Inventory Control Form Variable Angle LCP™ Distal Radius Plates Case Information (eg, Case ID): Date: Hospital: Surgeon: Procedure: Implants 2.4 mm VA LCP™ Narrow Two-Column Volar Distal Radius Plates Volar Distal Radius Plates Head Shaft 02.111.520 right 02.111.521 left 02.111.530 right 02.111.531 left 02.111.540 right 02.111.541 left 02.111.550 right 02.111.551 left 2.4/2.7 mm VA LCP Two-Column Volar Distal Radius Plate, Extra-Long* 02.111.620 right 02.111.621 left 02.111.630 right 02.111.631 left 02.111.640 right 02.111.641 left 02.111.650 right 02.111.651 left 02.111.720 right 02.111.721 left 02.111.730 right 02.111.731 left 02.111.740 right 02.111.741 left 02.111.750 right 02.111.751 left 2.4 mm VA LCP Dorsal Distal Radius Plate, Radial Column *Available sterile only. Some devices in this form may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada. VALCPDISRADPLATICF001 04/22

Inventory Control Form Variable Angle LCP Distal Radius Plates Implants (cont’d) 2.4 mm VA LCP Volar Rim Distal Radius Plates 2.4 mm VA LCP Dorsal Distal Radius Plate, Intermediate Column 02.115.630 02.115.631 02.115.640 02.115.641 2.4 mm VA LCP Dorsal Distal Radius L-Plate, 2 holes head 02.115.130 02.115.131 02.115.150 02.115.151 Head Holes Length 6 57 mm, right 6 57 mm, left 7 57 mm, right 7 57 mm, left Volar Distal Radius Plates Angled +90° –90° +90° –90° 2.4 mm VA LCP Dorsal Distal Radius L-Plate, 3 holes head 2.4 mm VA LCP Dorsal Distal Radius L-Plate, oblique, 3 holes head Shaft Holes Length...

Inventory Control Form Variable Angle LCP Distal Radius Plates Implants (cont’d) 2.7 mm Cortex Screw, self-tapping, Drill Bits with T8 STARDRIVE Recess Plate Reduction Wires 2.4 mm Locking Screw, self-tapping, with T8 STARDRIVE Recess 1.25 Plate Reduction Wire, threaded top with large stop, 150 mm Kirschner Wires with T8 STARDRIVE Recess 02.111.500.10 1.25 Plate Reduction Wire, threaded top with small stop, 150 mm 1.8 mm Variable Angle Locking Buttress Pins, 310.19 2.0 mm, quick coupling, 100 mm 310.26 2.7 mm, quick coupling, 100 mm 310.509 mm with depth mark, quick coupling, 110 mm 1.8 310.530...

Some devices in this form may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada. © DePuy Synthes 2017, 2022. All rights reserved. VALCPDISRADPLATICF001 04/22 DV