chester, PA 19380 Telephone: (610) 719-5000 To order: (800) 523-0322 Fax: (610) 251-9056 Synthes (Canada) Ltd. 2566 Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) 567-0440 To order: (800) 668-1119 Fax: (905) 567-3185 www.synthes.com 2009 Synthes, Inc. or its affiliates. All rights reserved. Synthes is a trademark of Synthes, Inc. or its affiliates. Printed in U.S.A. 9/11 J8654-D