Surgical Technique Radiographs courtesy of James Nicholson MD, Stony Brook, NY Grip and Plate System US Patent Nos. 7,207,090; 8,469,967; 9,107,720. JP Pat. No. 4,829,236; 5,938,095. EU Pat. Nos. 1,389,940; 1,781,961; 2,117,452; 2,432,401; 3,013,268. TUR Pat. Nos. TR201309922T4; TR201405440T4. Additional US & World Patents Pending.

Trochanteric Gre 6 Hole Plat* Straight. 245mm 5-200 1 TROCHANTERIC GRIPS CABLE PLATES Refer to product package insert for additional details. 2

The Kinamed SuperCable® Trochanteric Grip and Cable-Plate System is designed specifically for use with the SuperCable Iso-Elastic™ polymer cerclage cable3637. Holes integrated in the grips and plates allow passage of the SuperCable for secure fixation of the plate to bone. Screw fixation may be achieved using locking screws*, compression screws, or a combination of both. The unique figure-of-eight design of the screw fixation holes allows locking or compression screws to be used on either side, giving the surgeon greater flexibility in the management of complex fractures. Trochanteric grips and...

• Integrated holes designed specifically for use with SuperCable polymer cerclage cables • Unique cable hole geometry minimizes cable stress • Proximal tines designed to engage lateral cortex of trochanter • Smaller distal tines provide additional stability • Proximal screw hole allows for secure fixation of the greater trochanter using a locking or standard bone screw • Extended grips allow additional cable placement and compression, locking, or combination screw fixation distal to the lesser trochanter • Titanium construction • Integrated holes designed specifically for use with SuperCable...

Fixation PrinciplesCompression Plating • Fracture is stabilized with the option of imparting interfragmentary compression • Absolute stability of the fracture is necessary for primary healing response to occur4,7,17,37 • Stability of the construct under loading is dependent on compression of the plate against bone resulting in friction between the plate and bone4,7,25 • Not a fixed angle construct; screws may toggle in the plate and loosen independently4,7,14,32 • Periosteum may be compressed beneath plate, limiting blood flow4,26 • Compression of the plate against bone may not be possible in...

Grip Design Rationale “Lateral vs. Over-the-Top” Background Unlike prior grip designs, in which the tines are intended to be placed "over the top” of the trochanter, SuperCable grips are designed to achieve trochanteric fixation laterally without violating the hip abductors. This approach generally requires less need for implant contouring. To enable lateral fixation, the grip has sharp proximal tines that are designed to penetrate the lateral trochanter as well as a proximal locking screw hole that allows for supplementary locking screw fixation. The SuperCable Grip design offers several unique...

Surgical Technique Trochanteric Grip Fixation Technique Step 1. Select Grip Choose the trochanteric grip that is most appropriate for the fractured or osteotomized trochanter fragment. Refer to page 2 for available grip options. A “trial” grip is available in the instrument set to assess fit and help select the best size option. Note that the trial has shortened and dulled tines such that the tines on the trial do not need to penetrate the trochanter to assess approximate fit. The trial is the length of a 2-hole, 135 mm grip implant and the requirement for a longer or shorter grip implant can...

Contouring of the grips is not recommended (see d e s i g n rationale on Page 6). If contouring of the grip is necessary, use a bending press rather than plate bending irons. The optimal location for bending is in the “neck” region, between the second and third set of cable holes. Do not bend in the area of cable or screw holes. DO NOT BEND AT HOLES BEND HERE Step 4. Cable Passage Introduce the Cable Passer such that the distal end of the cannula emerges on the operator’s side of the bone. Introduce cable strands into distal end of the cannula and pass around the bone. The strands of the proximal...

Surgical Technique Trochanteric Grip Fixation Technique (continued) Step 5. Secure Cable and Apply Tension Feed the ends of the cable through its locking clasp (A) and pull taut so that each cable strand is the same length (B). Tension in each cable strand should be equalized. After the two free cable ends are inserted into the tensioning instrument (C), the ends should be pulled taut so as to equalize their length and so the tensioner can be slid down into position (D), engaging the nosepiece into the slots on the clasp (E). Use thumb to push free cable ends into cleat to firmly grip cable ends...

Maintain proper alignment with cable clasp. Confirm zero alignment of knobs prior to tensioning. • While maintaining engagement and proper alignment between the tensioning instrument and clasp (G), apply tension by turning the outer knob on the tensioning instrument clockwise. Be careful to grasp only the outer knurled (textured) part of the knob while turning. Confirm zero alignment of knobs prior to tensioning (H). Continue turning the knob until the desired compression is achieved. The indicator marks (LO, HI) should be read while torque is applied to the outer knob (I and J) and the knob...

• It may be helpful to rotate the cable locking clasp to improve tensioner access. In general, position the locking clasp close to the grip or cable-plate at the 2 o’clock position as shown in the cross-sectional illustration in order to provide the best “approach angle” for the tensioner. Such positioning also reduces the amount of soft-tissue that could be impinged by the tensioner. • Firmly secure the grip with cables or reduction clamps prior to drilling and placing locking screws. Failure to do so may prevent the threaded screw head from properly engaging the grip or plate. • Utilize large...