Summary The Pangea® Femur Reconstruction System is indicated for complex proximal and distal femur fractures through a dedicated nail-plate system, adaptable modular fixation options to span the entire femur, and focused trochanteric femur plates. Predetermined screw trajectories and nail plate interlocking facilitates more rigid fixation construct. A specialized guide facilitates the physical linking of the T2 Alpha® Retrograde nail and the NPC plate. Related Implants T2 Alpha™ Femur Retrograde Nailing System when used together, the system is used for the indications of the T2 Alpha Femur Retrograde Nailing System uses AlphaLink™ technology to link NPC plates to the T2 Alpha Retrograde nail via a 5.0mm AlphaLink™ Dowel and the T2 Alpha Retrograde targeting device NPC plates are stated to be compatible only with Ø9–Ø11mm T2 Alpha Retrograde Nails Pangea® Medial NPC Plate serves as the medial large fragment option within the system can be used as a standalone plating construct, dual-plating construct, or nail-plate combination construct has one linking hole for linkage to the T2 Alpha Retrograde nail includes an AP hole designed to capture Hoffa fragments is offered in 155mm and 265mm lengths Pangea® Lateral NPC Plate serves as the lateral large fragment option within the system can be used as a standalone plating construct, dual-plating construct, or nail-plate combination construct has two linking hole options for linkage to the T2 Alpha Retrograde nail includes a proximal interface for the Femur Spanning Attachment, Proximal Femur Attachment, and Trochanteric Attachment, except on the 160mm, 200mm, and 240mm plates is offered in 160mm to 438mm lengths Trochanteric Plate plate arms are designed to be bent in-situ to meet individual patient anatomy of the trochanter region (proximal femur) suture cleats in proximal arms allows for suture threading after place placement cable grooves in the shaft of the plate are designed to accept cerclage cables (Dall-Miles Cables) is offered in small and large versions small short: 153mm long: 242mm large short: 166mm long: 255mm Trochanteric Attachment Plate plate arms are designed to be bent in-situ to meet individual patient anatomy of the trochanter region (proximal femur) suture cleats in proximal arms allows for suture threading after place placement provides two posterior fixation holes for bone purchase attachment interface allows for 22mm of proximal and distal adjustments with the NPC Lateral Plate or Utility Shaft Plate is offered in 155mm and 168mm Proximal Femur Attachment five T20 screw holes that accept locking or non-locking screws designed to provide variable angle fixation around a hip stem, nail or lag screw screw trajectories designed to work around common proximal femoral implants, including femoral stems and cephalomedullary nails provides two posterior fixation holes for bone purchase attachment interface allows for 22mm of proximal and distal adjustments with the NPC Lateral Plate or Utility Shaft Plate is offered in 94mm Utility Shaft Plate proximally can be attached to the Trochanteric Attachment, Proximal Femur Attachment, or Femur Spanning Attachment is offered in 193mm, 237mm, 281mm, and 324mm Indications Indications internal fixation and stabilization of femur bone fractures and osteotomies in normal and osteopenic bone diaphyseal, metaphyseal, epiphyseal, extra- and intra-articular fractures non-unions, malunions, and deformities peri-implant fractures Contraindications any active or suspected latent infection or marked local inflammation in or about the affected area compromised vascularity that would inhibit adequate blood supply to the fracture or the operative site bone stock compromised by disease, infection or prior implantation that cannot provide adequate support and / or fixation of the devices material sensitivity, documented or suspected patients having inadequate tissue coverage over the operative sit implant utilization that would interfere with anatomical structures or physiological performance any mental or neuromuscular disorder which would create an unacceptable risk of fixation failure or complications in postoperative care other medical or surgical conditions which would preclude the potential benefits of surgery Anatomy Osteology distal femur, femoral shaft, femoral neck, and femoral head are referenced articular and bony landmarks referenced include the anterior margin of the articular surface, medial articular margin of the trochlea, medial epicondyle, intercondylar notch, intercondylar fossa, medial femoral condyle, medial posterior condyle, and vastus ridge Ligaments posterior cruciate ligament is referenced as an entry-point landmark for retrograde nail placement Blood supply compromised vascularity that would inhibit adequate blood supply to the fracture or operative site is listed as a condition that increases risk of failure minimizing periosteal disruption during plate insertion is recommended to help preserve bone blood supply proximal screw insertion requires familiarity with the vascular anatomy of the thigh Approach Lateral NPC plate insertion may use a standard lateral, modified lateral (anterolateral), or lateral parapatellar approach to the distal lateral femur Medial NPC plate insertion may use a standard medial, medial parapatellar, or medial subvastus approach to the distal medial femur When combined with the T2 Alpha Retrograde nail, a lateral or medial parapatellar arthrotomy is recommended respectively, with an incision sized to accommodate both nail and plate insertion Trochanter Plate insertion must be appropriate for adequate exposure and direct visualization of the Greater Trochanter Technical specifications NPC plates feature variable angle universal holes that accept locking and non-locking screws within a 30° cone of angulation NPC plates are described as being designed with SOMA software for evidence-based screw hole placement and anatomically influenced left- and right-specific plate fit for native and periprosthetic situations When an NPC construct is desired, additional T2 Alpha trays are required Lateral NPC plate features nine distal T20 screw holes 2 linking holes 2 kickstand holes 1 threaded monoaxial hole staggered shaft holes 2.0mm K-wire holes The lateral distal cluster provides four screw trajectories designed to avoid nail collision separate kickstand trajectories target the medial femoral condyle the monoaxial and kickstand holes are not designed to avoid nail collision in NPC constructs The lateral L2 Sagittal Alignment Slot is oblong in nail-plate constructs it is designed exclusively for AlphaLink™ linkage in plate-only constructs it accepts non-locking cortical and cancellous screws Medial NPC plate features eight distal T20 screw holes 1 linking hole 1 AP hole 2.0mm K-wire holes The medial distal cluster provides four screw trajectories designed to avoid nail collision and additional AP or orthogonal options for medial condylar fixation The medial plate has a proximal twist so the shaft lies on the anterior femur Proximal Plates Trochanter Plate the Trochanter plates feature Pangea's variable angle locking technology, offering universal holes that accept both locking and non-locking screws within a 30° cone of angulation twelve proximal T15 screw holes in the arms of the large plate; ten proximal T15 screw holes in the arms of the small plate seven staggered distal T20 screw holes in the shaft of the long plate; three staggered distal T20 screw holes in the shaft of the short plate six suture hooks in the proximal arms that accept #2 to #5 non absorbable sutures five cable grooves in the distal shaft of the long plate; one cable groove in the distal shaft of the short plate designed for use with Ø2.0mm vitallium cables from the Dall-Miles Cable System proximal tines designed for impaction fit slotted 2.0mm K-wire hole Trochanteric Attachment Plate the Trochanter plates feature Pangea's variable angle locking technology, offering universal holes that accept both locking and non-locking screws within a 30° cone of angulation. twelve proximal T15 screw holes in the arms of the large plate; Ten proximal T15 screw holes in the arms of the small plate two T20 screw holes in the posterior shaft six suture hooks in the proximal arms that accept #2 to #5 non absorbable sutures attachment interface for use with the Utility Shaft Plate or the Lateral NPC Plate that allows for 22mm of length adjustment proximal tines designed for impaction fit Utility Shaft Plate staggered T20 shaft holes in the middle of the plate attachment interface on both ends of the plate precontoured plate to match the bow of the femur universal for both left and right femurs Proximal Femur Attachment five proximal T20 screw holes that accept locking or non-locking screws designed to provide variable angle fixation into the femoral head attachment interface for use with the Utility Shaft Plate or the Lateral NPC Plate that allows for 22mm of proximal distal adjustments two posterior T20 screw holes Screws Compatible fixation options 4.5mm cortex screws 14–150mm titanium alloy 6.0mm cancellous screws with 16mm partial thread 30–150mm titanium alloy 6.0mm cancellous screws with 32mm partial thread 45–150mm titanium alloy 6.0mm cancellous fully threaded screws 20–150mm titanium alloy 3.5mm locking screws 10-120mm cobalt-chrome 3.5mm cortex screws 10-120mm titanium alloy 4.0mm locking screws 14–95mm cobalt-chrome 5.0mm locking screws 14–120mm cobalt-chrome 5.0mm locking flat-tip screws 10–20mm cobalt-chrome 5.0mm AlphaLink™ Dowel 50–90mm cobalt-chrome Pilot drill sizes 3.2mm for 4.5mm cortex 4.3mm for 4.0mm and 5.0mm locking screws 4.3/5.0mm step drilling for AlphaLink™ Dowels