Braun Aesculap MACS II Manual

Aesculap®
Aesculap Spine
en Instructions for use/Technical description
MACS II
USA Note for U.S. users
This Instructions for Use is NOT intended for United
States users. Please discard. The Instructions for Use
for United States users can be obtained by visiting our
website at www.aesculapImplantsystems.com. If you
wish to obtain a paper copy of the Instructions for
Use, you may request one by contacting your local
Aesculap representative or Aesculap's customer ser-
vice at 1-866-229-3002. A paper copy will be pro-
vided to you upon request at no additional cost.
de Gebrauchsanweisung/Technische Beschreibung
MACS II
fr Mode d’emploi/Description technique
MACS II
es Instrucciones de manejo/Descripción técnica
MACS II
it Istruzioni per l’uso/Descrizione tecnica
MACS II
pt Instruções de utilização/Descrição técnica
MACS II
nl Gebruiksaanwijzing/Technische beschrijving
MACS II
sv Bruksanvisning/Teknisk beskrivning
MACS II
ru Инструкция по примению/Техническое опи-
сание
MACS II
cs Návod k použití/Technický popis
MACS II
pl Instrukcja użytkowania/Opis techniczny
MACS II
sk Návod na použitie/Technický opis
MACS II
tr Kullanım Kılavuzu/Teknik açiklama
MACS II

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6 7 9
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10 11 7 1312
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711
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17 18 19 2015 6 16
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13 7
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G

11 13 6 15
9
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13 7
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26
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27a 27
27b
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29 30 31 32
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Aesculap®
MACS II
Legend
A Mounting instruments
1Torque wrench for mounting the retaining bolt
2Mounting tool for SX804T
B K-wire instruments
3K-wire protection
4K-wire set, sterile
aK-wire (x2)
b Removal instrument (x1)
5K-wire insertion instrument
aAiming tube
bHandle rod
cImpactor
dCounter holder
C Insertion instruments for polyaxial screw
6Cannulated screwdriver
7Guide tube
8Counter torque (cleaning rod, counter torque with-
out cleaning rod)
9Ball-end screwdriver
D Insertion instruments for stabilization plate
7Guide tube
8Counter torque (cleaning rod, counter torque with-
out cleaning rod)
10 Holding forceps for rods/plates
11 Socket wrench for nut
12 Torque wrench for nut
13 Screwdriver for retaining bolt (optional)
E Insertion instruments for SSE connecting rods
7Guide tube
8Counter torque (cleaning rod, counter torque with-
out cleaning rod)
10 Holding forceps for rods/plates
11 Socket wrench for nut
12 Torque wrench for nut
13 Screwdriver for retaining bolt (optional)
14 SSE rod bending pliers
F Insertion instruments for stabilization screw
6Cannulated screwdriver
15 Screw revision instrument
16 Lumbar centering tool
17 Aiming sleeve for lumbar stabilization screw
18 Aiming sleeve for thoracic stabilization screw
19 Centering tool for purple stabilization screw
20 Screwdriver for purple stabilization screw, see
TA011177
G Insertion instruments for stabilization screw
7Guide tube
8Counter torque (cleaning rod, counter torque with-
out cleaning rod)
13 Screwdriver for retaining bolt (optional)
21 Torque wrench for retaining bolt
H Revision instruments
6Cannulated screwdriver
9Ball-end screwdriver
10 Holding forceps for rods/plates
11 Socket wrench for nut
13 Screwdriver for retaining bolt (optional)
15 Screw revision instrument
20 Screwdriver for purple stabilization screw, see
TA011177
22 T-handle with ¼" coupling
I Instruments for intraoperative disassembly/
mounting of the pre-assembled retaining bolt
1Torque wrench for mounting the retaining bolt
7Guide tube
8Counter torque (cleaning rod, counter torque with-
out cleaning rod)
13 Screwdriver for retaining bolt (optional)
22 T-handle with ¼" coupling
J Implant components
23 SSE connecting rod, 5.2 mm
24 Stabilization plate
25 Clamping element T

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26 Clamping element TL
27 Pre-assembled retaining bolt
aCentralizer
bRetaining bolt
28 Locknut
29 Stabilization screw, 4.5 mm, purple
30 Stabilization screw, 6.5 mm, yellow
31 Polyaxial screw, 7.0 mm, blue
32 Polyaxial screw XL, 10 mm, blue
1. About this document
Note
General risk factors associated with surgical procedures
are not described in these instructions for use.
1.1 Scope
These instructions for use apply for MACS II systems.
Note
The applicable CE mark for the product can be seen on
the label or packaging of the product.
►For article-specific instructions for use as well as
information on material compatibility and lifetime
see B. Braun eIFU at eifu.bbraun.com
1.2 Safety messages
Safety messages make clear the dangers to patient,
user and/or product that could arise during the use of
the product. Safety messages are labeled as follows:
WARNING
Indicates a possible threat of danger. If not avoided,
minor or moderate injury may result.
CAUTION
Indicates a possible threat of material damage. If
not avoided, the product may be damaged.
2. Clinical use
2.1 Product description
2.1.1 System components and available sizes
Item no. Art. no. Designation
1FW419R Torque wrench for mounting
the retaining bolt
2FW429 Mounting tool for SX804T
3FW394R K-wire protection
4FW406S K-wire set, sterile
(K-wire x2, removal instru-
ment x1)
5FW408R K-wire insertion instrument
(aiming tube, handle rod,
impactor, counter holder)
6FW398R Cannulated screwdriver
7FW397R Guide tube
8FW399R Counter torque (cleaning rod,
counter torque without
cleaning rod)
9FW396R Ball-end screwdriver
10 FW326R Holding forceps for
rods/plates
11 FW417R Socket wrench for nut
12 FW416R Torque wrench for nut (cas-
ing, handle, wrench)
13 FW411R Screwdriver for retaining bolt
14 FW013R SSE rod bending pliers
15 FW336R Screw revision instrument
16 FW407R Lumbar centering tool
17 FW409R Aiming sleeve for lumbar sta-
bilization screw
18 FW413R Aiming sleeve for thoracic
stabilization screw
19 FW405R Centering tool for purple sta-
bilization screw

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20 FW342R Screwdriver for purple stabi-
lization screw (see TA011177
instructions for use)
21 FW412R Torque wrench for retaining
bolt
22 FW395R T-handle, 1/4" coupling
23 SX110T
SX112T
SX115T
SX118T
SX120T
100 mm SSE connecting rod,
5.2 mm
120 mm SSE connecting rod,
5.2 mm
150 mm SSE connecting rod,
5.2 mm
180 mm SSE connecting rod,
5.2 mm
200 mm SSE connecting rod,
5.2 mm
24 SX810T
SX811T
SX812T
SX813T
SX814T
SX834T
SX835T
SX839T
SX816T
SX840T
SX817T
SX841T
SX818T
Stabilization plate, 40 mm
Stabilization plate, 45 mm
Stabilization plate, 50 mm
Stabilization plate, 55 mm
Stabilization plate, 60 mm
Stabilization plate, 65 mm
Stabilization plate, 70 mm
Stabilization plate, 75 mm
Stabilization plate, 80 mm
Stabilization plate, 85 mm
Stabilization plate, 90 mm
Stabilization plate, 95 mm
Stabilization plate, 100 mm
25 SX801T Clamping element T
26 SX800T Clamping element TL
27 SX804T Pre-assembled retaining bolt
(retaining bolt, centralizer)
28 SX802T Locknut
29 SX826T
SX827T
SX828T
SX829T
Stabilization screw,
4.5 mm x 15 mm, purple
Stabilization screw,
4.5 mm x 20 mm, purple
Stabilization screw,
4.5 mm x 25 mm, purple
Stabilization screw,
4.5 mm x 30 mm, purple
Item no. Art. no. Designation
30 SX782T
SX783T
SX784T
SX785T
SX786T
SX787T
Stabilization screw,
6.5 mm x 25 mm, yellow
Stabilization screw,
6.5 mm x 30 mm, yellow
Stabilization screw,
6.5 mm x 35 mm, yellow
Stabilization screw,
6.5 mm x 40 mm, yellow
Stabilization screw,
6.5 mm x 45 mm, yellow
Stabilization screw,
6.5 mm x 50 mm, yellow
31 SX790T
SX791T
SX792T
SX793T
SX794T
SX795T
SX796T
SX797T
SX798T
Polyaxial screw,
7.0 mm x 15 mm, blue
Polyaxial screw,
7.0 mm x 20 mm, blue
Polyaxial screw,
7.0 mm x 25 mm, blue
Polyaxial screw,
7.0 mm x 30 mm, blue
Polyaxial screw,
7.0 mm x 35 mm, blue
Polyaxial screw,
7.0 mm x 40 mm, blue
Polyaxial screw,
7.0 mm x 45 mm, blue
Polyaxial screw,
7.0 mm x 50 mm, blue
Polyaxial screw,
7.0 mm x 55 mm, blue
32 SX821T
SX823T
Polyaxial screw XL,
10 mm x 30 mm, blue
Polyaxial screw XL,
10 mm x 40 mm, blue
Item no. Art. no. Designation

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2.1.2 System configurations
WARNING
System incompatibility may result in increased
operating time or abortion of the procedure!
►Follow only these instructions for use and the
TA013373 instructions for use when using the
pre-assembled retaining bolt SX804T.
►Do not use MACS II in conjunction with the HMA
monoaxial or polyaxial screws of MACS TL®.
■Polyaxial Twin Screw system TL 26, 30, 31 with
stabilization plate 24 or two SSE 5.2 mm connect-
ing rods 23
■Polyaxial Twin Screw system T 25, 29, 31 with sta-
bilization plate 24 or two SSE 5.2 mm connecting
rods 23
■Polyaxial Twin Screw system XL 30, 32 with stabi-
lization plate 24 or two SSE 5.2 mm connecting
rods 23
2.2 Areas of use and limitations of use
2.2.1 Intended use
The MACS II system is used for ventral monosegmental
and multisegmental stabilization of the lumbar and
thoracic vertebrae.
2.2.2 Indications
Note
The manufacturer is not responsible for any use of the
product against the specified indications and/or the
described applications.
For indications, see Intended use.
2.2.3 Contraindications
No known contraindications.
2.3 Safety information
2.3.1 Clinical user
General safety information
To prevent damage caused by improper setup or oper-
ation, and to not compromise the manufacturer war-
ranty and liability:
►Use the product only according to these instruc-
tions for use.
►Follow the safety and maintenance instructions.
►Ensure that the product and its accessories are
operated and used only by persons with the requi-
site training, knowledge and experience.
►Store any new or unused products in a dry, clean,
and safe place.
►Prior to use, check that the product is in good work-
ing order.
►Keep the instructions for use accessible for the
user.
Note
The user is obligated to report all severe events in con-
nection with the product to the manufacturer and the
responsible authorities of the state in which the user is
located.
Notes on surgical procedures
It is the user's responsibility to ensure that the surgical
procedure is performed correctly.
Appropriate clinical training as well as a theoretical
and practical proficiency of all the required operating
techniques, including the use of this product, are pre-
requisites for the successful use of this product.
The user is required to obtain information from the
manufacturer if there is an unclear preoperative situa-
tion regarding the use of the product.
2.3.2 Sterility
Non-sterile packaged products
The product is delivered in an unsterile condition.
►Clean the new product after removing its transport
packaging and prior to its initial sterilization.
Pre-assembled retaining bolt and sterile K-wire set
The product has been gamma-sterilized and is supplied
in sterile packaging.
►Do not use products from open or damaged sterile
packaging.
►Do not use the product after its use-by date.

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2.4 Application
WARNING
Risk of injury and/or malfunction!
►Prior to each use, inspect the product for loose,
bent, broken, cracked, worn, or fractured com-
ponents.
►Always carry out a function test prior to each
use of the product.
WARNING
Risk of injury when using the product beyond the
field of view!
►Apply the product only under visual control.
Note
For a detailed description of the operating procedure,
see MACS II operating technique, brochure number
O42702.
2.4.1 Mounting the clamping element and
7.0 mm blue polyaxial screw or
10 mm blue polyaxial screw XL with
pre-assembled retaining bolt
►Select either clamping element TL, T 25, 26 or
10 mm blue polyaxial screw XL 32.
►Select 7.0 mm blue polyaxial screw 31 and stabili-
zation screw 29, 30 (this step is missed out if the
10 mm blue polyaxial screw XL is used 32).
WARNING
Risk of injury if incorrect anchoring screws are
selected!
►To ensure safe implantation of the anchoring
screws, ensure that the diameter of the vertebral
body is carefully measured in the planned screw
position and direction.
►Choose a screw length shorter than the diameter
measured.
►Screw the 7.0 mm blue polyaxial screw 31 into the
clamping element 25, 26.
►Insert the assembled 7.0 mm blue polyaxial
screw 31 and clamping element 25, 26 or XL
screw 32 into the mounting tool for SX804T 2.
WARNING
Risk of injury if centralizer comes loose during the
procedure!
►If the 10 mm blue polyaxial screw XL is used,
insert this in the appropriate side of the mount-
ing tool for SX804T (labeled with XL).
►If the 7.0 mm blue polyaxial screw is used, insert
this in the appropriate side of the mounting tool
for SX804T (labeled with POLY).
►Remove the pre-assembled retaining bolt 27 from
the packaging using the torque wrench for mount-
ing the retaining bolt 1.
WARNING
Take care not to drop the pre-assembled retaining
bolt!
►Open the packaging correctly and do not turn it
to prevent the retaining bolt from falling out.
►Apply the torque wrench for mounting the
retaining bolt as far as it will go onto the pre-
assembled retaining bolt.
►Screw the pre-assembled retaining bolt 27 onto
the clamping element 25, 26 with 1.8 N∙m.
WARNING
Risk of injury if pre-assembled retaining bolt comes
loose during the procedure!
►To mount the pre-assembled retaining bolt, use
the mounting tool for SX804T and the torque
wrench for mounting the retaining bolt and
tighten with 1.8 N∙m.
►Prior to applying the torque wrench, make cer-
tain the display arrow points to zero.
►Replace the torque wrench if it is damaged.
►Check that the retaining lug of the centralizer 27a
is correctly positioned in the clamping element 25,
26.
WARNING
Risk of injury if the necessary counter torque is not
applied when tightening the locknut or pre-assem-
bled retaining bolt SX804T!
►Make sure that the retaining lugs of the central-
izer engage fully in the appropriate grooves in
the clamping element.

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2.4.2 Applying the K-wires
►Assemble the K-wire insertion instrument 5.
►Insert the threaded end of the K-wire 4a into the
end of the aiming tube 5a and screw tight.
WARNING
Damage to the K-wire insertion instrument if the
thread of a K-wire is damaged!
►Do not re-use a sterile K-wire set.
►Position the K-wire 4a correctly and drive it in
under radiographic control.
WARNING
Risk of injury if K-wires are positioned incorrectly!
►Always use radiographic control when position-
ing K-wires.
►Use radiographic control to constantly monitor
the position of the K-wires throughout the
operation.
►Apply K-wires in such a way that neither nerve
roots, the spinal column, nor blood vessels or
organs are injured in any way!
►Unscrew the impactor 5c counterclockwise.
►Open the cortical bone.
WARNING
The K-wire will twist if the aiming tube is tilted!
►Do not tilt the K-wire insertion instrument and
K-wire assembly.
►Insert the counter holder 5d into the K-wire inser-
tion instrument 5.
WARNING
Risk of injury if incorrect instruments are used!
►Do not use the screw revision instrument to
apply counterforce at the K-wires.
►Only use the counter holder to apply counter-
force at the K-wires.
►Remove the K-wire insertion instrument 5from the
K-wire 4a. While doing so, use the counter
holder 5d to apply counterforce to the K-wire 4a.
WARNING
Risk of injury if K-wire is driven forwards with
counter holder!
►Remove the K-wire insertion instrument from
the K-wire under radiographic control.
►Attach K-wire protection 3if desired, using the
holding forceps for rods/plates 10 in order to pro-
tect the adjacent soft tissue.
WARNING
Risk of injury if K-wire is driven forwards with K-
wire protection!
►When attaching the K-wire protection, ensure
that the K-wire is not pushed forwards.
►Attach the K-wire protection under radiographic
control.
2.4.3 Implanting the 7.0 mm blue polyaxial
screw or the 10 mm blue polyaxial
screw XL
►Remove K-wire protection 3using the holding for-
ceps for rods/plates 10.
WARNING
Risk of injury caused by the tip of the K-wire!
►Ensure that, when the K-wire protection is being
removed with the holding forceps for
rods/plates, the K-wire is not withdrawn from
the vertebral body.
►Attach the counter torque 8onto the guide tube 7.
WARNING
Damage to the guide tube caused by incorrect oper-
ation!
►Fit the counter torque onto the guide tube until
it clicks into position.
►To detach the counter torque from the guide
tube, release the snap connection by pulling the
handle of the cleaning rod, and pull the counter
torque up and out.
►Fit the counter torque onto the correct side of
the guide tube. Look for the gold marking.
►Attach the guide tube 7onto the centralizer 27a
ex situ. Ensure that this is done in the correct direc-
tion.

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WARNING
Risk of the cannulated screwdriver getting jammed
in the guide tube caused by incorrect operation!
►Ensure that the guide tube snaps fully onto the
centralizer and a click is heard.
►Insert the cannulated screwdriver 6into the guide
tube 7.
►Guide the 7.0 mm blue polyaxial screw 31 over the
K-wire 4a and use the cannulated screwdriver 6to
screw it in, until the first turns of the thread are
held in the vertebral body.
WARNING
Risk of injury if the K-wire is driven forwards with
the 7.0 mm blue polyaxial screw, the 10 mm blue
polyaxial screw XL, or the cannulated screwdriver!
►Insert the cannulated screwdriver fully into the
guide tube when threading and when screwing in
the 7.0 mm blue polyaxial screw or the 10 mm
blue polyaxial screw XL.
►Never withdraw the cannulated screwdriver
from the guide tube and reinsert it while screw-
ing the 7.0 mm blue polyaxial screw or the
10 mm blue polyaxial screw XL into the verte-
bral body.
►Thread the 7.0 mm blue polyaxial screw or the
10 mm blue polyaxial screw XL over the K-wire
in an orthograde direction.
►Screw in the 7.0 mm blue polyaxial screw or the
10 mm blue polyaxial screw XL a maximum of 2
- 3 turns before withdrawing the K-wire using
the removal instrument.
►Insert the removal instrument 4b for the K-wire 4a
into the cannulated screwdriver 6and screw onto
K-wire 4a.
►Remove the K-wire 4a.
►Screw down the 7.0 mm blue polyaxial screw 31 or
the 10 mm blue polyaxial screw XL 32.
The clamping element 25, 26 lies almost on the
vertebral body.
►Ensure that the polyaxiality of the clamping
element 25, 26 is not restricted.
WARNING
Risk of injury if posterior wall of the vertebral body
is penetrated!
►Screw in the 7.0 mm blue polyaxial screw or the
10 mm blue polyaxial screw XL under radio-
graphic control.
If SSE connecting rods or stabilization plates cannot be
screwed down:
►Only screw in the 7.0 mm blue polyaxial screw 31
or the 10 mm blue polyaxial screw XL 32 as far as
necessary so that polyaxiality is not restricted.
►Pull the cannulated screwdriver 6out of the guide
tube 7.
►Remove the guide tube 7, including the counter
torque 8, from the centralizer 27a.
WARNING
Risk of injury if the 7.0 mm blue polyaxial screw or
10 mm blue polyaxial screw XL is pulled out of the
vertebral body through incorrect operation or non-
observance of the correct sequence of operating
steps!
►For easy withdrawal of the cannulated screw-
driver, apply the insertion instrument ortho-
grade to the 7.0 mm blue polyaxial screw or the
10 mm blue polyaxial screw XL.
►Remove the cannulated screwdriver from the
guide tube before detaching the guide tube
together with counter torque from the central-
izer.
►Apply pulling force over the head part of the
counter torque.
2.4.4 Fastening the stabilization plate
►Measure the distance between the clamping
elements 25, 26 using bone graft measuring
instrument FG045R.
Note
The correct plate length is derived from this measured
value plus 30 mm.

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WARNING
Risk of injury to the bordering mobile segment
caused by projecting stabilization plate!
►Choose the smallest stabilization plate possible
(at 5 mm intervals).
►Thread the stabilization plate 24 onto the
centralizer 27a using the holding forceps for
rods/plates 10. Ensure that the flat, labeled side
faces upwards.
WARNING
Risk of injury caused by insufficient system stabil-
ity!
►Place the stabilization plate onto the clamping
element or the 10 mm blue polyaxial screw XL
with the flat, labeled side facing upwards.
►Pick up the locknut 28 using the socket wrench for
nut 11.
►Insert the guide tube 7with the counter torque 8
into the socket wrench for nut 11.
►Snap the guide tube 7using the socket wrench for
nut 11 onto the centralizer 27a in situ.
If you cannot snap the guide tube 7onto the
centralizer 27a:
►To snap the guide tube onto the centralizer:
Remove the screwdriver 6, 13 from the guide
tube 7.
- or -
►Guide the guide tube 7onto the centralizer 27a in
an orthograde direction.
►Optional: Insert the screwdriver for retaining
bolt 13 into the guide tube 7.
►Screw on the locknut 28, using the T-handle of the
socket wrench for nut 11.
WARNING
Risk of injury if the locknut has insufficient clamp-
ing stability!
►Apply locknuts in an orthograde direction.
►Tighten the locknuts smoothly to avoid damag-
ing the external thread of the clamping element
or the 10 mm blue polyaxial screw XL.
►Replace the external thread of the clamping ele-
ment or the 10 mm blue polyaxial screw XL if it
is damaged.
If you cannot screw the locknut 28 onto the clamping
element 25, 26 or the 10 mm blue polyaxial screw
XL 32:
►Apply tensile force via the guide tube 7. To do this,
insert the screwdriver for retaining bolt 13 into the
guide tube 7.
►Tighten the locknut 28 using the torque wrench for
nut 12. Use the counter torque 8to apply counter-
force.
WARNING
Risk of injury if the locknut has insufficient clamp-
ing stability!
►Set locknuts in place correctly.
►Tighten locknuts with the torque wrench for nut.
►Have the torque wrench for the nut recalibrated
by the manufacturer at intervals no longer than
every two years.
WARNING
Risk of injury if no or insufficient counterforce is
applied!
►Use the counter torque provided to apply the
counterforce.
►Ensure that as little force as possible is trans-
ferred to the spinal column.
WARNING
Damage to the implant caused by overtightening of
the locknut!
►Tighten the locknut to the exact torque speci-
fied for this purpose.
►Do not block the release mechanism of the
torque wrench for nut.
►Have the torque wrench for the nut recalibrated
by the manufacturer at intervals no longer than
every two years.
WARNING
Injuries to blood vessels and/or soft tissue caused by
the torque wrench for the nut slipping off from the
socket wrench for the nut!
►Fit the wrench part of the torque wrench for the
nut fully onto the socket wrench for the nut.
►Optional for the transfer of tensile forces: Pull the
screwdriver for retaining bolt 13 out of the guide
tube 7.

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►Remove the guide tube 7with the counter torque 8
from the centralizer 27a. Use the socket wrench for
nut 11 to apply counterforce.
WARNING
Risk of injury if the 7.0 mm blue polyaxial screw or
10 mm blue polyaxial screw XL is pulled out of the
vertebral body through incorrect operation or non-
observance of the correct sequence of operating
steps!
►For easy detachment from the centralizer, apply
the guide tube with counter torque in an ortho-
grade direction to the centralizer.
►Remove the screwdriver for retaining bolt from
the guide tube before detaching the guide tube
together with counter torque from the central-
izer.
►Apply pulling force over the head part of the
counter torque.
►Remove the socket wrench for nut 11 from the
locknut 28.
2.4.5 Fastening the SSE 5.2 mm connecting
rods
►Measure the distance between the clamping
elements 25, 26 or the 10 mm blue polyaxial
screws XL 32 using bone graft measuring instru-
ment FG045R.
Note
The correct rod length is derived from this measured
value plus 30 mm.
WARNING
Risk of injury caused by projecting SSE connecting
rods or sharp edges!
►Choose the shortest SSE connecting rod possible.
►If necessary, shorten the SSE connecting rod
with a suitable instrument. Also round off sharp
edges with a suitable tool if necessary.
►Adjust the SSE connecting rods 23 to the required
curvature of the spine using SSE rod bending
pliers 14.
WARNING
Risk of injury caused by insufficient system stabil-
ity!
►Do not bend or bend back the SSE connecting
rods excessively.
►Use SSE rod bending pliers to adjust the curva-
ture of the SSE connecting rods.
►Do not bend the SSE connecting rods in the
region of the support on the clamping elements
or the 10 mm blue polyaxial screws XL.
►Pick up the locknut 28 using the socket wrench for
nut 11.
►Insert the guide tube 7with the counter torque 8
into the socket wrench for nut 11.
►Snap the guide tube 7using the socket wrench for
nut 11 onto the centralizer 27a in situ.
If you cannot snap the guide tube 7onto the
centralizer 27a:
►To snap the guide tube onto the centralizer:
Remove the screwdriver 6, 13 from the guide
tube 7.
- or -
►Guide the guide tube 7onto the centralizer 27a in
an orthograde direction.
►Fit the first SSE 5.2 mm connecting rod 23 into the
posterior hollow of the first clamping element 25,
26 or the 10 mm blue polyaxial screws XL 32 using
the holding forceps for rods/plates 10.
►Ensure that the polyaxiality of the clamping ele-
ment or the 10 mm blue polyaxial screws XL is not
restricted.
►Screw on the locknut 28 using the T-handle of the
socket wrench for nut 11 with a maximum of two
turns.
The posterior rod is secured.
WARNING
Risk of injury if the locknut has insufficient clamp-
ing stability!
►Apply locknuts in an orthograde direction.
►Tighten the locknuts smoothly to avoid damag-
ing the external thread of the clamping element
or the 10 mm blue polyaxial screw XL.
►Replace the external thread of the clamping ele-
ment or the 10 mm blue polyaxial screw XL if it
is damaged.