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SuPraPatellar InStrumentatIonfor tItanIumcannulated tIbIal naIlSExpert Nailing System with Radiolucent Instrumentation
SurgIcal technIque
IntroductIon
SurgIcal technIque
Product InformatIon
table of contentS
Suprapatellar Instrumentation for titanium 2 cannulated tibial nails
titanium cannulated tibial nails expert nailing System 4
ao Principles 6
Indications 7
Preoperative Planning 8
opening the tibia 9
reaming (optional) 17
Inserting the nail 19
locking options 24
distal locking 25
Proximal locking—diaphyseal and distal Segment 31 fractures
Proximal locking—compression locking mode 35 (optional)
Proximal locking—Proximal Segment fractures 38
end cap Insertion 45
Implant removal (optional) 47
Implants 52
Instruments 62
Set lists 70
Image intensifier control
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma
2 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
advanced InStrumentatIonTwo-hole wire guidesx offset hole to “dial-in” placement of the guide wirex blunt tipx gentle transitions
Soft outer protection sleevesx Soft, flexible material to cushion soft tissuex locks into handle with a ¼ turnx conforms to nail shape during insertion
SuPraPatellar InStrumentatIon for tItanIum cannulated tIbIal naIlS exPert naIlIng SyStem
Reusable PEEK opening trocarsx reusable solid designx Smooth, rounded tipx gentle transitions
Steel inner protection sleevesx Suction holesx retention featurex finger grips for easy removalx Protects soft outer sleeve during drilling
and reaming
Handlex retention knobx lever locksx through slot and holes to anchor handlex Suction port
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 3
Insertion handlex longer length for suprapatellar insertionx Smaller diameter tipx Smooth contoured reverse bevel for smooth transition
Aiming armx radiolucent materialx Protection sleeve retentionx Precise targetingx Standard attachment mechanism
Extraction screwx drill point tipx cutting flutes to remove debrisx longer tip
Inter-lock screwdriversx locks into the recess of the screwx firm, mechanical locking mechanismx engages and disengages with the turn of a nut
Suprapatellar Instrumentation for titanium cannulated tibial nails expert nailing System
4 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
advanced SolutIonS
Advanced proximal locking optionsx three innovative locking options, in
combination with dual core locking screws, to increase the stability of the proximal fragment for proximal third fractures
x two state-of-the-art mediolateral (ml) locking options enable primary compression or secondary controlled dynamization
tItanIum cannulated tIbIal naIlS exPert naIlIng SyStem
ImProved StabIlIty
End capsx gold end caps securely lock the most
proximal oblique locking screw to create a fixed-angle construct
x gray end caps feature a lead-in design for easier end cap insertion
x end caps prevent ingrowth of tissue and facilitate nail extraction
x Self-retaining t40 Stardrive recess for easy pick up and insertion of end cap
x cannulated x 0 mm end caps sit flush with nailx 5, 10, and 15 mm end caps extend
nail height if nail is overinserted
StarDriveT40
15 mm 10 mm 5 mm 0 mm
15 mm 10 mm 5 mm 0 mm
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 5
Advanced nail designx titanium alloy* for improved
mechanical and fatigue properties x cannulated nails (from 8 mm to
13 mm) for reamed or unreamed techniques, enabling nail insertion over guide wire
x all 2.5 mm or 3.0 mm ball- tipped guide wires may be removed through the nail and insertion handle assembly (no exchange tube required)
Advanced distal locking optionsx distal oblique locking options to
prevent soft tissue damage and increase stability of the distal fragment
x two ml and one anteroposterior (aP) locking options for stability of the distal fragment
* titanium-6% aluminum-7% niobium alloy
titanium cannulated tibial nails expert nailing System
All locking screwsx double-lead thread for more contact
points enhance stability and ease of insertion
x thread closer to screwhead provides better bone purchase in the near cortex and improved stability
x titanium alloy* for improved mechanical and fatigue properties
x Self-tapping blunt tip x Self-retaining t25 Stardrive recess
allows improved torque transmission and increased resistance to stripping relative to a hex recess and secure locking screw pick-up
Dual-core locking screwsx Indicated for the three proximal
locking options of all tibial nailsx dual-core design for optimized
purchase in cancellous bone x unicortical x lengths: 30 mm–90 mm
multIdIrectIonal lockIng oPtIonS for ImProved StabIlIty
StarDriveT25
Standard locking screwsx larger cross section for
improved mechanical resistance
x 4.0 mm diameter for 8 mm and 9 mm tibial nails, lengths: 18 mm–80 mm
x 5.0 mm diameter for 10 mm to 13 mm tibial nails, lengths: 26 mm–100 mm
titanium cannulated tibial nail ex with Proximal bend
titanium cannulated tibial nail ex
6 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
ao PrIncIPleS
1. müller me, m allgöwer, r Schneider, and h Willenegger: Manual of Internal Fixation, 3rd edition. berlin, germany: Springer-verlag. 1991.
In 1958, the ao formulated four basic principles, which have become the guidelines for internal fixation.1 they are:
Anatomic reductionfracture reduction and fixation to restore anatomical relationships.
Stable fixationStability by fixation or splintage, as the personality of the fracture and the injury requires.
Preservation of blood supplyPreservation of the blood supply to soft tissue and bone by careful handling.
Early, active mobilizationearly, active mobilization of the part and patient.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 7
IndIcatIonS
the Suprapatellar Insertion Instruments are part of the tibial nail System ex. the tibial nail System ex is intended to stabilize fractures of the proximal and distal tibia and the tibial shaft; open and closed tibial shaft fractures; certain pre- and post-isthmic fractures; and tibial malunions and non-unions.
8 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
PreoPeratIve PlannIng
use the ao preoperative planner template for the tibial nail–ex to estimate nail diameter and nail length.
to estimate nail diameter, place the template on the aP or lateral x-ray of the uninjured tibia and measure the diameter 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 tibia and select the appropriate nail length based on patient anatomy. When selecting nail size, consider canal diameter, indication, fracture pattern, patient anatomy, and postoperative 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.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 5
2 Reduce fracture
Instrument
394.35* large distractor
Perform closed reduction manually by axial traction under image intensification. the use of the large distractor may be appropriate in certain circumstances.
Note: The reduction can be temporarily fi xed with reduction clamps. In epiphyseal fractures the condyles or the pilon are fi xed fi rst in order to enable the nail insertion.
oPenIng the tIbIa
1 Position patient
Position the patient supine on the radiolucent table. ensure that the knee of the injured leg can be fl exed 10°–20°. Position the image intensifier so that visualization of the tibia, including the articular surface proximally and distally, is possible in aP and lateral views.
Note: The knee roll can be placed under the lower part of the thigh if it obstructs the view of the tibial plateau in the AP view.
* also available
26 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
opening the tibia
3 Confi rm nail length and diameter
Instrument
03.010.021 radiographic ruler, for titanium cannulated tibial nails–ex
the required nail length must be determined after reduction of the lower leg fracture.
Position the c-arm for an aP view of the distal tibia. With long forceps, hold the radiographic ruler along the leg, parallel to and at the same level as the tibia. adjust the ruler until the distal tip is at the level of the physeal scar or the desired nail insertion depth. mark the skin at that site.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 22
move the c-arm to the proximal tibia, replace the distal end of the ruler at the skin mark, and take an aP image of the proximal tibia. read nail length directly from the ruler image, selecting the measurement at or just below the level of the anterior edge of the tibial plateau.
When using the large distractor, measure the distance from the inferior border of the distal pin to the superior border of the proximal pin to determine optimal nail length.
Position the c-arm for an aP or lateral view of the tibia at the level of the isthmus. hold the radiographic ruler over the tibia with the diameter gauge centered over the narrowest part of the medullary canal. read the diameter measurement on the circular indicator that fi lls the canal.
Note: Compression or dynamization must be taken into account when determining the nail length. A shorter nail should be chosen when active compression is planned for the procedure. The dynamic locking option allows 7 mm of travel.
Important: The ruler is not at the same level as the tibia. This affects the accuracy of the measurement, providing only an estimate of the canal diameter.
opening the tibia
22 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
opening the tibia
entry point
4 Make incision and determine entry point
With the knee in full extension, make a 2–4 cm longitudinal skin incision 4 cm proximal to the superior pole of the patella. the deep incision, also longitudinal, splits the quadriceps tendon in its midsubstance, just above its insertion into the patella, and enters the knee joint through the suprapatellar pouch. blunt dissection can be used to loosen the patella in the suprapatellar pouch, allowing the patella to lift off. displace the patella anteriorly.
Note: In arthritic knees, blunt release with an elevator or cauterization can be done in the suprapatellar pouch area medially and laterally.
If these methods are not suffi cient, extend the incision medially or laterally along the patella.
the entry point defi nes the optimal position of the nail in the intramedullary canal. this is more important for proximal and distal-third fractures to prevent fragment displacement.
In the aP view, the entry point is in line with the axis of the intramedullary canal and with the lateral tubercle of the intercondylar eminence.
In the lateral view the entry point is at the ventral edge of the tibial plateau.
entry point
10°
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 23
5Insert protection sleeves
Instruments
03.010.430 handle for Protection Sleeves, for Suprapatellar
for 8 mm to 11 mm nails:
03.010.435 12.0 mm Protection Sleeve, straight, for 8 mm–11 mm nails
03.010.437S 12.0 mm outer Protection Sleeve, for suprapatellar, sterile
03.010.455 12.0 mm trocar, Peek, for Suprapatellar
for 12 mm to 13 mm nails:
03.010.436 14.5 mm Protection Sleeve, straight, for 12 mm–13 mm nails
03.010.438S 14.5 mm outer Protection Sleeve, for suprapatellar, sterile, and
03.010.456 14.5 mm trocar, Peek, for Suprapatellar
assemble the inner protection sleeve to the handle from the top. the inner protection sleeve locks into place with the two lever locks on the sides of the handle. Insert the trocar through the inner protection sleeve. rotate the black knob to hold in place. dip the outer protection sleeve and inner protection sleeve in saline solution before assembly. Slide the outer protection sleeve over the inner protection sleeve from the bottom. line up the tabs on the outer protection sleeve with the notches on the handle. rotate clockwise to attach to the handle.
Insert the handle assembly through the incision into the knee joint, so that it glides between the articular surface of the patella and the trochlea of the distal femur and rests securely in this groove, while the patella is displaced anteriorly above the cannula. When the trocar reaches the surface of the tibia, rotate the knob on the handle to allow the trocar to slide out, as the cannula is advanced to the anterior surface of the proximal tibia. remove the trocar.
Warning: The knee must remain in extension once the handle assembly has been inserted.
opening the tibia
24 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
4.3 mm
opening the tibia
6 Insert guide wire
Instruments
03.010.433 Wire guide, 2 holes, 12.0 mm/3.2 mmor03.010.434 Wire guide, 2 holes, 14.5 mm/3.2 mm
357.399 3.2 mm guide Wire, 400 mm
after removal of the trocar, insert the two-hole wire guide through the inner protection sleeve. advance to the anterior surface of the tibia. Slight adjustment of the knee fl exion (between 10° and 20°) will provide the ideal radiographic location for the starting point and insertion of a guide wire.
Insert the guide wire approximately 8 cm–10 cm and check the position under imaging in the aP and lateral views.
adjustments to the guide wire location can be “dialed-in” by rotating the two-hole drill guide to place a second guide wire while the fi rst guide wire remains in place. after correct placement of the second guide wire, remove the initial guide wire and two-hole wire guide.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 25
7Anchor handle for protection sleeves
Instrument
357.399 3.2 mm guide Wire, 400 mm
use a 3.2 mm guide wire to anchor the handle assembly to the femoral condyles and maintain the position of the handle assembly during the procedure. this anchor prevents the cannula from backing out and off of the tibia.
Alternative instruments
03.010.115 3.2 mm guide Wire, 290 mm
310.243 2.5 mm drill tip guide Wire, 200 mm
292.75 2.5 mm kirschner wire with 15 mm threaded trocar point, 150 mm
opening the tibia
26 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
opening the tibia
8 Open medullary canal
Instruments
03.010.439 12.0 mm cannulated drill, long, with large quick coupling
357.399 3.2 mm guide Wire, 400 mm
Place the drill bit over the guide wire, through the inner protection sleeve, and down to the bone. drill to a depth of approximately 8 cm–10 cm. the guide wire and drill bit should not reach the posterior cortex.
remove the drill bit and guide wire.
Note: Dispose of the guide wire. Do not reuse.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 27
reamIng (oPtIonal)
* also available
Instruments
03.010.024 holding device, for guide wires and reaming rods
03.010.093 reaming rod Push rod, with ball handle
2.5 mm reaming rods, sterile351.704S* with ball tip and extension, 1150 mm351.706S* with ball tip, 950 mm
351.707S* with ball tip and extension, 950 mm
351.708S* with ball tip, 1150 mm
352.044 5.0 mm flexible Shaft, 620 mm
393.105* Small universal chuck with t-handle
Note: If inserting a nail 330 mm or longer, the 5.0 mm Flexible Reamer Shaft, 620 mm (352.044) must be used.
Also available sets
01.004.306 flexible reamer Set, long for Im nails
150.060 flexible reamer Set, for Im nails
If necessary, enlarge the tibial canal to the desired diameter, using the medullary reamer.
check fracture reduction under radiographic imaging.
Warning: Do not ream without the inner protection sleeve in place to protect the outer protection sleeve.
28 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
reaming (optional)
Inserting the reaming rodusing the holding device, insert the reaming rod with ball tip into the medullary canal to the desired depth.
ReamStarting with the 8.5 mm diameter reaming head, ream to a diameter of 0.50 mm–1.0 mm greater than the nail diameter.
ream in 0.5 mm increments and advance the reamer with steady, moderate pressure. do not force the reamer. Partially retract the reamer often to clear debris from the medullary canal.
Note: All nails in the cannulated Tibial Nail Expert System can be inserted over the reaming rod with ball tip.
If a nail length greater than 330 mm is required, the long 5.0 mm fl exible shaft must be used.
Technique tip: The reamer can catch on the edge of the inner protection sleeve because of the sharp angle entering the tibia (Figure 1). Stop reamer rotation and lift up on the drill to center the reamer shaft in the sleeve (Figure 2). Move the reamer in and out until the reamer comes out.
Optional techniqueuse the reaming rod push rod to help retain the reaming rod during reamer extraction.
figure 1: reamer shaft angled through sleeve.
figure 2: reamer shaft centered through sleeve.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 25
InSertIng the naIl
1Assemble insertion instruments
Instruments
03.010.093 reaming rod Push rod, with ball handle
03.010.404 cannulated connecting Screw, for Percutaneous Instruments for nails–ex
03.010.440 Insertion handle, for suprapatellar
orient the insertion handle anteriorly, and match the tang on the handle to the notch in the nail.
Place the connecting screw into the insertion handle and thread it into the proximal nail end, using the reaming rod push rod.
verify the nail is oriented properly on the insertion handle; secure the assembly with the reaming rod push rod.
Alternative instrument
03.010.092 ball hex Screwdriver, 8 mm
optionally, secure the assembly using the 8 mm ball hex screwdriver.
remove inner protection sleeve from handle for protection sleeves.
Technique tip:When removing the inner protection sleeve, lift or rotate handle to gain access to the lower lever lock. Depress both upper and lower lever locks and slide the inner protection sleeve out.
Note: If the knee is tight, the pressure on the sleeve will make it diffi cult to remove the inner protection sleeve.
26 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Inserting the nail
2 Insert nail
ensure inner protection sleeve is removed.
Insert the nail into the intramedullary canal. use a twisting motion to advance the nail.
monitor the nail passage across the fracture; control in two planes to avoid malalignment.
Insert the nail until it is at or below the tibial opening. check final nail position in aP and lateral views.
Note: For proximal locking, mount the aiming arm only when the tibial nail has been completely inserted, otherwise the aiming arm may loosen during nail insertion.
Optional instruments
03.010.056 Slide /fixed hammer, 700 grams
03.010.475 driving cap
321.17 4.5 mm Pin Wrench
321.20 ratchet Wrench, 11 mm width across fl ats
357.22 hammer guide, for slide hammer
357.398 cannulated Shaft with 8 mm hex
If needed, use light, controlled hammer blows to seat the nail. thread the driving cap into the insertion handle and secure it, using the 11 mm wrench. lock the head of the hammer in place by tightening the nut onto the threads located below the hammer head, using the 4.5 mm pin wrench. Strike the driving cap directly.
optionally, the hammer guide can be threaded into the driving cap and the hammer can be used as a slide hammer. the hammer guide helps to assure the driving cap is struck optimally. loosen the nut from the threads located below the hammer head and secure onto the threads located above the handle.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 22
Note: If nail insertion is difficult, choose a smaller diameter tibial nail or ream the medullary canal to a larger diameter. If reaming to a larger diameter, assemble the two-hole wire guide into the inner protection sleeve. Insert this assembly through the handle and into the outer protection sleeve. Often the outer protection sleeve is flattened by the pressure of the patella and the wire guide helps to expand the sleeve as the inner protection sleeve is reinserted. This also reduces the potential of the inner protection sleeve damaging the outer protection sleeve.
Inserting the nail
22 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Inserting the nail
3Check proximal nail position
Instruments
03.010.441 aiming arm, for suprapatellar
357.399 3.2 mm guide Wire, 400 mm
attach the aiming arm and insert a 3.2 mm guide wire through the hole as shown in the illustration.
the tip of the guide wire indicates the exact proximal position of the tibial nail.
remove the driving cap.
remove the aiming arm, unless proximal locking is the next step.
check proximal nail position under image intensifi cation in the lateral view.
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 or for correcting the nail location within the medullary canal.
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.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 23
4 Check distal nail position
Instruments
03.010.092 ball hex Screwdriver, 8 mm
03.010.444 8 mm hex Screwdriver, cannulated, inter-lock
03.010.445 Sd40 Stardrive Screwdriver, long, inter-lock
check final nail position under image intensification in aP and lateral views.
remove the reaming rod.
Important: Confi rm that the nail is securely connected to the insertion handle, especially after hammering, using either the 8 mm ball hex screwdriver or the cannulated shaft with 8 mm hex screwdriver, cannulated, interlock.
Note: Insertion depth is critical for distal third fractures where a minimum of two locking screws below the fracture line are required to stabilize the distal segment.
Inserting the nail
24 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
lockIng oPtIonS
Proximal segment fracturesProximal locking using the suprapatellar technique is performed with the knee in extension. this neutralizes the deforming forces on proximal fragments caused by the quadriceps mechanism, and relieves the pressure on the soft tissue usually associated with tibial nail insertion instruments. this position also facilitates assessment of rotational alignment before locking.
Diaphyseal segment fracturesfor diaphyseal fractures, it is recommended to lock distally first, to allow intraoperative compression.
Distal segment fracturesfor distal fractures, it is recommended to lock distally first, to facilitate reduction.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 25
dIStal lockIng
* also available** for radiolucent drive† See page 21
1 Determine instrumentation
Instruments
03.010.404 cannulated connecting Screw, for Percutaneous Instruments for nails–ex
03.010.440 Insertion handle for suprapatellar
511.30* radiolucent drive
use the appropriate locking screws and drill bit for the nail diameter selected.
Nail diameter Locking screw Drill bit
8 mm and 9 mm 4.0 mm 3.2 mm(blue) (blue) 03.010.100** or 03.010.103
10 mm to 13 mm 5.0 mm 4.2 mm(green) (green) 03.010.101** or 03.010.104
If using the backslap technique,† distal locking must be performed prior to proximal locking to prevent loss of reduction. verify the nail has been inserted to the appropriate depth.
locking of the tibial nail is usually performed from the medial side. the knee must be in extension during nail locking. this position helps counteract the forces exerted by the quadriceps muscle that would tend to deform the proximal fragment and also facilitates rotational control of the tibial axis before locking.
distal locking with the radiolucent drive is described on page 27.
Note: The use of the most distal locking option is recommended for distal fractures. This locking option is oriented 30° from the sagittal plane.
26 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
distal locking
3 Determine incision point
Place a guide wire on the skin over the center of the hole to mark the incision point and make a stab incision.
2 Align image
check the reduction, 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. (distal ml hole shown in illustration).
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 27
4 Drill
Instruments
03.010.100* 3.2 mm three-fluted drill bit, 145 mm, for radiolucent drive
03.010.101* 4.2 mm three-fluted drill bit, 145 mm, for radiolucent drive
using the radiolucent drive under radiographic imaging, insert the tip of the appropriate 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.
Technique tip: 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.
Alternative instruments
03.010.103 3.2 mm three-fluted drill bit, quick coupling, 145 mm
03.010.104 4.2 mm three-fluted drill bit, quick coupling, 145 mm
Standard freehand locking technique can be performed without the radiolucent drive. use the appropriate drill bit shown above.
* also available
distal locking
28 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
distal locking
5Determine locking screw length Instruments
03.010.100* 3.2 mm three-fluted drill bit, 145 mm, for radiolucent drive
03.010.101* 4.2 mm three-fluted drill bit, 145 mm, for radiolucent drive
03.010.103 3.2 mm three-fluted drill bit, quick coupling, 145 mm
03.010.104 4.2 mm three-fluted drill bit, quick coupling, 145 mm
03.010.106 direct measuring device, for locking screws to 100 mm, for intermedullary nails
Stop drilling immediately after both cortices and disassemble the drill bit from the radiolucent drive.
ensure the correct position of the drill bit beyond the far cortex under radiographic imaging.
Place the direct measuring device onto the drill bit. read the graduation of the measuring device at the end of the drill bit. this corresponds to the appropriate locking screw length.
Note: Drill bit location with respect to the far cortex is critical for measuring the appropriate locking screw length.
* also available
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 25
Alternative instrument
03.010.072 depth gauge, for locking screws to 100 mm, for Im nails
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.
read the locking screw length directly from the depth gauge at the back of the outer sleeve.
distal locking
36 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
distal locking
* backslap technique: with the hammer guide attached to the driving cap and insertion handle (see page 21) light, reverse hammer blows may be used to compress the fracture; monitor reduction radiographically.
6 Insert locking screw
Instruments
03.010.107 Stardrive Screwdriver, t25, self-retaining
03.010.112 holding Sleeve, with locking device
Insert the appropriate length locking screw using the t25 Stardrive screwdriver and the holding sleeve with locking device, if needed.
verify locking screw length under image intensifi cation. If needed, a second locking screw may be inserted using the same technique.
Note: If compression is desired, the backslap technique* can be used after insertion of the second distal locking screw. Alternatively, the compression device can be used, refer to pages 35 and 36.
use the holding sleeve as described below:
a Insert the holding sleeve onto the shaft of the screwdriver and place the tip of the screwdriver in the recess of the locking screw.
b Push the holding sleeve in the direction of the locking screw; the sleeve now holds the locking screw.
c lock the holding sleeve by tightening it counterclockwise.d release the holding sleeve after insertion of the locking
screw, by loosening it clockwise and pushing backwards.
Alternative instrument
03.010.472 Inter-lock Screwdriver, Stardrive, 2.5/3.5 mm hex, 330 length
a
b
c
d
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 32
ProxImal lockIng— dIaPhySeal and dIStal Segment fractureS
1 Choose locking screws and instruments
use the correct locking screw, drill sleeve, trocar and drill bit for the selected nail diameter, as shown in the table.
three proximal ml locking options can be targeted using the aiming arm:
1 the dynamic locking option (dynam) corresponds to the upper position of the proximal locking slot. this type of locking allows primary compression or secondary, controlled dynamization of the bone fragments.
2 Static 2 (Stat 2) corresponding to the lower position of the proximal locking slot. this type of locking does not allow primary compression or secondary controlled dynamization.
3 Static 1 (Stat 1) corresponding to most distal proximal locking hole.
Nail diameter Locking screws Protection sleeve Drill sleeve Trocar Calibrated drill bit
8 mm and 9 mm 4.0 mm 12.0 mm/8.0 mm 8.0 mm/3.2 mm 3.2 mm 3.2 mm(blue) (blue) with fl ats 03.010.064 03.010.069 03.010.060 03.010.422
10 mm–13 mm 5.0 mm 12.0 mm/8.0 mm 8.0 mm/4.2 mm 4.2 mm 4.2 mm(green) (green) with fl ats 03.010.065 03.010.070 03.010.061 03.010.422
dynam
Stat 2
Stat 1
32 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Proximal locking— diaphyseal and distal Segment fractures
2Mount aiming arm
Instrument
03.010.441 aiming arm, for suprapatellar
confi rm that the nail is securely connected to the insertion handle using the 8 mm ball hex. mount the aiming arm to the insertion handle.
Note: Do not exert force on the aiming arm, protection sleeve, drill sleeves and drill bits. These forces may prevent accurate targeting through the proximal locking holes and damage the drill bits.
3Insert trocar assembly
Instruments
03.010.064 8.0 mm/3.2 mm drill Sleeve, 200 mm (with blue and gold marking)
03.010.065 8.0 mm/4.2 mm drill Sleeve, 200 mm (with green marking)
03.010.069 3.2 mm trocar, 210 mm (with blue and gold marking)
03.010.070 4.2 mm trocar, 210 mm (with green marking)
03.010.442 12.0 mm/8.0 mm Protection Sleeve with fl ats
Insert the three-part trocar assembly (protection sleeve, corresponding drill sleeve and trocar) through the desired ml hole in the aiming arm, make a stab incision and insert the trocar to the bone. remove the trocar.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 33
4 Drill and determine locking screw length
Instruments
03.010.060 3.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration (with blue and gold marking)
03.010.061 4.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration (with green marking)
ensure that the drill sleeve is pressed fi rmly to the near cortex. using the corresponding drill bit (3.2 mm for 4.0 mm locking screws, or 4.2 mm for 5.0 mm locking screws), drill through both cortices until the tip of the drill bit penetrates the far cortex.
confi rm drill bit position under radiographic imaging. ensure that the drill sleeve is pressed firmly to the near 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 the drill sleeve.
Alternative instrument
03.010.072 depth gauge, for locking screws to 100 mm, for Im nails
after drilling both cortices, remove the drill bit and the 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 and that the protection sleeve is on the bone.
read the measurement from the back of the protection sleeve, which indicates the appropriate length locking screw.
Proximal locking— diaphyseal and distal Segment fractures
34 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Proximal locking— diaphyseal and distal Segment fractures
5 Insert locking screw
Instrument
03.010.107 Stardrive Screwdriver, t25, self-retaining
Insert the appropriate length locking screw through the protection sleeve using the t25 Stardrive screwdriver. verify locking screw length under image intensifi cation.
the tip of the locking screw should not project more than 1 mm–2 mm beyond the far cortex.
repeat the Steps 3 to 5 for the second proximal ml locking screw.
Option additional dual core locking screws can be added for proximal fractures and highly unstable fractures.
refer to pages 38–44 for details on proximal locking with the dual core locking screws.
Alternative instrument
03.010.472 Inter-lock Screwdriver, Stardrive, 2.5/3.5 mm hex, 330 length
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 35
ProxImal lockIng— comPreSSIon lockIng mode (oPtIonal)
1Compression locking mode (optional)
If the fracture gap needs compression after nail insertion, it can be accomplished without removing the insertion instruments.
the nail allows a maximum compression of 7 mm. If more compression of the fracture gap is needed, the conventional backslap technique is recommended (see page 21).
Note: Distal locking is required prior to compression locking, refer to page 25.
Insert one proximal locking screw in the dynamic locking hole (dynam). refer to diaphyseal and distal Segment fractures (page 31) for details on inserting this locking screw.
36 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Proximal locking—compression locking mode (optional)
2Insert compression device
Instruments
03.010.092 ball hex Screwdriver, 8 mm
03.010.443 compression device, for suprapatellar, for use with (03.010.404) and (03.010.440)
confi rm that the nail is securely connected to the insertion handle using the 8 mm ball hex screwdriver.
Insert the compression device through the connecting screw and into the nail using the 8 mm ball hex screwdriver.
the compression device will contact the dynamic locking screw.
advance the compression device until the fracture gap is reduced. monitor reduction under image intensifi cation. each revolution of the compression device corresponds to compression of 1 mm (maximum 7 mm).
Important: Do not overtighten the compression device, it may deform the locking screw.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 37
4Insert static locking screw
Insert second proximal locking screw in the most distal hole of the proximal locking options (Static 1). refer to section diaphyseal and distal Segment fractures.
remove the compression device.
additional oblique dual core locking screws can be inserted if required. refer to Proximal Segment fractures (pages 38–44).
3Monitor fracture
control the fracture gap before, during, and after the compression procedure.
Proximal locking—compression locking mode (optional)
38 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
ProxImal lockIng— ProxImal Segment fractureS
Proximal oblique
a/P oblique
distal oblique
1 Oblique proximal locking
Instruments
03.010.404 cannulated connecting Screw for Percutaneous Instruments for nails–ex
03.010.440 Insertion handle for Suprapateller
Proximal locking is performed with the knee in extension when using the suprapatellar technique. this neutralizes the deforming forces on proximal fragments caused by the quadriceps mechanism and relieves the pressure on the soft tissue usually associated with tibial nail insertion instruments. this position also facilitates assessment of rotational alignment prior to locking.
Note: When locking with the leg in full extension, it is recommended to use the Tibial Nail–EX insertion handle and cannulated connecting screw to prevent impingement on the patella. These devices are not compatible with the compression device.
the aiming arm can target all three proximal oblique locking options:
1 the oblique locking option (ProxImal oblIque) corresponds to the most proximal locking position. Inserting a tibial nail end cap with this locking screw will create a fi xed-angle construct.
2 the oblique locking option (dIStal oblIque) corresponds to the second proximal locking position.
3 the oblique locking option in anteroposterior direction (a/P) corresponds to the third proximal locking position.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 35
Popliteal artery
common peroneal nerve
tibial nerve
use the dual core locking screws (gold) only in combination with the two oblique proximal locking holes (ProxImal oblIque, dIStal oblIque) and a/P proximal locking hole for all nail diameters.
use a 3.2 mm drill bit for the 5.0 mm dual core locking screws.
Important: Drilling for the oblique proximal locking screws requires special attention. To avoid lesion of the popliteal artery, the tibial nerve, and the common peroneal nerve, as well as damage to the proximal tibiofibular joint, drilling must be stopped immediately before penetrating the far cortex.
Proximal locking— Proximal Segment fractures
46 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Proximal locking— Proximal Segment fractures
2 Mount aiming arm
Instruments
03.010.092 ball hex Screwdriver, 8 mm
03.010.441 aiming arm, for suprapatellar
confi rm 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 as shown in the illustration.
Note: Do not exert forces on the aiming arm, protection sleeve, drill sleeves and drill bits. These forces may prevent accurate targeting through the proximal locking holes and damage the drill bits.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 42
3Insert trocar assembly
Instruments
03.010.064 8.0 mm/3.2 mm drill Sleeve, 200 mm (with blue and gold marking)
03.010.069 3.2 mm trocar, 210 mm (with blue and gold marking)
03.010.442 12.0 mm/8.0 mm Protection Sleeve, with fl ats for suprapatellar
Insert the three-part trocar assembly (protection sleeve, corresponding drill sleeve and trocar) through the desired hole for oblique locking options in the aiming arm, make a stab incision, and insert the trocar to the bone. remove the trocar.
4 Drill and determine dual core locking screw length
Instrument
03.010.060 3.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration (with blue and gold marking)
Ensure that the drill sleeve is pressed fi rmly to the near cortex.
Insert the calibrated drill bit and start drilling the near cortex. Stop drilling immediately after penetrating the near cortex. DO NOT penetrate the far cortex.
Proximal locking— Proximal Segment fractures
42 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Proximal locking—Proximal Segment fractures
monitor the position of the drill bit with image intensifi cation. this can be done by orienting the image intensifi er perpendicular to the drill bit.
drill to the desired depth. a long dual core locking screw will achieve better bone purchase than a shorter dual core locking screw.
Important: Do not perforate the far cortex with the drill bit. Do not damage the tibial plateau.
confirm drill bit position after drilling under image intensifi cation.
ensure that the drill sleeve is pressed firmly to the bone and read the measurement from the calibrated drill bit at the back of the drill sleeve.
this measurement indicates the appropriate length of the dual core locking screw.
remove the drill bit and the drill sleeve. Important: To avoid perforation of the far cortex with the dual core locking screw, a dual core locking screw 5 mm shorter than the measured length is recommended.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 43
5Insert dual core locking screws
Instrument
03.010.107 Stardrive Screwdriver, t25, self-retaining
Insert the appropriate 5.0 mm dual core locking screw through the protection sleeve, using the t25 Stardrive screwdriver. do not overtighten.
verify locking screw length under image intensifi cation.
repeat this procedure for the second dual core locking screw.
Alternative instrument
03.010.472 Inter-lock Screwdriver, Stardrive, 2.5/3.5 mm hex, 330 mm length
Proximal locking—Proximal Segment fractures
44 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Proximal locking—Proximal Segment fractures
Option repeat the steps described above for the third proximal dual core locking screw in the aP direction.
the position of the dual core locking screw should be controlled under image intensification to ensure its correct position.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 45
end caP InSertIon
Instrument
03.010.445 Sd40 Stardrive Screwdriver, long, inter-lock
all titanium end caps for the nails are available in extension lengths of 0 mm, 5 mm, 10 mm, and 15 mm. they prevent bone ingrowth into the nail and they extend the nail height if it is overinserted.
the gold end caps lock the proximal oblique screw providing a stable, fi xed-angle construct.
the gray end caps have a lead-in design for easier insertion. these are only used for standard transverse proximal locking. the two proximal oblique locking holes cannot be used with the gray end caps.
Alternative instruments
03.010.447 Sd40 Stardrive Screwdriver, long, cannulated
357.399 3.2 mm guide Wire, 400 mm
the end caps are cannulated for use over a guide wire, if necessary.
remove the connecting screw. the insertion handle can remain in place to help align the end cap to the top of the nail. the end cap fi ts through the barrel of the insertion handle.
alternatively, remove the connecting screw and insertion handle. reinsert the inner protection sleeve to open the cannula through the outer protection sleeve.
46 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
end cap Insertion
engage the end cap with the cannulated Sd40 Stardrive screwdriver, inter-lock. 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 t40 Stardrive screwdriver.
Note: The end cap will engage the most proximal oblique locking screw to create a fi xed-angle construct.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 47
ImPlant removal (oPtIonal)
1Remove end cap and locking screws
Instruments
03.010.107 Stardrive Screwdriver, t25, self-retaining
03.010.112 holding Sleeve, with locking device
03.010.445 Sd40 Stardrive Screwdriver, long, inter-lock
03.010.447* Sd40 Stardrive Screwdriver, long, cannulated
Note: Implant removal may be performed through a standard approach or a suprapatellar approach. The suprapatellar approach is shown for illustrative purposes only.
clear the Stardrive socket of the end cap and the locking implants of any tissue ingrowth. remove the end cap with the long inter-lock Sd40 Stardrive screwdriver.
remove all locking screws except one of the proximal locking screws, using the t25 Stardrive screwdriver and holding sleeve.
Note: Always remove the most proximal dual core locking screw in order to insert the extraction screw into the proximal end of the nail.
*also available
48 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Implant removal (optional)
2Attach extraction screw and hammer guide
Instruments
03.010.107 Stardrive Screwdriver, t25, self-retaining
03.010.446 extraction Screw/m8, for suprapatellar
357.22 hammer guide
before removing the fi nal locking screw, screw the extraction screw into the tibial nail and tighten it to prevent rotation or displacement of the nail posteriorly below the tibial plateau.
attach the hammer guide to the extraction screw.
remove the remaining locking screw with the t25 Stardrive screwdriver.
3 Remove nail
Instrument
03.010.056 Slide/fixed hammer, 700 grams
extract the nail by applying gentle blows with the hammer.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 45
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.
Alternative TechniqueExtraction Hook for removal of broken nail
Instruments
355.399◊ extraction hook, for titanium cannulated nails
393.10 universal chuck with t-handleor393.105 Small universal chuck with t-handle
1clear tissue from the end of the nail and remove the end cap.
2remove the locking bolts and/or screws with the appropriate screwdriver.
3Insert 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. this facilitates visualization of the hook position in the bone.
Implant removal (optional)
56 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Implant removal (optional)
4attach the appropriate extraction bolt or connecting screw to the nail. remove the near nail fragment using the extraction bolt or the connecting screw.
Note: The extraction hook can be used as an alternative to the extraction screw.
5ream the medullary canal 1 mm larger than the diameter of the nail to clear a path for the distant nail fragment.
6Insert 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 distal nail fragment.
7Pass the extraction hook through the cannula of the distant nail fragment.
Note: Under image intensifi cation, verify that the hook has passed through and engaged the distal end of the nail.
8extract both nail fragments.
Note: Keep the patient’s limb restrained to increase the effi ciency of the extraction force.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 52
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.
For removal of an intact nail
Instruments
355.399◊ extraction hook, for titanium cannulated nails
393.10 universal chuck with t-handleor393.105 Small universal chuck with t-handle
1clear tissue from the end of the nail and remove the end cap.
2remove the locking bolts and/or screws with the appropriate screwdriver.
3Insert 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.
4Insert the extraction hook through the nail cannula. Note: Under image intensifi cation, verify that the hook has passed through and engaged the distal end of the nail.
5extract the nail.
Note: Keep the patient’s limb restrained to increase the effi ciency of the extraction force.
Implant removal (optional)
52 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
ImPlantS
Titanium Cannulated Tibial Nails–EXuniversal design for the left or right tibia
Material titanium-6% aluminum-7% niobium alloy
Diameters8 mm–13 mm (1 mm increments)x 8 mm–10 mm nails have a proximal
diameter of 11 mmx 11 mm–13 mm nails have a proximal
diameter consistent with the shaft diameter
Colorsx 8 mm and 9 mm (blue) use 4.0 mm
titanium locking screws (blue)x 10 mm–13 mm (green) use 5.0 mm
titanium locking screws (green)
Lengths255 mm–435 mm (15 mm increments)
Cross sectionx 8 mm–10 mm nails are roundx 11 mm–13 mm nails are fluted
36 mm
7 mm
5 mm
22 mm
aP
oblique
ml
ml
13 mm
14 mm
20 mm
30 mmdistal oblique
Proximal oblique
aP57 mm
Stat 1
Stat 2
dynamic
Start of bend is 75 mm
10.5º
end of bend is half length of nail
radius varies
37 mm
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 53
8 mm9 mm
11 mm12 mm13 mm
10 mm
Titanium Cannulated Tibial Nails–EX, sterile*
length 8 mm dia. 9 mm dia. 10 mm dia.(mm) dark blue dark blue light green
255 04.004.231S 04.004.331S 04.004.431S
270 04.004.234S 04.004.334S 04.004.434S
285 04.004.237S 04.004.337S 04.004.437S
300 04.004.240S 04.004.340S 04.004.440S
315 04.004.243S 04.004.343S 04.004.443S
330 04.004.246S 04.004.346S 04.004.446S
345 04.004.249S 04.004.349S 04.004.449S
360 04.004.252S 04.004.352S 04.004.452S
375 04.004.255S 04.004.355S 04.004.455S
390 04.004.258S 04.004.358S 04.004.458S
405 04.004.261S 04.004.361S 04.004.461S
420 04.004.264S 04.004.364S 04.004.464S
435 04.004.267S 04.004.367S 04.004.467S length 11 mm dia. 12 mm dia. 13 mm dia.(mm) light green light green light green
255 04.004.531S 04.004.631S 04.004.731S
270 04.004.534S 04.004.634S 04.004.734S
285 04.004.537S 04.004.637S 04.004.737S
300 04.004.540S 04.004.640S 04.004.740S
315 04.004.543S 04.004.643S 04.004.743S
330 04.004.546S 04.004.646S 04.004.746S
345 04.004.549S 04.004.649S 04.004.749S
360 04.004.552S 04.004.652S 04.004.752S
375 04.004.555S 04.004.655S 04.004.755S
390 04.004.558S 04.004.658S 04.004.758S
405 04.004.561S 04.004.661S 04.004.761S
420 04.004.564S 04.004.664S 04.004.764S
435 04.004.567S 04.004.667S 04.004.767S
*titanium-6% aluminum-7% niobium alloy
Implants
54 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Implants
Titanium Cannulated Tibial Nails–EX with proximal benduniversal design for the left or right tibia
Material titanium-6% aluminum-7% niobium alloy
Diameters8 mm–13 mm (1 mm increments)x 8 mm–10 mm nails have a proximal
diameter of 11 mmx 11 mm–13 mm nails have a
proximal diameter consistent with the shaft diameter
Colorsx 8 mm and 9 mm (blue) use 4.0 mm
titanium locking screws (blue)x 10 mm–13 mm (green) use 5.0 mm
titanium locking screws (green)
Lengths255 mm– 435 mm (15 mm increments)
Cross sectionx 8 mm–10 mm nails are roundx 11 mm–13 mm nails are fluted
14 mm20 mm
distal oblique
Proximal oblique
aP
5 mm
22 mm
aP
oblique
30 mm
36 mm
7 mmStat 2dynamic
Stat 1
57 mm
10.5º
37 mm
ml
ml
13 mm
Start of 3º tip bend is 57 mm
r 100
Start of bendis 65 mm
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 55
8 mm9 mm
Implants
11 mm12 mm13 mm
10 mm
Titanium Cannulated Tibial Nails–EX with proximal bend, sterile
length 8 mm dia. 9 mm dia. 10 mm dia.(mm) dark blue dark blue light green255 04.034.231S 04.034.331S 04.034.431S 270 04.034.234S 04.034.334S 04.034.434S 285 04.034.237S 04.034.337S 04.034.437S 300 04.034.240S 04.034.340S 04.034.440S 315 04.034.243S 04.034.343S 04.034.443S 330 04.034.246S 04.034.346S 04.034.446S 345 04.034.249S 04.034.349S 04.034.449S 360 04.034.252S 04.034.352S 04.034.452S 375 04.034.255S 04.034.355S 04.034.455S 390 04.034.258S 04.034.358S 04.034.458S 405 04.034.261S 04.034.361S 04.034.461S 420 04.034.264S 04.034.364S 04.034.464S 435 04.034.267S 04.034.367S 04.034.467S length 11 mm dia. 12 mm dia. 13 mm dia.(mm) light green light green light green255 04.034.531S 04.034.631S 04.034.731S270 04.034.534S 04.034.634S 04.034.734S285 04.034.537S 04.034.637S 04.034.737S300 04.034.540S 04.034.640S 04.034.740S315 04.034.543S 04.034.643S 04.034.743S330 04.034.546S 04.034.646S 04.034.746S345 04.034.549S 04.034.649S 04.034.749S360 04.034.552S 04.034.652S 04.034.752S375 04.034.555S 04.034.655S 04.034.755S390 04.034.558S 04.034.658S 04.034.758S405 04.034.561S 04.034.661S 04.034.761S420 04.034.564S 04.034.664S 04.034.764S435 04.034.567S 04.034.667S 04.034.767S
56 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Implants
5.0 mm Titanium Dual Core Locking Screws, with T25 StarDrive recess, for IM Nails (gold)x titanium alloy*x lengths: 28 mm–90 mmx used for proximal locking in the metaphysis (through the
3 most proximal holes)x dual core: smaller core (3.4 mm) for better purchase
in cancellous bone, larger core (4.3 mm) to withstand load-bearing from the nail
x fully threadedx Self-tapping, blunt tip
length (mm)
04.015.518S 28 (sterile only)
04.015.520◊ 30
04.015.522S 32 (sterile only)
04.015.525◊ 35
04.015.527S 37 (sterile only)
04.015.530◊ 40
04.015.532S 42 (sterile only)
04.015.535◊ 45
04.015.537S 47 (sterile only)
04.015.540◊ 50
04.015.542S 52 (sterile only)
04.015.545◊ 55
04.015.547S 57 (sterile only)
04.015.550◊ 60
04.015.552S 62 (sterile only)
04.015.555◊ 65
04.015.557S 67 (sterile only)
04.015.560◊ 70
04.015.562S 72 (sterile only)
04.015.565◊ 75
04.015.567S 77 (sterile only)
04.015.570◊ 80
04.015.572S 82 (sterile only)
04.015.575◊ 85
04.015.577S 87 (sterile only)
04.015.580◊ 90
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.*titanium-6% aluminum-7% niobium alloy
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 57
Instruments
length (mm)
04.005.408 1804.005.410 2004.005.412 2204.005.414 2404.005.416 2604.005.418 2804.005.420 3004.005.422 3204.005.424 3404.005.426 3604.005.428 3804.005.430 4004.005.432 4204.005.434 4404.005.436 4604.005.438 48
length (mm)
04.005.440 5004.005.442 5204.005.444 5404.005.446 5604.005.448 5804.005.450 6004.005.452 6204.005.454 6404.005.456 6604.005.458 6804.005.460 7004.005.462 7204.005.464 7404.005.466 7604.005.468 7804.005.470 80
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.*titanium-6% aluminum-7% niobium alloy
4.0 mm Titanium Locking Screws◊, with T25 StarDrive recess, for IM nails (blue)x titanium alloy*x lengths: 18 mm–80 mm (2 mm increments)x 3.3 mm core diameterx fully threadedx Self-tapping, blunt tip
58 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Implants
5.0 mm Titanium Locking Screws◊, with T25 StarDrive recess, for IM nails (light green)x titanium alloy*x lengths: 26 mm–80 mm (2 mm increments)
85 mm–100 mm (5 mm increments)x 4.3 mm core diameterx fully threadedx Self-tapping, blunt tip
length (mm)
04.005.516 2604.005.518 2804.005.520 3004.005.522 3204.005.524 3404.005.526 3604.005.528 3804.005.530 4004.005.532 4204.005.534 4404.005.536 4604.005.538 4804.005.540 5004.005.542 5204.005.544 5404.005.546 56
length (mm)
04.005.548 5804.005.550 6004.005.552 6204.005.554 6404.005.556 6604.005.558 6804.005.560 7004.005.562 7204.005.564 7404.005.566 7604.005.568 7804.005.570 8004.005.575 8504.005.580 9004.005.585 9504.005.590 100
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.*titanium-6% aluminum-7% niobium alloy
Titanium Angular Stable Locking Screws, with T25 StarDrive recess, for intramedullary nails, sterile*x titanium alloy**x available lengths
– 4.0 mm aSlS screw: 26 mm–80 mm – 5.0 mm aSlS screw: 30 mm–100 mm
x 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 cortexx t25 Stardrive recessx Sterile packaged
d1
d2
d3
*also available*titanium-6% aluminum-7% niobium alloy
01.025.008 4.0 mm Angular Stable Locking System Screw Set
4.0 mm titanium angular Stable locking Screws, with t25 Stardrive recess, for intramedullary nails, sterile, 2 ea.
length (mm) length (mm)
04.025.416S 26 04.025.444S 54
04.025.418S 28 04.025.446S 56
04.025.420S 30 04.025.448S 58
04.025.422S 32 04.025.450S 60
04.025.424S 34 04.025.452S 62
04.025.426S 36 04.025.454S 64
04.025.428S 38 04.025.456S 66
04.025.430S 40 04.025.458S 68
04.025.432S 42 04.025.460S 70
04.025.434S 44 04.025.462S 72
04.025.436S 46 04.025.464S 74
04.025.438S 48 04.025.466S 76
04.025.440S 50 04.025.468S 78
04.025.442S 52 04.025.470S 80
01.025.009 5.0 mm Angular Stable Locking System Screw Set
5.0 mm titanium angular Stable locking Screws, with t25 Stardrive recess, for intramedullary nails, sterile, 2 ea.
length (mm) length (mm)
04.025.520S 30 04.025.550S 60
04.025.522S 32 04.025.552S 62
04.025.524S 34 04.025.554S 64
04.025.526S 36 04.025.556S 66
04.025.528S 38 04.025.558S 68
04.025.530S 40 04.025.560S 70
04.025.532S 42 04.025.562S 72
04.025.534S 44 04.025.564S 74
04.025.536S 46 04.025.566S 76
04.025.538S 48 04.025.568S 78
04.025.540S 50 04.025.570S 80
04.025.542S 52 04.025.575S 85
04.025.544S 54 04.025.580S 90
04.025.546S 56 04.025.585S 95
04.025.548S 58 04.025.590S 100
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 55
Implants
ASLS Compatibility with Existing Nailsthe angular Stable locking System is compatible with all Synthes titanium cannulated nailing systems.
angular Stable locking Systems
nail 4.0 mm 5.0 mm nailing System diameters (mm) (brown) (light blue)
Tibia titanium cannulated tibial nail-ex 8, 9 • and tibial nail-ex with Proximal bend 10–13 •
TitaniumTibialNail(cannulated) 10–13 •
ASLS Sleeves*
Resorbable Sleeves for Angular Stable Locking Screws, sterile*x 70:30 poly(l/dl-lactide)x bioresorbable polymer material gradually resorbs
within 18–24 months1
x Inner thread for secure fit to aSlS screwx expands in nail’s locking hole to provide angular stabilityx 4.0 mm and 5.0 mm sleeves used with
corresponding aSlS screwsx Sterile packaged (2 per package)
resorbable Sleeve for angular Stable locking Screws, sterile, 2/pkg.
08.025.032S for 4.0 mm aSlS Screws08.025.044S for 5.0 mm aSlS Screws
Implantsx
1 based on in-vivo animal testing. In-vivo animal testing may not necessarily be indicative of human clinical performance.
*must be ordered separately
66 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 62
Instruments
Titanium End Caps◊, with T40 StarDrive recess, for Titanium Tibial Nails–EXx titanium alloy*x Protect nail threads from tissue ingrowthx cannulatedx t40 Stardrive recess
0 mmx Sits flush with end of nail
5 mm, 10 mm, and 15 mm extensionsx extend nail height if nail is overinserted
Titanium End Caps◊, with T40 StarDrive recess, for Titanium Tibial Nails–EX (gold)x Securely lock the proximal oblique dual core locking screw
extension (mm) 04.004.000 0 04.004.001 5 04.004.002 10 04.004.003 15
Titanium End Caps◊, with T40 StarDrive recess, for Titanium Tibial Nails–EX (gray)•Lead-indesignforeasierendcapinsertion•Willblockthetwomostproximalobliquelockingholes
extension (mm)04.004.008 0 04.004.009 5 04.004.010 10 04.004.011 15
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.*titanium-6% aluminum-7% niobium alloy
5 mm 10 mm 15 mm0 mm
5 mm 10 mm 15 mm0 mm
62 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
InStrumentS for SuPraPatellar InSertIon
03.010.436 14.5 mm Protection Sleeve, straight, for 12 mm–13 mm nails
03.010.437S 12.0 mm outer Protection Sleeve, for suprapatellar, sterile
03.010.404 cannulated connecting Screw for Percutaneous Instruments for nails–ex
03.010.430 handle for Protection Sleeves, for suprapatellar
03.010.433 Wire guide, 2 holes, 12.0 mm/3.2 mm
03.010.434 Wire guide, 2 holes, 14.5 mm/3.2 mm
03.010.435 12.0 mm Protection Sleeve, straight, for 8 mm–11 mm nails
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 63
03.010.438S 14.5 mm outer Protection Sleeve, for suprapatellar, sterile
03.010.439◊ 12.0 mm cannulated drill, long, with large quick coupling
03.010.440◊ Insertion handle, for suprapatellar
03.010.441 aiming arm, for suprapatellar
03.010.442 12.0 mm/8.0 mm Protection Sleeve with flats, for suprapatellar
03.010.443 compression device, for suprapatellar
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.
Instruments for Suprapatellar Insertion
64 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
03.010.475 driving cap
Instruments for Suprapatellar Insertion
03.010.444 8 mm hex Screwdriver, cannulated, inter-lock
03.010.445 Sd40 Stardrive Screwdriver, long, inter-lock
03.010.446 extraction Screw, m8, for suprapatellar
03.010.447 Sd40 Stardrive Screwdriver, long, cannulated
03.010.455 12.0 mm trocar, Peek for suprapatellar
03.010.456 14.5 mm trocar, Peek for suprapatellar
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 65
InStrumentS for tIbIal naIl–ex
03.010.015 compression device, for titanium cannulated tibial nails–ex
03.010.021 radiographic ruler, for titanium cannulated tibial nails
03.010.023 radiographic canal Width estimator, for Im nails
03.010.035 12.0 mm Protection Sleeve
03.010.036◊ 12.0 mm cannulated drill bit, large quick coupling, 190 mm
03.010.024 holding device, for guide wires and reaming rods
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.
66 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
03.010.052 aiming arm, for titanium cannulated tibial nails–ex
03.010.045 Standard Insertion handle
03.010.047 driving cap with handle adapter
03.010.056 Slide/fixed hammer, 700 grams
03.010.040 12.0 mm cannulated awl
03.010.044 cannulated connecting Screw, for Standard Insertion handle
Instruments for tibial nail–ex
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes 67
Instruments for tibial nail–ex
03.010.060 3.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration
03.010.061 4.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration
03.010.063 12.0 mm/8.0 mm Protection Sleeve, 188 mm
03.010.064 8.0 mm/3.2 mm drill Sleeve, 200 mm
03.010.065 8.0 mm/4.2 mm drill Sleeve, 200 mm
03.010.069 3.2 mm trocar, 210 mm
03.010.070 4.2 mm trocar, 210 mm
03.010.072 depth gauge, for locking Screws to 100 mm, for Im nails
03.010.093 reaming rod Push rod, with ball handle
03.010.103 3.2 mm three-fluted drill bit, quick coupling, 145 mm
03.010.104 4.2 mm three-fluted drill bit, quick coupling, 145 mm
03.010.092 ball hex Screwdriver, 8 mm
03.010.106 direct measuring device, for locking screws to 100 mm, for Im nails
03.010.107 Stardrive Screwdriver, t25, self-retaining
03.010.110 cannulated Stardrive Screwdriver, t40, self-retaining
Instruments for tibial nail–ex
68 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 65
321.17 4.5 mm Pin Wrench, 120 mm
321.20 ratchet Wrench, 11 mm width across flats
357.22 hammer guide, for slide hammer
357.133 extraction Screw, for titanium femoral and tibial nails
357.398 cannulated Shaft with 8 mm hex, 125 mm
357.399 3.2 mm guide Wire, 400 mm
03.010.112 holding Sleeve, with locking device
Instruments for tibial nail–ex
Graphic Case61.010.401 Suprapatellar Instrument Set graphic case
Instruments03.010.404 cannulated connecting Screw for
Percutaneous Instruments for nail–ex
03.010.430 handle for Protection Sleeves, for suprapatellar
03.010.433 Wire guide, 2 holes, 12.0 mm/3.2 mm
03.010.434 Wire guide, 2 holes, 14.5 mm/3.2 mm
03.010.435 12.0 mm Protection Sleeve, straight, for 8 mm–11 mm nails
03.010.436 14.5 mm Protection Sleeve, straight, for 12 mm–13 mm nails
03.010.437S 12.0 mm outer Protection Sleeve, for suprapatellar, sterile
03.010.438S 14.5 mm outer Protection Sleeve, for suprapatellar, sterile
03.010.439◊ 12.0 mm cannulated drill, long, with large quick coupling
03.010.440 Insertion handle, for suprapatellar
03.010.441 aiming arm, for suprapatellar
03.010.442 12.0 mm/8.0 mm Protection Sleeve with flats, for suprapatellar
03.010.443 compression device, for suprapatellar
03.010.444 8 mm hex Screwdriver, cannulated, inter-lock
03.010.445 Sd40 Stardrive Screwdriver, long, inter-lock
03.010.446 extraction Screw, m8, for suprapatellar
03.010.447 Sd40 Stardrive Screwdriver, long, cannulated
03.010.455 12.0 mm trocar, Peek for suprapatellar
03.010.456 14.5 mm trocar, Peek for suprapatellar
03.010.475 driving cap
SuPraPatellar InSertIon InStrument Set (01.004.305)
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.
for detailed cleaning and sterilization instructions, please refer to: www.synthes.com/cleaning-sterilization In canada, the cleaning and sterilization instructions will be provided with the loaner shipments.
76 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 72
tIbIal naIl– ex InStrument Set (01.004.303)
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.
Graphic Case69.004.300 tibial nail–ex Instrument Set graphic case
Instruments03.010.015 compression device, for titanium
cannulated tibial nails–ex
03.010.021 radiographic ruler, for titanium cannulated tibial nails
03.010.023 radiographic canal Width estimator, for Im nails
03.010.024 holding device, for guide Wires and reaming rods
03.010.035 12.0 mm Protection Sleeve
03.010.036◊ 12.0 mm cannulated drill bit, large quick coupling, 190 mm
03.010.040 12.0 mm cannulated awl
03.010.044 cannulated connecting Screw, for standard insertion handle, 2 ea.
03.010.045 Standard Insertion handle
03.010.047 driving cap with handle adapter
03.010.052 aiming arm, for titanium cannulated tibial nails–ex
03.010.056 Slide/fixed hammer, 700 grams
03.010.060◊ 3.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration, 2 ea.
03.010.061◊ 4.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration, 2 ea.
03.010.063 12.0 mm/8.0 mm Protection Sleeve, 188 mm
03.010.064 8.0 mm/3.2 mm drill Sleeve, 200 mm
03.010.065 8.0 mm/4.2 mm drill Sleeve, 200 mm
03.010.069 3.2 mm trocar, 210 mm
03.010.070 4.2 mm trocar, 210 mm
03.010.072 depth gauge, for locking screws to 100 mm, for Im nails
03.010.092 ball hex Screwdriver, 8 mm
03.010.093 reaming rod Push rod, with ball handle
tibial nail–ex Instrument Set (01.004.303)
03.010.103◊ 3.2 mm three-fluted drill bit, quick coupling, 145 mm, 2 ea.
03.010.104◊ 4.2 mm three-fluted drill bit, quick coupling, 145 mm, 2 ea.
03.010.106 direct measuring device, for locking Screws to 100 mm, for Im nails
03.010.107 Stardrive Screwdriver, t25, self-retaining
03.010.110 cannulated Stardrive Screwdriver, t40, self-retaining
03.010.112 holding Sleeve, with locking device
321.17 4.5 mm Pin Wrench, 120 mm, 2 ea.
321.20 ratchet Wrench, 11 mm width across flats
357.133 extraction Screw, for titanium femoral and tibial nails
357.22 hammer guide, for Slide hammer
357.398 cannulated Shaft with 8 mm hex, 125 mm
357.399 3.2 mm guide Wire, 400 mm, 3 ea.
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.
72 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 73
tIbIa– ex InSertIon InStrument Set WIth SuPraPatellar (01.116.048)
Complete Set60.116.148 Insertion tray for tibia nail-ex with
Suprapatellar Instruments
60.116.168 label Sheet for tibia nail-ex with Suprapatellar Insertion Instrumentation
Instruments03.010.060 3.2 mm three-fluted drill bit, quick
coupling, 330 mm, 100 mm calibration, 2 ea.
03.010.061 4.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration, 2 ea.
03.010.063 12.0 mm/8.0 mm Protection Sleeve, 188 mm, 2 ea.
03.010.064 8.0 mm/3.2 mm drill Sleeve, 200 mm, 2 ea.
03.010.065 8.0 mm/4.2 mm drill Sleeve, 200 mm, 2 ea.
03.010.069 3.2 mm trocar, 2 ea.
03.010.070 4.2 mm trocar, 210 mm, 2 ea.
03.010.103 3.2 mm three-fluted drill bit, quick coupling, needle point, 145 mm, 2 ea.
03.010.104 4.2 mm three-fluted drill bit, quick coupling, needle point, 145 mm, 2 ea.
03.010.137 long compression device, for titanium cannulated tibial nails-ex
03.010.146 cannulated connection Screw, for 100 mm Insertion handle, 2 ea.
03.010.404 cannulated connecting Screw, for Percutaneous Instruments for nails-ex
03.010.430 handle for Protection Sleeves, for Suprapatellar
03.010.433 12.0 mm/3.2 mm Wire guide, 2 holes, for Suprapatellar
03.010.434 14.5 mm/3.2 mm Wire guide, 2 holes,
for Suprapatellar
03.010.435 12.0 mm Protection Sleeve, for 8–11 mm nails
03.010.436 14.5 mm Protection Sleeve, for 12–13 mm nails
03.010.439 12 mm cannulated drill, 270 mm, with large quick coupling
03.010.440 Insertion handle for Suprapatellar
03.010.441 aiming arm for ex tibia nails
03.010.442 12.0 mm/8.0 mm Protection Sleeve with flats for Suprapatellar
03.010.443 compression device for Suprapatellar
03.010.444 8 mm hex Screwdriver cannulated, Inter-lock
03.010.445 t40 Stardrive Screwdriver, long, Inter-lock
03.010.446 extraction Screw, m8, for Suprapatellar
03.010.447 t40 Stardrive Screwdriver, long, cannulated
03.010.455 12.0 mm trocar, Peek, for Suprapatellar
03.010.456 14.5 mm trocar, Peek, for Suprapatellar
03.010.475 driving cap
03.010.486 radiolucent Insertion handle, for expert nails, 100 mm
03.010.517 t-handle ball hex Screwdriver, 8 mm
03.010.523 driving cap, threaded
Additionally Available*03.010.004 compression device for titanium
cannulated tibial nails–ex, 2 ea.
03.010.095 cannulated connection Screw for Short Insertion handle, 2 ea.
03.010.100 3.2 mm radiolucent drill bit, 2 ea.
03.010.101 4.2 mm three-fluted drill bit, quick coupling, needle point, 145 mm, 2 ea.
03.010.137 compression device for titanium cannulated tibial nails–ex
03.010.485 radiolucent Short Insertion handle, 23 mm
*additionally available items are not included in sets
74 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
tibia–ex Insertion Instrument Set with Suprapatellar (01.116.048)
x tray weight without additionally available items: 19.68 lbs.
x tray height: 4 highx graphic cases are available in 1, 2, 3, and 4 heights. x Set does not include graphic case, which must be
ordered separately.
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 75
Existing Instruments03.010.060 3.2 mm three-fluted drill bit, quick coupling,
330 mm, 100 mm calibration, 2 ea.
03.010.061 4.2 mm three-fluted drill bit, quick coupling, 330 mm, 100 mm calibration, 2 ea.
03.010.063 12.0 mm/ 8.0 mm Protection Sleeve, 188 mm, 2 ea.
03.010.064 8.0 mm/ 3.2 mm drill Sleeve, 200 mm, 2 ea.
03.010.065 8.0 mm/ 4.2 mm drill Sleeve, 200 mm, 2 ea.
03.010.069 3.2 mm trocar, 2 ea.
03.010.070 4.2 mm trocar, 210 mm, 2 ea.
03.010.103 3.2 mm three-fluted drill bit, quick coupling, needle point, 145 mm, 2 ea.
03.010.104 4.2 mm three-fluted drill bit, quick coupling, needle point, 145 mm, 2 ea.
03.010.137 long compression device, for titanium cannulated tibial nails – ex
03.010.146 cannulated connection Screw, for 100 mm Insertion handle, 2 ea.
03.010.404 cannulated connecting Screw, for Percutaneous Instruments for nails–ex
03.010.430 handle for Protection Sleeves, for Suprapatellar
03.010.433 12.0 mm / 3.2 mm Wire guide, 2 holes, for Suprapatellar
03.010.434 14.5 mm / 3.2 mm Wire guide, 2 holes, for Suprapatellar
03.010.435 12.0 mm Protection Sleeve, for 8 –11 mm nails
03.010.436 14.5 mm Protection Sleeve,
for 12 –13 mm nails
03.010.439 12 mm cannulated drill, 270 mm, with large quick coupling
03.010.440 Insertion handle for Suprapatellar
03.010.441 aiming arm for ex tibia nails
03.010.442 12.0 mm / 8.0 mm Protection Sleeve with flats for Suprapatellar
03.010.443 compression device for Suprapatellar
03.010.444 8 mm hex Screwdriver cannulated, Inter-lock
03.010.445 t40 Stardrive Screwdriver, long, Inter-lock
03.010.446 extraction Screw, m8, for Suprapatellar
03.010.447 t40 Stardrive Screwdriver, long, cannulated
03.010.455 12.0 mm trocar, Peek, for Suprapatellar
03.010.456 14.5 mm trocar, Peek, for Suprapatellar
03.010.475 driving cap
tibia –ex Insertion Instrument Set with Suprapatellar (01.116.048)
76 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Existing Instruments
Tibia–EX Insertion Instrument Upgrade Set with Suprapatellar (01.116.248)
New Instruments60.116.148 Insertion tray for tibia nail-ex with
Suprapatellar Instruments
60.116.168 label Sheet for tibia nail-ex with Suprapatellar Insertion Instrumentation
03.010.486 radiolucent Insertion handle, for expert nails, 100 mm
03.010.517 t-handle ball hex Screwdriver, 8 mm
03.010.523 driving cap, threaded
tibia –ex Insertion Instrument Set with Suprapatellar (01.116.048)
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 77
tIbIal naIl– ex ImPlant Set (01.004.304)
Graphic Case690.504 locking Screw rack, for tibial nail–ex Implants
Instrument
319.97 Screw forceps
Implantstitanium end caps, with t40 Stardrive recess, for tibial nails–ex◊ (gold)
extension (mm)04.004.000 0 04.004.001 5 04.004.002 1004.004.003 15
titanium end caps, with t40 Stardrive recess, extended tip, for tibial nails–ex◊ (gray), 2 ea.
extension (mm)04.004.008 0 04.004.009 5 04.004.010 1004.004.011 15
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.
length (mm) 04.015.520 30 04.015.525 35 04.015.530 40 04.015.535 45 04.015.540 50 04.015.545 55 04.015.550 60
length (mm) 04.015.555 65 04.015.560 70 04.015.565 75 04.015.570 80 04.015.575 85 04.015.580 90
5.0 mm titanium dual core locking Screws, with t25 Stardrive recess, for Im nails◊, 2 ea.
tibial nail–ex Implant Set (01.004.304)
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.
5.0 mm titanium locking Screws, with t25 Stardrive recess, for Im nails◊, 2 ea.
length (mm)
04.005.544 54
04.005.546 56
04.005.548 58
04.005.550 60
04.005.552 62
04.005.554 64
04.005.556 66
04.005.558 68
04.005.560 70
04.005.562 72
04.005.564 74
04.005.566 76
04.005.568 78
04.005.570 80
length (mm)
04.005.516 26
04.005.518 28
04.005.520 30
04.005.522 32
04.005.524 34
04.005.526 36
04.005.528 38
04.005.530 40
04.005.532 42
04.005.534 44
04.005.536 46
04.005.538 48
04.005.540 50
04.005.542 52
4.0 mm Titanium Locking Screws, with T25 StarDrive recess, for IM Nails, 2 ea. length (mm)
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
length (mm)
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
78 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 75
tIbIal naIl–ex InStrument and tItanIum ImPlant Set (01.004.300)
01.004.300 consists of:01.004.303 tibial nail–ex Instrument Set
01.004.304 tibial nail–ex Implant Set
01.025.008 4.0 mm Angular Stable Locking System Screw Set
4.0 mm titanium angular Stable locking Screws, with t25 Stardrive recess, for intramedullary nails, sterile, 2 ea.
length length (mm) (mm)
04.025.416S 26 04.025.444S 54
04.025.418S 28 04.025.446S 56
04.025.420S 30 04.025.448S 58
04.025.422S 32 04.025.450S 60
04.025.424S 34 04.025.452S 62
04.025.426S 36 04.025.454S 64
04.025.428S 38 04.025.456S 66
04.025.430S 40 04.025.458S 68
04.025.432S 42 04.025.460S 70
04.025.434S 44 04.025.462S 72
04.025.436S 46 04.025.464S 74
04.025.438S 48 04.025.466S 76
04.025.440S 50 04.025.468S 78
04.025.442S 52 04.025.470S 80
aSlS ScreW SetS
01.025.009 5.0 mm Angular Stable Locking System Screw Set
5.0 mm titanium angular Stable locking Screws, with t25 Stardrive recess, for intramedullary nails, sterile, 2 ea.
length length (mm) (mm)
04.025.520S 30 04.025.550S 60
04.025.522S 32 04.025.552S 62
04.025.524S 34 04.025.554S 64
04.025.526S 36 04.025.556S 66
04.025.528S 38 04.025.558S 68
04.025.530S 40 04.025.560S 70
04.025.532S 42 04.025.562S 72
04.025.534S 44 04.025.564S 74
04.025.536S 46 04.025.566S 76
04.025.538S 48 04.025.568S 78
04.025.540S 50 04.025.570S 80
04.025.542S 52 04.025.575S 85
04.025.544S 54 04.025.580S 90
04.025.546S 56 04.025.585S 95
04.025.548S 58 04.025.590S 100
Alternative Set Configurations
01.025.001 angular Stable locking System Screw Set consists of: 4.0 mm aSlS Screw Set (01.025.008) and 5.0 mm aSlS Screw Set (01.025.009)
ASLS Sleeves*
resorbable Sleeve for angular Stable locking Screws, sterile, 2/pkg.
08.025.032S for 4.0 mm aSlS Screws
08.025.044S for 5.0 mm aSlS Screws
* must be ordered separately
86 DePuy Synthes Trauma Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique
Suprapatellar Instrumentation for Titanium Cannulated Tibial Nails Surgical Technique DePuy Synthes Trauma 82
alSo avaIlable
Set 01.004.306 flexible reamer Set, long, for Im nails
150.060 flexible reamer Set for Im nails
Instruments03.010.017 tibial nail–ex Insertion handle
03.010.046 Percutaneous Insertion handle
03.010.100◊ 3.2 mm three-fluted drill bit, quick coupling, 145 mm, for radiolucent drive
03.010.101◊ 4.2 mm three-fluted drill bit, quick coupling, 145 mm, for radiolucent drive
03.010.119 4.6 mm cleaning brush
03.010.120 4.6 mm cleaning Stylet
03.010.121 large hexagonal Screwdriver, 3.5 mm width across flats
03.010.136 Short compression device, for titanium cannulated tibial nail–ex
03.010.137 long compression device, for titanium cannulated tibial nail–ex
03.010.145 cannulated connecting Screw, with internal thread for short insertion handle
03.010.146 cannulated connecting Screw, for percutaneous insertion handle
314.119 Stardrive Screwdriver Shaft, t25, self-retaining, quick coupling, 165 mm
351.706S 2.5 mm reaming rod with ball tip, 950 mm, sterile
351.707S 2.5 mm reaming rod with ball tip and extension, 950 mm, sterile
357.408 cleaning Stylet (3.2 mm)
357.409 cleaning brush (3.2 mm)
360.251 7.5 mm Intramedullary reduction tool, 460 mm
393.105 Small universal chuck with t-handle
394.35 large distractor, complete
399.43 hammer, 700 grams
◊ available nonsterile or sterile-packed. add “S” to catalog number to order sterile product.
Implants5.0 mm titanium dual core locking Screws, with t25 Stardrive recess, for Im nails, sterile only
length (mm)
04.015.518S 28
04.015.522S 32
04.015.527S 37
04.015.532S 42
04.015.537S 47
04.015.542S 52
04.015.547S 57
04.015.552S 62
04.015.557S 67
04.015.562S 72
04.015.567S 77
04.015.572S 82
04.015.577S 87
Power Equipment511.30 radiolucent drive
511.73 Jacobs chuck with key (large)
511.75 quick coupling, for drill bits
511.761 large quick coupling
511.785 reduction drive unit
511.791 quick coupling for kirschner wires
530.100 Power drive
530.200 battery, for Power drive
530.280 battery casing, for Power drive
Synthes (USA)1302 Wrights lane eastWest chester, Pa 19380telephone: (610) 719-5000to order: (800) 523-0322
www.depuysynthes.com
© dePuy Synthes trauma, a division of doI 2013. all rights reserved.J10459-c 1/14
Synthes (Canada) Ltd.2566 meadowpine boulevardmississauga, ontario l5n 6P9telephone: (905) 567-0440to order: (800) 668-1119fax: (905) 567-3185
CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.
the legal manufacturers for the uS and canada are listed below: