Stryker T2, Operative Technique

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Fig. 19
Operative Technique
The nail is advanced through the
entry point passing the fracture site to
the appropriate level.
If dense bone is encountered, fi rst
re-evaluate that suffi cient reaming
has been achieved, then, if necessary,
the Strike Plate can be attached to
the Targeting Arm and the Slotted
Hammer may be used to further insert
the nail (Fig. 19).
Caution:
The nail must progress smoothly,
without excessive force. If too
much resistance is encountered,
removal of the nail and additional
reaming is recommended.
Note:
Remove the Guide Wire prior to
drilling or K-Wire insertion.
The carbon fi ber guide should never
be struck as it may break or become
deformed. The impactor that is
provided can be utilized to assist with
fi nal seating of the nail. Gentle tapping
will produce small adjustments (in
the nail position) that can help to
optimize the ultimate position of the
lag screw in the femoral head. The nail
holding screw should be re-tightened
following any use of the impactor.
The impactor should not be utilized
to force the nail down the canal. If
the nail cannot be seated manually
or if there is no advancement each
time the impactor is tapped, A/P and
Lateral fl uoroscopic X-Rays should
be reviewed to determine the cause
of the impingement - there may be a
mismatch between the nail geometry
and the medullary canal. The starting
position, the femoral bow and the
canal diameter should all be examined
to ensure that the leading end of the
nail is not impinging on the medial
or anterior cortex and that the canal
itself has been suffi ciently reamed.
Nail Insertion
Final Seating with Impactor
Periodically, nail removal and further
reaming of the diaphysis may be
required.
The proximal metaphyseal fl air may
be undersized (particularly in young
patients or those of short stature) and
serve to prevent nail advancement. If
this situation is encountered, a fl exible
reamer may be used to further widen
this area to the level of the lesser
trochanter.
To facilitate manual passage, the
nail internally rotated 90° until the
fracture has been passed.
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