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TFN – Titanium Trochanteric Fixation Nail System

Technique Guide

Biomechanical Features

Improved resistance to varus collapse

M.B. Sommers, M. Bottlang, C. Roth, H. Hall, J.C. Krieg (2004) A laboratory
model to evaluate cutout resistance of implants for pertrochanteric fracture
fixation. Journal of Orthopaedic Trauma, Vol 18(6):361–368

lbid.

Improved resistance to femoral head rotation

Cycles

Varus rotation of femoral head at 1000 N

(Unstable pertrochanteric fracture using simulated cancellous bone)

Cycles

IM Device
with Lag Screw

Rotation of femoral head around implant axis at 1000 N

(Unstable pertrochanteric fracture using simulated cancellous bone)

Summary of Contents for TFN

Page 1: ...chanteric Fixation Nail System For intramedullary fixation of proximal femur fractures Technique Guide Instruments and implants approved by the AO Foundation This publication is not intended for distribution in the USA ...

Page 2: ...l guidelines function control and dismantling of multi part instruments as well as processing guidelines for implants please contact your local sales representative or refer to www synthes com reprocessing For general information about reprocessing care and maintenance of Synthes reusable devices instrument trays and cases as well as processing of Synthes non sterile implants please consult the Im...

Page 3: ...Distal Locking Short Nails 35 SureLock Distal Targeting Device Long Nails 39 Freehand Distal Locking Long Nails 40 Insert End Cap 44 Implant Removal 45 Instrument Cleaning 54 Locking Mechanism Assembly 55 Implants 56 For Titanium Cannulated Trochanteric Fixation Nails 56 Titanium Trochanteric Fixation Nails green Short 59 Titanium Trochanteric Fixation Nails green Long 61 Instruments 64 Sets 73 Al...

Page 4: ... varus col lapse and rotational control of the medial fracture segment compared to single screw fixation i e lag screws The result is superior life to cut out versus single screw fixation This is accomplished through the use of the 11 0 mm helical blade In addition the use of the 11 0 mm helical blade results in reduced bone removal versus use of a traditional hip screw These helical blade feature...

Page 5: ...of load cycles to cut out at varying loads When tested at a load of 1 2 kN the lag screw cut out before 1 000 cycles whereas the helical blade cut out after 10 000 cycles Biomechanical Features 1 M B Sommers M Bottlang C Roth H Hall J C Krieg 2004 A laboratory model to evaluate cutout resistance of implants for pertrochanteric fracture fixation Journal of Orthopaedic Trauma Vol 18 6 361 368 2 lbid...

Page 6: ...y model to evaluate cutout resistance of implants for pertrochanteric fracture fixation Journal of Orthopaedic Trauma Vol 18 6 361 368 5 lbid Improved resistance to femoral head rotation Varus rotation Cycles Varus rotation Varus rotation of femoral head at 1000 N4 Unstable pertrochanteric fracture using simulated cancellous bone Cycles IM Device with Lag Screw IM Device with Lag Screw Rotation of...

Page 7: ...antly less bone is removed than with a predrilled lag screw The helical blade compacts trabecular bone around the blade as it advances into the femoral head Note The amount of bone removed by an implant is directly related to its cross sectional area The helical blade s cross sectional area is only 38 that of a standard lag screw Longer fatigue life in mechanical testing7 Example of bone removal w...

Page 8: ...ed blood loss versus plate fixation of subtrochanteric fractures 10 11 Use of the 11 0 mm helical blade results in reduced bone removal com pared to a hip screw Early active mobilization The shortened moment arm associated with an intra medullary approach permits early mobilization In conjunc tion with AO principles the Trochanteric Fixation Nail System creates an environment for bone healing and ...

Page 9: ...ic fractures of osteo porotic bone including prophylactic use in both trochanteric and diaphyseal regions long subtrochanteric fractures proxi mal or distal nonunions malunions and revisions Indications Long 300 mm 460 mm Trochanteric Fixation Nails with helical blade Short 170 mm and 235 mm Trochanteric Fixation Nails with helical blade Long 300 mm 460 mm Trochanteric Fixation Nails with screw Sh...

Page 10: ... 2 8 Synthes TFN Titanium Trochanteric Fixation Nail System Technique Guide Preoperative AP Preoperative lateral Postoperative AP Postoperative lateral Preoperative AP Preoperative lateral Postoperative AP Postoperative lateral ...

Page 11: ... A P View 80 85 90 95 100 105 110 115 120 END CAP EXTENSIONS 0 mm 5 mm 10 mm 170 mm 235 mm 235 mm mm 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 0 Titanium Trochanteric Fixation Nail Ruler AO For distal locking use 4 9 mm Titanium Locking Bolts or 5 0 mm Titanium Locking Screws 7 08 GP2026 B J8770A For use only with the instruments and implants approved b...

Page 12: ...lateral side or adduct the affected leg by 10 15 Reduce the fracture The universal large distractor may be useful when not using a fracture table Open Proximal Femur 2 Determine femoral neck angle Instruments 357 391 Radiographic Ruler for TFN 357 399 Guide Wire 3 2 mm length 400 mm The three oblique slots at the proximal end of the radio graphic ruler can be used to determine the femoral neck an ...

Page 13: ...fy fracture reduc tion Read nail length directly from the ruler image selecting the measurement that places the distal end of the nail at or just proximal to the physeal scar or the chosen insertion depth Alternative technique Instrument 360 255 Measuring Device for Reaming Rod for TFN Nail length may also be determined by using the reaming rod measuring device and a 950 mm reaming rod or guide ro...

Page 14: ... AP view of the femur at the level of the isthmus Hold the radiographic ruler perpendicular to the femur and posi tion the diameter tabs over the isthmus Read the diameter measurement on the tab that fills the canal Note Take into consideration that the ruler is not at the same level as the femur This will affect the accuracy of the measurement Open Proximal Femur ...

Page 15: ...s fascia longitudinally in the direction of the wound Separate the underlying muscle fibers and palpate the tip of the greater trochanter Insert the 22 0 17 0 protection sleeve the 17 0 3 2 drill sleeve and the 3 2 mm trocar assembly into the incision site and down to the bone Remove the trocar The lateral angle of the nail is 6 therefore the 3 2 mm guide wire must be inserted at an angle 6 latera...

Page 16: ... Nail System Technique Guide Insert the guide wire through the protection sleeve and drill sleeve Confirm guide wire placement in both the AP and lateral planes Insert to a depth of approximately 15 cm Re move the drill sleeve Open Proximal Femur ...

Page 17: ...the fracture to be fixed in varus When the 17 0 mm drill bit is removed the 3 2 mm guide wire may be captured and removed simultaneously If the guide wire remains in the bone remove it by hand Dispose of the guide wire Do not reuse Note The cannulated reverse awl may also be used to open the canal or expand the opening created by the 17 0 mm drill bit Use the tissue protector to spare the soft tis...

Page 18: ...east 1 0 mm greater than the nail diameter as determined by surgeon preference After reaming remove the reaming assembly leaving the reaming rod in place Note The trochanteric fixation nail can be passed over the 2 5 mm reaming rod with olive ball tip if used No reaming rod exchange is required Nail length may be determined by using the reaming rod measuring device and a 950 mm reaming rod or guid...

Page 19: ...w of the femur Also confirm left or right nail is being assembled for correct affected limb Pass the cannulated connecting screw through the insertion handle and into the nail Secure using the ball hexagonal screwdriver To verify appropriate position of the locking mechanism for the head element pass the 5 0 mm flexible hexagonal screwdriver through the cannulated connecting screw and turn counter...

Page 20: ...o the femoral opening When using a reaming rod pass the can nulated nail over the reaming rod and into the femoral open ing Optional technique Ensure correct anteversion of the nail by placing a guide wire ventral to the femoral neck and into the femoral head Under image intensification verify fracture reduction and insert the nail as far as possible by hand Use the insertion assembly to manipulat...

Page 21: ...al seating This will allow the bow of the long nails to aid nail passage through the 6 laterally angled entry point For long nails insertion can be aided by light hammer blows When using a hammer monitor the tip of the nail using image intensification Verify that there is no evidence of im pingement distally Synthes 19 TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthes 19 ...

Page 22: ...n handle and secure it in place using the 11 mm ratchet wrench or spanner wrench A free hammer can be used to strike the connector directly If desired the slide hammer and hammer guide can be threaded into the driving cap and light blows used to seat the nail Remove the con nector once the nail has been seated Important Confirm that the nail is tightly connected to the insertion handle especially ...

Page 23: ...to the insertion handle Nail insertion depth can be confirmed by inserting a 3 2 mm guide wire through the aiming arm To ensure the correct an teversion of the nail an additional guide wire can be inserted ventral to the femoral neck and into the femoral head Take a lateral image of the proximal femur to verify nail rotation and ensure that the head element will be aimed toward the center of the f...

Page 24: ...g arm and to the skin Make an incision to accommodate the path of the sleeve assembly Ensure that the incision and dissec tion of the fascia are in line with the path of the blade guide sleeve Pass the sleeve assembly through the soft tissue to the bone The buttress compression nut will snap into the aiming arm Technique tip When assembling the buttress compression nut onto the blade guide sleeve ...

Page 25: ... to the bone The buttress com pression nut is locked into the aiming arm ensuring that the blade guide sleeve will remain in position on the lateral cortex throughout the remainder of the procedure for head element insertion Take an AP C arm image to confirm that the blade guide sleeve is on the lateral cortex Reconfirm fracture reduction using image intensification TFN Titanium Trochanteric Fixat...

Page 26: ...topping approxi mately 5 mm from subchondral bone The guide wire should be centered in the femoral head and neck in both the AP and lateral planes The tip of the guide wire is positioned where the tip of the head element will be when it is properly inserted Confirm guide wire placement in both planes using the image intensifier Note If the nail must be repositioned to improve guide wire placement ...

Page 27: ...ock can be added to obtain an additional 10 cm of soft tissue clearance Position the C arm for an AP image Rotate the C arm until any two orientation lines are symmetric to the blade guide sleeve The midline line between the two orientation lines repre sents the guide wire trajectory Notes The outer lines can be used to determine the center of the femoral head If the nail must be repositioned to i...

Page 28: ...arm either anterior or posterior to the nail Set the thumbscrews to desired wire spread position and tighten using the 11 mm ratchet wrench Leave the 11 0 3 2 drill sleeve assembled in the blade guide sleeve Pass the 5 6 3 2 drill sleeve through the Miss A Nail jig Make a stab incision and pass the sleeve to the bone Ad vance a 3 2 mm guide wire into the femoral head Monitor passage with the image...

Page 29: ...or No 357 399 Using the measuring device for guide wire measure for head element length Pass the measuring device over the guide wire to the back of the blade guide sleeve Length to tip of guide wire is read directly from the measuring device No calculations are required TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthes 27 ...

Page 30: ...head neck it may be removed before drilling and head element insertion If the guide wire falls out or comes out when the drill bit is removed it may be left out for head element insertion Care should be taken to ensure the orientation of the insertion handle and aiming arm is not altered For dense bone the 6 0 mm 10 0 mm cannulated reamer should be used to prepare a path for the full length of the...

Page 31: ...e sleeve and through the nail Advance the tap reamer manually by turning clockwise until the tip of the tap reamer reaches the desired screw placement in the femoral head Important There is no stop on the tap reamer so monitor ing insertion via the following methods is recommended Monitor the depth under fluoroscopy Monitor the respective graduations on the instrument shaft in relation to the blad...

Page 32: ... insertion assembly through the blade guide sleeve Align the pins on the impactor with the grooves in the blade guide sleeve They will only align in one orientation which is indicated when the gold pin on the back of the impactor is positioned toward the patient s head Hold the gold handle of the inserter and advance the blade as far as possible by hand Use light hammer blows on the back of the co...

Page 33: ...s on the tabs of the inserter extractor with the flats on the back end of the screw Thread the connecting screw into the screw and fingertighten the assembly Pass the screw insertion assembly over the guide wire through the blade guide sleeve and through the nail Advance the screw by turning the inserter extractor clock wise until the mark on the inserter meets the flange surface of the blade guid...

Page 34: ...kwise as this will pre vent the locking mechanism from fully engaging the screw Advance the 11 mm screw in 1 75 mm increments by turning the handle 180 or 3 5 mm by turning 360 When aligning the inserter handle always rotate the handle clockwise further engaging the screw in the bone Do not rotate counterclockwise as this will leave a gap between the screw and the bone 32 Synthes TFN Titanium Troc...

Page 35: ...the lock drive Turn clockwise to advance the locking mechanism Advance to the stop The head element is now locked in rotation but can still slide see figures A and B Optional technique Instruments 321 200 Ratchet Wrench for Nut hexagonal 11 0 mm 357 415 Shaft hexagonal 5 0 mm length 210 mm Use the 5 0 mm hexagonal shaft 210 mm in conjunction with the ratchet wrench to advance the locking mechanism...

Page 36: ...y compression can be obtained by turning either the buttress compression nut attached to the impactor clockwise by hand or with the as sistance of the 4 5 mm pin wrench Remove the connecting screw from the head element and in serter If the connecting screw cannot be loosened by hand use the 5 0 mm flexible hexagonal screwdriver to loosen the connection Remove the blade guide sleeve from the aiming...

Page 37: ...0 mm length 176 mm for No 357 389 357 389 Drill Sleeve 8 0 4 0 length 164 mm for No 357 386 357 407 Drill Bit 4 0 mm calibrated length 260 60 mm 3 flute for Quick Coupling Make a stab incision Alternatively use the incision for the blade guide sleeve The incision for the blade guide sleeve may be used for distal locking Note Ensure that the path of the incision and dissection of the fascia are in ...

Page 38: ...hort Nails 170 mm and 235 mm Remove the trocar and drill through both cortices using the calibrated 4 0 mm three fluted drill bit Read the length of the locking bolt directly from the drill bit at the back of the drill sleeve Press the drill sleeve to the bone to ensure accurate measurement ...

Page 39: ...rotec tion sleeve to determine locking bolt length Remove the 8 0 4 0 drill sleeve and pass the measuring hook through the 11 0 8 0 protection sleeve Read locking bolt length directly from the depth gauge at the back of the protection sleeve Note In order to pass the measuring hook through the protection sleeve the sleeve of the depth gauge must be re moved TFN Titanium Trochanteric Fixation Nail ...

Page 40: ...57 398 Drill Sleeve 8 0 4 0 length 164 mm for No 357 386 357 515 Screwdriver hexagonal with spherical head 8 0 mm Insert the appropriate 4 9 mm locking bolt through the pro tection sleeve using the hexagonal screwdriver Remove the protection sleeve and aiming arm Note the in sertion depth of the nail as indicated by the rings on the in sertion handle This will help in end cap selection Remove the ...

Page 41: ...as been challenging once inserted the nail fol lows the bow of the medullary canal and may be deformed in different planes The SureLock system addresses nail deflection in a simple and effective manner The design of the SureLock aiming arm and its specific techniques allow accurate distal locking for long trochanteric fixation nails Note For information on distal locking technique using the SureLo...

Page 42: ...lateral images For static interlocking use the superior locking hole For dynamic interlocking use the inferior locking hole only Oblique incorrect Round correct 2 Align image Align the image intensifier with the hole in the nail until a perfect circle is visible in the center of the screen Important Confirm that the nail is securely connected to the insertion handle especially after hammering ...

Page 43: ...1 417 Drill Bit 4 0 mm with centering tip length 148 122 mm 3 flute with Coupling for RDL Under image intensification insert the tip of the 4 0 mm three fluted drill bit for the radiolucent drive through the in cision and place it onto the bone Keep the drill bit oblique to the x ray beam until the tip is centered in the locking hole TFN Titanium Trochanteric Fixation Nail System Technique Guide S...

Page 44: ...t is in line with the beam and appears centered in the outer ring The drill bit will nearly fill the locking hole image Hold the drill bit firmly in this posi tion and drill through both cortices 6 Measure Instrument 357 402 Depth Gauge for Locking Screws 5 0 mm Use the depth gauge to measure locking bolt length Read locking bolt length directly from the depth gauge ...

Page 45: ...ng bolt using the hexagonal screwdriver holding sleeve and holding sleeve locking device Note The insertion depth of the nail is indicated by the rings on the insertion handle This will help in end cap selection Remove the connecting screw and insertion handle using the ball hexagonal screwdriver or the cannulated shaft and ratchet wrench Standard freehand technique Instrument 315 400 Drill Bit 4 ...

Page 46: ...ation If the nail has been overinserted it should be extended by the use of an end cap of appropriate length The end cap for the Titanium Trochanteric Fixation Nail System is cannulated and can be inserted over a guide wire Place a 3 2 mm guide wire through the incision and into the top of the nail Select the appropriate end cap and slide the end cap over the guide wire and into the top of the nai...

Page 47: ...p Thread the nail extraction screw into the top of the nail Pass the 5 0 mm flexible hexagonal screwdriver through the ex traction screw and engage the hex in the locking mechanism Turn the locking mechanism counterclockwise until it stops The locking mechanism is now disengaged Technique tip It may be easier to align the extraction screw with the top of the nail if the flexible screwdriver is pas...

Page 48: ... mm with Groove length 280 mm Thread the helical blade extractor into the helical blade Align the shaft of the extractor with the notch in the helical blade The extractor is aligned when the flat points toward the patient s head Pass the slide hammer over the hammer guide and thread the hammer guide into the back end of the helical blade extractor Hold onto the shaft of the helical blade extractor...

Page 49: ... Groove length 280 mm Align the inserter extractor with the back end of the screw The inserter is aligned when the tabs on the inserter mate with the flats on the screw Insert the connecting screw Extract the screw by turning the inserter extractor counter clockwise Remove the locking bolt using the 3 5 mm hexagonal screw driver TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthe...

Page 50: ...ct nail Instruments 357 220 Hammer Guide for No 357 250 357 250 Slide Hammer for Nos 357 220 and 357 221 To remove the nail thread the hammer guide and slide ham mer assembly onto the back end of the nail extraction screw Hold onto the extraction screw and use light hammer blows to extract the nail ...

Page 51: ...1 Extraction Screw Guide for TFN Use the extraction screw guide to help center the extraction screw in the top of the nail The conical extraction bolt can be used instead of the extrac tion screw TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthes 49 ...

Page 52: ...of broken nail Instruments 355 399 Extraction Hook 3 7 mm for Cannulated Nails 393 100 Universal Chuck with T Handle or 393 105 Universal Chuck small with T Handle Begin with Steps 1 and 2 of Implant Removal then remove the extraction screw from the nail Available nonsterile or sterile packed Add S to catalog number to order sterile product ...

Page 53: ...including the distant fragment Note Under image intensification verify that the hook has passed through and engaged the distant end of the nail 1 Assemble extraction hook and universal chuck Insert the extraction hook into the universal chuck with T handle The hook should be parallel with the T handle This facilitates visualization of the hook position in the bone TFN Titanium Trochanteric Fixatio...

Page 54: ...xtraction hook with the cannulation of the distant nail fragment 2 Ream canal Ream the medullary canal 1 mm larger than the nail dia meter to clear a path for the distant nail fragment 1 Remove near nail fragment Attach the appropriate extraction bolt or extraction screw to the nail Remove the near nail fragment using the extraction bolt or extraction screw Note The extraction hook can be used as ...

Page 55: ...r image intensification verify that the hook has passed through and engaged the distant end of the nail 5 Extract nail Extract both nail fragments Note Keep the patient s limb restrained to increase the efficiency of the extraction force TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthes 53 ...

Page 56: ... instruments Instruments 357 369 Guide Sleeve for Helical Blade for TFN 357 408 Cleaning Stylet 3 2 mm Clear the cannulations of the instruments intraoperatively using the cleaning stylet Always ensure that the grooves in the blade guide sleeve are free of debris Clean only with neutral pH detergents approved for use on anodized aluminum ...

Page 57: ...into the mating groove on the lock prong forming one assembly 2 Align the two lobes on the lock prong with the channels in the proximal end of the nail The lobes are asymmetrical and will only fit into the nail in one orientation 3 Drop the lock drive and lock prong as one piece into the top of the nail 4 Place the head element through the hole in the nail with the flat facing the distal end of th...

Page 58: ...6 301S 80 456 307S 110 456 302S 85 456 308S 115 456 303S 90 456 309S 120 456 304S 95 456 310S 125 456 305S 100 456 650S 130 11 0 mm Femoral Neck Screws gold Titanium alloy Lengths 70 mm 130 mm 5 mm increments 11 0 mm diameter Cannulated Femoral Neck Screw for TFN 11 0 mm Titanium Alloy TAN gold sterile Length Length mm mm 04 032 070S 70 04 032 105S 105 04 032 075S 75 04 032 110S 110 04 032 080S 80...

Page 59: ...5 mm and 10 mm extensions Cannulated End Cap for TFN Titanium Alloy TAN green sterile Extension mm 456 311S 0 456 312S 5 456 313S 10 Titanium 6 aluminum 7 niobium TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthes 57 ...

Page 60: ...car tip 3 5 mm hexagonal drive Locking Bolt 4 9 mm self tapping Titanium Alloy TAN green Length Length mm mm 459 260 26 459 540 54 459 280 28 459 560 56 459 300 30 459 580 58 459 320 32 459 600 60 459 340 34 459 640 64 459 360 36 459 680 68 459 380 38 459 720 72 459 400 40 459 760 76 459 420 42 459 800 80 459 440 44 459 850 85 459 460 46 459 900 90 459 480 48 459 950 95 459 500 50 459 100 100 459 ...

Page 61: ...le Distal diameters of 10 mm 11 mm 12 mm Preassembled locking mechanism for controlling rotation and amount of travel of the head element Static interlocking Universal design for left and right femurs Distal locking slot accepts 4 9 mm locking bolts or 5 0 mm locking screws 170 mm nail 32 5 mm 0 mm Distal locking slot accepts 4 9 mm locking bolts or 5 0 mm locking screws 0 mm 235 mm nail TFN Titan...

Page 62: ...S 11 125 456 318S 11 130 456 319S 11 135 456 321S 12 125 456 322S 12 130 456 323S 12 135 TFN Cannulated Trochanteric Fixation Nail length 235 mm Titanium Alloy TAN green sterile Diameter mm Angle 456 324S 10 125 456 325S 10 130 456 326S 10 135 456 327S 11 125 456 328S 11 130 456 329S 11 135 456 510S 12 125 456 511S 12 130 456 512S 12 135 60 Synthes TFN Titanium Trochanteric Fixation Nail System Te...

Page 63: ... 17 mm Anatomic 6 lateral angle Distal diameters of 10 mm 11 mm 12 mm and 14 mm Preassembled locking mechanism for controlling rotation and amount of travel of the head element Anatomic 1 5 m radius of curvature Static or dynamic interlocking with controlled dynamiza tion of 10 mm Anatomic 10 anteversion Nail designs for both left and right femurs Static Dynamic Distal locking slot accepts 4 9 mm ...

Page 64: ... 411S 300 130 456 352S 456 353S 320 130 456 412S 456 413S 320 130 456 354S 456 355S 340 130 456 414S 456 415S 340 130 456 356S 456 357S 360 130 456 416S 456 417S 360 130 456 358S 456 359S 380 130 456 418S 456 419S 380 130 456 360S 456 361S 400 130 456 420S 456 421S 400 130 456 362S 456 363S 420 130 456 422S 456 423S 420 130 456 364S 456 365S 440 130 456 424S 456 425S 440 130 456 366S 456 367S 460 ...

Page 65: ...56 641S 400 130 456 462S 456 463S 420 125 456 642S 456 643S 420 130 456 464S 456 465S 440 125 456 644S 456 645S 440 130 456 466S 456 467S 460 130 456 646S 456 647S 460 130 456 470S 456 471S 300 130 456 472S 456 473S 320 130 456 474S 456 475S 340 130 456 476S 456 477S 360 130 456 478S 456 479S 380 130 456 480S 456 481S 400 130 456 482S 456 483S 420 130 456 484S 456 485S 440 130 456 486S 456 487S 46...

Page 66: ...ric Fixation Nail System Technique Guide 03 010 471 Guide Wire Aiming Device Offset Block 100 mm 03 010 427 Curved Awl 8 0 mm for intramedullary Reduction 03 010 415 Connecting Screw for TFN for No 03 010 412 03 010 405 Insertion Handle radiolucent for PFNA 03 010 474 Connecting Screw cannulated for TFN for No 03 010 405 ...

Page 67: ... mm 3 flute for Quick Coupling 314 750 Screwdriver hexagonal large 3 5 mm with Groove length 280 mm 314 110 Holding Sleeve large 321 250 Spanner Wrench for Nos 357 180 357 181 359 201 and 359 219 TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthes 65 03 019 030 Connecting Screw for MultiLoc Humeral Nailing System for Nos 03 019 008 and 03 019 012 03 010 475 Connector for Inserti...

Page 68: ...ique Guide 357 367 Aiming Arm for TFN 135 357 366 Aiming Arm for TFN 130 357 365 Aiming Arm for TFN 125 357 250 Slide Hammer for Nos 357 220 and 357 221 Instruments 357 220 Hammer Guide for No 357 250 357 052 Compression Nut for No 357 048 351 050 Tissue Protector ...

Page 69: ... Guide Wire 3 2 mm for No 357 399 357 383 Trocar 3 2 mm length 232 mm for No 357 381 357 381 Drill Sleeve 11 0 3 2 length 222 mm for No 357 369 357 378 Extraction Instrument for Helical Blade for TFN 357 377 Connecting Screw for Helical Blade for TFN 357 386 Protection Sleeve 11 0 8 0 for TFN TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthes 67 ...

Page 70: ...FN 357 396 Extraction Screw for TFN 357 394 Drill Bit 17 0 mm cannulated length 300 mm for Quick Coupling No 511 760 357 393 Trocar 3 2 mm length 172 mm for No 357 392 357 392 Drill Sleeve 17 0 3 2 length 161 mm for No 357 410 357 387 Trocar 4 0 mm length 176 mm for No 357 389 357 391 Radiographic Ruler for TFN 357 389 Drill Sleeve 8 0 4 0 length 164 mm for No 357 386 ...

Page 71: ...mm cannulated short length 125 mm 357 410 Protection Sleeve 22 0 17 0 for No 357 394 357 407 Drill Bit 4 0 mm calibrated length 260 60 mm 3 flute for Quick Coupling 357 406 Screwdriver hexagonal 5 0 mm flexible 357 405 Fixation Sleeve 357 404 Drill Bit 11 0 mm conical cannulated length 280 mm for Quick Coupling No 511 760 TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthes 69 ...

Page 72: ... for TFN 70 Synthes TFN Titanium Trochanteric Fixation Nail System Technique Guide 357 415 Shaft hexagonal 5 0 mm length 210 mm 357 414 Socket hexagonal 11 0 mm length 180 mm 357 413 Drill Sleeve 5 6 3 2 length 198 mm 357 412 Awl for TFN ...

Page 73: ...tractor for TFN Femoral Neck Screw 357 427 Screwdriver hexagonal 5 0 mm 357 421 Extraction Screw Guide for TFN 357 420 Conical Extraction Bolt for TFN 357 419 Percutaneous Connecting Screw cannulated 357 418 Percutaneous Insertion Handle for TFN TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthes 71 ...

Page 74: ...es TFN Titanium Trochanteric Fixation Nail System Technique Guide 399 420 Hammer 500 g 393 100 Universal Chuck with T Handle 360 255 Measuring Device for Reaming Rod for TFN 360 253 Locking Device for Holding Sleeve No 314 110 357 920 Aiming Jig for Miss A Nail Technique for TFN ...

Page 75: ...10 357 393 Trocar 3 2 mm length 172 mm for No 357 392 357 394 Drill Bit 17 0 mm cannulated length 300 mm for Quick Coupling No 511 760 357 395 Connector for TFN for No 357 411 357 397 Connecting Screw cannulated for TFN 357 398 Shaft hexagonal 8 0 mm cannulated short length 125 mm 357 399 Guide Wire 3 2 mm length 400 mm 357 410 Protection Sleeve 22 0 17 0 for No 357 394 357 411 Insertion Handle fo...

Page 76: ... Impactor for Helical Blade for TFN 357 377 Connecting Screw for Helical Blade for TFN 357 378 Extraction Instrument for Helical Blade for TFN 357 381 Drill Sleeve 11 0 3 2 length 222 mm for No 357 369 357 383 Trocar 3 2 mm length 232 mm for No 357 381 357 385 Measuring Device for Guide Wire 3 2 mm for No 357 399 357 386 Protection Sleeve 11 0 8 0 for TFN 357 387 Trocar 4 0 mm length 176 mm for No...

Page 77: ...flexible 357 407 Drill Bit 4 0 mm calibrated length 260 60 mm 3 flute for Quick Coupling 357 408 Cleaning Stylet 3 2 mm 357 413 Drill Sleeve 5 6 3 2 length 198 mm 357 414 Socket hexagonal 11 0 mm length 180 mm 357 415 Shaft hexagonal 5 0 mm length 210 mm 357 920 Aiming Jig for Miss A Nail Technique for TFN 360 253 Locking Device for Holding Sleeve No 314 110 TFN Titanium Trochanteric Fixation Nail...

Page 78: ...r No 03 010 412 03 010 427 Curved Awl 8 mm intramedullary reduction tool for intramedullary reduction 03 010 471 Guide Wire Aiming Device Offset Block 100 mm 321 170 Pin Wrench 4 5 mm length 120 mm 357 052 Compression Nut for No 357 048 357 418 Percutaneous Insertion Handle for TFN 357 419 Percutaneous Connecting Screw cannulated 357 420 Conical Extraction Bolt for TFN 357 421 Extraction Screw Gui...

Page 79: ...mer 700 g Power Equipment 511 300 Radiolucent Drive 511 750 AO ASIF Quick Coupling for Compact Air Drive and Power Drive 511 761 Quick Coupling for DHS DCS Triple Reamers 511 791 Quick Coupling for Kirschner Wires 0 6 to 3 2 mm for Compact Air Drive and Power Drive 511 417 Drill Bit 4 0 mm with centering tip length 148 122 mm 3 flute with Coupling for RDL 530 100 Power Drive 530 200 Battery for Po...

Page 80: ...78 Synthes TFN Titanium Trochanteric Fixation Nail System Technique Guide ...

Page 81: ...TFN Titanium Trochanteric Fixation Nail System Technique Guide Synthes 79 ...

Page 82: ...80 Synthes TFN Titanium Trochanteric Fixation Nail System Technique Guide ...

Page 83: ......

Page 84: ...AC ä Synthes GmbH 2014 All rights reserved 036 000 288 AC DSEM TRM 0714 0116 07 2014 Synthes GmbH Eimattstrasse 3 CH 4436 Oberdorf www depuysynthes com This publication is not intended for distribution in the USA All surgical techniques are available as PDF files at www synthes com lit ...

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