Zimmer Periarticular Distal Femoral Locking Plate Surgical Technique

: Pdf Zimmer Periarticular Distal Femoral Locking Plate Surgical Technique Zimmer_Periarticular_Distal_Femoral_Locking_Plate_Surgical_Technique 4 2016 pdf

Open the PDF directly: View PDF .
Page Count: 20

Zimmer®

Periarticular

Distal Femoral

Locking Plate

Surgical Technique

The Science of the Landscape

1

Zimmer Periarticular Distal Femoral Locking Plate

Surgical Technique

Developed in conjunction with

Stephen K. Benirschke, M.D.

Professor, Department of

Orthopaedics and Sports Medicine

University of Washington

Harborview Medical Center

Seattle, Washington

Paul J. Duwelius, M.D.

Adjunct Associate Professor

Orthopaedics

Oregon Health Sciences University

Clinical Attending

St. Vincent Hospital & Medical Center

Portland, Oregon

James A. Goulet, M.D.

Professor and Director

Section of Orthopaedic Trauma

Department of Orthopaedic Surgery

The University of Michigan Hospitals

Ann Arbor, Michigan

David A. Templeman, M.D.

Associate Professor

Orthopaedic Surgery

University of Minnesota

Staff, Hennepin County Medical Center

Minneapolis, Minnesota

Robert A. Winquist, M.D.

Clinical Professor,

Department of Orthopaedics

University of Washington

Orthopaedic Surgeon

Swedish Hospital and Medical Center

Seattle, Washington

Table of Contents

Introduction 2

Locking Screw Technology 2

Locking Plate Technology 2

Distal Femur Plate Indications 2

Fracture Classification 2

Plate Features 3

Surgical Technique 4

Required Instrumentation 4

Preoperative Preparation 4

Fracture Reduction 4

Plate Positioning 5

Screw Trajectory 9

Condylar Fixation 10

Shaft Fixation 12

Wound Closure 14

Postoperative Treatment 14

Implant Removal 14

Surgical Pearls 14

Instruments and Implants 15

Order Information 16

2Zimmer Periarticular Distal Femoral Locking Plate

Introduction

The Zimmer Periarticular Locking

Plate System combines locking screw

technology with periarticular plates to

create fixed-angle constructs for use in

comminuted fractures or where deficient

bone stock or poor bone quality is

encountered. The fixed-angle plate/

screw device can be used in osteopenic

bone and other areas where traditional

screw fixation may be compromised.

The Periarticular Locking Plates will

accommodate standard screws, as well

as locking screws with threaded heads.

When necessary, interfragmentary

compression can be achieved with

lag screws.

Cannulated screws and instruments

allow provisional fixation with guide pins

in the metaphysis. This helps ensure

that the threaded locking screw heads

align properly with the threaded

plate holes.

All plate configurations contain locking

screw holes in the plate head, and

alternating locking and compression

screw slots in the shaft.

Three types of locking screws are

available with the system:

• 5.5mm cannulated locking screws

for use in the plate head

• 5.5mm cannulated conical screws for

use in the plate head

• 4.5mm noncannulated locking screws

for use in the plate shaft

Locking Screw Technology

The heads of the locking screws contain

male threads while the holes in the

plates contain female threads. This

allows the screw head to be threaded

into the plate hole, locking the screw

into the plate. This technical innovation

provides the ability to create a fixed-

angle construct while using familiar

plating techniques.

Locking Plate Technology

By using locking screws in a bone plate,

a fixed-angle construct is created. In

osteopenic bone or fractures with

multiple fragments, secure bone

purchase with conventional screws may

be compromised. Locking screws do

not rely on bone/plate compression to

resist patient load, but function similarly

to multiple small angled blade plates.

In osteopenic bone or comminuted

fractures, the ability to lock screws into

a fixed-angle construct is imperative.

By combining locking screw holes with

compression screw slots in the shaft,

the plate can be used as both a locking

device and a fracture compression

device. If compression is desired, it

must be achieved first by inserting the

standard screws in the compression

screw slots before inserting any

locking screws.

Indications

The Periarticular Locking Plate System is

indicated for temporary internal fixation

and stabilization of osteotomies and

fractures, including:

• Comminuted fractures

• Supracondylar fractures

• Intra-articular and extra-articular

condylar fractures

• Fractures in osteopenic bone

• Nonunions

• Malunions

Fracture Classification

Refer to OTA Fracture and Dislocation

Compendium

, or the Schatzker

classification for more information.

3

Zimmer Periarticular Distal Femoral Locking Plate

Fig. 1 Zimmer Periarticular Distal Femoral Locking Plate features.

Plate Features

• Anatomically contoured plates

are precontoured to create a fit

that requires little or no additional

bending and helps with metaphyseal/

diaphyseal reduction

• Threaded holes create a 95 degree

fixed angle between the plate head

and the locking screws to allow screw

placement that is parallel to the

joint line

• The central locking screw hole in plate

head provides initial reduction of the

plate to the condyles

Thick-to-thin plate profiles make the plates

autocontourable

The anatomical shape of the head of the

plate matches the shape of the distal femur

Multiple locking holes in the plate head

allow placement of the screws to capture

fragments

The plate shaft design allows for a

minimally invasive technique with

submuscular passage of the plate

• The low profile plate facilitates

fixation without impinging

on soft tissue

• Plates are available in a variety of

sizes and lengths, from 6 to 18 holes,

left and right

• Dual-compression slots will

accommodate periarticular screws or

conventional stainless steel screws

and allow bi-directional compression

• The last diaphyseal plate hole is

designed to accomodate the tension

device (00-4817-000-05)

The locking plate design does not

require compression between the plate

and bone to accommodate loading.

Therefore, purchase of the screws in

the bone can be achieved with a thread

profile that is shallower than that of

traditional screws. The shallow thread

profile, in turn, allows for screws with

a large core diameter to accommodate

loading with improved bending and

shear strength (Fig. 1).

4Zimmer Periarticular Distal Femoral Locking Plate

Surgical Technique

Required Instrumentation

The following sets may be required for

application of the 5.5mm Periarticular

Locking Proximal Tibia Plates:

• Standard Screw Set

• Basic Instrument Set

• Basic Forcep Set

• 5.5mm/4.5mm Locking Screw and

Instrument Set

• Periarticular Distal Femoral Locking

Plate and Standard Jig Set

• Linear Bone Clamps

Preoperative Preparation

After assessing the fracture

radiographically and preparing a

preoperative plan, place the patient in

the supine position on a radiolucent

table. Be sure that the fluoroscope can

be positioned to visualize the distal

femur in both the lateral and anterior/

posterior (A/P) views (Figs. 2 & 3).

Fracture Reduction

It is imperative that accurate reduction

of the fracture be obtained prior to and

maintained during application of the

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.

The Plate Reduction Instrument is

designed to aid in minor varus-valgus

and translation corrections prior to

screw placement.

Fig. 2

Fig. 3

After radiographic verification of

preliminary reduction of the fracture, use

the preferred approach and technique to

expose the distal lateral femur.

Reduce the intra-articular fragments

using linear bone clamps or Kirschner

wires to temporarily hold the reduction.

For a Hoffa fracture, reduce the posterior

articular fragment and stabilize it with

K-wires inserted from anterior

to posterior.

Use lag screws to secure the intra-

articular fragments. To help avoid

inserting the lag screws where they will

interfere with the plate placement, hold

the plate on the bone in its approximate

position. Then insert the lag screws

as needed.

Use 3.5mm cortical screws, 4.0mm

cancellous screws, HerbertTM or Herbert/

Whipple® screws for fixation of a

posterior articular Hoffa fragment. Insert

the screws from anterior to posterior,

and where applicable countersink the

heads below the level of the

articular cartilage.

Quadriceps

Hamstrings

Gastrocnemius

5

Zimmer Periarticular Distal Femoral Locking Plate

Plate Positioning

Hold the Metaphyseal Jig on the selected

plate (Fig. 4). Insert the 5.5mm Standard

Jig Sleeve into the CENTRAL hole of the

Jig/plate (Fig. 5.) and thread the 3.2mm

Standard Cannula into the plate hole

(Fig. 6). DO NOT tighten the set screw.

NOTE: Attaching the Metaphyseal Jig

to the plate using the set screw at this

time may cause or result in improper

placement of the plate on the bone.

NOTE: The Cannula Inserter may be used

to tighten the cannula if necessary

(Fig. 6A).

Fig. 5

Fig. 6A

Fig. 4

Central Distal Hole

Strut Screw Hole

Central Hole

Fig. 6

6Zimmer Periarticular Distal Femoral Locking Plate

Use this construct to place the initial

3.2mm Drill Tip Guide Wire in the

metaphysis (Fig. 7). Check plate

placement – visually and fluoroscopically

to ensure that the plate is positioned

correctly on the metaphysis of the bone.

If placement is appropriate, hold the Jig

on the plate and finger tighten or use the

3.5mm Screwdriver to tighten the

set screw (Fig. 8).

NOTE: The position of the plate on the

bone must be verified because of the

tendency to place the proximal end of

the plate too far anterior on the femoral

shaft. This placement can cause the

locking screws to be placed at a tangent

and can result in insufficient

holding strength.

Because the femoral shaft may not be

aligned with the distal fragment, the

plate head should be used to determine

the appropriate placement of the plate.

The plate head should conform to the

shape of the intact or reconstructed

condyles. This will determine the

alignment of the shaft.

Fig. 7

Fig. 8

NOTE: The Metaphyseal Jig and

Standard Cannulas MUST be used to

ensure that the screws align properly

with the threaded plate holes. Failure to

use the Metaphyseal Jig and Standard

Cannulas may result in cross-threading

or improper seating of the screws.

7

Zimmer Periarticular Distal Femoral Locking Plate

NOTE: It is easier to thread the cannulas

into the plate before placing the plate on

the bone.

Once the plate is properly positioned,

insert the Jig Sleeve into the most

CENTRAL DISTAL locking hole in the plate

head (Fig. 9). Thread the 3.2mm Guide

Wire Cannula through the sleeve and into

the plate hole (Fig. 10).

WARNING: Do not contour or bend

the plate at or near a threaded hole,

as doing so may deform the threaded

hole and cause incompatibility with the

Locking Screw.

Insert a 3.2mm Drill Tip Guide Wire

through the cannula until the tip engages

the medial cortical wall (Fig. 11). Be sure

that the wire remains parallel to both

axes. Use the fluoroscope to confirm the

wire position in both the A/P and lateral

planes. Adjust the wire location

if necessary.

Fig. 9

Fig. 11

Fig. 10

8Zimmer Periarticular Distal Femoral Locking Plate

Black Ring

Fig. 14

Fig. 15

Fig. 12

Thread a 3.2mm Standard Cannula into

one of the most proximal holes in the

plate shaft. Insert a 3.2mm Drill Tip

Guide Wire though the Cannula. Again,

check plate and bone position both

visually and fluoroscopically to ensure

proper fracture reduction and

plate placement.

Once the plate is placed appropriately

and properly aligned, slide the 5.5mm

Cannulated Screw Depth Gauge over the

guide wire in the CENTRAL plate hole

until it contacts the top of the cannula.

Read proper screw length from the

guide (Fig. 12).

Screw length measurement:

Metaphyseal Screws – the length

measurement for screws in the

metaphyseal region of the plate is

measured line-to-line – from the base

of the screw head to the tip of the screw.

Placement of the tip of the Guide Wire

will determine placement of the tip

of the screw.

Diaphyseal Screws – the length

measurement for screws in the

diaphyseal region of the plate is also

measured line-to-line – from the base

of the screw head to the tip of the screw.

In order to achieve full cortical purchase

with these screws, it is recommended

that 5mm be added to the screw length

measurement to allow for the self-

tapping flutes.

The Zimmer Periarticular Distal Femoral

Locking Plate is designed to be placed

slightly anteriorly on the distal femoral

condyles. In order to achieve an

accurate lateral x-ray or c-arm image,

it will be necessary to externally

rotate the affected limb 20-30˚. As in

distal targeting of intramedullary nails,

visualization of “round holes” from the

cannulas will ensure a true lateral image.

In other words, the x-ray beam must be

in line with the axis of the cannulas.

Fig. 13

NOTE: Slide the Screwdriver Stop Ring

onto the screwdriver shaft and place it

at the level of the black ring etched on

the driver shaft (Fig. 13). When the Blue

Stop Ring hits the top of the Jig Sleeve,

power insertion must stop. Screws must

be seated by hand. The Screwdriver Stop

Ring is intended to be a visual cue to

stop power insertion of locking screws.

Remove the Guide Wire Cannula and

use the 5.0mm Hex-head Cannulated

Screwdriver to insert a 70mm Long

5.5mm Conical Screw (Fig. 14) into

the CENTRAL plate hole to secure the

plate, or if preferred, use a linear bone

clamp or Plate Reduction Instrument

for provisional fixation. Observe

placement of the plate head and use the

fluoroscope to confirm that it is in the

desired location (Fig. 15).

9

Zimmer Periarticular Distal Femoral Locking Plate

Fig. 16

NOTE: Insertion of a screw longer than

70mm may cause interference with

other screws.

NOTE: A screwdriver shaft can be

used to loosely insert the screw under

power, but the final seating MUST be

accomplished by hand to avoid cross-

threading of the screws in the plate

holes or failure of the screw or driver.

NOTE: If lag screw fixation is necessary

for any fragment, the lag screw must be

inserted before inserting locking screws

into that fragment.

Strut Screw

Predrilling and tapping are typically not

necessary as the flutes of the screws

are self-drilling and self-tapping. If the

bone is dense, the lateral cortex can be

predrilled and tapped. If desired, use

the 4.7mm Cannulated Drill and 5.5mm

Cannulated Tap (Fig. 16) for a

5.5mm screw.

Screw Trajectory

10 Zimmer Periarticular Distal Femoral Locking Plate

Fig. 17

Fig. 19

Fig. 18

Condylar Fixation

For additional condylar fixation, slide the

5.5mm Cannulated Screw Depth Gauge

over the guide wire in the CENTRAL

DISTAL locking hole in the plate head

until it contacts the top of the cannula.

Read the proper screw length from the

guide, remove the 3.2mm Guide Wire

Cannula and use the 5.0mm Hex-head

Screwdriver to insert the appropriate

length 5.5mm Conical or Locking Screw

over the guide wire and into the

bone (Fig. 17).

Follow the same procedure for each

additional 5.5mm Cannulated Locking

Screw to be inserted into the

metaphyseal portion of the plate. Be sure

that all screws are securely tightened.

Next, insert the Jig Sleeve into the STRUT

screw hole (Fig. 18). Thread a 3.2mm

Guide Wire Cannula into the plate hole

and insert a 3.2mm Drill Tip Guide Wire

(Fig. 19). Again, carefully position the

tip of the guide wire; it will indicate the

position of the tip of the screw once it is

inserted into the plate.

Slide the 5.5mm Cannulated Screw

Depth Gauge over the guide wire in the

STRUT screw hole in the plate until it

contacts the top of the cannula. Read

the proper screw length from the guide.

Insert the appropriate length 5.5mm

Conical or Locking Screw over the guide

wire and into the bone.

11

Zimmer Periarticular Distal Femoral Locking Plate

Remove the 3.2mm Guide Wire Cannula

(Fig. 20) and use the 5.0mm Hex-

head Cannulated Driver to insert the

appropriate length 5.5mm Conical or

Locking Screw over the guide wire and

into the bone (Fig. 21). A screwdriver

shaft can be used to loosely insert the

screw under power, but final seating

MUST be accomplished by hand to

avoid cross-threading of the screws in

the plate holes or failures of the screw

or driver. Once adequate fixation is

achieved, if necessary or desired, remove

the Conical Screw from the CENTRAL

plate hole and replace it with a

Locking Screw.

NOTE: If the plate shifts during screw

insertion, all the pins and screws must

be removed and reinserted for the

screws to lock properly to the plate.

NOTE: If a plate screw impinges on

one of the intra-articular lag screws,

the lag screw must be removed and

repositioned.

Loosen the set screw and remove the

Metaphyseal Jig (Fig. 22).

Fig. 20

Fig. 22

Fig. 21

12 Zimmer Periarticular Distal Femoral Locking Plate

Fig. 25

Fig. 24

Shaft Fixation

Reduce the plate to the shaft. Confirm

rotation of the extremity by clinical

examination. Check the alignment of the

shaft with A/P and lateral fluoroscopic

views. The shaft portion of the plate can

be compressed to the bone by either

inserting a nonlocking screw through the

most proximal shaft compression slot or

by using the Plate Reduction Instrument

to hold the plate against the bone while

inserting a locking screw. If preferred,

a linear bone clamp can be used.

The Plate Reduction Instrument can be

used for:

• MINOR varus-valgus adjustment (<5°)

• Translational adjustments

• Stabilization of plate orientation with

respect to the bone during insertion

of the first screws

• Alignment of segmental fragments

When used without the MIS Jig

To use the Plate Reduction Instrument,

make a stab incision at the desired

location. Insert the 5.5mm/4.5mm

Percutaneous Sleeve and Trocar through

soft tissues ensuring that contact is

made with the surface of the plate

at the desired location. Remove the

Trocar. Insert the Plate Reduction Sleeve

through the Percutaneous Sleeve and

thread it into the plate. Thread the

Reduction Spin Knob all the way onto

the Shaft of the Reduction Instrument.

Next insert the Reduction Instrument

through the Reduction Sleeve and into

the bone fragment by hand or under

power. Rotating the Spin Knob clockwise

will cause it to contact the top of the

Reduction Sleeve and in turn, draw

the plate and bone together. Monitor

progress using C-Arm images. Stop when

desired reduction is achieved.

Once reduction is achieved, and it is

appropriate, the plate may be loaded in

tension using the Tension Device

[00-4817-005-00].

NOTE: In comminuted fractures, it may

not always be possible or desirable

to achieve anatomic reduction of the

fracture.

Insert standard 4.5mm cortical (Fig. 23)

screws through the compression slots in

the plate as desired. If both locking and

nonlocking screws will be used in the

shaft, the nonlocking screws must

be inserted first.

Predrill both cortices with the drill bit.

Measure for screw length using the

depth gauge. Then select and insert

the appropriate length 4.5mm Cortical

Screws using the Large Hex Screwdriver.

To insert 4.5mm Locking Screws, thread

the 3.7mm Standard Cannula (Black

Ring) into the desired locking hole

(Fig. 24). Use the 3.7mm Standard Drill

through the cannula to drill (Fig. 25).

Use the fluoroscope to confirm the drill

position in both the A/P and lateral

planes. Then remove the cannula.

Fig. 23

13

Zimmer Periarticular Distal Femoral Locking Plate

Fig. 26

Fig. 27

Fig. 28

Tapping is typically not necessary as the

flutes of the screws are self-tapping. If

the bone is dense, the lateral cortex can

be tapped. If desired, use the 4.5mm

Screw Tap (Fig. 26) to tap for the

4.5mm screw.

Insert the 4.5mm Locking Screw Depth

Gauge (Fig. 27) into the screw hole until

the tip of the gauge bottoms out in the

hole. Read the proper screw length from

the gauge at the point where the gauge

meets the surface of the plate.

Use the 5.0mm Hex-head Driver to insert

the 4.5mm Locking Screw (Fig. 28). A

screwdriver shaft can be used to loosely

insert the screw under power, but the

final seating MUST be accomplished

by hand to avoid cross-threading of the

screws in the plate holes or failure of

the screw or driver.

Follow the same procedure for each

additional 4.5mm Locking Screw. Be sure

that all screws are securely tightened.

Make a final check of the limb alignment

and fracture reduction. Then make sure

that all shaft locking screws are

securely tightened.

Securely tighten the distal locking screws

again by hand before closing.

14 Zimmer Periarticular Distal Femoral Locking Plate

Wound Closure

Use the appropriate method for surgical

closure of the incision.

Postoperative Treatment

Postoperative treatment with locking

plates does not differ from conventional

open reduction internal fixation (ORIF)

procedures.

Implant Removal

To remove locking screws, use the Large

Hexagonal screwdriver, 5.0mm Hex to

first unlock all screws from the plate and

then remove the screws completely. DO

NOT use the forward captive screwdrivers

for screw removal.

Please refer to the package insert

for product information, including

contraindications, warnings, and

precautionary information.

Surgical Pearls

Depending upon the screw position in

the plate, the screw head may not be

flush with the plate surface. If unsure

that the screw is seated, loosen screw

and retighten.

If the locking screw is difficult to insert

or stops advancing before locking to the

plate, remove the screw and pre-drill with

the appropriate drill bit. Then reinsert

the screw. (This condition may be caused

by very dense or thick cortical bone.)

Flexion/extension of the distal femoral

fragment may be achieved using the

Plate Reduction Instrument as a joystick.

Bumps or other devices may be used

under the distal femoral metaphyseal

area to help reduce the fracture in the

lateral view.

Varus/valgus can be checked using the

C-arm and a cord or long guide wire

from the femoral head to the center of

the ankle joint on antero-posterior view.

Use the C-Arm over the knee joint to

check that the cord or guide wire passes

10mm medially of the center of the knee

joint. Minor adjustment to varus/valgus

reduction can be achieved using the

Plate Reduction Instrument.

A distractor or large external fixator may

also be useful in gaining reduction.

Cleaning of the cannulated instruments

is necessary for proper function. The

cleaning stylet can clear debris in the

cannulations and prevent binding of the

instruments. The cleaning brush should

be used postoperatively.

15

Zimmer Periarticular Distal Femoral Locking Plate

Instruments and

Implants

Distal Lateral Femoral Plate Jig, Right

00-2360-090-01

5.5mm/4.5mm Standard Jig Sleeve

00-2360-090-04

3.7mm Standard Cannula

00-2360-020-37

3.2mm Standard Cannula

00-2360-021-32

3.2mm Standard Drill Tip Guide Wire

00-2360-033-32

4.5mm Locking Screw Standard

Depth Gauge 00-2360-040-45

5.5mm Cannulated Locking Screw

Depth Gauge 00-2360-041-55

4.5mm Locking Screw Tap

00-2360-053-45

5.0mm Hex Std Screwdriver

00-2360-065-50

5.0mm Hex Std Cannulated

Screwdriver 00-2360-066-50

4.7mm Std Cannulated Drill

00-2360-071-47

Cannula Inserter 00-2360-088-00

Guide Wire Inserter 00-2360-085-00

Modular Handle 00-2360-186-00

3.7mm Std Drill 00-2360-225-37

5.0mm Screwdriver Stop Ring

00-2360-065-05

Distal Lateral Femoral Plate Jig, Left

00-2360-090-02

16 Zimmer Periarticular Distal Femoral Locking Plate

Order Information

Distal Femoral Plate Standard Jig Set - Set #00-2360-000-11

Prod. No. Description

00-2360-090-01 Distal Lateral Femoral Plate Jig, Right

00-2360-090-02 Distal Lateral Femoral Plate Jig, Left

00-2358-010-05 Dist Lat Fem Plate/Jig Case

00-2360-093-03 Standard Jig Set Screw 2 ea.

Distal Lateral Femoral Locking Plate Set - Set #00-2357-000-13

Prod. No. Description

00-2357-102-06 Distal Lateral Femoral Locking Plate, 6 Hole,

159mm Lng, Left

00-2357-102-10 Distal Lateral Femoral Locking Plate, 10 Hole,

223mm Lng, Left

00-2357-102-14 Distal Lateral Femoral Locking Plate, 14 Hole,

286mm Lng, Left

00-2357-102-18 Distal Lateral Femoral Locking Plate, 18 Hole,

349mm Lng, Left

00-2357-102-20 Distal Lateral Femoral Locking Plate, 20 Hole,

368mm Lng, Left

00-2357-101-06 Distal Lateral Femoral Locking Plate, 6 Hole,

159mm Lng, Right

00-2357-101-10 Distal Lateral Femoral Locking Plate, 10 Hole,

223mm Lng, Right

00-2357-101-14 Distal Lateral Femoral Locking Plate, 14 Hole,

286mm Lng, Right

00-2357-101-18 Distal Lateral Femoral Locking Plate, 18 Hole,

349mm Lng, Right

00-2357-101-20 Distal Lateral Femoral Locking Plate, 20 Hole,

368mm Lng, Right

Also Available:

47-2357-101-22 Distal Lateral Femoral Locking Plate, 22 Hole, 400mm

Lng, Right, Sterile Only

47-2357-102-22 Distal Lateral Femoral Locking Plate, 22 Hole, 400mm

Lng, Left, Sterile Only

5.5mm/4.5mm Periarticular Locking Instrument Set - Set #00-2360-000-01

Prod. No. Description

00-1147-073-00 Cleaning Stylet

00-1147-078-00 Cleaning Brush

00-2358-035-05 5.5mm/4.5mm Periarticular Locking Screw/

Instrument Case

00-2360-012-01 5.5mm Plate Reduction Instrument

00-2360-012-02 5.5mm Plate Reduction Sleeve

00-2360-012-03 Plate Reduction Spin Knob

00-2360-020-37 3.7mm Standard Cannula

00-2360-021-32 3.2mm Standard Cannula

00-2360-033-32 3.2mm Standard Drill Tip Guide Wire

00-2360-040-45 4.5mm Locking Screw Standard Depth Gauge

00-2360-041-55 5.5mm Cannulated Locking Screw Depth Gauge

00-2360-053-45 4.5mm Locking Screw Tap

00-2360-054-55 5.5mm Cannulated Locking Screw Tap

00-2360-065-05 5.0mm Screwdriver Stop Ring

00-2360-065-50 5.0mm Hex Std Screwdriver

00-2360-066-50 5.0mm Hex Std Cannulated Screwdriver

00-2360-071-47 4.7mm Std Cannulated Drill

00-2360-085-00 Guide Wire Inserter

00-2360-186-00 Modular Handle

00-2360-088-00 Cannula Inserter

00-2360-090-04 5.5mm/4.5mm Standard Jig Sleeve

00-2360-225-37 3.7mm Std Drill

00-4812-045-00 Large Hex Screwdriver

5.5mm/4.5mm Locking Screw Set - Set #00-2359-000-01

Prod. No. Description

00-2359-030-55 5.5mm Cannulated Locking Screw 30mm Lng

00-2359-035-55 5.5mm Cannulated Locking Screw 35mm Lng

00-2359-040-55 5.5mm Cannulated Locking Screw 40mm Lng

00-2359-045-55 5.5mm Cannulated Locking Screw 45mm Lng

00-2359-050-55 5.5mm Cannulated Locking Screw 50mm Lng

00-2359-055-55 5.5mm Cannulated Locking Screw 55mm Lng

00-2359-060-55 5.5mm Cannulated Locking Screw 60mm Lng

00-2359-065-55 5.5mm Cannulated Locking Screw 65mm Lng

00-2359-070-55 5.5mm Cannulated Locking Screw 70mm Lng

00-2359-075-55 5.5mm Cannulated Locking Screw 75mm Lng

00-2359-080-55 5.5mm Cannulated Locking Screw 80mm Lng

00-2359-085-55 5.5mm Cannulated Locking Screw 85mm Lng

00-2359-090-55 5.5mm Cannulated Locking Screw 90mm Lng

00-2359-095-55 5.5mm Cannulated Locking Screw 95mm Lng

00-2359-100-55 5.5mm Cannulated Locking Screw 100mm Lng

00-2359-050-56 5.5mm Cannulated Conical Screw 50mm Lng

00-2359-055-56 5.5mm Cannulated Conical Screw 55mm Lng

00-2359-060-56 5.5mm Cannulated Conical Screw 60mm Lng

00-2359-065-56 5.5mm Cannulated Conical Screw 65mm Lng

00-2359-070-56 5.5mm Cannulated Conical Screw 70mm Lng

00-2359-075-56 5.5mm Cannulated Conical Screw 75mm Lng

00-2359-080-56 5.5mm Cannulated Conical Screw 80mm Lng

00-2359-085-56 5.5mm Cannulated Conical Screw 85mm Lng

00-2359-090-56 5.5mm Cannulated Conical Screw 90mm Lng

00-2359-012-45 4.5mm Locking Screw 12mm Lng

00-2359-014-45 4.5mm Locking Screw 14mm Lng

00-2359-016-45 4.5mm Locking Screw 16mm Lng

00-2359-018-45 4.5mm Locking Screw 18mm Lng

00-2359-020-45 4.5mm Locking Screw 20mm Lng

00-2359-022-45 4.5mm Locking Screw 22mm Lng

00-2359-024-45 4.5mm Locking Screw 24mm Lng

00-2359-026-45 4.5mm Locking Screw 26mm Lng

00-2359-028-45 4.5mm Locking Screw 28mm Lng

00-2359-030-45 4.5mm Locking Screw 30mm Lng

00-2359-032-45 4.5mm Locking Screw 32mm Lng

00-2359-034-45 4.5mm Locking Screw 34mm Lng

00-2359-036-45 4.5mm Locking Screw 36mm Lng

00-2359-038-45 4.5mm Locking Screw 38mm Lng

00-2359-040-45 4.5mm Locking Screw 40mm Lng

00-2359-042-45 4.5mm Locking Screw 42mm Lng

00-2359-044-45 4.5mm Locking Screw 44mm Lng

00-2359-046-45 4.5mm Locking Screw 46mm Lng

00-2359-048-45 4.5mm Locking Screw 48mm Lng

00-2359-050-45 4.5mm Locking Screw 50mm Lng

00-2359-055-45 4.5mm Locking Screw 55mm Lng

00-2359-060-45 4.5mm Locking Screw 60mm Lng

00-2359-065-45 4.5mm Locking Screw 65mm Lng

00-2359-070-45 4.5mm Locking Screw 70mm Lng

5.5mm/4.5mm Periarticular Locking Instrument Set - Set #00-2360-000-01

Prod. No. Description

Also Available:

47-2360-080-05 Torque Limiting Attachment

Contact your Zimmer representative or visit us at www.zimmer.com

97-2347-044-00 Rev. 2 5ML Printed in USA ©2005,2007 Zimmer, Inc.

+H124972347044001/$070427R2D07$