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CMF Matrix MatrixRIB. Stable fixation of normal and osteoporotic ribs. Technique Guide

MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

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Page 1: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

CMF Matrix

MatrixRIB. Stable fixation of normal and osteoporotic ribs.

Technique Guide

Page 2: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6
Page 3: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Synthes 1

Table of Contents

Introduction

Surgical Technique

Product Information

Bibliography

Synthes – In the Service of Health

MatrixRIB 2

AO Principles 4

Indications 5

Patient Positioning 5

Plating Rib 6

Splint Insertion 16

Implants 24

Instruments 25

Sets 29

37

38

WarningThis description alone does not provide sufficient background for direct use ofthe instrument set. Instruction by a surgeon experienced in handling this product ishighly recommended.

Reprocessing, Care and Maintenance of Synthes InstrumentsFor general guidelines, function control and dismantling of multipart instrumentsplease refer to: www.synthes.com/reprocessing

Page 4: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

2 Synthes MatrixRIB Technique Guide

MatrixRIB. Stable fixation of normal and osteoporotic ribs.

The Synthes MatrixRIB Fixation System consists of precon-toured locking plates, locking screws, and intramedullarysplints for the fixation and stabilization of ribs.Although some rib fractures are treated with pain manage-ment and bracing, as well as endotracheal intubation andmechanical ventilation if necessary, some patients could benefit from surgical stabilization (osteosynthesis).

Locking screws– Screws work with self-retaining

screwdriver blades to reduce cam-out

– Locking design for stable construct– One screw diameter for use with all

plates and splints

* Ti-6Al-7Nb1 Ahmed Z, Mohyuddin Z, 1995, 1676–802 Engel C, et al., 2005, 181–63 Lardinois D, et al., 2001, 496–5014 Tanaka H, et al., 2002, 727–32

There are several potential benefits of surgical stabilization ofrib fractures. These include reduced mortality and increasedcost effectiveness due to a reduced duration of mechanicalventilation support, shortened ICU stays, and less complica-tions. Patients could also benefit from preserved pulmonaryfunction, improved pain control, better clearance of secre-tions through efficient cough, minimized chest wall deformi-ties resulting from trauma and shorter back to work time.1,2,3,4

Right plates

Longitudinal Twist

Locking holes In-plane radius

R3

R4-5

R6-7

R8-9

Features– Designed to be used without removing periosteum, to

maximize blood supply to the bone– All implants are manufactured from titanium alloy*

for flexibility and strength– Drill bit with stop to prevent over-drilling– Self-retaining screwdriver blades

Page 5: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

rib 3

rib 4

rib 5

rib 6

rib 7

rib 8

rib 9

rib 3

rib 4

rib 5

rib 6

rib 7

rib 8

rib 9

L6-7

L8-9

L3

L4-5R4-5

R6-7

R8-9

R3R3

R8-9

R6-7

R4-5 L4-5

L3

L8-9

L6-7

rib 9

rib 8

rib 7

rib 6

rib 5

rib 4

rib 3

rib 9

rib 8

rib 7

rib 6

rib 5

rib 4

rib 3

5 Mohr M, et al., 2007, 1310–7

Locking plates– Plates are precontoured to fit an average rib shape,

which minimizes intraoperative bending5

– Locking plate construct provides stable fixation– Low-profile 1.5 mm thick plates– Plates are color-coded to distinguish left and right designs– Plates are etched on medial end to indicate the correspon-

ding rib– A universal plate with 8 holes is available

Intramedullary splints– Intramedullary splints allow less invasive procedures– Three widths available (3 mm, 4 mm, 5 mm)– Only one screw needed to secure splint

Left plates

Tubular radius

Out of plane radius

Etching

L3

L4-5

L6-7

L8-9

Synthes 3

Page 6: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

4 Synthes MatrixRIB Technique Guide

AO Principles

In 1958, the AO formulated four basic principles, which havebecome the guidelines for internal fixation.6 These principles,as applied to the MatrixRIB Fixation system, are:

Anatomic reductionFracture reduction and fixation to restore anatomical rela-tionships. A comprehensive implant and instrument selectionaddresses most simple and complex fixation needs.

Stable fixationStability by rigid fixation or splintage, as the personality ofthe fracture and the injury requires. The MatrixRIB plate andscrew locking technology are optimized to achieve stablebone fixation.

Preservation of blood supplyPreservation of the blood supply to soft tissue and bone by careful handling and gentle reduction techniques. Instrumentation, with rounded plate profiles and edges, preserve vascular blood flow for bone healing.

Early, active mobilizationEarly and safe mobilization of the body part and patient. The MatrixRIB implants, combined with AO technique, providestable fixation to allow functional aftercare.

6 Müller ME, Allgöwer M, Schneider R, Willenegger H, 1995

Page 7: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Indications

The Synthes MatrixRIB Fixation System is indicated for the fixation and stabilization of rib fractures, fusions and osteotomies of normal and osteoporotic bone.

Position the patient to optimize access to the rib to be repaired.

For pure lateral chest injuries, a lateral thoracotomy may beused with the patient in a lateral decubitus position, and the arms abducted 90° on padded arm rests.

Anterolateral chest injuries may be approached with an anterolateral thoracotomy with the patient in a supine position, with both arms abducted 90°.

Patient Positioning

Synthes 5

Page 8: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Plating Rib

1Expose fractured rib

Make an incision over the fracture area.

Expose the rib to allow a minimum of three screws on eachside of the fracture.

Remove any nonviable bone.

Caution: Avoid significant muscle division to preserve asmuch respiratory function as possible. The serratus anteriormuscle insertions on the chest wall are generally the onlymuscle fibers that are divided for anterolateral injuries.

Notes– For lateral chest wall injuries, the anterior aspect of the

latissimus dorsi can be dissected to gain access to the fracture.

– Removal of the periosteum is not required.

6 Synthes MatrixRIB Technique Guide

Page 9: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Synthes 7

2Determine rib thickness

Instrument

03.501.065 Calliper

Optional instrument

03.501.074 Universal Calliper

Make a small incision in the intercostal space at the superiorborder of the rib to allow insertion of the calliper tip.

Insert the calliper tip through the incision and determine the rib thickness.

Note: If an existing access into the intercostal space is avail-able for determining the rib thickness, it is recommended toinsert the calliper tip using the existing access.

To select the appropriate drill bit with stop and the appropri-ate screw length, add 2 mm to allow for the plate thickness.

Caution: Take care to avoid damaging the nerve and vesselbundle at the inferior border of the rib.

Page 10: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

8 Synthes MatrixRIB Technique Guide

Plating Rib

3Approximate broken rib segments

Instrument

398.400 Reduction Forceps with Points, narrow, ratchet lock, length 132 mm

Use the forceps to approximate the broken rib segments.

4Cut and contour plate template

Instrument

03.501.072 MatrixRIB Bending Template for Rib Plates

Cut the bending template to a length that allows placementof a minimum of three screws on each side of the fracture.

Contour the template to the rib.

Page 11: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

5Select and cut plate

Instrument

391.990 Plate and Rod Cutter

Use the plate template contoured in step 4 to select the bestmatching plate.

Notes– Position the precontoured plate with the etching

toward the sternum. – A universal plate is available for use in place of a

precontoured plate (see implants on page 24).

If necessary, cut the plate to the desired length.

Caution: Use a minimum of three screws on each side of the fracture, to properly secure the plate.

Synthes 9

Page 12: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Plating Rib

6Contour plate

Instrument

329.142 Bending Pliers with Nose, for Pure Titanium Plates 2.4 and 2.7

If contouring is necessary, use the bending pliers, contour theplate to match the template.

Caution: Avoid sharp bends, reverse bends, or bending theimplant at a screw hole. Avoid notching or scratching the implant. These factors may produce internal stresses whichmay become the focal point for eventual breakage of the implant.

10 Synthes MatrixRIB Technique Guide

Page 13: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Synthes 11

7Position plate

Instrument

03.501.071 MatrixRIB Plate Holding Forceps, small

Optional instruments

03.501.030 MatrixRIB Plate Holding Forceps, small, with ball tip

03.501.031 MatrixRIB Plate Holding Forceps, large, with ball tip

Position the plate on the rib over the fracture, allowing aminimum of three screws on each side of the fracture.

Verify the contour of the plate matches the rib.

Using the plate holding forceps, hold the plate on the rib.

Caution: It is recommended to insert the forceps from the superior border of the rib to avoid damaging the nerve and vessel bundle located at the inferior border of the rib.

Page 14: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Plating Rib

8Drill

Instruments

03.501.033 MatrixRIB Drill Guide 2.2 for Plates

03.501.036– MatrixRIB Drill Bits � 2.2 mm with stop,03.501.044 length 135, 6 mm to 14 mm, 2 flute,

for J-latch Coupling

Thread the drill guide into the plate. This will help ensuresafe drilling and alignment of the drill hole with the platehole.

Select the drill bit with stop as determined in step 2 and drill.

Drill bits with stop are available with stop lengths rangingfrom 6 mm to 14 mm, in 2 mm increments, matching thelocking screw lengths.

Note: Irrigate during drilling to avoid thermal damage to the bone.

Caution: Do not drill any deeper than necessary, to avoid the risk of pneumothorax.

Remove the 2.2 drill guide after drilling.

12 Synthes MatrixRIB Technique Guide

Page 15: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Synthes 13

9Select and insert first screw

Instruments

03.501.001 Depth Gauge for Sternal Cable

03.503.071 Screwdriver Shaft MatrixMANDIBLE, medium, self-holding, for Hexagonal Coupling

311.023 Ratcheting Screwdriver Handle, with Hexagonal Coupling

Optional instrument

03.503.072 Screwdriver Shaft MatrixMANDIBLE, long, self-holding, for Hexagonal Coupling

Use the depth gauge through the plate to confirm the appropriate screw length determined in step 2.

Caution: Do not extend the tip of the depth gauge too far beyond the posterior cortex of the rib.

Page 16: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Plating Rib

14 Synthes MatrixRIB Technique Guide

Select the proper length screw.

Caution: The screw should be no longer than necessary toengage the posterior cortex, to avoid deeper injury. The tipof the screw should not extend more than 1 mm beyond theposterior cortex. The screw length indicator on the modulecan be used to select the appropriate screws.

Insert the locking screw through the plate and tighten until secure.

Optionally, a 6 mm nonlocking screw is available to ensurethe plate sits flush with the bone. This nonlocking screw is atemporary fixation and will need to be replaced with a lock-ing screw before closure.

Page 17: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

10Drill and place remaining screws

Verify proper reduction of the fracture.

Insert a second screw on the opposite side of the fracturefollowing steps 8 and 9. Insert remaining screws in the same manner.

Synthes 15

Page 18: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Intramedullary splints improve the ability to fix posterior ribfractures.

The intramedullary splints have a rectangular profile for rotational stability within the canal, and a locking feature toprevent migration and rotation of the implant.

Intramedullary splints– Intramedullary splints allow less invasive procedures– Three widths available (3 mm, 4 mm, 5 mm)– Only one screw needed to secure splint

Splint Insertion

1Expose fractured rib

Make incisions over the fractured area.

Expose the fractured rib to allow splint head placement. A minimum of 50 mm on the medial side of the fracture is recommended.

Remove any nonviable bone.

Notes– It is recommended to minimize the dissection of the soft

tissue on the lateral side of the fracture.– Removal of the periosteum is not recommended.

Caution: Avoid significant muscle division to preserve asmuch respiratory function as possible.

16 Synthes MatrixRIB Technique Guide

Page 19: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Determine rib thickness

Instrument

03.501.065 Calliper

Optional instrument

03.501.074 Universal Calliper

Make a small incision in the intercostal space at the superiorborder of the rib to allow insertion of the calliper tip.

Insert the calliper tip through the incision and determine the rib thickness.

Note: If an existing access into the intercostal space is avail-able for determining the rib thickness, it is recommended toinsert the calliper tip using the existing access.

To select the appropriate drill bit with stop and the appropri-ate screw length, add 1 mm to allow for the plate thickness.

Caution: Take care to avoid damaging the nerve and vesselbundle at the inferior border of the rib.

Synthes 17

Page 20: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

3Prepare splint insertion hole

Instruments

03.501.055 MatrixRIB Drill Guide 5.5 for Intramedullary Splint Insertion

03.501.070 MatrixRIB Drill Bit � 5.5 mm with Stop, length 125 mm, 2-flute, for J-Latch Coupling

03.501.071 MatrixRIB Plate Holding Forceps, small

Optional instruments

03.501.032 MatrixRIB Intramedullary Splint Driver

03.501.075 Drill Guide 5.5, for MatrixRIB Intramedullary Splints, without Handle

Insert the hook end of the drill guide into the intramedullarycanal of the medial segment until it is seated fully on the rib.

Notes– It is recommended to insert the hook near the superior

edge of the rib, and to drill an entry hole in the upper 2⁄3of the rib.

– The small plate holding forceps can be used to clampdown the 5.5 splint drill guide during drilling.

Caution: If the drill guide without handle is used, ensure thetapered end, labeled “Fracture”, is aligned with the fractureto ensure the hole is approximately 30 mm from the fractureline.

Note: The splint driver may be threaded into the drill guideto act as handle, as needed.

Ensure the medial end of the drill guide contacts the bone.

Using the � 5.5 mm drill bit with stop, drill monocortically.

Splint Insertion

18 Synthes MatrixRIB Technique Guide

Page 21: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Synthes 19

Remove the drill guide and verify the hole is approximately30 mm from the fracture line.

Notes– Ensure the lateral fracture segment is long enough to

accommodate the insertion length of the splint beforedrilling.

– Irrigate during drilling to avoid thermal damage to the bone.

Page 22: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

4Select splint

Instruments

03.501.032 MatrixRIB Intramedullary Splint Driver

03.501.061 MatrixRIB Template for Intramedullary Splint, small

03.501.062 MatrixRIB Template for Intramedullary Splint, medium

03.501.066 Mallet

398.400 Reduction Forceps with Points, narrow, ratchet lock, length 132 mm

The splint template is used to prepare the canal and selectthe correct size of splint. It is recommended to start with thesmall template before using the medium template.

Thread the splint driver into the splint template and fully insert the template into the insertion hole prepared in step 3.

Remove the splint template.

Fully insert the template into the canal of the lateral fracture segment.

Remove the splint template.

Notes– If the small template fits snugly, use the 3 mm wide splint.– If the medium template fits snugly, use the 4 mm wide

splint.– If the medium template fits loosely, use the 5 mm wide

splint.– The mallet can be used to assist insertion of the splint

template, if needed.

Use bone reduction forceps to hold the rib segment duringsplint template insertion.

20 Synthes MatrixRIB Technique Guide

Splint Insertion

Page 23: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

5Insert splint

Instruments

03.501.032 MatrixRIB Intramedullary Splint Driver

03.501.066 Mallet

398.400 Reduction Forceps with Points, narrow, ratchet lock, length 132 mm

Thread the splint driver into the splint selected in step 4 withthe splint markings facing up towards the handle.

Insert the splint through the insertion hole prepared in step 3.

Drive the splint across the fracture line and into the canal of the lateral segment. The splint is fully inserted when thehead of the splint rests flush on the outside of the rib.

Remove the splint driver after the splint is fully seated.

Caution: To prevent additional injuries to the rib, do not insert the splint head further once it is seated in the insertionhole.

Note: The mallet can be used to assist insertion of the splint,if needed.

Synthes 21

Page 24: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Splint Insertion

6Drill screw hole

Instruments

03.501.033 MatrixRIB Drill Guide 2.2 for Plates

03.501.036– MatrixRIB Drill Bits � 2.2 mm with Stop,03.501.044 length 135, 6 mm to 14 mm, 2 flute,

for J-latch Coupling

Thread the drill guide into the splint. This will help ensuresafe drilling and alignment of the screw with the splint locking hole.

Select the drill bit with stop as determined in step 2 and drill.

Drill bits with stop are available with stop lengths rangingfrom 6 mm to 14 mm, in 2 mm increments, matching thelocking screw lengths.

Note: Irrigate during drilling to avoid thermal damage to the bone.

Caution: Do not drill any deeper than necessary, to avoid the risk of pneumothorax.

Remove the 2.2 drill guide after drilling.

22 Synthes MatrixRIB Technique Guide

Page 25: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Synthes 23

7Select and insert screw

Instruments

03.501.001 Depth Gauge

03.503.071 Screwdriver Shaft MatrixMANDIBLE, medium, self-holding, for Hexagonal Coupling

311.023 Ratcheting Screwdriver Handle

Optional instruments

03.503.072 Screwdriver Shaft MatrixMANDIBLE, long, self-holding, for Hexagonal Coupling

03.501.074 Universal Calliper

Use the depth gauge through the splint to confirm the screwlength determined in step 2.

Caution: Do not extend the tip of the depth gauge too far beyond the posterior cortex of the rib.

Select the proper length screw.

Caution: The screw should be no longer than necessary toengage the posterior cortex, to avoid deeper injury. The tipof the screw should not extend more than 1 mm beyond theposterior cortex. The screw length indicator on the modulecan be used to select the appropriate screws.

Insert the locking screw through the splint and tighten until secure.

Page 26: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

MatrixRIB Intramedullary Splints, Titanium Alloy (TAN)*

04.501.010 Small, 3 mm width04.501.011 Medium, 4 mm width04.501.012 Large, 5 mm width

MatrixRIB LOCK Screws, � 2.9 mm, self-tapping, Titanium Alloy (TAN)** (in 2 mm increments)

04.501.016.01– 6 mm – 14 mm04.501.024.01

04.501.036.01 MatrixRIB NON-LOCK Screw � 2.9 mm**, self-tapping, length 6 mm, Titanium Alloy (TAN)

04.501.009 MatrixRIB Universal Plate,8 holes, Titanium Alloy (TAN)*

MatrixRIB Pre-Contoured Plates, Titanium Alloy (TAN)*

04.501.001 15 holes, for left rib 304.501.002 15 holes, for right rib 3 04.501.003 16 holes, for left ribs 4 and 504.501.004 16 holes, for right ribs 4 and 504.501.005 17 holes, for left ribs 6 and 704.501.006 17 holes, for right ribs 6 and 704.501.007 18 holes, for left ribs 8 and 904.501.008 18 holes, for right ribs 8 and 9

Right plate (rose red) 04.501.002

Left plate (light blue) 04.501.001

**For sterile plates and splints add suffix “S”**For screws in packs of 5, add suffix “.05”; for sterile screws add suffix “.01S”

Implants

24 Synthes MatrixRIB Technique Guide

Page 27: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Synthes 25

Instruments

03.501.001 Depth Gauge for Sternal Cable

03.501.030 MatrixRIB Plate Holding Forceps, small,with ball tip

03.501.031 MatrixRIB Plate Holding Forceps, large,with ball tip

03.501.032 MatrixRIB Intramedullary Splint Driver

03.501.033 MatrixRIB Drill Guide 2.2 for Plates

03.501.036– MatrixRIB Drill Bits � 2.2 mm with stop,03.501.044 length 135, 6 mm to 14 mm, 2 flute,

for J-latch coupling

Page 28: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

03.501.055 MatrixRIB Drill Guide 5.5 for IntramedullarySplint Insertion

03.501.061 MatrixRIB Template for IntramedullarySplint, small

03.501.062 MatrixRIB Template for IntramedullarySplint, medium

03.501.065 Calliper

03.501.066 Mallet

03.501.070 MatrixRIB Drill Bit � 5.5 mm with Stop, length 125 mm, 2-flute, for J-LatchCoupling

03.501.071 MatrixRIB Plate Holding Forceps, small

26 Synthes MatrixRIB Technique Guide

Instruments

Page 29: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Synthes 27

03.501.072 MatrixRIB Bending Template for Rib Plates

311.023 Ratcheting Screwdriver Handle, with Hexagonal Coupling

Screwdriver Shaft MatrixMANDIBLE, self-holding, for Hexagonal Coupling

03.503.071 medium03.503.072 long

329.142 Bending Pliers with Nose, for Pure Titanium Plates 2.4 and 2.7

03.501.074 Universal Calliper

03.501.075 Drill Guide 5.5, for MatrixRIB Intramedullary Splints, without Handle

Page 30: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

28 Synthes MatrixRIB Technique Guide

Instruments

391.990 Cutting Pliers for Plates and Rods

398.400 Reduction Forceps with Points, narrow,ratchet lock, length 132 mm

Page 31: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

MatrixRIB Fixation System Set (01.501.001)

Graphic Case

60.501.001 Graphic Case, with Lid, for MatrixRIB Fixation System

Length Marker, black

304.106 Type 6

304.108 Type 8

304.110 Type 10

304.112 Type 12

304.114 Type 14

Art. No. Quantity

03.501.001 Depth Gauge 1

03.501.030 MatrixRIB Plate Holding Forceps, 2 small, with ball tip

03.501.031 MatrixRIB Plate Holding Forceps, 2 large, with ball tip

03.501.032 MatrixRIB Intramedullary Splint Driver 1

03.501.033 MatrixRIB Drill Guide 2.2 for Plates 2

03.501.036 MatrixRIB Drill Bit � 2.2 mm with 2 Stop, length 135/6 mm, 2-flute, for J-Latch Coupling

03.501.038 MatrixRIB Drill Bit � 2.2 mm with 2 Stop, length 135/8 mm, 2-flute, for J-Latch Coupling

03.501.040 MatrixRIB Drill Bit � 2.2 mm with 2 Stop, length 135/10 mm, 2-flute, for J-Latch Coupling

03.501.042 MatrixRIB Drill Bit � 2.2 mm with 2 Stop, length 135/12 mm, 2-flute, for J-Latch Coupling

03.501.044 MatrixRIB Drill Bit � 2.2 mm with 2 Stop, length 135/14 mm, 2-flute, for J-Latch Coupling

03.501.055 MatrixRIB Drill Guide 5.5 for 1 Intramedullary Splint Insertion

Art. No. Quantity

03.501.061 MatrixRIB Template for 1 Intramedullary Splint, small

03.501.062 MatrixRIB Template for 1 Intramedullary Splint, medium

03.501.065 Calliper 1

03.501.066 Mallet 1

03.501.070 MatrixRIB Drill Bit � 5.5 mm with 2 Stop, length 125 mm, 2-flute, for J-Latch Coupling

03.501.071 MatrixRIB Plate Holding Forceps, small 2

03.501.072 MatrixRIB Bending Template 2 for Rib Plates

03.503.071 Screwdriver Shaft MatrixMANDIBLE, 2 medium, self-holding, for Hexagonal Coupling

03.503.072 Screwdriver Shaft MatrixMANDIBLE, 2 long, self-holding, for Hexagonal Coupling

311.023 Ratcheting Screwdriver Handle, 2 with Hexagonal Coupling

329.142 Bending Pliers with Nose 1 for Pure Titanium Plates 2.4 and 2.7

391.990 Cutting Pliers for Plates and Rods 1

398.400 Reduction Forceps with Points, 2 narrow, ratchet lock, length 132 mm

Synthes 29

Page 32: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Art. No. Quantity

04.501.001 MatrixRIB Precontoured Plate, 2 left, for Rib No. 3, 15 holes, Titanium Alloy (TAN)*

04.501.002 MatrixRIB Precontoured Plate, 2 right, for Rib No. 3, 15 holes, Titanium Alloy (TAN)*

04.501.003 MatrixRIB Precontoured Plate, 2 left, for Ribs No. 4 and 5, 16 holes, Titanium Alloy (TAN)*

04.501.004 MatrixRIB Precontoured Plate, 2 right, for Ribs No. 4 and 5, 16 holes, Titanium Alloy (TAN)*

04.501.005 MatrixRIB Precontoured Plate, 2 left, for Ribs No. 6 and 7, 17 holes, Titanium Alloy (TAN)*

04.501.006 MatrixRIB Precontoured Plate, right, 2 for Ribs No. 6 and 7, 17 holes, Titanium Alloy (TAN)*

04.501.007 MatrixRIB Precontoured Plate, left, 2 for Ribs No. 8 and 9, 18 holes, Titanium Alloy (TAN)*

04.501.008 MatrixRIB Precontoured Plate, right, 2 for Ribs No. 8 and 9, 18 holes, Titanium Alloy (TAN)*

04.501.009 MatrixRIB Universal Plate, 8 holes, 4 Titanium Alloy (TAN)*

04.501.010 MatrixRIB Intramedullary Splint, 6 small, width 3 mm, Titanium Alloy (TAN)*

04.501.011 MatrixRIB Intramedullary Splint, 6 medium, width 4 mm, Titanium Alloy (TAN)*

* For sterile plates and splints add suffix “S”** For screws in a pack of 5, add suffix “.05”; for sterile screws, add suffix “.01S”

Art. No. Quantity

04.501.012 MatrixRIB Intramedullary Splint, large, 6 width 5 mm, Titanium Alloy (TAN)*

04.501.016 MatrixRIB LOCK Screw � 2.9 mm, 15 self-tapping, length 6 mm, Titanium Alloy (TAN) **

04.501.018 MatrixRIB LOCK Screw � 2.9 mm, 35 self-tapping, length 8 mm, Titanium Alloy (TAN) **

04.501.020 MatrixRIB LOCK Screw � 2.9 mm, 35 self-tapping, length 10 mm, Titanium Alloy (TAN) **

04.501.022 MatrixRIB LOCK Screw � 2.9 mm, 15 self-tapping, length 12 mm, Titanium Alloy (TAN) **

04.501.024 MatrixRIB LOCK Screw � 2.9 mm, 10 self-tapping, length 14 mm, Titanium Alloy (TAN) **

04.501.036 MatrixRIB NON-LOCK Screw 10 � 2.9 mm, self-tapping, length 6 mm, Titanium Alloy (TAN) **

Also available

03.503.073 MatrixMANDIBLE Screwdriver, 1 self-holding

MatrixRIB Fixation System Set (01.501.001)

30 Synthes MatrixRIB Technique Guide

Page 33: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Compact Graphic Case

60.501.010 MatrixRIB Compact Graphic Case (without Inserts)

60.501.012 MatrixRIB Compact Splint System

Art. No. Quantity

03.501.030 MatrixRIB Plate Holding Forceps, 2 small, with ball tip

03.501.032 MatrixRIB Intramedullary Splint Driver 1

03.501.033 MatrixRIB Drill Guide 2.2 for Plates 2

03.501.036 MatrixRIB Drill Bit � 2.2 mm with 2 Stop, length 135/6 mm, 2-flute, for J-Latch Coupling

03.501.038 MatrixRIB Drill Bit � 2.2 mm with 2 Stop, length 135/8 mm, 2-flute, for J-Latch Coupling

03.501.040 MatrixRIB Drill Bit � 2.2 mm with 2 Stop, length 135/10 mm, 2-flute, for J-Latch Coupling

03.501.042 MatrixRIB Drill Bit � 2.2 mm with 2 Stop, length 135/12 mm, 2-flute, for J-Latch Coupling

03.501.044 MatrixRIB Drill Bit � 2.2 mm with 2 Stop, length 135/14 mm, 2-flute, for J-Latch Coupling

03.501.075 Drill Guide 5.5, for MatrixRIB 1 Intramedullary Splints, without Handle

03.501.061 MatrixRIB Template for 1 Intramedullary Splint, small

03.501.062 MatrixRIB Template for 1 Intramedullary Splint, medium

03.501.074 Universal Calliper 1

03.501.066 Mallet 1

MatrixRIB Compact Plate and Splint System(01.501.010)

60.501.012 MatrixRIB Compact Insert Tray, plate and splint

60.501.010 MatrixRIB Compact Graphic Case, without tray

Synthes 31

Page 34: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Art. No. Quantity

03.501.070 MatrixRIB Drill Bit � 5.5 mm 2 with Stop, length 125 mm, 2-flute, for J-Latch Coupling

03.501.071 MatrixRIB Plate Holding Forceps, small 1

311.023 Ratcheting Screwdriver Handle, 1 with Hexagonal Coupling

398.400 Reduction Forceps with Points, 2 narrow, ratchet lock, length 132 mm

03.501.072 MatrixRIB Bending Template 1 for Rib Plates

04.501.009 MatrixRIB Universal Plate, 8 holes, 6 Titanium Alloy (TAN)

04.501.010 MatrixRIB Intramedullary Splint, small, 2 width 3 mm, Titanium Alloy (TAN)

04.501.011 MatrixRIB Intramedullary Splint, medium, 2 width 4 mm, Titanium Alloy (TAN)

04.501.012 MatrixRIB Intramedullary Splint, large, 2 width 5 mm, Titanium Alloy (TAN)

04.501.016.05 MatrixRIB LOCK Screw � 2.9 mm, 2 self-tapping, length 6 mm, Titanium Alloy (TAN), pack of 5 units

04.501.018.05 MatrixRIB LOCK Screw � 2.9 mm, 4 self-tapping, length 8 mm, Titanium Alloy (TAN), pack of 5 units

04.501.020.05 MatrixRIB LOCK Screw � 2.9 mm, 4 self-tapping, length 10 mm, Titanium Alloy (TAN), pack of 5 units

04.501.022.05 MatrixRIB LOCK Screw � 2.9 mm, 4 self-tapping, length 12mm, Titanium Alloy (TAN), pack of 5 units

04.501.024.05 MatrixRIB LOCK Screw � 2.9 mm, 2 self-tapping, length 14mm, Titanium Alloy (TAN), pack of 5 units

MatrixRIB Compact Plate and Splint System (01.501.010)

32 Synthes MatrixRIB Technique Guide

Page 35: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Compact Graphic Case

60.501.010 MatrixRIB Compact Graphic Case (without Inserts)

60.501.011 MatrixRIB Compact Plate Only Insert Tray

Art. No. Quantity

03.501.030 MatrixRIB Plate Holding Forceps, 2 small, with ball tip

03.501.033 MatrixRIB Drill Guide 2.2 for Plates 2

03.501.036 MatrixRIB Drill Bit � 2.2 mm 2 with Stop, length 135/6 mm, 2-flute, for J-Latch Coupling

03.501.038 MatrixRIB Drill Bit � 2.2 mm 2 with Stop, length 135/8 mm, 2-flute, for J-Latch Coupling

03.501.040 MatrixRIB Drill Bit � 2.2 mm 2 with Stop, length 135/10 mm, 2-flute, for J-Latch Coupling

03.501.042 MatrixRIB Drill Bit � 2.2 mm 2 with Stop, length 135/12 mm, 2-flute, for J-Latch Coupling

03.501.044 MatrixRIB Drill Bit � 2.2 mm 2 with Stop, length 135/14 mm, 2-flute, for J-Latch Coupling

03.501.074 Universal Calliper 1

311.023 Ratcheting Screwdriver Handle, 1 with Hexagonal Coupling

398.400 Reduction Forceps with Points, 2 narrow, ratchet lock, length 132 mm

03.501.072 MatrixRIB Bending Template 1 for Rib Plates

MatrixRIB Compact Plate System (01.501.011)

60.501.010 MatrixRIB Compact Graphic Case, without tray

60.501.011 MatrixRIB Compact Insert Tray, plate only

Synthes 33

Page 36: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Art. No. Quantity

04.501.009 MatrixRIB Universal Plate, 8 holes, 6 Titanium Alloy (TAN)

04.501.016.05 MatrixRIB LOCK Screw � 2.9 mm, 2 self-tapping, length 6 mm, Titanium Alloy (TAN), pack of 5 units

04.501.018.05 MatrixRIB LOCK Screw � 2.9 mm, 4 self-tapping, length 8 mm, Titanium Alloy (TAN), pack of 5 units

04.501.020.05 MatrixRIB LOCK Screw � 2.9 mm, 4 self-tapping, length 10 mm, Titanium Alloy (TAN), pack of 5 units

04.501.022.05 MatrixRIB LOCK Screw � 2.9 mm, 4 self-tapping, length 12 mm, Titanium Alloy (TAN), pack of 5 units

04.501.024.05 MatrixRIB LOCK Screw � 2.9 mm, 2 self-tapping, length 14 mm, Titanium Alloy (TAN), pack of 5 units

MatrixRIB Compact Plate System (01.501.011)

34 Synthes MatrixRIB Technique Guide

Page 37: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Compact Graphic Case

60.501.010 MatrixRIB Compact Graphic Case (without Inserts)

60.501.012 MatrixRIB Compact Splint System

Art. No. Quantity

03.501.032 MatrixRIB Intramedullary Splint Driver 1

03.501.033 MatrixRIB Drill Guide 2.2 for Plates 2

03.501.036 MatrixRIB Drill Bit � 2.2 mm 2 with Stop, length 135/6 mm, 2-flute, for J-Latch Coupling

03.501.038 MatrixRIB Drill Bit � 2.2 mm 2 with Stop, length 135/8 mm, 2-flute, for J-Latch Coupling

03.501.040 MatrixRIB Drill Bit � 2.2 mm 2 with Stop, length 135/10 mm, 2-flute, for J-Latch Coupling

03.501.042 MatrixRIB Drill Bit � 2.2 mm 2 with Stop, length 135/12 mm, 2-flute, for J-Latch Coupling

03.501.044 MatrixRIB Drill Bit � 2.2 mm 2 with Stop, length 135/14 mm, 2-flute, for J-Latch Coupling

03.501.075 Drill Guide 5.5, for MatrixRIB 1 Intramedullary Splints, without Handle

03.501.061 MatrixRIB Template for 1 Intramedullary Splint, small

03.501.062 MatrixRIB Template for 1 Intramedullary Splint, medium

03.501.074 Universal Calliper 1

03.501.066 Mallet 1

MatrixRIB Compact Splint System (01.501.012)

60.501.012 MatrixRIB Compact Insert Tray, plate and splint

60.501.010 MatrixRIB Compact Graphic Case, without tray

Synthes 35

Page 38: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Art. No. Quantity

03.501.070 MatrixRIB Drill Bit � 5.5 mm 2 with Stop, length 125 mm, 2-flute, for J-Latch Coupling

03.501.071 MatrixRIB Plate Holding Forceps, small 1

311.023 Ratcheting Screwdriver Handle, 1 with Hexagonal Coupling

398.400 Reduction Forceps with Points, 2 narrow, ratchet lock, length 132 mm

03.501.072 MatrixRIB Bending Template 1 for Rib Plates

04.501.010 MatrixRIB Intramedullary Splint, small, 4 width 3 mm, Titanium Alloy (TAN)

04.501.011 MatrixRIB Intramedullary Splint, medium, 4 width 4 mm, Titanium Alloy (TAN)

04.501.012 MatrixRIB Intramedullary Splint, large, 4 width 5 mm, Titanium Alloy (TAN)

04.501.016.05 MatrixRIB LOCK Screw � 2.9 mm, 1 self-tapping, length 6 mm, Titanium Alloy (TAN), pack of 5 units

04.501.018.05 MatrixRIB LOCK Screw � 2.9 mm, 2 self-tapping, length 8 mm, Titanium Alloy (TAN), pack of 5 units

04.501.020.05 MatrixRIB LOCK Screw � 2.9 mm, 2 self-tapping, length 10 mm, Titanium Alloy (TAN), pack of 5 units

04.501.022.05 MatrixRIB LOCK Screw � 2.9 mm, 2 self-tapping, length 12mm, Titanium Alloy (TAN), pack of 5 units

04.501.024.05 MatrixRIB LOCK Screw � 2.9 mm, 1 self-tapping, length 14mm, Titanium Alloy (TAN), pack of 5 units

36 Synthes MatrixRIB Technique Guide

MatrixRIB Compact Splint System (01.501.012)

Page 39: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Bibliography

Ahmed Z, Mohyuddin Z (1995) Management of flail chest injury: internal fixation versus endotracheal intubation andventilation. J Thorac Cardiovasc Surg. 110(6):1676–80

Engel C, Krieg JC, Madey SM, Long WB, Bottlang M (2005)Operative chest wall fixation with osteosynthesis plates.J Trauma. 58(1):181–6

Lardinois D, Krueger T, Dusmet M, Ghisleta N,Gugger M, Ris H (2001) Pulmonary function testing after operative stabilization of the chest wall for flail chest.Eur J Cardiothorac Surg, 20(3): 496–501

Mohr M, Abrams E, Engel C, Long WB, Bottlang M (2007)Geometry of Human Ribs Pertinent to OrthopaedicChest-Wall Reconstruction. J Biomech. 40(6):1310–7

Müller ME, Allgöwer M, Schneider R, Willenegger H (1995)AO Manual of Internal Fixation. 3rd expandet and completlyrevised ed. 1991. Berlin: Springer

Tanaka H, Yukioka T, Yamaguti Y, Shimizu S, Goto H,Matsuda H, Shimazaki S (2002) Surgical stabilization of internal pneumatic stabilization. A prospective randomizedstudy of management of severe flail chest patients.J Trauma. 52(4):727–32; discussion 32

Synthes 37

Page 40: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

Synthes – In the Service of Health

Synthes is an internationally lead-ing company in medical technology.

Over 10,000 Synthes employees world-wide are involved in serving the needsof surgeons, surgical support staff andpatients. Synthes–a company specializing in the field of osteosynthesis–develops, pro-duces and markets surgical instru-ments, implants, and biomaterials forthe surgical treatment of bone frac-tures and reconstructions of the humanskeleton and its associated soft tissue.

The main goal of Synthes is to providesafe and highly advanced implants, sur-gical instruments and technologies thatenable reliable operations, fast healingand a complaint-free life after surgery.We gua rantee high quality, continuousinnovation and a focused customer ori-entation.

Synthes products are a familiar sight in nearly every operating room in the world.

AO Foundation, Davos, Switzerland.

The AO Foundation offers numerous training courses worldwide.

AO – A medically oriented nonprofit organization in the service of surgeons and patients

Synthes works closely with the AO Foundation, and is licensee of the prod-ucts bearing the brand name Synthes.

AO stands for “Arbeitsgemeinschaftfür Osteosynthesefragen” (Associationfor the Study of Internal Fixation). Thefoundation boasts more than 5,000surgeons who participate in AO activi-ties throughout the world –one of thelargest networks in the field of medi-cine. In the professional world, this sur-geon-led, scientific nonprofit organiza-tion focused on treating bone fracturesand diseases of the musculoskeletalsystem is a pioneer in research, docu-mentation and development.

The Technical Commission of the AOmonitors the implementation of med-ical studies of new products, as a fullyindependent institution administeredby health professionals. Only when itconfirms the effectiveness and qualityof a product does it award the seal ofquality of the Synthes brand. Surgeonsthroughout the world place great trustin Synthes products because they knowthey have been carefully evaluated andtested.

Yet even the best implants and instru-ments are useless if they are not usedproperly. AO International, the arm ofthe foundation responsible for training,annually organizes more than 160 AOcourses throughout the world that of-fer practical exercises and discussions.Since the beginnings of the AO, experi-enced AO physicians have providedtheoretical and practical training formore than 500,000 surgeons and morethan 150,000 surgical support staffmembers.

38 Synthes MatrixRIB Technique Guide

Page 41: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6
Page 42: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6
Page 43: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6
Page 44: MatrixRIB. Stable fixation of normal and osteoporotic ribs. · AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.6

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