Stryker T2 Operative Technique Download Page 2

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T2 Recon Nailing System

We greatly acknowledge and
appreciate the contributions to this
operative technique made by:

Kevin W. Luke, M.D.

Parkview Orthopaedic Group
Assistant Clinical Professor
Department of Orthopaedic Surgery
University of Illinois
Illinois, Chicago
USA

Anthony T. Sorkin, M.D.

Rockford Orthopaedic Associates, LLP
Clinical Instructor
Dep. of Surgery University of Illinois
College of Medicine
Director Orthopaedic Traumatology
Rockford Memorial Hospital
Rockford, Illinois
USA

Ariaan D.P. van Walsum, MD

Trauma surgeon
Medical Spectrum Twente
Enschede
Netherlands

Don Weber, MD, FRCSC

Associate Clinical Professor of
Orthopaedics
Chief of Orthopaedics
University of Alberta Hospital
Edmonton, Alberta
Canada

Contributing Surgeons

Summary of Contents for T2

Page 1: ...Operative Technique KnifeLight Carpal Tunnel Ligament Release T2 Recon Nailing System R2 0 Operative Technique Hip Femur Fractures Hip Femur ...

Page 2: ... Anthony T Sorkin M D Rockford Orthopaedic Associates LLP Clinical Instructor Dep of Surgery University of Illinois College of Medicine Director Orthopaedic Traumatology Rockford Memorial Hospital Rockford Illinois USA Ariaan D P van Walsum MD Trauma surgeon Medical Spectrum Twente Enschede Netherlands Don Weber MD FRCSC Associate Clinical Professor of Orthopaedics Chief of Orthopaedics University...

Page 3: ...llow the instructions provided in our reprocessing guide L24002000 Multi component instruments must be disassembled for cleaning Please refer to the corresponding assembly disassembly instructions See package insert L22000007 for a complete list of potential adverse effects contraindications warnings and precautions The surgeon must discuss all relevant risks including the finite lifetime of the d...

Page 4: ...Patient Positioning and Fracture Reduction 11 Incision 11 Entry Point 12 Reaming 14 Nail Selection 16 Assembly of the Targeting Device and the Nail 17 Nail Insertion 18 Final Seating with Impactor 18 Guided Locking for the Recon Mode 19 Guided Locking for Antegrade Femoral Mode 29 Freehand Distal Locking 32 Set Screw or End Cap Insertion 34 Nail Removal 34 Ordering Information Implants 35 Ordering...

Page 5: ...ch utilize 6 5mm cannulated Lag Screws This CCD angle allows easy insertion of the 2 lag screws into the femoral head Alternatively a proximal 70 Oblique hole with 7 retroversion provides a 5mm Fully Threaded Screw for targeting the lesser trochanter in the Femoral Antegrade mode The 6 5 mm Cannulated Lag Screws have a unique thread design that provide an excellent grip Improved front cutting flut...

Page 6: ...al representative regarding availability of nail sizes 5 0mm Fully Threaded Locking Screws L 25 120mm 6 5mm Cannulated Lag Screws L 65 130mm Antegrade Set Screw end Caps Standard 5mm 10mm 15mm 0mm Antecurvature radius 2 0M 40mm 20mm 15mm 0mm 4 Medial Lateral bend 44mm 70 125 Nail angle 0mm 26mm 10 5mm Technical Speciﬁcations Recon Set Screw 17 0mm Note Screw length is measured from top of head to ...

Page 7: ...oral neck and head B Targets the Proximal Recon 6 5 mm Lag Screw A Targets the Distal Recon 6 5 mm Lag Screw Antegrade Femoral Mode Provides a single 5mm Oblique Screw targeting the lesser trochanter LEFT is used for a left nail and RIGHT for a right nail With the exception of the carbon fiber targeting device dedicated instruments for the recon mode are color coded with bronze This makes it easy ...

Page 8: ...operative site Bone stock compromised by disease infection or prior implantation that can not provide adequate support and or fixation of the devices Material sensitivity documented or suspected Obesity An overweight or obese patient can produce loads on the implant that can lead to failure of the fixation of the device or to failure of the device itself Stryker Osteosynthesis systems have not bee...

Page 9: ...cation is corresponding with the template According to the fracture type either Recon or Antegrade Femoral Mode can be chosen Evaluation of the femoral neck angle on the pre operative X Rays is mandatory as the T2 Recon Nail has a fixed 125 neck angle for the two Lag Screws Proper placement of both Lag Screws in the femoral head is essential If possible X Rays of the contralateral side should be u...

Page 10: ... Lag Screws Recon Mode Fig 1 or with one 5mm Fully Threaded Screw Antegrade Femoral Mode Fig 2 For both Recon and Antegrade Femoral applications depending on fracture pattern either static or dynamic distal locking can be used Fig 1 Fig 2 Recon Mode Antegrade Femoral Mode 10 ...

Page 11: ...as far as possible to ease image intensifier positioning This will also allow easier access to entry point Patient Positioning and Fracture Reduction Incision The design of the T2 Recon Nail with a 4 medial lateral bend will only allow for insertion through the tip of the greater trochanter With experience the tip of the greater trochanter can be identified by palpation Fig 4 A longitudinal skin i...

Page 12: ...k the tip of the Awl during opening of the entry portal Inserting first the optional Awl Plug into the Awl will avoid penetration of bone debris into the cannulated Awl shaft The Awl Plug is then removed for Guide Wire insertion Entry point with Curved Awl Once the tip of the greater trochanter has been opened Fig 7a the Ø3 1000mm Ball Tip Guide Wire may be advanced through the cannulation of the ...

Page 13: ...tion It is recommended that a new K Wire be utilized The Recon Protection Sleeve and Multi hole Trocar are positioned with the central hole over the K Wire Note The Multi hole Trocar has a special design for more precise insertion of the Ø3 2mm Recon K Wire Fig 8 Beside the central hole 4 other holes are located eccentrically at different distances from the center Fig 8a to easily revise insertion...

Page 14: ...ire with the image in tensifier Lateral displacement of the Guide Wire could lead to resection of more bone on the lateral side of the wire which in turn will lead to an offset position of the nail and increase the risk of a shaft fracture Note Make sure that the reduction is maintained throughout the reaming process Reaming is commenced in 0 5mm increments until cortical contact occurs Fig 12 For...

Page 15: ... Guide Wire Applying pressure to hold the Guide Wire in place while removing the drill under power Fig 14 When close to the Guide Wire end place the Guide Wire Pusher with its funnel tip at the end of the power tool cannulation Fig 15 While removing the power tool the Guide Wire Pusher will keep the Guide Wire in place Guide Wire Pusher 1806 0271 Fig 15 Fig 14 Reaming of the trochanteric region is...

Page 16: ...so that it does not loosen during nail insertion Caution Prior to the nail insertion check the correct assembly by passing the Stepdrill for Lag Screw through the Recon Tissue Protection Sleeve and Drill Sleeve Recon placed in the corresponding hole of the Targeting Arm and through the holes of the nail Fig 17b For the Antegrade Femoral Mode use the targeting hole for Antegrade with the Tissue Pro...

Page 17: ...e Knob clockwise to the position labeled A the sleeve inserted in target A position which is the distal Recon Mode targeting hole can be locked Fig 18b By further turning the Knob clockwise to the position labeled A B both sleeves inserted in A and B which are the both proximal and distal recon mode targeting holes can be locked Fig 18c Operative Technique Assembly of Targeting Device Fig 18c 17 ...

Page 18: ... 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 fluoroscopic 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 T...

Page 19: ...age intensifier before drilling into the femoral head Alignment of the anteversion M L view Depth of nail insertion A P view The distal Lag Screw should run along the calcar region on the A P view and centered into the femoral neck and head on the M L view Note The use of the One Shot Device 1213 3010 is recommended to predetermine the optimal Lag Screw placement Details are described on Page 20 t...

Page 20: ...urn the Knob clockwise to the position labeled A Fig 22 Remove the Trocar and then insert the Recon K Wire Sleeve through the Tissue Protection Sleeve Place a Recon K Wire into the K Wire Inserter and attach it to the T Handle The K Wire is then manually advanced through the K Wire Sleeve until it reaches the subchondral bone of the femoral head Fig 23 Alternatively the K Wire Inserter can be atta...

Page 21: ...to correct the nail position More commonly the nail is positioned too proximal and correction of the nail should be carried out either by hand or by using the Strike Plate placed into the Target Device If a higher position is required the Universal Rod and Slotted Hammer may then be attached to the Strike Plate to carefully and smoothly extract the assembly Fig 25 The new position is checked again...

Page 22: ...steps in the T2 Recon Operative Technique While pressing the attachment grip the device is positioned between the anterior aspect of the patient s hip and the fluoroscope screen positioned for an A P view of the hip Fig 26 27 Note It is important to drape the patient so that the One Shot Device does not interfere with any drapes anterior to the patient s hip When positioned correctly the target wi...

Page 23: ...n determined When positioned correctly the target will appear in the fluoroscopic lateral view Fig 29 If the dashed wire of the target ap pears between the two solid wires then advance the Recon Tissue Protection Sleeve and Trocar as shown in Fig 21 Warning Prior to advancing the K Wire check the correct guidance through the K Wire Sleeve Do not use bent K Wires Note The K Wire inserted into the m...

Page 24: ...labeled A B Fig 30 Then remove the Trocar assembly and insert the Drill Sleeve for the Recon Solid Stepdrill while the distal K Wire and K Wire Sleeve are still left in place The Drill Sleeve for the Recon Solid Stepdrill is inserted through the proximal target hole labeled B of the Targeting Device The Ø6 5mm Solid Stepdrill for Recon Lag Screw is forwarded through the Tissue Protection Sleeve an...

Page 25: ...the end of the Tissue Protection Sleeve Fig 32 32a The required length of the second Lag Screw can be measured using the Recon Lag Screw Gauge Remove the Distal K Wire and K Wire Sleeve Then insert the Sleeve for the solid Stepdrill into the distal Tissue Protection Sleeve Repeat the same surgical steps for drilling and insertion of the distal Lag Screw without K Wire guidance After the completion...

Page 26: ... measured using the Recon Lag Screw Gauge Note Before starting to measure ensure that the Tissue Protection Sleeve and K Wire Sleeve assembly is firmly pressed against the lateral cortex of the femur Fig 32b Take the Recon Lag Screw Gauge and place it directly under the K Wire and against the K Wire Sleeve Fig 32c The correct Lag Screw length corresponds to the measurement indicated at the end of ...

Page 27: ...he first Recon K Wire slide the second Recon Tissue Protection Sleeve together with the Recon K Wire Sleeve into the proximal target hole on the Targeting Arm labeled B A small skin incision is made and the assembly is pushed through until it is in contact with the lateral cortex Fig 33 Place a second Recon K Wire into the K Wire Inserter and attach it to the T Handle or power tool The K Wire is t...

Page 28: ...g Screw over a deﬂected K Wire Using the Recon Screwdriver the selected Lag Screw is inserted through the Tissue Protection Sleeve and threaded up to the subchondral bone of the femoral head The screw is near its proper seating position when the groove around the shaft of the screwdriver is approaching the end of the Tissue Protection Sleeve Fig 37 Alternatively the Recon Screwdriver Shaft may be ...

Page 29: ...Tissue Protection Sleeve the safety clip must be pressed again A small skin incision is made and the assembly is pushed through by mani pulating the T Handle until the Tissue Protection Sleeve is in contact with the lateral cortex Fig 41 Guided Locking for Antegrade Femoral Mode Fig 41 Fig 41 Fig 39 Now attach the Paddle Trocar Antegrade and the AO T Handle Medium Coupling Fig 39 Then advance them...

Page 30: ...d tip green coded 4 2mm Drill The Drill can be connected with the AO Teardrop Handle Coupling allowing pre drilling by hand Fig 43 It also can be done using power Note For optimal stability the tip of the oblique screw should be positioned at the level of the lesser trochanter Fig 44 Then use the center tipped calibrated Ø4 2 340mm Drill and drill through both cortices Fig 45 The screw length may ...

Page 31: ...ve Drill Sleeve Assembly and K Wire Sleeve assembly is firmly pressed against the lateral cortex of the femur Fig 46 47 The Long Screw Gauge is calibrated so that with the bend at the end pulled back flush with the far cortex the screw tip will end 3mm beyond the far cortex Fig 47 When the Drill Sleeve is removed the correct Locking Screw is inserted through the Tissue Protection Sleeve using the ...

Page 32: ...the center of the locking hole Fig 49 Upon X Ray verification the Drill is placed perpendicular to the nail and drilled through the lateral and medial cortices Fig 50 Confirm in both the A P and lateral views by X Ray that the Drill passes through the hole in the nail After drilling both cortices the screw length may be read directly off of the Long Screw Scale at the green ring on the center tipp...

Page 33: ...f the nail this will require a freehand distal targeting of the oblong hole in a dynamic position This allows the nail to move and the fracture to settle while torsional stability is maintained Note As an alternative for distal locking the guided distal targeting system can be used For details please refer to the separate operative techniques Distal Targeting System Gamma3 Long Nail R2 0 T2 Recon ...

Page 34: ...hs confirm satisfactory reduction and hardware implantation Fig 54 Be sure to fully seat the End Cap or Set Screw to minimize the potential risk for loosening Nail Removal The Set Screw or End Cap is removed with the Long Screwdriver Shaft and Teardrop Handle Fig 55 The Universal Rod is inserted into the driving end of the nail Alternatively the Conical Extraction Rod can be attached to the Univer...

Page 35: ...1544S 15 0 440 1846 1546S 15 0 460 1846 1548S 15 0 480 T2 Recon Nail Left T2 Recon Nail Right Titanium Diameter Length REF mm mm 1847 0928S 9 0 280 1847 0930S 9 0 300 1847 0932S 9 0 320 1847 0934S 9 0 340 1847 0936S 9 0 360 1847 0938S 9 0 380 1847 0940S 9 0 400 1847 0942S 9 0 420 1847 0944S 9 0 440 1847 0946S 9 0 460 1847 0948S 9 0 480 1847 1128S 11 0 280 1847 1130S 11 0 300 1847 1132S 11 0 320 18...

Page 36: ...er Length REF mm mm 1847 0001S 8 0 Set Screw Recon 1847 0003S 8 0 Set Screw Antegrade Titanium Diameter Length REF mm mm 1822 0003S 8 0 Standard 1847 0005S 13 0 5mm 1847 0010S 13 0 10mm 1847 0015S 13 0 15mm Titanium REF 1896 5025S 1896 5030S 1896 5035S 1896 5040S 1896 5045S 1896 5050S 1896 5055S 1896 5060S 1896 5065S 1896 5070S 1896 5075S 1896 5080S 1896 5085S 1896 5090S 1896 5095S 1896 5100S 1896...

Page 37: ...leeve Retrograde Guide Wire Ruler Awl Plug Awl Universal Rod Reduction Spoon Wrench 8mm 10mm Insertion Wrench 10mm Strike Plate Slotted Hammer Tissue Protection Sleeve Long Screwdriver Self Holding Extra Short 3 5 Drill Sleeve Long Screwdriver Shaft AO Long Screwdriver Self Holding Long 3 5 Screwdriver Shaft Compression hex3 5 Guide Wire Pusher Trocar Long Screw Gauge Long Screw Gauge 20 120mm Ext...

Page 38: ...n One Step Conical Reamer Ø15 Recon Solid Stepdrill for Lag Screw Recon K Wire Recon K Wire Recon CoCr Lag Screw Gauge Recon K Wire Sleeve Recon Drill Sleeve for Solid Stepdrill Tissue Protection Sleeve Recon Screwdriver Shaft Recon Multihole Trocar Protection Sleeve Antegrade Screwdriver Recon K Wire Inserter Screwdriver Shaft AO Ball Tip Screwdriver Shaft Selfholding 3 5 85mm Drill Ø4 2 230mm AO...

Page 39: ...ed axial stress on the Elastosil handle those components are pressed into the surrounding cylinder resulting in a complete blockage of the device and possible bending To help avoid intra operative complica tions and promote long term functional ity we mandate that Elastosil handles be used only for their intended use DO NOT HIT them Bixcut Modular Head 9 10 11 12 13 14 15 16 17 and 2 additional Mo...

Page 40: ...r Designs Eur J of Trauma 2001 5 2 Medhi Moussavi et al Pressure Changes During Reaming with Different Parameters and Reamer Designs Clinical Orthopaedics and Related Research Number 373 pp 295 303 2000 3 Andreas Speitling Intramedullary Reamers commented slides of internal test report Sep 1999 Large clearance rate resulting from reduced number of reamer blades coupled with reduced length of reame...

Page 41: ... 16 0 16 5 17 0 17 5 18 0 18 5 19 0 19 5 20 0 20 5 21 0 21 5 22 0 22 5 23 0 23 5 24 0 24 5 25 0 25 5 26 0 26 5 27 0 27 5 28 0 0227 8240S Mod Trinkle 284 0227 3000S Mod Trinkle 448 0227 8510S Mod Trinkle 510 0227 8885S Mod Trinkle 885 0226 8240S AO 284 0226 3000S AO 448 0225 6000 Tray Modular Head up to size 22 0mm 0225 6001 Tray Modular Head up to size 28 0mm 0225 8000 Tray Fixed Head up to size 1...

Page 42: ...Notes 42 ...

Page 43: ...Notes 43 ...

Page 44: ...ays refer to the package insert product label and or user instructions including the instructions for Cleaning and Sterilization if applicable before using any Stryker products Products may not be available in all markets Product availability is subject to the regulatory or medical practices that govern individual markets Please contact your Stryker representative if you have questions about the a...

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