Surgical Technique

Clavicle Locking Plate

PERI-LOC Locked Plating System

Clavicle Locking Plate Surgical Technique

Table of Contents
Introduction ......................................................................................................................2 Indications ........................................................................................................................3 Plate Features ....................................................................................................................3 Patient Positioning ............................................................................................................4 Incision ..............................................................................................................................4 Fracture Reduction and Provisional Fixation ....................................................................5 Plate Selection ..................................................................................................................5 Plate Contouring................................................................................................................6 Plate Positioning ..............................................................................................................6 Screw Insertion..................................................................................................................7 2.7mm Locking Screw ......................................................................................................7 2.7mm Cortex Screw ........................................................................................................8 3.5mm Locking Screw ......................................................................................................9 3.5mm Cortex Screw ........................................................................................................10 Closure ..............................................................................................................................11 Catalog Information ..........................................................................................................12

Nota Bene The technique description herein is made available to the healthcare professional to illustrate the author's suggested treatment for the uncomplicated procedure. In the final analysis, the preferred treatment is that which addresses the needs of the specific patient.
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Introduction
The PERI-LOC Locked Plating System combines the advantages of locked plating with the versatility and benefits of traditional plates and screws. Utilizing both locking and non-locking screws, the PERI-LOC system allows for the creation of a fixed-angle construct capable of resisting angular collapse. Its enhanced stability also allows it to function as an effective fracture reduction aid. A simple, intuitive instrument set featuring standardized drill bits and screwdrivers along with color-coded drill guides, helps make the PERI-LOC system efficient and easy to use. The PERI-LOC Clavicle Locking Plates are available in a variety of sizes and options and are compatible with both the PERI-LOC Small Fragment and the Elbow/2.7mm Instrument and Implant Sets. Their precise screw trajectories, anatomic contour and locking/non-locking capabilities provide a stable construct for predictable reconstruction of complex fractures of the clavicle.

Indications
The PERI-LOC Clavicle Locking Plates are indicated for fixation of fractures, non-unions and osteotomies of the clavicle.

Plate Features
Four

plates: superior medial, superior distal, inferior medial and inferior distal configurations allow for both superior and anterior-inferior plating techniques superior distal plates with convergent lateral screw trajectory for maximum pull-out strength precontoured for optimal fit plate segments facilitate additional contouring if necessary stainless steel for strength option in all screw holes
Superior Medial Inferior Medial

Plate

Left/right-specific

Inferior Distal

Anatomically Recon 316L

Locking/non-locking

Superior and inferior distal plate screw holes accept 2.7mm Locking and 2.7mm Cortex Screws in the lateral section and 3.5mm Locking and 3.5mm Cortex Screws in the shaft and inferior medial plate screw holes accept 3.5mm Locking and 3.5mm Cortex Screws
Superior Distal

Superior

Surgical Technique
Patient Positioning
Place the patient in either the beach chair or supine position on a radiolucent table. A bolster may be placed between the scapulae to assist with fracture reduction.

Incision
A parallel incision is made along the inferior border of the clavicle. Dissect down to the bone either superiorly or inferiorly as desired. Care should be taken to preserve soft tissue attachments to fracture fragments.

Fracture Reduction and Provisional Fixation

Reduce and provisionally fix the fracture under fluoroscopy with K-Wires, Reduction Forceps or suture fixation. Particular care must be taken to retain the clavicle's proper length and to avoid periosteal stripping. Reduction aids should be placed so as not to interfere with final plate placement.

Plate Selection
Following fracture reduction, select the Clavicle Locking Plate that best accommodates patient anatomy and fracture pattern. Note The PERI-LOC Clavicle Locking Plate Preoperative Templates (7118-0987, 0988, 0989, 0990) are available to assist with preoperative radiographic planning.

PERI-LOC Inferior Medial Clavicle Locking Plate Preoperative Template Cat. No. 7118-0987

PERI-LOC Inferior Distal Clavicle Locking Plate Preoperative Template Cat. No. 7118-0988

PERI-LOC Superior Medial Clavicle Locking Plate Preoperative Template Cat. No. 7118-0989

PERI-LOC Superior Distal Clavicle Locking Plate Preoperative Template Cat. No. 7118-0990

Plate Contouring
Occasionally, minor plate contouring is required prior to implantation. If necessary, this may be accomplished with Bending Irons (7117-3482). Note Avoid excessive plate contouring as this can alter screw trajectory to the point that certain screw holes cannot be used due to the risk of screw interdigitation.

Plate Positioning
Superior Medial The plate lies along the superior aspect of the clavicle providing full coverage of the length of the bone.

Superior Distal The plate lies along the superior aspect of the clavicle with the 2.7mm screw section covering the distal edge.

Inferior Medial The plate lies along the anterior-inferior aspect of the clavicle providing full coverage of the length of the bone.

Inferior Distal The plate lies along the anterior-inferior aspect of the clavicle with the 2.7mm screw section contouring to the distal edge. Provisionally fix the plate to the bone using one 2.7mm x 18mm Provisional Fixation Pin (7117-3322). Alternatively, Fracture Reduction Forceps may be used.

Screw Insertion
2.7mm Locking Screw Thread the 2.7mm Locking Screw Guide (7117-3452) with 2.0mm Locking Drill Guide Insert (7117-3449)* into the desired screw hole and drill both cortices with the Short 2.0mm Drill Bit (7117-3555). Measure for screw length by reading the exposed calibrations off the drill bit or by using the 2.7mm Screw Depth Gauge (7117-3525).

Attach the 2.5mm Hexdriver Shaft w/AO Quick Connect (7117-3535) to the Large Screwdriver Handle (7117-3547) and insert the appropriate length 2.7mm Self-Tapping Locking Screw**. Avoid over-penetration of the clavicle's far cortex due to the risk of damage to vulnerable neurovascular structures located inferiorly. Note Locking screws may be inserted on power, but should always be tightened by hand in order to avoid loss of reduction, stripping of the screw head or damage to the screwdriver.

* The 2.0mm Locking Drill Guide (7117-3448) may be substituted for the 2.7mm Locking Screw Guide with 2.0mm Locking Drill Guide Insert ** Screws may be inserted through the 2.7mm Locking Screw Guide, but it must be removed prior to insertion of a screw less than 24mm in length

2.7mm Cortex Screw Insert the Universal Drill Guide Handle (7117-3349) with 2.0mm Neutral Locking Hole Insert (7117-3453) into the desired screw hole and drill both cortices with the Short 2.0mm Drill Bit.

Measure for screw length by reading the exposed calibrations off the drill bit or by using the 2.7mm Screw Depth Gauge.

Insert the appropriate length 2.7mm Self-Tapping Cortex Screw using the 2.5mm Hexdriver/Screwdriver Handle assembly. Note If non-locking screws are to be used in the plate to gain compression, it is preferred that they be inserted prior to any locking screws.

3.5mm Locking Screw Thread the 3.5mm Locking Screw Guide (7117-3538) with 2.7mm Locking Drill Guide Insert (7117-3529)* into the desired screw hole and drill both cortices with the Short 2.7mm Drill Bit (7117-3502). Measure for screw length by reading the exposed calibrations off the drill bit or by using the Short 3.5mm Screw Depth Gauge (7117-3523).

Attach the 3.5mm Hexdriver Shaft w/AO Quick Connect (7117-3537) to the Large Screwdriver Handle (7117-3547) and insert the appropriate length 3.5mm Self-Tapping Locking Screw**. Avoid over-penetration of the clavicle's far cortex due to the risk of damage to vulnerable neurovascular structures located inferiorly. Note Locking Screws may be inserted on power, but should always be tightened by hand in order to avoid loss of reduction, stripping of the screw head or damage to the screwdriver.

* The 2.7mm Locking Drill Guide-One Piece (7117-3450) may be substituted for the 3.5mm Locking Screw Guide insert with 2.7mm Locking Drill Guide insert ** Screws may be inserted through the 3.5mm Drill Guide assembly, but it must be removed prior to the insertion of a screw less than 24mm in length

3.5mm Cortex Screw Insert the Universal Guide Handle (7117-3349) with 2.7mm Neutral Locking Hole Insert (7117-3514) into the desired screw hole and drill both cortices with the Short 2.7mm Drill Bit.

Measure for screw length by reading the exposed calibrations off the drill bit or by using the Short 3.5mm Screw Depth Gauge.

Insert the appropriate length 3.5mm Self-Tapping Cortex Screw using the 3.5mm Hexdriver/Screwdriver Handle assembly. Fill remaining screw holes as desired. Note If non-locking screws are to be used to gain compression, it is preferred that they be inserted prior to any locking screws.

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Closure
Obtain final radiographic images to confirm screw placement and fracture reduction. Wound closure follows standard technique.

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Catalog Information

PERI-LOC Small Fragment Instrument, Implant and Disposables Set

Set No. 7181-0220

Instrument Cases
Cat. No. 7112-9400 7112-9402 7117-0350 7117-0352 Description Large Outer Case Lid for Outer Case Small Fragment Drill Guide Caddy Small Fragment Straight Locking Plate Caddy Cat. No. 7117-0353 7117-0354 7117-0359 7117-0361 Description Small Fragment Straight Plate Caddy Small Fragment Screw Caddy Small Fragment Drill Caddy Small Fragment Instrument Tray

Instruments
Cat. No. 7117-0043 7117-0045 7117-0057 7117-0063 7117-0076 7117-0095 7117-0097 7117-0175 7117-3344 7117-3349 7117-3369 7117-3370 7117-3377 7117-3378 7117-3482 Description Sharp Hook Screw Forceps Hohmann Retractor, 8mm Wire Bending Pliers, 140mm Hohmann Retractor, 15mm Periosteal Elevator Bending Pliers for 3.5mm Reconstruction Plates Countersink Universal Drill Guide Handle Hohmann Retractor, Bent, 8mm Reduction Forceps w/Ratchet, 205mm Reduction Forceps w/Points, Broad Reduction Forceps w/Serrated Jaw Small Fragment Bending Irons Tray Qty 1 ea 1 ea 2 ea 1 ea 2 ea 1 ea 1 ea 1 ea 2 ea 2 ea 2 ea 2 ea 2 ea 2 ea 7117-3510 7117-3511 7117-3512 7117-3513 7117-3514 7117-3515 7117-3516 7117-3517 7117-3523 7117-3525 7117-3527 7117-3528 7117-3529 7117-3534 Cat. No. 7117-3487 Description 3.5mm Self-Retaining Hexdriver Shaft w/AO Quick Connect, 178mm 2.7mm Drill Guide Insert 2.7mm Compression Slot Insert 2.7mm Neutral Slot Insert 3.5mm Drill Guide Insert 2.7mm Neutral Locking Hole Insert 2.7mm Compression Locking Hole Insert 2.0mm Parallel Wire Drill Guide 2.0mm Wire/Drill Insert Short 3.5mm Screw Depth Gauge 2.7mm Screw Depth Gauge Cannulated K-Wire Bending Iron Cannulated AO-to-Trinkle Adaptor 2.7mm Locking Drill Guide Insert 3.5mm Screw Depth Gauge Tray Qty 2 ea 2 ea 1 ea 1 ea 2 ea 1 ea 1 ea 1 ea 1 ea 1 ea 1 ea 1 ea 1 ea 1 ea 1 ea

Bending Pliers for 2.7mm & 3.5mm Plates 1 ea

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Instruments (continued) Cat. No. Description 7117-3535 7117-3538 7117-3542 7117-3543 2.5mm Hexdriver Shaft w/AO Quick Connect 3.5mm Locking Screw Guide Small T-Handle w/AO Quick Connect Teardrop Handle Screwdriver w/AO Quick Connect

Tray Qty 2 ea 1 ea 1 ea 1 ea

Cat. No. 7117-3544 7117-3547 7117-3549

Description Self-centering Reverse Verbrugge Forceps, 190mm Large Screwdriver Handle w/AO Quick Connect

Tray Qty 1 ea 1 ea

Small Fragment Guide Removal Assembly 1 ea

Optional Instruments
Cat. No. 7117-3488 7117-3487 7117-3450 Description Split Hex Screwdriver Shaft, 119mm Split Hex Screwdriver Shaft, 178mm 2.7mm Locking Drill Guide-One Piece Tray Qty 1 ea 1 ea 1 ea

Disposables
Cat. No. 7116-1012 7116-1016 7116-1020 7117-3318 7117-3366 7117-3386 7117-3322 7117-3323 7117-3501 Description 1.6mm x 150mm K-Wire w/Trocar Point 2.0mm x 150mm K-Wire w/Trocar Point 3.5mm Tap w/AO Quick Connect 2.7mm Tap w/AO Quick Connect 4.0mm Tap w/AO Quick Connect 2.7mm x 18mm Provisional Fixation Pin 2.7mm x 40mm Provisional Fixation Pin 2.0mm Calibrated Drill Bit w/AO Quick Connect Tray Qty 6 ea 6 ea 2 ea 2 ea 2 ea 4 ea 4 ea 2 ea 7117-3503 7117-3504 7117-3502 Cat. No. 7117-3555 Description 2.0mm Short Calibrated Drill Bit w/AO Quick Connect 2.7mm Short Calibrated Drill Bit w/AO Quick Connect 2.7mm Calibrated Drill Bit w/AO Quick Connect 3.5mm Short Calibrated Drill Bit w/AO Quick Connect Tray Qty 2 ea 2 ea 2 ea 2 ea 1.25mm x 150mm K-Wire w/Trocar Point 6 ea

Implants
2.7mm Self-Tapping Cortex Screws
Cat. No. 7182-3010 7182-3012 7182-3014 7182-3016 7182-3018 7182-3020 7182-3022 7182-3024 Length 10mm 12mm 14mm 16mm 18mm 20mm 22mm 24mm Cat. No. 7182-3026 7182-3028 7182-3030 7182-3032 7182-3034 7182-3036 7182-3038 7182-3040 Length 26mm 28mm 30mm 32mm 34mm 36mm 38mm 40mm Cat. No. 7182-3045 7182-3050 7182-3055 7182-3060 7182-3065 7182-3070 Length 45mm 50mm 55mm 60mm 65mm 70mm

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Catalog Information
3.5mm Self-Tapping Cortex Screws
Cat. No. 7182-4010 7182-4012 7182-4014 7182-4016 7182-4018 7182-4020 7182-4022 7182-4024 7182-4026 7182-4028 Length 10mm 12mm 14mm 16mm 18mm 20mm 22mm 24mm 26mm 28mm Cat. No. 7182-4030 7182-4032 7182-4034 7182-4036 7182-4038 7182-4040 7182-4045 7182-4050 7182-4055 7182-4060 Length 30mm 32mm 34mm 36mm 38mm 40mm 45mm 50mm 55mm 60mm Cat. No. 7182-4065 7182-4070 7182-4075 7182-4080 7180-4085* 7180-4090* 7180-4095* 7180-4100* 7180-4105* 7180-4110* Length 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm

3.5mm Self-Tapping Locking Screws

Cat. No. 7182-5010 7182-5012 7182-5014 7182-5016 7182-5018 7182-5020 7182-5022 7182-5024 7182-5026 7182-5028 Length 10mm 12mm 14mm 16mm 18mm 20mm 22mm 24mm 26mm 28mm Cat. No. 7182-5030 7182-5032 7182-5034 7182-5036 7182-5038 7182-5040 7182-5045 7182-5050 7182-5055 7182-5060 Length 30mm 32mm 34mm 36mm 38mm 40mm 45mm 50mm 55mm 60mm Cat. No. 7182-5065 7182-5070 7182-5075 7182-5080 7180-5085* 7180-5090* 7180-5095* 7180-5100* 7180-5105* 7180-5110* Length 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm 105mm 110mm

* Available sterile only

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4.0mm Cancellous Screws, Fully Threaded

Cat. No. 7182-5210 7182-5212 7182-5214 7182-5216 7182-5218 7182-5220 7182-5222 7182-5224 7182-5226 7182-5228 Length 10mm 12mm 14mm 16mm 18mm 20mm 22mm 24mm 26mm 28mm Cat. No. 7182-5230 7182-5232 7182-5234 7182-5236 7182-5238 7182-5240 7182-5245 7182-5250 7182-5255 7182-5260 Length 30mm 32mm 34mm 36mm 38mm 40mm 45mm 50mm 55mm 60mm Cat. No. 7182-5265 7182-5270 7182-5275 7182-5280 7180-5285* 7180-5290* 7180-5295* 7180-5300* Length 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm

4.0mm Cancellous Screws, Partially Threaded

Cat. No. 7182-5310 7182-5312 7182-5314 7182-5316 7182-5318 7182-5320 7182-5322 7182-5324 7182-5326 7182-5328 Length 10mm 12mm 14mm 16mm 18mm 20mm 22mm 24mm 26mm 28mm Cat. No. 7182-5330 7182-5332 7182-5334 7182-5336 7182-5338 7182-5340 7182-5345 7182-5350 7182-5355 7182-5360 Length 30mm 32mm 34mm 36mm 38mm 40mm 45mm 50mm 55mm 60mm Cat. No. 7182-5365 7182-5370 7182-5375 7182-5380 7180-5385* 7180-5390* 7180-5395* 7180-5400* Length 65mm 70mm 75mm 80mm 85mm 90mm 95mm 100mm

Washer, 7.0mm Outer Diameter

Cat. No. 7114-3007

* Available sterile only

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Catalog Information

PERI-LOC Elbow/2.7mm Locking Plate Tray

Set No. 7181-1005

Instrument Cases
Cat. No. 7112-9400 7112-9402 7117-0397 7117-0399 7117-0373 7117-0374 7117-0398 Description Large Outer Case Lid for Outer Case Elbow Locking Plate Tray 2.7mm Instrument & Screw Tray 2.7mm Drill Guide Caddy 2.7mm Self-Tapping Cortex Locking Screw Caddy Clavicle Plate Caddy

Instruments
Cat. No. 7117-3455 7117-3448 7117-3452 7117-3449 7117-3453 Description 2.7mm Screw Guide Remover 2.0mm Locking Drill Guide 2.7mm Locking Screw Guide 2.0mm Locking Drill Guide Insert 2.0mm Neutral Locking Hole Insert Tray Qty 1 ea 2 ea 2 ea 2 ea 1 ea

2.7mm Self-Tapping Locking Screws

Cat. No. 7182-2310 7182-2312 7182-2314 7182-2316 7182-2318 7182-2320 7182-2322 7182-2324 Length 10mm 12mm 14mm 16mm 18mm 20mm 22mm 24mm Cat. No. 7182-2326 7182-2328 7182-2330 7182-2332 7182-2334 7182-2336 7182-2338 7182-2340 Length 26mm 28mm 30mm 32mm 34mm 36mm 38mm 40mm Cat. No. 7182-2345 7182-2350 7182-2355 7182-2360 Length 45mm 50mm 55mm 60mm

Clavicle Locking Plates

Cat. No. 7182-3401 7182-3402 7182-3403 7182-3404 7182-3409 Description Superior Medial, 8H, Left Superior Medial, 10H, Left Superior Distal, Left Superior Distal, Right Superior Medial, 8H, Right Length 97mm 121mm 109mm 109mm 97mm Cat. No. 7182-3410 7182-3405 7182-3406 7182-3407 Description Superior Medial, 10H, Right Inferior Medial, 8H Inferior Medial, 10H Inferior Distal Length 121mm 96mm 117mm 81mm

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