Clavo Expert LFN Diafisis Femur

EXPERT
Nailing System
Surgical Technique
This publication is not intended for
distribution in the USA.
Instruments and implants
approved by the AO Foundation
Expert LFN. Lateral Femoral Nail.
Image intensier control
Warning
This description alone does not provide sufcient background for direct use of
the instrument set. Instruction by a surgeon experienced in handling these
instruments is highly recommended.
Reprocessing, Care and Maintenance of
Synthes Instruments
For general guidelines, function control and dismantling of multi-part
instruments, please refer to: www.synthes.com/reprocessing
Cleaning of instruments:
For detailed information please refer to Reprocessing, Care and Maintenance
of Synthes Instruments, Article No. 035.000.090.
For more information about alternative Expert Nail Instruments, please consult
pages 6569.
Expert Lateral Femoral Nail Surgical Technique DePuy Synthes 1
TABLE OF CONTENTS
INTRODUCTION Expert LFN 2
AO Principles 4
Indications 5
Clinical Cases 6
SURGICAL TECHNIQUE Preoperative Planning 8
Open Femur 9
Insert Nail 19
Proximal Locking Standard 28
Recon (Optional) 34
Distal Locking 38
Insert End Cap 44
Implant Removal 45
PRODUCT INFORMATION Nails 51
Locking Implants 55
Instruments 59
Comparison Table 68
Handling Information 70
Set List 72
Modular Cases 72
Vario Case 76
Optional: Angular Stable Locking System (ASLS) 78
BIBLIOGRAPHY 80
Optimal t in bone
Easier insertion and extraction
2 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique
One concept, one system
Shorter learning curve
Easier surgical procedure due to streamlined
instrumentation
Cost-efciency thanks to common implants and
instruments
Expanded indications
Standard locking
femoral shaft fractures
(except subtrochanteric fractures)
Recon locking
subtrochanteric fractures
combined femoral shaft
and neck fractures
Expert Nailing System
Optimized locking implants
Advanced anatomical nail design
EXPERT LFN
OPTIMIZED ANATOMICAL DESIGN FOR IMPROVED
CLINICAL OUTCOME
Improved locking options
Higher angular stability
through multiplanar screws
Less damage of soft tissues
Improved mechanical
resistance
Easier and safer access
to entry site
Time-saving surgical
technique
Less soft tissue
damage
Lower risk of avascular
necrosis
Optimized locking implants
Better purchase in osteoporotic bone
Time-saving surgical technique
Optimal torque transmission
Cannulated end caps
Easier insertion and extraction
Self-holding Stardrive recess
Optimal lateral entry point
1
4
2
3
4_Priciples_03.pdf 1 05.07.12 12:08
AO PRINCIPLES
In 1958, the AO formulated four basic principles, which
have become the guidelines for internal xation
1, 2
.
1
Mller ME, M Allgwer, R Schneider, H Willenegger. Manual of Internal
Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991.
2
Redi TP, RE Buckley, CG Moran. AO Principles of Fracture Management.
2nd ed. Stuttgart, New York: Thieme. 2007.
Anatomic reduction
Fracture reduction and xation to
restore anatomical relationships.
Early, active mobilization
Early and safe mobilization and
rehabilitation of the injured part
and the patient as a whole.
Stable fixation
Fracture xation providing abso-
lute or relative stability, as
required by the patient, the injury,
and the personality of the
fracture.
Preservation of blood supply
Preservation of the blood supply
to soft tissues and bone by
gentle reduction techniques and
careful handling.
Standard locking indications
The Expert Lateral Femoral Nail with standard locking is
indicated for fractures in the femoral shaft:
32-A/B/C (except subtrochanteric fractures 32-A [13].1
and 32-B [13].1)
INDICATIONS
Recon locking indications
The Expert Lateral Femoral Nail with recon locking
is indicated for fractures in the femoral shaft in case of
combination with femoral neck fractures:
32-A/B/C combined with 31-B (double ipsilateral
fractures)
Additionally the Expert Lateral Femoral Nail is indicated
for fractures in the subtrochanteric section:
32-A [13].1 and 32-B [13].1
Case 1 standard locking
85 year old female
Isolated femoral shaft fracture (AO 32-A1.2)
For simple shaft fractures, two proximal and two distal
ML locking screws are normally sufcient to stabilize the
fracture. Stability of the distal fragment can be enhanced
by the use of a third locking screw in the oblique hole.
CLINICAL CASES
preoperative
follow up
(1 month after surgery)
Case 2 recon locking
49 year old male
Ipsilateral femoral neck and shaft fractures
The use of two hip screws (recon locking) ensures opti-
mal stabilization for the treatment of combined femoral
neck and shaft fractures.
The distal segment can be stabilized by using two ML
locking screws. Stability of the distal fragment can be
enhanced by the use of a third locking screw in the
oblique hole.
preoperative
follow up
(1 month after surgery)
Use the preoperative planner template for the Expert
Lateral Femoral Nail (034.000.460) to estimate nail
diameter and length.
To estimate the nail diameter, place the template on the
lateral x-ray of the uninjured femur and measure the di-
ameter of the medullary canal at the narrowest part that
will contain the nail.
To estimate the nail length, place the template on the
AP x-ray of the uninjured femur and select the appropri-
ate nail length based on patient anatomy.
Note: When selecting the nail size, consider canal
diameter, fracture pattern, patient anatomy and
post-operative protocol.
PREOPERATIVE PLANNING
1
Position patient
Position the patient supine on a fracture or radiolucent
operating table. Position the C-arm to allow visualization
of the proximal femur, the fracture and the distal femur
in both AP and lateral planes.
Alternatively, the patient can be positioned supine with
the injured leg adducted or in the lateral decubitus posi-
tion.
OPEN FEMUR
2
Reduce fracture
Instrument
394.350 Large Distractor, complete
Perform closed reduction manually by axial traction un-
der image intensier control. The use of the large dis-
tractor may be appropriate in certain circumstances.
3
Confirm nail length and diameter
Instruments
03.010.020 Radiographic Ruler for Expert Femoral
Nails
03.010.023 Radiographic Ruler for Nail Diametersfor
Expert Femoral Nails
The required nail length must be determined after re-
duction 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. Ad-
just the ruler until the proximal end is at the desired nail
insertion position. Mark the skin at the proximal end of
the ruler.
Move the C-arm to the distal femur. Align the proximal
end of the radiographic ruler to the skin mark, and take
an AP image of the distal femur. Verify fracture reduc-
tion going from proximal to the fracture to distal.
Read nail length directly from the ruler image, selecting
the measurement at or just proximal to the epiphyseal
scar, or at the chosen insertion position.
Precautions:
It is recommended that all fractures are treated
with the longest nail possible, taking into account
patient anatomy or a previous implant.
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
7mm of movement).
* Backstroke technique: with the hammer guide attached to the connector and
insertion handle (see Chapter 2 Insert Nail), light reverse hammer blows may
be used to compress the fracture; monitor reduction radiographically.
Open Femur
Alternatives
Determine the nail length by the procedure above on the
uninjured leg before draping (unsterile) or compare the
length of two identical SynReam reaming rods
B 2.5 mm (352.032) or use the Depth Gauge (351.717
and 351.719) in com bination with the SynReam Reaming
Rod B 2.5 mm, Length 950 mm (352.032).
Place the radiographic canal width estimator perpendicu-
lar to the femur axis so that the round diameter gauge is
located over the isthmus. Select the nail diameter with
which the medullary canal-to-cortex transition is still visi-
ble on both sides of the diameter gauge.
Notes:
The ruler provides only an estimate of the canal
diameter as it is not at the same level as the femur.
If the reamed technique is used, the diameter of
the largest medullary reamer applied must be
0.5mm to 1.5mm larger than the nail diameter.
4
Approach
Palpate the posterior edge of the greater trochanter.
Make a 3 cm incision in line with the central axis of the
intramedullary canal in lateral view and 2 to 5 cm proxi-
mal to the tip of the greater trochanter, depending on
the anatomy of the patient.
Open Femur
5
Determine entry point
The entry point is a determinant factor for the entire op-
eration, especially for the optimal nal position of the
Expert Lateral Femoral Nail in the medullary canal.
In AP view the entry point for the nail is approximately
10 lateral to the axis of the medullary canal. Depending
on individual anatomy it is situated slightly lateral from
the greater trochanter.
In lateral view the entry point is in line with the axis of
the intramedullary canal.
Note: To ensure a correct entry point the preopera-
tive planner template for the Expert Lateral Femoral
Nail can be used.
6
Insert guide wire
Instruments
357.399 Guide Wire B 3.2 mm, length 400 mm
393.100 Universal Chuck with T-Handle
03.010.505 Protection Sleeve 17.0 for Expert
Lateral Femoral Nail, with Quick
Coupling
and
03.010.510 Multihole Drill Guide for Protection
Sleeve 17.0, for Expert Lateral
Femoral Nail
and
03.010.500 Handle, with Quick Coupling
or
357.410 Protection Sleeve 22.0/17.0,
for No. 357.394
and
357.392 Drill Sleeve 17.0/3.2, length 161 mm,
for No. 357.410
and
357.393 Trocar B 3.2 mm, length 172 mm,
for No. 357.392
Secure the guide wire in the universal chuck.
The effective mediolateral angle of the Lateral Femoral
Nail is 10; this means that in the AP view the guide wire
must be inserted laterally to the greater trochanter at an
angle of 10 to the intended extension of the medullary
canal. Insert the guide wire for approx. 15 to 20 cm into
the medullary canal and check the position under the
image intensier.
Thread the drill sleeve into the protection sleeve and in-
sert the assembly over the guide wire through the inci-
sion to the bone.
In the lateral view, verify whether the position of the
guide wire is straight and in the center of the medullary
cavity.
Precaution: The correct entry point and angle are
essential for a successful result. To ensure the cor-
rect position of the guide wire, hold a sterile Expert
Lateral Femoral Nail onto the femur and check ra-
diographically.
Option: percutaneous technique
Insert the trocar assembly (protection sleeve, drill sleeve
and trocar) through the incision and to the bone. Lightly
mark the insertion point at a 10 angle to the shaft axis
in the AP view. Remove the trocar and insert the guide
wire through the drill sleeve for approx. 15 to 20 cm into
the medullary canal. Check the position in the AP and
lateral views under the image intensier.
7
Option: realign guide wire
Instruments
357.066 Parallel Guide for Guide Wires
B 3.2 mm
Precaution: The position of the guide wire will be
decisive for the success of the next steps. If the posi-
tion of the inserted guide wire is not optimal, it
needs to be realigned.
Slide the parallel guide over the guide wire. Direct the
parallel guide (ML/AP directions) so that the new guide
wire can be inserted at the correct entry point.
Secure a new guide wire in the universal chuck.
Press the parallel guide rmly to the bone and insert the
wire through the free sleeve of the parallel guide.
Verify the correct position of the new guide wire in both
views.
Remove the parallel guide and the rst guide wire.
Note: This instrument facilitates the realignment of
a guide wire as it uses the frst wire as reference for
the positioning of the new one.
Open Femur
8
Open medullary canal
Instruments
03.010.505 Protection Sleeve 17.0,
with Quick Coupling
and
03.010.500 Handle, with Quick Coupling
or
357.410 Protection Sleeve 22.0/17.0 mm,
for No.357.394
03.010.165 Drill Bit B 15.0 mm, cannulated,
exible,
length 250 mm
exible,
length 250 mm
Remove the drill sleeve.
Alternative instruments
03.010.028 Drill Bit 15.0 mm, cannulated,
length 300 mm, 3-ute
03.010.029 Drill Bit 17.0 mm, cannulated,
length 280 mm
Secure the exible cannulated drill bit with the DHS
quick coupling and guide it over the guide wire through
the protection sleeve to the bone. Drill the medullary ca-
nal as far as the stop on the protection sleeve. Move the
drill bit continuously backwards and forwards to clear
the debris from the medullary cavity and to avoid jam-
ming.
Use image intensier control while drilling the medullary
canal.
Remove the drill bit, the protection sleeve and the guide
wire.
Note: The drill bit B 15.0mm is suitable for nails
with diameters from 9.0 to 12.0mm and drill bit
B 17.0mm for nails with diameters from 13.0 to
16.0mm.
Precaution: In case of small or diffcult anatomy use
the fexible drill bit in order to avoid damage to the
far cortex.
Open medullary canal with awl
Instruments
03.010.041 Awl B 14.0/3.2 mm, cannulated
Remove the protection sleeve and the drill sleeve.
Place the cannulated awl B 14.0 mm over the guide
wire and open the medullary canal. Use a twisting mo-
tion to advance the awl to a depth of approximately
10 cm.
Remove the awl and the guide wire.
Open Femur
9
Option: ream medullary canal
Instruments
189.060/ SynReam Intramedullary
175.500 Reaming System
351.782 Holding Forceps for Reaming Rods
03.010.093 Alternative: Rod Pusher for Reaming
Rod with Hexagonal Screwdriver
B 8.0 mm
If necessary, enlarge the femoral canal with the medul-
lary reamer to the desired diameter.
Check fracture reduction under image intensier.
Insert reaming rod
Insert the SynReam reaming rod into the medullary canal
to the desired insertion depth. The tip must be correctly
positioned in the medullary canal since it determines the
nal distal position of the Expert Lateral Femoral Nail.
Reaming
Starting with the 8.5 mm diameter reaming head, ream
to a diameter of 0.5 to 1.5 mm greater than the nail di-
ameter. 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 medullary canal.
Use the holding forceps to retain the reaming rod while
reaming and to prevent it from rotating.
Option
The length of the nail can be measured with two identi-
cal reaming rods using the overlapping method.
Use the rod pusher to help retain the reaming rod during
reamer extraction.
Note: All Expert Lateral Femoral Nails are cannu-
lated and can be inserted over the SynReam ream-
ing rod. Reaming rod exchange is not required.
Open Femur
1
Assemble insertion instruments
Instruments
03.010.486 Insertion Handle, radiolucent,
length 100 mm
and
03.010.146 Connecting Screw, cannulated, with
Internal M6x1 Thread
or
03.010.045 Insertion Handle, for Expert Tibial and
Femoral Nails
and
03.010.044 Connecting Screw, cannulated,
for Expert Tibial and Femoral Nails,
for No. 03.010.045
or
03.010.046 Insertion Handle, long, for Expert
Femoral Nails
and
03.010.092 Screwdriver, Hexagonal with
Spherical Head B 8 mm
or
03.010.517 Screwdriver, hexagonal with spherical
head B 8.0 mm, with T-Handle
Orient the insertion handle laterally towards the nail, and
match the notch of the handle to the nail.
Place the connecting screw into the insertion handle and
thread it into the proximal nail end using the screwdriver.
Note: The anatomical design of the 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 cor-
rectly tightened. Do not over-tighten.
INSERT NAIL
Optional instrument
03.010.093 Rod Pusher for Reaming Rod with
Hexagonal Screwdriver B 8.0 mm
Optionally, slide the connecting screw onto the rod
pusher. Slide the assembly through the insertion handle
and match the notch of the handle to the nail. Tighten
using the rod pusher. Do not over-tighten.
Insert Nail
2
Insert nail
Instruments
length 100 mm
and
or
03.010.045 Insertion Handle, for Expert Tibial and
Femoral Nails
and
for Expert Tibial and Femoral Nails,
for No. 03.010.045
or
03.010.046 Insertion Handle, long,
for Expert Femoral Nails
and
Orient the insertion handle anteriorly to insert the nail
into the medullary canal.
Use slight twisting motions to advance the nail.
Monitor nail passage across the fracture, and control in
two planes to avoid malalignment.
Insert the nail until it is at or below the femoral opening.
Check the nal nail position in AP and lateral views.
Note: The nail rotates approximately 90 during in-
sertion. The insertion handle rotates from anterior
to lateral during insertion of the last one-third of
the nail length.
Precautions:
If the nail does not rotate to the lateral position,
remove the nail and reinsert
Mount the aiming arm for proximal locking only
when the nail has been completely inserted.
Note: The Lateral Femoral Nail can be passed over
the SynReam Reaming Rod without use of the ex-
change tube.
Insert Nail
Optional instruments
03.010.523 Driving Cap with thread,
for Insertion Handle
and
03.010.522 Combined Hammer, 500 g
and
03.010.170 Hammer Guide
or
03.010.047 Connector, for Insertion Handle
and
03.010.056 Combined Hammer 700 g,
can be mounted, for No. 357.220
and
357.220 Hammer Guide, for No. 357.250
321.160 Combination Wrench B 11 mm
321.170 Pin Wrench B 4.5 mm, length 120 mm
If necessary, use light hammer blows to insert the nail.
Slide the connector into the medial grooves on the inser-
tion handle (use the lateral position only when the pa-
tient anatomy requires this) and secure it in place using
the combination wrench.
Lock the head of the combined hammer in place by
tightening the nut onto the threads located below the
hammer head using the pin wrench if necessary. Strike
the connector directly.
Remove the connector.
Optionally, the hammer guide can be threaded into the
connector and the hammer can be used as a slide ham-
mer. Loosen the nut away from the threads located be-
low the hammer head and secure onto the threads lo-
cated above the handle.
Remove the hammer guide and the connector.
Precautions:
If nail insertion is diffcult, choose a smaller di-
ameter nail or ream the intramedullary canal to a
larger diameter.
Do not hammer directly onto the insertion handle.
Especially after hammering, confrm that the nail
is securely connected to the insertion handle. Re-
tighten if necessary.
Insert Nail
Alternatives
Compression
It is recommended to close fracture gaps in order to de-
crease the incidence of non-union or malunion.
If compression is planned, over-insert the nail to com-
pensate for backstriking the nail: the nal position of the
nail should be ush with the trochanteric cortex.
First lock distally and then use the hammer guide and
the slide hammer to backstrike the nail under image in-
tensication.
Precaution: Do not hammer directly on the connec-
tor or on the aiming arm.
Dynamization
If dynamization is planned, it is recommended to over-in-
sert the nail by more than 7 mm (maximum distance be-
tween positions in static and dynamic modes).
Recon locking (optional)
If Recon locking is planned, insert the nail to a depth
that allows centering of two recon screws in the femoral
neck.
AP view: to ensure the correct position of the screws,
hold two guide wires on the grooves in the insertion
handle and check radiographically.
Lateral view: rotate the handle until it bisects the femo-
ral head within the lateral view.
Insert Nail
20 mm
15 mm
10 mm
5 mm
3
Check proximal nail position
Instruments
03.010.097 Aiming Arm for Expert Lateral Femoral
Nail
or
03.010.482 Aiming Arm, radiolucent,
for Expert Lateral Femoral Nail
Attach the aiming arm to the insertion handle and insert
a guide wire in the hole as shown in the illustration. The
tip of the guide wire indicates the exact proximal posi-
tion of the nail. Check nal nail position under image in-
tensication in AP and lateral views.
Remove the aiming arm when distal locking is the next
step.
Note: The distance between the markings on the in-
sertion handle is 5mm and corresponds to the ex-
tensions of the end caps. This feature can be used
for over-insertion of the nail or for correcting the
nail length.
1
a
c
b
2
1
Locking options
There are three standard locking positions:
1. The 120 antegrade locking option allows static lock-
ing.
2. The dynamic locking option (DYN) corresponds to the
proximal position of the standard locking slot.
3. The static locking option (STAT) corresponds to the
distal position of the standard locking slot.
PROXIMAL LOCKING
STANDARD
Proximal standard locking options:
a For sufcient proximal static locking, always use the
120 antegrade locking option together with the
transverse static screw.
b For immediate primary dynamization, insert only one
proximal locking screw through the dynamic slot.
c For secondary dynamization use both the dynamic
and the 120 antegrade locking positions.
2
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.
Nail diameter Locking screw Protection sleeve Drill sleeve Trocar Drill bit
B 913 mm
(light green)
B 5.0 mm
(light green)
12.0/8.0 mm
03.010.063
(no color)
8.0/4.2 mm
03.010.065
(green)
B 4.2 mm
03.010.070
(green)
B 4.2 mm
03.010.061
(green)
B 1416 mm
(aqua)
B 6.0 mm
(aqua)
12.0/8.0 mm
03.010.063
(no color)
8.0/5.0 mm
03.010.066
(no color)
B 5.0 mm
03.010.071
(no color)
B 5.0 mm
03.010.062
(no color)
3
Insert trocar combination
Instruments
03.010.097 Aiming Arm for Expert Lateral Femoral
Nail
or
03.010.482 Aiming Arm, radiolucent, for
Expert Lateral Femoral Nail
03.010.063 Protection Sleeve 12.0/8.0,
length 188 mm
03.010.065 Drill Sleeve 8.0/4.2, for No. 03.010.063
or
03.010.070 Trocar B 4.2 mm, for No. 03.010.065
or
03.010.071 Trocar B 5.0 mm, for No. 03.010.066
Conrm that the insertion handle is securely connected
to the nail and attach the aiming arm to the insertion
handle.
Insert the three-part trocar combination (protection
sleeve, corresponding drill sleeve and trocar) through the
desired ML hole marked green/aqua in the aiming arm,
make a stab incision and insert the trocar to the bone.
Remove the trocar.
Precaution: Do not exert force on the aiming arm,
protection sleeve, drill sleeve and trocar. This force
may prevent accurate targeting through the proxi-
mal locking holes and damage the drill bits.
Proximal Locking
Standard
4
Drill and determine locking screw length
Instruments
03.010.061 Drill Bit B 4.2 mm, calibrated,
length 340 mm, 3-ute, for
Quick Coupling, for No. 03.010.065
or
length 340 mm, 3-ute, for
Quick Coupling, for No. 03.010.066
Use the corresponding drill bit (B 4.2 mm for B 5.0 mm
locking screws or B 5.0 mm for B 6.0 mm locking
screws) to drill through both cortices until the tip of the
drill bit just penetrates the far cortex.
Conrm drill bit position after drilling both cortices.
Ensure that the drill sleeve is pressed rmly to the lateral
cortex and read the measurement corresponding to the
appropriate length of the locking screw at the back of
the drill sleeve. Remove the drill bit and the drill sleeve.
Precaution: A correct end position of the drill sleeve
is important in order to choose the correct length of
the locking screw.
Alternative instrument
03.010.072 Depth Gauge for Locking Screws,
measuring range up to 110 mm,
for No. 03.010.063
or
measuring range to 110 mm
After both cortices are drilled, remove the drill bit and
the drill sleeve.
Disassemble the depth gauge into 2 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 protec-
tion sleeve is rmly pressed against the lateral cortex.
Read the measurement from the back of the protection
sleeve, which corresponds to the appropriate length of
the locking screw.
Precaution: A correct end position of the protection
sleeve is important in order to choose the correct
length of the locking screw.
Proximal Locking
Standard
5
Insert locking screws
Instruments
03.010.107 Screwdriver Stardrive, T25,
length 330 mm
or
self-holding, length 320 mm
Insert the appropriate locking screw through the protec-
tion sleeve using the screwdriver Stardrive T25. Verify
the position of the locking screw under image intensier.
The tip of the locking screw should not project more
than 1 to 2 mm beyond the medial far cortex.
Note: A groove on the screwdriver indicates when
the locking screw is fully inserted.
Repeat steps 3 to 5 for the second proximal standard
locking screw.
Note: If using 120 antegrade locking option, insert
the trocar combination through the hole labeled
120 on the insertion handle.
Proximal Locking
RECON (OPTIONAL)
1
Check nail position
Instruments
03.010.097 Aiming Arm for Expert Lateral
Femoral Nail
or
Conrm that the insertion handle is securely connected
to the nail and attach the aiming arm to the insertion
handle.
In the AP view adjust the nail insertion depth to ensure
that the two recon screws can be placed into the femo-
ral neck. The position of the nail can be veried by plac-
ing two guide wires onto the aiming arm and checking
radiographycally.
Ensure the correct anteversion of the implant in the lat-
eral view. To improve visability, insert an additional guide
wire into the femoral head on the ventral side of the
femoral neck.
Precaution: Adjusting for the correct anteversion be-
fore making a skin incision is crucial to allow un-
complicated guide wire and screw insertion.
2
Insert guide wires for hip screws
Instruments
03.010.075 Protection Sleeve 11.5/8.5, for Expert
LFN Reconstruction Locking
03.010.077 Trocar B 3.2 mm, for No. 03.010.076
Insert both yellow three-part trocar combinations (pro-
tection sleeve, drill sleeve and trocar) through the yellow
marked holes in the aiming arm, make a stab incision
and insert the trocars to the bone.
Remove the caudal trocar.
Insert a guide wire subchondrally into the femoral head.
Check guide wire placement radiographically in both
planes.
Remove the cranial trocar.
Insert the second guide wire subchondrally into the fem-
oral head. Check the guide wire placement radiographi-
cally in both AP and lateral views.
Precautions:
Verify in the AP view the guide wires are straight,
and in the lateral view that they are in the center
of the femoral neck.
Do not exert force on the aiming arm, protection
sleeves, drill sleeves and trocars. This force may
prevent accurate targeting through the proximal
locking holes and damage the drill bits.
Proximal Locking
Recon (Optional)
3
Determine length and drill for caudal hip screw
Instruments
03.010.493 Direct Measuring Device for Guide
Wires 3.2 mm, length 400 mm
or
03.010.085 Direct Measuring Device for Guide
Wires B 3.2 mm, length 400 mm
03.010.078 Reamer B 4.5/6.5 mm, length 450 mm,
for Hip Screws Expert Lateral
Femoral Nail
03.010.079 Fixation Sleeve for No. 03.010.078
It is recommended that you start with the insertion of
the caudal hip screw.
Remove the drill sleeve and insert the direct measuring
device over the guide wire into the protection sleeve to
the bone. Read the length of the required hip screw di-
rectly on the measuring device.
Remove the measuring device and the caudal guide
wire.
Note: The determined length indicates the effective
screw length.
Set the previously measured length for the screw on the
reamer by xing the xation sleeve in the corresponding
position. Read off the correct length on the side of the
xation sleeve pointing towards the tip of the reamer.
Guide the reamer through the protection sleeve to the
bone and drill to the stop. The xed xation sleeve pre-
vents further drilling.
Precaution: Secure so that the locking mechanism is
engaged in the locking grooves of the drill.
4
Insert caudal hip screw
Instrument
length 380 mm
or
Insert the appropriate hip screw through the protection
sleeve into the femoral head using the longer screw-
driver Stardrive T25. Verify the position of the locking
screw under image intensication in both planes.
Note: A groove on the screwdriver indicates when
the locking screw is fully inserted.
Repeat steps 3 and 4 for the second more cranial
hip screw.
DISTAL LOCKING
1
Choose locking screws and instruments
Use the appropriate locking screws and drill bit for the
nail diameter selected:
Nail diameter Locking screw Drill bit
B 913 mm B 5.0 mm B 4.2 mm
(light green) (light green) 03.010.101*
or 03.010.104
B 1416 mm B 6.0 mm B 5.0 mm
(aqua) (aqua) or 03.010.105
* For radiolucent drive
It is recommended that you lock distally rst, enabling
the use of the backstroke technique to prevent diastasis.
Verify that the nail has been inserted to the appropriate
depth.
2
Align image
Check reduction, correct alignment of the fragments
and leg length before locking the nail.
Align the C-arm with the hole in the nail until a perfect
circle is visible in the center of the screen.
3
Determine incision point
Place a scalpel blade on the skin over the center of the
hole to mark the incision point and make a stab incision.
Distal Locking
4
Drill
Instrument
03.010.061 Drill Bit 4.2 mm, calibrated,
length 340 mm, 3-ute,
for Quick Coupling, for No. 03.010.065
or
03.010.062 Drill Bit 5.0 mm, calibrated,
for Quick Coupling
Using the radiolucent drive (511.300), under image inten-
sication, insert the tip of the appropriate drill bit
through the incision down to the bone.
Incline the drive in order that the tip of the drill bit is
centered over the locking hole. The drill bit should al-
most completely ll the circle of the locking hole. Hold
the drill bit in this position and drill through both corti-
ces until the tip of the drill bit penetrates the medial far
cortex.
Tip: For greater drill bit control, discontinue drill
power after perforating the near cortex. Manually
guide the drill bit through the nail before drilling
the far cortex.
03.010.101 Drill Bit B 4.2 mm, calibrated, length
145 mm, 3-ute, with Coupling for RDL
or
03.010.102 Drill Bit B 5 mm, calibrated,length
145 mm, 3-ute, with Coupling for RDL
or
145 mm, 3-ute, for Quick Coupling
or
145 mm, 3-ute, for Quick Coupling
Standard freehand locking technique can be performed
without the radiolucent drive. Use the appropriate drill
bit shown in the table above.
5
Determine length of the locking screw
Instrument
measuring range to 110 mm
or
for No. 03.010.063
Measure the locking screw length using the depth
gauge. Ensure that the outer sleeve is in contact with the
bone and the hook grasps the far cortex.
Read the screw length directly from the measuring de-
vice at the back of the outer sleeve.
Distal Locking
Alternative instrument
03.010.429 Direct Measuring Device for Drill Bits,
length 145 mm
or
03.010.106 Direct Measuring Device for Drill Bits
of length 145 mm,
for Nos. 03.010.10003.010.105
Stop drilling immediately after both cortices are pene-
trated and disassemble the drill bit from the radiolucent
drive. Ensure the correct position of the drill bit beyond
the far cortex.
Place the direct measuring device onto the drill bit. Read
the measurement on the measuring device at the end of
the drill bit.
Precaution: This corresponds to the appropriate
locking screw length.
Precaution: The end position of the drill bit beyond
the far cortex, as well as the correct position of the
measuring device, is important in order to choose
the optimal locking screw length.
6
Insert locking screw
Instruments
or
length 330 mm

03.010.112 Holding Sleeve, with Locking Device
or
03.010.472 Inter-Lock Screwdriver,
combined, Stardrive, T25 /
hexagonal B 3.5, length 330 mm
Insert the locking screw with the appropriate length us-
ing the screwdriver Stardrive T25 and the holding sleeve,
if required.
Verify the screw length under image intensication. The
screw tip should be about 2 mm outside of the cortex.
Exchange the locking screw with the appropriate length
if necessary.
Use the holding sleeve:
a Insert the holding sleeve onto the shaft of the screw-
driver and place the tip of the screwdriver in the re-
cess 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 counter-clock-
wise.
d Release the holding sleeve after insertion of the lock-
ing screw by loosening it clockwise and pushing back-
wards.
Repeat steps 2 to 6 for the second and third locking
screws.
Technique tip: In the event of diastasis, the back-
stroke technique can be used after insertion of the
second distal locking screw.
INSERT END CAP
1
Insert end cap
Instruments
03.010.520 Screwdriver Stardrive, T40, with
spherical head, cannulated,
length 280 mm
or
03.010.110 Screwdriver Stardrive, T40, cannulated,
length 300 mm
The end caps for the Expert Lateral Femoral Nails are
available in extension lengths from 0 to 20 mm as
shown in the table.
End caps fulll two functions: they prevent bone in-
growth into the nail; and they extend the nail height if it
is over-inserted.
Remove the insertion handle, the aiming arm and the
connecting screw.
The end caps are cannulated for use over a guide wire if
necessary. Insert the guide wire into the proximal end of
the nail. Engage the end cap with the screwdriver
Stardrive T40 by exerting axial pressure. To minimize the
chance of cross threading turn the end cap counter-
clockwise until the thread of the end cap aligns with
that of the nail. Then turn the end cap clockwise to
thread it into the nail.
Remove the screwdriver and the guide wire.
Nail diameter End Cap extension: 0 mm 5 mm 10 mm 15 mm 20 mm
B 912 mm (grey) 04.003.000 04.003.001 04.003.002 04.003.003 04.003.004
B 1316 mm (grey) 04.003.000 04.003.006 04.003.007 04.003.008 04.003.009
Nail diameter End Cap extension: 0 mm 5 mm 10 mm 15 mm 20 mm
B 912 mm (grey) 04.003.000 04.003.001 04.003.002 04.003.003 04.003.004
B 1316 mm (grey) 04.003.000 04.003.006 04.003.007 04.003.008 04.003.009
IMPLANT REMOVAL
1
Remove end cap and locking screws
Instruments
with spherical head, cannulated,
length 280 mm
or
length 300 mm
03.010.518 Screwdriver Stardrive, T25, self-holding,
length 320 mm
or
length 330 mm

03.010.472 Inter-Lock Screwdriver, combined,
Stardrive, T25 / hexagonal
B 3.5, length 330 mm
or
Implant removal is an optional procedure.
Clear the Stardrive socket of the end cap and the locking
implants 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.
Remove all locking screws except one of the proximal
locking screws using the screwdriver Stardrive T25 and
the holding sleeve.
2
Remove nail
Instruments
03.010.522 Combined Hammer, 500 g
and
03.010.170 Hammer Guide
or
and
03.010.000 Extraction Screw, for Tibial and
Femoral Nails
length 330 mm
or
length 320 mm
Before removing the nal locking screw, attach the ex-
traction screw to the nail and tighten it to prevent rota-
tion or displacement of the nail. Attach the hammer
guide to the extraction screw.
Remove the remaining locking screw with the screw-
driver Stardrive T25.
Extract the nail by applying gentle blows with
the hammer.
Note: The nail will rotate about 90, analogous to the
movement during the insertion.
Implant Removal
Alternative Technique Extraction Hook
For removal of broken nail
Instruments
355.399* Extraction Hook 3.7 mm,
for Cannulated Nails
Begin with Steps 1 and 2 of Implant Removal, then re-
move the extraction screw from the nail.
*Available nonsterile or sterile-packed.
Add S to catalog number to order sterile product.
Alternative Technique Extraction Hook
For removal of broken nail
Instruments
355.399* Extraction Hook 3.7 mm,
or
393.105 Universal Chuck, small, with T-Handle
Begin with Steps 1 and 2 of Implant Removal, then remove
the extraction screw from the nail.
*Available nonsterile or sterile-packed.
Add S to catalog number to order sterile product.
Implant Removal
54 Synthes Expert A2FN Technique Guide
Option 1
1
Assemble 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.
2
Insert extraction hook through nail
Pass the extraction hook through the cannula of the nail,
including the distant fragment.
Precaution: Under image intensifcation, verify that
the hook has passed through and engaged the dis-
tant end of the nail.
3
Extract nail
Extract both nail fragments.
Technique Tip: Keep the patients limb restrained to
increase the effciency of the extraction force.
Implant Removal
Option 2
1
Remove 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.
Technique Tip: The extraction hook can be used as
an alternative to extraction instrumentation.
2
Ream canal
Ream the medullary canal 1 mm larger than the nail dia-
meter to clear a path for the distant nail fragment.
3
Align extraction hook
Insert the extraction hook and explanted near nail frag-
ment into the medullary canal. The near nail fragment
aligns the extraction hook with the cannulation of the
distant nail fragment.
4
Engage distant fragment
Pass the extraction hook through the cannula of the dis-
tant nail fragment.
Precaution: Under image intensifcation, verify that
the hook has passed through and engaged the dis-
tant end of the nail
5
Extract nail
Technique tip: Keep the patients limb restrained to
increase the effciency of the extraction force.
4
Engage distant fragment
Pass the extraction hook through the cannula of the distant
nail fragment.
Precaution: Under image intensification, verify that the
hook has passed through and engaged the distant end of
the nail
5
Extract nail
Technique Tip: Keep the patients limb restrained to increase
the efficiency of the extraction force.
Synthes 57
Implant Removal
NAILS
Anatomical design with left and right nails
Material: Ti-6Al-7Nb (TAN)
Diameters: 916 mm (1 mm increments)
912 mm nails have a proximal
diameter of 13.5 mm
316 mm nails have a proximal
diameter of 16 mm
Colors: 913 mm (light green) use locking
screws B 5.0 mm (light green)
1416 mm (aqua) use locking screws
B 6.0 mm (aqua)
Lengths: 300480 mm (20 mm increments)
Cannulation: All nails are cannulated.
In the Vario Case for Lateral Femoral Nails (68.003.000
for right nails; 68.003.001 for left nails) space is pro-
vided for 40 nails (20 right and 20 left nails, each space
is available to all diameters and lengths).
* Available non-sterile or sterile packed. Add S to the
article number to order sterile products.
Length
mm
B 9 mm, right*
light green
B 9 mm, left*
light green
300 04.003.240 04.003.241
320 04.003.244 04.003.245
340 04.003.248 04.003.249
360 04.003.252 04.003.253
380 04.003.256 04.003.257
400 04.003.260 04.003.261
420 04.003.264 04.003.265
440 04.003.268 04.003.269
460 04.003.272 04.003.273
480 04.003.276 04.003.277
Length
mm
B 10 mm, right*
light green
B 10 mm, left*
light green
300 04.003.340 04.003.341
320 04.003.344 04.003.345
340 04.003.348 04.003.349
360 04.003.352 04.003.353
380 04.003.356 04.003.357
400 04.003.360 04.003.361
420 04.003.364 04.003.365
440 04.003.368 04.003.369
460 04.003.372 04.003.373
480 04.003.376 04.003.377
Nails
Length
mm
B 11 mm, right*
light green
B 11 mm, left*
light green
300 04.003.440 04.003.441
320 04.003.444 04.003.445
340 04.003.448 04.003.449
360 04.003.452 04.003.453
380 04.003.456 04.003.457
400 04.003.460 04.003.461
420 04.003.464 04.003.465
440 04.003.468 04.003.469
460 04.003.472 04.003.473
480 04.003.476 04.003.477
Length
mm
B 12 mm, right*
light green
B 12 mm, left*
light green
300 04.003.540 04.003.541
320 04.003.544 04.003.545
340 04.003.548 04.003.549
360 04.003.552 04.003.553
380 04.003.556 04.003.557
400 04.003.560 04.003.561
420 04.003.564 04.003.565
440 04.003.568 04.003.569
460 04.003.572 04.003.573
480 04.003.576 04.003.577
Length
mm
B 13 mm, right*
light green
B 13 mm, left*
light green
300 04.003.640 04.003.641
320 04.003.644 04.003.645
340 04.003.648 04.003.649
360 04.003.652 04.003.653
380 04.003.656 04.003.657
400 04.003.660 04.003.661
420 04.003.664 04.003.665
440 04.003.668 04.003.669
460 04.003.672 04.003.673
480 04.003.676 04.003.677
* Available non-sterile or sterile packed. Add S to the article number
to order sterile products.
Length
mm
B 14 mm, right*
aqua
B 14 mm, left*
aqua
300 04.003.740S 04.003.741S
320 04.003.744S 04.003.745S
340 04.003.748S 04.003.749S
360 04.003.752S 04.003.753S
380 04.003.756S 04.003.757S
400 04.003.760S 04.003.761S
420 04.003.764S 04.003.765S
440 04.003.768S 04.003.769S
460 04.003.772S 04.003.773S
480 04.003.776S 04.003.777S
Length
mm
B 15 mm, right*
aqua
B 15 mm, left*
aqua
300 04.003.840S 04.003.841S
320 04.003.844S 04.003.845S
340 04.003.848S 04.003.849S
360 04.003.852S 04.003.853S
380 04.003.856S 04.003.857S
400 04.003.860S 04.003.861S
420 04.003.864S 04.003.865S
440 04.003.868S 04.003.869S
460 04.003.872S 04.003.873S
480 04.003.876S 04.003.877S
Length
mm
B 16 mm, right*
aqua
B 16 mm, left
aqua
300 04.003.940S 04.003.941S
320 04.003.944S 04.003.945S
340 04.003.948S 04.003.949S
360 04.003.952S 04.003.953S
380 04.003.956S 04.003.957S
400 04.003.960S 04.003.961S
420 04.003.964S 04.003.965S
440 04.003.968S 04.003.969S
460 04.003.972S 04.003.973S
480 04.003.976S 04.003.977S
* These diameters are available only sterile packed.
Nails
LOCKING IMPLANTS
Locking Screw B 5.0mm
Used for standard proximal locking and for distal locking
(nails B 913 mm)
Drill: B 4.2 mm
Color: Light green
85100 mm (5 mm increments)
Design: 4.3 mm core diameter
Stardrive T25 recess (self-holding)
Fully threaded
Self-tapping, blunt tip
Double lead
Length
mm
B 5.0 mm*
light green
Length
mm
B 5.0 mm*
light green
26 04.005.516 58 04.005.548
28 04.005.518 60 04.005.550
30 04.005.520 62 04.005.552
32 04.005.522 64 04.005.554
34 04.005.524 66 04.005.556
36 04.005.526 68 04.005.558
38 04.005.528 70 04.005.560
40 04.005.530 72 04.005.562
42 04.005.532 74 04.005.564
44 04.005.534 76 04.005.566
46 04.005.536 78 04.005.568
48 04.005.538 80 04.005.570
50 04.005.540 85 04.005.575
52 04.005.542 90 04.005.580
54 04.005.544 95 04.005.585
56 04.005.546 100 04.005.590
* Available non-sterile or sterile packed. Add S to the article number to order
sterile products.
In the Vario Case for the Expert Femoral Nails Locking Implants (68.003.010),
space is provided for two locking screws B 5.0 mm per length.
Locking Screws B 6.0mm
Used for standard proximal locking and for distal locking
(nails B 1416 mm)
Drill: B 5.0 mm
Color: Aqua
85100 mm (5 mm increments)
Design: 4.8 mm core diameter
Fully threaded
Double lead
Length
mm
B 6.0 mm*
aqua
Length
mm
B 6.0 mm*
aqua
26 04.005.616 58 04.005.648
28 04.005.618 60 04.005.650
30 04.005.620 62 04.005.652
32 04.005.622 64 04.005.654
34 04.005.624 66 04.005.656
36 04.005.626 68 04.005.658
38 04.005.628 70 04.005.660
40 04.005.630 72 04.005.662
42 04.005.632 74 04.005.664
44 04.005.634 76 04.005.666
46 04.005.636 78 04.005.668
48 04.005.638 80 04.005.670
50 04.005.640 85 04.005.675
52 04.005.642 90 04.005.680
54 04.005.644 95 04.005.685
56 04.005.646 100 04.005.690
sterile products.
In the Vario Case for the Expert Femoral Nails Locking Implants
(68.003.010), space is provided for two locking screws B 6.0 mm per
length (requires optional screw rack 68.003.010.06).
Locking Implants
Hip Screw B 6.5mm
Used for recon locking (all nails)
Drill: B 6.5/4.5 mm
Color: Gold
Design: 6.5 mm shaft diameter/
4.5 mm core diameter
Thread length 30 mm
Length
mm
B 6.5 mm*
gold
Length
mm
B 6.5 mm*
gold
60 04.003.022 100 04.003.030
65 04.003.023 105 04.003.031
70 04.003.024 110 04.003.032
75 04.003.025 115 04.003.033
80 04.003.026 120 04.003.034
85 04.003.027 125 04.003.035
90 04.003.028 130 04.003.036
95 04.003.029
* Available non-sterile or sterile packed. Add S to the catalogue number to
order sterile products.
In the Vario Case for the Expert Femoral Nails Locking Implants (68.003.010),
space is provided for two hip pin screws B 6.5 mm per length (requires
optional module 685.132)
End Caps
Used to protect nail threads from tissue ingrowth)
Color: Grey
Diameters: 12 mm for nails B 912 mm
16 mm for nails B 1316 mm
Lengths: 0 mmsits ush with end of nail
5, 10, 15 and 20 mm extensions
extend nail height if nail is overinserted
Cannulation: All end caps are cannulated
Design: Stardrive T40 recess (self-holding)
sterile products.
Extensions mm B 12 mm* B 16 mm*
0 04.003.000 04.003.000
5 04.003.001 04.003.006
10 04.003.002 04.003.007
15 04.003.003 04.003.008
20 04.003.004 04.003.009
Locking Implants
INSTRUMENTS
Standard instruments
321.160 Combination Wrench B 11.0 mm
321.170 Pin Wrench B 4.5 mm, length 120 mm
357.398 Shaft, hexagonal, B 8.0 mm,
cannulated, short, length 125 mm
03.010.000 Extraction Screw, for Tibial and
Femoral Nails
03.010.020 Radiographic Ruler for Femoral Nails
for Quick Coupling, for No. 03.010.065
03.010.023 Radiographic Ruler for Medullary Nails,
length 365 mm
length 188 mm
03.010.070 Trocar B 4.2 mm, for No. 03.010.065
Instruments
03.010.165 Flex. Drill Bit cannulated B 15.0 mm
for No. 03.010.063
length 100 mm
03.010.497 Cam-Lock Lever for Aiming Arm
Expert Lateral Femoral Naill
03.010.500 Handle, with Quick Coupling for
Protection Sleeves
Note: Do not use standard instruments together with
alternative instruments without contacting your
Synthes representative frst.
03.010.505 Protection Sleeve 17.0 for
Expert Lateral Femoral Nail, with
Quick Coupling
03.010.510 Multihole Drill Guide for
Protection Sleeve 17.0, for
03.010.523 Driving Cap with thread,
for Insertion Handle
03.010.517 Screwdriver, hexagonal B 8.0 mm,
with T-Handle, with spherical head,
length 322 mm
length 320 mm
with spherical head, cannulated,
length 280 mm
03.010.522 Combined Hammer 500 g, mountable,
for No. 357.220
Instruments
357.066 Parallel guide for guide wires B 3.2 mm
355.399 Extraction Hook 3.7 mm,
for Quick Coupling
03.010.019 Distal Depth Gauge for
Locking screw, short
03.010.001 Extraction Screw, for Tibial and Femoral
Nails, for No. 516.100
03.010.041 Awl B 14.0/3.2 mm, cannulated
Note: Do not use standard instruments together with
alternative instruments without contacting your
Synthes representative frst.
for LFN Reconstruction Locking
03.010.077 Trocar B 3.2 mm, for No. 03.010.076
03.010.078 Reamer B 4.5/6.5 mm, length 450 mm,
for Hip Screws LFN
03.010.079 Fixation Sleeve, for No. 03.010.078
03.010.093 Rod Pusher for Reaming Rod with
Hexagonal Screwdriver B 8.0 mm
03.010.071 Trocar B 5.0 mm
03.010.167 Flex. Drill Bit cannulated B 17.0 mm
for Quick Coupling
length 145 mm
03.010.429 Direct Measuring Device for Drill Bits,
length 145 mm, for Nos. 03.010.100 to
03.010.105
with Coupling for RDL
03.010.102 Drill Bit B 5.0 mm, calibrated
Instruments
03.010.493 Direct Measuring Device for
Guide Wires B 3.2 mm, length 400 mm
Stardrive, T25 / hexagonal B 3.5,
length 250 mm
03.010.491 Handle for Scalpel, long
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
length 250 mm
03.010.515 Inter-Lock Screwdriver Stardrive, T40,
length 380 mm
length 440 mm
Stardrive, T25 / hexagonal B 3.5,
length 330 mm
357.392 Drill Sleeve 17.0/3.2, length 161 mm,
for No. 357.410
357.393 Trocar B 3.2 mm, length 172 mm,
for No. 357.392
357.410 Protection Sleeve 22.0/17.0,
for No. 357.394
357.117 Hammer Guide for DFN, for No.
357.026
length 300 mm, 3-ute
for Tibial and Femoral Nails,
for No. 03.010.045
03.010.045 Insertion Handle, for Tibial and Femoral
Nails
* Alternative Instrument for 03.010.044
**Alternative Instrument for 03.010.045
length 280 mm
Instruments
03.010.046 Insertion Handle for Percutaneous
Insertion**
03.010.047 Connector, for Insertion Handle
for No. 03.010.063
03.010.085 Direct Measuring Device for
Guide Wires
B 3.2 mm, length 400 mm
03.010.092 Screwdriver, hexagonal with spherical
head B 8.0 mm
03.010.097 Aiming Arm for LFN
03.010.106 Direct Measuring Device for Drill Bits of
length 145 mm, for Nos. 03.010.100
to 03.010.105
length 330 mm
length 380 mm
cannulated, length 300 mm
Standard Article Alternative Article

03.010.505

03.010.510

03.010.500

357.410

357.392

357.393

03.010.486

03.010.146

03.010.523

03.010.046

03.010.146

03.010.047
03.010.482 03.010.097
Instruments
COMPARISON TABLE


03.010.493 03.010.085
03.010.517 03.010.092
03.010.518 03.010.107
03.010.519 03.010.108
03.010.520 03.010.110
03.010.522 03.010.056
03.010.170 357.220
03.010.428 03.010.072
03.010.429 03.010.106
03.010.472
03.010.107

03.010.112

Instruments
HANDLING INFORMATION
Insertion Handle
03.010.486
Radiolucent
Attachment for driving cap with threaded end
(03.010.523)
Inter-Lock Screwdriver
Compatible with all Synthes T25 or 3.5 mm hexagonal
recess. For further information, please refer to brochure
036.001.581.
Tear drop shape
Silicon handle
Precaution: When removing implants after long-
term implantation, especially in the presence of
Scalpel Handle
(03.010.491)
For channel cutting to minimize muscle force on the
protection sleeves
Yellow Silicon handle for SHARP
1. Attach a blade to the scalpel holding the end of the
handle.
2. Pass the scalpel handle through the aiming arm holes
and perform a minimally invasive and accurate inci-
sion.
3. Remove the scalpel from the aiming arm.
Aiming Arm
(03.010.482)
Easy snap-on and snap-off mechanism
Friction and True locking
Radiolucent
More soft tissue clearance
Easy disassembly for cleaning
1. Some force is required to push the cam lock mecha-
nism over the wings.
2. To x the cam lock mechanism at the corresponding
pins, the cam lock must be pushed back in open posi-
tion.
large amounts of bony ingrowth, frst use a solid
screwdriver to loosen the screw. The inter-lock
screwdriver can then be used to remove the screw
from the surgical site. If using the inter-lock screw-
driver with locking screws, use a solid screwdriver
for fnal tightening.
1 2
IMN Reduction Tool and T-Handle 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 Fe-
mur Set
12 mm Hexagonal Quick Coupling with marking for
orientation
If the initial Kirschner wire (1) is placed slightly offset, a
second Kirschner wire (2) can be inserted to correct the
placement.
Multihole Drill Guide for Protection Sleeve
(03.010.50003.010.510)
Center hole and offset holes (4 mm and/or 6 mm)
Color coded
SET LIST
MODULAR CASES
The modularity of the system enables sets to be cong-
ured according to the hospitals clinical needs. Each set
conguration consists of basic instruments, dedicated
system instruments and optional instruments (if re-
quired). For femoral nails (LFN, ALFN, R/AFN) the femur
set must be added to the set conguration.
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)
01.010.411
Instruments for Expert Femoral Nail
01.010.410
Basic Instruments for Expert Nail
01.010.416
Additional Instruments for Expert Nail (Optional)
Control Picture
LFN Instruments
Basic Instruments 01.010.410
Femur Instruments 01.010.411
Optional Instruments 01.010.416
LFN BASIC FEMUR
LFN
BASIC
FEMUR
OPT
OPT
Modular Cases
Modular Tray for LFN Instruments
68.010.415 Modular Tray for LFN Instruments,
size 1/1, without Contents,
Vario Case System
Aiming Arm Vario Case, size 1/2
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,
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
VARIO CASE
689.530 Lid (Stainless Steel), extra-large,
for Vario Case
68.003.000 Vario Case for Expert Lateral Femoral
Nails, right
68.003.001 Vario Case for Expert Lateral Femoral
Nails, left
68.003.010 Vario Case for Locking Implants,
for Expert Femoral Nails
68.003.010.06 Rack for Locking Screws Stardrive
6.0 mm, for Vario Case No. 68.003.010
685.132 Module for Hip Screws B 6.5 mm,
for Vario Case No. 685.130
689.507 Lid, size 1/1, for Vario Case
68.003.301 Vario Case for Standard Instruments,
for Expert LFN, without Lid,
without Contents
OPTIONAL:
ANGULAR STABLE LOCKING
SYSTEM (ASLS)
What is ASLS?
The Angular Stable Locking System (ASLS) provides the
ability to create a xed-angle construct to an intrame
dullary nail. Therefore, it combines the advantages of an-
gular stability and a minimally invasive approach. ASLS
together with an intra medullary nail form the principle
of the Intramedullary Fixator.
How does ASLS work?
The system consists of a screw with three outer diame-
ters and a resorbable sleeve. The resorbable sleeve is
placed on the screw tip which has the smallest screw di-
ameter 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 xation in the nail creates the angu-
lar stability.
01
02
03
ASLS screws
Titanium alloy*
Screws ASLS4: Length 26 mm80 mm, are compatible
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, pro-
vides purchase in far cortex
T25 Stardrive recess
Sterile packaged
ASLS sleeves
70:30 poly (L-lactide-co-D,L-lactide)
Bioresorbable, provides 80% decreased fracture site
motion during rst 12 weeks of healing
Gradually degrades within 2 years (resorption rate var-
ies per patient and implant site)
Inner thread for secure t to screw
Expands in nail locking hole
Available in diameters of 4.0 mm (ASLS4), 5.0 mm
(ASLS5) and 6.0 mm (ASLS6)
Sterile-packed
Note: For more details regarding the intramedullary
fxator principle please consult the ASLS surgical
technique (036.000.708) and concept fyer
(036.001.017).
* Titanium-6% Aluminum-7% Niobium alloy
BIBLIOGRAPHY
Fernndez DellOca AA (2002) The principle of helical
implants Unusual ideas worth considering. Injury, Vol.
33, Suppl. 1, S-A-1-27
Dora C, Leunig M, Beck M, Rothenuh D and Ganz R
(2001) Entry Point Soft Tissue Damage in Antegrade
Femoral Nailing: A Cadaver Study. Journal of Orthopae-
dic Trauma, Vol. 15, No. 7: 488493
McConnell T, Tornetta P, Benson E, Manuel J (2003) Glu-
teus Medius Tendon Injury During Reaming for Gamma
Nail Insertion. Clinical Orthopaedics and related re-
search, Number 407: 199202
Benirschke SK, Melder I, Henley MB, Routt ML, Smith
DG, Chapman JR, Swiontkowski M F (1993) Closed Inter-
locking Nailing of Femoral Shaft Fractures: Assessment
of Technical complications and Functional Outcomes by
Comparison of a Prospective Database with Retrospec-
tive Review. Journal of Orthopaedic Trauma, Vol. 7, No.
2: 118122
Bain GI, Zacest AC, Paterson DC, Middleton J, Pohl AP
(1997) Abduction Strength Following Intramedullary
Nailing of the Femur. Journal of Orthopaedic Trauma,
Vol. 11,
No. 2: 9397
0123
Synthes GmbH
Eimattstrasse 3
CH-4436 Oberdorf
www.depuysynthes.com
036.000.392ABI
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This publication is not intended for distribution in the USA.
All surgical techniques are available as PDF les at
www.synthes.com/lit

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Expert Lateral Femoral Nail Surgical Technique DePuy Synthes 69

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