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Standard Locking

130˙ Antegrade Locking

Spiral Blade Locking

Miss-A-Nail Locking

The Titanium
Femoral Nail System

Solid and Cannulated Nails

TECHNIQUE GUIDE

Содержание The Titanium Femoral Nail System

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

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

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 19: ......

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 29: ......

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 39: ......

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 53: ......

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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...

Страница 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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