Synthes The Titanium Femoral Nail System User manual

R
Standard Locking 130˙ Antegrade Locking
Spiral Blade Locking Miss-A-Nail Locking
The Titanium
Femoral Nail System
Solid and Cannulated Nails
TECHNIQUE GUIDE

Implant Specifications ......................2
Implant Chart .............................7
Indications................................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 Information .......................68
Table of Contents
TECHNIQUES

Implant Specifications
Titanium Femoral Nails (green)
9 mm – 12 mm solid nails
10 mm – 15 mm cannulated nails
1.5 m radius
of curvature
Locking holes accept
4.9 mm locking bolts or
5.0 mm locking screws
50 mm from
end of nail
20 mm from
end of nail 12 mm proximal end accepts locking
sleeves for 13 mm –15 mm nails.
2
Universal design
for the right and
left femur
12 mm diameter
proximal end
Proximal flats
orient the specialty
locking sleeves
Material:
Titanium - 6% aluminum - 7% niobium
alloy implant material
Lengths:
300 mm – 480 mm, in 20 mm increments
Diameters:
9 mm and 10 mm diameters:
round cross section
11 mm – 15 mm diameters:
fluted cross section
Dynamic slot accepts 4.9 mm
locking bolt, 5.0 mm locking
screw, Spiral Blade, or 5.0 mm
shaft screw. Permits up to 8 mm
controlled, axial dynamization
with transverse locking bolt or
locking screw.
13 mm–15 mm
cannulated nails

15 mm Titanium End Caps, for standard locking sleeve
Protect proximal nail threads from tissue ingrowth
Secure locking sleeve to nail
•
0 mm extension
•
10 and 20 mm extensions
extend proximal nail end to
level of greater trochanter
Standard Locking Implants (green)
For 9 mm–12 mm solid nails
and 10 mm–12 mm cannulated nails
4.9 mm Titanium Locking
Bolts and 5.0 mm
Titanium Locking Screws
•
Lengths:
26 –100 mm, in 2 –5 mm
increments
•
4.3 mm core diameter
•
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 profile
of 13 mm –15 mm nails to provide smooth
transition on nail
•
Flats key onto proximal nail end in one
of two positions for right or left femur
12 mm Titanium End Caps
Protect proximal nail threads
from tissue ingrowth
•
0 mm extension
•
10 and 20 mm extensions:
extend proximal nail end to
level of greater trochanter
IMPLANT SPECIFICATIONS
3
0mm
10 mm
20 mm
0mm
10 mm
20 mm
For all nails
459.012 459.013 459.014
459.26–.100
458.926–.999
474.920 474.921 474.922
474.900

Implant Specifications (continued)
130 ° Locking Implants (pink)
For 9 mm–12 mm solid nails
and 10 mm–12 mm cannulated nails
130
° Locking Sleeve
•
15 mm diameter sleeve adapts dynamic
slot to a 130
° antegrade locking hole
•
Flats key onto proximal nail end in one
of two positions for right or left femur
0mm
10 mm
20 mm
130
°
For 13 mm–15 mm cannulated nails
130
° Locking Sleeve
for use 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
profile of 13 mm–15 mm nails to provide
smooth transition on nail
•
Flats key onto proximal nail end in one
of two positions for right or left femur
15 mm Titanium End Caps
for 130
° locking sleeves
Protect proximal nail threads
from tissue ingrowth
Secure locking sleeve to nail
•
0 mm extension
•
10 and 20 mm extensions:
extend proximal nail end to
level of greater trochanter
For all nails
4
456.013
457.210 457.211 457.212
474.913

Spiral Blade Locking Implants (blue)
For 9 mm–12 mm solid nails
and 10 mm–12 mm cannulated nails
Spiral Blades
•
Lengths: 70 –120 mm,
in 5 mm increments
•
Cannulated for insertion
over 3.2 mm guide wire
•
Front-cutting end
•
Spiral rotates counterclockwise
90
° between nail and front tip
•
Width: 12.5 mm
Locking Sleeves for Spiral Blade
•
100 ° , 110 ° , 120 ° angles adapt nail
slot for Spiral Blade
•
15 mm diameter
•
Flats key onto proximal nail end in
one of two positions for right or left femur
•
Etching identifies the lateral side
90 ° Spiral
Cannulated
Front-cutting end
0mm
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 from tissue
ingrowth
Secure Spiral Blade locking sleeve to nail
•
0 mm extension
•
10 and 20 mm extensions:
extend proximal nail end to level
of greater trochanter
IMPLANT SPECIFICATIONS
5
456.010 456.011 456.012
•
15 mm diameter Locking Sleeves match
proximal profile of 13 mm–15 mm nails
to provide smooth transition on nail
474.910 474.911 474.912
456.70 –.120
457.010 457.011 457.012
For 13 mm –15 mm cannulated nails
UHMWPE* tip deforms
over blade for secure
locking of blade in
initial postoperative
period
100 ° 110 °
120 °
100 ° 110 °
120 °

Miss-A-Nail Locking Implants (gold)
7.3 mm Titanium
Cannulated Screws
•
16 mm cancellous thread
length for interfragmentary
compression
•
Lengths: 70 –125 mm,
in 5 mm increments
•
Accept 2.8 mm guide wire
•
Self-drilling/self-tapping
•
Reverse-cutting flute
for removal
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 femoral neck
fracture fixation
•
Self-tapping
•
Front-cutting flutes permit
insertion of 5.0 mm shaft screw
into 3.2 mm drilled hole
7.3 mm Titanium Cannulated Screws
5.0 mm Titanium Shaft Screws
13.0 mm Titanium Washers
(optional)
6
Implant Specifications (continued)

IMPLANT CHART
7
9–12 mm Solid Femoral Nails and 13–15 mm Cannulated
10–12 mm Cannulated Femoral Nails Femoral Nails
Locking Sleeve
not needed
12 mm End Caps
459.012–.014
15 mm End Caps
474.920 –.922
Standard Locking
Sleeve
474.900
15 mm End 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
457.010 –.012
Spiral Blades
456.70 –.120
Locking Sleeves
for Spiral Blade
474.910 –.912
Locking Sleeves
for Spiral Blade
456.010 –.012
7.3 mm Cannulated Screws
408.870–.925
Not
Recommended
MISS-A-NAIL SPIRAL BLADE LOCKING 130° LOCKING STANDARD LOCKING

Indications for the
Titanium Femoral Nail
System include:
•
Femoral shaft fractures
•
Subtrochanteric fractures
•
Ipsilateral femoral
neck/shaft fractures
•
Impending pathologic
fractures
•
Nonunions
Femoral shaft
fractures
For the femoral shaft fracture,
two standard locking
configurations are possible:
•
Static transverse locking
•
Dynamic transverse locking
8
Static locking Dynamic locking
Indications
STANDARD STANDARD

INDICATIONS
9
CASE 2
CASE 1