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DFN Distal Femoral Nail

Surgical Technique

Standard Locking

Spiral Blade Locking

Original Instruments and Implants of the Association
for the Study of Internal Fixation – AO/ASIF

Summary of Contents for DFN

Page 1: ...DFN Distal Femoral Nail Surgical Technique Standard Locking Spiral Blade Locking Original Instruments and Implants of the Association for the Study of Internal Fixation AO ASIF ...

Page 2: ...arge 357 360 Extraction Screw for Spiral Blade 357 117 Hammer Guide for DFN 357 026 Slotted Hammer 400 g can be mounted 511 790 Quick Coupling for Kirschner Wires 511 701 COMPACT AIR DRIVE II 511 760 Quick Coupling for DHS DCS Triple Reamers 511 750 Quick Coupling 117 500 Reaming Instrument Set for Medullary Nails not illustrated 357 133 Extraction Screw for AFN DFN ...

Page 3: ... 531 Drill Sleeve 15 0 3 2 357 120 Spiral Inserter for Spiral Blade Insertion 357 132 Connecting Screw for Spiral Blade 351 270 Drill Bit 13 0 mm 357 129 Guide Wire 3 2 mm 357 123 Protection Sleeve 15 0 13 0 357 124 Drill Sleeve 13 0 3 2 450 862 872 Locking Screws 450 862 872 Locking Screws 315 400 Drill Bit 4 0 mm 357 122 Radiographic Ruler for DFN 357 112 Insertion Handle for DFN 357 135 Connect...

Page 4: ... immediate application of the instrumentation Instruction by a surgeon experienced in handling this instrumentation is highly recommended Image intensifier control Indications contraindications 2 Implants 3 Standard locking 4 Spiral blade locking 17 Implant removal 20 Cleaning of instruments 23 ...

Page 5: ...rograde approach is indicated e g ipsilateral tibia and or patella fractures proximal or distal endoprosthesis adipositas permagna These include according to the AO classification Indications Fractures of type 33 A1 to A3 Fractures of type 33 C1 to C3 1 Fractures of type 32 A to C 2 Contraindications Fractures of type 33 B 33 C3 2 and 33 C3 3 Proximal femoral fractures and high subtrochanteric fra...

Page 6: ...l locking Locking Bolts 4 9 mm self tapping 459 260 680 Lengths 26 to 68 mm Standard locking For non osteoporotic bone and simple supracondylar fracture morphology Locking Screws 6 0 mm self tapping 450 862 872 turquoise Lengths 50 to 100 mm End Cap for Locking Screw 6 0 mm 451 896 turquoise Spiral blade locking For better purchase in osteoporotic bone and for all complex supracondylar fracture mo...

Page 7: ...are mandatory for a successful surgical result 1 Position patient Position the patient supine on the operating table The knee of the injured leg should be flexed 70 90 A leg roll may be used or the lower leg be flexed by lowering part of the table to allow proper reduction and stabilization of the reduced fracture Position the image intensifier in such a way that vi sualisation of the entire femur...

Page 8: ...ar ap proach 6 The Distal Femoral Nail may be used for either reamed or unreamed application Determine nail entry point and insert guide wire The entry point for the nail is in the axis of the medullary canal and in the intercondylar notch just anterior and lateral to the femoral attachment of the posterior cruciate ligament Insert the Protection Sleeve 17 0 15 0 357 530 and the Drill Sleeve 357 5...

Page 9: ...ely 30 mm Remove the protection sleeve the drill sleeve and the guide wire Do not re use the guide wire Remove the bone and cartilage debris and thoroughly rinse the knee joint Alternative The medullary canal can also be opened with the Large Reverse Awl 351 110 Reaming of the femur may be indicated depending on the fracture type or if the medullary canal is too narrow If reaming is not indicated ...

Page 10: ...vity with SynReam Option 1 Assemble reduction system Assemble the reduction system of the SynReam Intra medullary Reaming System 189 060 Attach the T Handle 351 150 at the rear of the SynReam Flexible Shaft 352 040 and a Reduction Head 352 050 or 352 055 at the front ...

Page 11: ...lary cavity and reduce the distal fragments under image intensifier control Note Always reduce with the reaming rod since secure fixa tion can only be ensured if the reduction system is used in conjunction with the reaming rod Using the reduction system without the reaming rod entails the risk of losing the reduc tion head in the medullary canal 3 Remove reduction instruments After completing the ...

Page 12: ...sing the SynReam flexible shaft Start with the smallest reamer head 8 5 mm 352 085 and then increase in 0 5 mm increments using the larger reamer heads 352 090 190 The reaming depth should be identical to the chosen nail length 5 Insert reaming system Insert the assembled reaming system without rotating it over the SynReam reaming rod into the medullary canal Use the Tissue Protector 351 050 to sp...

Page 13: ...hange reamer head Having reamed the medullary cavity along its full length re tract the SynReam flexible shaft with the first reamer head until the whole reamer head is visible Grasp the reaming rod with the Holding Forceps for SynReam Reaming Rod 351 782 immediately above the bone insertion point and hold in situ to avoid loss of reduction Draw the SynReam flexible shaft through the slot of the I...

Page 14: ... right turns or with gentle hammer taps to the Holding Forceps for SynReam Reaming Rod 351 782 fastened to the SynReam Reaming Rod Ø 2 5 mm 352 032 or 352 033 9 Attach nail to insertion handle With the Insertion Handle 357 112 facing laterally match the teeth on the handle with the notches in the nail The anterior curvature of the implant must be aligned with that of the femur Note the inscription...

Page 15: ... 399 430 399 505 Using the distal end of the connecting screw as striking surface advance the nail until its distal end is 2 to 5 mm beyond the articular cartilage The insertion depth is indicated by the grooves on the shaft of the insertion handle Remove the guide rod 0 10 5 Note After nail insertion check that the connecting screw is still tight as it could have loosened during hammering Do not ...

Page 16: ... both cortices using the calibrated Drill Bit 4 9 mm 357 099 stopping just after penetrating the far cortex Confirm the drill bit position radiographically Make sure the drill sleeve is in contact with the bone and read the length for the locking screw from the ringmarks on the drill bit The locking screw should not surpass the medial cortex by more than 2 mm Alternative The Depth Gauge for Lockin...

Page 17: ...ure the screw head is in contact with the medial cortex The locking screw should surpass the medial cortex by at least 2 mm but not more than 4 mm 14 Insert second locking screw Repeat steps 11 to 13 for inserting the second locking screw in the caudal screw hole on the aiming arm Note For standard locking use two locking screws whenever possible ...

Page 18: ...and the correct length of the femur Align the image intensifier so that the distal hole is visible as a perfect circle in the centre of the image 16 Make incision Determine the incision point and make a stab incision 17 Drill Under image intensification insert the tip of the Drill Bit 4 0 mm for the radiolucent drive through the incision and place it on the bone Tilt the drive until the drill bit ...

Page 19: ... nail and blocks the distal Locking Screw 6 0 mm thus providing a stable angle Remove the insertion instruments Using the hexagonal screwdriver align the end cap with the nail axis and fix it by means of the holding sleeve To minimise the chance of cross threading turn the end cap counterclock wise until the thread of the end cap aligns with that of the nail By turning clockwise completely screw t...

Page 20: ...nsert double sleeve combination Insert the pink double sleeve combination Protection Sleeve 15 0 13 0 357 123 and Drill Sleeve 13 0 3 2 357 124 through the caudal hole on the aiming arm Make a stab incision and advance the combination to the lateral cortex The spiral blade locking option with one Spiral Blade 450 882 892 and one Locking Screw 6 0 mm 450 862 872 is used for patients with an osteopo...

Page 21: ...0 mm 351 270 over the guide wire through the protection sleeve and open the lateral cortex manually or with a power tool The drill bit should open the lateral cortex only to prepare the seat of the spiral blade head The automatic stop prevents the drill bit from pene trating too far Remove the drill bit and protection sleeve 15 Attach spiral blade to spiral inserter Assemble the spiral blade inser...

Page 22: ... and locks the spiral blade proximally providing a stable angle The end cap presses against the edge of the spiral blade preventing it from backing out Remove the insertion instruments Using the hexagonal screwdriver align the end cap with the nail axis and fix it by means of the holding sleeve To minimise the chance of cross threading turn the end cap counterclock wise until the thread of the end...

Page 23: ...he most distal locking implant Remove the most distal locking implant locking screw 6 mm or spiral blade Locking screw 6 mm unscrew the locking screw using the Hexagonal Screwdriver 314 750 and Holding Sleeve 314 280 Spiral blade screw the Extraction Screw for Spiral Blade 357 360 into the blade head and screw the Hammer Guide 357 117 onto the extraction screw Knock the spiral blade out with the S...

Page 24: ...re removing the last locking implant screw the Extraction Screw for DFN 357 133 into the distal end of the nail and tighten with the Pin Wrench 321 170 The last locking implant prevents the nail from rotating or sliding away Screw the Hammer Guide 357 117 onto the extraction screw for DFN and tighten Alternative If the extraction screw for DFN is not available the hammer guide can be screwed direc...

Page 25: ...lant Unscrew the last locking implant using the Hexagonal Screw driver 314 750 and if necessary the Holding Sleeve 314 280 6 Remove nail Knock the nail out with gentle blows of the slide hammer Distal Femoral Nail Implant removal ...

Page 26: ...Synthes 23 Cleaning of instruments Proper functioning of the instruments can be maintained by careful cleaning Distal Femoral Nail Cleaning of instruments ...

Page 27: ...SK 05899 Poprad Tel 421 52 7723 488 Fax 421 52 7723 393 Spain Stratec Medical S A E 28230 Las Rozas Madrid Tel 34 902 190 128 Fax 34 902 190 347 Sweden Stratec Medical AB S 171 28 Solna Tel 46 8 743 71 00 Fax 46 8 641 48 56 Switzerland Stratec Medical CH 4436 Oberdorf Tel 41 61 965 61 11 Fax 41 61 965 66 00 Latin America Argentina Synthes Argentina S A C1183AEY Buenos Aires Tel 54 11 4867 49 49 Fa...

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