ZIMMER®

LOCKING

BLADE PLATE

SYSTEM

Surgical Technique for 95° Fracture,Adult & Small Blade Plates

1

SURGICAL TECHNIQUE FOR THE

ZIMMER LOCKINGBLADE PLATE SYSTEM

BY:

Paul J. Duwelius, M.D.Adjuvant Associate Professor Orthopaedics

Oregon Health Sciences UniversityClinical Attending

St. Vincent Hospital & Medical Ctr.

Portland, OR

James A. Goulet, M.D.Professor and Director

Section of Orthopaedic TraumaDepartment of Orthopaedic SurgeryThe University of Michigan Hospitals

David Templeman, M.D.Assistant Professor Orthopaedic Surgery

University of MinnesotaStaff,Hennepin County Medical Center

Robert winquist, M.D.Clinical Professor

University of Washington

Orthopaedic SurgeonSwedish Hospital and Medical Center

Seattle, WA

CONTENTS

INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

SURGICAL TECHNIQUE . . . . . . . . . . . . . . . . . . . . .4

Guide Wire Insertion . . . . . . . . . . . . . . . . . . . .4

Chisel Prep . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

Chisel Insertion . . . . . . . . . . . . . . . . . . . . . . . . .8

Chamfering Entry Point . . . . . . . . . . . . . . . . .10

Blade Insertion . . . . . . . . . . . . . . . . . . . . . . . . .11

Reduction and Fixation . . . . . . . . . . . . . . . . .13

#1 Screw Insertion . . . . . . . . . . . . . . . . . . . . .14

Shaft Screw Insertion . . . . . . . . . . . . . . . . . .15

Strut Screw Insertion . . . . . . . . . . . . . . . . . . .16

Final Fixation Options . . . . . . . . . . . . . . . . . .18

2

INTRODUCTIONThe Zimmer® Locking Blade Plate System

provides an instrument set developed to align

and insert a Locking Blade Plate. Instruments

in the system provide a reliable and reproducible

technique for the insertion of a blade plate,

providing surgeons with limited blade plate

experience the ability to easily implant the blade

plate. The Zimmer Locking Blade Plate System

also provides for various fixation options,

including the use of a strut screw and/or

divergent screw placement in the metaphysis.

The following technique details the use of the

instruments for the Zimmer Locking Blade Plate.

(Note: Use of an image intensifier is

recommended and described in the following tech-

nique. If an image intensifier is not

used, the anatomic descriptions provided

will help in alignment

using standard

fixation concepts/

technique.)

The blade plate

is manufactured

from Rex 734 Stainless

Steel. The implants are

available in a wide range of size plates as well

as blade lengths. The blade is designed with a

U-cross-section, which provides high strength

with minimum bone displacement. The blade

lengths range between 40-80mm. The plates can

accept a 4.5mm cortical strut screw for increase

structural stability. The #1 and #2 holes can

accept a 4.5mm cortical screw or a 6.5mm can-

cellous screw for all 60-80mm blade plates.

The compression holes will accept 4.5mm

cortical screws

INDICATIONS FOR USEThe Zimmer Locking Blade Plate 95 Degree

Fracture System is indicated for use in the

following femoral fractures:

* Proximal Femoral Fractures

* Distal Femoral Fractures

Preoperative Planning

Due to the design of the Locking Blade Plate,

the insertion of the blade plate requires a well

thought out preoperative plan. It is essential to

determine the exact placement of the chisel

guide for placement of the locking blade plate.

The blade must be correctly placed in both the

frontal and the sagittal planes, and the shaft

must line up with the axis of the femur. An A/P

and lateral pre-operative x-rays must be taken

to assess plate size. X-ray templates are available

to determine the correct implant size.

Distal Femur Patient Positioning After anesthesia is administered, place the

patient in the supine position on the radiolucent

operating table. If desired, place a sterile bump

under the ipsilateral thigh. Prep and drape the

affected leg using a sterile technique. Place

the calf and foot in a sterile stockinette. The

ipsilateral iliac crest should be included in the

operative field, should a bone graft be required.

It will be necessary to use image intensification

or other x-ray imaging. The image intensifier

should be sterile draped and is typically

positioned from the contralateral side of the

operating table.

3

Incision, and ExposureExpose the supracondylar fracture through an

anterolateral approach. Make a linear incision

starting approximately 10cm to 15 cm proximal

to the patella along a line that runs from the

anterior-superior iliac spine to the lateral border

of the patella. The exact length of the incision is

based on the location and extent of the fracture.

Continue the incision through the iliotibial band

and fascialata and expose the distal femur by

reflecting the vastus lateralis muscle anteriorly.

Reduction Intraarticular fractures should be reduced and

stabilized with interfragmentary screws. The

interfragmentary screws should be positioned to

avoid interference with blade plate instrumenta-

tion. Correct placement of the chisel and of the

blade plate will allow an “indirect” reduction of

the stabilized articular fragments to the femoral

shaft. The technique of chisel and blade plate

insertion can be found starting on page 8.

Proximal Femur Patient Positioning After anesthesia is administered, place the

patient in the supine or lateral decubitus position

on the radiolucent operating table. Some

surgeons may prefer to place patient on fracture

table to administer traction. The supine position

facilitates fracture reduction and rotational

alignment of the femur. The image intensifier

should be sterile-draped and positioned from

the contralateral side of the operating table.

Incision, and ExposureBegin the incision laterally 1cm distal to the tip

of the greater trochanter and extend it distally

to accommodate the length of the blade plate.

Expose the lateral surface of the femur.

Reduction Fractures are usually reduced with pointed

reduction forceps. Additional provisional

stabilization with Kirshchner wires may be

required for some fractures. Proper placement

of the chisel and the blade, as described below,

will allow an indirect reduction of the fracture

using standard techniques.

The Chisel Guide should lie parallel to the

femoral shaft if enough of the shaft is intact

to allow this determination to be made; often

a small anterior fragment of the anterior margin

of the lateral femoral condyle is present to allow

appropriate placement. If the amount of bone

present is insufficient to be used as a guide, the

lateral condylar axis can be used as a secondary

guide. Note: The axis of the lateral femoral

condyle is not perfectly perpendicular to the

femoral shaft; rather, this axis is relatively extended

(approximately 10 degrees). All Guide Pins placed

through the Chisel Guide should be oriented

perpendicular to the surface of the lateral

femoral condyle.

SURGICAL TECHNIQUEGuide Wire InsertionPlacement of the appropriate Chisel Guide (white

grooves for adult blade plates and black grooves

for small blade plates) and Guide Pins is the first

step. The Chisel Guide targets the placement of

the Guide Pins, which directs the insertion of the

Chisel and blade plate. The T-Handle attachment

assists in positioning the Chisel Guide.

Distal Femur: Place the Chisel Guide directly

on the lateral surface of the distal femur

approximately 1cm proximal from the articular

surface and 1cm posterior from the anterior

margin of the lateral femoral condyle (Fig. 1).

Fig. 1

4

Fig. 2

5

* Saleh KJ, Gross AF, Gafni A, et al. Radiographic classification for failed hip arthroplasty. 53rd Annual Meeting, Canadian Orthopaedic Association, June 1998, Ottawa, Ontario.

Insert a 3.2mm Guide Pin into the anterior

or posterior hole of the Chisel Guide continuing

into the far cortex (Fig. 2). A Guide Pin Extension

(Screw Inserter/Extractor) may be used to aid in

insertion of the second Guide Pin. Confirm the

Guide Pin position with an image intensifier.

The anterior Guide Pin should not penetrate the

articular surface of the patello-femoral joint. Note

that the distal femur increases in width from the

anterior to posterior. Penetration of the anterior

medial cortex is possible even when the Guide

Pin appears to be within the cortex as judged on

AP X-ray views.

Oblique views on the image intensifier may help

clarify this. Depth of the anterior Guide Pin may

be referenced to estimate the Chisel/blade length

in the distal femur. For most patients, 60mm

blade lengths are commonly used in the distal

femur; large patients may require a longer blade.

After reconfirming the plate orientation with the

shaft of the femur, insert a second Guide Pin into

the posterior or anterior hole of the Chisel Guide

(Fig. 3). The placement of two pins stabilizes the

Chisel Guide for blade preparation. One Guide

Pin can be inserted in the middle hole but Chisel

Guide orientation must be controlled during

bone preparation and chisel insertion.

Note: When longer plates are required, the bow

of the femur should be considered when using

the guide. X-ray templates are available to assist

with preoperative planning. Blade length can be

estimated from pre-op X-ray, X-ray templates, and

confirmed from the chisel depth. Plate length is

chosen to provide sufficient support to the fracture.

Proximal Femur: Place the appropriate Chisel

Guide (white grooves for adult blade plates and

black grooves for small blade plates) on the

femur approximately 1cm from proximal end of

the greater trochanter. The Guide Pins should not

penetrate the superior cortex of the femoral neck

in this position. Insert 3.2mm Guide Pins into the

anterior and posterior holes of the Chisel Guide

continuing into the far cortex. Confirm Guide

Pin and Chisel Guide position with the image

intensifier. When the Guide Pin/Chisel Guide

position is checked on the lateral view, both the

anterior and posterior cortices of the femoral

neck should be visible around the Guide Pins.

This confirms that the implant will lie within

the femoral neck and will not penetrate the

anterior or posterior cortex of the femoral neck.

The Chisel Guide should lie parallel to the

femoral shaft, if enough of the shaft is intact

to allow this determination to be made, to

reference the long axis of the femur.

Fig. 3

6

7

Chisel PrepInsert the attached Chisel Guide Sleeve into the

Chisel Guide slot. Drill each of the three sleeve

holes with the 4.5mm 95 Degree Adult Chisel

Drill (Fig. 4) or the 3.2mm 95 Degree Small

Chisel Drill. Epoxy lines on drills match the

corresponding Chisel and Chisel Guide. This

prepares the near cortex for the insertion of the

Chisel. Calibrations on the drill correspond to

blade lengths (Fig. 5). Remove the sleeve.

Note: The Chisel and Chisel Guide can be matched

by the colored stripes on each.

White grooves on the Chisel Guide and Chisel indi-

cate use for the Adult 95 Degree Fracture Blade

Plates. Black grooves indicate use for the Small 95

Degree Fracture Blade Plates. The Chisel can only

be inserted in one direction to match the orienta-

tion of the Blade Plate. If the Chisel can fit in both

ways, then the wrong Chisel has been inserted.

Fig. 4

Fig. 5

Double Lines For Every 50mm

Posterior Pin

Anterior Pin

Chisel Guide Sleeve

8

Chisel InsertionAttach the Slap Hammer onto the Chisel for

impacting the Chisel (Fig. 6). Insert the Chisel

into the Chisel Guide and impact to the appro-

priate blade plate depth (Fig. 7), for example

up to 60mm for a 60mm blade plate. (For soft

osteoporotic bone, it is recommended to stop

approximately 10mm from the desired blade

length.) The depth of the Chisel is determined

from the inscribed calibrations (Fig. 8). Ensure

Chisel Guide is seated flush on the bone when

reading the calibration.

Fig. 6

Fig. 8

Fig. 7

9

Note: When inserting the Chisel into dense

cancellous bone, it is recommended to partially

insert the Chisel then partially back-out the Chisel.

Repeat this motion until the Chisel

is inserted to the desired depth. This helps

prevent the Chisel from becoming

incarcerated (stuck).

Two sets of calibrations exist on the Chisel

for determining blade depths with and without

use of the Chisel Guide (Fig. 9). The second

set of calibrations should be used with the

Chisel Guide referencing the edge of the Chisel

opening in the guide. If the Chisel Guide is not

used, then the first set of calibrations, noted

as “w/o guide”, should be used referencing

the bone surface directly.

Fig. 9

Double Lines for 50mm

10

Fig. 10

Chamfering Entry PointRemove the Chisel from the Chisel Guide. Insert

the Chamfer Router into the angled chamfer slot

of the Chisel Guide (Fig. 10). Chamfering will

allow the plate to sit flush against the bone at

the blade entry point. Use the router to chamfer

the slot from end to end. The router should be

inserted from both sides of the guide (Fig. 11)

and moved back and forth to make sure that the

chamfer extends along the whole width of the

blade. Remove the Chisel Guide from the bone.

Fig. 11

11

Blade InsertionAttach the Insertion Guide to the Blade Plate by

placing the alignment peg into the top through

hole of the plate and the Thumb Screw into the

#2 Screw Hole of the plate (Fig. 12). The Thumb

Screw should be finger tightened to avoid

cross-threading (Fig. 13). After finger tightening,

the Thumb Screw can be gently tightened with

a 3.5mm hex screwdriver, but care should be

taken not to strip the thread in the plate.

Fig. 12

Fig. 13

12

Fig. 14

Place the Insertion Guide over the Guide Pins

while inserting the blade into the hole made

by the Chisel (Fig. 14). Use the Impactor and a

surgical mallet to insert the blade into the bone

(Fig. 15). The Impactor fits around the Insertion

Guide in one direction only to contact the plate

surface (Fig. 16). The Impactor can be used to

direct the alignment of the Blade Plate during

insertion. Slowly impact the blade into the

bone. If the Blade Plate does not advance,

confirm alignment with fluoroscopy.

Fig. 15

Fig. 16

13

Reduction and FixationBlade Plate fixation is a versatile technique.

In certain instances the Blade Plate can be used

as a reduction tool, alternatively Blade Plates

can be inserted after reduction of the fracture.

Once the Blade Plate is inserted, screws are

inserted into the #1 screw hole of the plate to

secure the plate to the metaphysis. Before the

Strut Screw is inserted, a 4.5mm cortical screw

should be inserted into the compression slot

closest to the Strut Screw hole to secure the

plate to the diaphysis (Fig. 17). When a Strut

Screw is used, the two screw holes closest to the

blade (#1 & #2 screw holes) must be targeted

with the Insertion Guide and Second Screw

Guide, respectively.

Screws inserted in this area without the proper

orientation may block the subsequent insertion

of the Strut Screw (Fig. 17). Either 4.5mm corti-

cal or 6.5mm cancellous screws can be inserted

into the #1 and #2 holes of 60-80mm blade

plates. In 40-50mm Blade Plates, 4.5mm cortical

screws are recommended in the #1 and #2 holes

to avoid interference with the Strut Screw.

Without a Strut Screw, the Insertion Guide and

Second Screw Guide can still be used to orient

the #1 and #2 screws in anterior or posterior

directions, if desired (surgeon preference could

be either). Otherwise, a free hand approach may

be used without the Insertion Guide using stan-

dard screw insertion techniques and equipment.

Fig. 17

#3

Compression Slots

#1

#2

Dual Hole

Insertion Guide Hole

Screw insertion is based

on strut angle, therefore it

is based on the blade length.

• 60-80mm blades (blue)

can use either 4.5mm or

6.5mm screws in #1 & #2 holes

• 40 to 50mm blades (green)

can only use 4.5mm screws in

in #1 & #2 holes

Fig. 19

14

#1 Screw InsertionThread the metal Drill and Tap Bushings into

the Insertion Guide and drill the #1 hole with

the 3.2mm Guide Calibrated Drill Bit (Fig. 18).

Drilling is recommended from anterior to

posterior (surgeon preference could be either).

The length of screw is determined from

the drill calibrations when used in the Drill

Bushing (Fig. 19). Note the measurement on

the Calibrated Drill to determine the appropriate

screw length. The inner sleeve is removed to

allow passage of the 4.5mm Guide Calibrated

Tap, if a non-self tapping screw is used.

Otherwise remove both sleeves and insert a

4.5mm self-tapping cortical screw (Fig. 20).

If a 6.5mm screw is desired, drill with the 3.2mm

Guide Calibrated Drill using the metal Drill and

Tap Bushing. To tap, remove the Drill Tap Sleeve

and use a free hand technique to tap using the

3.2mm drill hole path and Insertion Guide

as reference.

Fig. 20

Fig. 18

15

Fig. 21

Fig. 22

Shaft Screw Insertion4.5mm Cortical Screws are inserted into the

compression screw holes (#5 through 18 holes)

lying over the intact shaft of the femur (Fig. 21).

Securing the Blade Plate to the shaft of the

bone will help reduce the fracture and is recom-

mended before Strut Screw insertion (Fig. 22).

A 4.5mm compression Drill Guide is used to

drill for the 4.5mm Cortical Screws in neutral

or compression, as needed. A Large Fragment

Depth Gauge can be used to determine screw

length.

Note: An articulated compression device can be

inserted into the slot in the end of the Locking

Blade Plate if further fracture compression is

desired. Care should be taken to not change the

angle of the blade with too much tension.

Fig. 23

16

Strut Screw InsertionRemove all Guide Pins. Confirm the Insertion

Guide is firmly against the Blade Plate. Retighten

the Thumb Screw if needed. Attach the Strut

Screw Guide (Fig. 23) by threading the Thumb

Screw into the Insertion Guide, which

is already in place. The Strut Screw Guide is

matched to blade length and color-coded

accordingly. Insert the matching color of the

metal Drill Sleeve into the colored Strut Screw

Guide. Note: The Guide is to be tightened prior to

sleeve insertion.

Push the metal Drill Sleeve down to the bone.

This will prevent the drill from skiving.

For 60-80mm blades, the Blue Guide and Drill

Sleeve is used to prepare for a 4.5mm x 95mm

cortical Strut Screw. For 40- 50mm blades, the

Green Guide and Drill Sleeve is used to prepare

for a 4.5mm x 85mm cortical Strut Screw.

17

Drill with the 3.2mm Guide Calibrated Drill Bit

(Fig. 24). Drilling slightly past the required screw

length is recommended. To assist in targeting

the drill with an image intensifier, each blade

has locator ‘notches’ on the top edge of the blade

(Fig. 25). The notches are located over the middle

of the blade screw hole and a landing area

adjacent to the hole in the blade, respectively.

The drill will pass through or deflect into the

blade screw hole when it passes through the

area between these notches. A drill that is

diverging past both notches may miss the hole.

Correct insertion may be confirmed with AP

and lateral image intensifier views. Remove

the Drill Sleeve. Insert the gray Tap Sleeve to

tap with a 4.5mm tap, if necessary (Fig. 26).

Fig. 25

Fig. 24

Fig. 26

Tap Sleeve

Blade Notches

Blade StrutScrew Hole

18

The #4 hole in the plate provides the option of

“Blocking” the Strut Screw in place if the near

cortex is compromised or the Strut Screw strips

in the blade. To BLOCK the Strut Screw, use a

Compression Drill Guide placed against the

hole edge nearest to the Strut Screw, with the

arrow pointing away from the Strut Screw.

This positions the #4 screw head in contact

with the head of the Strut Screw and prevent

the Strut Screw from backing out. If the

BLOCKED position is NOT required, a

Neutral Drill Guide is placed at the hole edge

farthest from the Strut Screw, placing the #4

screw away from the Strut Screw, and avoiding

contact between the screw heads.

Fixation is now complete. Radiographs

should be obtained intraoperatively to

confirm implant position.

Remove all sleeves from the guide. Insert the

Strut Screw through the guide with a standard

hex screwdriver (Fig. 27). The image intensifier

can help target the screw into the hole. DO NOT

overtighten the Strut Screw, as the screw hole in

the blade can strip out. Remove the Strut Screw

guide by loosening the Thumb Screw.

Final Fixation OptionsAfter the Strut Screw is inserted the #2 and #4

screws are then inserted. The Second Screw Drill

Guide is used to insert the #2 screw (Fig. 28),

orienting the screw to pass by the Strut Screw.

Note: This guide does not secure to the plate. The

Second Screw Guide is matched to blade length

and color-coded accordingly. Drill with the

3.2mm Guide Calibrated Drill Bit, using the

Drill Guide and Drill and Tap Bushings. Note

the measurement on the calibrated drill to

determine the appropriate screw length. The

Drill Bushing is then removed to allow passage

of a 4.5mm tap through the tap bushing.

Tapping is optional if self-tapping screws are

used. After the Tap Bushing is removed, a

4.5mm Cortical Screw is inserted through

the guide.

Fig. 28

Fig. 29: Both views are recommended forconfirmation of screw placement.

Fig. 27

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Please refer to package insert for complete product information, including contraindications, warnings, precautions, and adverse effects.

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

LOCKING BLADE PLATE 95° ADULT STANDARDAssembly

Part Product Name Qty4745 95° Fracture Adult Standard Implant Set w/o case

(Includes each of the items listed below)4745-60 95° Adult Standard Case 14745-06-50 95° Fracture Blade-Plate, Adult 6 Hole 50mm Blade 14745-06-60 95° Fracture Blade-Plate, Adult 6 Hole 60mm Blade 14745-06-70 95° Fracture Blade-Plate, Adult 6 Hole 70mm Blade 14745-06-80 95° Fracture Blade-Plate, Adult 6 Hole 80mm Blade 14745-07-50 95° Fracture Blade-Plate, Adult 7 Hole 50mm Blade 14745-07-60 95° Fracture Blade-Plate, Adult 7 Hole 60mm Blade 14745-07-70 95° Fracture Blade-Plate, Adult 7 Hole 70mm Blade 14745-07-80 95° Fracture Blade-Plate, Adult 7 Hole 80mm Blade 14745-09-50 95° Fracture Blade-Plate, Adult 9 Hole 50mm Blade 14745-09-60 95° Fracture Blade-Plate, Adult 9 Hole 60mm Blade 14745-09-70 95° Fracture Blade-Plate, Adult 9 Hole 70mm Blade 14745-09-80 95° Fracture Blade-Plate, Adult 9 Hole 80mm Blade 14745-11-50 95° Fracture Blade-Plate, Adult 11 Hole 50mm Blade 14745-11-60 95° Fracture Blade-Plate, Adult 11 Hole 60mm Blade 14745-11-70 95° Fracture Blade-Plate, Adult 11 Hole 70mm Blade 14745-11-80 95° Fracture Blade-Plate, Adult 11 Hole 80mm Blade 14845-85 4.5mm Cortical Screw, Non Self-Tapping, Large Hex,

85mm Length 34845-95 4.5mm Cortical Screw, Non Self-Tapping, Large Hex,

95mm Length 3

LOCKING BLADE PLATE 95° ADULT EXTENDEDAssembly

Part Product Name Qty4745-00-01 95° Fracture Adult Extended Implant Set w/o Case

(Includes each of the items listed below)4745-65 95° Adult Extended Case 14745-13-50 95° Fracture Blade-Plate, Adult 13 Hole 50mm Blade 14745-13-60 95° Fracture Blade-Plate, Adult 13 Hole 60mm Blade 14745-13-70 95° Fracture Blade-Plate, Adult 13 Hole 70mm Blade 14745-13-80 95° Fracture Blade-Plate, Adult 13 Hole 80mm Blade 14745-15-50 95° Fracture Blade-Plate, Adult 15 Hole 50mm Blade 14745-15-60 95° Fracture Blade-Plate, Adult 15 Hole 60mm Blade 14745-15-70 95° Fracture Blade-Plate, Adult 15 Hole 70mm Blade 14745-15-80 95° Fracture Blade-Plate, Adult 15 Hole 80mm Blade 14745-18-50 95° Fracture Blade-Plate, Adult 18 Hole 50mm Blade 14745-18-60 95° Fracture Blade-Plate, Adult 18 Hole 60mm Blade 14745-18-70 95° Fracture Blade-Plate, Adult 18 Hole 70mm Blade 14745-18-80 95° Fracture Blade-Plate, Adult 18 Hole 80mm Blade 14845-85 4.5mm Cortical Screw, Non Self-Tapping, Large Hex,

85mm Length 34845-95 4.5mm Cortical Screw, Non Self-Tapping, Large Hex,

95mm Length 3

LOCKING BLADE PLATE 95° SMALLAssembly

Part Product Name Qty4745-00-02 95° Fracture Small Implant Set w/o Case

(Includes each of the items listed below)4745--70 95° Small Case 14745-107-40 95° Fracture Blade-Plate, Small 7 Hole 40mm Blade 14745-107-50 95° Fracture Blade-Plate, Small 7 Hole 50mm Blade 14745-107-60 95° Fracture Blade-Plate, Small 7 Hole 60mm Blade 14745-109-40 95° Fracture Blade-Plate, Small 9 Hole 40mm Blade 14745-109-50 95° Fracture Blade-Plate, Small 9 Hole 50mm Blade 14745-109-60 95° Fracture Blade-Plate, Small 9 Hole 60mm Blade 14745-111-40 95° Fracture Blade-Plate, Small 11 Hole 40mm Blade 14745-111-50 95° Fracture Blade-Plate, Small 11 Hole 50mm Blade 14745-111-60 95° Fracture Blade-Plate, Small 11 Hole 60mm Blade 14845-85 4.5mm Cortical Screw, Non Self-Tapping, Large Hex,

85mm Length 34845-95 4.5mm Cortical Screw, Non Self-Tapping, Large Hex,

95mm Length 3

LOCKING BLADE PLATE 95° INSTRUMENT SETAssembly

Part Product Name Qty4745-00-10 95° Fracture Instrument Set w/Case and Lid

(Includes each of the items listed below)4745-75 95° Instrument Case with Lid 14745-61 Locking Blade Plate Lid1193-08 T-Handle 14705-01 Chamfer Router 24705-04 Insertion Guide, 95° 14705-04-02 Guide Thumb Screw 14705-05 Impactor Handle 14705-06 Slap Hammer 14705-07 Strut Guide, 60-80mm Blade 14705-07-02 Strut Guide Screw, 95° 14705-07-10 Strut Guide, 95° 40-50mm Blade 14705-08 3.2 Drill Sleeve-Strut, 95° 60-80mm Blade 14705-08-10 3.2 Drill Sleeve-Strut, 95° 40-50mm Blade 14705-09 4.5 Tap Sleeve-Strut, 95° 14705-10 Drill Guide, Second Screw, 95° 60-80mm Blade 14705-10-10 Drill Guide, Second Screw, 95° 40-50mm Blade 14705-11 3.2mm Drill Bushing, Insertion Guide, 95° 14705-12 4.5mm Tap Bushing, Insertion Guide, 95° 14705-13 Wedge Extractor 14705-20-32 Drill Bit, Q-C 3.2mm x 215mm, Guide Calibrated 34705-21-45 Tap, Q-C 4.5mm x 215mm Guide Calibrated 24901-32-16 K-Wires, Trocar Point, 3.2mm x 165mm 15791-49 Guide Pin Extension (Screw Inserter/Extractor) 1

LOCKING BLADE PLATE 95° ADULT SPECIAL INSTRUMENT SETAssembly

Part Product Name Qty4745-00-11 95° Fracture Adult Special Instrument Set w/o Case

(Includes each of the items listed below)4705-02 Chisel Guide, 95°, Adult 14705-03 Chisel, 95°, Adult 14705-20-45 Drill Bit, Q-C 4.5mm x 215mm, Adult Chisel Guide Calibrated 3

LOCKING BLADE PLATE 95° SMALL SPECIAL INSTRUMENT SETAssembly

Part Product Name Qty4745-00-12 95° Fracture Small Special Instrument Set w/o Case

(Includes each of the items listed below)4705-02-10 Chisel Guide, 95°, Small 14705-03-10 Chisel, 95°, Small 14705-22-32 Drill Bit, Q-C 3.2mm x 195mm, Small Chisel Guide Calibrated 3