Synthes DFN User manual

DFN Distal Femoral Nail
Surgical Technique
Standard Locking
Spiral Blade Locking
Original Instruments and Implants of the Association
for the Study of Internal Fixation – AO/ASIF

399.430 Hammer 700 g
351.110 Reverse Awl
393.100 Universal Chuck with T-Handle
355.041 Guide Rod 3.0 mm,
with flat tip
399.505 Hammer, synthetic
314.280 Holding Sleeve, large
357.360 Extraction Screw for
Spiral Blade
357.117 Hammer Guide for DFN
357.026 Slotted Hammer 400 g,
can be mounted
511.790 Quick Coupling for Kirschner Wires
511.701 COMPACT™ AIR DRIVE II
511.760 Quick Coupling
for DHS/DCSTriple Reamers
511.750 Quick Coupling
117.500 Reaming Instrument Set for
Medullary Nails (not illustrated)
357.133 Extraction Screw for
AFN/DFN

314.750 Screwdriver, hexagonal
357.791 Depth Gauge for Locking Bolts
450.862–872 Locking Screws
459.260–680 Locking Bolts 4.9 mm
450.882–892 Spiral Blade for DFN
451.895 End Cap for Spiral Blade
for DFN
451.896 End Cap for Locking Screw
357.116 Aiming Arm for Spiral
Blade Locking
357.115 Aiming Arm for Standard Locking
351.270 Drill Bit 13.0 mm
357.129 Guide Wire 3.2 mm
357.530 Protection Sleeve 17.0/15.0
357.531 Drill Sleeve 15.0/3.2
357.120 Spiral Inserter for Spiral Blade Insertion
357.132 Connecting Screw for Spiral Blade
351.270 Drill Bit 13.0 mm
357.129 Guide Wire 3.2 mm
357.123 Protection Sleeve 15.0/13.0
357.124 Drill Sleeve 13.0/3.2
450.862–872 Locking Screws
450.862–872 Locking Screws
315.400 Drill Bit 4.0 mm
357.122 Radiographic Ruler for DFN
357.112 Insertion Handle for DFN
357.135 Connecting Screw
321.170 Pin Wrench
451.701–831 Distal Femoral Nail
357.098 Trocar 4.9 mm
357.097 Drill Sleeve 8.0/4.9
357.118 Protection Sleeve 11.0/8.0
357.099 Drill Bit 4.9 mm,
calibrated
314.750 Screwdriver, hexagonal

Synthes 1
Distal Femoral Nail
Table of contents
Warning
This description is not sufficient for immediate application of
the instrumentation. Instruction by a surgeon experienced in
handling this instrumentation is highly recommended.
Image intensifier control
Indications/contraindications 2
Implants 3
Standard locking 4
Spiral blade locking 17
Implant removal 20
Cleaning of instruments 23

Distal Femoral Nail
Indications/contraindications
The Distal Femoral Nail DFN is indicated for the stabilization
of fractures of the distal femur. It can also be used for
diaphyseal fractures in which a retrograde approach is
indicated (e.g. ipsilateral tibia and/or patella fractures,
proximal or distal endoprosthesis, adipositas permagna).
These include according to the AO classification:
Indications
–Fractures of type 33-A1 to A3
–Fractures of type 33-C1 to C3.1
–Fractures of type 32-A to C
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2
Contraindications
–Fractures of type 33-B, 33-C3.2 and 33-C3.3
–Proximal femoral fractures and high subtrochanteric fractures

Synthes 3
Distal Femoral Nail
Implants
Nails
Short and long, for standard locking and
spiral blade locking
Solid: 9.0 and 10.0 mm
Cannulated: 12.0 mm
–Long Nail (451.705–711, 725–731, 825–831)
Lengths: 300, 340, 380, 420 mm
Proximal locking:
1 dynamic hole AP
1 static hole ML
1 static hole AP
–Short Nail (451.701–703, 721–723, 821–823)
Lengths: 160, 200, 240 mm
Proximal locking:
2 static holes ML
Proximal locking
Locking Bolts 4.9 mm, self-tapping
(459.260–680)
Lengths: 26 to 68 mm
Standard locking
For non-osteoporotic bone and simple supracondylar fracture
morphology.
Locking Screws 6.0 mm, self-tapping
(450.862–872) (turquoise)
Lengths: 50 to 100 mm
End Cap for Locking Screw 6.0 mm (451.896)
(turquoise)
Spiral blade locking
For better purchase in osteoporotic bone and for all complex
supracondylar fracture morphologies.
Locking Screws 6.0 mm, self-tapping (450.862–872)
(turquoise)
Lengths: 50 to 100 mm
Spiral Blades for DFN (450.882–892) (pink)
Lengths: 50 to 100 mm
End Cap for Spiral Blade (451.895) (pink)

3
Determine nail length
Position the image intensifier for an AP view of the distal
femur (Position 1). With long forceps, hold the Radiographic
Ruler (357.122) parallel to and on the same level as the femur.
Adjust the ruler until the distal end is at the desired nail inser-
tion depth. Mark the skin laterally.
Move the image intensifier to the proximal femur (Position 2),
place the distal end of the ruler on the skin mark, and take
an AP image of the middle third of the femur (for short nails)
and of the proximal femur (for long nails). Verify fracture
reduction and read the nail length from the ruler image. When
using a long nail, select its length so that it can be locked level
with the lesser Trochanter.
4
Careful preoperative planning with clear classification of the
fracture and correct choice of implants are mandatory for a
successful surgical result.
1
Position patient
Position the patient supine on the operating table. The knee
of the injured leg should be flexed 70°–90°. A leg roll may be
used or the lower leg be flexed by lowering part of the table
to allow proper reduction and stabilization of the reduced
fracture. Position the image intensifier in such a way that vi-
sualisation of the entire femur is possible in anterior-posterior
(AP) as well as lateral views.
2
Reduce fracture
If possible, carry out closed reduction under image intensifier
control. In some cases the use of the Large Distractor (394.350)
is required.
Note: After repositioning, and prior to the insertion of the
nail, intra-articular fractures should be definitely stabilised with
two interfragmentary lag screws. Position the screws so as not
to interfere with the path of the nail. The intramedullary canal
and the nail are slightly dorsal, therefore, lag screws are placed
ventrally.
Distal Femoral Nail
Standard locking
Position 1 Position 2

Synthes 5
4
Determine nail diameter
Place the radiographic ruler perpendicular to the femur and
position it over the isthmus to confirm the nail diameter.
Choose the nail diameter with which the transition between
the medullary canal and the cortex is still visible left and right
of the marking.
5
Incision
For 33-A.X and 32-X.X fractures, either make a transligamen-
tar (ligamentum patellae) or a medial parapatellar incision.
For 33-C.X fractures always make a medial parapatellar ap-
proach.
6
The Distal Femoral Nail may be used for either reamed or
unreamed application.
Determine nail entry point and insert guide wire
The entry point for the nail is in the axis of the medullary
canal and in the intercondylar notch, just anterior and lateral
to the femoral attachment of the posterior cruciate ligament.
Insert the Protection Sleeve 17.0/15.0 (357.530) and the Drill
Sleeve (357.531) through the incision to the bone. Insert the
calibrated Guide Wire 3.2 mm (357.129) to a depth of 10
to 15 cm, taking into consideration the 7° to 9° valgus angle
of the anatomic axis of the femur. AP and lateral image inten-
sifier control is mandatory.
Cortex Cortex
Lateral Medial

6
7
Open medullary canal
Place the cannulated Drill Bit 13.0 mm (351.270) into a
cannulated power drill. Guide the drill bit through the
protection sleeve and over the guide wire to the bone. Drill
to a depth of approximately 30 mm. Remove the protection
sleeve, the drill sleeve and the guide wire. Do not re-use the
guide wire.
Remove the bone and cartilage debris and thoroughly rinse
the knee joint.
Alternative
The medullary canal can also be opened with the Large
Reverse Awl (351.110).
Reaming of the femur may be indicated depending on the
fracture type or if the medullary canal is too narrow. If
reaming is not indicated proceed with step 9.

Distal Femoral Nail
Standard locking
Synthes 7
8
Ream medullary cavity with SynReam (Option)
1Assemble reduction system
Assemble the reduction system of the SynReam Intra-
medullary Reaming System (189.060): Attach the T-Handle
(351.150) at the rear of the SynReam Flexible Shaft
(352.040) and a Reduction Head (352.050 or 352.055) at
the front.