expert alfn. adolescent lateral femoral nail.synthes.vo.llnwd.net/o16/llnwmb8/int mobile/synthes...

Surgical Technique

EXPERTNailing System

Expert ALFN. Adolescent Lateral Femoral Nail.

This publication is not intended for distribution in the USA.

Instruments and implants approved by the AO Foundation.

Image intensifier control

This description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly recommended.

Processing, Reprocessing, Care and MaintenanceFor 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:http://emea.depuysynthes.com/hcp/reprocessing-care-maintenanceFor 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: http://emea.depuysynthes.com/hcp/reprocessing-care-maintenance

Expert ALFN Surgical Technique DePuy Synthes 1

Table of Contents

Introduction Expert ALFN 2

AO Principles 4

Indications and Contraindications 5

Clinical Cases 6

Surgical Technique Preoperative Planning 10

Opening the Femur 13

Inserting the Nail 18

Locking Options 24

Proximal Locking – Standard 26

Proximal Locking – Recon (Optional) 31

Distal Locking 36

End Cap Insertion 42

Implant Removal 44

Product Information Implants 50

Instruments 54 � Comparison Table 65 � Handling Information 67

Set List 69 � Modular Cases 69 � Vario Cases 73

Optional: Angular Stable Locking System (ASLS) 77

MRI Information 79

2 DePuy Synthes Expert ALFN Surgical Technique

Nail features – Design accommodates a lateral entry site through

the greater trochanter – Anatomic nail design based on a femoral canal study* – Titanium cannulated nail for reamed or unreamed tech-

niques – Lengths from 240 mm to 400 mm, in 20 mm increments – Designed for use in patients where Titanium Elastic Nails

are not large enough and the Expert Lateral Femoral Nail for adults is too large

– 8.2 mm, 9.0 mm, and 10.0 mm diameter nails with 11.0 mm diameter proximal ends

End caps – Prevent ingrowth of tissue and facilitate nail extraction – Self-retaining, T40 Stardrive recess for easy pickup

and insertion of the end cap – Cannulated for insertion over a guide wire – 0 mm end cap sits flush with the nail – 5 mm, 10 mm, and 15 mm end caps extend nail height if

the nail is overinserted

* Ehmke L, Polzin B, Roth C, Bottlang M (2006) Femoral Nailing Through the Trochanter: The Reamer Pathway Indicates A Helical Shape. Journal of Orthopedic Trauma Vol. 20 (Number 10): 668–674

Improved instrumentation – Easy-to-use instrumentation facilitates the surgical

procedure – Ball-tip reaming rod can be removed through the nail and

the insertion instruments, eliminating the need for an exchange tube

– Tailored to the needs of the clinic available as: – an upgrade set for adolescents to Expert Lateral Femoral

System for adults or

– a standard Instrument Set for Expert Adolescent Lateral Femoral Nail

Expert ALFN Adolescent Lateral Femoral Nail System


Standard locking screws – Double-lead thread for ease of insertion – Thread closer to screw head provides better bone

purchase in the near cortex and improved stability – Titanium alloy* for improved mechanical and fatigue

properties – Self-tapping blunt tip – Self-retaining T25 Stardrive recess allows improved torque

transmission, increased resistance to stripping relative to a hex recess, and secure locking screw pickup

– 4.0 mm diameter

5.0 mm hip screws – Lengths from 50 mm to 125 mm in 5 mm increments – Self-retaining T25 Stardrive recess – Titanium alloy*

* Titanium/6% aluminum/7% niobium alloy

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AO Principles

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1,2

1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991

2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007

Anatomic reductionFracture reduction and fixation to restore anatomical relationships.

Early, active mobilizationEarly and safe mobilization and rehabilitation of the injured part and the patient as a whole.

Stable fixationFracture fixation providing absolute or relative stability, as required by the patient, the injury, and the personality of the fracture.

Preservation of blood supplyPreservation of the blood supply to soft tissues and bone by gentle reduction techniques and careful handling.


Indications and Contraindications

IndicationsThe Expert Adolescent Lateral Femoral Nail is indicated for use in adolescent and small-stature adult patients to stabilize: – Fractures of the femoral shaft – Subtrochanteric fractures – Ipsilateral neck/shaft fractures – Impending pathologic fractures – Nonunions and malunions

Note: ASLS, the Angular Stable Locking System, is indicated in cases where increased stability is needed in fractures closer to the metaphyseal area or in poor quality bone. For more details regarding the intramedullary fixator principle, please consult the ASLS technique guide (036.000.708) and concept flyer (036.001.017).

ContraindicationsNo specific contraindications.


Clinical Cases

Case 1 – standard transverse locking – 16-year-old female, 45 kg – Isolated transverse femoral shaft fracture

Case 2 – antegrade locking – 15-year-old male, 55 kg – Oblique midshaft femoral shaft fracture

Preoperative

Preoperative


Intraoperative

Postoperative

Follow-up (6 weeks after surgery)

Follow-up (4 months after surgery)


Clinical Cases

Case 3 – recon locking – 12-year-old male, 43 kg – Pathologic proximal femoral shaft fracture

Case 4 – distal locking – 12-year-old male, 30 kg – Oblique distal third femoral shaft fracture

Preoperative

Preoperative


Postoperative

Postoperative

Follow-up (3 weeks after surgery)

Follow-up (1 month after surgery)


Preoperative Planning

Use the AO preoperative planner templates for the Expert Adolescent Lateral Femoral Nail (034.000.600/605) to estimate nail length and medullary canal diameter.

To estimate medullary canal diameter, place the template on the AP or lateral x-ray of the femur and measure the dia-meter of the medullary canal at the narrowest part that will contain the nail.

To estimate nail length, place the template on the AP x-ray of the uninjured femur and select the appropriate nail length based on patient anatomy. When selecting nail size, consider canal diameter, fracture pattern, patient anatomy and post-operative protocol.

Note: Templates are available in two sizes: actual size and 115% magnification in which the image is enlarged 15% to correspond to typical radiographic magnification; however, variations in magnification levels are common.

Affected leg10º–15º adduction

Expert Adolescent Lateral Entry Femoral Nail for Right Femur8.2 mm, 9 mm and 10 mm diameter 240 mm to 400 mm lengths

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For use only with the Original AO System ofInstruments and Implants

Synthes GmbHEimattstrasse 3CH-4436 Oberdorfwww.synthes.com

1.0 Magnification

Locking Screw Stardrive � 4.0 mm, TAN [04.005.408 – 04.005.470]

Hip Screw Stardrive � 5.0 mm, TAN [04.031.020 – 04.031.035]

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1Position patient

Position the patient in the lateral decubitus or supine position on a fracture table or radiolucent operating table. Position the C-arm to allow visualization of the proximal femur in both the AP and lateral planes.

To facilitate access to the medullary canal, abduct the upper part of the body approximately 10°–15° to the contralateral side and adduct the affected limb by 10°–15°.


2Reduce fracture

Perform closed reduction manually by axial traction under image intensifier control. The use of the large distractor may be appropriate in certain circumstances (refer to the surgical technique 036.000.038).

3Confirm nail length

Instrument

03.010.020 Radiographic Ruler for Expert Femoral Nails

The required nail length must be determined after reduction of the femoral fracture.

Position the C-arm for an AP view of the proximal femur. With long forceps, hold the ruler alongside the lateral thigh, parallel to and at the same level as the femur. Adjust the ruler until the proximal end is at the desired nail insertion.


Preoperative Planning

Move the C-arm to the distal femur. Verify fracture reduction. Align the proximal end of the radiographic ruler to the skin mark, and take an AP image of the distal femur.

Read nail length directly from the ruler image, selecting the measurement proximal to the epiphysis, or at the chosen insertion depth.

Notes: � It is recommended to treat the fracture with the longest nail possible without crossing the physis, taking into account patient anatomy or a previous implant. The distal end of the nail should be 15 mm from the physis.

� Compression (with the conventional backstroke technique) or dynamization must be taken into account when determining the nail length. A shorter nail should be chosen when back hammer ing or dynamization is planned for the procedure (the dynamic slot allows for 7 mm of movement).

4Confirm canal diameter

Instrument

03.010.023 Radiographic Ruler for Nail Diameters for Expert Femoral Nails, length 365 mm

The required nail length must be determined after reduction of the femoral fracture.

Position the C-arm for an AP or lateral view of the femur at the level of the isthmus. Hold the radiographic canal width estimator over the femur with the diameter gauge centered over the narrowest part of the medullary canal. Read the estimated diameter measurement on the circular indicator that fills the canal.

Notes: � If the reamed technique is used, the diameter of the largest medullary reamer must be at least 1.0 mm greater than the nail diameter.

� The ruler provides only an estimate of the canal diameter as it is not at the same level as the femur.

12°

20 mm


1Approach

Palpate the posterior edge of the greater trochanter.

Make a 3 cm incision in line with the central axis of the intramedullary canal in the lateral view, and depending on the anatomy of the patient, 2–5 cm proximal to the tip of the greater trochanter.

Opening the Femur

2Determine entry point

The insertion point is 12° lateral to the greater trochanter, as measured from a point 20 mm distal to the lesser trochanter.

The entry point can also be described as lateral to the greater trochanter at the same level as the superior aspect of the base of the femoral neck (just above the piriformis fossa). This point can be found by extending a line horizontally from the base of the femoral neck to the lateral side of the femur.

Note: To ensure a correct entry point the preoperative planner template for the ALFN can be used.


Opening the Femur

3Insert guide wire

Instruments

03.010.500 Handle, with Quick Couplingand03.010.504 Protection Sleeve 13.0 for Expert

Adolescent Lateral Femoral Nail, with Quick Coupling

and03.010.509 Multihole Drill Guide for Protection

Sleeve 13.0, for Expert Adolescent Lateral Femoral Nail

or

03.010.031 Drill Sleeve 13.0/3.2, for antegrade approach, for No. 03.010.030

and03.010.229 Protection Sleeve 15.5/13.7,

length 122.5 mm and357.393 Trocar B 3.2 mm, length 172 mm,

for No. 357.392

357.399 Guide Wire B 3.2 mm, length 400 mm

Insert the protection sleeve, wire guide and trocar assembly into the incision site and to the bone.

Remove the trocar. Insert the guide wire through the wire guide.

The guide wire must be inserted laterally at an angle of 12° to the center of the medullary canal. The tip of the guide wire should be centered in the medullary canal 20 mm distal to the lesser trochanter.

Verify that the guide wire position allows adequate clearance on the lateral side of the femur for the opening drill bit.

The guide wire is inserted with it centered in the lateral view.

Precaution: The correct entry point and angle are essential for a successful result. To ensure the correct position of the guide wire, hold a sterile Adolescent Lateral Femoral Nail onto the femur and check radiographically.

75 mm


4Open proximal femur to medullary canal

Instruments

03.010.229 Protection Sleeve 15.5/13.7, length 122.5 mm

or03.010.509 Multihole Drill Guide for Protection

Sleeve 13.0, for Expert Adolescent Lateral Femoral Nail

and03.010.500 Handle, with Quick Coupling

351.270 Drill Bit B 13.0 mm, cannulated, length 290 mm, 3-flute, for Quick Coupling No. 511.760


Drill to open cortexDrill through the protection sleeve. Drill the cortex until the drill bit stops in the sleeve.

Remove the guide wire, drill bit and protection sleeve.

Precaution: Dispose of the guide wire. Do not reuse.

Alternative technique to open proximal femurInsert the 2.5 mm reaming rod. Use a reaming system in-tended for femoral reaming procedures to open the proximal femur to a depth of approximately 75 mm, starting with an 8.5 mm reamer and ending with a 13.0 mm reamer.

If reaming the medullary canal, proceed to page 17.


Opening the Femur

Alternative technique (with awl)

Alternative instruments

03.010.041 Awl B 14.0/3.2 mm, cannulated


Place the cannulated awl over the guide wire and open the medullary canal. Use a twisting motion to advance the awl to a depth of approximately 75 mm.

Remove the guide wire and awl.

Precaution: After opening the proximal femur, dispose of the guide wire. Do not reuse.


5Ream medullary canal (optional)

Instrument

03.010.093 Rod Pusher for Reaming Rod with Hexagonal Screwdriver B 8.0 mm

Note: For the detailed reaming procedure, please consult SynReam Surgical Technique.

If necessary, use a reaming system intended for femur ream-ing procedures to enlarge the medullary femoral canal to the desired diameter.

Check fracture reduction under image intensifier.

Insert reaming rodInsert a 2.5 mm reaming rod into the medullary canal until the desired insertion depth. The tip must be correctly positioned in the medullary canal since it determines the final distal position of the Expert ALFN. The use of the Reduction Instrument for Medullary Nails may be helpful in certain circumstances.

ReamingStarting with the smallest diameter reaming head, ream to a diameter of 0.5 to 1.5 mm greater than the nail dia meter. Ream in 0.5 mm increments and advance the reamer with steady, moderate pressure. Do not force the reamer. Partially retract the reamer repeatedly to clear debris from the medul-lary canal.

Use the holding forceps to retain the reaming rod while reaming and to prevent it from rotating.


1Assemble insertion instruments

Instruments

03.010.146 Connecting Screw, cannulated, with Internal M6x1 Thread

and03.010.488 Insertion Handle, radiolucent,

length 100 mm, for ALFN

or

03.010.044 Connecting Screw, cannulated, for Expert Tibial and Femoral Nails, for No. 03.010.045

and03.010.226 Insertion Handle for Expert Adolescent

Lateral Femoral Nail


03.010.092 Screwdriver, hexagonal with spherical head B 8.0 mm

or03.010.517 Screwdriver, hexagonal B 8.0 mm,

with T-Handle, with spherical head, length 322 mm

Match the tangs on the handle to the notches in the Expert Adolescent Lateral Femoral Nail.

Place the connecting screw into the insertion handle and thread it into the proximal nail end, using the 8 mm hexa gonal screwdriver with spherical head.

The Expert Adolescent Lateral Femoral Nails are labeled left or right on the proximal nail end.

Inserting the Nail


Slide the connecting screw onto the reaming rod push rod. Slide the assembly through the insertion handle and match the tangs on the handle to the nail. Tighten using the hex on the reaming rod push rod.

Secure the assembly using the 8 mm hexagonal screwdriver with spherical head.

Note: The anatomical design of the Adolescents Lateral Femoral Nail requires left and right version nails. The nails are therefore labeled left or right on the proximal anterior end.

Precaution: Check that the connecting screw is correctly tightened. Do not overtighten.


2Insert nail

Instruments

03.010.523 Driving Cap with thread, for Insertion Handle

and03.010.522 Combined Hammer, 500 gand03.010.170 Hammer Guide

or

03.010.047 Connector, length 141 mm, for Insertion Handle

and03.010.056 Combined Hammer 700 g, can be

mounted, for No. 357.220and357.220 Hammer Guide, for No. 357.250




321.170 Pin Wrench B 4.5 mm, length 120 mm

321.160 Combination Wrench B 11.0 mm

357.398 Shaft, hexagonal, B 8.0 mm, cannulated, short, length 125 mm

Inserting the Nail


Slide the connector into the groove on the insertion handle and secure it using the 11 mm ratchet wrench. If patient anatomy allows, attach the driving cap in the medial position.

Orient the insertion handle in an anterior position. Use the C-arm to verify fracture reduction. Insert the nail as far as possible.

The nail rotates approximately 90° during insertion. The insertion handle rotates from an anterior to a lateral po-sition during insertion of the last one-third of the nail length. If the nail does not rotate to the lateral position, remove the nail and reinsert it with the handle slightly lateral to the sagittal plane.

Monitor nail passage across the fracture, and control in two planes to avoid malalignment.


If desired, insert the nail using light hammer blows.

Lock the head of the hammer in place by tightening the nut onto the threads located below the hammer head. Use the pin wrench if necessary. Strike the driving cap directly.

Optionally, the hammer guide can be threaded onto the driving cap and the hammer can be used as a slide hammer. Loosen the nut from the threads located below the hammer head and secure the nut onto the threads located above the handle.

Precautions: � Do not mount the aiming arm until the nail has been completely inserted.

� If nail insertion is difficult, choose a smaller diameter nail or ream the intramedullary canal to a larger diameter.

� Do not hammer directly onto the insertion handle. Retighten and confirm that the nail is securely connected to the insertion handle.

Inserting the Nail


3Check proximal nail position

Insert the nail until it is at or below the femoral opening.Check final nail position under image intensification in AP and lateral views.

If primary compression or secondary dynamization is planned, it is recommended to overinsert the nail by more than 7 mm, which corresponds to the maximum distance between the positions in static and dynamic modes.

Note: The distance between the markings on the insertion handle is 5 mm and corresponds to the extensions of the end caps. This feature can be used for overinsertion of the nail.

4Check distal nail location

Use image intensification to ensure the nail is centered in both AP and lateral views. Verify fracture alignment.

Remove the reaming rod.


Locking Options

Proximal locking with recon locking Proximal locking with 120° locking screw

130° CCD

120°


Proximal locking with dynamization Proximal locking with static transverse locking screw


1Choose locking option

For standard locking, three targeted proximal locking options are possible:

1 120° antegrade locking2 Dynamic locking (LM)3 Static locking (LM)

For immediate dynamization, insert one proximal locking screw through the dynamic slot. If dynamization may be required in the future, use the dynamic locking option with the 120° antegrade locking hole.

Proximal Locking – Standard

2Mount aiming arm

Instruments




03.010.227 Aiming Arm for Expert Adolescent Lateral Femoral Nail

or03.010.483 Aiming Arm, radiolucent, for

Expert Adolescent Lateral Femoral Nail

Confirm that the nail is securely connected to the insertion handle using the 8 mm ball hex screwdriver. Mount the aiming arm to the insertion handle.


3Insert trocar assembly

Instruments

03.010.063 Protection Sleeve 12.0/8.0, length 188 mm

03.010.064 Drill Sleeve 8.0/3.2, for No. 03.010.063

03.010.069 Trocar B 3.2 mm, for No. 03.010.064

Insert the three-part trocar assembly (protection sleeve, drill sleeve and trocar) through the desired hole in the aiming arm, make a stab incision and insert the trocar to the bone. Remove the trocar.

If using the 120° antegrade locking option, insert the trocar assembly through the hole labeled “120°” on the insertion handle.

Precaution: Do not exert forces on the aiming arm, protection sleeve, drill sleeves or drill bits. Such force may prevent accurate targeting through the proximal locking holes and damage the drill bits.


4Drill and determine locking screw length

Instrument

03.010.060* Drill Bit B 3.2 mm, calibrated, length 340 mm, 3-flute, for Quick Coupling, for No. 03.010.064

Ensure that the drill sleeve is pressed firmly to the lateral cortex. Drill through both cortices until the tip of the drill bit just penetrates the far cortex.

Confirm drill bit position.

Ensure that the drill sleeve is pressed firmly to the lateral cortex and read the measurement from the calibrated drill bit at the back of the drill sleeve. This measurement corresponds to the appropriate length locking screw. Remove the drill bit and drill sleeve.

Note: A correct end position of the drill sleeve is important in order to choose the correct length of the locking screw.

* Available nonsterile or sterile-packed. Add "S" to catalog number to order sterile product.



Alternative instrument

03.010.072 Depth Gauge for Locking Screws, measuring range up to 110 mm for No. 03.010.063

or03.010.428 Depth Gauge for Locking Screws,

measuring range to 110 mm

After drilling both cortices, remove the drill bit and drill sleeve.

Disassemble the depth gauge into two parts: the outer sleeve and the measuring device with hook. Insert the measuring device into the protection sleeve. Make sure that the hook grasps the far cortex.

Ensure that the protection sleeve is firmly pressed against the lateral cortex.

Read the measurement from the back of the protection sleeve, which indicates the appropriate length locking screw.

Note: A correct end position of the protection sleeve is important in order to choose the correct length of the locking screw.


Option: Locking with ASLSASLS, the Angular Stable Locking System, can be used as an alternative to standard locking screws in any round hole of a Synthes cannulated titanium nail. For more details regarding the intramedullary fixator principle please consult the ASLS surgical technique (036.000.708) and concept flyer (036.001.017). Please note that for the use of ASLS special instruments are required.

3Insert locking screw

Instrument

03.010.107 Screwdriver Stardrive, T25, length 330 mmor03.010.518 Screwdriver Stardrive, T25, self-holding, length 319 mm

Insert the appropriate length locking screw through the protection sleeve using the Stardrive screwdriver. Verify locking screw length under image intensification.

The tip of the locking screw should not project more than 2 mm to 4 mm beyond the far cortex.

Note: A groove on the screwdriver provides a rough indication that the locking screw is fully inserted through the sleeve.

Repeat for a second proximal locking screw if desired.



1Confirm nail position

In the AP view, adjust the nail insertion depth to ensure that the two hip screws can be placed into the femoral head.

Adjust nail position for correct anteversion through the lateral view.

Precaution: Adjusting for the correct anteversion before making a skin incision is crucial to allow uncomplicated guide wire and screw insertion.

2Mount aiming arm

Instruments





or03.010.483 Aiming Arm, radiolucent, for

Expert Adolescent Lateral Femoral Nail

Confirm that the nail is securely connected to the insertion handle using the screwdriver, hexagonal with spherical head B 8.0 mm. Mount the aiming arm to the insertion handle.

Proximal Locking – Recon (Optional)


3Insert guide wires for hip screws

Instruments

03.010.075 Protection Sleeve 11.5/8.5, for LFN Reconstruction Locking


03.010.077 Trocar B 3.2 mm, for No. 03.010.076


Insert both three-part trocar combinations (protection sleeve, drill sleeve, and trocar) through the aiming arm. Make a stab incision and insert the trocars to the bone.

Following the arrows on the aiming arm, rotate the cams so that the protection sleeves are locked in the aiming arm. This will ensure proper measurement for the hip screws.

Remove the inferior trocar.



In case of an arrested or closed physis, insert a guide wire into the femoral head, stopping approximately 5 mm from the subchondral bone.

If the physis in the femoral head is not fully arrested, stop the wire short of the physis. Check the guide wire placement radiographically in both planes.

Remove the superior trocar and repeat steps for second guide wire.

Precaution: Do not exert force on the aiming arm, protection sleeves, or drill sleeves. Such force may prevent accurate targeting through the locking holes.


4Determine length and drill for inferior hip screw

Instruments

03.010.493 Direct Measuring Device for Guide Wires B 3.2 mm, length 400 mm

or03.010.085 Direct Measuring Device for Guide Wires

B 3.2 mm, length 400 mm

03.010.228 Drill Bit B 3.2 mm, calibrated, length 474 mm, 3-flute, for Mini Quick Coupling, for Hip Screw Stardrive B 5.0 mm

03.010.079 Fixation Sleeve, for No. 03.010.078

Measure for the inferior screw.

Ensure the protection sleeve is pressed firmly to the lateral cortex. Remove the wire guide and insert the specialty mea-suring device over the guide wire, into the protection sleeve, and to the bone. Read the length of the required hip screw directly on the measuring device.

Remove the measuring device and the inferior guide wire.

Attach the fixation sleeve to the stepped drill bit for the appropriate length screw.

Guide the stepped drill bit through the protection sleeve to the bone. Drill to the stop.

Note: Secure the fixation sleeve by engaging the locking mechanism in the locking grooves of the drill.



5Insert inferior hip screw

Instrument

03.010.108 Screwdriver Stardrive, T25, length 380 mmor03.010.519 Screwdriver Stardrive, T25,

self-holding, length 440 mm

Insert the appropriate hip screw through the protection sleeve into the femoral neck using the long T25 Stardrive screwdriver. Verify the position of the locking screw under image intensification in both planes.

A groove on the screwdriver indicates when the locking screw is fully inserted.

6Insert superior hip screw

Repeat steps 3 through 5 for the superior hip screw.


1Distal locking

There are two transverse distal locking holes.

2Align image

Check the reduction and correct alignment of the fragments and leg length before locking the nail.

Align the C-arm with the hole in the nail closest to the fracture until a perfect circle is visible in the center of the screen.

3Determine incision point

Place a Kirschner wire on the skin over the center of the hole to mark the incision point and make a stab incision.

Distal Locking


4Drill

Standard locking with locking screws

Instrument

03.010.103 Drill Bit B 3.2 mm, calibrated, length 145 mm, 3-flute, for Quick Coupling

If using the standard freehand technique, insert the tip of the drill bit through the incision and down to the bone.

Incline the drive so that the tip of the drill bit is centered over the locking hole. Hold the drill bit in this position and drill through both cortices.

Note: For greater drill bit control, discontinue drill power after perforating the near cortex. Manually guide the drill bit through the nail before resuming power to drill the far cortex.



03.010.100 Drill Bit B 3.2 mm, calibrated, length 145 mm, 3-flute, with Coupling for RDL

Using the radiolucent drive under image intensification, insert the tip of the drill bit through the incision and down to the bone.

Incline the drive so that the tip of the drill bit is centered over the locking hole. The drill bit should almost completely fill the circle of the locking hole. Hold the drill bit in this position and drill through both cortices.

Option: Locking with ASLSASLS, the Angular Stable Locking System, can be used as an alternative to standard locking screws in any round hole of a Synthes cannulated titanium nail. For more details regarding the intramedullary fixator prin ciple please consult the ASLS surgical technique (036.000.708) and concept flyer (036.001.017). Please note that for the use of ASLS special instruments are required.

Distal Locking


5Determine locking screw length

Instruments


or03.010.103 Drill Bit B 3.2 mm, calibrated,

length 145 mm, 3-flute, for Quick Coupling

03.010.428 Depth Gauge for Locking Screws, measuring range to 110 mm

or03.010.072 Depth Gauge for Locking Screws,

measuring range up to 110 mm, for No. 03.010.063

Stop drilling immediately after penetrating the far cortex. Disassemble the power drive or radiolucent drive from the drill bit.

Ensure the correct position of the drill bit in regard to the far cortex of the femur.

Place the direct measuring device onto the drill bit. Read the graduation on the measuring device at the end of the drill bit. This corresponds to the appropriate locking screw length.

Precaution: Drill bit location with respect to the far cortex is critical for measuring the appropriate locking screw length.



03.010.429 Direct Measuring Device for Drill Bits, length 145 mmor03.010.106 Direct Measuring Device for Drill Bits

of length 145 mm, for Nos. 03.010.100 to 03.010.105

Measure the locking screw length using the depth gauge for locking screws. Ensure the outer sleeve is in contact with the bone and the hook grasps the far cortex.

Distal Locking


6Insert locking screw

Instruments

03.010.518 Screwdriver Stardrive, T25, self-holding, length 319 mm

or03.010.107 Screwdriver Stardrive, T25,

length 330 mm

03.010.112 Holding Sleeve, with Locking Deviceor03.010.472 Inter-Lock Screwdriver, combined,

Stardrive, T25/hexagonal B 3.5, length 330 mm

Insert the locking screw using the screwdriver, and the holding sleeve with locking device, if desired.

Verify locking screw length under image intensification. The screw tip should be about 2 mm beyond the far cortex. If needed, a second locking screw may be inserted using the same technique.

Use the holding sleeve as described below: Insert the holding sleeve onto the shaft of the screwdriver and place the tip of the screwdriver in the recess of the locking screw (Figure 1).

Push the holding sleeve in the direction of the locking screw. The sleeve now holds the locking screw.

Lock the holding sleeve by tightening it counterclockwise (Figure 2). After insertion of the locking screw, release the holding sleeve by loosening it clockwise and pulling it back (Figure 3).

Read the locking screw length directly from the depth gauge at the back of the outer sleeve.

Note: In the event of a diastasis, the backstroke technique can be used after insertion of the second distal locking screw.

Figure 1

Figure 2

Figure 3


1Insert end cap

Instruments

03.010.520 Screwdriver Stardrive, T40, with spherical head, cannulated, length 277 mm

or03.010.110 Screwdriver Stardrive, T40, cannulated,

length 300 mm


Choose an end cap with the appropriate extension; 0 mm if the nail is not overinserted, 5 mm, 10 mm or 15 mm if the nail is overinserted.

The end caps are cannulated for use over a guide wire, if necessary.

Note: End caps fulfill two functions: they prevent bone ingrowth into the nail; and they extend the nail height if it is overinserted.

Remove the nail insertion instruments.

Optionally, for insertion of the 0 mm end cap, remove the connecting screw only. The insertion handle can r emain to help align the end cap to the top of the nail. The 0 mm end cap fits through the barrel of the insertion handle.

Insert the guide wire into the proximal end of the nail.

Engage the end cap with the cannulated screwdriver by exerting axial pressure. To prevent cross-threading, align the end cap with the nail axis and turn the end cap counter-clockwise, until the thread of the end cap aligns with that of the nail.

Turn the end cap clockwise to thread the end cap into the nail.

Remove the guide wire and screwdriver.

End Cap Insertion



03.010.111 Screwdriver Stardrive, T40, cannulated, length 190 mm, with Lever Arm


The cannulated Stardrive, screwdriver, T40, with lever handle, may be used with the 11 mm combination wrench to insert the end cap.


1Remove end cap and locking screws

Instruments

03.010.518 Screwdriver Stardrive, T25,self-holding, length 319 mm

or03.010.107 Screwdriver Stardrive, T25,

length 330 mm


or03.010.110 Screwdriver Stardrive, T40, cannulated,

length 300 mm


Optional instrument

03.010.472 Inter-Lock Screwdriver, combined, Stardrive, T25/hexagonal B 3.5, length 330 mm

or03.010.112 Holding Sleeve, with Locking Device

Implant removal is an optional procedure.

Clear the Stardrive socket of the end cap and the locking im-plants from any tissue ingrowth. Remove the end cap with the screwdriver Stardrive T40. A guide wire can be inserted for easy aligning of the screwdriver into the cannulated end cap.

Implant Removal


2Attach extraction screw and hammer guide

Instruments

03.010.107 Screwdriver Stardrive, T25, length 330 mm

or03.010.518 Screwdriver Stardrive, T25,self-holding,

length 319 mm

357.133 Extraction Screw for AFN/DFN

357.220 Hammer Guide, for No. 357.250or03.010.170 Hammer Guide

Before removing the final locking screw, screw the extraction screw into the nail and tighten it. The locking screw will prevent nail rotation as the extraction screw is tightened.

Attach the hammer guide to the extraction screw.

Remove the remaining locking screw with the screwdriver. Implant removal is an optional procedure.

3Remove nail

Instrument

03.010.056 Combined Hammer 700 g, can be mounted, for No. 357.220

or03.010.522 Combined Hammer, 500 g

Extract the nail by applying gentle blows with the hammer.

Note: The nail will rotate about 90°, similar to the movement during the insertion.


Alternative Technique – Extraction Hook

For removal of broken nail

Instruments

355.399 Extraction Hook B 3.7 mm, for Cannulated Nails

393.100 Universal Chuck with T-Handle or393.105 Universal Chuck, small, with T-Handle

Begin with Steps 1 and 2 of Implant Removal, then remove the extraction screw from the nail.

Implant Removal


Option 1

1Assemble extraction hook and universal chuck

Insert the extraction hook into the universal chuck with T-handle. The hook should be parallel with the T-handle. This facilitates visualization of the hook position in the bone.

2Insert extraction hook through nail

Pass the extraction hook through the cannula of the nail, including the distant fragment.

Precaution: Under image intensification, verify that the hook has passed through and engaged the distant end of the nail.

3Extract nail

Extract both nail fragments.

Note: Keep the patient’s limb restrained to increase the efficiency of the extraction force.


Option 2

1Remove near nail fragment

Attach the appropriate extraction bolt or extraction screw to the nail. Remove the near nail fragment using the extraction bolt or extraction screw.

Note: The extraction hook can be used as an alternative to extraction instrumentation.

2Ream canal

Ream the medullary canal 1 mm larger than the nail diameter to clear a path for the distant nail fragment.

3Align extraction hook

Insert the extraction hook and explanted near nail fragment into the medullary canal. The near nail fragment aligns the extraction hook with the cannulation of the distant nail fragment.

Implant Removal


4Engage distant fragment

Pass the extraction hook through the cannula of the distant nail fragment.

Precaution: Under image intensifi cation, verify that the hook has passed through and engaged the distant end of the nail.

5Extract nail

Extract both nail fragments.

Note: Keep the patient’s limb restrained to increase the effi ciency of the extraction force.


Expert Adolescent Lateral Femoral Nail – Available for left or right femur – Anatomic nail design based on a femoral canal tracing

study*

Material – Titanium-6% aluminum–7% niobium alloy

Diameters – 8.2 mm, cannulated – 9.0 mm, cannulated – 10.0 mm, cannulated

Lengths – 240 mm through 400 mm in 20 mm increments

Cross Section – Helical fluted

Proximal locking – Dynamization slot (LM) – Static transverse locking hole (LM) – 120° antegrade locking – Two recon locking holes

Distal locking – Two transverse locking holes (LM)

Implants

* L. Ehmke, et al.

50 mm

7 mm

36.25 mm

12.5 mm

20.6 mm120° antegrade

Recon locking

Dynamic transverse

Static transverse

12 mm

LM

42 mm

LM


Expert Adolescent Lateral Femoral Nail, sterile

Length (mm) B mm Right Left

240 8.2 04.031.924* 04.031.925*

260 8.2 04.031.926* 04.031.927*

280 8.2 04.031.928* 04.031.929*

300 8.2 04.031.930* 04.031.931*

320 8.2 04.031.932* 04.031.933*

340 8.2 04.031.934* 04.031.935*

360 8.2 04.031.936* 04.031.937*

380 8.2 04.031.938* 04.031.939*

400 8.2 04.031.940* 04.031.941*


240 9 04.031.944* 04.031.945*

260 9 04.031.946* 04.031.947*

280 9 04.031.948* 04.031.949*

300 9 04.031.950* 04.031.951*

320 9 04.031.952* 04.031.953*

340 9 04.031.954* 04.031.955*

360 9 04.031.956* 04.031.957*

380 9 04.031.958* 04.031.959*

400 9 04.031.960* 04.031.961*


240 10 04.031.964* 04.031.965*

260 10 04.031.966* 04.031.967*

280 10 04.031.968* 04.031.969*

300 10 04.031.970* 04.031.971*

320 10 04.031.972* 04.031.973*

340 10 04.031.974* 04.031.975*

360 10 04.031.976* 04.031.977*

380 10 04.031.978* 04.031.979*

400 10 04.031.980* 04.031.981*

* Available non-sterile or sterile packed. Add “S” to the article number to order sterile products.


Expert End Cap for Adolescent Lateral Femoral Nail B 8.2 mm, Titanium Alloy (TAN), (dark purple)* – Titanium alloy** – Protect nail threads from tissue ingrowth – Cannulated to allow insertion over a guide wire – T40 Stardrive recess

0 mm: Sits flush with end of nail

5 mm, 10 mm and 15 mm extensions: Extend nail height if nail is overinserted

Article No. Extension (mm)

04.031.000 0

04.031.001 5

04.031.002 10

04.031.003 15

Hip Screw Stardrive B 5.0 mm, selftapping, Titanium Alloy (TAN), (dark purple)* – Titanium alloy** – Lengths: 50 mm–125 mm (5 mm increments) – 3.2 mm core diameter – Partially threaded – Self-tapping, blunt tip – T25 Stardrive recess for improved torque transmission

and self-retention on screwdriver

Article No. Length (mm)

04.031.020 50

04.031.021 55

04.031.022 60

04.031.023 65

04.031.024 70

04.031.025 75

04.031.026 80

04.031.027 85


04.031.028 90

04.031.029 95

04.031.030 100

04.031.031 105

04.031.032 110

04.031.033 115

04.031.034 120

04.031.035 125

** Available nonsterile or sterile-packed. Add “S” to catalog number to order sterile product.

** Titanium–6% Aluminum–7% Niobium alloy

Implants


Locking Screw Stardrive B 4.0 mm, for Medullary Nails, Titanium Alloy (TAN), (dark blue)* – Titanium alloy** – Lengths: 18 mm–80 mm (2 mm increments) – 3.3 mm core diameter – Fully threaded – Self-tapping, blunt tip – T25 Stardrive recess for improved torque transmission and

self-retention on screwdriver


04.005.408 18

04.005.410 20

04.005.412 22

04.005.414 24

04.005.416 26

04.005.418 28

04.005.420 30

04.005.422 32

04.005.424 34

04.005.426 36

04.005.428 38

04.005.430 40

04.005.432 42

04.005.434 44

04.005.436 46

04.005.438 48


04.005.440 50

04.005.442 52

04.005.444 54

04.005.446 56

04.005.448 58

04.005.450 60

04.005.452 62

04.005.454 64

04.005.456 66

04.005.458 68

04.005.460 70

04.005.462 72

04.005.464 74

04.005.466 76

04.005.468 78

04.005.470 80

* Available nonsterile or sterile-packed. Add “S” to catalog number to order sterile product.

** Titanium–6% Aluminum–7% Niobium alloy


Standard instrumentation


357.398 Shaft, hexagonal, B 8.0 mm, cannulated, short, length 125 mm


393.100 Universal Chuck with T-Handle

321.170 Pin Wrench B 4.5 mm, length 120 mm


Instruments



* Available nonsterile or sterile-packed. Add “S” to catalog number to order sterile product.

03.010.000 Extraction Screw, for Tibial and Femoral Nails


03.010.063 Protection Sleeve 12.0/8.0, length 188 mm


03.010.069 Trocar B 3.2 mm, for No. 03.010.064

03.010.020 Radiographic Ruler for Expert Femoral Nails


03.010.500 Handle, with Quick Coupling

03.010.170 Hammer Guide

03.010.497 Cam-Lock Lever for Aiming Arm

03.010.146 Connecting Screw, cannulated,with Internal M6x1 Thread

03.010.483 Aiming Arm, radiolucent, for Expert Adolescent Lateral Femoral Nail

03.010.488 Insertion Handle, radiolucent, length 100 mm, for Expert ALFN

03.010.428 Depth Gauge for Locking Screws, measuring range up to 110 mm

Instruments


03.010.504 Protection Sleeve 13.0 for Expert Adolescent Lateral Femoral Nail, with Quick Coupling

03.010.509 Multihole Drill Guide for Protection Sleeve 13.0, for Expert Adolescent Lateral Femoral Nail

03.010.517 Screwdriver, hexagonal B 8.0 mm, with T-Handle, with spherical head, length 322 mm



03.010.523 Driving Cap with thread, for Insertion Handle

03.010.522 Combined Hammer, 500 g


03.010.041 Awl B 14.0/3.2 mm, cannulated

355.399 Extraction Hook B 3.7 mm, for Cannulated Nails

Optional instruments

351.050 Tissue Protector

03.010.019 Depth Gauge for Locking Screws, measuring range up to 110 mm, for No. 03.010.009

03.010.075 Protection Sleeve 11.5/8.5, for LFN Reconstruction Locking


03.010.077 Trocar B 3.2 mm, for No. 03.010.076

Instruments


03.010.079 Fixation Sleeve, for No. 03.010.078



03.010.103 Drill Bit B 3.2 mm, calibrated, length 145 mm, 3-flute, for Quick Coupling




03.010.429 Direct Measuring Device for Drill Bits, length 145 mm


03.010.491 Handle for Scalpel, long



Instruments



03.010.515 Inter-Lock Screwdriver Stardrive, T40, length 377 mm

03.010.495 Intramedullary Reduction Tool, curved, with Quick Coupling, Hex 12 mm

03.010.496 T-Handle, cannulated, with Quick Coupling, Hex 12 mm




393.105 Universal Chuck, small, with T-Handle


03.010.047 Connector, length 141 mm, for Insertion Handle


357.133 Extraction Screw for AFN/DFN

357.220 Hammer Guide, for No. 357.250

357.393 Trocar B 3.2 mm, length 172 mm, for No. 357.392

03.010.031 Drill Sleeve 13.0/3.2 for antegrade approach, for No. 03.010.030

Instruments





03.010.106 Direct Measuring Device for Drill Bits of length 145 mm, for Nos. 03.010.100 to 03.010.105



03.010.110 Screwdriver Stardrive, T40, cannulated, length 300 mm


03.010.226 Insertion Handle for Expert Adolescent Lateral Femoral Nail

03.010.229 Protection Sleeve 15.5/13.7, length 122.5 mm


03.010.112 Holding Sleeve, with Locking Device

Instruments

� � ��


Standard Article Alternative Article

� 03.010.504� 03.010.509� 03.010.500

� 03.010.229� 03.010.031� 357.393

InstrumentsComparison Table


� 03.010.488� 03.010.146� 03.010.523

� 03.010.226� 03.010.146� 03.010.047


03.010.483 03.010.227

��



03.010.493 03.010.085

03.010.517 03.010.092

03.010.518 03.010.107


03.010.429 03.010.106

03.010.170 357.220

03.010.472 � 03.010.107� 03.010.112

03.010.428 03.010.072


03.010.519 03.010.108

03.010.520 03.010.110

03.010.522 03.010.056

InstrumentsComparison Table


InstrumentsHandling Information

Aiming Arm (03.010.483)

– Easy snap-on and snap-off mechanism – “Friction” and “True locking” – Backward compatible with existing devices – Radiolucent – More soft tissue clearance – Easy disassembly for cleaning

1. Some force is required to push the cam lock mechanism over the wings.

2. To fi x the cam lock mechanism at the corresponding pins, the cam lock must be pushed back in open position.

Scalpel Handle (03.010.491)

– For channel cutting to minimize muscle force on the protection sleeves

– Yellow Silicon handle indicates sharpness of instrument

1. Attach a blade to the scalpel holding the end of the handle.

Insertion Handle (03.010.488)

– Radiolucent – Attachment for driving cap with threaded end

(03.010.523)

InterLock ScrewdriverCompatible with all Synthes T25 or 3.5 mm hexagonal re-cess. For further information, please refer to brochure 036.001.581.

– Tear drop shape – Silicon handle

Precaution: When removing implants after longterm implantation, especially in the presence of large amounts of bony ingrowth, fi rst use a solid screw-driver to loosen the screw. The interlock screwdriver

can then be used to remove the screw from the surgical site. If using the interlock screwdriver with locking screws, use a solid screwdriver for fi nal tightening.

2. Pass the scalpel handle through the aiming arm holes and perform a minimally invasive and accurate incision.

3. Remove the scalpel from the aiming arm.

1 2


IMN Reduction Tool and THandle with Quick Coupling (03.010.495 and 03.010.496)

Fracture Reduction Tool – Flat curved tip to aid fragment alignment – Supplied separately due to length

T-Handle – Can be added to the auxiliary bin in the Modular

Femur Set – 12 mm Hexagonal Quick Coupling with marking

for orientation

Multihole Drill Guide for Protection Sleeve (03.010.500–03.010.510)

– Center hole and offset holes (4 mm and/or 6 mm) – Color coded

If the initial Kirschner wire (1) is placed slightly offset, a second Kirschner wire (2) can be inserted to correct the placement.

InstrumentsHandling Information


Set ListModular Cases

The modularity of the system enables sets to be confi gured according to the hospital’s clinical needs. Each set confi gu-ration consists of basic instruments, dedicated system instru-ments and optional instruments (if required). For femoral nails (LFN, ALFN, R/AFN) the femur set must be added to the set confi guration. New modular trays also contain the ASLS instruments. For further information about ASLS refer to pages 77 and 78.

The instrument modules listed on the right side are available.

For ease of use within the operating theatre, all modular trays have an additional marking: – Mandatory modular trays have a solid white marking – Optional trays have a hatched black marking – Each system has a control picture for reference

ETN R/AFN LFN ALFN

01.010.412 Instruments for ETN

01.010.413 Instruments for R/AFN

01.010.414 Instruments for LFN

01.010.415 Instruments for ALFN

ETN Aiming Arm (separate)

01.010.411Instruments for Expert Femoral Nail

01.010.410Basic Instruments for Expert Nail

01.010.416Additional Instruments for Expert Nail (Optional)

FEMUR

BASIC

ALFN

ALFN BASIC FEMUR

OPT

OPT


Modular ALFN Set 01.010.413Control Picture

ALFN Instruments Tray

Basic Instruments Tray

Femur Instruments Tray

Optional Instruments Tray



Modular Tray for ALFN Instruments

68.010.413 Modular Tray for Instruments for ALFN, size 1/1, without Contents, Vario Case System

Modular Tray for Basic Expert Nail Instruments

68.010.410 Modular Tray for Basic Instruments, for Expert Nail, size 1/1, without Contents, Vario Case System


Modular Tray for Femur Expert Nail Instruments

68.010.411 Modular Tray for Femur Nail Instruments, for Expert Femoral Nails, size 1/1, without Contents, Vario Case System

Modular Tray for Optional Expert Nail Instruments

68.010.416 Modular Tray, for Additional Instruments, for Expert, size 1/1, without Contents, Vario Case System



Set List

Vario Cases

* Available nonsterile or sterile-packed. Add “S” to catalog number to order sterile product. Note: For additional information, please refer to package insert.

01.031.004 Expert Adolescent Lateral Femoral Nail Instrument Set in Vario Case

68.031.004 Vario Case for Standard Instrument Set, for Expert Ado-lescent Lateral Femoral Nail, without Lid, without Contents


1

321.160 Combination Wrench B 11.0 mm 1

321.170 Pin Wrench B 4.5 mm, length 120 mm 1

357.133 Extraction Screw for AFN/DFN 1

357.220 Hammer Guide, for No. 357.250 1

357.393 Trocar B 3.2 mm, length 172 mm, for No. 357.392 1

357.399 Guide Wire B 3.2 mm, length 400 mm 10

393.105 Universal Chuck, small, with T-Handle 1

03.010.020 Radiographic Ruler for Expert Femoral Nails 1


1

03.010.031 Drill Sleeve 13.0/3.2, for antegrade approach, for No. 03.010.030

1


2

03.010.047 Connector, length 141 mm, for Insertion Handle 1


1


2

03.010.063 Protection Sleeve 12.0/8.0, lenght 188 mm 1

03.010.064 Drill Sleeve 8.0/3.2, for No. 03.010.063 1

03.010.069 Trocar B 3.2 mm, for No. 03.010.064 1


1

03.010.075 Protection Sleeve 11.5/8.5, for LFN Reconstruction Locking 2


03.010.077 Trocar B 3.2 mm, for No. 03.010.076 2

03.010.079 Fixation Sleeve, for No. 03.010.078 1


1


1


1


1

03.010.103* Drill Bit B 3.2 mm, calibrated, length 145 mm, 3-flute, for Quick Coupling

1

03.010.106 Direct Measuring Device for Drill Bits of length 145 mm for Nos. 03.010.100 to 03.010.105

1

03.010.107 Screwdriver Stardrive, T25, length 330 mm 1

03.010.108 Screwdriver Stardrive, T25, length 380 mm 1

03.010.110 Screwdriver Stardrive, T40, cannulated, length 300 mm 1


1

03.010.112 Holding Sleeve, with Locking Device 1

03.010.226 Insertion Handle for Expert Adolescent Lateral Femoral Nail 1

03.010.227 Aiming Arm for Expert Adolescent Lateral Femoral Nail 1


1

03.010.229 Protection Sleeve 15.5/13.7, length 122.5 mm 1


* Available nonsterile or sterile-packed. Add “S” to catalog number to order sterile product. Note: For additional information, please refer to package insert.

01.031.005 Expert Adolescent Lateral Femoral Nail Upgrade for LFN Instrument Set in Vario Case

68.031.005 Vario Case for Upgrade Instrument Set, for Expert Ado-lescent Lateral Femoral Nail, without Lid, without Contents

1

351.270 Drill Bit B 13.0 mm, cannulated, length 290 mm, 3-flute,

for Quick Coupling No. 511.760

1

357.133 Extraction Screw for AFN/DFN 1

357.393 Trocar B 3.2 mm, length 172 mm, for No. 357.392 1

03.010.031 Drill Sleeve 13.0/3.2 for antegrade approach, for No. 03.010.030

1


2

03.010.063 Protection Sleeve 12.0/8.0, length 188 mm 1


03.010.069 Trocar B 3.2 mm, for No. 03.010.064 1


1


2

03.010.103 Drill Bit B 3.2 mm, calibrated, length 145 mm, 3-flute,for Quick Coupling

1


1

03.010.226 Insertion Handle for Expert Adolescent Lateral Femoral Nail 1

03.010.227 Aiming Arm for Expert Adolescent Lateral Femoral Nail 1


1

03.010.229 Protection Sleeve 15.5/13.7, length 122.5 mm 1

01.031.004 Expert Adolescent Lateral Femoral Nail Instrument Set in Vario Case

01.031.005 Expert Adolescent Lateral Femoral Nail Upgrade for LFN Instrument Set in Vario Case

Set ListVario Cases


Option: Modular Aiming Device ModAD

Option for Carm independent distal locking of nails for femur, tibia and humerus

When using the ModAD for the interlocking of intra-medullary nails, no image intensifier control is required. The system is especially suitable when no C-arm is available.

01.010.309 ModAD for Expert LFN and HN

68.010.035 Sliding Carriage for Expert Tibial Nails, for Calibration Block No. 312.952

The ModAD for Expert LFN has to be used with the Sliding Carriage for Expert Tibial Nails. Distal locking is performed using the sliding carriage.


01.031.003 Implant Set for Expert Adolescent Lateral Femoral Nail

68.031.002 Screw Rack, 1/4, for Locking Screw Stardrive B 4.0 mm and Hip Screw Stardrive B 5.0 mm, with Module, with Lid

Instrument

319.970 Screw Forceps, self-holding, length 85 mm

Implants

Locking Screw Stardrive B 4.0 mm, for Medullary Nails, Titanium Alloy (TAN), dark blue, 2 each*

Article No. Length (mm) Article No. Length (mm)

04.005.416 26 04.005.444 54

04.005.418 28 04.005.446 56

04.005.420 30 04.005.448 58

04.005.422 32 04.005.450 60

04.005.424 34 04.005.452 62

04.005.426 36 04.005.454 64

04.005.428 38 04.005.456 66

04.005.430 40 04.005.458 68

04.005.432 42 04.005.460 70

04.005.434 44 04.005.462 72

04.005.436 46 04.005.464 74

04.005.438 48 04.005.466 76

04.005.440 50 04.005.468 78

04.005.442 52 04.005.470 80

Hip Screw Stardrive B 5.0 mm, selftapping, for Expert ALFN, Titanium Alloy (TAN), dark purple, 4 each

5.0 mm Titanium Recon Screws*, with T25 StarDrive recess, for IM Nails, 4 each.

Article No. Length (mm) Article No. Length (mm)

04.031.022 60 04.031.029 95

04.031.023 65 04.031.030 100

04.031.024 70 04.031.031 105

04.031.025 75 04.031.032 110

04.031.026 80 04.031.033 115

04.031.027 85 04.031.034 120

04.031.028 90

Expert End Cap, for Expert ALFN B 8.2 mm, Titanium Alloy (TAN), dark purple*

Article No. Extension (mm)

04.031.000 0 2 each

04.031.001 5 1

04.031.002 10 1

04.031.003 15 1 * Available nonsterile or sterile-packed. Add “S” to catalog number to order sterile product. Note: For additional information, please refer to package insert.

Optionally available

Hip Screws*

04.031.020 Hip Screw Stardrive B 5.0 mm, self-tapping, length 50 mm, for Expert ALFN, Titanium Alloy (TAN), dark purple



Locking Screws

04.005.408 Locking Screw Stardrive B 4.0 mm, length 18 mm, for Medullary Nails, Titanium Alloy (TAN), blue




Set ListVario Cases


What is ASLS?The Angular Stable Locking System (ASLS) provides the abil-ity to create a fixed-angle construct to an intrame dullary nail. Therefore, it combines the advantages of angular stability and a minimally invasive approach. ASLS together with an intramedullary nail form the principle of the Intramedullary Fixator.

Optional: Angular Stable Locking System (ASLS)

The following description contains general information about ASLS. For further details on the application and compatibility of ASLS please refer to the Surgical Technique 036.000.708.

How does ASLS work?The system consists of a screw with three outer diameters and a resorbable sleeve.

The resorbable sleeve is placed on the screw tip which has the smallest screw diameter and is pushed into the locking hole of the nail.

During screw advancement, the resorbable sleeve is ex-panded by the larger middle diameter. Radial expansion of the sleeve and its fixation in the nail creates the angular stability.

D1

D2

D3


ASLS screws – Titanium alloy* – Screws ASLS4: Length 26 mm–80 mm, are compa tible

with Expert Adolescent Lateral Femoral Nails – Fully threaded shaft with 3 diameters – D1: Provides purchase in reamed near cortex – D2: Expands sleeve, providing angular stability – D3: Holds unexpanded sleeve for screw insertion, provides

purchase in far cortex – T25 Stardrive recess – Sterile packaged

* Titanium–6% aluminum–7% niobium alloy

ASLS sleeves – 70:30 poly (L-lactide-co-D, L-lactide) – Bioresorbable, provides 80% decreased

fracture site motion during first 12 weeks of healing – Gradually degrades within 2 years (resorption rate varies

per patient and implant site) – Inner thread for secure fit to screw – Expands in nail locking hole – Available in diameters of 4 mm (ASLS4), 5 mm

(ASLS5) and 6 mm (ASLS6) – Sterile-packed

Note: For more details regarding the intramedullary fixator principle please consult the ASLS surgical technique (036.000.708) and concept flyer (036.001.017).

Optional: Angular Stable Locking System (ASLS)


MRI Information

Torque, Displacement and Image Artifacts according to ASTM F 221306, ASTM F 205206e1 and ASTM F211907Non-clinical testing of worst case scenario in a 3 T MRI system did not reveal any relevant torque or displacement of the construct for an experimentally measured local spatial gradient of the magnetic field of 3.69 T/m. The largest image artifact extended approximately 169 mm from the construct when scanned using the Gradient Echo (GE). Testing was conducted on a 3 T MRI system.

RadioFrequency(RF)induced heating according to ASTM F218211aNon-clinical electromagnetic and thermal testing of worst case scenario lead to peak temperature rise of 9.5 °C with an average temperature rise of 6.6 °C (1.5 T) and a peak temperature rise of 5.9 °C (3 T) under MRI Conditions using RF Coils (whole body averaged specific absorption rate [SAR] of 2 W/kg for 6 minutes [1.5 T] and for 15 minutes [3 T]).

Precautions: The above mentioned test relies on non-clini-cal testing. The actual temperature rise in the patient will depend on a variety of factors beyond the SAR and time of RF application. Thus, it is recommended to pay particular attention to the following points: – It is recommended to thoroughly monitor patients under-

going MR scanning for perceived temperature and/or pain sensations.

– Patients with impaired thermoregulation or temperature sensation should be excluded from MR scanning proce-dures.

– Generally, it is recommended to use a MR system with low field strength in the presence of conductive implants. The employed specific absorption rate (SAR) should be reduced as far as possible.

– Using the ventilation system may further contribute to reduce temperature increase in the body.

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