2022 Jul;10(13):727. doi: 10.21037/atm-22-750. An official website of the United States government. Martin Hessmann, Sean Nork, Christoph Sommer, Bruce Twaddle, Joseph Schatzker, Peter Trafton, Michael Baumgaertner. Level of evidence: The pin placement in the talar neck, which is anterior to the axis of rotation of the talus, will produce ankle joint distraction and plantarflexion, maximizing articular visualization. This incision is centered at the ankle joint, parallel to the fourth metatarsal distally, and parallel to and between the tibia and fibula proximally. Advantages also include good soft tissue cover, ability to get to both tibia and fibula and if there is an open wound on the medial side. 0000034365 00000 n based on the fracture line measurements, three different distal tibia anterolateral plates from two manufacturers (depuy synthes, paoli, pa; smith and nephew, memphis, tn) were applied to three distal tibia sawbones according to the manufacturer's guide (smith & nephew 3.5 mm peri-loc plate fig. Since the anterior compartment muscles arise from the anterior fibula, the incision is usually not extended more than seven centimeters above the ankle joint. Treatment of the tibial pilon fractures using the antero-medial fibula approach: Ten case series. Attempting to advance beyond this point maycause screw threads to strip in the bone.Remove the power tool and begin tightening the nut towardthe plate while monitoring progress under C-arm. Find top doctors who treat Distal Tibia Pilon Fractures near you in Fremont, CA. LCP Anterolateral Distal Tibia Plates (3.5 mm) LCP Medial Distal Tibia Plate (3.5 mm) LCP Posteromedial Proximal Tibia Plate (3.5 mm) Proximal Tibia Plates; Small Fragment LCP Titanium Cannulated Tibial Nail EX; TomoFix Medial High Tibia Plate; Variable Angle LCP Ankle Trauma System (2.7mm/3.5mm) Variable Angle LCP Proximal Tibia . LCP Anterolateral Distal Tibia Plate 3.5. sharing sensitive information, make sure youre on a federal Introduction Accepted approaches for tibial plateau fractures vary from minimally invasive to combinations of incisions for complex fracture . Background: 0000057337 00000 n anterolateral plateau provides access to extensive posterior plateau fractures. 0000033310 00000 n Bethesda, MD 20894, Web Policies Performing this action will revert the following features to their default settings: Hooray! All four anterolateral plates buttressed the area of highest comminution and had an average of 1.25 screws in the medial fragment and an average of 3 screws in the posterolateral fragment. The 3.5 mm LCP Anterolateral Distal Tibia Plates are part of the DePuy Synthes Locking Compression Plate (LCP ) System, merging locking screw technology with conventional plating techniques. 0000093725 00000 n 2011 Jun;32(6):630-7. doi: 10.3113/FAI.2011.0630. Unable to load your collection due to an error, Unable to load your delegates due to an error. 0000018410 00000 n The threaded rod of the small distractor is placed posterolaterally to avoid interference with reduction and implant placement. Distally, the extensor retinaculum is incised, and the anterior compartment tendons are all retracted medially. 0000079764 00000 n This nerve invariably crosses the surgical incision proximal to the ankle joint. FOIA Stopwhen the desired reduction is achieved.Synthes 13. LCP Anterolateral Distal Tibia Plate 3.5. 0000016155 00000 n Grau L, Collon K, Alhandi A, Kaimrajh D, Varon M, Latta L, Vilella F. Rammelt S, Bartonek J, Schepers T, Kroker L. Oper Orthop Traumatol. 2 a, depuy synthes 3.5 mm locking compression plate hb```b``Wa`c`` B@1v",lm,@I7|)}LP=|-q#2+.=Ji /4'?}"` Distally, the incision can extend as far as the talonavicular joint. World J Clin Cases. Materials and methods: The biomechanical stiffness of anterolateral or medial plated pilon fracture models was evaluated. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation. Based on these average measurements, three distal tibia sawbones had three different anterolateral plates applied. 0000012114 00000 n With the nut in thehighest position possible, begin power insertion of the instrumentfor temporary reduction into the near cortex. Anterolateral and medial locking plate stiffness in distal tibial fracture model. These muscles and tendons are usually easy to mobilize from the underlying anterior tibiofibular ligament, the periosteum of the distal tibia, and the joint capsule. Identification of risk factors for surgical site infection after type II and type III tibial pilon fracture surgery. It is well suited for an accurate articular reduction, as well as submuscular and subcutaneous plate applications spanning metaphyseal comminution. Gafam. Hollensteiner M, Sandriesser S, Bliven E, von Rden C, Augat P. Curr Osteoporos Rep. 2019 Dec;17(6):363-374. doi: 10.1007/s11914-019-00535-9. LCP Anterolateral Distal Tibia Plate 3.5. This instrument can be used for: Minor varus-valgus adjustment Translational adjustments Provisional fixation Stabilization of plate-bone orientation during insertion ofthe first screws Alignment of segmental fragmentsConnect the instrument for temporary reduction to a powerdrive and place it in the desired hole. Dissection through the skin and subcutaneous tissues should proceed sharply with maintenance of full thickness skin flaps. 0000032905 00000 n Epub 2021 Mar 22. IndicationsThe LCP Anterolateral Distal Tibia Plate 3.5 is indicated for:- Extra-articular and simple intra-articular distal tibiafractures- Distal tibia fracture, percutaneous or reducible by limitedarthrotomy- Distal tibia fracture extending into the diaphyseal areaSynthes 5 Keywords: 2020 Jul 10;99(28):e20576. 0000023611 00000 n 0000027301 00000 n Overview The LCP Anterolateral Distal Tibia Plate 3.5 is part of the Synthes Small Fragment LCP System that merges locking screw technology with conventional plating techniques. Epub 2010 Sep 25. The combi-holes in the LCP limited-contact plate shaft com-bine a dynamic compression unit (DCU) hole with a locking screw hole. 1-A through 1-G Complications after conventional nailing in a 71-year-old woman.Figs. All three plates were deficient in capturing the medial malleolar fragment. 0000034247 00000 n 0000079685 00000 n . Performing this action will revert the following features to their default settings: Hooray! 0000065759 00000 n 1-E Radiograph, made at 6 months, showing a femoral . doi: 10.1097/MD.0000000000020576. The fascia of the extensor digitorum brevis can be incised, with the muscle carefully dissected and retracted medially. Illustration shows a partial articular distal tibia fracture. You have already flagged this document.Thank you, for helping us keep this platform clean.The editors will have a look at it as soon as possible. Dec 416, 2022, Revised proximal femur module is now online, Anterior and anterolateral partial articular pilon fractures, Some extraarticular distal tibia fractures stabilized with a submuscular anterior compartment plate. trailer <<69176510A62847A0B5FBD9DF1535896B>]/Prev 987202/XRefStm 2711>> startxref 0 %%EOF 1204 0 obj <>stream 0000032984 00000 n Book an appointment today! Foot Ankle Int. Please enter a valid 5-digit Zip Code. 2 Surgical Technique LCP Anterolateral Distal Tibia Plate 3.5 The LCP Anterolateral Distal Tibia Plate 3.5 is part of the Synthes Small Fragment LCP System that merges locking screw technology with conventional plating techniques. LCP Anterolateral Distal Tibia Plate 3.5 LCP Clavicle Hook Plate LCP Compact Foot / Compact Hand LCP Compact Hand LCP Compact Hand 1.5 LCP Condylar Plate 4.5/5.0 LCP DHHS . If the plate contour is changed, it is importantto check the position of the screws in relation to thejoint, using the screw placement verification technique onpage 14.Technique tip: To adjust the plate into final position, inserta Kirschner wire or partially insert a cortex screw or cancellousbone screw into the elongated hole or a combi-hole beforeinserting a locking screw.12 Synthes LCP Anterolateral Distal Tibia Plate 3.5 Technique Guide, Optional instruments324.214 Drill Bit 2.8 mm, with Scale,length 200/100 mm324.024324.024 Instrument for Temporary ReductionThe instrument for temporary reduction is placed throughplate holes to push or pull bone fragments in relation to theplate. 0000004419 00000 n 0000003096 00000 n 0000007843 00000 n 0000057378 00000 n Scallops on the distal end of the Anterolateral Distal Tibia Locking Plate allow easy placement of lag screws outside the plate for fixation of articular fractures. 0000007652 00000 n Magazine: LCP Anterolateral Distal Tibia Plate 3.5. Tarsal Plates The Synthes 2.4 mm/2.7 mm locking tarsal plates are intended for the fixation of fractures, osteotomies, nonunions, replantations, and 0000033159 00000 n Biomechanics of Osteoporotic Fracture Fixation. The Aplus Asia Distal Lateral . Clipboard, Search History, and several other advanced features are temporarily unavailable. It is well suited for an accurate articular reduction, as well as submuscular and subcutaneous plate applications spanning metaphyseal comminution. Axial CT scan images were used to determine the efficacy of screw purchase in main fracture fragments in pilon fractures. 0000002711 00000 n Intra-articular Pilon fractures remain therapeutically challenging due to osteochondral fracturing and comminution, marginal impaction, and insult to the soft tissue envelope. Number and placement of plate holes as well as the screw trajectories are designed for treatment of a wide range of fracture types. 0000004458 00000 n 2 mm. Level of Evidence Level IV, retrospective study. The PERI-LOC and 2.7/3.5 mm VA-LCP did not differ with respect to percentage of fragments captured (p = 0.721) but both outperformed the 3.5 mm LCP (p = 0.021 and p = 0.05, respectively). Plate Insertion4Position plate and fix provisionallyOptional instrumentsX92.200 Kirschner Wire 2.0 mm, with trocar tip324.024 Instrument for Temporary ReductionThe plate may be temporarily held in place using any of thefollowing options. 1-C and 1-D Postoperative anteroposterior and lateral radiographs made after intramedullary nailing.Fig. The low profile - Synthes. 0000033793 00000 n The three radiographic views show a distal tibial complete articular fracture. Proximally, the dissection is limited by the origin of the anterior compartment muscles from the fibula and from the interosseous membrane. Yan L, Zhan Y, Xie X, Wang Y, Zhang Y, Luo C. Ann Transl Med. Accessibility 1149 0 obj <> endobj xref Proper location of the arthrotomy, preplanned to lie over the fracture, is critical to avoid unnecessary and damaging devascularization of fracture fragments. You have already flagged this document.Thank you, for helping us keep this platform clean.The editors will have a look at it as soon as possible. The combi-holes in the LCP limited-contact plate shaft combine a dynamic compression unit (DCU) hole with a 0000018872 00000 n The Synthes 3.5 mm LCP captured 86.5% of the fracture lines but was the best at securing the Volkmann fragment (1.2% missed). This allows exposure of the talar neck for pin placement and distractor application. Find a doctor near you. 0000065377 00000 n For Proximal Lateral Tibia, Proximal Medial Tibia, Distal Anterolateral Tibia, Distal Medial Tibia, Proximal Lateral Humerus, Distal Lateral Femur Plating System, AxSOS 3 Titanium Plating System, 4.0 ORIF Instrumentation. 5:7\e7O). Epub 2016 May 20. Crossref Medline Google Scholar; 8. 2016 Aug;47(8):1761-9. doi: 10.1016/j.injury.2016.05.026. Once locking screws are inserted, further reductionis not possible without loosening the locking screws.Note: This locking plate is precontoured to fit the anterolateraldistal tibia. Penny P, Swords M, Heisler J, Cien A, Sands A, Cole P. Injury. 3rd Edition. These anatomically shaped 3.5mm plates are available in stainless steel or titanium alloy with 5-21 hole configurations. official website and that any information you provide is encrypted 0000016626 00000 n Ability of modern proximal tibial lateral plates to capture posterolateral tibial plateau fracture fragments. The distal approach for anterolateral plate fixation of the tibia: an anatomic study. Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: Is dual plate fixation necessary? 0000008022 00000 n Results: The anatomical contour of the 3.5mm Anterolateral Distal Tibia Locking Plate provides an excellent fit against the surface of the bone. Are you sure you want to delete your template? 0000033618 00000 n - Synthes . 0000108722 00000 n Figs. For Use With. Please enable it to take advantage of the complete set of features! 0000065336 00000 n Of the 4 anterolateral plates used, only the variable angle anterolateral plate by Depuy Synthes captured the medial fragment with two screws. 0000017374 00000 n Filling Open Screw Holes in the Area of Metaphyseal Comminution Does Not Affect Fatigue Life of the Synthes Variable Angle Distal Femoral Locking Plate in the AO/OTA 33-A3 Fracture Model. The low profile - Synthes. 0000065645 00000 n Medicine (Baltimore). Berlin: Springer-Verlag. These options also prevent plate rotationwhile inserting the first locking screw: Instrument for temporary reduction in a screw hole thatwill not immediately be used (as shown in this techniqueguide) Cortex screw 3.5 mm or cancellous bone screw 4.0 in a locking or combi-hole Standard plate holding forceps Kirschner wires through the plate Cortex screw 2.7 mm in one of the distal holesAfter plate insertion, check alignment on the bone using fluoroscopy.Ensure proper reduction before inserting the firstlocking screw. However, access to the medial ankle joint is poor, and proximal extension is limited. 1991.4 Synthes LCP Anterolateral Distal Tibia Plate 3.5 Technique Guide, IndicationsThe LCP Anterolateral Distal Tibia Plate 3.5 is indicated for: Extra-articular and simple intra-articular distal tibiafractures Distal tibia fracture, percutaneous or reducible by limitedarthrotomy Distal tibia fracture extending into the diaphyseal areaSynthes 5. 0000001443 00000 n 0000021537 00000 n The slope of the tibial plateau is altered by cutting the tibia and rotating the tibial plateau and applying a plate which is further locked into place with locking screws in order to stabilize the joint. The low profile - Synthes. The low profile . The Synthes 2.7/3.5 mm VA-LCP captured 87.3% of the fracture lines while missing the Volkmann fragment 3.2% of the time. Disposable. The distal design respects the minimal . All three implants were deficient in capturing the medial malleolar fragment. 2 Surgical Technique LCP Anterolateral Distal Tibia Plate 3.5 The LCP Anterolateral Distal Tibia Plate 3.5 is part of the Synthes Small Fragment LCP System that merges locking screw technology with conventional plating techniques. The anterolateral approach offers excellent visualization of the tibial articular surface as far as the medial malleolus, while avoiding dissection of the anteromedial tibial face. MeSH The Arthrex Distal Tibial Plating System has been designed for versatile treatment of all distal tibial fracture patterns. 0000000016 00000 n 0000017840 00000 n 2022 Jul 6;10(19):6399-6405. doi: 10.12998/wjcc.v10.i19.6399. Methods: Post-operative x-rays are taken to assess whether the repair in sufficient. LCP Anterolateral Distal Tibia Plate 3.5. This study was consistent with prior literature in defining three main fracture fragments: anterior, medial, and posterior. Length. Locking screw technology is an innovation in fixation systems because it provides surgeons with the ability to create a fixed-angle construct while using familiar AO plating techniques. Proximal Tibia Plates DePuy Synthes Proximal Tibia Plates are available in 3.5 and 4.5mm and merge conventional plating techniques with locking screw technology. 0000095989 00000 n The Aplus Asia Distal Lateral Tibial Locking Plate has better stabilization and is an anterolateral plate that avoids more soft tissue damage than other bone plates. Sterile. The Arthrex Distal Tibia Plating System was designed for the versatile treatment of distal tibia fractures. Includes anterolateral, medial, anterior, and posterior tibia plates; 2.7 mm straight plates; and two styles of posterolateral fibula plates Particular attention was placed on maintaining a low-profile design by optimizing contour and fit to minimize soft-tissue irritation The . Yenna ZC, Bhadra AK, Ojike NI, ShahulHameed A, Burden RL, Voor MJ, Roberts CS. The comprehensive plate offering . 0000002914 00000 n Take care not to damage the superficial peroneal nerve which lies directly beneath the skin. Distal Tibia and Fibula Plates 2.7/3.5. See Guidelines for Authors for a complete description of levels of evidence. Contact Us . Casstevens C, Le T, Archdeacon MT, Wyrick JD. 2008; 22(6):404-407. NCI CPTC Antibody Characterization Program. HHS Vulnerability Disclosure, Help Email a Rep. For each patient, the fracture lines were mapped, digitized, and graphically superimposed to create a compilation of fracture lines. The LCP Anterolateral Distal Tibia Plate 3.5 is part of the Synthes Small Fragment LCP System that merges locking screw technology with conventional plating techniques. The DePuy Synthes TPLO System has been designed for you and your patients in conjunction with and approved by the AO Technical Commission to ensure the best possible outcomes. %PDF-1.4 % Your file is uploaded and ready to be published. The low profile - Synthes. 0000017940 00000 n 0000033675 00000 n 1-A and 1-B Preoperative radiograph and MRI scan showing an incomplete atypical femoral fracture with grade-III lateral bowing and bone edema.Figs. Bookshelf 0000004304 00000 n The system comprises LOQTEQ distal tibia plates for medial and anterolateral application as well as lateral distal fibula plates. Additionally, the distractor helps to align several of the major articular fragments. 2021 Apr;33(2):125-138. doi: 10.1007/s00064-021-00703-0. 3 . Combi-holes provide the flexibility of axial com- The combi-holes in the LCP limited-contact plate shaft combine a dynamic compression unit (DCU) hole with a Conclusions MIPO for distal tibia fracture is considered to be an effective operative method, because of its high bone union rate and low complications by minimal disruption of soft tissue and. AO Manual of InternalFixation. A 4 mm Schanz pin is placed transversely from lateral to medial at the talar neck through the surgical incision. This site needs JavaScript to work properly. 0000019501 00000 n From May 2011 to Dec 2015, 169 OTA C-type pilon fractures met inclusion and exclusion criteria with computed tomographic (CT) scans performed prior to definitive fixation. 1 These principles,as applied to the LCP Anterolateral Distal Tibia Plate 3.5, are:Anatomic reductionAnatomic plate profile and four parallel screws near the jointassist reduction of metaphysis to diaphysis to restore alignmentand functional anatomy. This comprehensive ankle plating system addresses the individual surgeons preferences, offering low-profile variable angle locking compression plating (VA-LCP) options for the medial, anteromedial, anterolateral and posterolateral aspects of the distal tibia, and the lateral distal fibula. 0000033060 00000 n The LCP Anterolateral Distal Tibia Plate 3.5 is part of the Synthes Small Fragment LCP System that merges locking screw technology with conventional plating techniques. Each screw hole will accept one of four different The .gov means its official. The Smith and Nephew PERI-LOC plate secured the most number of fracture lines, while the Synthes 3.5 mm LCP was least likely to miss the Volkmann fragment and most likely to miss the medial malleolar fragment. 10.1097/BOT.0b013e31817614b2. The fascia over the anterior compartment of the distal tibia is incised sharply, beneath the superficial peroneal nerve. The low profile anatomic fixation system with optimal plate placement and angular stability. Tibial pilon fractures: which method of treatment? The purpose of this study was to compare the efficacy of anterolateral distal tibial locking plates in capturing main fracture fragments in tibial plafond fractures. The anterolateral approach is useful for: The anterolateral approach offers excellent visualization of the tibial articular surface as far as the medial malleolus, while avoiding dissection of the anteromedial tibial face. 1149 56 PMC Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software. 8600 Rockville Pike Calori GM, Tagliabue L, Mazza E, de Bellis U, Pierannunzii L, Marelli BM, Colombo M, Albisetti W. Injury. Disclaimer, National Library of Medicine 0000010326 00000 n 0000098253 00000 n 0000030905 00000 n Yes. Anatomic reduction ismandatory for intra-articular fractures to restore joint congruency.Stable fixationThe combination of conventional and locking screws offersoptimum fixation regardless of bone density.Preservation of blood supplyLimited-contact plate design reduces plate-to-bone contactand helps to preserve the periosteal blood supply.Early mobilizationPlate features combined with AO technique create anenvironment for early bone healing, expediting return tofunction.1M.E. Connect with peers, learn from experts. The site is secure. LCP Anterolateral Distal Tibia Plate 3.5. Careers. 0000006238 00000 n government site. The location you tried did not return a result. LIST YOUR PRACTICE ; Dentist ; Pharmacy ; Search . A second 4 mm Schanz pin is placed from lateral to medial at the tibia, proximal to the anticipated plate application. Proximally, the entire anterior compartment musculature, including the peroneus tertius, can then be mobilized and retracted medially. The combi-holes in the LCP limited-contact plate shaft com- bine a dynamic compression unit (DCU) hole with a locking screw hole. synthes dentoalveolar bone fixation system: SYNTHES (USA) K102656: 12/20/2010 synthes orthodontic bone anchor system: SYNTHES (USA) K093299: 12/16/2010 2.4mm va-lcp dorsal distal radius plates: SYNTHES (USA) K102694: 12/09/2010 Diameter. Three. YUMPU automatically turns print PDFs into web optimized ePapers that Google loves. AO ASIF PrinciplesIn 1958, the AO ASIF (Association for the Study of Internalfixation) formulated four basic principles, which have becomethe guidelines for internal fixation. 0000065456 00000 n Six Sawbones Composite Tibiae with a simulated pilon fracture representing varus or valgus comminution (OTA 43-A2.2) were plated with a Synthes 3.5-mm contoured LCP anterolateral or medial locking distal tibia plate. . The https:// ensures that you are connecting to the 0000031025 00000 n Anterolateral distal tibia locking plate osteosynthesis and their ability to capture OTAC3 pilon fragments Anterolateral distal tibia locking plate osteosynthesis and their ability to capture OTAC3 pilon fragments Authors Arun Aneja 1 , T David Luo 2 , Boshen Liu 3 , Molina Domingo 4th 4 , Kerry Danelson 5 , Jason J Halvorson 6 , Eben A Carroll 6 This comprehensive Variable Angle LCP Ankle Trauma System 2.7/3.5 addresses the individual surgeon's preferences, offering low-profile variable angle locking compression plating (VA-LCP) options for the medial, anteromedial, anterolateral and posterolateral aspects of the distal tibia, and the lateral distal fibula. Stopinsertion before the end of the threaded portion meets theplate surface. Magazine: LCP Anterolateral Distal Tibia Plate 3.5. In particular, the overall slope of the tibial . 0000033872 00000 n Our products -spanning reconstruction, trauma, instruments, soft tissue repair, and biologics -treat lower extremity fractures and deformities,and provide one of the most comprehensive portfolios of orthopedic patient solutions in the world. Application of a distractor intraoperatively greatly assists with articular visualization. It should be identified, mobilized, and protected throughout the surgical procedure. Are you sure you want to delete your template? 1* The DePuy Synthes TPLO System is the ONLY AO-Approved TPLO System. Foot and Ankle Foot and Ankle DePuy Synthes is a global leader in medical devices for Foot & Ankle. and transmitted securely. Would you like email updates of new search results? 2010 Nov;41(11):1183-90. doi: 10.1016/j.injury.2010.08.041. Distal tibia; Fracture pattern; OTA 43C; Osteosynthesis; Tibial pilon fracture. Conclusions: J Orthop Trauma. No plate was found to be superior to the other in capturing all fracture lines of the OTAC3 pilon fragments. Tibial Plateau Leveling Osteotomy (TPLO) System. . 0000016816 00000 n Before 0000034190 00000 n Fixation of anterolateral distal tibial fractures: the anterior malleolus. 1. The Smith & Nephew PERI-LOC plate secured the largest number of fracture lines (90.1%) but missed the Volkmann fragment with greatest frequency at 3.6%. 234 mm. Search doctors, conditions, or procedures . Federal government websites often end in .gov or .mil. Your file is uploaded and ready to be published. Post-Surgery Care. 0000014147 00000 n 0000138013 00000 n Synthes Trauma develops, manufactures, and markets the AO system of orthopaedic implants and instruments, including trauma implants and instruments are used for the surgical treatment of fractures . 0000019415 00000 n Mller, M. Allgwer, R. Schneider, H. Willenegger. 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Efficacy of screw purchase in main fracture fragments in pilon fractures, then... Ojike NI, ShahulHameed a, Sands a, Sands a, RL! Complications after conventional nailing in a 71-year-old woman.Figs full thickness skin flaps 2.7/3.5 mm VA-LCP captured 87.3 % the... A dynamic compression unit ( DCU ) hole with a locking screw hole System was designed for of. Practice ; Dentist ; Pharmacy ; Search you like email updates of new Search?! Insertion of the fracture lines of the tibial surgical site infection after type II and III., made at 6 months, showing a femoral anterolateral distal tibia plate synthes Osteosynthesis ; tibial pilon fractures this nerve crosses. Of the small distractor is placed from lateral to medial at the neck! The Volkmann fragment 3.2 % of the time for surgical site infection type... Far as the screw trajectories are designed for versatile treatment of the time dissection limited. 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