Stryker T2 Operative Technique

Operative Technique
KnifeLight
Carpal Tunnel Ligament Release
T2
Recon Nailing System R2.0
Operative Techn ique
Hip & Femur Fractures
Femur
T2 Recon Nailing System
We greatly acknowledge and appreciate the contributions to this operative technique made by:
Kevin W. Luke, M.D.
Parkview Orthopaedic Group Assistant Clinical Professor Department of Orthopaedic Surgery University of Illinois Illinois, Chicago USA
Anthony T. Sorkin, M.D.
Rockford Orthopaedic Associates, LLP Clinical Instructor Dep. of Surgery University of Illinois College of Medicine Director Orthopaedic Traumatology Rockford Memorial Hospital Rockford, Illinois USA
Ariaan D.P. van Walsum, MD
Trauma surgeon Medical Spectrum Twente Enschede Netherlands
Don Weber, MD, FRCSC
Associate Clinical Professor of Orthopaedics Chief of Orthopaedics University of Alberta Hospital Edmonton, Alberta Canada
Contributing Surgeons
2
This publication sets forth detailed recommended procedures for using Stryker Osteosynthesis devices and instruments.
It offers guidance that you should heed, but, as with any such technical guide, each surgeon must consider the particular needs of each patient and make appropriate adjustments when and as required.
A workshop training is required prior
to first surgery.
All non-sterile devices must be
cleaned and sterilized before use.
Follow the instructions provided in
our reprocessing guide (L24002000).
Multi-component instruments must
be disassembled for cleaning. Please refer to the corresponding assembly/ disassembly instructions.
See package insert (L22000007) for a complete list of potential adverse effects, contraindications, warnings and precautions. The surgeon must discuss all relevant risks, including the finite lifetime of the device, with the patient, when necessary.
Warn ing :
Fixation Screws: Stryker Osteosynthesis bone screws are not approved or intended for screw attachment or fixation to the posterior ele­ments (pedicles) of the cervical, thoracic or lumbar spine.
3
Contents
Page
1. Introduction & Features 5
Implant Features 5
Technical Specifications 6 Instrument Features 7
2. Indications, Precautions & Contraindications 8
3. Pre-operative Planning 9
4. Locking Options 10
5. Operative Technique 11
Patient Positioning and Fracture Reduction 11
Incision 11 Entry Point 12 Re a ming 14 Nail Selection 16 Assembly of the Targeting Device and the Nail 17 Nail Insertion 18 Final Seating with Impactor 18 Guided Locking for the Recon Mode 19 Guided Locking for Antegrade Femoral Mode 29 Freehand Distal Locking 32 Set Screw or End Cap Insertion 34 Nail Removal 34
Ordering Information – Implants 35
Ordering Information – Instruments 37
4
Introduction
Over the past decades antegrade and retrograde femoral nailing have become widely accepted choices for the treatment of femoral fractures.
The T2 Recon nail is one of the first femoral nailing systems to offer a greater trochanter entry point with both recon and antegrade locking options.
Through the development of a common, streamlined instrument system and intuitive surgical approach, both in principle and in detail, the T2 Recon Nail offers the potential for more efficient treatment of fractures as well as simplifying the training requirements for all person nel involved.
Furthermore, the T2 Recon Nail offers the following competitive advantages:
• Versatility-offerstheabilityto
switch from antegrade to a recon option without changing either
the nail or targeting arm.
• ReconSetScrew-thisoptional
screw sets the most proximal Lag Screw thus minimizing the potential for screw sliding (Z-effect).
• LockingOptions-distaloptions
include dynamic as well as static.
• DistalTargeting-eliminatesthe
need for freehand locking of either the static or dynamic modes.
RequiresoptionalGamma3/T2 ReconDTSR2.0
The T2 Recon Nail is the realization of excellent biomechanical intrame­dullary stabilization for internal femoral fixation with several locking options to address fracture variability.
As with all other T2 Nails, the T2 Recon Nail is made of Type II
anodized Titanium Alloy (Ti6Al4V) for enhanced biomechanical and biomedical performance*.
The T2 Recon Nail features a 125°
CCDanglewitha10°anteversion
angle. The 2 proximal holes, each utilize 6.5mm cannulated Lag Screws. This CCDangle allows easy
insertion of the 2 lag screws into the femoral head.
Alternatively a proximal 70° Oblique hole with 7° retroversion provides a 5mm Fully Threaded Screw for targeting the lesser trochanter in the Femoral Antegrade mode.
The 6.5 mm Cannulated Lag Screws
have a unique thread design that provide an excellent grip. Improved front cutting flutes allow for lesser insertion torque and thinner flanks for less bone removal.
Secure placement of the Lag Screws within small neck diameters can be achieved due to 10mm separating the two 6.5mm lag screws or 17mm outer distance between the 6.5mm Lag screws.
Two Set Screws are available:
- Recon Set Screw: Tightens the
6.5mm proximal Lag Screw (Recon Mode) and
- Antegrade Set Screw: Tightens the oblique 5mm Fully Threaded Screw (Femoral Antegrade Mode).
Available as left and right versions, the T2 Recon Nail incorporates an antecurvature radius of 2.0M, as well as a 4° medial lateral bend for trochanteric insertion.
The distal locking configuration features a round and an oblong hole to allow for staticand/ordynamic
distal locking.
Low profile 5mm cortical screws,
common to the T2 Nailing System, are designed to simplif y the surgical procedure and promote a minimally invasive approach.
5mm Fully Threaded Locking Screws are available for distal locking (Recon or Femoral Antegrade Mode) and for the proximal locking in Femoral Antegrade Mode.
End Caps are available in various lengths to provide a better fit.
See the detailed chart on the next page for the design specifications and size offerings.
Implant FeaturesIntroduction
* Axel Bauman n, Nils Zander, Ti6Al4V with
Anodization Type II: Biological Behaviour and Biomecha nical Effects, White Paper, March 2005.
5
Introduction
NailDiameter 9, 11, 13 and 15mm (Left and Right) Sizes 280−480mm, in 20mm increments
Note:
Proximal diameter is 13mm for
the 9 and 11mm Nails and 15mm for the 13 and 15mm Nails.
Check with your local
representative regarding availability of nail sizes.
5.0mm Fully Threaded Locking Screws
L = 25–120mm
6.5mm Cannulated Lag Screws
L = 65–130mm
Antegrade Set Screw
End Caps
Stand ard +5mm +10mm +15mm
0mm
Antecurvature radius 2.0M
40mm
20mm 15mm
0mm
4° Medial Lateral bend
44mm
70°
125°Nail angle
0mm
26mm
10.5 mm
Technical Specifi cations
Recon Set Screw
17.0 mm
Note:
Screw length is measured from top of head to tip.
6
Introduction
Instrument Features
A major advantage of the T2 instrument platform is the integration of core instruments that can be used not only for the complete T2 Nailing System, but for future Stryker Osteosynthesis nailing systems, thereby, reducing complexity and inventory.
The T2 instrument platform offers
precision and usability, as well as ergonomically styled targeting devices.
Except for the addition of a small number of dedicated instruments, the T2 Femur instrument platform is used for the T2 Recon Nail.
The T2 Recon targeting device is designed to provide two proximal locking options: Recon or Antegrade Femoral Modes.
Reconmode: Provides two (2) proximal holes targeting the femoral neck and head:
• B Targets the Proximal Recon
6.5 mm Lag Screw
• A Targets the Distal Recon
6.5 mm Lag Screw
Antegrade Femoral Mode : Provides a single 5mm Oblique Screw targeting the lesser trochanter. LEFT is used for a left nail and RIGHT for a right nail.
With the exception of the carbon fi ber targeting device, dedicated instruments for the recon mode are color coded with “bronze”. This makes it easy to differentiate them from the core T2 instrument platform.
Drills
Drillsfeaturecolorcodedrings:
4.2mm = Green
(Consistent with the Gamma3 and T2 Instrument Plat form, this drill features a green color ring.) The 4.2mm drills are used for 5.0mm Fully Threaded Locking Screws (either for distal locking or for proximal oblique locking).
6.5mm
The Solid Stepdrill for the Lag Screw is color coded with “bronze”.
Targeting holes for Recon Mode
B
A
Targeting holes for Antegrade Femoral Mode
Left
Right
7
Indications, Precautions & Contraindications
Indications
The T2 Recon Nail is indicated for:
• Subtrochanteric fractures
• Intertrochanteric fractures
• Ipsilateral neck/shaft fractures
• Comminuted proximal femoral
shaft fractures
• Femoral fi xation required as a result of pathological disease
• Temporary stabilization of fractures of the femoral shaft ­ranging from the femoral neck to the supracondylar regions of the femur.
Precautions
Contraindications
The physician’s education, training and professional judgement must be relied upon to choose the most appropriate device and treatment. Conditions presenting an increased risk of failure include:
• Any active or suspected latent infection or marked local infl ammation in or about the affected area.
• Compromised vascularity that would inhibit adequate blood supply to the fracture or the operative site.
• Bone stock compromised by disease, infection or prior implantation that can not provide adequate support and/or fi xation of the devices.
• Material sensitivity, documented or suspected.
• Obesity. An overweight or obese patient can produce loads on the implant that can lead to failure of the fi xation of the device or to failure of the device itself.
Stryker Osteosynthesis systems have not been evaluated for safety and use in MR environment and have not been tested for heating or migration in the MR environment, unless specified otherwise in the product labeling or respective operative technique.
Antegrade Mode
Recon Mode
• Patients having inadequate tissue coverage over the operative site.
• Implant utilization that would interfere with anatomical structures or physiological performance.
• Any mental or neuromuscular disorder which would create an unacceptable risk of fi xation failure or complications in postoperative care.
• Other medical or surgical conditions which would preclude the potential benefi t of surgery.
8
An X-Ray Recon Template (1806-3080) is available for pre-operative planning. Thorough evaluation of pre-operative radiographs of the affected extremity is critical. Careful radiographic examination of the trochanteric region and neck regions can reduce the potential of intra-operative complications.
Note:
TheX-RayReconTemplate
features a scale of 1.15:1 which is adapted to conventional
analoguousX-Rays.Fordigital X-Rays,attentionhastobe
paid that the magnification is corresponding with the template.
According to the fracture type either Recon or Antegrade Femoral Mode can be chosen.
Evaluation of the femoral neck angle on the pre-operative X-Rays is mandatory as the T2 Recon Nail has a fixed 125° neck angle for the two Lag Screws. Proper placement of both Lag Screws in the femoral head is essential.
If possible, X-Rays of the contralateral side should be used to determine the normal neck angle and length of the femur.
The proper nail length should extend from the tip of the greater trochanter to the epiphyseal scar.
Note:
Check with your local representative regarding availability of nail sizes.
Pre-Operative Planning
9
Locking Options
The T2 Recon Nail can be locked proximally with two 6.5mm Lag Screws (Recon Mode, Fig. 1) or with one 5mm Fully Threaded Screw (Antegrade Femoral Mode, Fig. 2).
For both Recon and Antegrade Femoral applications, depending on fracture pattern, either static or dynamic distal locking can be used.
Fig. 1
Fig. 2
Recon Mode
Antegrade Femoral Mode
10
Operative Technique
Fig. 3
Fig. 5
Fig. 4
Patient positioning for T2 Recon Nail insertion is surgeon dependent. However, it is recommended that patients are positioned in either the supine or lateral position on a fracture table to allow closed reduction of the frac ture (Fig. 3).
Manipulate and reduce the fracture in the usual fashion, according to the fracture type. Reduction should be achieved as anatomically as possible. If this is not possible, reduction in one plane should be complete, leaving reduction in the other plane to be achieved prior to reaming and nail insertion.
The unaffected leg is abducted as far as possible to ease image intensifi er positioning. This will also allow easier access to entry point.
Patient Positioning and Fracture Reduction
Incision
The design of the T2 Recon Nail, with a 4° medial lateral bend, will only allow for insertion through the tip of
the greater trochanter.
With experience, the tip of the greater trochanter can be identifi ed by palpation (Fig. 4).
A longitudinal skin incision of approximately 3−5cm is made starting just above the greater trochanter to the iliac crest (Fig. 5). The incision is then deepened to expose the tip of greater trochanter.
Smaller or larger incisions may be used based on individual patients anatomy and at the surgeon’s discretion.
Note:
The targeting instruments of the
T2ReconNailhavebeendesigned
to allow for a more percutaneous approach.
11
The entry point is located at the junction of the anterior third and posterior two-thirds of the greater trochanter on the medial edge of the tip itself (Fig. 6).
Note:
Before opening the tip of greater trochanter, image intensifi er
views(A/PandM/L)should
be used to confi rm correct identifi cation of the entry point.
The medullary canal can be opened with the
• CurvedAwl/CurvedAwl,90°
Handle or
• OneStepConicalReamer.
Note:
Densecorticalbonemayblock
the tip of the Awl during opening of the entry portal. Inserting fi rst the optional Awl Plug into the Awl will avoid penetration of bone debris into the cannulated Awl shaft. The Awl Plug is
thenremovedforGuideWire
insertion.
• Entry point with Curved Awl
Once the tip of the greater trochanter has been opened (Fig. 7a), the Ø3 × 1000mm Ball Tip Guide Wire may be advanced through the cannulation of the Curved Awl with the Guide Wire Handle and Chuck (Fig. 7 b).
The proximal femur may then be prepared with the One Step Conical Reamer.
anterior posterior
1
/
3
2
/
3
Fig. 6
Fig. 7a
Fig. 7b
Operative Technique
Entry Point
• The Tip of the
Greater Trochanter
Fig. 7a
12
Fig. 9
Fig. 8
K-Wire
Fig. 8a
Operative Technique
• Entry point with
One Step Conical Reamer
Alternatively, the 13mm diameter One Step Conical Reamer for the 9 and 11mm nails or the 15mm diameter Reamer for the 13 and 15mm nails may be used for opening the medullary canal and reaming of the trochanteric region.
Under image intensifi cation control, the entry point is made with a Ø3.2 × 400mm Recon K-Wire which is attached to the Guide Wire Handle and advanced into the medullary canal. Confi rm its placement within the center of the medullary canal on A/P and lateral image intensifi er views.
Note:
TheReconK-Wireusedforthe
entry point should not be used again for the Lag Screw insertion. It is recommended that a new
K-Wirebeutilized.
The Recon Protection Sleeve and Multi-hole Trocar are positioned with the central hole over the K-Wire.
Note:
The Multi-hole Trocar has a special design for more precise
insertionoftheØ3.2mmRecon K-Wire(Fig.8).Besidethecentral
hole, 4 other holes are located eccentrically at different distances from the center (Fig. 8a) to easily revise insertion of the guiding
K-Wireintheproperposition
(entry point).
When correct placement of the guiding Recon K-Wire is confi rmed on image intensifi er views (A/P and lateral), keep the Tissue Protection Sleeve in place and remove the Multi-hole Trocar.
The T-Handle is attached to the One Step Conical Reamer and hand reaming is performed over the Recon K-Wire through the Tissue Protection Sleeve (Fig. 9).
The Recon K-Wire is then removed and replaced with the Ø3 × 1000mm Ball Tip Guide Wire.
13
The Ø 3 × 1000mm Ball Tip Guide Wire is inserted with the Guide Wire Hand le throug h the frac tu re site to the level of the epiphyseal scar.
The Ø 9mm Universal Rod with Reduction Spoon may be used as a fracture reduction tool to facilitate Guide Wire insertion through the fracture site (Fig. 10).
Note:
The Ball Tip at the end of the
GuideWirewillstoptheBixcut
reamer* head (Fig. 11).
Caution:
Prior to reaming, it is important to check the centered intramedullary position of the
GuideWirewiththeimagein-
ten sifi er. Lateral displacement
oftheGuideWirecouldleadto
resection of more bone on the lateral side of the wire, which in turn will lead to an offset position of the nail and increase the risk of a shaft fracture.
Note:
Make sure that the reduction is maintained throughout the reaming process.
Reaming is commenced in 0.5mm in crements until cortical contact occurs (Fig. 12).
For easier nail insertion, the medullary canal should be reamed at least 2mm more than the diameter of selected nail (Fig. 13).
Fig. 10
Fig. 12
Fig. 13
Fig. 11
Operative Technique
Reaming
* see pages 36-37 for additiona l Bixcut Reamer
system details
+ 2mm more than the selected nail diameter
14
Note:
TheT2ReconNailmaybeinser-
ted without reaming of the subtrochanteric and diaphyseal region of the femur, particularly in eldery patients with wide medullary canals. If appropriate, after the trochanteric region has been prepared with the One Step
ConicalReamer,thenailcanbe
inserted without further reaming of the medullary canal.
Operative Technique
The Guide Wire Pusher can be used to keep the Guide Wire in position during reamer shaft extraction. The metal cavity at the end of the blue Elastosil handle may be placed on the end of Guide Wire. Applying pressure to hold the Guide Wire in place while removing the drill under power. (Fig. 14).
When close to the Guide Wire end, place the Guide Wire Pusher with its funnel tip at the end of the power tool cannulation (Fig. 15).
While removing the power tool the Guide Wire Pusher will keep the Guide Wire in place.
Guide Wire Pusher (1806- 0271)
Fig. 15
Fig. 14
Reaming of the trochanteric region is needed (Fig. 13) as the proximal nail diameter (driving end) is larger than the nail diameter (13mm for the 9 and 11mm diameter nails and 15mm for the 13 and 15mm diameter nails). For both reamed or unreamed applications, the proximal 5cm of the trochanteric region must be opened to at least 13mm or 15mm, depending on the proximal diameter of the nail.
15
Fig. 17a
Fig. 16a
Diameter
The diameter of the selected nail should be at least 2.0mm smaller than that of the last reamer used.
Length
Nail length may be determined by measuring the remaining length of the Guide Wire. The Guide Wire Ruler may be used by placing it on the Guide Wire and reading the correct nail length at the end of the Guide Wire on the Guide Wire Ruler (Fig. 16a, b).
Upon completion of reaming, the appropriate size nail is ready for insertion. A unique design feature of the T2 Recon Nail is that the Ø3 × 1000mm Ball Tip Guide Wire does not need to be exchanged.
The selected nail is assembled onto the Targeting Arm with the Nail Holding Screw (Fig. 17a). Be sure to securely tighten the Nail Holding Screw with the Screwdriver Shaft, Ball Tip and T-Handle so that it does not loosen during nail insertion.
Caution:
Prior to the nail insertion, check the correct assembly by passing the Stepdrill for
LagScrewthroughtheRecon
Tissue Protection Sleeve and
DrillSleeve,Recon(placedin
the corresponding hole of the Targeting Arm) and through the holes of the nail (Fig. 17b).
For the Antegrade Femoral Mode, use the targeting hole for Antegrade with the Tissue
ProtectionSleeveandDrill
Sleeve assembly to pass the
Ø4.2×340mmDrillthroughthe
oblique hole of the nail.
Operative Technique
Nail Selection
Fig. 17b
Fig. 17a
Tissue Protection Sleeve and
DrillSleeve,Recon(placedin
the corresponding hole of the
Targeting Arm) and through the
holes of the nail (Fig. 17b).
For the Antegrade Femoral
Mode, use the targeting hole
for Antegrade with the Tissue
ProtectionSleeveandDrill
Sleeve assembly to pass the
Ø4.2×340mmDrillthroughthe
oblique hole of the nail.
Fig. 16b
End of Guide Wire Ruler is measurement reference
16
Fig. 18a Fig. 18b Fig. 18c
First, assemble the Knob to the Target­ing Device by aligning the arrow on the Knob with the white line on the Target Sleeve, (Fig. 18a) then push hard to click it.
By turning the Knob clockwise to the position labeled (A), the sleeve inserted in target (A) position, which is the distal Recon Mode targeting hole, can be locked. (Fig. 18b)
By further turning the Knob clockwise to the position labeled (A+B), both sleeves inserted in (A) and (B), which are the both proximal and distal recon mode targeting holes, can be locked. (Fig. 18c)
Operative Technique
Assembly of Targeting Device
17
Fig. 19
Operative Technique
The nail is advanced through the entry point passing the fracture site to the appropriate level.
If dense bone is encountered, fi rst re-evaluate that suffi cient reaming has been achieved, then, if necessary, the Strike Plate can be attached to the Targeting Arm and the Slotted Hammer may be used to further insert the nail (Fig. 19).
Caution:
The nail must progress smoothly, without excessive force. If too much resistance is encountered, removal of the nail and additional reaming is recommended.
Note:
RemovetheGuideWirepriorto drillingorK-Wireinsertion.
The carbon fi ber guide should never be struck as it may break or become deformed. The impactor that is provided can be utilized to assist with fi nal seating of the nail. Gentle tapping will produce small adjustments (in the nail position) that can help to optimize the ultimate position of the lag screw in the femoral head. The nail holding screw should be re-tightened following any use of the impactor.
The impactor should not be utilized to force the nail down the canal. If the nail cannot be seated manually or if there is no advancement each time the impactor is tapped, A/P and Lateral fl uoroscopic X-Rays should be reviewed to determine the cause of the impingement - there may be a mismatch between the nail geometry and the medullary canal. The starting position, the femoral bow and the canal diameter should all be examined to ensure that the leading end of the nail is not impinging on the medial or anterior cortex and that the canal itself has been suffi ciently reamed.
Nail Insertion
Final Seating with Impactor
Periodically, nail removal and further reaming of the diaphysis may be required.
The proximal metaphyseal fl air may be undersized (particularly in young patients or those of short stature) and serve to prevent nail advancement. If this situation is encountered, a fl exible reamer may be used to further widen this area to the level of the lesser trochanter.
To facilitate manual passage, the nail internally rotated 90° until the fracture has been passed.
18
Nail / La g S crews Posit ioning
Drive the T2 Recon Nail to the depth that correctly aligns the proxi mal screw holes parallel with the femoral head and neck under fluoroscopic control (Fig. 20) .
Two aspects regarding the Nail/Lag Screws position must be carefully checked with the image intensifier before drilling into the femoral head:
- Alignment of the anteversion (M//L view)
- Depth of nail insertion (A/P view).
The distal Lag Screw should run along the calcar region (on the A/P view) and centered into the femoral neck and head (on the M/L view).
Note:
TheuseoftheOneShotDevice
(1213-3010) is recommended to predetermine the optimal Lag
Screwplacement.Detailsare
described on Page 20 to 21.
Fig. 20
Fig. 20a
Operative Technique
Guided Locking for the Recon Mode
19
Now attach the Recon Paddle Trocar to the T-Handle, AO Medium Coupling (Fig. 21).
Then, advance them together with the Recon Tissue Protection Sleeve to the skin through the hole on the Target Device labeled (A). Make a small skin incision and push the assembly through until it is in contact with the lateral cortex. Then turn the Knob clockwise to the position labeled (A) (Fig. 22).
Remove the Trocar and then insert the Recon K-Wire Sleeve through the Tissue Protection Sleeve. Place a Recon K-Wire into the K-Wire Inserter and attach it to the T-Handle. The K-Wire is then man u ally advanced through the K-Wire Sleeve until it reaches the subchon dral bone of the femoral head (Fig. 23). Alternatively, the K-Wire Inserter can be attached to a Power Tool and the Recon K-Wire is inserted to the same depth.
Fig. 22
Fig. 23
Fig. 21
Operative Technique
20
Operative Technique
Note:
With the image intensifier, verify
iftheK-Wireisplacedalongthe calcarregionintheA/Pview
and central on the lateral view (correct anteversion) (Fig. 24).
If the K-Wire is incorrectly positioned, the first step is to remove it and then to correct the nail position.
More commonly, the nail is posi tioned too proximal and correction of the nail should be carried out either by hand or by using the Strike Plate placed into the Target Device. If a higher position is required, the Universal Rod and Slot ted Hammer may then be at tached to the Strike Plate to carefully and smoothly extract the assembly (Fig. 25).
The new position is checked again with the image intensifier as described above.
Fig. 24
Fig. 25
21
Nail/Lag Screws Positioning with the One Shot Device
The use of the One Shot device (1213-3010) is recommended to predetermine the optimal Lag Screw placement* (Fig. 26). The One Shot Device is made of carbon fiber and works by providing a target to indicate the position of the K-Wire on the fluoroscope screen. The target contains 3 radio-opaque wires embedded in the arm – a dashed inner wire and two solid outer wires. These wires work like a gun sight to indicate the position of the K-Wire.
The One Shot Device is attached by slightly pressing the grip and releasing it when positioned onto the Tissue Protection Sleeve. To correct the position or remove the device, the grip must be pressed.
Note:
TheuseoftheOneShotDevice
should not replace any steps in the
T2ReconOperativeTechnique.
While pressing the attachment grip, the device is positioned between the anterior aspect of the patient’s hip and the fluoroscope screen positioned for an A/P view of the hip (Fig. 26, 27).
Note:
It is important to drape the patient so that the OneShotDevicedoes not interfere with any drapes anterior to the patient’s hip.
When positioned correctly, the target will appear in the f luoroscopic image (A/P view) with the dashed inner wire in the middle of the two solid outer wires (Fig. 27). If it does not, the One Shot Device should be moved towards or away from the patient by pressing the grip slightly until the target is seen as described above.
* Tokunaga et al, Correct lag screw positioning
for the Gamma Nail: Development for the targeting device for inser tion, Osteo Trauma Care 2005; 13:14-17
Operative Technique
Fig. 27
optimal nail position
too cranial nail position
A/Pview
too caudal nail position
Fig. 26
22
Operative Technique
To identify the accurate position, the dashed wire of the target must appear between the two solid wires at the desired position. If the position is incorrect the T2 Recon Nail position may be corrected by ei ther pulling backwards or pushing forwards (Fig. 28).
The K-Wire can then be placed into the femur and the targeting arm is held in place until the K-Wire’s position in the lateral view has been determined. When positioned correctly, the target will appear in the fluoroscopic lateral view (Fig. 29).
If the dashed wire of the target ap ­pears between the two solid wires, then advance the Recon Tissue Protection Sleeve and Trocar as shown in Fig. 21.
Warn ing :
PriortoadvancingtheK-Wire,
check the correct guidance
throughtheK-WireSleeve.Do notusebentK-Wires.
Note:
TheK-Wireinsertedintothemost
distal Lag Screw hole of the nail helps in achieving the correct positioning of the nail (depth and rotation) with minimal resection of bone in case correction of the position is needed.
Lateral view
Fig. 2 9
Fig. 2 8
23
Operative Technique
Solid Stepdrill Technique
For the insertion of proximal screws in Recon Mode, the Solid Stepdrill Technique, which is mentioned in this chapter, is the recommended method to optimize the proximal targeting accuracy.
Attach the Recon Paddle Trocar to the T-Handle, AO Medium Coupling as demonstrated in Fig. 21. Then slide the Tissue Protection Sleeve together with the Paddle Trocar assembly to the skin through the proximal target hole labeled (B).
A small skin incision is made and the assembly is pushed through until it is in contact with the lateral cortex. When the tip of the sleeve is in contact with the lateral cortex, lock the sleeve by turning the knob further to the position labeled (A+B) (Fig. 30).
Then remove the Trocar assembly and insert the Drill Sleeve for the Recon Solid Stepdrill while the distal K-Wire and K-Wire Sleeve are still left in place. The Drill Sleeve for the Recon Solid Stepdrill is inserted through the proximal target hole labeled (B) of the Targeting Device. The Ø6.5mm Solid Stepdrill for Recon Lag Screw is forwarded through the Tissue Protection Sleeve and Drill Sleeve assembly and pushed onto the lateral cortex. There is a dedicated Drill Sleeve for the Solid Stepdrill Technique. This Sleeve is marked “Use with Solid Step Drill“ as shown (Fig. 31b).
Reaming is performed under fluoroscopic control just until the tip of the Solid Stepdrill for Lag Screw reaches the subchondral bone. The required length of the Lag Screw can be read directly off the Recon Solid Stepdrill for Lag Screw at the end of the Drill Sleeve (Fig. 31a).
Fig. 31
Fig. 31a
Fig. 31b
Fig. 30
24
Operative Technique
Using the Recon Screwdriver the correct Lag Screw is inserted through the Tissue Protection Sleeve and threaded up to the subcondral part of the femoral head. The screw is near its proper seating position when the groove around the shaft of the screwdriver is approaching the end of the Tissue Protection Sleeve (Fig. 32, 32a). The required length of the second Lag Screw can be measured using the Recon Lag Screw Gauge.
Remove the Distal K-Wire and K-Wire Sleeve. Then insert the Sleeve for the solid Stepdrill into the distal Tissue Protection Sleeve.
Repeat the same surgical steps for drilling and insertion of the distal Lag Screw without K-Wire guidance.
After the completion of the distal Lag Screw insertion, move on to the distal locking procedure.
Fig. 32
Fig. 32 a
25
Operative Technique
Alternatively, the K-Wire can be used prior to drilling with the Solid Drill.
Place a second Recon K-Wire into the K-Wire Inserter and attach it to the T-Handle or power tool. The K-Wire is then advanced through the K-Wire Sleeve until it reaches the subchondral bone of the femoral head.
Warn ing :
CorrectplacementoftheK-Wire
tip in subchondral bone must be checked with image intensifier in
bothA/PandM/Lviews.
The required length of the Lag Screw is measured using the Recon Lag Screw Gauge.
Note:
Before starting to measure, ensure that the Tissue Protection Sleeve
andK-WireSleeveassemblyis
firmly pressed against the lateral cortex of the femur (Fig. 32b).
Take the Recon Lag Screw Gauge and place it directly under the K-Wire and against the K-Wire Sleeve (Fig. 32c). The correct Lag Screw length corresponds to the measurement indicated at the end of the K-Wire on the Lag Screw Gauge.
After the measurement, remove the K-Wire and drill the channel with the Solid Stepdrill according to the Solid Stepdrill technique described on page 22.
Fig. 32 b
Fig. 32c
26
Operative Technique
Fig. 35
Fig. 33
Fig. 34
The required length of the Lag Screw is measured using the Recon Lag Screw Gauge (1806-3035). Before start ing to measure, ensure that the Tissue Protection Sleeve and K-Wire Sleeve assembly is fi rmly pressed against the lateral cortex of the femur. Take the Recon Lag Screw Gauge and place it directly under the distal K-Wire and against the K-Wire Sleeve (Fig. 34).
As the Cannulated Stepdrill technique was also discussed in a previous version of the operative technique, the insertion of the proximal screws in Recon Mode using this method will also be mentioned as a potential option.
After achieving a satisfactory position of the fi rst Recon K-Wire slide the second Recon Tissue Protection Sleeve together with the Recon K-Wire Sleeve into the proximal target hole on the Targeting Arm, labeled (B). A small skin incision is made and the assembly is pushed through until it is in contact with the lateral cortex (Fig. 33).
Place a second Recon K-Wire into the K-Wire Inserter and attach it to the T-Handle or power tool. The K-Wire is then advanced through the K-Wire Sleeve until it penetrates the subchondral bone of the femoral head.
Caution:
CorrectplacementoftheK-Wire
tip in subchondral bone must be checked with image intensifi er in
bothA/PandM/Lviews.
Cannulated Stepdrill Technique
The correct Lag Screw length corresponds to the measurement indicated at the end of the K-Wire on the Lag Screw Gauge. This length will then be set on the cannulated Recon Stepdrill for Lag Screw (Fig. 35).
27
Operative Technique
Fig. 38
Caution:
Before proceeding with drilling for the selected Lag Screw, check
theA/Pfluoroscopicviewsto seeifthetwoReconK-Wiresare
parallel.
The distal K-Wire Sleeve is removed while the Tissue Protection Sleeve remains in position (Fig. 36a). The cannulated Ø6.5mm Recon Stepdrill for Lag Screw (REF 1806-3025) is forwarded through the Tissue Protec tion Sleeve and pushed onto the lateral cortex. The stop on the drill will only allow drilling up to 5mm before the K-Wire ends (Fig. 36b).
Warn ing :
Donotusethecannulated ReconStepdrillforLagScrew overadeflectedK-Wire.
Using the Recon Screwdriver, the selected Lag Screw is inserted through the Tissue Protection Sleeve and threaded up to the subchondral bone of the femoral head. The screw is near its proper seating position when the groove around the shaft of the screw driver is approaching the end of the Tissue Protection Sleeve (Fig. 37).
Alternatively, the Recon Screwdriver Shaft may be assembled into the T-Handle and used for the Lag Screw insertion.
The required length of the second Lag Screw is measured using the Recon Lag Screw Gauge. Repeat the same surgi cal steps for drilling and insertion of the proximal Lag Screw (Fig. 38).
After the completion of the distal Lag Screw insertion, move on to the proximal locking procedure.
Fig. 36b
Fig. 36a
Fig. 37
28
Operative Technique
Fig. 40
Now attach the Paddle Trocar, Antegrade and the AO T-Handle Medium Coupling (Fig. 39). Then, advance them together with the Long Tissue Protection Sleeve through the targeting hole for the Antegrade Femoral Mode (left or right) by pressing the safety clip (Fig. 40). The mecha nism will keep the sleeve in place and prevent it from falling out. It will also prevent the sleeve from sliding during screw measurement. To release the Tissue Protection Sleeve, the safety clip must be pressed again.
A small skin incision is made and the assembly is pushed through by mani­pulating the T-Handle until the Tissue Protection Sleeve is in contact with the lateral cortex (Fig. 41).
Guided Locking for Antegrade Femoral Mode
Fig. 41
Fig. 41
Fig. 39
29
Pre-drilling the lateral cortex
Fig. 4 5a
65mm
65mm
Fig. 4 4
Fig. 4 5
Fig. 42
Fig. 4 3
Operative Technique
Pre-drilling opens the lateral cortex for the drill entry. Pre-drilling helps to prevent a possible slipping of the drill on the cortex and may avoid deflection within the cancellous bone.
The Paddle Trocar Assembly is then removed and the Drill Sleeve is inserted through the Long Tissue Protection Sleeve (Fig. 42). With the Long Tissue Protection Sleeve firmly engaged in the cortex, the lateral cortex should be opened using the centered tip green coded 4.2mm Drill.
The Drill can be connected with the AO Teardrop Handle Coupling allowing pre-drilling by hand (Fig.
43). It also can be done using power.
Note:
For optimal stability, the tip of the oblique screw should be positioned at the level of the lesser trochanter (Fig. 44).
Then use the center-tipped, calibrated Ø4.2 × 340mm Drill and drill through both cortices (Fig. 45).
The screw length may be read directly from the Calibrated Drill at the end of the Drill Sleeve (Fig. 45a).
Caution:
Start the drill before touching the bone and then keep a gentle pressure on the pre-dri lled c ortex to ensure ac cu rate drilling.
Note:
The position of the drill end, as it relates to the far cortex, is the same position where the screw will end.
30
Operative Technique
Therefore, if the end of the Drill is 3mm beyond the far cortex, the end of the screw will also be 3mm beyond (Fig. 46). Check the position
oftheendoftheDrillwithimage intensification before measuring the screw length. If the screw
measurement using the Long Screw Gauge is preferred, first remove the Long Drill Sleeve and read the screw length directly at the end of the Long Tissue Protection Sleeve.
Note:
• Before starting to measure, ensure that the Tissue Protection
Sleeve/DrillSleeveAssemblyand K-WireSleeveassemblyisfirmly
pressed against the lateral cortex of the femur (Fig. 46, 47).
• TheLongScrewGaugeis
calibrated so that with the bend at the end pulled back flush with the far cortex, the screw tip will end 3mm beyond the far cortex (Fig. 47).
When the Drill Sleeve is removed, the correct Locking Screw is inserted through the Tissue Protection Sleeve using the Long Screwdriver Shaft with Teardrop Handle (Fig. 48). The screw is ad vanced through both cortices. The screw is near its proper seating posi tion when the groove around the shaft of the screwdriver is approach ­ing the end of the Tissue Protection Sleeve (Fig. 48a).
Fig. 47
65mm
Fig. 46
Fig. 4 8
Fig. 4 8a
31
The freehand technique is used to insert Fully Threaded Locking Screws into both distal transverse holes in the nail.
Rotational alignment must be checked prior to locking the nail. This is performed by checking a lateral view at the hip and a lateral view at the knee. The anteversion should be the same as on the contralateral side.
Multiple locking techniques and radiolu cent drill devices are available for freehand locking. The critical step with any freehand locking technique, proximal or distal, is to visualize a perfectly round locking hole with the C-Arm.
The center-tipped ø4.2 × 180mm Drill is held at an oblique angle to the center of the locking hole (Fig. 49). Upon X-Ray verification, the Drill is placed perpendicular to the nail and drilled through the lateral and medial cortices (Fig. 50). Confirm in both the A/P and lateral views by X-Ray that the Drill passes through the hole in the nail.
After drilling both cortices, the screw length may be read directly off of the Long Screw Scale at the green ring on the center-tipped ø4.2 × 180mm Drill (Fig. 51).
Alternatively, the Screw Gauge for freehand technique can be used insted of the Long Screw Scale to determine the screw length.
Routine Locking Screw insertion is employed with the assembled Long Screwdriver Shaft and Teardrop Handle.
Note:
The Screwdriver Shaft can be used in conjunction with the Long Screw Capture Sleeve.
Operative Technique
Freehand Distal Locking
Fig. 49
Fig. 50
Fig. 51
Green Ring
32
Operative Technique
Fig. 52
Repeat the locking procedure for the insertion of the second 5mm Fully Threaded Locking Screw into the oblong hole in a static position (Fig. 52).
The T2ReconNail may be used in the dynamic locking mode. When the fracture pattern permits, dynamic lock ing may be utilized for transverse, rotationally stable fractures. While dynam ic locking can only be performed at the end of the nail, this will require a freehand distal targeting of the oblong hole in a dynamic position. This al lows the nail to move and the fracture to settle while torsional stability is maintained.
Note:
As an alternative for distal locking, the guided distal targeting system can be used. For details, please refer to the separate
operativetechniques(Distal TargetingSystemGamma3Long NailR2.0,T2ReconnailR2.0)or askStrykerRepresentativefor
further assistance.
Release the Nail Holding Screw using the Screwdriver Shaft, Ball Tip and T-Handle. Then remove the Targeting Arm to complete surgery.
33
End Caps
Stand ard +5mm +10mm +15mm
Operative Technique
After removal of the Target Device, a Set Screw or End Cap can be used.
Two different Set Srews are available (Fig. 53a):
- a ReconSetScrewto tighten down on the Proximal Lag Screw for the Recon Mode
- an Antegrade Set Screw to tighten down on the oblique Fully Threaded Screw for the Femoral Antegrade Mode
Note:
If a Set Screw is used, an End Cap can no longer be inserted.
Four different sizes of End Caps are available to adjust nail length and to reduce the potential for bony ingrowth into the proximal thread of the nail (Fig. 53b) .
The Set Screw or End Cap is inserted with the Long Screwdriver Shaft and Teardrop Handle after intra-operative radio graphs confirm satisfactory reduction and hardware implantation (Fig. 54). Be sure to fully seat the End Cap or Set Screw to minimize the potential risk for loosening.
Nail Removal
The Set Screw or End Cap is removed with the Long Screwdriver Shaft and Tear drop Handle (Fig. 55).
The Universal Rod is inserted into the driving end of the nail. Alternatively, the Conical Extraction Rod, can be attached to the Universal Rod to facilitate extraction of the nail. All 5mm Fully Threaded Lock­ing Screws are removed with the Screwdriver, Selfholding. The optional Long Screw Capture Sleeve may be used on the Screwdriver Shaft. For removal of the Lag Screws, the Recon Screwdriver or the Recon Screwdriver Shaft and T-Handle are to be used.
The Slotted Hammer is used to ex tract the nail in a controlled man ner (Fig. 56).
Set Screw or End Cap Insertion
Set Screw, Antegrade
Set Screw, Recon
Fig. 53b
Fig. 54
Fig. 55
Fig. 56
Fig. 53a
34
Ordering Information – Implants
Titanium Diameter Length  REF mm mm
1846-0928S 9.0 280 1846-0930S 9.0 300 1846-0932S 9.0 320 1846-0934S 9.0 340 1846-0936S 9.0 360 1846-0938S 9.0 380 1846-0940S 9.0 400 1846-0942S 9.0 420 1846-0944S 9.0 440 1846-0946S 9.0 460 1846-0948S 9.0 480
184 6 -112 8S 11.0 280 184 6 -113 0S 11.0 30 0 184 6 -1132S 11.0 32 0 184 6 -113 4S 11. 0 34 0 184 6 -1136S 11.0 360 184 6 -1138S 11.0 380 184 6 -1140S 11.0 40 0 184 6 -1142S 11.0 420 184 6 -1144S 11.0 44 0 184 6 -1146S 11.0 46 0 184 6 -1148S 11.0 480
1846-1328S 13.0 280 1846-1330S 13.0 300 1846-1332S 13.0 320 1846-1334S 13.0 340 1846-1336S 13.0 360 1846-1338S 13.0 380 1846-1340S 13.0 400 1846-1342S 13.0 420 1846-1344S 13.0 440 1846-1346S 13.0 460 1846-1348S 13.0 480
1846-1528S 15.0 280 1846-1530S 15.0 300 1846-1532S 15.0 320 1846-1534S 15.0 340 1846-1536S 15.0 360 1846-1538S 15.0 380 1846-1540S 15.0 400 1846-1542S 15.0 420 1846-1544S 15.0 440 1846-1546S 15.0 460 1846-1548S 15.0 480
T2 Recon Nail, Left T2 Recon Nail, Right
Titanium Diameter Length  REF mm mm
1847-0928S 9.0 280 1847-0930S 9.0 300 1847-0932S 9.0 320 1847-0934S 9.0 340 1847-0936S 9.0 360 1847-0938S 9.0 380 1847-0940S 9.0 400 1847-0942S 9.0 420 1847-0944S 9.0 440 1847-0946S 9.0 460 1847-0948S 9.0 480
1847-1128S 11.0 28 0 1847-1130S 11.0 300 1847-1132 S 11.0 32 0 1847-1134S 11.0 340 184 7-1136 S 11 . 0 36 0 184 7-11 3 8S 11. 0 38 0 184 7-114 0 S 11.0 40 0 184 7-114 2 S 11 . 0 42 0 184 7-114 4 S 11.0 4 4 0 184 7-114 6 S 11.0 46 0 184 7-114 8 S 11 . 0 48 0
1847-1328S 13.0 280 1847-1330S 13.0 300 1847-1332S 13.0 320 1847-1334S 13.0 340 1847-1336S 13.0 360 1847-1338S 13.0 380 1847-1340S 13.0 400 1847-1342S 13.0 420 1847-1344S 13.0 440 1847-1346S 13.0 460 1847-1348S 13.0 480
1847-1528S 15.0 280 1847-1530S 15.0 300 1847-1532S 15.0 320 1847-1534S 15.0 340 1847-1536S 15.0 360 1847-1538S 15.0 380 1847-1540S 15.0 40 0 1847-1542S 15.0 420 1847-1544S 15.0 440 1847-1546S 15.0 460 1847-1548S 15.0 480
Note:
Check with your local representa­tive regarding availability of nail sizes.
35
Ordering Information – Implants
Implants are in steri le pack aging. Outside of the U. S., Locki ng Screws may be ordered non-ster ile w ithout t he “S” at the end of the corre­spondi ng catalog number.
5mm Fully Threaded Locking Screws
6.5mm Lag Screws
Titanium Diameter Length  REF mm mm
1897-6065S 6.5 65 1897-6070S 6.5 70 1897-6075S 6.5 75 1897-6080S 6.5 80 1897-6085S 6.5 85 1897-6090S 6.5 90 1897-6095S 6.5 95 1897- 6100S 6 .5 100 1897- 6105S 6.5 10 5 1897-6110S 6.5 110 1897-6115S 6.5 115 1897-6120S 6.5 120 1897-6125S 6.5 125 1897-6130S 6.5 130
Titanium Diameter Length  REF mm mm
1847-0001S 8.0 Set Screw, Recon 1847-0003S 8.0 Set Screw, Antegrade
Titanium Diameter Length  REF mm mm
1822-0003S 8.0 Standard 1847-0005S 13.0 + 5mm 1847- 0010S 13.0 +10mm 1847-0015S 13.0 +15mm
Titanium
REF
1896-5025S 1896-5030S 1896-5035S 1896-5040S 1896-5045S 1896-5050S 1896-5055S 1896-5060S 1896-5065S 1896-5070S 1896-5075S 1896-5080S 1896-5085S 1896-5090S 1896-5095S 1896-5100 S 1896-5105S 1896-5110S 1896-5115 S 1896-5120S
5.0 25.0
5.0 30.0
5.0 35.0
5.0 40.0
5.0 45.0
5.0 50.0
5.0 55.0
5.0 60.0
5.0 65.0
5.0 70.0
5.0 75.0
5.0 80.0
5.0 85.0
5.0 90.0
5.0 95.0
5.0 100.0
5.0 105.0
5.0 110.0
5.0 115.0
5.0 120.0
End Caps Set Screws
DiameterLeng th
mm mm
Note:
Check with your local representa­tive regarding availability of nail sizes.
36
REF Description
Ordering Information – Instruments
**Caution:
The coupling of Elastosil handles contains a mechanism with one or multiple ba ll bearings. In case of applied a xial stress on the Elastosil handle, those components are pressed into t he surrounding cyl inder resulting in a complete blockage of t he device and possible bending.
To help avoid intra- operative complica­tions and promote long-term functional­ity, we mandate that Elastosi l handles be
usedonlyfortheirintendeduse.DONOT HITthem.
*** item s a r e part of T2 B a si c L on g In s t rument set (1806-9901); however, not used for
T2ReconNailingsurgery
T2 Basic Long
Teardrop Hand le, AO Coupling**
Protection Sleeve, Retrograde***
Guide Wire Ruler
Awl Plug
Awl
Universal Rod
Reduction Spoon
Wrench 8mm/10mm
Ins er tion Wrench, 10mm***
Stri ke Plate
Slotted Hammer
Tissue Protection Sleeve, Long
Screwdriver, Self-Holding, Extra Short (3.5)
Drill Sleeve, Long
Screwdriver Sha ft AO, Long
Screwdriver, Self-Holding, Long (3.5)
Screwdriver Shaft, Compression (hex3.5)***
Guide Wire Pusher
Trocar, Long***
Screw Gauge, Long
Screw Gauge (20-120mm)
Extraction Rod, Conical (Ø8mm)
Screw Scale, Long
Guide Wire Handle
Guide Wire Handle Chuck
Rigid Rea mer Ø12mm***
T2 Basic Long Inst rument Tray
T2 Basic Long Inst rument Set, Completely f illed
702429
703165
1806- 0 022
1806- 0 032
180 6-0 041
180 6 -0110
1806- 0125
1806- 013 0
1806- 0135
1806- 015 0
1806-0170
1806- 0185
1806- 0203
1806- 0215
1806- 0227
1806- 0233
1806- 0268
1806- 0271
180 6 - 0315
1806- 0325
180 6 - 0331
1806- 0350
1806- 0365
180 6 -1095
180 6 -1096
180 6 -2014
1806-9900
1806-9901
37
Ordering Information – Instruments
180 6 -310 0
180 6-3101
1806-3005
1806-3010
1806-3015
1806-3026S
1806-3030S
180 6-30 31S
1806-3035
1806-3040
1806-3041
1806-3045
1806-3050
1806-3055
1806-3057
1806-3060
1806-3070
1806-3090
1806- 0294
1806-4290S
1806- 4260 S
1806- 4270S
1806- 8018S
Target Device
Knob for Target Device
Nail Holding Screw, Recon
One Step Conical Reamer Ø13, Recon
One Step Conical Reamer Ø15, Recon
Solid Stepdri ll for Lag Screw*
Recon K-Wire, Recon*
K-Wire, Recon, CoCr
Lag Screw Gauge, Recon
K-Wire Sleeve, Recon
Dril l Sleeve for Solid Stepdri ll
Tissue Protection Sleeve, Recon
Screwdriver Sha ft, Recon
Multihole Trocar
Protection Sleeve, Antegrade
Screwdriver, Recon
K-Wire Inserter
Screwdriver Sha ft, AO, Ball Tip
Screwdriver Sha ft, Self holding, 3.5 × 85mm
Dril l Ø4.2 × 230 mm, AO*
Dril l Ø4.2 × 34 0mm, AO*
Dril l Ø4.2 × 180m m, AO*
Drill Ø4.2 × 250mm , oblique AO*
* For non-sterile, leave “S” off the REF number
when ordering.
REF Description
T2ReconInstruments
38
REF Description
Optional Instruments
REF Description
Spare Parts
Ordering Information – Instruments
1806-0040
1806-3025
1806-0240
1806- 0292
1806-0480
1806-9993
1806-9992
1806-9995
1806-9996
1320-5375
Awl, Cu r ved
Stepdrill for Lag Screw, Recon
Screw Capture Sleeve, Long
Screwdriver Sha ft, 3.5 x 85mm
Screw Gauge, Femur
T2 Recon Instrument Tray Insert
T2 Recon Silicone Mat Free Space
T2 Recon Drill Rack
T2 Recon Insert for Reamer Heads****
DTS Tray Calibration Stand
* For non-sterile, leave “S” off the REF number
when ordering.
**Caution:
The coupling of Elastosil handles contains a mechanism with one or multiple ba ll bearings. In case of applied a xial stress on the Elastosil handle, those components are pressed into t he surrounding cyl inder resulting in a complete blockage of t he device and possible bending.
To help avoid intra- operative complica­tions and promote long-term functional­ity, we mandate that Elastosi l handles be
usedonlyfortheirintendeduse.DONOT HITthem.
**** Bixcut Modular Head 9, 10, 11, 12, 13, 14,
15, 16, 17 and 2 additional Modular Heads can be stored. See page 37 for details.
1213-3010
702628
1806-3065
1806- 0085S
1806-3047
1806-3048
1806-3080
1806-9990
1806-9991
One Shot Device
T-Handle, AO Medium Coupling**
Extraction Screwdriver
Guide Wire, Ball Tip, Ø3 × 1000mm, steri le*
T2 Paddle Trocar Recon Mode
T2 Paddle Trocar Antegrade Mode
X-Ray Template, Recon
T2 Recon Instrument Tray
T2 Recon Instrument Set, completely f illed
REF Description
T2ReconInstruments
39
Complete range of modular and fixed-head reamers to match surgeon preference and optimize
O.R.efficiency,presentedinfully
sterilizable cases.
Studies
1
have demonstrated that the pressures developed within the medullary cavity through the introduction of unreamed IMnails can be far greater than those devel oped during reaming − but this depends very much upon the design of the reamer.
After a three year development study2 involving several universities, the factors that determine the pressures and temperatures developed during reaming were clearly established. These factors were applied to the de ­velopment of advanced reamers that demonstrate significantly better per ­form ance than the best of previous designs3.
1
Ja n Paul M. Frolke, e t al. ;
Intramedullary Pressure in Rea med Femor al
Nail ing with Two Different Rea mer Designs.,
Eur. J. of Trauma, 2001 #5
2
Medhi Moussavi, et al.;
Pressure Changes Duri ng Reaming w ith Di fferent
Parameters a nd Reamer Designs,
Clinical Orthopaedics a nd Related Research
Number 373, pp. 295-303, 2000
3 Andrea s Speit ling;
Intra medul lar y Reamers, commented slides of internal test repor t, Sep 1999
Large c learance rate resulting f rom reduced number of reamer blades coupled with reduced length of reamer head to allow for ef fect ive relief of pressure and effi cient removal of materia l
3
.
Cutti ng fl ute geometry optimized to lower pressure generation
3
.
Forwa rd- and side-cut ting face combination produces effi cient material removal and rapid clearance
3
.
Double-wound shaf t tra nsmits torque effectively a nd with h igh reliabi lity. Low-fric tion surface fi nish aids rapid debris clea ranc e
3
.
Smal ler, 6 and 8mm shaf t diameters a re designed to reduce IM pressure.
Typical Standard
Ream erØ14 mm
Clea ra nc e are a : 32% of cross section
Bixcut
Ream erØ14 mm
Clea ra nc e are a : 59% of cross sec tion
Ordering Information – Instruments
Bixcut
Bixcut
40
 REF Description Diameter
mm
BIXCUT MODULAR HEAD
 REF Diameter Length
mm mm
BIXCUT FIXED HEAD − AO FITTING**
 REF Description Length
mm
BIXCUT SHAFTS (STERILE)
1,2, 3, 4
 REF Description
SHAFT ACCESSORIES
 REF Description
BIXCUT TRAYS EMPTY
Ordering Information – Instruments
 REF Description
OPTIONAL INSTRUMENTS
0227- 0060 Hand Reamer 6 mm
w/Mod Trinkle connection
0227-0070 Hand Reamer 7 mm
w/Mod Trinkle connection
0227-0080 Hand Reamer 8 mm
w/Mod Trinkle connection
0227-0090 Hand Reamer 9 mm
w/Mod Trinkle connection
1806-6520 Curved Reduction Rod 8.5 mm
w/Mod Trinkle connection
1806- 6500 T-Handle w/Mod Trink le connection
0226-3090 0226-3095 0226 -3100 0226-3105 0226 -3110 0226 -3115 0226 -3120 0226 -3125 0226 -3130 0226-3135 0226 -3140 0226 -3145 0226 -3150 0226-3155 0226 -3160 0226 -3165 0226 -3170 0226 -3175 0226 -3180 022 6-4185 0226 -4190 0226 -4195 0226-4200 0226-4205 0226- 4210 0226- 4215 0226-4220 0226-4225 0226-4230 0226-4235 0226-4240 0226-4245 0226-4250 0226-4255 0226-4260 0226-4265 0226-4270 0226-4275 0226-4280
Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head Bixcut Head
9.0
9.5
10.0
10.5
11.0
11.5
12.0
12.5
13.0
13.5
14.0
14. 5
15.0
15.5
16.0
16.5
17.0
17. 5
18.0
18.5
19.0
19.5
20.0
20.5
21.0
21.5
22.0
22.5
23.0
23.5
24.0
24.5
25.0
25.5
26.0
26.5
27. 0
27. 5
28.0
0227-8240S Mod. Trink le 284 0227-3000S Mod. Trink le 448 0227-8 510S Mod. Tri n k le 510 0227-8885S Mod. Trinkle 885 0226-8240S AO 284 0226-3000S AO 448
0225-6000 Tray, Modular Head
(up to size 22.0mm)
0225-6001 Tray, Modular Head
(up to size 28.0mm)
0225-8000 Tray, Fixed Head
(up to size 18.0mm) 0225-6040 Mini Trauma Tray (for modular heads 9-18) 0225-6050 Mini Revision Tray (for modular heads 9-28)
0225-5060 0225-5065 0225-5070 0225- 6075 0225-6080 0225-6085 0225-6090 0225-6095 0225- 6100 0225-6105 0225 -6110 0225 -8115 022 5-8120 0225-8125 022 5-813 0 0225-8135 0225 -8140 0225 -8145 022 5-815 0 0225-8155 0225-8160 0225-8165 022 5-8170 022 5-8175 022 5-8180
6.0*
6.5*
7.0 *
7.5
8.0
8.5
9.0
9.5
10.0
10.5
11.0
11.5
12.0
12.5
13.0
13.5
14.0
14. 5
15.0
15.5
16.0
16.5
17.0
17. 5
18.0
400 400 400 480 480 480 480 480 480 480 480 480 480 480 480 480 480 480 480 480 480 480 480 480 480
3212-0-210 Grommet (pack of 25) 3212-0-220 Grommet inserter/extractor 0225-6010 Grommet Case
Note:
Bixcut Fi xedHead−ModiedTrinkletting available in same diameters and leng th as the AOFitting(REFNo :0227-xxxx)
* Use with 2.2mm × 800mm Smooth Tip and 2.5mm × 800mm Ball Tip Guide Wires only. **
Use with Stryker power equipment.
1. Non-Sterile shafts supplied without Grommet. Use new Grommet for each surgery. See shaft accessories.
2. Sterile shafts supplied with grommet pre-assembled.
3. For non-sterile leave “S” off the REF Number when ordering (510 and 885mm available only sterile Modified Trinkle Fitting).
4. non-sterile, AO Fitting Shafts in 510 and 885mm are available as build to order items:
• CM810921 AO Fitting Shaft, length 510mm
• CM810923 AO Fitting Shaft, length 885mm.
41
Notes
42
Notes
43
Manufactured by:
Stryker Trauma GmbH Prof.-Küntscher-Strasse 1-5 D-24232 Schönkirchen Germany
www.osteosynthesis.stryker.com
This document is intended solely for the use of healthca re professional s. A surgeon must a lways rely on his or her own professional cl inical judg ment when deciding whether to use a par ticular product when treating a particular patient . Stryker does not dispense medica l advice and recommend s that surgeon‘s be trained in the use of any part icular product before usi ng it in surgery. The information presented in this brochure is intended to demonstrate a Str yker product. Alway s refer to the package ins ert, product label and /or user inst ructions includi ng the instr uctions for Clean ing and Steri lization (if applicable) before u sing any Stryker products. Product s may not be available in a ll markets. Product ava ilabilit y is subject to the regulatory or medical prac tices that govern ind ividual markets. Please contact your Stryker representative if you have question s about the avai lability of St ryker products in you r area.
Stryker Cor poration or its divisions or other corporate af filiated ent ities own, use or have applied for the followi ng trademarks or serv ice marks : Bixcut, Gam ma, Gamma3, Stryker, T2. A ll other trademark s are trademarks of their respec tive owners or holders.
The produc ts listed above are CE ma rked.
Literat u re Num be r : B1000 084Re v1
1/11
Copyright © 2011 Stryker
Loading...