Synthes Titanium Trochanteric FixationNail System User manual

Titanium Trochanteric Fixation
Nail System—Screw Option.
For intramedullary fixation of proximal
femur fractures.
Technique Guide

Introduction
Surgical Technique
Product Information
Table of Contents
Titanium Trochanteric Fixation Nail System— 2
Screw Option
AO Principles 4
Indications 5
Preoperative Implant Selection 6
Open Proximal Femur 7
Insert Nail 14
Proximal Locking 18
Distal Locking—Short Nails 31
SureLock Distal Targeting Device—Long Nails 34
Freehand Distal Locking—Long Nails 35
Insert End Cap 39
Implant Removal 40
Instrument Cleaning 45
Locking Mechanism Assembly 46
Implants 47
Instruments 53
Set Lists 62
Image intensifier control
Synthes
Important: These devices have not been evaluated for safety
and compatibility in the MR environment. These devices
have not been tested for heating or migration in the MR
environment.

End caps
– Prevent ingrowth of tissue and
facilitate nail extraction
– Cannulated for insertion over a guide
wire
– 0 mm end cap sits flush with nail
– 5 mm, and 10 mm end caps extend
nail height if nail is overinserted
– Titanium alloy*
Instrumentation
– Easy-to-use instrumentation facilitates
the surgical procedure
– Ball-tip reaming rod can be removed
through the nail and insertion instru-
ments, eliminating the need for an
exchange tube
2 Synthes Titanium Trochanteric Fixation Nail System—Screw Option Technique Guide
Titanium Trochanteric Fixation Nail System—Screw Option.
For intramedullary fixation of proximal femur fractures.
Nail features
– 6° lateral angle accommodates entry
site through the greater trochanter
– Cannulated nails with 17 mm proxi-
mal diameter
– Distal diameters of 10 mm–12 mm
(14 mm option for long nails) for
reamed or unreamed techniques
– Lengths: 170 mm, 235 mm,
300 mm–460 mm in 20 mm
increments
– Preassembled locking mechanism
for controlling screw rotation and
amount of screw travel
– Femoral neck angles of 125°, 130°,
135°
– Long nails with anatomic 1.5 m
radius of curvature
– Titanium alloy*

11.0 mm screw features
– 11.0 mm diameter
– Inverse-angle threads
– Self-tapping
– 70 mm– 130 mm lengths
– Titanium alloy*
Distal locking
– 4.9 mm locking bolts or 5.0 mm
locking screws
– Titanium alloy* for improved
mechanical and fatigue properties
– Self-cutting trocar tip
Synthes 3
*Titanium-6% aluminum-7% niobium
4.9 mm locking bolt
5.0 mm locking screw

AO Principles
In 1958, the AO formulated four basic principles, which have
become the guidelines for internal fixation.1They are:
Anatomic reduction
Precontoured plate assists in reduction of metaphysis to
diaphysis and facilitates restoration of length and rotation.
Stable fixation
Locking screws create a fixed-angle construct providing
angular stability.
Preservation of blood supply
Tapered end facilitates submuscular plate insertion. Submus-
cular insertion may help to preserve tissue viability.
Early, active mobilization
Early mobilization per standard AO technique creates an
environment for bone healing, expediting a return to optimal
function.
4 Synthes Titanium Trochanteric Fixation Nail System—Screw Option Technique Guide
1. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger, Manual of
Internal Fixation, 3rd Edition. Berlin: Springer-Verlag, 1991.
2. M. Baumgaertner, S. Curtin, D. Lindskog. “Intramedullary Versus
Extramedullary Fixation for the Treatment of Intertrochanteric Hip Fractures.”
Clinical Orthopaedics and Related Research, 348, pp 87-94, 1998.
3. D. Hardy, P. Descamps, P. Krallis, et al. “Use of an Intramedullary Hip-Screw
Compared with a Compression Hip-Screw with a Plate for Intertrochanteric
Femoral Fractures.” The Journal of Bone and Joint Surgery, 80-A(5),
pp 618-630, 1998.

Indications
Synthes 5
The Synthes Titanium Trochanteric
Fixation Nail (TFN) is intended to treat
stable and unstable pertrochanteric
fractures, intertrochanteric fractures,
basal neck fractures, and combinations
thereof. The long TFN is additionally
indicated for subtrochanteric fractures,
pertrochanteric fractures associated
with shaft fractures, pathologic
fractures of osteoporotic bone
(including prophylactic use) in both
trochanteric and diaphyseal regions,
long subtrochanteric fractures,
proximal or distal nonunions,
malunions, and revisions.
Short (170 mm and 235 mm)
Trochanteric Fixation Nails
Long (300 mm–460 mm)
Trochanteric Fixation Nails

Preoperative Implant Selection
6 Synthes Titanium Trochanteric Fixation Nail System—Screw Option Technique Guide
Use the AO preoperative planner rulers for the Titanium
Trochanteric Fixation Nail System to determine nail length,
nail diameter, and femoral neck angle.
Note: Check the magnification on the specific preoperative
planner ruler. Magnification levels are either 0% or 15%.
Determine the typical magnification factor at your institution
and then adjust measurements accordingly. To do this, divide
the measured length by the magnification factor and choose
the nearest nail length. Note that this will provide an esti-
mated nail length and implant size.
Example (for 0% magnification planner ruler):
– Measured nail length is 420 mm
– Typical femoral x-ray image is enlarged by 5%
(magnification factor 1.05)*
– 420/1.05 = 400
– Estimated nail length is 400 mm
When selecting nail size, consider canal diameter, fracture
pattern, patient anatomy, and postoperative protocol.
* Magnification factor may vary
Titanium Trochanteric Fixation Nail Ruler
For use with the Original AO/ASIF System of Instruments and Implants. ASIF is a registered trademark of SYNTHES (USA) and SYNTHES AG Chur.
170 mm and 235 mm Lengths, for 10 mm, 11 mm and 12 mm Cannulated Nails
80
85
90
95
100
105
110
115
120
125°130°
135°
10 mm 11 mm
12mm
170 mm 170 mm 235 mm
235 mm
10 mm 11 mm 12 mm
10 mm
5 mm
0mm
END CAP EXTENSIONS
mm 0
Titanium Helical Blade
80 mm – 120 mm
(5 mm increments)
Lateral View A-P View
For distal locking use
4.9 mm Titanium Locking Bolts or
5.0 mm Titanium Locking Screws
AO ASIF
GP2028-A 1/02 J3898A
Millimeters Illustrations (1.15 Magnification)

Synthes 7
Open Proximal Femur
1
Position patient
Instrument
394.35* Large Distractor
Position the patient in the lateral decubitus or supine
position on a fracture or radiolucent table. Position the
image intensifier to enable visualization of the proximal
femur in both the AP and lateral planes.
For unimpeded access to the medullary canal, abduct
the upper part of the body approximately 10–15° to the
contralateral side (or adduct the affected leg by 10–15°).
Reduce the fracture. The universal large distractor may
be useful when not using a fracture table.
2
Determine femoral neck angle
Instruments
357.391 Radiographic Ruler
357.399 3.2 mm Guide Wire, 400 mm
The three oblique slots at the proximal end of the radiographic
ruler can be used to determine the femoral neck angle. Select
a 3.2 mm guide wire and clamp the guide wire into one of
the grooves marked 125°, 130°, or 135°. Position the ruler
over the proximal femur and take an AP image. Select the an-
gle that most closely matches the angle of the femoral neck.
10°–15°
Affected leg
* Also available

8 Synthes Titanium Trochanteric Fixation Nail System—Screw Option Technique Guide
Open Proximal Femur
3
Determine nail length
(for nails 300 mm–460 mm)
Instrument
357.391 Radiographic Ruler
Position the image intensifier for an AP view of the proximal
femur. With long forceps, clamp the guide wire in the
appropriate neck angle position as previously determined.
Place the radiographic ruler over the femur. Adjust the
radiographic ruler until the guide wire is centered in the
femoral head. Mark the skin at the proximal end of the ruler.
Move the image intensifier to the distal femur, replace the
proximal end of the radiographic ruler at the skin mark,
and take an AP image of the distal femur. Verify fracture
reduction. Read nail length directly from the ruler image,
selecting the measurement that places the distal end of the
nail at, or just proximal to, the physeal scar, or the chosen
insertion depth.
Alternative technique
Instrument
360.255 Reaming Rod Measuring Device
Nail length may also be determined by using the reaming rod
measuring device and a 950 mm reaming rod or guide rod.
Insert the reaming rod to hold fracture reduction. Position
the image intensifier over the distal femur and take an image
to confirm reaming rod insertion depth. Pass the reaming
rod measuring device over the proximal end of the reaming
rod and through the incision to the bone. Read nail length
directly from the measuring device.