Synthes The Titanium Femoral Nail System Technique Manual Download Page 54 | Manualshive

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The Miss-A-Nail device allows screw ﬁxation
of the neck fracture prior to nail ﬁxation of
the shaft fracture.

Steps of the procedure:

•

Fracture reduction

•

Insertion of Miss-A-Nail instrument
assembly through the standard nail
insertion site

•

Cannulated screw ﬁxation of the femoral
neck fracture

•

Insertion of the nail, locking bolts or
locking screws and end cap

Follow standard technique for opening the femur,
pages 14 –16.

53

Miss-A-Nail Locking

MISS-A-NAIL

L

OCKING

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Summary of Contents for The Titanium Femoral Nail System

Page 1: ...R Standard Locking 130 Antegrade Locking Spiral Blade Locking Miss A Nail Locking The Titanium Femoral Nail System Solid and Cannulated Nails TECHNIQUE GUIDE...

Page 2: ...ations 8 Preoperative Implant Selection 13 Opening the Femur 14 Standard Locking 19 130 Antegrade Locking 29 Spiral Blade Locking 39 Miss A Nail Locking 53 Distal Locking 64 Implant Removal 66 Product...

Page 3: ...or the right and left femur 12 mm diameter proximal end Proximal ats orient the specialty locking sleeves Material Titanium 6 aluminum 7 niobium alloy implant material Lengths 300 mm 480 mm in 20 mm i...

Page 4: ...Self cutting trocar tip 3 5 mm hex drive For 13 mm 15 mm cannulated nails Standard Locking Sleeve For use with 13 mm 15 mm diameter nails 15 mm diameter sleeve matches proximal pro le of 13 mm 15 mm n...

Page 5: ...with 13 mm 15 mm diameter nails 15 mm diameter sleeve adapts dynamic slot to a 130 antegrade locking hole 15 mm diameter sleeve matches proximal pro le of 13 mm 15 mm nails to provide smooth transiti...

Page 6: ...ed Front cutting end 0 mm 10 mm 20 mm Ultra High Molecular Weight Polyethylene implant material For all nails 15 mm Titanium End Caps for Spiral Blade locking sleeves Protect proximal nail threads fro...

Page 7: ...5 0 mm Titanium Shaft Screws 16 mm cancellous thread length for interfragmentary compression Lengths 70 125 mm in 5 mm increments 5 0 mm diameter for insertion through nail slot as a third point of fe...

Page 8: ...d Caps 457 210 212 15 mm End Caps 457 210 212 130 Locking Sleeve 474 913 130 Locking Sleeve 456 013 15 mm End Caps 457 010 012 12 mm End Caps 459 012 014 Spiral Blades 456 70 120 15 mm End Caps 457 01...

Page 9: ...es Ipsilateral femoral neck shaft fractures Impending pathologic fractures Nonunions Femoral shaft fractures For the femoral shaft fracture two standard locking con gurations are possible Static trans...

Page 10: ...INDICATIONS 9 CASE 2 CASE 1...

Page 11: ...or stable subtrochanteric fractures For the femoral shaft or the stable subtrochanteric fracture 130 antegrade locking is possible 10 130 ANTEGRADE Lesser trochanter and medial buttress intact attach...

Page 12: ...For the subtrochanteric fracture with a detached lesser trochanter the Spiral Blade provides secure xation of the proximal fragment The Spiral Blade is not indicated for intertrochanteric fractures SP...

Page 13: ...ents permit insertion of titanium cannulated screws into the femoral head anterior to the nail path for xation of the neck fracture prior to intramedullary xation of the shaft fracture The Miss A Nail...

Page 14: ...of bone in the femoral head this blade placement maximizes purchase and cutout resistance The Spiral Blade should be in the proximal fragment and should not cross the fracture For high subtrochanteri...

Page 15: ...rile 351 706S for cannulated nails Large Reverse Awl 351 11 13 0 mm Cannulated Drill Bit 351 27 Universal Chuck 393 10 Battery Casing for 14 4 V Battery 532 032 Large Quick Coupling 532 015 Small Batt...

Page 16: ...ove the image intensi er to the distal femur replace the proximal end of the ruler at the skin mark and take an AP image of the distal femur Verify fracture reduction Read nail length directly from th...

Page 17: ...er for a length of 90 mm from the proximal end Remove the drill bit 4 Do not use the 15 mm 13 mm Protection Sleeve with the Cannulated Drill Bit This sleeve prevents adequate drill bit penetration int...

Page 18: ...ally retract the reamer often to clear debris from the medullary canal For Ream 9 mm or 10 mm nails 0 5 mm nail diameter 11 mm or 12 mm nails 1 0 mm nail diameter 13 mm 15 mm nails 1 5 mm 2 0 mm nail...

Page 19: ......

Page 20: ...sverse locking for xation of the femoral shaft fracture Steps of the procedure Fracture reduction Insertion of the nail Insertion of proximal and distal locking bolts or locking screws Insertion of en...

Page 21: ...or 13 15 mm nails green 474 900 4 0 mm Trocar 357 75 Insertion Handle 357 511 Cannulated Connecting Screw 357 512 Connecting Screw 357 54 8 mm Ball Hexagonal Screwdriver 357 515 Hammer Guide 357 22 Sl...

Page 22: ...he nail bow faces anteriorly For solid nails Use Connecting Screw 357 54 Use the ratchet wrench to secure the connecting screw to the nail For cannulated nails Use Cannulated Connecting Screw 357 512...

Page 23: ...the handle to lock it in place Thread this assembly into the proximal end of the driving cap and nger tighten the assembly Attach driving cap Assemble hammer and hammer guide The surgeon may also use...

Page 24: ...ide of the insertion handle Seat the nail Using light blows of the hammer seat the nail into the distal metaphysis leaving the proximal nail end at or just below the level of the tip of the greater tr...

Page 25: ...al slot in the nail 4 Drill through both cortices with the 4 0 mm calibrated drill bit stopping the drill immediately after penetrating the far cortex Con rm drill bit position radiographically Be sur...

Page 26: ...en the bit hits the far cortex Press the drill sleeve to the lateral cortex continue drilling until the bit just penetrates the far cortex and read the direct locking bolt or locking screw length at t...

Page 27: ...n 12 mm end cap with 0 mm extension If the proximal nail end is distal to the tip of the greater trochanter and the surgeon chooses to extend nail length note the position of the insertion handle barr...

Page 28: ...threads of the end cap turn into the nail the surgeon will feel increased resistance Continue turning until the shoulder of the end cap contacts the proximal nail end This will help prevent backout No...

Page 29: ......

Page 30: ...ser trochanter intact and attached to the proximal fragment Steps of the procedure Fracture reduction Insertion of the nail and locking sleeve Insertion of the 130 locking bolt or locking screw Insert...

Page 31: ...314 75 Titanium Locking Sleeve pink 456 013 700 gram Hammer 399 43 8 mm Ball Hexagonal Screwdriver 357 515 11 0 mm 8 0 mm Protection Sleeve 357 76 11 mm Hexagonal Socket 321 21 4 0 mm Trocar 357 75 In...

Page 32: ...eter 130 locking sleeve 1 Assemble the implants Orient the pink 130 locking sleeve to the nail so the word lateral faces laterally convex side of nail bow faces anteriorly Seat the sleeve onto the pro...

Page 33: ...n and pass the nail as far as possible by hand Monitor nail passage across the fracture under image intensi cation Use the insertion assembly to manipu late the nail across the fracture For cannulated...

Page 34: ...r If the nail has been inserted over a 2 5 mm Reaming Rod remove the reaming rod 5 Verify nail insertion depth Insert the 11 0 mm 8 0 mm protection sleeve into the 130 hole in the black section of the...

Page 35: ...far cortex Con rm drill bit position radiographically Be sure the drill sleeve is pressed rmly to the cortex and read direct locking bolt or locking screw length from the calibrated drill bit at the b...

Page 36: ...verinserted or if the drill sleeve is not pressed down to the lateral cortex To minimize measuring errors use the pause and consider method Temporarily stop the drill when the bit hits the far cortex...

Page 37: ...on on the image intensi er This is the level of the proximal nail end The etched line on the insertion handle is also at the level of the proximal nail end If the proximal nail end is distal to the ti...

Page 38: ...into the nail until it seats fully As the nal threads of the end cap turn into the nail the surgeon will feel increased resistance Continue turning until the shoulder of the end cap contacts the prox...

Page 39: ......

Page 40: ...he proximal fragment Steps of the procedure Fracture reduction Insertion of the nail with locking sleeve Spiral Blade insertion into the femoral head Insertion of locking bolt s or locking screw s and...

Page 41: ...g Arm 357 80 700 gram Hammer 399 43 Cannulated Shaft 8 mm Hex 357 516 Hammer Guide 357 22 Slide Hammer 357 25 Depth Gauge for Locking Bolts 357 79 5 0 mm Titanium Locking Screw 458 xx 4 0 mm Three Flu...

Page 42: ...moral opening using a twisting hand motion The opening must accommodate the blue 15 mm Locking Sleeve for Spiral Blade If needed adjust the insertion site location at this time Ideally the end of the...

Page 43: ...l insertion 3 Insert the nail Prior to nail insertion estimate the insertion path of the Spiral Blade by considering both femoral anteversion and nail insertion site The Spiral Blade should pass throu...

Page 44: ...ll pass through the opening in the side of the insertion handle Monitor nail passage across the fracture under image intensi cation and further insert the nail until the proximal end is at the level o...

Page 45: ...one Remove the trocar and insert the 3 2 mm guide wire into the sleeve Con rm direction and position with AP and or lateral image 6 44 Spiral Blade Locking continued Attach the Aiming Arm then insert...

Page 46: ...handle is partially radiolucent If wire position is incorrect remove the wire adjust the insertion assembly and replace the wire Press the wire sleeve against the lateral cortex and read direct Spiral...

Page 47: ...ove the trocar Couple the 13 mm cannulated drill bit to a power drill Pass the drill bit over the guide wire and open the lateral cortex The shoulder of the drill bit will contact the protection sleev...

Page 48: ...the nail slot Note If the Spiral Blade doesn t enter the nail slot ensure that The Spiral Blade entry hole is deep enough complete cortical circle removed Guide wire angle Spiral Blade locking sleeve...

Page 49: ...e blade should advance with each hammer blow Monitor blade insertion radiographically The blade is fully inserted when its hub is ush with the lateral cortex Disconnect the insertion assembly and remo...

Page 50: ...statically locks the blue sleeve to the nail Upon nal seating of the end cap the UHMWPE tip deforms around the blade edge further securing the Spiral Blade during the nonweightbearing period 9 trocha...

Page 51: ...on to the tip of the greater trochanter on the image If the indented ring is at the tip of the greater trochanter use the blue 15 mm end cap with 10 mm extension If the base of the are is at the tip o...

Page 52: ...p into the nail until it seats fully 51 Use the ratchet to insert the blue end cap End cap fully seated As the nal threads of the end cap turn into the nail the surgeon will feel increased resistance...

Page 53: ......

Page 54: ...e Fracture reduction Insertion of Miss A Nail instrument assembly through the standard nail insertion site Cannulated screw xation of the femoral neck fracture Insertion of the nail locking bolts or l...

Page 55: ...5 0 mm Cannulated Drill Bit optional 310 63 12 5 mm 8 5 mm Protection Sleeve optional 312 05 8 5 mm 2 8 mm Wire Sleeve optional 312 08 Cannulated Hexagonal Screwdriver 314 05 11 mm Hexagonal Socket 32...

Page 56: ...usually allow room for the Miss A Nail placed anterior cannulated screws However consider each case individually and move the point slightly posteriorly if needed to accommodate the screws Open the c...

Page 57: ...istance remove the dummy nail redrill the entry site and manually reinsert the dummy nail Attach the Specialty Aiming Arm to the insertion handle 5 56 Insert the dummy nail Assemble the Miss A Nail in...

Page 58: ...terally gently move the instrument assembly up or down along the insertion site until the guide wire corresponds to one of the four Miss A Nail angles etched on the aiming arm 6 57 Determine screw ang...

Page 59: ...moral neck and into the femoral head 7 Insert the stabilization wire Holding the correct axial and rotational position of the insertion assembly insert the blue 3 2 mm wire sleeve through the aiming a...

Page 60: ...maximize distance between the screws while remaining within the femoral neck Secure the bushings to the jig using the ratchet wrench with socket Notes If the patient is small statured the surgeon may...

Page 61: ...bone Excessive axial force can cause wire misdirection 10 Insert the second guide wire using the same technique Remove all instrumentation and the stabilization wire leaving only the guide wires in pl...

Page 62: ...eon prefers 6 5 mm Titanium Cancellous Bone Screws use the 3 2 mm wire sleeve s with 3 2 mm trocar through the Miss A Nail jig Insert the 3 2 mm calibrated guide wire through the sleeve and into the f...

Page 63: ...at the same angle as the Miss A Nail placed screws When using the 130 angle use the 11 0 mm 8 0 mm protection sleeve with the drill sleeve 12 Insert the 3 2 mm calibrated guide wire through the sleeve...

Page 64: ...low standard proximal locking technique see pages 24 25 Lock distally For distal locking techniques see pages 64 65 14 13 Place the green end cap To insert an end cap follow the procedure on pages 26...

Page 65: ...lucent Drive Align the image intensi er with the most distal hole in the nail until a perfect circle is visible in the center of the screen Place a scalpel blade on the skin to determine the incision...

Page 66: ...rs as a radiopaque solid circle in the center of the outer ring The drill bit will nearly ll in the locking hole image Hold the drill in this position and drill through both cortices Measure for the l...

Page 67: ...ve the locking bolt s or locking screw s Using the screwdriver with holding sleeve remove the locking bolt or locking screw Note Before removing the last locking bolt or locking screw thread the extra...

Page 68: ...pon extraction 3 Remove the nail and locking sleeve Assemble the hammer and hammer guide and thread the assembly into the extraction screw Thread the extraction screw into the proximal nail end throug...

Page 69: ...ts with Locking Bolts 105 655 with Locking Screws 105 657 68 304 500 Titanium Femoral Nail Standard Insertion and Locking Set Graphic Case 305 580 Locking Screw Labels for Graphic Case included in set...

Page 70: ...uck with T Handle 399 43 Hammer 700 grams 292 69 3 2 mm Calibrated Guide Wire 300 mm 5 ea 314 11 Holding Sleeve for Hexagonal Screwdriver 314 75 314 75 Hexagonal Screwdriver 315 40 4 0 mm Three Fluted...

Page 71: ...2 52 mm 2 ea 4 9 mm Titanium Locking Bolts in 105 655 458 926 26 mm 2 ea 458 928 28 mm 2 ea 458 930 30 mm 2 ea 458 932 32 mm 2 ea 458 934 34 mm 2 ea 458 936 36 mm 2 ea 458 938 38 mm 2 ea 458 940 40 mm...

Page 72: ...474 044 440 mm 474 046 460 mm 474 048 480 mm 11 mm diameter 474 131 300 mm 474 132 320 mm 474 134 340 mm 474 136 360 mm 474 138 380 mm 474 141 400 mm 474 142 420 mm 474 144 440 mm 474 146 460 mm 474...

Page 73: ...Locking Set Graphic Case Titanium Femoral Nail Specialty Locking Set 105 68 Implant tray with lid for independent autoclaving and storage of back up inventory May also be purchased separately 72 Note...

Page 74: ...used for Miss A Nail locking 357 96 3 2 mm Trocar for use with Wire Sleeve 357 82 292 68 2 8 mm Threaded Guide Wire 300 mm 5 ea 310 63 5 0 mm Cannulated Drill Bit 300 mm 255 mm 2 ea 312 05 12 0 mm 8 5...

Page 75: ...a 457 012 20 mm 2 ea 15 mm Titanium End Caps for 130 Locking Sleeve EXTENSION 457 210 0 mm 2 ea 457 211 10 mm 2 ea 457 212 20 mm 2 ea SPIRAL BLADE 130 ANTEGRADE Implants 74 Also Available Titanium Loc...

Page 76: ...25 125 mm 2 ea 419 99 13 0 mm Titanium Washer 6 ea Also Available 5 0 mm Titanium Shaft Screws LENGTH 457 070 70 mm 2 ea 457 075 75 mm 2 ea 457 080 80 mm 2 ea 457 085 85 mm 2 ea 457 090 90 mm 2 ea 457...

Page 77: ...2 055 7 0 mm Reduction Head angled 355 01 Medullary Tube 393 10 Universal Chuck with T Handle Medullary Reamer Heads 352 085 8 5 mm 352 090 9 0 mm 352 095 9 5 mm 352 100 10 0 mm 352 105 10 5 mm 352 11...

Page 78: ...ates Printed in U S A Rev 9 09 J2052 E Synthes USA 1302 Wrights Lane East West Chester PA 19380 Telephone 610 719 5000 To order 800 523 0322 Fax 610 251 9056 Synthes Canada Ltd 2566 Meadowpine Bouleva...

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