Distal Medial Tibia Plate Surgical Technique

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Esther O’Neal’
5 years ago
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1 Locking Compression Technology by aap

3 1

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 Materials Description Indications/Contraindications Processing (Sterilization & Cleaning) Preoperative Planning Positioning Access Repositioning Insertion of the plate Securing of distal plate holes Securing the gliding holes in the shaft Locking screw in compression position Explantation Trays LOQTEQ, Set of Plates LOQTEQ Small Fragment Set, complete LOQTEQ Small Fragment Set, Set of Instruments LOQTEQ Small Fragment Set, Set of Plates, complete LOQTEQ Small Fragment Set, Screw Rack, complete

Introduction The distal medial tibia plate is part of the LOQTEQ plate system and unifies angular stability with modern plate design.

Materials For the manufacture of angle stable plate systems materials are used which have been proven to be successful in medical technology for decades.

They are characterized by good biocompatibility, a high degree of reliability against allergic reactions and good mechanical properties.

6 Introduction The distal medial tibia plate is part of the LOQTEQ plate system and unifies angular stability with modern plate design. Special features include the gliding-locking holes in the plate shaft. They enable both compression and angle-stable locking in one single step. Materials 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 plates and bone screws are made of titanium alloy. All materials used are standardized in national and international norms. They are characterized by good biocompatibility, a high degree of reliability against allergic reactions and good mechanical properties. Description The anatomic plate design is adapted to the proximal medial tibia Available as right and left version Flat design in the distal area provides sufficient soft tissue coverage Minor contact undercuts are designed to minimize the reduction in blood supply to the periosteum The flattened end of the plate shaft enables the tissue-conserving, submuscular insertion of the plate Gliding-locking holes in the shaft area allow compression and angular stability with LOQTEQ technology Round locking holes in the plate head are suitable for 3.5 mm locking screws (blue) as well as standard screws with small head 3 distal screws run parallel to the joint Fitted targeting devices guarantee a safe placement of drill guides at the preset angle Numerous distal screw options provide screw placement according to fracture pattern (see Design Rational) Holes for K-wires and an oblong hole facilitate the primary fixation of the plate 3-14 holes in the plate shaft 4

7 Introduction Indications/ Contraindications Indications The distal medial tibia plate 4.5 mm is indicated for stabilizing: Complex intra-articular and extra-articular fractures of the distal tibia Osteotomies of the distal tibia 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 under any circumstances (see Instructions for Use). 5

8 Preoperative Planning Evaluation of the fracture situation on the basis of the x-ray and selection of the appropriate plate length Positioning Position patient in supine position on a radiolucent operating table. If necessary, apply a tourniquet to the thigh. Access Open or percutaneous, depending on the fracture situation For percutaneous access: Incision for access to the medial malleolus; if necessary, reposition using external fixator. 6

9 Repositioning After having anatomically repositioned the joint surfaces, temporarily fixate the result, e.g. with K-wires. If closed repositioning is possible, align the shaft to length, axis and rotation. Then check the result of repositioning using fluoroscopy. 7

Insertion of the plate Mount the targeting device on the plate using the fixation screw.

For this purpose, you can use the provided holes in the plate or an appropriately positioned threaded drill guide with inserted

For this purpose use a double drill guide and a drill bit ø2.5 and pilot drill to the desired depth.

10 Insertion of the plate Mount the targeting device on the plate using the fixation screw. Depending on the access, carefully insert the plate and position, or directly apply to the bone and temporarily fixate with K-wires. For this purpose, you can use the provided holes in the plate or an appropriately positioned threaded drill guide with inserted reduction sleeve. Alternatively, a standard screw can be inserted into the oblong hole. For this purpose use a double drill guide and a drill bit ø2.5 and pilot drill to the desired depth. Then determine the length of the screw with the depth gauge and insert a screw of appropriate length with the hexagonal wrench. The plate can be simultaneously pulled against the shaft with this screw. Check plate position using fluoroscopy and correct if needed. 8

$N CAUTION: Fractures with involvement of the joint require compression of the fracture with lag screws before using locking screws.$ N NOTE: To check the final screw position in the metaphyseal area, a K-wire can be placed through an appropriately positioned threaded drill guide with reduction

N NOTE: To check the final screw position in the metaphyseal area, a K-wire can be placed through an appropriately positioned threaded drill guide with reduction

Securing of distal plate holes The distal area of the plate only features round locking holes.

Insert the threaded drill guide (blue) for round holes into the appropriate plate hole to insert a locking screw.

11 N CAUTION: Fractures with involvement of the joint require compression of the fracture with lag screws before using locking screws. Ensure here that the later position of the plate is not obstructed. N NOTE: To check the final screw position in the metaphyseal area, a K-wire can be placed through an appropriately positioned threaded drill guide with reduction sleeve before inserting the screws. Then check the result of repositioning using fluoroscopy. Securing of distal plate holes The distal area of the plate only features round locking holes. These can be used either with locking screws (blue) or standard screws with small head. Insert the threaded drill guide (blue) for round holes into the appropriate plate hole to insert a locking screw. The use of the Screwdriver Duo may facilitate the screwing or later unscrewing of the threaded drill guide. Pilot drill with a drill bit ø2.7 (marked in blue & red) to the desired depth. Then remove the drill guide and determine the length of the screw with the depth gauge. Choose a locking screw (blue) of the appropriate length and loosely insert with screwdriver T15. Finally, tighten the screw with the torque wrench. Optimal fixation is reached once an audible click is heard. Secure all distal screw holes in this way. Then remove the targeting device. 9

Pilot drill with drill bit ø2.5 for a standard screw.

12 N NOTE: As soon as the head of the screw reaches the plate, it is compulsory to switch to the torque limiter. N CAUTION: If using lag screws, they must be inserted before using locking screws! Pilot drill with drill bit ø2.5 for a standard screw. Use either the double drill guide in neutral position or the appropriate threaded drill guide. N CAUTION: In round hole, use only screws with small head! 10

$(red) with/without compression Standard screw with/without compression N NOTE: If compression of the fracture is necessary, an$ anatomically correct and secure fixation of the plate in the periarticular fragment must first be achieved.

anatomically correct and secure fixation of the plate in the periarticular fragment must first be achieved.

13 Securing the gliding holes in the shaft The gliding-locking holes in the plate shaft can be used in various ways: Locking screw (red) with/without compression Standard screw with/without compression N NOTE: If compression of the fracture is necessary, an anatomically correct and secure fixation of the plate in the periarticular fragment must first be achieved. Locking screw in compression position Screw the holding pin (IU ) into a shaft hole in the proximal region or, if necessary, above the fracture line. 11

$Choose a compression drill guide in accordance with the compression distance (1mm or 2mm) and position on the holding pin, away from the fracture gap. Use the drill bit ø2.$ Loosely insert a locking screw (red) of the appropriate length with screwdriver T15 and finally tighten the screw with the torque wrench.

Loosely insert a locking screw (red) of the appropriate length with screwdriver T15 and finally tighten the screw with the torque wrench.

In cases of very hard bone in the diaphysis it is necessary to make sure that the screw head is flush to the plate.

14 Choose a compression drill guide in accordance with the compression distance (1mm or 2mm) and position on the holding pin, away from the fracture gap. Use the drill bit ø2.7 (marked in blue & red) and determine the length of the screw using the depth gauge. Loosely insert a locking screw (red) of the appropriate length with screwdriver T15 and finally tighten the screw with the torque wrench. 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 bone in the diaphysis it is necessary to make sure that the screw head is flush to the plate. Therefore it is permissible in exceptionally hard bone of the diaphysis to finish the screw without the torque limiter. Alternatively, a standard screw can be inserted as compression screw. For this purpose, use the double drill guide in compression position and position without pressure on the edge of the hole that is away from the centre. Use the drill bit ø

$The fracture gap shall serve as orientation in the setting of the compression distance (max.$ 2mm). For this purpose, turn the wheel of the compression drill guide until an appropriate gap

2mm). For this purpose, turn the wheel of the compression drill guide until an appropriate gap

15 Alternatively, the adjustable compression drill guide (IU ) can be used. The fracture gap shall serve as orientation in the setting of the compression distance (max. 2mm). For this purpose, turn the wheel of the compression drill guide until an appropriate gap forms in the upper part of the instrument. Position the drill guide on the holding pin, away from the fracture gap. 13

To place screws in neutral position, use the threaded drill guide (red) for locking screws or the double drill guide for standard screws.

16 N CAUTION: For optimal plate-screw connection, we generally recommend using the threaded drill guides for the insertion of locking screws. If the angle is not properly aligned, a firm fixation of screw and plate is not guaranteed! To place screws in neutral position, use the threaded drill guide (red) for locking screws or the double drill guide for standard screws. When applying pressure on the variable end of the double drill guide, it is automatically centered in the plate hole. Standard screws can be addi tionally inserted with any required angulation or as lag screws. A drill bit ø3.5 for drilling a gliding hole is included in the set. N CAUTION: Screws with small head as well as blue locking screws are not suitable for use in a gliding hole! When all required screws have been inserted, perform final check using fluoroscopy, AP and lateral, and close the wound. 14

17 Explantation N NOTE: The screwdrivers (T15) in the set are self-retaining. To achieve maximum torque during screw removal, we recommend using the appropriate explantation screwdriver (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. 15

Trays LOQTEQ, Set of Plates IC 6932-00* ARTICLE QUANTITY ART.-NO. Tray for implants LOQTEQ DMT 3.5, empty 1 IC 6932-01 Lid for trays, large 1 IC 2008-00 LOQTEQ 3.

5, 4 holes, L 120, L 1 PA 3532-04-2 LOQTEQ 3.5, 6 holes, L 146, L 1 PA 3532-06-2 LOQTEQ 3.5, 8 holes, L 172, L 1 PA 3532-08-2 LOQTEQ 3.5, 10 holes, L 198, L 1 PA 3532-10-2 Aiming device LOQTEQ 3.

18 Trays LOQTEQ, Set of Plates IC * ARTICLE QUANTITY ART.-NO. Tray for implants LOQTEQ DMT 3.5, empty 1 IC Lid for trays, large 1 IC LOQTEQ 3.5, 4 holes, L 120, R 1 PA LOQTEQ 3.5, 6 holes, L 146, R 1 PA LOQTEQ 3.5, 8 holes, L 172, R 1 PA LOQTEQ 3.5, 10 holes, L 198, R 1 PA LOQTEQ 3.5, 4 holes, L 120, L 1 PA LOQTEQ 3.5, 6 holes, L 146, L 1 PA LOQTEQ 3.5, 8 holes, L 172, L 1 PA LOQTEQ 3.5, 10 holes, L 198, L 1 PA Aiming device LOQTEQ 3.5, R 1 IU Aiming device LOQTEQ 3.5, L 1 IU Fixing screw aiming device LOQTEQ Tibia Plates 2 IU OPTIONAL LOQTEQ 3.5, 3 holes, L 107, R 1 PA LOQTEQ 3.5, 12 holes, L 224, R 1 PA LOQTEQ 3.5, 3 holes, L 107, L 1 PA LOQTEQ 3.5, 12 holes, L 224, L 1 PA AVAILABLE ON REQUEST **LOQTEQ 3.5, 14 holes, L 250, R PA **LOQTEQ 3.5, 14 holes, L 250, L PA * No Instruments! Please complete with Small Fragment Set IC and/or IC and IC **Available non-steril, single packed 16

19 Trays LOQTEQ Small Fragment Set, complete IC A B C Set of Instruments IC Set of Plates, complete IC Screw Rack, complete IC

Trays LOQTEQ Small Fragment Set, Set of Instruments IC 6931-10 A ARTICLE QUANTITY ART.-NR.

plates, closed 1 IP 8405-50 Depth gauge for locking screws, small 1 IS 7904-00 Twist drill ø2.5, L 110, coil 50, quick coupling 1 IU 7425-00 Twist drill ø2.

5, L 110, coil 50, quick coupling 1 IU 7435-00 Handle for quick coupling, large, cannulated 1 IU 7706-00 Handle with quick coupling, with torque limiter, 2.

20 Trays LOQTEQ Small Fragment Set, Set of Instruments IC A ARTICLE QUANTITY ART.-NR. Tray for instruments LOQTEQ Small Fragment, empty 1 IC Lid for trays, large 1 IC Bending iron 1 for small fragment plates, closed 1 IP Bending iron 2 for small fragment plates, closed 1 IP Depth gauge for locking screws, small 1 IS Twist drill ø2.5, L 110, coil 50, quick coupling 1 IU Twist drill ø2.5, L 180, coil 50, quick coupling 1 IU Twist drill ø2.7, L 150, coil 50, quick coupling 1 IU Twist drill ø2.7, L 220, coil 50, quick coupling 1 IU Twist drill ø3.5, L 110, coil 50, quick coupling 1 IU Handle for quick coupling, large, cannulated 1 IU Handle with quick coupling, with torque limiter, 2.0 Nm 1 IU Screwdriver T15, short, quick coupling 1 IU Screwdriver hexagonal, ø2.5, quick coupling 1 IU Screwdriver Duo, T15, quick coupling 1 IU Screw forceps, self-holding 1 IU Double drill guide, ø2.5/3.5, with spring aided centering 1 IU Load drill guide LOQTEQ 3.5, compression 1 mm 1 IU Load drill guide LOQTEQ 3.5, compression 2 mm 1 IU Basic Insert for load drill guide LOQTEQ IU Drill guide for gliding hole LOQTEQ 3.5, I-ø 2.8, red 2 IU Reduction sleeve for K-wire ø1.6 2 IU Drill guide for round hole LOQTEQ 3.5, I-ø 2.8, blue 2 IU K-wire with trocar point, ø1.6, L NK OPTIONAL Load drill guide LOQTEQ 3.5, adjustable up to 2 mm 1 IU

Trays LOQTEQ Small Fragment Set, Set of Plates, complete IC 6931-25 B ARTICLE QUANTITY ART.-NO.

21 Trays LOQTEQ Small Fragment Set, Set of Plates, complete IC B ARTICLE QUANTITY ART.-NO. Tray for implants LOQTEQ Small Fragment, empty 1 IC Lid for trays, large 1 IC LOQTEQ Straight Plate 3.5, 4 holes, L 60 1 PG LOQTEQ Straight Plate 3.5, 5 holes, L 73 1 PG LOQTEQ Straight Plate 3.5, 6 holes, L 86 2 PG LOQTEQ Straight Plate 3.5, 7 holes, L 99 2 PG LOQTEQ Straight Plate 3.5, 8 holes, L PG LOQTEQ Straight Plate 3.5, 9 holes, L PG LOQTEQ Straight Plate 3.5, 10 holes, L PG LOQTEQ Straight Plate 3.5, 11 holes, L PG LOQTEQ Straight Plate 3.5, 12 holes, L PG LOQTEQ Reconstruction Plate 3.5, 5 holes, L 58 1 PR LOQTEQ Reconstruction Plate 3.5, 6 holes, L 70 1 PR LOQTEQ Reconstruction Plate 3.5, 7 holes, L 82 1 PR LOQTEQ Reconstruction Plate 3.5, 8 holes, L 94 1 PR LOQTEQ Reconstruction Plate 3.5, 9 holes, L PR LOQTEQ Reconstruction Plate 3.5, 10 holes, L PR LOQTEQ Reconstruction Plate 3.5, 12 holes, L PR LOQTEQ Reconstruction Plate 3.5, 14 holes, L PR LOQTEQ Reconstruction Plate 3.5, 16 holes, L PR LOQTEQ 1/3 Tubular Plate 3.5, 4 holes, L 52 1 PG LOQTEQ 1/3 Tubular Plate 3.5, 5 holes, L 64 1 PG LOQTEQ 1/3 Tubular Plate 3.5, 6 holes, L 76 1 PG LOQTEQ 1/3 Tubular Plate 3.5, 7 holes, L 88 1 PG LOQTEQ 1/3 Tubular Plate 3.5, 8 holes, L PG LOQTEQ 1/3 Tubular Plate 3.5, 9 holes, L PG AVAILABLE ON REQUEST *LOQTEQ Reconstruction Plate 3.5, 18 holes, L 214 PR *LOQTEQ 1/3 Tubular Plate 3.5, 3 holes, L 40 PG *LOQTEQ 1/3 Tubular Plate 3.5, 10 holes, L 124 PG *LOQTEQ 1/3 Tubular Plate 3.5, 11 holes, L 136 PG *LOQTEQ 1/3 Tubular Plate 3.5, 12 holes, L 148 PG *Available non-steril, single packed 19

Trays LOQTEQ Small Fragment Set, Screw Rack, complete IC 6931-35 C ARTICLE QUANTITY ART.-NO. Screw rack LOQTEQ Small Fragment, empty 1 IC 6931-31 Screws for gliding-locking hole ARTICLE QUANTITY ART.

5, T15, self-tapping, L 16 8 SK 3525-16-2 LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 18 8 SK 3525-18-2 LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 20 8 SK 3525-20-2 LOQTEQ Cortical Screw 3.

5, T15, self-tapping, L 28 8 SK 3525-28-2 LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 30 8 SK 3525-30-2 LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 32 8 SK 3525-32-2 LOQTEQ Cortical Screw 3.

22 Trays LOQTEQ Small Fragment Set, Screw Rack, complete IC C ARTICLE QUANTITY ART.-NO. Screw rack LOQTEQ Small Fragment, empty 1 IC Screws for gliding-locking hole ARTICLE QUANTITY ART.-NO. LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 12 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 14 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 16 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 18 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 20 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 22 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 24 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 26 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 28 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 30 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 32 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 34 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 36 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 38 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 40 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 45 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 50 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 55 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 60 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 65 8 SK LOQTEQ Cortical Screw 3.5, T15, self-tapping, L 70 8 SK

Trays Screws for round locking hole ARTICLE QUANTITY ART.-NO. LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 12 8 SK 3526-12-2 LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 14 8 SK 3526-14-2 LOQTEQ Cortical Screw 3.

23 Trays Screws for round locking hole ARTICLE QUANTITY ART.-NO. LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 12 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 14 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 16 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 18 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 20 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 22 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 24 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 26 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 28 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 30 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 32 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 34 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 36 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 38 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 40 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 45 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 50 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 55 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 60 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 65 8 SK LOQTEQ Cortical Screw 3.5, small head T15, self-tapp. L 70 8 SK Standard screws ARTICLE QUANTITY ART.-NO. Cortical Screw 3.5, self-tapping, L 12 4 SK Cortical Screw 3.5, self-tapping, L 14 4 SK Cortical Screw 3.5, self-tapping, L 16 4 SK Cortical Screw 3.5, self-tapping, L 18 4 SK Cortical Screw 3.5, self-tapping, L 20 4 SK Cortical Screw 3.5, self-tapping, L 22 4 SK Cortical Screw 3.5, self-tapping, L 24 4 SK Cortical Screw 3.5, self-tapping, L 26 4 SK Cortical Screw 3.5, self-tapping, L 28 4 SK Cortical Screw 3.5, self-tapping, L 30 4 SK Cortical Screw 3.5, self-tapping, L 32 4 SK Cortical Screw 3.5, self-tapping, L 34 4 SK Cortical Screw 3.5, self-tapping, L 36 4 SK Cortical Screw 3.5, self-tapping, L 38 4 SK Cortical Screw 3.5, self-tapping, L 40 4 SK Cortical Screw 3.5, self-tapping, L 45 4 SK Cortical Screw 3.5, self-tapping, L 50 4 SK Cortical Screw 3.5, self-tapping, L 55 4 SK Cortical Screw 3.5, self-tapping, L 60 4 SK Cortical Screw 3.5, self-tapping, L 65 4 SK Cortical Screw 3.5, self-tapping, L 70 4 SK

24 Trays Standard screws with small head ARTICLE QUANTITY ART.-NO. Cortical Screw 3.5, small head, self-tapping, L 12 4 SK Cortical Screw 3.5, small head, self-tapping, L 14 4 SK Cortical Screw 3.5, small head, self-tapping, L 16 4 SK Cortical Screw 3.5, small head, self-tapping, L 18 4 SK Cortical Screw 3.5, small head, self-tapping, L 20 4 SK Cortical Screw 3.5, small head, self-tapping, L 22 4 SK Cortical Screw 3.5, small head, self-tapping, L 24 4 SK Cortical Screw 3.5, small head, self-tapping, L 26 4 SK Cortical Screw 3.5, small head, self-tapping, L 28 4 SK Cortical Screw 3.5, small head, self-tapping, L 30 4 SK Cortical Screw 3.5, small head, self-tapping, L 32 4 SK Cortical Screw 3.5, small head, self-tapping, L 34 4 SK Cortical Screw 3.5, small head, self-tapping, L 36 4 SK Cortical Screw 3.5, small head, self-tapping, L 38 4 SK Cortical Screw 3.5, small head, self-tapping, L 40 4 SK Cortical Screw 3.5, small head, self-tapping, L 45 4 SK Cortical Screw 3.5, small head, self-tapping, L 50 4 SK Cortical Screw 3.5, small head, self-tapping, L 55 4 SK Cortical Screw 3.5, small head, self-tapping, L 60 4 SK Cortical Screw 3.5, small head, self-tapping, L 65 4 SK Cortical Screw 3.5, small head, self-tapping, L 70 4 SK

25 23

26 24 Notes

27 Subject to technical modifications, errors and misprints. WM / 0314 Layout, typesetting: design graphic - Wolfram Passlack Illustrations: Karen Hilberg Lorenzweg Berlin Germany Phone Fax customer.service@aap.de

28 Lorenzweg Berlin Germany Phone Fax customer.service@aap.de WM / 0314 (not for the USA)

Proximal Humerus Plate 3.5 Surgical Technique

Proximal Humerus Plate 3.5 Surgical Technique Locking Compression Technology by aap 1 Disclaimer This surgical technique is exclusively intended for medical professionals, especially physicians, and therefore may not be regarded as a source of information