Zimmer Locking Plate Surgical Technique
Zimmer PeriarticularProximal HumeralLocking PlateSurgical TechniqueThe Science of the Landscape
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueSurgical TechniqueTable of ContentsDeveloped in conjunction withStephen K. Benirschke, M.D.Professor, Department ofOrthopaedics and Sports MedicineUniversity of Washington,Harborview 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 ProfessorDepartment of OrthopaedicsUniversity of WashingtonOrthopaedic SurgeonSwedish Hospital and Medical CenterSeattle, WashingtonIntroductionLocking Plate TechnologyProximal Humeral Plate IndicationsFracture ClassificationPlate FeaturesSurgical TechniqueRequired InstrumentationPreoperative PreparationFracture ReductionSurgical ApproachReduction of Intra-articular FragmentsPlate PositioningScrew TrajectoryFracture FixationWound ClosurePostoperative TreatmentImplant Removal222334444566910141414Surgical Pearls14Instruments and Implants15Order Information18
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueIntroductionThe Zimmer Periarticular LockingPlate System combines locking screwtechnology with periarticular platesto create fixed-angle constructs foruse in comminuted fractures or wheredeficient bone stock or poor bonequality is encountered. The fixedangle plate/screw device can be usedin osteopenic bone and other areaswhere traditional screw fixation may becompromised.The Periarticular Locking Plates willaccommodate standard screws, aswell as locking screws with threadedheads that allow the screw to belocked into the plate. When necessary,interfragmentary compression can beachieved using standard screws in thedual compression slots.Cannulated screws and instrumentsallow provisional fixation with guidepins in the metaphysis. This helpsensure that the threaded locking screwheads align properly with the threadedplate holes.All plate configurations contain lockingscrew holes in the plate head, andalternating locking and compressionscrew slots in the shaft.Locking Screw TechnologyThe 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.Locking Plate TechnologyIndicationsBy using locking screws in a bone plate,a fixed-angle construct is created.In osteopenic bone or fractures withmultiple fragments, secure bonepurchase with conventional screws maybe compromised. The locking screwsdo not rely on bone/plate compressionto resist patient load, but functionsimilarly to multiple small angledblade plates. In osteopenic bone orcomminuted fractures, the ability tolock screws into a fixed-angle constructis imperative.The Periarticular Locking PlateSystem is indicated for temporaryinternal fixation and stabilization ofosteotomies and fractures, including:By 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 any lockingscrews.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. Comminuted fractures Supracondylar fractures Intra-articular and extra-articularcondylar fractures Fractures in osteopenic bone Nonunions Malunions
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueFracture ClassificationThe OTA/AO classification for long bonefractures is divided into three generalgroups each with three subgroups.The groups are extra-articular, partialarticular, and complex articular.The subgroups reflect the degree ofmetaphyseal comminution.Refer to the OTA/AO ComprehensiveClassification of Fractures of LongBones for more specific information.Plate Features Anatomically contoured plates areprecontoured to create a fit thatrequires little or no additionalbending and helps withmetaphyseal/diaphyseal reductionThe anatomical shape ofthe plate head matchesthe shape of the proximalhumerus Low plate profile facilitates fixationwithout impinging soft tissue Dual compression slots willaccommodate periarticularscrews or conventional stainlessscrews and allow bi-directionalcompressionMultiple locking holes in theplate head allow placementof the screws to capturefragments while avoidinglag screws that have beenplaced outside the plateThe locking plate design does notrequire compression between the plateand bone to accommodate loading.Therefore, purchase of screws in thebone 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).Tapered Shaft designallows for a minimallyinvasive techniqueFig. 1
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueSurgical TechniqueRequired InstrumentationThe following sets may be required forapplication of the 3.5mm PeriarticularLocking Proximal Humeral Plate: Small Fragment Screw andInstrument Set Basic Forceps Set 3.5mm/2.7mm Locking Screw andInstrument Set 3.5mm Locking Proximal HumeralPlate and Standard Jig SetNOTE: The 2.7mm Locking Screwsshould not be used with the 3.5mmLocking Proximal Tibial Plate.Preoperative PreparationAfter assessing the fractureradiographically and preparing apreoperative plan, place the patientin the beach chair position withthe injured shoulder resting on atranslucent part of the operating table(Fig. 2). Be sure that the fluoroscopecan be positioned to visualize theproximal humerus in both the lateraland A/P views.X-rays and ClassificationFracture ReductionAt least two x-rays of the glenohumeraljoint taken at right angles to each otherare mandatory to identify the fracturetype. X-rays in internal and externalrotation can be important if tuberosityfractures are suspected. Traction viewscan frequently help to clarify complexfracture patterns. If standard x-raysdo not allow clear evaluation of thefracture features, articular damage,displacement and soft tissue damage,CT may be helpful. You must be ableto determine whether the fracture runsthrough the anatomical or surgical neckof the humerus.It is imperative that accurate reductionof the fracture be obtained prior to andmaintained during application of theproximal humeral plate. Intraoperativex-ray visualization is critical in allplanes.Recommended X-raysAP ViewThe patient must be placed withthe posterior aspect of the injuredside against the x-ray plate, and theopposite side must be elevated at least30 degrees.Lateral Anterior ViewThe lateral/anterior aspect of theinjured shoulder is placed againstthe x-ray plate. The x-ray beam is thendirected posteriorly along the spineof the scapula at 90 degrees to thedirection of the AP.Axillary ViewThe patient is supine with the xray plate placed above the injuredshoulder. Abduction of about 30degrees is needed.Fig. 2Closed reduction should be tried underimage intensification. In acute fracturesand fracture dislocations, reduction isoften successful.If closed reduction cannot be achieved,assisted percutaneous reduction bymeans of a joystick or hook, or openreduction will be necessary in orderto obtain good alignment and fracturefixation.Exposing the HumerusAfter radiographic verification ofpreliminary reduction of the fracture,use the preferred approach andtechnique to expose the proximalhumerus.
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueSurgical ApproachDeltopectoral ApproachThe standard approach for fixation offractures of the proximal humerus isbetween the deltoid and the pectoralmuscles. Start the skin incision at thecoronoid process and continue it in aslightly convex way toward the medialside as far as the insertion of thedeltoid muscle on the lateral humeralshaft (Fig. 3). The cephalic vein canusually be identified proximally with itsmain connections on the lateral side.Incise the fascia medial to the vein andwith the arm slightly abducted. Thefracture and the humeral head can bepalpated after blunt separation of thedeltoid muscle from around the bursa,soft tissues and fracture hematoma.After removal of the hematoma, thelong biceps tendon can be identifiedunder internal and external rotationand will lead to identification of thegreater and lesser tuberosities. Evenif the tuberosities are fractured, theywill still have some connections to theadjacent tissues and their attachedmuscles.On the distal shaft, especially incomminuted fractures, the insertionsof the deltoid and pectoralis major mayhave to be partially released, especiallyfor reduction and plate fixation on thelateral aspect of the humerus. The plateshould lie dorsal to the long bicepstendon and the lateral branch of theanterior circumflex humeral artery. Theposition of this artery and the axillarynerve should be noted, and damageshould be avoided (Fig. 4).Retract the deltoid muscle to thelateral side to look for the humeralhead (Fig. 5).Fig. 5anterior viewposterior view1. Axillary artery2. Posterior circumflex artery3. Anterior circumflex artery4. Anterolateral branch of the anterior circumflex artery5. Greater tuberosity6. Lesser tuberosity (anterior)7. Tendon insertions a) infraspinatus, b) teres minor8. Entry of anterolateral branch of the circumflex artery into the bone9. Intertubular grooveFig. 3Fig. 4
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueReduction of Intra-articularFragmentsIt is imperative that accurate reductionof the fracture be obtained prior to, orthrough application of the plate, andmaintained during application of theproximal humerus plate. Reduce theintra-articular fragments using linearbone clamps or Kirschner wires totemporarily hold the reduction. Uselag screws to secure the intra-articularfragments. To help avoid inserting thelag screws where they will interfere withthe plate placement, hold the plate onthe bone in its approximate position.Then insert the lag screws as needed.Plate PositioningHold the appropriate Metaphyseal Jigon the selected plate and finger tightenor use the 2.5mm Screwdriver totighten the set screw (Fig. 6). Insert a3.5mm Standard Jig Sleeve into thecenter hole of the Jig (Fig. 7) and threadthe 1.6mm Standard Cannula into theplate hole (Fig. 8).Before placing the plate on the bone,thread the appropriate number ofStandard Cannulas into the proximalholes in the head of the plate (Fig. 9). Itis easier to thread the cannulas into theplate holes before the plate is appliedto the bone. The cannulas can be usedas handles to position the plate.Fig. 6Fig. 8Fig. 7Fig. 9
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueUse this construct to place the initial1.6mm Drill Tip Guide Wire in themetaphysis. Check plate placement– visually and fluoroscopically ifnecessary.Use anatomic landmarks andfluoroscopic images to position theplate. Because the humeral shaftmay not be aligned with the proximalfragment, the plate head should beused to determine the appropriateplacement of the plate. The platehead should conform to the shape ofthe intact or reconstructed proximalhumerus. This will determine thealignment of the shaft.Note: The cannula inserter may be usedto tighten the cannula if necessary(Fig. 10).Fig. 10
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueHold the plate in the desired positionand insert a 1.6mm Drill Tip GuideWire through one of the Guide WireCannulas until the tip engages orreaches the subchondral bone (Fig. 11).Use the fluoroscope to confirm theposition of the wire in both the A/Pand lateral planes. Adjust the wirelocation if necessary. If preferred, usea linear bone clamp or bone reductioninstrument to secure the plate.When the first wire is satisfactory,rotate the plate, if necessary. Theninsert Drill Tip Guide Wires through theother proximal Guide Wire Cannulas tohelp prevent rotation of the plate (Fig. 12).Fig. 11NOTE: If desired, after removal of themetaphyseal jig, additional 1.6mmDrill Tip Guide Wires can be insertedthrough the proximal K-wire holes tofurther stabilize the plate (Fig. 13).Use the fluoroscope for both A/P andlateral views to confirm the position ofthe plate head, shaft, and guide wires.Fig. 12Fig. 13
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueScrew Trajectory
10Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueFracture FixationMetaphyseal Screw FixationIf required, lag screw reduction of afragment must be accomplished beforeinserting any locking screws. The3.5mm Cannulated Conical Screws canbe used for lag screw fixation.Slide the 3.5mm Cannulated ScrewDepth Gauge over the guide wires tomeasure for the screw lengths (Fig. 14).The tip of the gauge must contactthe end of the guide wire cannula foran accurate measurement. This willposition the tip of the screw at thetip of the guide wire. Read the properscrew length from the guide.Fig. 14Predrilling 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 using the 2.7mm CannulatedDrill and tapped using the 3.5mmCannulated Screw Tap.Remove the Guide Wire Cannulas anduse the 2.5mm Hex-head CannulatedDriver to insert a 3.5mm CannulatedConical or Cannulated Locking Screwover each of the guide wires and intoas many proximal holes as necessary(Fig. 15). Sleeves and cannulas may beinserted into the additional proximalplate holes if locked screws arenecessary in these holes.Fig. 15
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueA driver shaft can be used to looselyinsert the screw under power, but thefinal seating must be accomplished byhand to avoid cross-threading of thescrews in the plate holes.Follow the same procedure for eachproximal screw. Be sure that all screwsare securely tightened.Note: Slide the Screwdriver Stop Ringonto the screwdriver shaft and placeit at the level of the black ring etchedon the driver shaft (Fig. 16). Before theBlue Stop Ring approaches the top ofthe Jig Sleeve, power insertion muststop. Screws must be seated by hand.The Screwdriver Stop Ring is intendedto be a visual cue to stop powerinsertion of locking screws.NOTE: 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.Use direct or indirect reductiontechniques to reduce the proximalhumerus to the shaft. Confirm that thearm is in proper rotation. Temporarilysecure the plate shaft to the bone withplate holding forceps, a nonlockingscrew or the appropriate platereduction instrument.If lag screws will be used through someof the slots in the shaft, insert the firstlag screw to reduce the fracture or astandard screw to reduce the plate tothe bone and compress the fracture.Black RingFig. 1611
12Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueShaft FixationIf both locking and nonlockingscrews will be used in the shaft, thenonlocking screws must be insertedfirst. Insert additional nonlockingscrews through the compression holesin the plate as desired.Apply the appropriate drill guide ([004808-035-01] 3.5mm/2.5mm DoubleDrill Sleeve, [00-4808-035-02] 3.5mm/2.5mm Insert Drill Sleeve, [00-4808035-04] 3.5mm Universal Drill Guide,[00-4808-035-05] 3.5mm CompressionDrill Guide) to one of the nonlockingshaft slots, and use the 2.5mm QC DrillBit [00-4806-110-25] to drill throughboth cortices. Use the Depth Gauge tomeasure the appropriate screw length.Then insert a self-tapping screw. Checkthe position of the screw with thefluoroscope. Repeat this procedurefor each of the standard screws to beinserted.To insert solid locking screws, threadthe 2.7mm Standard Cannula intothe most proximal shaft locking holeof the plate (Fig. 17). Use the 2.7mmStandard Drill through the cannula todrill a pilot hole (Fig. 18). Check thedepth and position of the drill withfluoroscopic images. Remove thecannula and use the Depth Gauge tomeasure the appropriate screw length(Fig. 19). Then insert the locking screw(Fig. 20).Fig. 17Fig. 18Fig. 19Tapping is typically not necessary asthe flutes of the screws are self-drillingand self-tapping. If the bone is dense,the lateral cortex can be tapped usingthe 3.5mm tap.Insert locking screws as desiredthrough the remaining locking holes ofthe shaft in the same manner.Fig. 20
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueStrut Screw FixationA locking strut screw can be insertedinto the plate to buttress the medialcortex. Insert the 1.6mm StandardCannula into the oblique locking hole(Fig. 21). Then insert a 1.6mm Drill TipGuide Wire through the Cannula untilthe tip engages or touches the medialsubchondral bone. Use the fluoroscopeto confirm the position of the wire inboth the A/P and lateral planes.Fig. 21Slide the 3.5mm Cannulated LockingScrew Depth Gauge over the guidewire to measure for the screw length,making sure that the tip of the gaugecontacts the end of the guide wirecannula (Fig. 22). This will position thetip of the screw at the tip of the guidewire. Read the proper screw lengthfrom the guide.Remove the Guide Wire Cannula anduse the 2.5mm Hex-head CannulatedDriver to insert a Cannulated LockingScrew over the guide wire (Fig. 23).Fig. 22Make a final check of the limbalignment and fracture reduction. Thenmake sure that all locking screws in thehead and shaft are securely tightenedbefore closing (Fig. 24).Fig. 23Fig. 2413
14Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueWound ClosureUse the appropriate method forsurgical closure of the incision.Postoperative TreatmentPostoperative treatment withlocking plates does not differ fromconventional open reduction internalfixation (ORIF) procedures.Implant RemovalTo remove locking screws, use theStandard Hexagonal Screwdrivers[2360-065-25, 2360-065-50] to firstunlock all screws from the plate andthen remove the screws completely.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 lockingto the plate, remove the screw andpre-drill with the appropriate drill bit.Then reinsert the screw. (This conditionmay be caused by very dense or thickcortical bone.)Cleaning of the cannulated instrumentsis necessary for proper function. Thecleaning stylet can clear debris in thecannulations and prevent binding ofthe instruments. The cleaning brushshould be used postoperatively.
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueInstrument and Implants3.5mm Proximal Humeral Plate Jig,Right 00-2360-093-01, Left 00-2360-093-023.5mm Standard Jig Sleeve 00-2360-093-041.6mm Standard Cannula 00-2360-021-16Cannula Inserter 00-2360-088-001.6mm Standard Drill Tip Guide Wire 00-2360-033-162.7 Standard Drill 00-2360-205-273.5mm/2.7mm Locking Screw Depth Gauge00-2360-040-3515
16Zimmer Periarticular Proximal Humeral Locking Plate Surgical Technique2.7mm Standard Cannula 00-2360-020-272.5mm Hex Standard Cannulated Screwdriver00-2360-066-25Modular Handle 00-2360-086-002.0mm Standard Cannula 00-2360-020-202.0mm Standard Drill 00-2360-175-202.5mm Hex Standard Screwdriver 00-2360-065-253211 3.5mm / 2.7mm Locking Plate Reduction Instrument00-2360-011-012 3.5mm / 2.7mm Plate Reduction Sleeve 00-2360-011-023 Spin Knob 00-2360-012-033.5mm Cannulated Locking Screw Standard Depth Gauge00-2360-041-35
Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueCleaning Brush 00-1147-076-00Cleaning Stylet 00-1147-071-002.5mm Hex Forward Captive Screwdriver 00-2360-050-252.5mm Hex Forward Captive Cannulated Screwdriver00-2360-051-252.7mm Locking Screw Tap 00-2360-053-273.5mm Locking Screw Tap 00-2360-053-353.5mm Cannulated Locking Screw Tap 00-2360-054-3517
18Zimmer Periarticular Proximal Humeral Locking Plate Surgical TechniqueOrder InformationDescriptionPart Number3.5mm/2.7mm Periarticular Locking Instrument Set- Set #00-2360-000-02Modular Handle00-2360-086-003.5mm Cannulated Locking Screw 55mm Lng00-2359-055-36Ratcheting Modular Handle00-2360-087-003.5mm Cannulated Locking Screw 60mm Lng00-2359-060-361.6mm Standard Cannula00-2360-021-163.5mm Cannulated Locking Screw 65mm Lng00-2359-065-361.6mm Standard Drill Tip Guide Wire00-2360-033-163.5mm Cannulated Locking Screw 70mm Lng00-2359-070-363.5mm / 2.7mm Locking Plate ReductionInstrument00-2360-011-013.5mm Cannulated Locking Screw 75mm Lng00-2359-075-363.5mm / 2.7mm Locking Plate ReductionSleeve00-2360-011-023.5mm Cannulated Locking Screw 80mm Lng00-2359-080-363.5mm Cannulated Locking Screw 85mm Lng00-2359-085-363.5mm Cannulated Locking Screw DepthGauge00-2360-041-353.5mm Cannulated Locking Screw 90mm Lng00-2359-090-363.5mm Cannulated Conical Screw 30mm Lng00-2359-030-372.7mm Standard Cannulated Drill00-2360-071-273.5mm Cannulated Conical Screw 35mm Lng00-2359-035-37Cleaning Stylet00-1147-071-003.5mm Cannulated Conical Screw 40mm Lng00-2359-040-37Cleaning Brush00-1147-076-003.5mm Cannulated Conical Screw 45mm Lng00-2359-045-37Plate Reduction Spin Knob00-2360-012-033.5mm Cannulated Conical Screw 50mm Lng00-2359-050-372.5mm Hex Forward Captive Screwdriver00-2360-050-253.5mm Cannulated Conical Screw 55mm Lng00-2359-055-372.5mm Hex Cannulated Forward CaptiveScrewdriver00-2360-051-253.5mm Cannulated Conical Screw 60mm Lng00-2359-060-372.5mm Hex Standard Screwdriver00-2360-065-253.5mm Cannulated Conical Screw 65mm Lng00-2359-065-372.5mm Hex Standard Cannulated Screwdriver00-2360-066-253.5mm Cannulated Conical Screw 70mm Lng00-2359-070-37Cannula Inserter00-2360-088-003.5mm Locking Screw 12mm Lng00-2359-012-352.7mm Standard Cannula00-2360-020-273.5mm Locking Screw 14mm Lng00-2359-014-352.7mm Standard Drill00-2360-205-273.5mm Locking Screw 16mm Lng00-2359-016-353.5mm/2.7mm Locking Screw StandardDepth Gauge00-2360-040-353.5mm Locking Screw 18mm Lng00-2359-018-353.5mm Locking Screw 20mm Lng00-2359-020-3500-2359-022-352.0mm Standard Cannula00-2360-020-203.5mm Locking Screw 22mm Lng3.5mm Standard Jig Sleeve00-2360-093-043.5mm Locking Screw 24mm Lng00-2359-024-352.0mm Standard Drill00-2360-175-203.5mm Locking Screw 26mm Lng00-2359-026-352.7mm Locking Screw Tap00-2360-053-273.5mm Locking Screw 28mm Lng00-2359-028-353.5mm Locking Screw Tap00-2360-053-353.5mm Locking Screw 30mm Lng00-2359-030-3500-2360-054-353.5mm Locking Screw 32mm Lng00-2359-032-353.5mm/2.7mm Locking Screw and Instrument 00-2358-040-00Case3.5mm Locking Screw 34mm Lng00-2359-034-353.5mm Locking Screw 36mm Lng00-2359-036-353.5mm / 2.7mm Locking Screw Set - Set # 00-2359-000-023.5mm Locking Screw 38mm Lng00-2359-038-353.5mm Cannulated Locking Screw 30mm Lng00-2359-030-363.5mm Locking Screw 40mm Lng00-2359-040-353.5mm Cannulated Locking Screw 35mm Lng00-2359-035-363.5mm Locking Screw 42mm Lng00-2359-042-353.5mm Cannulated Locking Screw 40mm Lng00-2359-040-363.5mm Locking Screw 44mm Lng00-2359-044-353.5mm Cannulated Locking Screw 45mm Lng00-2359-045-363.5mm Locking Screw 46mm Lng00-2359-046-353.5mm Cannulated Locking Screw 50mm Lng00-2359-050-363.5mm Locking Screw 48mm Lng00-2359-048-353.5mm Cannulated Locking Screw Tap
19Zimmer Periarticular Proximal Humeral Locking Plate Surgical Technique3.5mm Locking Screw 50mm Lng00-2359-050-35Prox Lat Hum Lock Plt Set - Set # 00-2358-000-053.5mm Locking Screw 52mm Lng00-2359-052-3500-2358-002-043.5mm Locking Screw 54mm Lng00-2359-054-35Proximal Lateral Humeral Locking Plate,4 Hole 90mm Lng, Left3.5mm Locking Screw 56mm Lng00-2359-056-35Proximal Lateral Humeral Locking Plate,6 Hole 114mm Lng, Left00-2358-002-063.5mm Locking Screw 58mm Lng00-2359-058-3500-2359-060-35Proximal Lateral Humeral Locking Plate,8 Hole 138mm Lng, Left00-2358-002-083.5mm Locking Screw 60mm Lng3.5mm Locking Screw 65mm Lng00-2359-065-3500-2358-002-123.5mm Locking Screw 70mm Lng00-2359-070-35Proximal Lateral Humeral Locking Plate,12 Hole 186mm Lng, Left3.5mm Locking Screw 75mm Lng00-2359-075-35Proximal Lateral Humeral Locking Plate,16 Hole 234mm Lng, Left00-2358-002-163.5mm Locking Screw 80mm Lng00-2359-080-3500-2359-085-35Proximal Lateral Humeral Locking Plate,4 Hole 90mm Lng, Right00-2358-001-043.5mm Locking Screw 85mm Lng3.5mm Locking Screw 90mm Lng00-2359-090-3500-2358-001-062.7mm Locking Screw 10mm Lng00-2359-010-27Proximal Lateral Humeral Locking Plate,6 Hole 114mm Lng, Right2.7mm Locking Screw 12mm Lng00-2359-012-27Proximal Lateral Humeral Locking Plate,8 Hole 138mm Lng, Right00-2358-001-082.7mm Locking Screw 14mm Lng00-2359-014-2700-2359-016-27Proximal Lateral Humeral Locking Plate,12 Hole 186mm Lng, Right00-2358-001-122.7mm Locking Screw 16mm Lng2.7mm Locking Screw 18mm Lng00-2359-018-27Proximal Lateral Humeral Locking Plate,16 Hole 234mm Lng, Right00-2358-001-162.7mm Locking Screw 20mm Lng00-2359-020-27Prox Lat Hum Plate Std Jig Set - Set # 00-2360-000-142.7mm Locking Screw 22mm Lng00-2359-022-27Proximal Lateral Humeral Plate Jig, Right00-2360-092-012.7mm Locking Screw 24mm Lng00-2359-024-27Proximal Lateral Humeral Plate Jig, Left00-2360-092-022.7mm Locking Screw 26mm Lng00-2359-026-27Case00-2358-030-052.7mm Locking Screw 28mm Lng00-2359-028-272.7mm Locking Screw 30mm Lng00-2359-030-272.7mm Locking Screw 32mm Lng00-2359-032-272.7mm Locking Screw 34mm Lng00-2359-034-272.7mm Locking Screw 36mm Lng00-2359-036-272.7mm Locking Screw 38mm Lng00-2359-038-272.7mm Locking Screw 40mm Lng00-2359-040-272.7mm Locking Screw 42mm Lng00-2359-042-272.7mm Locking Screw 44mm Lng00-2359-044-272.7mm Locking Screw 46mm Lng00-2359-046-272.7mm Locking Screw 48mm Lng00-2359-048-272.7mm Locking Screw 50mm Lng00-2359-050-272.7mm Locking Screw 52mm Lng00-2359-052-272.7mm Locking Screw 54mm Lng00-2359-054-272.7mm Locking Screw 56mm Lng00-2359-056-272.7mm Locking Screw 58mm Lng00-2359-058-272.7mm Locking Screw 60mm Lng00-2359-060-27
97-2347-041-00 Rev.1 7.5ML Printed in USA 2005 Zimmer, Inc.Contact your Zimmer representative or visit us at www.zimmer.com
Small Fragment Screw and Instrument Set Basic Forceps Set 3.5mm/2.7mm Locking Screw and Instrument Set 3.5mm Locking Proximal Humeral Plate and Standard Jig Set NOTE: The 2.7mm Locking Screws should not be used with the 3.5mm Locking Proximal Tibial Plate. Preoperative Preparation After assessing the fracture
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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
6 Zimmer Continuum Acetabular System Surgical Technique Provisional Liner Insertion Inserting the Provisional Liner There are two different Provisional Liners. One with a Locking Screw that is independent of the Provisional Liner (Fig. 9) and one with a Locking Screw permanentl
fructose, de la gélatine alimentaire, des arômes plus un conservateur du fruit – sorbate de potassium –, un colorant – E120 –, et deux édulco-rants – aspartame et acésulfame K. Ces quatre derniers éléments relèvent de la famille des additifs. Ils fleuris-sent sur la liste des ingrédients des spécialités laitières allégées .
