Synthes Titanium Trochanteric Fixation Nail System Technique Manual Download Page 62

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Instruments

Synthes

Titanium Trochanteric Fixation Nail System—Screw Option Technique Guide

357.427 5.0 mm Hexagonal Screwdriver

357.428 Trochanteric Fixation Nail Screw Inserter/

Extractor

357.418 Percutaneous Insertion Handle, for

Trochanteric Fixation Nail

357.419 Percutaneous Cannulated Connecting

Screw, for Trochanteric Fixation Nail

357.420 Conical Extraction Bolt, for Trochanteric

Fixation Nail

357.421 Extraction Screw Guide, for Trochanteric

Fixation Nail

Summary of Contents for Titanium Trochanteric Fixation Nail System

Page 1: ...Titanium Trochanteric Fixation Nail System Screw Option For intramedullary fixation of proximal femur fractures Technique Guide...

Page 2: ......

Page 3: ...Locking Short Nails 31 SureLock Distal Targeting Device Long Nails 34 Freehand Distal Locking Long Nails 35 Insert End Cap 39 Implant Removal 40 Instrument Cleaning 45 Locking Mechanism Assembly 46 I...

Page 4: ...Trochanteric Fixation Nail System Screw Option Technique Guide Titanium Trochanteric Fixation Nail System Screw Option For intramedullary fixation of proximal femur fractures Nail features 6 lateral a...

Page 5: ...pping 70 mm 130 mm lengths Titanium alloy Distal locking 4 9 mm locking bolts or 5 0 mm locking screws Titanium alloy for improved mechanical and fatigue properties Self cutting trocar tip Synthes 3 T...

Page 6: ...ation per standard AO technique creates an environment for bone healing expediting a return to optimal function 4 Synthes Titanium Trochanteric Fixation Nail System Screw Option Technique Guide 1 M E...

Page 7: ...long TFN is additionally indicated for subtrochanteric fractures pertrochanteric fractures associated with shaft fractures pathologic fractures of osteoporotic bone including prophylactic use in both...

Page 8: ...ail length is 420 mm Typical femoral x ray image is enlarged by 5 magnification factor 1 05 420 1 05 400 Estimated nail length is 400 mm When selecting nail size consider canal diameter fracture patte...

Page 9: ...adduct the affected leg by 10 15 Reduce the fracture The universal large distractor may be useful when not using a fracture table 2 Determine femoral neck angle Instruments 357 391 Radiographic Ruler...

Page 10: ...of the radiographic ruler at the skin mark and take an AP image of the distal femur Verify fracture reduction Read nail length directly from the ruler image selecting the measurement that places the d...

Page 11: ...t the level of the isthmus Hold the radiographic ruler perpendicular to the femur and position the diameter tabs over the isthmus Read the diameter measurement on the tab that fills the canal Note Tak...

Page 12: ...ry the dissection down to the gluteus maximus fascia longi tudinally in the direction of the wound Separate the underlying muscle fibers and palpate the tip of the greater trochanter Insert the 22 0 m...

Page 13: ...nthes 11 Insert the guide wire through the protection sleeve and wire guide Confirm guide wire placement in both the AP and lateral planes Insert to a depth of approximately 15 cm Remove the wire guid...

Page 14: ...rus Take care to remove the bone on the medial segment of the fracture to prepare an adequate opening for the proximal end of the nail When the 17 0 mm drill bit is removed the 3 2 mm guide wire may b...

Page 15: ...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...

Page 16: ...the geometry of the handle to the nail Note For long 300 mm to 460 mm nails the bow of the nail must be aligned with the anterior bow of the femur Also confirm left or right nail is being assembled fo...

Page 17: ...ng a reaming rod pass the cannulated nail over the reaming rod and into the femoral opening Optional technique Ensure correct anteversion of the nail by placing a guide wire ventral to the femoral nec...

Page 18: ...il reaches the isthmus As the nail is advanced rotate the handle so it is positioned laterally for final seating This will allow the bow of the long nails to aid nail passage through the 6 laterally a...

Page 19: ...be used to strike the driving cap directly Alternatively the slide hammer and hammer guide can be threaded into the driving cap Light blows can be used to seat the nail Remove the driving cap once th...

Page 20: ...ghtly connected to the insertion handle Securely attach the appropriate aiming arm to the insertion handle Nail insertion depth can be confirmed by inserting a 3 2 mm guide wire through the aiming arm...

Page 21: ...he aiming arm and to the skin Make an incision to accommodate the path of the sleeve assembly Ensure that the incision and dissection of the fascia are in line with the path of the blade guide sleeve...

Page 22: ...of the aiming assembly Turn the buttress compression nut counterclockwise to advance the blade guide sleeve to the bone The buttress compression nut is locked into the aiming arm ensuring that the bl...

Page 23: ...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 at the intended screw tip position Con...

Page 24: ...lace using the connecting screw for guide wire aiming device Note The guide wire aiming device offset block can be added to obtain an additional 10 cm of soft tissue clearance Position the C arm for a...

Page 25: ...iming arm either anterior or posterior to the nail Set the thumb screws to desired wire spread position and tighten using the 11 mm ratchet wrench Leave the 11 0 mm 3 2 mm wire guide assembled in the...

Page 26: ...suring device over the guide wire to the back of the blade guide sleeve Screw length to the tip of the guide wire is read directly from the measuring device No calculations are required Note If compre...

Page 27: ...ead neck it may be removed before drilling and screw insertion If the guide wire falls out or comes out when the drill bit is removed it may be left out for screw insertion Care should be taken to ens...

Page 28: ...nce the tap reamer manually by turning clockwise until the end 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 ins...

Page 29: ...ractor Align the arrows on the tabs of the inserter extractor with the arrows on the flats on the back end of the screw Thread the coupling screw into the screw and finger tighten the assembly 8 Inser...

Page 30: ...rter 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 10 Engage locking mechanism...

Page 31: ...415 5 0 mm Hexagonal Shaft 210 mm Use the 5 0 mm hexagonal shaft 210 mm in conjunction with the ratchet wrench to advance the locking mechanism Note If the locking mechanism is not advanced use of an...

Page 32: ...e At this point inter fragmentary compression can be obtained by turning either the buttress compression nut attached to the blade guide sleeve or the compression nut attached to the screw in serter e...

Page 33: ...sleeve may be used for distal locking Note Ensure that the path of the incision and dissection of the fascia are in line with the path of the protection sleeve Insert the triple trocar assembly throu...

Page 34: ...2 Locking Bolt Measuring Device The locking bolt measuring device may be used through the 11 0 mm 8 0 mm protection sleeve to determine locking bolt screw length Remove the 8 0 mm 4 0 mm drill sleeve...

Page 35: ...locking bolt or 5 0 mm locking screw through the protection sleeve using the hexagonal screwdriver Remove the protection sleeve and aiming arm Note the inser tion depth of the nail as indicated by th...

Page 36: ...Increased working space Historically distal locking of intramedullary nails with an aiming device has been challenging once inserted the nail follows the bow of the medullary canal and may be deforme...

Page 37: ...tic interlocking use the superior locking hole For dynamic interlocking use the inferior locking hole only 2 Align image Align the image intensifier with the hole in the nail until a perfect circle is...

Page 38: ...he hole to mark the incision point and make a stab incision 4 Center drill bit in locking hole Instrument 511 417 4 0 mm Three Fluted Drill Bit for Radiolucent Drive Under image intensification insert...

Page 39: ...e drill bit will nearly fill the locking hole image Hold the drill firmly in this position and drill through both cortices 6 Measure Instrument 357 402 Locking Bolt Measuring Device Use the locking bo...

Page 40: ...11 mm width across flats 357 398 Cannulated Shaft with 8 mm hex 357 515 Ball Hexagonal Screwdriver 8 mm 360 253 Holding Sleeve Locking Device Insert the appropriate length 4 9 mm locking bolt or 5 0...

Page 41: ...sit slightly proud of the greater trochanter to provide an added point of fixation If the nail has been over inserted it should be extended by the use of an end cap of appropriate length The end cap...

Page 42: ...driver or 11 mm cannulated hexagonal socket to remove the end cap Thread the nail extraction screw into the top of the nail Pass the 5 0 mm hexagonal screwdriver through the extraction screw and engag...

Page 43: ...ts 357 420 Conical Extraction Bolt 357 421 Extraction Screw Guide Use the extraction screw guide to help center the extraction screw in the top of the nail The conical extraction bolt can be used inst...

Page 44: ...erter extractor counterclockwise Remove all locking bolts screws using the 3 5 mm hexagonal screwdriver Tip Inserting a K wire into the screw may facilitate aligning the inserter extractor with the sc...

Page 45: ...ersal 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 2 Insert ext...

Page 46: ...hook Insert the extraction hook and explanted near nail fragment into the medullary canal The near nail fragment aligns the ex traction hook with the cannulation of the distant nail fragment 4 Engage...

Page 47: ...9 Cleaning Brush Clear the cannulations of the instruments intraoperatively using the cleaning stylet Clean the instruments postoperatively with the cleaning stylet and cleaning brush Always ensure th...

Page 48: ...channels in the proximal end of the nail The lobes are asymmetri cal 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 Pla...

Page 49: ...m Locking Bolts green Titanium alloy Lengths 26 mm 60 mm 2 mm increments 64 mm 80 mm 4 mm increments 85 mm 100 mm 5 mm increments 4 3 mm core diameter Fully threaded Self cutting trocar tip 3 5 mm hex...

Page 50: ...stal diameters of 10 mm 11 mm 12 mm Preassembled locking mechanism for controlling screw rotation and amount of screw travel Static interlocking Universal design for left and right femurs 48 Synthes T...

Page 51: ...6S 10 135 456 317S 11 125 456 318S 11 130 456 319S 11 135 456 321S 12 125 456 322S 12 130 456 323S 12 135 235 mm Titanium Cannulated Trochanteric Fixation Nails sterile Diameter mm Angle 456 324S 10 1...

Page 52: ...nd 14 mm Preassembled locking mechanism for controlling screw rotation and amount of screw travel Anatomic 1 5 m radius of curvature Static or dynamic interlocking with controlled dynamization of 10 m...

Page 53: ...0 456 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 456 421...

Page 54: ...Length right left mm Angle 456 450S 456 451S 300 125 456 452S 456 453S 320 125 456 454S 456 455S 340 125 456 456S 456 457S 360 125 456 458S 456 459S 380 125 456 460S 456 461S 400 125 456 462S 456 463...

Page 55: ...Screw for Guide Wire Aiming Device for Trochanteric Fixation Nail 03 010 427 Curved Awl 8 mm intramedullary reduction tool 03 010 471 Guide Wire Aiming Device Offset Block 314 11 Holding Sleeve 314 75...

Page 56: ...57 22 Hammer Guide for use with Slide Hammer 357 25 Slide Hammer for use with Hammer Guide Instruments 351 05 Tissue Protector 321 20 Ratchet Wrench 11 mm width across flats 321 25 Spanner Wrench 357...

Page 57: ...for Trochanteric Fixation Nails 357 367 135 Aiming Arm for Trochanteric Fixation Nails 357 371 Buttress Compression Nut for use with Blade Guide Sleeve 357 377 Helical Blade Coupling Screw 357 381 11...

Page 58: ...4 0 mm Trocar 176 mm 357 389 8 0 mm 4 0 mm Drill Sleeve 164 mm 357 391 Radiographic Ruler for Trochanteric Fixation Nails 357 392 17 0 mm 3 2 mm Wire Guide 161 mm 357 385 Helical Blade Measuring Devic...

Page 59: ...7 396 Extraction Screw for Trochanteric Fixation Nails 357 397 Cannulated Connecting Screw for Trochanteric Fixation Nails 357 398 Cannulated Shaft with 8 mm hex 125 mm 357 394 17 0 mm Cannulated Dril...

Page 60: ...Bit quick coupling 260 mm 65 mm calibration 357 410 22 0 mm 17 0 mm Protection Sleeve 357 404 11 0 mm Tapered Cannulated Drill Bit large quick coupling 280 mm 357 405 Drill Stop for use with 357 403...

Page 61: ...gonal Socket 180 mm 357 415 5 0 mm Hexagonal Shaft 210 mm 357 417 5 0 mm Flexible Hexagonal Screwdriver coated 357 411 Insertion Handle for Trochanteric Fixation Nails 357 412 Cannulated Reverse Awl 3...

Page 62: ...57 428 Trochanteric Fixation Nail Screw Inserter Extractor 357 418 Percutaneous Insertion Handle for Trochanteric Fixation Nail 357 419 Percutaneous Cannulated Connecting Screw for Trochanteric Fixati...

Page 63: ...xagonal Screwdriver 8 mm for Titanium Femoral Nails 357 92 Miss A Nail Aiming Jig 360 253 Holding Sleeve Locking Device 360 255 Reaming Rod Measuring Device 393 10 Universal Chuck with T Handle 357 43...

Page 64: ...nulated Connecting Screw for Trochanteric Fixation Nails 2 ea 357 398 Cannulated Shaft with 8 mm hex 125 mm 357 399 3 2 mm Guide Wire 400 mm 10 ea 357 410 22 0 mm 17 0 mm Protection Sleeve 357 411 Ins...

Page 65: ...e Guide Sleeve 357 372 Helical Blade Inserter 357 377 Helical Blade Coupling Screw 357 378 Helical Blade Extractor 357 381 11 0 mm 3 2 mm Wire Guide 222 mm 357 383 3 2 mm Trocar 232 mm 357 385 Helical...

Page 66: ...95 459 50 50 459 100 100 459 52 52 5 0 mm Titanium Locking Screws 2 ea in set 105 643 Length Length mm mm 458 926 26 458 954 54 458 928 28 458 956 56 458 930 30 458 958 58 458 932 32 458 960 60 458 93...

Page 67: ...010 471 Guide Wire Aiming Device Offset Block 321 17 4 5 mm Pin Wrench 357 052 Trochanteric Fixation Nail Screw Compression Nut 357 418 Percutaneous Insertion Handle for Trochanteric Fixation Nail 357...

Page 68: ...al Blades sterile Length mm 456 300S 75 456 310S 125 456 650S 130 Instruments 351 706S 2 5 mm Reaming Rod with ball tip 950 mm sterile 351 707S 2 5 mm Reaming Rod with ball tip and extension 950 mm st...

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Page 72: ...610 251 9056 Synthes Canada Ltd 2566 Meadowpine Boulevard Mississauga Ontario L5N 6P9 Telephone 905 567 0440 To order 800 668 1119 Fax 905 567 3185 2010 Synthes Inc or its affiliates All rights reserv...

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