Zimmer Periarticular Distal Femoral Locking Plate .
Zimmer PeriarticularDistal FemoralLocking PlateSurgical TechniqueThe Science of the Landscape
Zimmer Periarticular Distal Femoral Locking PlateSurgical TechniqueTable of ContentsDeveloped in conjunction withIntroductionStephen K. Benirschke, M.D.Professor, Department ofOrthopaedics and Sports MedicineUniversity of WashingtonHarborview Medical CenterSeattle, WashingtonPaul J. Duwelius, M.D.Adjunct Associate ProfessorOrthopaedicsOregon Health Sciences UniversityClinical AttendingSt. Vincent Hospital & Medical CenterPortland, OregonJames A. Goulet, M.D.Professor and DirectorSection of Orthopaedic TraumaDepartment of Orthopaedic SurgeryThe University of Michigan HospitalsAnn Arbor, MichiganDavid A. Templeman, M.D.Associate ProfessorOrthopaedic SurgeryUniversity of MinnesotaStaff, Hennepin County Medical CenterMinneapolis, MinnesotaRobert A. Winquist, M.D.Clinical Professor,Department of OrthopaedicsUniversity of WashingtonOrthopaedic SurgeonSwedish Hospital and Medical CenterSeattle, Washington2Locking Screw Technology2Locking Plate Technology2Distal Femur Plate Indications2Fracture Classification2Plate Features3Surgical Technique4Required Instrumentation4Preoperative Preparation4Fracture Reduction4Plate Positioning5Screw Trajectory9Condylar Fixation10Shaft Fixation12Wound Closure14Postoperative Treatment14Implant Removal14Surgical Pearls14Instruments and Implants15Order Information16
Zimmer Periarticular Distal Femoral Locking PlateIntroductionThe Zimmer Periarticular LockingPlate System combines locking screwtechnology with periarticular plates tocreate fixed-angle constructs for use incomminuted fractures or where deficientbone stock or poor bone quality isencountered. The fixed-angle plate/screw device can be used in osteopenicbone and other areas where traditionalscrew fixation may be compromised.The Periarticular Locking Plates willaccommodate standard screws, as wellas locking screws with threaded heads.When necessary, interfragmentarycompression can be achieved withlag screws.Cannulated screws and instrumentsallow provisional fixation with guide pinsin the metaphysis. This helps ensurethat the threaded locking screw headsalign properly with the threadedplate holes.All plate configurations contain lockingscrew holes in the plate head, andalternating locking and compressionscrew slots in the shaft.Three types of locking screws areavailable with the system: 5.5mm cannulated locking screwsfor use in the plate head 5.5mm cannulated conical screws foruse in the plate head 4.5mm noncannulated locking screwsfor use in the plate shaftLocking Screw TechnologyIndicationsThe heads of the locking screws containmale threads while the holes in theplates contain female threads. Thisallows the screw head to be threadedinto the plate hole, locking the screwinto the plate. This technical innovationprovides the ability to create a fixedangle construct while using familiarplating techniques.The Periarticular Locking Plate System isindicated for temporary internal fixationand stabilization of osteotomies andfractures, including:Locking Plate Technology Fractures in osteopenic boneBy using locking screws in a bone plate,a fixed-angle construct is created. Inosteopenic bone or fractures withmultiple fragments, secure bonepurchase with conventional screws maybe compromised. Locking screws donot rely on bone/plate compression toresist patient load, but function similarlyto multiple small angled blade plates.In osteopenic bone or comminutedfractures, the ability to lock screws intoa fixed-angle construct is imperative. NonunionsBy combining locking screw holes withcompression screw slots in the shaft,the plate can be used as both a lockingdevice and a fracture compressiondevice. If compression is desired, itmust be achieved first by inserting thestandard screws in the compressionscrew slots before inserting anylocking screws. Comminuted fractures Supracondylar fractures Intra-articular and extra-articularcondylar fractures MalunionsFracture ClassificationRefer to OTA Fracture and DislocationCompendium, or the Schatzkerclassification for more information.
Zimmer Periarticular Distal Femoral Locking PlatePlate Features Anatomically contoured platesare precontoured to create a fitthat requires little or no additionalbending and helps with metaphyseal/diaphyseal reduction Threaded holes create a 95 degreefixed angle between the plate headand the locking screws to allow screwplacement that is parallel to thejoint line The central locking screw hole in platehead provides initial reduction of theplate to the condyles The low profile plate facilitatesfixation without impingingon soft tissue Plates are available in a variety ofsizes and lengths, from 6 to 18 holes,left and right Dual-compression slots willaccommodate periarticular screws orconventional stainless steel screwsand allow bi-directional compression The last diaphyseal plate hole isdesigned to accomodate the tensiondevice (00-4817-000-05)The plate shaft design allows for aminimally invasive technique withsubmuscular passage of the plateMultiple locking holes in the plate headallow placement of the screws to capturefragmentsThick-to-thin plate profiles make the platesautocontourableThe anatomical shape of the head of theplate matches the shape of the distal femurFig. 1 Zimmer Periarticular Distal Femoral Locking Plate features.The locking plate design does notrequire compression between the plateand bone to accommodate loading.Therefore, purchase of the screws inthe bone can be achieved with a threadprofile that is shallower than that oftraditional screws. The shallow threadprofile, in turn, allows for screws witha large core diameter to accommodateloading with improved bending andshear strength (Fig. 1).
Zimmer Periarticular Distal Femoral Locking PlateSurgical TechniqueQuadricepsRequired InstrumentationThe following sets may be required forapplication of the 5.5mm PeriarticularLocking Proximal Tibia Plates: Standard Screw Set Basic Instrument Set Basic Forcep Set 5.5mm/4.5mm Locking Screw andInstrument SetHamstringsFig. 2 Periarticular Distal Femoral LockingPlate and Standard Jig SetGastrocnemius Linear Bone ClampsAfter radiographic verification ofpreliminary reduction of the fracture, usethe preferred approach and technique toexpose the distal lateral femur.Preoperative PreparationAfter assessing the fractureradiographically and preparing apreoperative plan, place the patient inthe supine position on a radiolucenttable. Be sure that the fluoroscope canbe positioned to visualize the distalfemur in both the lateral and anterior/posterior (A/P) views (Figs. 2 & 3).Reduce the intra-articular fragmentsusing linear bone clamps or Kirschnerwires to temporarily hold the reduction.For a Hoffa fracture, reduce the posteriorarticular fragment and stabilize it withK-wires inserted from anteriorto posterior.Fracture ReductionUse lag screws to secure the intraarticular fragments. To help avoidinserting the lag screws where they willinterfere with the plate placement, holdthe plate on the bone in its approximateposition. Then insert the lag screwsas needed.It is imperative that accurate reductionof the fracture be obtained prior to andmaintained during application of thedistal lateral femoral locking plate.An external fixator or distractor canserve as preliminary fixation. This willmake operative reduction easier, andthe device can be used as atool intraoperatively.Before locking screws are placed in anyfragment, length, rotation, varus-valgusand recurvatum correction shouldbe achieved.The Plate Reduction Instrument isdesigned to aid in minor varus-valgusand translation corrections prior toscrew placement.Fig. 3Use 3.5mm cortical screws, 4.0mmcancellous screws, HerbertTM or Herbert/Whipple screws for fixation of aposterior articular Hoffa fragment. Insertthe screws from anterior to posterior,and where applicable countersink theheads below the level of thearticular cartilage.
Zimmer Periarticular Distal Femoral Locking PlatePlate PositioningHold the Metaphyseal Jig on the selectedplate (Fig. 4). Insert the 5.5mm StandardJig Sleeve into the CENTRAL hole of theJig/plate (Fig. 5.) and thread the 3.2mmStandard Cannula into the plate hole(Fig. 6). Do not tighten the set screw.Central Distal HoleNote: Attaching the Metaphyseal Jigto the plate using the set screw at thistime may cause or result in improperplacement of the plate on the bone.Strut Screw HoleNote: The Cannula Inserter may be usedto tighten the cannula if necessary(Fig. 6A).Fig. 4Fig. 5Fig. 6Fig. 6ACentral Hole
Zimmer Periarticular Distal Femoral Locking PlateUse this construct to place the initial3.2mm Drill Tip Guide Wire in themetaphysis (Fig. 7). Check plateplacement – visually and fluoroscopicallyto ensure that the plate is positionedcorrectly on the metaphysis of the bone.If placement is appropriate, hold the Jigon the plate and finger tighten or use the3.5mm Screwdriver to tighten theset screw (Fig. 8).Fig. 7Fig. 8Note: The Metaphyseal Jig andStandard Cannulas MUST be used toensure that the screws align properlywith the threaded plate holes. Failure touse the Metaphyseal Jig and StandardCannulas may result in cross-threadingor improper seating of the screws.Note: The position of the plate on thebone must be verified because of thetendency to place the proximal end ofthe plate too far anterior on the femoralshaft. This placement can cause thelocking screws to be placed at a tangentand can result in insufficientholding strength.Because the femoral shaft may not bealigned with the distal fragment, theplate head should be used to determinethe appropriate placement of the plate.The plate head should conform to theshape of the intact or reconstructedcondyles. This will determine thealignment of the shaft.
Zimmer Periarticular Distal Femoral Locking PlateNote: It is easier to thread the cannulasinto the plate before placing the plate onthe bone.Once the plate is properly positioned,insert the Jig Sleeve into the mostCENTRAL DISTAL locking hole in the platehead (Fig. 9). Thread the 3.2mm GuideWire Cannula through the sleeve and intothe plate hole (Fig. 10).Warning: Do not contour or bendthe plate at or near a threaded hole,as doing so may deform the threadedhole and cause incompatibility with theLocking Screw.Fig. 9Insert a 3.2mm Drill Tip Guide Wirethrough the cannula until the tip engagesthe medial cortical wall (Fig. 11). Be surethat the wire remains parallel to bothaxes. Use the fluoroscope to confirm thewire position in both the A/P and lateralplanes. Adjust the wire locationif necessary.Fig. 10Fig. 11
Zimmer Periarticular Distal Femoral Locking PlateThread a 3.2mm Standard Cannula intoone of the most proximal holes in theplate shaft. Insert a 3.2mm Drill TipGuide Wire though the Cannula. Again,check plate and bone position bothvisually and fluoroscopically to ensureproper fracture reduction andplate placement.Once the plate is placed appropriatelyand properly aligned, slide the 5.5mmCannulated Screw Depth Gauge over theguide wire in the CENTRAL plate holeuntil it contacts the top of the cannula.Read proper screw length from theguide (Fig. 12).Note: Slide the Screwdriver Stop Ringonto the screwdriver shaft and place itat the level of the black ring etched onthe driver shaft (Fig. 13). When the BlueStop Ring hits the top of the Jig Sleeve,power insertion must stop. Screws mustbe seated by hand. The Screwdriver StopRing is intended to be a visual cue tostop power insertion of locking screws.Remove the Guide Wire Cannula anduse the 5.0mm Hex-head CannulatedScrewdriver to insert a 70mm Long5.5mm Conical Screw (Fig. 14) intothe CENTRAL plate hole to secure theplate, or if preferred, use a linear boneclamp or Plate Reduction Instrumentfor provisional fixation. Observeplacement of the plate head and use thefluoroscope to confirm that it is in thedesired location (Fig. 15).Screw length measurement:Metaphyseal Screws – the lengthmeasurement for screws in themetaphyseal region of the plate ismeasured line-to-line – from the baseof the screw head to the tip of the screw.Placement of the tip of the Guide Wirewill determine placement of the tipof the screw.Diaphyseal Screws – the lengthmeasurement for screws in thediaphyseal region of the plate is alsomeasured line-to-line – from the baseof the screw head to the tip of the screw.In order to achieve full cortical purchasewith these screws, it is recommendedthat 5mm be added to the screw lengthmeasurement to allow for the selftapping flutes.The Zimmer Periarticular Distal FemoralLocking Plate is designed to be placedslightly anteriorly on the distal femoralcondyles. In order to achieve anaccurate lateral x-ray or c-arm image,it will be necessary to externallyrotate the affected limb 20-30 . As indistal targeting of intramedullary nails,visualization of “round holes” from thecannulas will ensure a true lateral image.In other words, the x-ray beam must bein line with the axis of the cannulas.Black RingFig. 12Fig. 13Fig. 14Fig. 15
Zimmer Periarticular Distal Femoral Locking PlateNote: Insertion of a screw longer than70mm may cause interference withother screws.Note: A screwdriver shaft can beused to loosely insert the screw underpower, but the final seating MUST beaccomplished by hand to avoid crossthreading of the screws in the plateholes or failure of the screw or driver.Predrilling and tapping are typically notnecessary as the flutes of the screwsare self-drilling and self-tapping. If thebone is dense, the lateral cortex can bepredrilled and tapped. If desired, usethe 4.7mm Cannulated Drill and 5.5mmCannulated Tap (Fig. 16) for a5.5mm screw.Note: If lag screw fixation is necessaryfor any fragment, the lag screw must beinserted before inserting locking screwsinto that fragment.Fig. 16Screw TrajectoryStrut Screw
10Zimmer Periarticular Distal Femoral Locking PlateCondylar FixationFor additional condylar fixation, slide the5.5mm Cannulated Screw Depth Gaugeover the guide wire in the CENTRALDISTAL locking hole in the plate headuntil it contacts the top of the cannula.Read the proper screw length from theguide, remove the 3.2mm Guide WireCannula and use the 5.0mm Hex-headScrewdriver to insert the appropriatelength 5.5mm Conical or Locking Screwover the guide wire and into thebone (Fig. 17).Follow the same procedure for eachadditional 5.5mm Cannulated LockingScrew to be inserted into themetaphyseal portion of the plate. Be surethat all screws are securely tightened.Fig. 17Next, insert the Jig Sleeve into the STRUTscrew hole (Fig. 18). Thread a 3.2mmGuide Wire Cannula into the plate holeand insert a 3.2mm Drill Tip Guide Wire(Fig. 19). Again, carefully position thetip of the guide wire; it will indicate theposition of the tip of the screw once it isinserted into the plate.Slide the 5.5mm Cannulated ScrewDepth Gauge over the guide wire in theSTRUT screw hole in the plate until itcontacts the top of the cannula. Readthe proper screw length from the guide.Insert the appropriate length 5.5mmConical or Locking Screw over the guidewire and into the bone.Fig. 18Fig. 19
Zimmer Periarticular Distal Femoral Locking PlateRemove the 3.2mm Guide Wire Cannula(Fig. 20) and use the 5.0mm Hexhead Cannulated Driver to insert theappropriate length 5.5mm Conical orLocking Screw over the guide wire andinto the bone (Fig. 21). A screwdrivershaft can be used to loosely insert thescrew under power, but final seatingMUST be accomplished by hand toavoid cross-threading of the screws inthe plate holes or failures of the screwor driver. Once adequate fixation isachieved, if necessary or desired, removethe Conical Screw from the CENTRALplate hole and replace it with aLocking Screw.Fig. 20Note: If the plate shifts during screwinsertion, all the pins and screws mustbe removed and reinserted for thescrews to lock properly to the plate.Note: If a plate screw impinges onone of the intra-articular lag screws,the lag screw must be removed andrepositioned.Loosen the set screw and remove theMetaphyseal Jig (Fig. 22).Fig. 21Fig. 2211
12Zimmer Periarticular Distal Femoral Locking PlateShaft FixationReduce the plate to the shaft. Confirmrotation of the extremity by clinicalexamination. Check the alignment of theshaft with A/P and lateral fluoroscopicviews. The shaft portion of the plate canbe compressed to the bone by eitherinserting a nonlocking screw through themost proximal shaft compression slot orby using the Plate Reduction Instrumentto hold the plate against the bone whileinserting a locking screw. If preferred,a linear bone clamp can be used.The Plate Reduction Instrument can beused for:Once reduction is achieved, and it isappropriate, the plate may be loaded intension using the Tension Device[00-4817-005-00].Note: In comminuted fractures, it maynot always be possible or desirableto achieve anatomic reduction of thefracture.Insert standard 4.5mm cortical (Fig. 23)screws through the compression slots inthe plate as desired. If both locking andnonlocking screws will be used in theshaft, the nonlocking screws mustbe inserted first. MINOR varus-valgus adjustment ( 5 ) Translational adjustments Stabilization of plate orientation withrespect to the bone during insertionof the first screwsFig. 23 Alignment of segmental fragmentsWhen used without the MIS JigTo use the Plate Reduction Instrument,make a stab incision at the desiredlocation. Insert the 5.5mm/4.5mmPercutaneous Sleeve and Trocar throughsoft tissues ensuring that contact ismade with the surface of the plateat the desired location. Remove theTrocar. Insert the Plate Reduction Sleevethrough the Percutaneous Sleeve andthread it into the plate. Thread theReduction Spin Knob all the way ontothe Shaft of the Reduction Instrument.Next insert the Reduction Instrumentthrough the Reduction Sleeve and intothe bone fragment by hand or underpower. Rotating the Spin Knob clockwisewill cause it to contact the top of theReduction Sleeve and in turn, drawthe plate and bone together. Monitorprogress using C-Arm images. Stop whendesired reduction is achieved.Fig. 24Fig. 25Predrill both cortices with the drill bit.Measure for screw length using thedepth gauge. Then select and insertthe appropriate length 4.5mm CorticalScrews using the Large Hex Screwdriver.To insert 4.5mm Locking Screws, threadthe 3.7mm Standard Cannula (BlackRing) into the desired locking hole(Fig. 24). Use the 3.7mm Standard Drillthrough the cannula to drill (Fig. 25).Use the fluoroscope to confirm the drillposition in both the A/P and lateralplanes. Then remove the cannula.
Zimmer Periarticular Distal Femoral Locking PlateTapping is typically not necessary as theflutes of the screws are self-tapping. Ifthe bone is dense, the lateral cortex canbe tapped. If desired, use the 4.5mmScrew Tap (Fig. 26) to tap for the4.5mm screw.Insert the 4.5mm Locking Screw DepthGauge (Fig. 27) into the screw hole untilthe tip of the gauge bottoms out in thehole. Read the proper screw length fromthe gauge at the point where the gaugemeets the surface of the plate.Fig. 26Use the 5.0mm Hex-head Driver to insertthe 4.5mm Locking Screw (Fig. 28). Ascrewdriver shaft can be used to looselyinsert the screw under power, but thefinal seating MUST be accomplishedby hand to avoid cross-threading of thescrews in the plate holes or failure ofthe screw or driver.Follow the same procedure for eachadditional 4.5mm Locking Screw. Be surethat all screws are securely tightened.Make a final check of the limb alignmentand fracture reduction. Then make surethat all shaft locking screws aresecurely tightened.Securely tighten the distal locking screwsagain by hand before closing.Fig. 27Fig. 2813
14Zimmer Periarticular Distal Femoral Locking PlateWound ClosureUse the appropriate method for surgicalclosure of the incision.Postoperative TreatmentPostoperative treatment with lockingplates does not differ from conventionalopen reduction internal fixation (ORIF)procedures.Implant RemovalTo remove locking screws, use the LargeHexagonal screwdriver, 5.0mm Hex tofirst unlock all screws from the plate andthen remove the screws completely. DONOT use the forward captive screwdriversfor screw removal.Please refer to the package insertfor product information, includingcontraindications, warnings, andprecautionary information.Surgical PearlsDepending upon the screw position inthe plate, the screw head may not beflush with the plate surface. If unsurethat the screw is seated, loosen screwand retighten.If the locking screw is difficult to insertor stops advancing before locking to theplate, remove the screw and pre-drill withthe appropriate drill bit. Then reinsertthe screw. (This condition may be causedby very dense or thick cortical bone.)Flexion/extension of the distal femoralfragment may be achieved using thePlate Reduction Instrument as a joystick.Bumps or other devices may be usedunder the distal femoral metaphysealarea to help reduce the fracture in thelateral view.Varus/valgus can be checked using theC-arm and a cord or long guide wirefrom the femoral head to the center ofthe ankle joint on antero-posterior view.Use the C-Arm over the knee joint tocheck that the cord or guide wire passes10mm medially of the center of the kneejoint. Minor adjustment to varus/valgusreduction can be achieved using thePlate Reduction Instrument.A distractor or large external fixator mayalso be useful in gaining reduction.Cleaning of the cannulated instrumentsis necessary for proper function. Thecleaning stylet can clear debris in thecannulations and prevent binding of theinstruments. The cleaning brush shouldbe used postoperatively.
15Zimmer Periarticular Distal Femoral Locking PlateInstruments andImplantsDistal Lateral Femoral Plate Jig, Right00-2360-090-01Distal Lateral Femoral Plate Jig, Left00-2360-090-025.5mm/4.5mm Standard Jig Sleeve00-2360-090-043.2mm Standard Cannula00-2360-021-32Cannula Inserter 00-2360-088-003.2mm Standard Drill Tip Guide Wire00-2360-033-32Guide Wire Inserter 00-2360-085-005.5mm Cannulated Locking ScrewDepth Gauge 00-2360-041-554.7mm Std Cannulated Drill00-2360-071-475.0mm Hex Std CannulatedScrewdriver 00-2360-066-50Modular Handle 00-2360-186-003.7mm Standard Cannula00-2360-020-373.7mm Std Drill 00-2360-225-374.5mm Locking Screw StandardDepth Gauge 00-2360-040-454.5mm Locking Screw Tap00-2360-053-455.0mm Hex Std Screwdriver00-2360-065-505.0mm Screwdriver Stop Ring00-2360-065-05
16Zimmer Periarticular Distal Femoral Locking PlateOrder InformationDistal Femoral Plate Standard Jig Set - Set #00-2360-000-115.5mm/4.5mm Periarticular Locking Instrument Set - Set #00-2360-000-01Prod. No.DescriptionProd. No.00-2360-090-01Distal Lateral Femoral Plate Jig, RightAlso Available:00-2360-090-02Distal Lateral Femoral Plate Jig, Left47-2360-080-0500-2358-010-05Dist Lat Fem Plate/Jig Case5.5mm/4.5mm Locking Screw Set - Set #00-2359-000-0100-2360-093-03Standard Jig Set Screw 2 ea.Prod. No.DescriptionDistal Lateral Femoral Locking Plate Set - Set #00-2357-000-1300-2359-030-555.5mm Cannulated Locking Screw 30mm LngProd. No.Description00-2359-035-555.5mm Cannulated Locking Screw 35mm Lng00-2357-102-06Distal Lateral Femoral Locking Plate, 6 Hole,159mm Lng, Left00-2359-040-555.5mm Cannulated Locking Screw 40mm Lng00-2357-102-10Distal Lateral Femoral Locking Plate, 10 Hole,223mm Lng, Left00-2359-045-555.5mm Cannulated Locking Screw 45mm Lng00-2359-050-555.5mm Cannulated Locking Screw 50mm Lng00-2357-102-14Distal Lateral Femoral Locking Plate, 14 Hole,286mm Lng, Left00-2359-055-555.5mm Cannulated Locking Screw 55mm Lng00-2359-060-555.5mm Cannulated Locking Screw 60mm LngDistal Lateral Femoral Locking Plate, 18 Hole,349mm Lng, Left00-2359-065-555.5mm Cannulated Locking Screw 65mm LngDistal Lateral Femoral Locking Plate, 20 Hole,368mm Lng, Left00-2359-070-555.5mm Cannulated Locking Screw 70mm Lng00-2359-075-555.5mm Cannulated Locking Screw 75mm LngDistal Lateral Femoral Locking Plate, 6 Hole,159mm Lng, Right00-2359-080-555.5mm Cannulated Locking Screw 80mm Lng00-2359-085-555.5mm Cannulated Locking Screw 85mm LngDistal Lateral Femoral Locking Plate, 10 Hole,223mm Lng, Right00-2359-090-555.5mm Cannulated Locking Screw 90mm LngDistal Lateral Femoral Locking Plate, 14 Hole,286mm Lng, Right00-2359-095-555.5mm Cannulated Locking Screw 95mm Lng00-2359-100-555.5mm Cannulated Locking Screw 100mm Lng00-2359-050-565.5mm Cannulated Conical Screw 50mm Lng00-2359-055-565.5mm Cannulated Conical Screw 55mm Lng00-2359-060-565.5mm Cannulated Conical Screw 60mm Lng00-2359-065-565.5mm Cannulated Conical Screw 65mm Lng00-2359-070-565.5mm Cannulated Conical Screw 70mm LngDistal Lateral Femoral Locking Plate, 22 Hole, 400mmLng, Right, Sterile Only00-2359-075-565.5mm Cannulated Conical Screw 75mm LngDistal Lateral Femoral Locking Plate, 22 Hole, 400mmLng, Left, Sterile Only00-2359-080-565.5mm Cannulated Conical Screw 80mm Lng00-2359-085-565.5mm Cannulated Conical Screw 85mm Lng5.5mm/4.5mm Periarticular Locking Instrument Set - Set #00-2360-000-0100-2359-090-565.5mm Cannulated Conical Screw 90mm LngProd. No.Description00-2359-012-454.5mm Locking Screw 12mm LngCleaning Stylet00-2359-014-454.5mm Locking Screw 14mm Lng00-1147-078-00Cleaning Brush00-2359-016-454.5mm Locking Screw 16mm Lng00-2358-035-055.5mm/4.5mm Periarticular Locking Screw/Instrument Case00-2359-018-454.5mm Locking Screw 18mm Lng00-2359-020-454.5mm Locking Screw 20mm Lng00-2360-012-015.5mm Plate Reduction Instrument00-2359-022-454.5mm Locking Screw 22mm Lng00-2360-012-025.5mm Plate Reduction Sleeve00-2359-024-454.5mm Locking Screw 24mm Lng00-2360-012-03Plate Reduction Spin Knob00-2359-026-454.5mm Locking Screw 26mm Lng00-2360-020-373.7mm Standard Cannula00-2359-028-454.5mm Locking Screw 28mm Lng00-2360-021-323.2mm Standard Cannula00-2359-030-454.5mm Locking Screw 30mm Lng00-2360-033-323.2mm Standard Drill Tip Guide Wire00-2359-032-454.5mm Locking Screw 32mm Lng00-2360-040-454.5mm Locking Screw Standard Depth Gauge00-2359-034-454.5mm Locking Screw 34mm Lng00-2360-041-555.5mm Cannulated Locking Screw Depth Gauge00-2359-036-454.5mm Locking Screw 36mm Lng00-2360-053-454.5mm Locking Screw Tap00-2359-038-454.5mm Locking Screw 38mm Lng00-2360-054-555.5mm Cannulated Locking Screw Tap00-2359-040-454.5mm Locking Screw 40mm Lng00-2360-065-055.0mm Screwdriver Stop Ring00-2359-042-454.5mm Locking Screw 42mm Lng00-2360-065-505.0mm Hex Std Screwdriver00-2359-044-454.5mm Locking Screw 44mm Lng00-2360-066-505.0mm Hex Std Cannulated Screwdriver00-2359-046-454.5mm Locking Screw 46mm Lng00-2360-071-474.7mm Std Cannulated Drill00-2359-048-454.5mm Locking Screw 48mm Lng00-2360-085-00Guide Wire Inserter00-2359-050-454.5mm Locking Screw 50mm Lng00-2360-186-00Modular Handle00-2359-055-454.5mm Locking Screw 55mm Lng00-2360-088-00Cannula Inserter00-2359-060-454.5mm Locking Screw 60mm Lng00-2360-090-045.5mm/4.5mm Standard Jig Sleeve00-2359-065-454.5mm Locking Screw 65mm Lng00-2360-225-373.7mm Std Drill00-2359-070-454.5mm Locking Screw 70mm Lng00-4812-045-00Large Hex l Lateral Femoral Locking Plate, 18 Hole,349mm Lng, Right00-2357-101-20Distal Lateral Femoral Locking Plate, 20 Hole,368mm Lng, RightAlso 00DescriptionTorque Limiting Attachment
Contact your Zimmer representative or visit us at www.zimmer.com H124972347044001/ 070427R2D07 97-2347-044-00 Rev. 2 5ML Printed in USA 2005,2007 Zimmer, Inc.
distal lateral femoral locking plate. An external fixator or distractor can serve as preliminary fixation. This will make operative reduction easier, and the device can be used as a tool intraoperatively. Before locking screws are placed in any fragment, length, rotation, varus-valgus and recurvatum correction should be achieved.
2 Zimmer Periarticular Distal Lateral Fibular Locking Plates Surgical Technique Introduction The Zimmer Periarticular Locking Plate System combines locking screw technology with periarticular plates to create fixed-angle constructs for use in multifragmentary fractures or where deficient bone stock or poor bone quality is encountered.
Zimmer MotionLoc Screw for the Periarticular Locking Plate System Zimmer MotionLoc Screw for the Periarticular Locking Plate System 5 Reducing Stiffness of Locked Plating Constructs MotionLoc Screws reduce the locked plating construct stiffness by more than 58% while retaining construct strength.3 The stiffness reduction through the screws .
With the Periarticular Locking Plate System, Zimmer offers advanced solutions for the management of comminuted fractures and fractures in which deficient bone stock or poor bone quality is encountered. The system combines anatomically contoured periarticular plates with locking screw technology. The unique plate
Distal Medial Tibial Plate DistalAnterolateral Tibial Plate Proximal Lateral Tibial Plate Distal Lateral Femoral Plate Proximal Humeral Plate TheAxSOS Locking Plate System is designed to treat periarticular or intra-articular fractures of the Distal Femur, Proximal Humerus, Proximal Tibia, and the Distal Tibia. The system design is based on .
48 306.310l 606.610l lcp periarticular proximal humerus plate-left -10 hole 49 306.310r 606.610r lcp periarticular proximal humerus plate-right -10 hole 50 306.312l 606.612l lcp periarticular proximal humerus plate-left -12 hole 51 306.312r 606.612r lcp periarticular proximal humerus plate-right -12 hole
with lateral locking plate. The appropriate application of the locking plate and operation strategy are the key to reduce the revision rate in distal femoral fractures. Keywords: Distal femoral fracture, Periprosthetic fracture, T
Zimmer MotionLoc Screw for the Periarticular Locking Plate System Background A plating construct needs to be strong enough to support the damaged bone while the fracture heals. However, too much stiffness forces the body to heal through osteonal or primary/direct healing.
Smith G. M., Cryptogamic Botany – Algae and Fungi, Vol. I, McGraw Hill publications, 1955. 5 Course code: SBOT502 Palaeobotany, Angiosperms, Anatomy, Palynology (Credits :04/ Lectures/Week:04) 60 L Learning Objectives: Learn about the process of fossilization and different fossils. Morphology of flower and fruits will help the students, understand the classification in an effective manner .
