LOCKING PLATES KÝLÝTLÝ PLAKLAR VE VÝDA SÝSTEMLERÝ SURGICAL TECHNIQUE CERRAHÝ TEKNÝK IMPLANTS & INSTRUMENTS ÝMPLANTLAR VE EL ALETLERÝ

CONTENTS ÝÇÝNDEKÝLER LOCKING PLATES Introduction 2 Giriþ Locking Plates 3 Kilitli Plaklar Screws Vidalar Locking Narrow and Broad Plate Surgical Technique Kilitli Dar ve Geniþ Plak Ameliyat Tekniði Round insertion of a cortical screw Kortikal vidanýn düz yerleþtirilmesi Dynamic compression, eccentric insertion of a cortical screw Kortikal vidanýn DCP olarak yerleþtirilmesi ve dinamik kompresyonu Insertion of 4.0 mm and.0 mm locking screws 4.0 mm ve.00 mm kilitli vidalarýn yerleþtirilmesi Alternative method of locking screw insertion 14 Kilitli vidalarýn yerleþtirilmesi için alternatif yöntem Instruments & Trays 1 El Aletleri & Tavalar IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

Introduction Giriþ Locking Plates allows the application of standard plating techniques, of locked internal fixator techniques as well as specific combinations of both. The main feature of Locking Plate is the combination hole consisting of a dynamic compression unit and a locking hole unit. Kilitli Plaklar ile standart plak uygulamalarý, kilitli dahili fiksatör uygulamalarý ya da iki uygulamanýn kombinasyonu yapýlabilir. Kilitli plaðýn ana özelliði dinamik çektirme özelliði olan deliði ve kilitleme deliði kýsýmýdýr. Indications Endikasyonlar The locking plate is primarly indicated for intertrochanteric fractures. However, it can be also find applications in selected sub-trochanteric fractures, mid cervical and low sub-capital fractures of the femoral neck. They are used in conjunction with large diameter sliding lag screws. The lag screws have a coarse buttress thread to provide secure fixation in the femoral head. The shaft of the lag screw is machined on two opposing sides to correspond to the internal flats of the plate barrel preventing rotation of the lag. If needed, added compression can be applied tothe fractures site by means of the compression screws. Kiltli plak özellikle intertrokanterik kýrýklarda kullanýlýrlar. Bununla beraber bu plak femoral boynun sub-trokanterik kýrýklarý, mid servikal ve low sub-kapital kýrýklarda da uygulama alaný bulurlar. Bu plaklarda geniþ çaplý DHS çivileri kullanýlýrlar. Büyük diþ yapýsýna sahip bu çiviler femoral kafada iyi bir tutunma saðlar. Çivi þaftlarýnýn karþýlýklý iki tarafý plak tüpünün içine uyum saðlayarak dönmeyi ortadan engellemek için düzleþtirilmiþlerdir. Gerekli olduðunda çektirme civatasý kýrýk bölgeye ilave çektirme yapýlabilir. Fixation with locking head screws is especially suitable in osteoporotic bones. Kilitli vidalarla fiksasyon özellikle osteoporotik kemikler için uygundur. Features & Benefits Özellikleri ve Faydalarý -Locking Plates can be used as a standard plate and screw system, for compression and absolute stability of the fracture. -Kilitli plaklar çektirme iþlemi ve kemikte tam bir sabitleme yapmak için standart plak vida sistemi olarak kullanýlabilirler. -Locking Plates can also be used as a locked internal fixator. This solves problems of postoperative loss of reduction by offering a better anchorage, in particular in osteoporotic bone. It can also, suppress problems of intraoperative loss of reduction as accurate plate contouring is not required. Finally, the blood supply is preserved as there is no compression of the plate onto the bone. -Kilitli plaklar kilitli dahili fiksatör olarak da kullanýlabilirler. Bu durum, özellikle osteoporotik kemiklerde daha iyi bir tutunma saðlayarak, operasyon sonrasý redüksiyon kayýplarýný ortadan kaldýrýr. Bu plaklar ayný zamanda operasyon sýrasýnda tam doðru plak konturlamayla ortadan kaldýrýlabilecek olan redüksiyon kayýplarý problemini de çözer. Son olarak plaktan kemiðe doðru bir kompresyon olmadýðý için kan akýþýnýn devamlýlýðý saðlanýr. IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ 2

LOCKING PLATES KÝLÝTLÝ PLAKLAR Metaphyseal Locking Narrow Plate 4.mm DCP Holes Length 300 300 30 30 3014 300 300 30 30 3014 14 1 20 241 2 313 Metaphyseal Locking Narrow Plate 3.mm DCP Holes Length 3304 330 330 330 332004 33200 33200 33200 4 0 3 3 IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

Locking Narrow Plate 4.mm DCP Holes Length 300 300 300 300 30 30 30 3013 3014 300 300 300 300 30 30 30 3013 3014 13 14 144 10 1 21 234 22 Locking Narrow Plate 3.mm DCP Holes Length 33000 33000 33000 33000 33000 3300 33000 33000 33000 33000 33000 3300 1 4 0 3 IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ 4

Locking Broad Plate 4.mm DCP 32000 32000 3200 3200 3200 320013 320014 32001 32001 32000 32000 3200 3200 3200 320013 320014 32001 32001 Holes Length 13 14 1 1 14 14 200 21 23 24 22 20 Locking Small T Plate, oblique 3.mm Style 3003 300 3003 300 Holes Length 4 2 2 3203 320 322003 32200 2 2 IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

Locking Proximal Humeral Plate 3.mm DCP Holes Length 30003 3000 3000 3000 30003 3000 3000 3000 3 0 4 13 Locking Distal FemurPlate 4.mm Style 300 300 30 3013 320 320 32 3213 300 300 30 3013 32200 32200 3220 322013 Holes 13 13 Length 1 23 2 31 1 23 2 31 IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

Distal Tibia Locking Compression Plate 3. mm Style Holes Length 31300 31300 31300 31300 3130 3130 3130 31300 31300 31300 31300 3130 3130 3130 140 13 1 1 20 21 31320 31320 31320 31320 3132 3132 3132 3132200 3132200 3132200 3132200 313220 313220 313220 140 13 1 1 20 21 Proximal Lateral Tibia Locking Compression Plate 4. mm Style Holes Length 31330 31330 31330 31330 31330 3133 3133 3133 313313 3133200 3133200 3133200 3133200 3133200 313320 313320 313320 31332013 13 14 1 1 20 22 24 2 2 303 31340 31340 31340 31340 31340 3134 3134 3134 313413 3134200 3134200 3134200 3134200 3134200 313420 313420 313420 31342013 13 14 1 1 20 22 24 2 2 303 IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

Distal Tibia Lateral Locking Plate 4. mm Style Holes Length 3130 3130 3130 3130 3130 313 313 313200 313200 313200 313200 313200 31320 31320 3 141 1 1 1 213 231 3130 3130 3130 3130 3130 313 313 313200 313200 313200 313200 313200 31320 31320 3 141 1 1 1 213 231 Locking T Plate 4. mm Holes Length 31003 31004 3100 3100 3100 3100 3100 310 310 310 31003 31004 3100 3100 3100 3100 3100 310 310 310 3 4 0 2 134 10 1 1 214 IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

Locking L Plate - Curved 4. mm Style Holes Length 3103 3104 310 310 310 310 310 31 31 31 3003 3004 300 300 300 300 300 30 30 30 3 4 31 4 3 1 143 1 1 3103 3104 310 310 310 310 310 31 31 31 3003 3004 300 300 300 300 300 30 30 30 3 4 31 4 3 1 143 1 1 IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

SCREWS VÝDALAR Large Cortical Screw with Self Tapping Ti - Ø4. Locking Butress Screw Ti - Ø3. Locking Spacer Ø3. 02303 02304 0230 0230 0230 0230 0230 023 023 023 02313 02314 0231 0231 0231 0231 0231 02320 02321 02322 02323 02324 0232 0232 02414 0241 0241 02420 02422 02424 0242 0242 02430 02432 02434 0243 0243 02440 0244 0240 024 0240 0243 Length 0232003 0232004 023200 023200 023200 023200 023200 02320 02320 02320 0232013 0232014 023201 023201 023201 023201 023201 0232020 0232021 0232022 0232023 0232024 023202 023202 0242014 024201 024201 0242020 0242022 0242024 024202 024202 0242030 0242032 0242034 024203 024203 0242040 024204 024200 02420 024200 024223 14 1 1 20 22 24 2 2 30 32 34 3 3 40 42 44 4 4 0 2 4 0 14 1 1 20 22 24 2 2 30 32 34 3 3 40 4 0 0 IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ 023 023 02314 0231 0231 02320 02322 02324 0232 0232 02330 02332 02334 0233 0233 02340 0234 0230 021 021 0220 0222 0224 022 022 0230 0232 0234 023 023 0240 0242 0244 024 024 020 02 020 02 020 02 020 02 020 02 0200 024 Length 02320 02320 0232014 023201 023201 0232020 0232022 0232024 023202 023202 0232030 0232032 0232034 023203 023203 0232040 023204 023200 02201 02201 022020 022022 022024 02202 02202 022030 022032 022034 02203 02203 022040 022042 022044 02204 02204 02200 0220 02200 0220 02200 0220 02200 0220 02200 0220 0220 02224 14 1 1 20 22 24 2 2 30 32 34 3 3 40 4 0 1 1 20 22 24 2 2 30 32 34 3 3 40 42 44 4 4 0 0 0 0 0 0 Small Cortical Screw with Self Tapping Pitch 1.2 Ti - Ø3. Locking Butress Screw Ti - Ø4. Locking Spacer Ø4.

LOCKING NARROW AND BROAD PLATE SURGICAL TECHNIQUE KÝLÝTLÝ GENÝÞ VE DAR PLAK AMELÝYAT TEKNÝÐÝ Insertion of a cortical or cancellous bone screw Korteks veya spongioz kemik vidalarýnýn yerleþtirilmesi LOCKING PLATES Use the 4. mm neutral and drill guide attachment for DCP or round insertion of cortical screws. Korteks vidalarýnýn DCP ya da düz giriþinde 4. mm düz drill gayd ucunu kullanýnýz. Determine whether cortical screws, cancellous bone screws or locking screws will be used for fixation. A combination of all may be used. Fiksasyon için kortikal vidalarý mý, spongioz kemik vidalarý mý yoksa kiltli vidalarýn mý kullanýlacaðýna karar verilir. Bunlarýn bir kombinasyonu da kullanýlabilir. Additional info/ek bilgi If a combination of cortical, cancellous and locking screws is used, a cortical screw should be used first to pull the plate to the bone. Eðer korteks, spongioz ve kilitli vidalarýn bir kombinasyonu kulanýlacaksa, plaðý kemiðe çektirmek için ilk olarak klasik vidalarý kuýllanýnýz. Attention/Dikkat If a locking screw is used first, care should be taken to ensure that the plate is held securely to the bone to avoid spinning of the plate about the bone as the locking screw is tightened to the plate. Eðer ilk olarak kilitli vida kullanýlacaksa, vidalar sýkýlýrken plaðý sýký bir þekilde tuttuðunuza emin olunuz ve plaðýn kemik üzerinde dönmemesine özen gösteriniz. Round insertion of a cortical screw Kortikal vidanýn düz yerleþtirilmesi When pressing the neutral and drill guide attachment into the DCP portion of the combi hole, it will center itself and allow neutral predrilling. Düz drill gayd ucu ile combi deliðin DCP kýsmýna basarken kendi kendini merkezleyecektir ve önceden yapýlan düz delmeye izin verecektir. IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

Dynamic compression, eccentric insertion of a cortical screw Kortikal vidanýn DCP olarak yerleþtirilmesi ve dinamik kompresyonu To drill a hole for dynamic compression, place the load drill guide attachment at the edge of the DCU portion of the Combi hole, without applying pressure. Tightening of the cortical screws will result in dynamic compression correspond ing to that of locking plates. Dinamik kompresyon için delik delmek istenirse, DCP drill gayd ucunu combi deliðin DCP kýsmýnýn kenarýna yerleþtirin. Kortex vida sýkýldýktan sonra kilitli plakta dinamik bir kompresyon oluþturur. Insertion of 4.0 mm and.0 mm locking screws 4.0 mm ve.00 mm kilitli vidalarýn yerleþtirilmesi Screw the appropriate drill sleeve for 4.0 mm screws and for.0 mm screws into an locking plate hole until fully seated. The use of a drill sleeve is critical to ensure proper mating of the locking screw in the threaded portion of the Combi hole. 4.0 mm ve.0 mm vidalar için uygun drill sleeve i kilitli plak deliðine yerleþtirerek, sabitlenene kadar vidalayýnýz. Drill seleeve in kullanýlmasý kilitli vidanýn kombi deliðin yivli kýsmýna tutunduðundan emin olmak için önemlidir. IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

Attention/Dikkat LOCKING PLATES Do not try to bend the plate using the threaded drill sleeve because damage may occur to the threads. Yivli drill sleeve kullanrak plaðý eðmeyi denemeyiniz, bu durum diþli yapýyý bozabilir. Use the appropriate drill (3.2 mm for 4.0 mm screws and 4.3 mm for.0 mm screws) to drill to the desired depth. Remove the drill sleeve. Ýstenilen derinliðe kadar delmek için uygun drill i (4.0 mm vidalar için 3.2mm,.0 mm vidalar için 4.3 mm) kullanýnýz. Drill sleeve i çýkarýnýz. Use the screw depth gauge to determine screw length. Vida uzunluðunu belirlemek için vida derinlik ölçeri kullanmýnýz. 13 IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

Insert the locking screw under power using the torque limiting screwdriver and hexagonal head screwdriver shaft. Tork limit tornavidasý ve altýgen vida anahtar þaftýnýn oluþturduðu güç altýnda kilitli vidayý yerleþtiriniz. The torque limiting screwdriver controls the tightening torque to 4 Nm: Ensures that enough torque is used to minimize the risk of the locking screw backing out of the plate; Avoids locking the screw to the plate at full speed and minimizes the risk of cold-welding the screw to the plate; Do Not fully insert the locking screws by power without using the torque limiting screwdriver. Tork limit tornavidasý, sýkma torkunun 4 Nm olmasýný saðlar. VÝdanýn plaktan geri çýkmamasý için gerekli torkla sýktýðýnýza emin olunuz. Vidayý plaða son hýzla sýkýþtýrmamaya dikkat ederek soðuk kaynama riskini minimize ediniz. Kilitli vidalarý asla tork limit anahtarý olmadan tam olarak yerleþtirmeyiniz. Additional info/ek bilgi The screw is securely locked to the plate when a click is heard. Klik sesi duyulduðunda vida plaða güvenli bir þekilde kilitlenmiþ demektir. Attention/Dikkat Locking screws may be partially inserted using power equipment alone. However, never use power equipment to seat the locking screws into the plate without a torque limiting screwdriver. Kilitli vidalar motorlu ekipman kullanýlarak belli bir derinliðe kadar yerleþtirilebilirler. Bununla beraber hiç bir zaman motorlu ekipmanýný tork tornavidasý olmadan kilitli vidalarý yerleþtirmek için kullanmayýnýz. Alternative method of locking screw insertion Kilitli vidalarýn yerleþtirilmesi için alternatif yöntem Use the hexagonal head screwdriver shaft to manually insert the appropriate locking screw. Carefully tighten the locking screw, as excessive force is not necessary to produce effective screw-to-plate locking. Altýgen vida anahtar þaftýný kullanarak uygun kilitli vidalarý elle yerleþtiriniz. Kilitli vidalarý dikkatlice sýkýnýz, fazla güç her zaman etkin bir kilitleme yapmak anlamýna gelmez. IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ 14

Instruments & Trays/El Aletleri & Tavalar 040000 0400 040001 Drill - Tap Handle Drill ve Teb Anahtarý Drill and Tap Handle (for AO Shaft) Drill ve Teb Anahtarý (AO þaft için) Hexagonal Head Screw Driver Ø2. Tornavida Ø2. 040003 Hexagonal Head Screw Driver Ø3. Tornavida Ø3. 04002 Hex. Head Screw Driver with AO Shaft Ø2. AO Þaftlý Tornavida Ø2. 04003 043003 043004 00203 0020 002 Hex. Head Screw Driver with AO Shaft Ø3. AO Þaftlý Tornavida Ø3. Torque Limiting Scr. Dr. with AO shaft - 3. Tork Limitli Tornavida - 3. Torque Limiting Scr. Dr. with AO shaft - 4. Tork Limitli Tornavida - 4. Tap AO shaft - Cortical 4. Teb - Kortikal 4. Tap AO shaft - Cortical 3. Teb - Kortikal 3. Load Drill Guide Attachment 3. Drill Gayd Ucu - DCP 3. 0032 Load Drill Guide Attachment 4. Drill Gayd Ucu - DCP 4. 003 004 0002 0003 00101 0002 00 000 00302 00221 1 Drill Sleeve for Locking Screw 3. Drill Seeve 3. Drill Sleeve for Locking Screw 4. Drill Seeve 4. Neutral and Load Drill Guide Attachment 3. Drill Gayd Ucu - Düz - 3. Neutral and Load Drill Guide Attachment 4. Drill Gayd Ucu - Düz - 4. Neutral and Load Drill Guide Attachment Shaft Drill Gayd Þaft Countersink with AO shaft 4. Havþa Aparatý - 4. Countersink with AO shaft 3. Havþa Aparatý - 3. Universal Adapter with AO shaft Adaptör Screw Depth Gauge - Large Vida Derinlik Ölçer - Büyük Bending Iron Plak Bükücü IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ

00201 Long Drill - Ø3.2 Uzun Drill - Ø3.2 00203 Long Drill - Ø4. Uzun Drill - Ø4. 00402 Drill with AO shaft - Ø2. Drill - Ø2. 00403 Drill with AO shaft - Ø2. Drill - Ø2. 00404 Drill with AO shaft - Ø3.2 Drill - Ø3.2 0040 Drill with AO shaft - Ø4. Drill - Ø4. instrument tray 1 instrument tray 2 plate tray 1 plate tray 2 plate tray 3 plate tray 4 screw tray 1 screw tray 2 screw tray 3 IMPLANTS & INSTRUMENTS / ÝMPLANTLAR VE EL ALETLERÝ 1

Revision 02 / Printed in TURKEY - 0/ - TIPSAN Design The products being manufactured by TIPSAN A.S. has been certified from SZUTEST (Strojírensk Zkušební Ústav) for EC certificate (CE 1) according to Annex II. 3 and II.4 of Council Directive 3/42/EEC concerning medical devices Kemalpasa Cd. 404/1 Sk. No: 3 Pinarbasi - IZMIR - TURKEY Tel: +0 232 4 4 Fax: +0 232 4 2 marketing@tipsan.com.tr www.tipsan.com.tr