Shukla Medical Xtract-All Nail Winquist III MSK1017 User manual

Surgical Technique Guide
...Because Every Minute Counts®
©Shukla Medical 2018 •FCD-0249 REV 02

2
®
FCD-0249 REV 02
Xtract-All®Nail (MSK1017) Winquist III Universal IM Nail Extraction System
Contents
Extraction Instruments; pg 4
Introduction ........................................................................................................................................................................ 3
List of Components .......................................................................................................................................................... 4-9
Case #1 ........................................................................................................................................................................................ 5
Case #2 • Level 1 ..................................................................................................................................................................... 6
Case #2 • Level 2 ..................................................................................................................................................................... 7
Surgical Technique ........................................................................................................................................................... 8-10
Methods of Extraction ......................................................................................................................................................... 9
Extractor Compatibility Matrix ..................................................................................................................................... 11

3
®
FCD-0249 REV 02
Xtract-All®Nail (MSK1017) Winquist III Universal IM Nail Extraction System
Introduction Warning and Precautions
Intended Use
The Xtract-All®Nail (MKS1017) Winquist III Universal
IM Nail Extraction System is designed to remove
virtually any intramedullary nail implant system.
Use together with the Xtract-All®Maxi system
(S9MAXI) for lateral IM nail screw removal.
Indications for Use
The Xtract-All®Nail system is intended for use by,
or as directed by, a surgeon in any IM nail removal
procedure. Includes 17 sizes of threaded extractors
to connect to the threaded proximal end of IM nails.
Also includes conical, solid, and hook extractors
for IM nail removal when nail threads cannot be
matched, are missing, or have been damaged.
Preoperative
• Clear x-rays and surgical notes may be used to
identify manufacturer, brand, location, & condition
of implanted hardware. Use X-Ray Search Engine™
for the most updated information on hardware (see
pg 10 for more).
• The surgeon should be familiar with general
principles of revision surgery and techniques for
removal of implants.
• The instruments should be inspected for visible
wear and tear prior to use. Do not use the product
if damage is suspected.
• Only validated cleaning and sterilization procedures
should be used.
Operative
• Proper handling and storage of the instrumentation
is mandatory. Long-term use of this system may
produce stresses and cause weakness, which could
become a focal point for failure.
• The surgeon should be cautious with limb position
change and/or excessive force exertion while
extracting implants using the instrumentation
provided in the tray.
For detailed sterilization instructions, please refer to industry standards ANSI/AAMI ST79:2012 & A1:2012
and ANSI/AAMI ST8:2001.
NOTE: All Shukla Medical surgical instruments require manual cleaning with a neutral pH cleanser. Open and
disassemble all instruments, making sure to remove all contamination during cleaning. Instruments must
be reassembled prior to sterilization. Machine washing is not recommended. Maintenance and care using
an autoclaveable lubricant on movable parts is required to preserve the life of the instrument. For more
cleaning, inspection, maintenance, and care tips, contact Shukla Medical directly.
For detailed cleaning and sterilization instructions, please visit www.ShuklaMedical.com/Sterilization
Cleaning and Sterilization

4
®
FCD-0249 REV 02
Xtract-All®Nail (MSK1017) Winquist III Universal IM Nail Extraction System
Xtract-All®Nail (MKS1017) Winquist III Universal IM Nail Extraction System
Emergo Europe
Prinsessegracht 20
2514 AP The Hague
The Netherlands
EC REP MKS1017
REF NON-STERILE
PRODUCT
NON
STERILE
Shukla Medical
8300 Sheen Drive
St. Petersburg, FL 33709
USA
CONSULT
INSTRUCTIONS
FOR USE
i
*Extractor tips (WIN1 through WIN17) are single-use only and must be discarded after use
Part Number Description Qty
CA133 Case #1 1
CA134 Lid #1 1
CA135 Case #2 1
CA136 Lid #2 1
TR001 Tray 1
MIWC Bone Chisel 1
MIWD T-Handle 1
MIWE C-Frame 1
MIWN C-Frame Locking Nut 1
MIWW 1/2” & 11/16” Double Open End Wrench 1
MIWWA 9/32” & 11/16” Double Open End Wrench 1
MMM5 Mallet 1
MDS030020 2.0mm Reverse Capture Hex Driver 1
MDS030025 2.5mm Reverse Capture Hex Driver 1
MDS030035 3.5mm Reverse Capture Hex Driver 1
MDS030040 4.0mm Reverse Capture Hex Driver 1
MDS030050 5.0mm Reverse Capture Hex Driver 1
MDS031562 5/32” Reverse Capture Hex Driver 1
MDS031875 3/16” Reverse Capture Hex Driver 1
MDS060080 T8 Reverse Capture Hex Driver 1
MDS060150 T15 Reverse Capture Hex Driver 1
MDS060200 T20 Reverse Capture Hex Driver 1
MDS060250 T25 Reverse Capture Hex Driver 1
MDS07 #2 Pozidriv 1
MDS08 Cruciform Driver 1
MDS09 Flat Tip Driver 1
MDE19250 1/4”sq. Adapter 1
MDA010006 6mm Standard Hex Tip 2
MDA011006 6mm Female Hex Tip 1
MDA010008 8mm Standard Hex Tip 1
Part Number Description Qty
HD233-M01 Ratcheting T-Handle 1
MHRS0311 Cannulated Ratcheting In-Line Handle 1
WIN1 1/4”-20 Female Extractor Tip 3
WIN2 M6 x 1mm Male Extractor Tip 3
WIN3 1/4”-20 Male Extractor Tip 3
WIN4 1/4”-28 Male Extractor Tip 3
WIN5 M8 x 1.25mm Male Extractor Tip 3
WIN6 5/16”-18 Male Extractor Tip 3
WIN7 5/16”-24 Male Extractor Tip 3
WIN8 M10 x 1.5mm Male Extractor Tip 3
WIN9 3/8”-16 Male Extractor Tip 3
WIN10 3/8”-24 Male Extractor Tip 3
WIN11 7/16”-20 Male Extractor Tip 3
WIN12 M5 x 0.8mm Male Extractor Tip 3
WIN13 M5.5 x 0.9mm Male Extractor Tip 3
WIN14 M6 x 0.75mm Male Extractor Tip 3
WIN15 #8-32 Female Extractor Tip 3
WIN16 M8 x 1mm Male Extractor Tip 3
WIN17 3/8”-32 Female Extractor Tip 3
WIN18 Socket Wrench for Extractor Tips 1
WIN19 Extractor Body 1
WIN20 Solid Nail Extractor 12.5mm-15mm 1
WIN21 Solid Nail Extractor 10mm-12.5mm 1
WIN22 Solid Nail Extractor 8mm-10mm 1
WIN23 Solid Nail Extractor 6mm-8mm 1
WIN24 6” Extension 1
WIN25 Large Hook Adapter 1
WIN26 Small Hook Adapter 1
WIN27 Conical Extractor 1
MKS1017 Xtract-All®Nail Winquist III Universal IM Nail Extraction System

5
®
FCD-0249 REV 02
Xtract-All®Nail (MSK1017) Winquist III Universal IM Nail Extraction System
MKS1017 Case #1
List of Components: Case #1
MKS1017 Case #1
CA133 Case 1: Body
CA134 Case 1: Lid
MIWE C-Frame
MMM5 Mallet
MIWN C-Frame Locking Nut
MIWD T-Handle
MIWC Bone Chisel
MIWWA 9/32” & 11/16” Double Open End Wrench
MIWW 1/2” & 11/16” Double Open End Wrench

6
®
FCD-0249 REV 02
Xtract-All®Nail (MSK1017) Winquist III Universal IM Nail Extraction System
Single-Use Only Extractors
List of Components: Case #2
MKS1017 Case #2
CA135 Case 2: Body
CA136 Case 2: Lid
TR001 Case 2: Tray
MKS1017 Case #2 Level #1
WIN18 Socket Wrench for Extractor Tips
WIN19 Extractor Body
WIN20 Solid Nail Extractor 12.5mm-15mm
WIN21 Solid Nail Extractor 10mm-12.5mm
WIN22 Solid Nail Extractor 8mm-10mm
WIN23 Solid Nail Extractor 6mm-8mm
WIN25 Large Hook Adapter
WIN26 Small Hook Adapter
WIN27 Conical Extractor
WIN1
1/4”-20 Female Extractor
WIN2
M6 x 1mm Male Extractor Tip
WIN3
1/4”-20 Male Extractor Tip
WIN4
1/4”-28 Male Extractor Tip
WIN5
M8 x 1.25mm Male Extractor Tip
WIN6
5/16”-18 Male Extractor Tip
WIN7
5/16”-24 Male Extractor Tip
WIN8
M10 x 1.5mm Male Extractor Tip
WIN9
3/8”-16 Male Extractor Tip
WIN10
3/8”-24 Male Extractor Tip
WIN11
7/16”-20 Male Extractor Tip
WIN12
M5 x 0.8mm Male Extractor Tip
WIN13
M5.5 x 0.9mm Male Extractor Tip
WIN14
M6 x 0.75mm Male Extractor Tip
WIN15
#8-32 Female Extractor Tip
WIN16
M8 x 1mm Male Extractor Tip
WIN17
3/8”-32 Female Extractor Tip
WIN24 6” Extension

7
®
FCD-0249 REV 02
Xtract-All®Nail (MSK1017) Winquist III Universal IM Nail Extraction System
List of Components: Case #2
MDS030020 2.0mm Reverse Capture Hex Driver
HD233-M01 Ratcheting T-Handle
MHRS0311 Cannulated Ratcheting In-Line Handle
MKS1017 Case #2 Level #2
MDE19250 1/4”sq. Adapter
MDS09 Flat Tip Driver
MDS08 Cruciform Driver
MDS07 #2 Pozidriv
MDS060250 T25 Reverse Capture Hex Driver
MDS060200 T20 Reverse Capture Hex Driver
MDS060150 T15 Reverse Capture Hex Driver
MDS060080 T8 Reverse Capture Hex Driver
MDS031875 3/16” Reverse Capture Hex Driver
MDS031562 5/32” Reverse Capture Hex Driver
MDS030050 5.0mm Reverse Capture Hex Driver
MDS030040 4.0mm Reverse Capture Hex Driver
MDS030035 3.5mm Reverse Capture Hex Driver
MDS030025 2.5mm Reverse Capture Hex Driver
MDA010008 8mm Standard Hex Tip
MDA011006 6mm Female Hex Tip
MDA010006 6mm Standard Hex Tip

8
®
FCD-0249 REV 02
Xtract-All®Nail (MSK1017) Winquist III Universal IM Nail Extraction System
Surgical Technique
1Remove Bone Screws
1. Determine size of bone screw & select appropriate
screwdriver shaft.
2. Insert screwdriver shaft into ratcheting handle & set
ratchet to counter-clockwise motion. (Fig. A)
3. Remove all proximal & distal screws.
Figure A
Prepare Nail for Extraction
1. Remove excess bone around proximal neck of IM nail
with Bone Chisel (MIWC). (Fig. B)
2. Remove threaded cap if present.
2
Figure B
Figure C
Extraction Method Selection
The Winquist III system contains several options (Option A-D; Fig. C) to remove IM nail systems in the event that primary or
subsequent methods fail.
Note: Extraction methods are presented in the recommended order of execution. Some methods are destructive, causing damage
to the nail threads that makes it difcult to return to preceding methods.
3

9
®
FCD-0249 REV 02
Xtract-All®Nail (MSK1017) Winquist III Universal IM Nail Extraction System
Figure E
Option A: Threaded Extractor Tips (Single-Use)
WIN1-WIN19
1. Select compatible extraction tip by matching threads on IM nail to an extractor tip (WIN1 through WIN17). (Fig. D)
2. Tighten the tip into the extractor body (WIN19) using the 9/32” & 11/16” wrenches (MIWWA and MIWW). (Fig. E)
Figure D
Option B: Conical Extractor
WIN27
If a compatible tip cannot be identied, or nail threads are damaged, use the Conical Extractor (Fig. F).
1. Clear excess bone around proximal end of IM nail using the Bone Chisel (MIWC).
2. Drive extractor clockwise into IM nail with downward force, inserting as far as possible and engaging at least 3-4 threads. Extractor
will cross-thread IM nail shaft threads, ensuring secure attachment.
Note: Once you use the conical extractor, threaded extraction tips can no longer be used due to thread deformation.
Figure F
Option C: Solid IM Nail Extractor
WIN20-WIN23
If the IM nail interior shaft is inaccessible due to bone growth, or if the IM nail has no opening, use a Solid IM Nail Extractor (Fig. G).
1. Clear excess bone around proximal end of IM nail using the Bone Chisel (MIWC).
2. Choose an extractor large enough to t completely over the exterior of the IM nail shaft.
3. Drive extractor as far as possible onto IM nail with downward force. The extractor threads will bite into the nail shaft, creating a
secure attachment.
Figure G
Option D: Hook Extractor
WIN25-WIN26
If the IM nail cannot be removed using Options A, B, or C, and if a slot, hole, or recess is present, a Hook Extractor may be used (Fig. H).
1. Clear excess bone around proximal end of IM nail using the Bone Chisel (MIWC) so that the hook can fully access the IM nail slot.
2. Engage Hook Extractor with the IM nail.
Figure H

10
®
FCD-0249 REV 02
Xtract-All®Nail (MSK1017) Winquist III Universal IM Nail Extraction System
Extract Implant
Extract implant with repeated strikes of the Mallet (MMM5) on Extraction C-frame strike plate. (Fig. M) If implant resists removal
after several strikes, use the Bone Chisel (MIWC) to loosen bone around implant before continuing.
5
If extractor tip breaks, (Fig. N) use Socket Wrench
(WIN18) to remove broken tip from IM nail.
Replace with a new tip and make another attempt.
A Note on Breakage
4Build Extractor Assembly
1. Connect T-handle (MIWD) securely to selected
extractor. Screw extractor into IM nail. (Fig. I)
2. Once extractor is securely attached to IM nail, remove
the t-handle, applying counter-torque with the 1/2”
Wrench (MIWW) (Fig. J).
3. Connect Extraction C-frame (MIWE) to extractor using
a Hex Nut (MIWN). (Fig. K) Tighten nut fully with the
11/16” Wrench (MIWWA), applying counter-torque with
the 1/2” Wrench (MIWW).
Figure M
Figure N
Figure L
Implant Removal Tip Compatibility Matrix
The table to the right shows compatibility between a wide range of proprietary implant systems and
corresponding Xtract-All®Spine removal tips. This information is updated frequently, as our engineering team
continually adds to our range of available tips to cover the continually expanding spinal implant market.
-RAY
Search Engine -RAY
Search Engine
For the most up-to-date information on supported
systems, contact customer service or your local rep
for access to our X-Ray Search Engine™ Implant
Compatibility Database.
Surgical Technique Continued
Figure I
Figure K
Figure J
Note: If extractor is not long enough to attach to C-frame, use 6” Extension (WIN24 or MIWA22). (Fig. L)

MFR Brand Extractor Winquist III
Tip #
Single
Use Driver Adapter
Acumed®Polarus®Humeral 1/4”-20 UNC-2A WIN3 ✓2.5mm† Hex & 3.5mm† Hex
Depuy/Ace®AIM®Humeral 1/4”-20 UNC-2A WIN3 ✓2.5mm† Hex & 3.5mm† Hex
AIM®Tibial 1/4”-20 UNC-2A WIN3 ✓3.5mm† Hex
AIM®Femoral, Supracondylar & A.R.T.®
Retrograde
5/16”-18 UNC-2A WIN6 ✓3.5mm† Hex & 5.0mm† Hex
Chandler Tibial 1/4”-28 UNF-2A WIN4 ✓Not Applicable
Versanail™ Ankle Fusion Nail 5/16”-18 UNC-2A WIN6 ✓3.5mm† Hex
smith&nephew®Russel-Taylor®Humeral 7/16”-20 UNF-2A WIN11 ✓3/16”† Hex
Russel-Taylor®Femoral & Recon 3/8”-24 UNF-2A WIN10 ✓3/16”† Hex & 5/32”† Hex
Russel-Taylor®Tibial 5/16”-24 UNF-2A WIN7 ✓5/32”† Hex
Trigen®All 5/16”-24 UNF-2A WIN7 ✓6mm Hex Socket & 1/4”sq.
Ender Nail Small hook WIN26 (MIWA14‡) Not applicable
Synthes®Solid Humeral M5.5x0.9 6g WIN13 ✓2.5mm† Hex
Solid Tibial M6x1.0 6g WIN2 ✓2.5mm† Hex
Solid Femoral, Recon, & Supracondylar M8x1.25 6g/M7x1.0 6g WIN5 ✓2.5mm† Hex
Universal Tibial & Femorial Conical WIN27 3.5mm† Hex
Cannulated Femoral, Recon, & Supracondylar M8x1.25 6g/M7x1.0 6g WIN5 ✓3.5mm† Hex
Flexible Humeral M5x0.8 6g WIN12 ✓2.5mm† Hex
Cannulated Tibial M8x1.25 6g/M7x1.0 6g WIN5 ✓3.5mm† Hex
Unknown Zickel 5/16”-24 UNF-2A WIN7 ✓5/32”† Hex
Biomet®Ankle Arthrodesis & Uniex®Tibial 5/16”-24 UNF-2A WIN7 ✓3.5mm† Hex
Knee Arthrodesis, Holland Femoral, Uniex®
Femoral, & Uniex®Reconstruction
3/8”-24 UNF-2A WIN10 ✓5.0mm† Hex
Retrograde Femoral 5/16”-24 UNF-2A WIN7 ✓5.0mm† Hex
Encore®Trueex®Humeral & Forearm #8-32 UNC-2B WIN15 ✓3.5mm† Hex
True/Fix®Distal Femoral, Prox Humeral, &
True/Fix®Ankle Fusion
1/4”-20 UNC-2A WIN3 ✓3.5mm† Hex
TrueFlex®Tibial 3/8”-32 UNEF-2B WIN17 ✓3.5mm† Hex & 8.0mm† Hex & 1/4”
sq.
Stryker®-
Howmedica®-
Osteonics®
T-2™ Humeral M6x0.75 6g WIN14 ✓2.5mm† Hex
Gross/Kempf®Femoral M10x1.5 6g WIN8 ✓3.5mm† Hex & 5.0mm† Hex
IC™ Nail Femoral, Tibial, & T-2 Tibial M8x1.0 6g WIN16 ✓3.5mm† Hex
T-2™ Femoral Antegrade/Retrograde M8x1.0 6g WIN16 ✓3.5mm† Hex & 6.0mm Hex & 1/4” sq.
Alta®Humeral 1/4”-20 UNC-2A WIN3 ✓T20 Torx
Alta®Femoral 5/16”-24 UNF-2A WIN7 ✓T25Torx
Zimmer®M/DN®All 5/16”-18 UNC-2A WIN6 ✓3.5mm† Hex
ZMS®Tibial & Humeral 1/4”-20 UNC-2A WIN3 ✓5.0mm† Hex
ZMS®Femoral 3/8”-16 UNC-2A WIN9 ✓5.0mm† Hex
Hansen-Street™, Harris®, Tibia®, Schneider®1/4”-20 UNC-2B WIN1 ✓2.5mm† Hex
Neff Nail Large Hook WIN25 (MIWA15‡) Not Applicable
Unknown - Solid &
Broken* IM Nails
Diameter 12.5mm-15mm Solid Nail Extractor 12.5mm-15mm WIN20 Not Applicable
Diameter 10mm-12.5mm Solid Nail Extractor 10mm-12.5mm WIN21 Not Applicable
Diameter 8mm-10mm Solid Nail Extractor 8mm-10mm WIN22 Not Applicable
Diameter 6mm-8mm Solid Nail Extractor 6mm-8mm WIN23 Not Applicable
Unknown Kuntscher Diameter 12.5mm-15mm Solid Nail Extractor 12.5mm-15mm WIN20 Not Applicable
Kuntscher Diameter 10mm-12.5mm Solid Nail Extractor 10mm-12.5mm WIN21 Not Applicable
Kuntscher Diameter 8mm-10mm Solid Nail Extractor 8mm-10mm WIN22 Not Applicable
Kuntscher Diameter 6mm-8mm Solid Nail Extractor 6mm-8mm WIN23 Not Applicable
*Broken: Nails broken mid-shaft or less †Reverse capture twist ‡Applies to upgrade kits only
IM NAIL EXTRACTOR COMPATIBILITY MATRIX
IM NAIL EXTRACTOR COMPATIBILITY MATRIX
IM Nail Extractor Compatibility Matrix

U
n
i
v
e
r
s
a
l
O
r
t
h
o
p
e
d
i
c
E
x
t
r
a
c
t
i
o
n
T
e
c
h
n
o
l
o
g
i
e
s
For more information on the
Xtract-All®Nail (MKS1017) Winquist III Universal IM Nail Extraction System
Call us at 888-4-SHUKLA (888-474-8552) or visit
www.ShuklaMedical.com
...Because Every Minute Counts®
T: 888-4-SHUKLA
T: 888-474-8552
F: 727-626-2770
[email protected]
Shukla Medical
8300 Sheen Drive
St. Petersburg, FL 33709
www.ShuklaMedical.com
©Shukla Medical 2018 •FCD-0249 REV 02