Synthes TFN User manual

TFN – Titanium Trochanteric Fixation
Nail System. For intramedullary
fixation of proximal femur fractures.
Technique Guide
Instruments and implants
approved by the AO Foundation.
This publication is not intended for
distribution in the USA.

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Warning
This description alone does not provide sufficient background for direct use of
the instrument set. Instruction by a surgeon experienced in handling these
instruments is highly recommended.
Processing, eprocessing, Care and Maintenance
For general guidelines, function control and dismantling of multi-part instruments,
as well as processing guidelines for implants, please contact your local sales
representative or refer to: www.synthes.com/reprocessing
For general information about reprocessing, care and maintenance of Synthes
reusable devices, instrument trays and cases, as well as processing of Synthes
non-sterile implants, please consult the Important Information leaflet (SE_023827)
or refer to: www.synthes.com/reprocessing

Table of Contents
Introduction
Surgical Technique
Product Information
TFN – Titanium Trochanteric Fixation Nail System 2
Biomechanical Features 3
AO Principles 6
Indications 7
Clinical Cases 8
Preoperative Implant Selection 9
Open Proximal Femur 10
Insert Nail 17
Proximal Locking 21
Distal Locking – Short Nails 35
SureLock Distal Targeting Device – Long Nails 39
Freehand Distal Locking – Long Nails 40
Insert End Cap 44
Implant emoval 45
Instrument Cleaning 54
Locking Mechanism Assembly 55
Implants 56
– For Titanium Cannulated Trochanteric Fixation Nails 56
– Titanium Trochanteric Fixation Nails (green) – Short 59
– Titanium Trochanteric Fixation Nails (green) – Long 61
Instruments 64
Sets 73
Also Available 77
Titanium Trochanteric Fixation Nail System Technique Guide Synthes 1

2 Synthes TFN – Titanium Trochanteric Fixation Nail System Technique Guide
The Synthes Titanium Trochanteric Fixation Nail (TFN) System
permits an intramedullary approach for the fixation of frac-
tures of the femur. The TFN System consists of a series of
cannulated nails, cannulated helical blades, cannulated
femoral neck screws, cannulated end caps, and locking bolts
and screws. All of the implants in the TFN System are made
of titanium alloy.*
The helical blade provides improved resistance to varus col-
lapse and rotational control of the medial fracture segment
compared to single screw fixation (i.e., lag screws). The result
is superior life-to-cut-out versus single screw fixation. This is
accomplished through the use of the 11.0 mm helical blade.
In addition, the use of the 11.0 mm helical blade results in
reduced bone removal versus use of a traditional hip screw.
These helical blade features are especially advantageous in
osteoporotic fracture fixation. However the TFN system also
offers a lag screw fixation using an 11.0 mm femoral neck
screw.
TFN – Titanium Trochanteric Fixation
Nail System. For intramedullary
fixation of proximal femur fractures.
* Titanium-6% aluminum-7% niobium

110 100 1,000 10,000
1.8 (405 lbs.)
1.6 (360 lbs.)
1.4 (315 lbs.)
1.2 (270 lbs.)
1.0 (225 lbs.)
0.8 (180 lbs.)
0.6 (135 lbs.)
0.4 (90 lbs.)
0.2 (45 lbs.)
0100,000
TFN
Greater resistance to cut-out
The helical blade of the Titanium Trochanteric Fixation Nail
(TFN) System provides increased resistance to cut-out.1
The innovative helical blade design was proven to provide
“superior resistance to migration and subsequent cut-out
failure.”2
Fixation life curves: number of load cycles to cut-out at
varying loads.
When tested at a load of 1.2 kN, the lag screw cut-out
before 1,000 cycles whereas the helical blade cut-out after
10,000 cycles.
Biomechanical Features
1M.B. Sommers, M. Bottlang, C. Roth, H. Hall, .C. Krieg (2004) A laboratory
model to evaluate cutout resistance of implants for pertrochanteric fracture
fixation. ournal of Orthopaedic Trauma, Vol 18(6):361–368
2lbid.
3lbid.
Load [kN (lbs)]
Proximal femur fixation device cut-out3
(Unstable pertrochanteric fracture using simulated cancellous bone)
IM Device
with Lag Screw
Cycles to cut-out
TFN –Titanium Trochanteric Fixation Nail System Technique Guide Synthes 3

1 10 100 1,000 10,000 100,000
25°
20°
15°
10°
5°
0
TFN
TFN
80°
70°
60°
50°
40°
30°
20°
10°
0
1 10 100 1,000 10,000 100,000
4 Synthes TFN – Titanium Trochanteric Fixation Nail System Technique Guide
Biomechanical Features
Improved resistance to varus collapse
4M.B. Sommers, M. Bottlang, C. Roth, H. Hall, .C. Krieg (2004) A laboratory
model to evaluate cutout resistance of implants for pertrochanteric fracture
fixation. ournal of Orthopaedic Trauma, Vol 18(6):361–368
5lbid.
Improved resistance to femoral head rotation
Varus rotation
Cycles
Varus rotation
Varus rotation of femoral head at 1000 N4
(Unstable pertrochanteric fracture using simulated cancellous bone)
Cycles
IM Device
with Lag Screw
IM Device
with Lag Screw
otation of femoral head around implant axis at 1000 N5
(Unstable pertrochanteric fracture using simulated cancellous bone)

1000 10,000 100,000 1,000,000 10,000,000
4.5 (1011 lbs)
4.0 (899 lbs)
3.5 (787 lbs)
3.0 (674 lbs)
2.5 (562 lbs)
2.0 (449 lbs)
1.5 (337 lbs)
1.0 (225 lbs)
0.5 (112 lbs)
0
TFN
6Test conducted at Legacy Research and Technology Center, Portland, OR.
7Test conducted at Synthes Mechanical Testing Lab, West Chester, PA.
The 11.0 mm helical blade reduces amount of bone
removed6
By using the 11.0 mm helical blade, significantly less bone is
removed than with a predrilled lag screw.
The helical blade compacts trabecular bone around the blade
as it advances into the femoral head.
Note: The amount of bone removed by an implant is directly
related to its cross-sectional area. The helical blade’s cross-
sectional area is only 38% that of a standard lag screw.
Longer fatigue life in mechanical testing7
Example of bone removal
with standard lag screw
Example of bone removal
with helical blade
Load [kN (lbs)]
Fatigue life
Cycles
IM Device
with Lag Screw
TFN – Titanium Trochanteric Fixation Nail System Technique Guide Synthes 5

6 Synthes TFN – Titanium Trochanteric Fixation Nail System Technique Guide
In 1958, the AO formulated four basic principles, which have
become the guidelines for internal fixation.8,9 Those prin -
ciples, as applied to the Titanium Trochanteric Fixation Nail
System, are:
Anatomic reduction
The Titanium Trochanteric Fixation Nail allows controlled
dynamic collapse and interfragmentary compression while
maintaining rotational control of the medial segment.
Stable fixation
The Trochanteric Fixation Nail System provides improved re-
sistance to varus collapse and rotational control of the medial
fracture segment versus single screw fixation (i.e., lag screws).
This results in superior life-to-cut-out versus single screw
fixation.
Preservation of blood supply
The instruments and implants in the Trochanteric Fixation
Nail System permit a more percutaneous technique and less
tissue stripping than current treatment methods. An in-
tramedullary approach shows decreased blood loss versus
plate fixation of subtrochanteric fractures.10,11 Use of the
11.0 mm helical blade results in reduced bone removal com-
pared to a hip screw.
Early, active mobilization
The shortened moment arm associated with an intra -
medullary approach permits early mobilization. In conjunc-
tion with AO principles, the Trochanteric Fixation Nail System
creates an environment for bone healing and rapid rehabili-
tation. For stable fractures, early postoperative weightbear-
ing is possible.
AO Principles
8M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger (1991), Manual of
Internal Fixation, 3rd Edition. Berlin: Springer
9Rüedi TP, Buckley RE, Moran CG (2007) AO Principles of Fracture Management.
2nd expanded ed. 2002. Stuttgart, New York: Thieme
10 M. Baumgaertner, S. Curtin, D. Lindskog (1998). Intramedullary Versus
Extramedullary Fixation for the Treatment of Intertrochanteric Hip Fractures.
Clinical Orthopaedics and Related Research, 348, 87–94
11 D. Hardy, P. Descamps, P. Krallis, et al (1998). Use of an Intramedullary Hip-Screw
Compared with a Compression Hip-Screw with a Plate for Intertrochanteric
Femoral Fractures. The ournal of Bone and oint Surgery, 80-A(5), 618–630

The Synthes Titanium Trochanteric Fixation Nail (TFN) is in-
tended to treat stable and unstable pertrochanteric fractures,
intertrochanteric fractures, basal neck fractures, and combi-
nations thereof. The Long TFN is additionally indicated for
subtrochanteric fractures, pertrochanteric fractures associ-
ated with shaft fractures, pathologic fractures of osteo-
porotic bone (including prophylactic use) in both trochanteric
and diaphyseal regions, long subtrochanteric fractures, proxi-
mal or distal nonunions, malunions, and revisions.
Indications
Long (300 mm– 460 mm)
Trochanteric Fixation Nails
with helical blade
Short (170 mm and 235 mm)
Trochanteric Fixation Nails
with helical blade
Long (300 mm– 460 mm)
Trochanteric Fixation Nails
with screw
Short (170 mm and 235 mm)
Trochanteric Fixation Nails
with screw
TFN – Titanium Trochanteric Fixation Nail System Technique Guide Synthes 7

Clinical Cases
Case 1
Case 2
8 Synthes TFN – Titanium Trochanteric Fixation Nail System Technique Guide
Preoperative AP Preoperative lateral Postoperative AP Postoperative lateral
Preoperative AP Preoperative lateral Postoperative AP Postoperative lateral