Cannulated Angled Blade Plate 3.5 and 4.5, 90° - Osteosyntese

Surgical TechniqueCannulated Angled Blade Plate3.5 and 4.5, 90°

Cannulated Angled Blade Plate 3.5 and 4.5, 90°Table of contentsIndications/Contraindications 2Implants 3Surgical technique 5Implant removal 8Cleaning of instruments 8Image intensifier controlWarningThis description is not sufficient for immediate application ofthe instrumentation. Instruction by a surgeon experienced inhandling this instrumentation is highly recommended.Synthes 1

Cannulated Angled Blade Plate 3.5 and 4.5, 90°Indications/ContraindicationsIndicationsHumerus– fractures of the surgical neck– 3-part fractures of the proximal humerus– non-unions of the proximal humerusTibia– metaphyseal fractures of the proximal and distal tibia– non-unions of the proximal and distal tibia– metaphyseal/diaphyseal hinged tibia osteotomiesFoot– arthrodeses of the ankleContraindications– fractures and osteotomies of the proximal and distal femurin adults2

Cannulated Angled Blade Plate 3.5 and 4.5, 90°ImplantsCannulated Angled Blade Plate 3.5, 90°– the cannulated blade allows accurate insertion and exactpositioning of the plate– blade geometry and oblique lag screw provide for a highrotational stability– blade lengths: 30, 35, 40 and 45 mm– number of screw holes: 4, 5, 6, 8 or 10– the three round holes next to the blade are suitable for CortexScrews 3.5 mm or Cancellous Bone Screws 4.0 mm– LC-DCP ® holes for Cortex Screws 3.5 mm– LC-DCP undercuts allow good periosteal blood supply– available in Pure Titanium (432.009–089) orStainless Steel (232.009–089)Guide Wire 2.0 mm with Threaded Tiplength 230 mm (292.650)To determine blade length and for exact positioning of bladeand plate shaft.Cortex Screws 3.5 mm, self-tappingPure Titanium (404.810–910),Stainless Steel (204.810–910)Cortex Screws 3.5 mmPure Titanium (404.010–110),Stainless Steel (204.010–110)Cancellous Bone Screws 4.0 mmPure Titanium (406.010–060),Stainless Steel (206.010–060)Synthes 3

Cannulated Angled Blade Plate 4.5, 90°– the cannulated blade allows accurate insertion and exactpositioning of the plate– blade geometry and oblique lag screw provide for a highrotational stability– blade lengths: 30, 40, 50, and 60 mm– number of screw holes: 4, 5, 6, 8, 10, or 12– the three round holes next to the blade are suitable for CortexScrews 4.5 mm or Cancellous Bone Screws 6.5 mm– LC-DCP holes for Cortex Screws 4.5 mm– LC-DCP undercuts allow good periosteal blood supply– available in Pure Titanium (437.043–126) orStainless Steel (237.043–126)Guide Wire 2.0 mm with Threaded Tiplength 230 mm (292.650)To determine blade length and for exact positioning of bladeand plate shaft.Cortex Screws 4.5 mm, self-tappingPure Titanium (414.814–940),Stainless Steel (214.814–940)Cortex Screws 4.5 mmPure Titanium (414.014–140),Stainless Steel (214.014–140)Cancellous Bone Screws 6.5 mmPure Titanium (418.020–110),Stainless Steel (218.020–110)4

Cannulated Angled Blade Plate 3.5 and 4.5, 90°Surgical techniqueA proximal humeral fracture is used to demonstrate thefollowing surgical technique for the cannulated angled bladeplate 3.5 and 4.5, 90°.Since the blade length is determined intraoperatively usingthe guide wire, the use of X-ray templates is not required.1Patient positioningThe patient is positioned in a beach chair position.2Fracture reductionReduce the fracture under image intensifier control.3ApproachThe approach is deltopectoral.4Determine blade entry point and insert guide wirePlace the Drill Guide (332.015 or 332.401) on the lateral metaphysisof the proximal humerus and insert the Guide Wire 2.0 mm (292.650) through the central hole 2.0 mm ofthe drill guide using the Compact Air Drive with QuickCoupling for Kirschner Wires (511.790). The tip of the guidewire is placed in subchondral position.Check the position of the guide wire with the image intensifier.The position of the guide wire indicates the final positionof the blade in a 90° angle in relation to the diaphysis.Note: The guide wire may also be inserted without usingthe drill guide. Check position with the image intensifier.Synthes 5

5Determine blade lengthRemove the drill guide, slide the Direct Measuring Devicefor Cannulated Screws 7.0 mm (319.210) onto the guidewire and read the blade length from the markings of themeasuring device. The length of the plate shaft is chosenaccording to the extent of the fracture.5040 306Open blade entry pointSlide the drill guide again onto the guide wire and align withthe humeral metaphysis. Using a drill bit 3.5 or 4.5 mm,drill a hole through the near cortical bone to the left and tothe right of the guide wire hole (1 and 2).Using a drill bit 2.5 or 3.2 mm, drill through the near corticalbone through the two oblique holes of the drill guidefrom distal to proximal (3 and 4).Remove the drill guide. Slide the cannulated Drill Bit 4.5/2.1 mm (315.690) onto the guide wire and drillthrough the remaining cortical bone.1324Note: In order to facilitate the insertion of the blade and toachieve an optimal fit of the plate limb to the metaphysis, thecortical bone at the blade entry point has to be removedcompletely.7Contour plateAdapt the aluminium Bending Template (329.917/918/919 or329.905/908/912) to the bone by placing it distally underthe blade entry point. Use bending pliers or a bending iron tocontour the plate to match the bending template, ensuring asnug fit of plate shaft and bone. The angle between the guidewire and the humeral metaphysis must identically match theangle between the blade and the plate shaft.Note: Avoid bending the plate back and forth.6

Cannulated Angled Blade Plate 3.5 and 4.5, 90°Surgical technique8Insert plateSlide the angled blade plate onto the guide wire and pressthe blade manually through the cortical and the cancellousbone until its final position is reached.Remove and dispose of the guide wire.Dense bone procedureAttach the Inserter/Extractor (332.016) as close to theplate angle as possible. Slide the blade onto the guide wireand press it manually through the opening in the corticalbone. Complete the insertion by slight taps with the SlottedHammer (332.403) onto the inserter/extractor until theplate is in its final position.Note: Additional compression between the proximalfragment of the humeral head and the metaphysis can beachieved using the Tension Device (321.120).9Attach plateAs a lag screw, insert a cortex screw 3.5 or 4.5 mm ora cancellous bone screw 4.0 or 6.5 mm obliquely throughthe hole in the angle of the plate. Increase the drill holewidth up to the fracture line to the same size as the outerdiameter of the screw thread, this will act as a gliding hole.To achieve compression between the proximal fragmentof the humeral head and the metaphysis, the lag screw has tobe seated in the far cortical bone distal to the fracture.The angled blade plate is secured in its final position byinserting cortex screws 3.5 or 4.5 mm or cancellous bonescrews 4.0 or 6.5 mm into the proximal round holes andcortex screws 3.5 or 4.5 mm into the distal LC-DCP holes.The screws are firmly seated in both cortices to achieve stablefixation.Synthes 7

Cannulated Angled Blade Plate 3.5 and 4.5, 90°Implant removalCleaning of instrumentsRemove plateAfter removing all screws attach the Inserter/Extractor(332.016) close to the angle between the plate shaft and theblade and extract the plate by slightly tapping with theSlotted Hammer (332.403).Cleaning of instrumentsProper functioning of the instruments can be maintainedby careful cleaning.Intraoperatively, the cannulation of the Drill Bit 4.5/2.1 mm(315.690) is cleaned with the Cleaning Stylet 2.0 mm(319.360). Postoperatively, the instruments are cleaned withthe cleaning stylet 2.0 mm and the Cleaning Brush 2.1 mm (319.270).8

Synthes GmbHEimattstrasse 3, CH-4436 Oberdorfwww.synthes.comPresented by:0123036.000.111 SE_028667 AA © Synthes 2006 Printed in Switzerland Subject to modifications.