Titanium Distal Femoral Nail System.
For retrograde insertion.
Technique Guide
Table of Contents
Introduction
Surgical Technique
Product Information
Titanium Distal Femoral Nail System
2
AO Principles
4
Indications
5
Clinical Cases
6
Preoperative Planning
8
Opening the Distal Femur
9
Inserting the Nail
14
Locking Distally
16
Locking Proximally
20
Inserting the End Cap
22
Implant Removal
23
Implant Specifications
27
Implants
28
Instruments
32
Set List
35
Image intensifier control
Synthes
Titanium Distal Femoral Nail System. For retrograde insertion.
Advanced solutions
Nail Features
– Universal design for the right and
left femur
– 1.5 m radius of curvature for
anatomic fit
– Titanium – 6% aluminum –
7% niobium alloy
– 9 mm solid nails
– 10 mm –13 mm cannulated nails
– 9 mm and 10 mm diameters,
round cross-section
– 11 mm, 12 mm, and 13 mm
diameters, fluted cross-section
– Lengths: 160 mm–460 mm
(20 mm increments)
4.9 mm Titanium Locking Bolts (green)
– Lengths: 26 mm – 100 mm
– 4.3 mm core diameter
– Fully threaded
– Self-cutting trocar tip
– 3.5 mm hex drive
5.0 mm Titanium Locking Screws (green)
– Lengths: 26 mm – 100 mm
– 4.3 mm core diameter
– Fully threaded
– Self-cutting trocar tip
– 3.5 mm hex drive
2
Synthes Titanium Distal Femoral Nail System Technique Guide
Proximal Locking
– Proximal locking holes accept 4.9 mm
locking bolts or 5.0 mm locking screws
– Dynamic slot accepts 4.9 mm locking
bolt or 5.0 mm locking screw
– Permits up to 5 mm controlled
axial dynamization
Distal Locking
– Distal locking holes accept
6.0 mm titanium locking screws
– 30 mm from end of nail
– 15 mm from end of nail
6.0 mm Titanium Locking Screws (aqua)
– Lengths: 30 mm – 100 mm
– 4.8 mm core diameter
– Fully threaded
– Self-tapping
– 3.5 mm hex drive
Titanium End Cap (aqua)
– 8 mm diameter
– Locks distal most 6.0 mm titanium locking
screw in place
– Protects nail threads from tissue ingrowth
– Sits flush with the distal end of the nail
Synthes
3
AO Principles
In 1958, the AO formulated four basic principles, which
have become the guidelines for internal fixation in general,
and intramedullary nailing in particular.1
Anatomic reduction
The Titanium Distal Femoral Nail is designed to fit anatomically
in the medullary canal, allowing indirect reduction.
Stable fixation
The intramedullary nail acts as an internal splint that controls
but does not prevent micromovements of the fragments. It
provides relative stability that leads to an indirect healing
through callus formation.
Preservation of blood supply
The instruments and implants in the Titanium Distal Femoral Nail
system permit a percutaneous technique and less tissue stripping
than other treatment methods. An intramedullary approach
results in decreased blood loss compared to plate fixation.
Early, active mobilization
The Titanium Distal Femoral Nail provides secure fixation
which permits controlled, early, active rehabilitation
conducive to optimal recovery.
1. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger:
Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991.
4
Synthes Titanium Distal Femoral Nail System Technique Guide
Indications
The Titanium Distal Femoral Nail is indicated for the stabilization
of fractures of the distal femur and/or diaphyseal fractures
in which a retrograde approach is indicated.
These include:
– supracondylar fractures, including those
with intra-articular extension
– ipsilateral hip / shaft fractures
– ipsilateral femur / tibia fractures
– femoral fractures in the multiply-injured patient
– fractures proximal to a total knee arthroplasty
– fractures distal to a hip implant
– fractures in the morbidly obese patient
– pathologic fractures including those in
osteoporotic bone
– malunions
– nonunions
The Titanium Distal Femoral Nail may be used in either
reamed or nonreamed applications.
Synthes
5
Clinical Cases
Case 1
6
Preoperative
Preoperative
Postoperative
Postoperative
Synthes Titanium Distal Femoral Nail System Technique Guide
Case 2
Preoperative
Postoperative
Postoperative
Synthes
7
Preoperative Planning
Recommended Set
AO
Small Battery Drive Set, with 14.4 V Battery
J5653C GP0801F Rev. 10/07
105.954
Lateral View
A–P View
9 mm
Note: There are two templates available for use: actual size
and 115%, with template image magnified 15% to account
for average radiograph magnification. However, variations in
magnification levels are common.
9 mm 10 mm
11 mm 12 mm
0% Magnification
Use the AO preoperative planner ruler for the Titanium Distal
Femoral Nail to determine nail length and nail diameter.
10 mm
13 mm
12 mm
DFN 9-13 mm
11 mm
13 mm
When selecting nail size, consider canal diameter, fracture
pattern, and postoperative protocol.
160 mm
180 mm
200 mm
220 mm
240 mm
260 mm
280 mm
300 mm
320 mm
360 mm
380 mm
400 mm
440 mm
J5653C GP0801F Rev. 10/07
8
Synthes Titanium Distal Femoral Nail System Technique Guide
Lateral View
For Titanium Distal Femoral Nails [450.XXX]
For proximal locking, use the 4.9 mm
Titanium Locking Bolts [459.30–459.60] or 5.0 mm
Titanium Locking Screws [458.926–458.960]
For distal locking, use the 6.0 mm
Titanium Locking Screws [450.86–450.872]
For use only with the AO System of instruments and implants.
460 mm
A–P View
For 9 mm, 10 mm, 11 mm, 12 mm, and 13 mm Nails
420 mm
Titanium Distal Femoral Nail Ruler
340 mm
Opening the Distal Femur
1
Position patient
Position the patient supine on a radiolucent table. The knee
of the injured leg should be flexed 30° – 40°. A leg roll may
be used to allow for proper reduction and stabilization of the
fracture. Ensure that x-ray visualization of the entire femur
is possible in both the AP and lateral views.
2
Reduce fracture
Intra-articular fractures should be stabilized with interfragmentary screw fixation prior to insertion of the nail. The
screws should be positioned so as not to interfere with the
path of the nail.
Optional instrument
394.35*
Large Distractor
A large distractor may also be used.
*Also available
Synthes
9
Opening the Distal Femur
3
Confirm nail length
Instrument
357.111
Radiographic Ruler
Position the image intensifier for an AP view of the distal
femur. With a long forceps, hold the radiographic ruler
along the lateral aspect of the leg, parallel to and at the same
level as the femur. Adjust the ruler until the distal end is at
the desired nail insertion depth. Mark the skin at that site.
Move the image intensifier to the proximal femur, replace
the distal end of the ruler at the skin mark, and take an
AP image of the proximal femur. Verify fracture reduction.
Read nail length directly from the ruler image, selecting the
measurement that places the proximal end of the nail at
the level of the lesser trochanter.
Note: All fractures should be treated with the longest
nail possible, taking into account patient anatomy or
previous implant.
10
Synthes Titanium Distal Femoral Nail System Technique Guide
4
Identify nail entry point
Instruments
292.69
3.2 mm Calibrated Guide Wire
357.127
13.0 mm Protection Sleeve
357.128
13.0 mm/3.2 mm Trocar
Make a medial parapatellar incision. Retract the patellar
tendon laterally.
The entry point for the nail is in the intercondylar notch,
just anterior and lateral to the femoral attachment of
the posterior cruciate ligament. The location of the entry
point in relation to the intercondylar notch varies with
patient anatomy.
Thread the 13.0 mm/3.2 mm trocar into the 13.0 mm
protection sleeve. Insert the assembly through the incision
to the bone. Hold the protection sleeve firmly and pass the
3.2 mm calibrated guide wire through the trocar. Insert the
guide wire using a power drill. The guide wire should be
inserted in line with the anatomic axis of the femur which is
7°–9° lateral to a line perpendicular to the articular surface.
AP view
Lateral view
Synthes
11
Opening the Distal Femur
5
Open canal
Instrument
351.27
13.0 mm Cannulated Drill Bit
Place the 13.0 mm cannulated drill bit into a cannulated drill.
Pass the drill bit over the guide wire and through the protection
sleeve. Advance the drill bit to the bone and drill to a depth
of 50 mm.
Optional instrument
351.11
Large Reverse Awl
The surgeon may also use the large reverse awl to open
the canal.
12
Synthes Titanium Distal Femoral Nail System Technique Guide
Optional technique: reaming
Instruments
355.006
Medullary Tube
Note: Single Sterilization only. Do not use with
3.0 mm Reaming Rod with offset ball tip
(351.71).
355.041*
3.0 mm Guide Rod, with smooth tip
Under image intensification, reduce the fracture and insert
the appropriate reaming rod into the canal to the desired
nail insertion depth.
Ream in 0.5 mm increments and advance the reamer with
steady, moderate pressure.
Note: Do not force the reamer.
Partially retract the reamer often to clear debris from the
medullary canal.
Ream to a diameter 0.5 mm to 1.0 mm greater than
nail diameter.
After reaming, remove the reaming assembly. Pass the
medullary tube down the reamed canal over the reaming rod.
Remove the reaming rod and insert a 3.0 mm guide rod,
with smooth tip, through the medullary tube.
Remove the medullary tube leaving the guide rod in position
for insertion of the cannulated nail.
*Also available
Synthes
13
Inserting the Nail
1
Assemble insertion instruments
Instruments
321.25
Spanner Wrench
357.095
Connecting Screw
357.112
Insertion Handle
357.22
Hammer Guide
357.25
Slide Hammer
Orient the insertion handle laterally and match the flats on
the handle and nail. The anterior bow of the implant must
be aligned with the anterior bow of the femur.
Place the connecting screw into the insertion handle and
thread it into the distal end of the nail. Tighten the connecting
screw with the spanner wrench.
Note: Do not overtighten.
Slide the hammer guide through the slide hammer and
attach the hammer guide to the connecting screw.
Finger-tighten the assembly.
Alternative technique
Instrument
399.43
Hammer, 700 grams
A hammer may also be used to insert the nail. The distal
end of the connecting screw is the direct striking surface
for the hammer.
14
Synthes Titanium Distal Femoral Nail System Technique Guide
2
Insert nail
Insert the nail as far as possible by hand using a twisting
motion. When using a guide wire, pass the cannulated nail
(10 mm – 13 mm nails) over the guide wire and into the
femoral opening. Monitor nail passage across the fracture
under image intensification. The insertion assembly may
be used to manipulate the nail across the fracture.
Use light blows of the slide hammer on the connecting screw
until the distal end of the nail is inserted 5 mm–10 mm beyond
the articular cartilage. Insertion depth is indicated by the
grooves on the barrel of the insertion handle.
Note: Do not attach the aiming arm to the insertion handle
until the nail is fully inserted. The aiming arm may loosen
during nail insertion.
5 mm
10 mm
Synthes
15
Locking Distally
1
Assemble instruments
Instruments
357.096
Aiming Arm, for 6.0 mm Titanium
Locking Screws
357.097
8.0 mm / 5.0 mm Drill Sleeve
357.098
5.0 mm Trocar
357.76
11.0 mm / 8.0 mm Protection Sleeve
Distal locking is performed using the 6.0 mm titanium
locking screws.
Attach the aiming arm to the insertion handle. Insert the
triple trocar assembly (11.0 mm / 8.0 mm protection sleeve,
8.0 mm / 5.0 mm drill sleeve and 5.0 mm trocar) into the
aiming arm and through a stab incision to the bone.
Remove the trocar.
16
Synthes Titanium Distal Femoral Nail System Technique Guide
2
Drill
Instrument
357.099
5.0 mm Three-Fluted Drill Bit
Drill through both cortices using the 5.0 mm three-fluted
drill bit, stopping the drill immediately after penetrating
the far cortex.
Confirm drill bit position radiographically. Ensure the drill
sleeve is pressed firmly to the cortex and read locking screw
length directly from the drill bit at the back of the drill sleeve.
The drill bit provides a direct measurement.
Note: Since drill bit position directly represents locking screw
position in bone, the locking screw will be too long if the
drill bit is overinserted, or if the drill sleeve is not pressed
down to the cortex.
Synthes
17
Locking Distally
2. Drill continued
Alternative technique
Instruments
357.097
8.0 mm / 5.0 mm Drill Sleeve
357.113
Locking Bolt Measuring Device
357.76
11.0 mm / 8.0 mm Protection Sleeve
The locking bolt measuring device may be used through
the 11.0 mm / 8.0 mm protection sleeve to determine
locking screw length.
Remove the 8.0 mm / 5.0 mm drill sleeve and pass the
measuring hook through the 11.0 mm/ 8.0 mm protection
sleeve. Read locking screw length directly from the
measuring device at the back of the protection sleeve.
18
Synthes Titanium Distal Femoral Nail System Technique Guide
3
Insert locking screws
Instrument
314.75
Hexagonal Screwdriver
Insert the locking screw through the protection sleeve
using the hexagonal screwdriver.
Repeat the procedure for a second distal locking screw.
Synthes
19
Locking Proximally
1
Reconfirm reduction
Instrument
511.30*
Radiolucent Drive
Confirm reduction / alignment of the fracture.
2
Align image
Align the image intensifier with the hole in the nail closest
to the fracture until a perfect circle is visible in the center
of the screen.
3
Determine incision point
Place a scalpel blade on the skin to determine the incision
point and make a stab incision.
4
Center drill bit in locking hole
Instrument
511.417*
4.0 mm Three-Fluted Drill Bit
Under image intensification, insert the tip of the 4.0 mm drill
bit for the radiolucent drive through the incision and place it
onto the bone. Keep the drill bit oblique to the x-ray beam
until the tip is centered in the locking hole.
*Also available
20
Synthes Titanium Distal Femoral Nail System Technique Guide
Oblique (incorrect)
Round (correct)
5
Drill
Tilt the drive until the drill bit is in line with the beam and
appears centered in the outer ring. The drill bit will nearly fill
the locking hole image. Hold the drill firmly in this position
and drill through both cortices.
6
Measure
Instrument
357.113
Locking Bolt Measuring Device
Measure for locking bolt or locking screw length using the
locking bolt measuring device. Locking bolt or locking screw
length is read directly from the device.
7
Insert locking bolt or locking screw
Instrument
314.75
Hexagonal Screwdriver
Insert the appropriate length 4.9 mm titanium locking
bolt or 5.0 mm titanium locking screw, using the
hexagonal screwdriver.
Alternative technique
Instrument
315.40
4.0 mm Three-Fluted Drill Bit
Use the 4.0 mm three-fluted drill bit to perform freehand
proximal locking.
Synthes
21
Inserting the End Cap
Insert end cap
Instrument
314.75
Hexagonal Screwdriver
The end cap locks the most distal 6.0 mm titanium locking
screw in place, thereby creating a fixed angle construct.
Remove the insertion instrumentation. Using the hexagonal
screwdriver, align the end cap with the nail axis to prevent
cross-threading. Thread the end cap into the nail until it
engages the locking screw.
Technique tip: To minimize the chance of cross-threading,
turn the end cap counterclockwise until the threads of the
end cap align with the threads of the nail. Insert the end cap
by turning clockwise until it is fully seated.
22
Synthes Titanium Distal Femoral Nail System Technique Guide
Implant Removal
1
Remove locking implants and end cap
Instrument
314.75
Hexagonal Screwdriver
Clear tissue ingrowth from the hex of the end cap and locking
implants and remove using the hexagonal screwdriver.
2
Remove nail
Instruments
357.095
Connecting Screw
357.22
Hammer Guide
357.25
Slide Hammer
Thread the connecting screw into the distal end of the
nail. Slide the hammer guide through the slide hammer
and attach it to the connecting screw. Finger-tighten
the assembly.
Remove the final locking screw and remove the nail.
Note: Before removing the last locking screw, thread the
connecting screw into the distal end of the nail. This will
prevent the nail from rotating in the medullary canal.
Synthes
23
Implant Removal
Alternative Technique – Extraction Hook
The extraction hook is for use with cannulated nails only.
For removal of broken nail
Instruments
355.399◊
Extraction Hook, for Titanium Cannulated Nails
393.10
or
393.105
Universal Chuck with T-Handle
Small Universal Chuck with T-Handle
1
Clear tissue from the end of the nail and remove the end cap.
2
Remove the locking bolts and/or screws with the appropriate
screwdriver.
3
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.
◊ Available nonsterile or sterile-packed. Add “S” to catalog number to order
sterile product.
24
Synthes Titanium Distal Femoral Nail System Technique Guide
4
Attach the appropriate extraction bolt or connecting screw
to the nail. Remove the near nail fragment using the extraction
the bolt or connecting screw.
Note: The extraction hook can be used as an alternative
to extraction instrumentation.
5
Ream the medullary canal 1 mm larger than the diameter
to clear a path for the distant nail fragment.
6
Insert the extraction hook and explanted, near nail fragment
into the medullary canal. The near nail fragment aligns the extraction hook with the cannulation of the distant nail fragment.
7
Pass the extraction hook through the cannula of the distant
nail fragment.
Note: Under image intensification, verify that the hook has
passed through and engaged the distant end of the nail.
8
Extract both nail fragments.
Note: Keep the patient’s limb restrained to increase the
efficiency of the extraction force.
Synthes
25
Implant Removal
For removal of an intact nail
Instruments
355.399◊
Extraction Hook, for Titanium Cannulated Nails
393.10
or
393.105
Universal Chuck with T-Handle
Small Universal Chuck with T-Handle
1
Clear tissue from the end of the nail and remove the end cap.
2
Remove the locking bolts and/or screws with the appropriate
screwdriver.
3
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.
4
Insert the extraction hook through the nail cannula.
Note: Under image intensification, verify that the hook has
passed through and engaged the distant end of the nail.
5
Extract the nail.
Note: Keep the patient’s limb restrained to increase the
efficiency of the extraction force.
◊ Available nonsterile or sterile-packed. Add “S” to catalog number to order
sterile product.
26
Synthes Titanium Distal Femoral Nail System Technique Guide
Implant Specifications
Titanium Distal Femoral Nails
– Universal design for the right and
left femur
– 1.5 m radius of curvature for
anatomic fit
0 mm
17 mm
22 mm
Material
– Titanium – 6% aluminum–
7% niobium alloy
•
•
37 mm
Diameters
– 9 mm solid nails
– 10 mm – 13 mm cannulated nails
– 9 mm – 12 mm nails are 12 mm
in diameter at the distal end
– 13 mm nails are 13 mm in
diameter throughout
52 mm
Dynamic
Static
Static
•
Static
Proximal locking hole orientation:
two anterior-to-posterior holes;
one lateral-to-medial hole
Color
– Aqua
Lengths
– 160 mm–460 mm (20 mm increments)
Cross Section
– 9 mm and 10 mm diameters,
round cross-section
– 11 mm, 12 mm, and 13 mm
diameters, fluted cross-section
Proximal Locking
– Proximal locking holes accept 4.9 mm
locking bolts or 5.0 mm locking screws
– Dynamic slot accepts 4.9 mm locking
bolt or 5.0 mm locking screw
– Permits up to 5 mm controlled
axial dynamization
Distal Locking
– Distal locking holes accept
6.0 mm titanium locking screws
30 mm from end of nail
15 mm from end of nail
Synthes
27
Implants
Titanium Solid Distal Femoral Nails
(9 mm diameter)
Length (mm)
450.701
160
450.706
450.714
180
450.707
450.702
200
450.708
450.715
220
450.709
450.703
240
450.710
450.716
260
450.711
450.704
280
450.712
450.705
300
450.713
Length (mm)
320
340
360
380
400
420
440
460
Titanium Cannulated Distal Femoral Nails
(10 mm – 13 mm diameters)
10 mm dia.
Length (mm)
450.781
160
450.801
450.794
180
450.814
450.782
200
450.802
450.795
220
450.815
450.783
240
450.803
450.796
260
405.816
450.784
280
450.804
450.785
300
450.805
450.786
320
450.806
450.787
340
450.807
450.788
360
450.808
450.789
380
450.809
450.790
400
450.810
450.791
420
450.811
450.792
440
450.812
450.793
460
450.813
11 mm dia.
Length (mm)
160
180
200
220
240
260
280
300
320
340
360
380
400
420
440
460
28
Synthes Titanium Distal Femoral Nail System Technique Guide
450.821
450.834
450.822
450.835
450.823
450.836
450.824
450.825
450.826
450.827
450.828
450.829
450.830
450.831
450.832
450.833
12 mm dia.
Length (mm)
160
180
200
220
240
260
280
300
320
340
360
380
400
420
440
460
450.841
450.854
450.842
450.855
450.843
450.856
450.844
450.845
450.846
450.847
450.848
450.849
450.850
450.851
450.852
450.853
13 mm dia.
Length (mm)
160
180
200
220
240
260
280
300
320
340
360
380
400
420
440
460
4.9 mm Titanium Locking Bolts (green)
– Titanium alloy*
– Lengths: 26 mm – 100 mm
– 4.3 mm core diameter
– Fully threaded
– Self-cutting trocar tip
– 3.5 mm hex drive
459.26
459.28
459.30
459.32
459.34
459.36
459.38
459.40
459.42
459.44
459.46
459.48
459.50
459.52
Length (mm)
26
28
30
32
34
36
38
40
42
44
46
48
50
52
459.54
459.56
459.58
459.60
459.64
459.68
459.72
459.76
459.80
459.85
459.90
459.95
459.100
Length (mm)
54
56
58
60
64
68
72
76
80
85
90
95
100
* Titanium-6% aluminum-7% niobium alloy
Synthes
29
Implants
5.0 mm Titanium Locking Screws (green)
– Titanium alloy*
– Lengths: 26 mm – 100 mm
– 4.3 mm core diameter
– Fully threaded
– Self-cutting trocar tip
– 3.5 mm hex drive
458.926
458.928
458.930
458.932
458.934
458.936
458.938
458.940
458.942
458.944
458.946
458.948
458.950
458.952
Length (mm)
26
28
30
32
34
36
38
40
42
44
46
48
50
52
458.954
458.956
458.958
458.960
458.964
458.968
458.972
458.976
458.980
458.985
458.990
458.995
458.999
Length (mm)
54
56
58
60
64
68
72
76
80
85
90
95
100
* Titanium-6% aluminum-7% niobium alloy
30
Synthes Titanium Distal Femoral Nail System Technique Guide
6.0 mm Titanium Locking Screws (aqua)
– Titanium alloy*
– Lengths: 30 mm – 100 mm
– 4.8 mm core diameter
– Fully threaded
– Self-tapping
– 3.5 mm hex drive
450.873
450.874
450.875
450.861
450.862
450.863
450.864
450.865
Length (mm)
30
35
40
45
50
55
60
65
450.866
450.867
450.868
450.869
450.870
450.871
450.872
Length (mm)
70
75
80
85
90
95
100
Titanium End Cap (aqua)
– Titanium alloy*
– 8 mm diameter
– Locks distal most 6.0 mm titanium locking screw in place
– Protects nail threads from tissue ingrowth
– Sits flush with the distal end of the nail
450.896
Titanium End Cap, for Titanium Distal
Femoral Nail
* Titanium-6% aluminum-7% niobium alloy
Synthes
31
Instruments
292.69
3.2 mm Calibrated Guide Wire, 300 mm
314.75
Hexagonal Screwdriver
315.40
4.0 mm Three-Fluted Drill Bit, 195 mm,
quick coupling
321.25
Spanner Wrench
351.11
Large Reverse Awl
351.27
13.0 mm Cannulated Drill Bit, 300 mm
357.095
Connecting Screw
32
Synthes Titanium Distal Femoral Nail System Technique Guide
357.096
Aiming Arm, for 6.0 mm Titanium
Locking Screws
357.097
8.0 mm / 5.0 mm Drill Sleeve
357.098
5.0 mm Trocar
357.099
5.0 mm Three-Fluted Drill Bit, 330 mm,
100 mm calibration, quick coupling
357.111
Radiographic Ruler
357.112
Insertion Handle
Synthes
33
Instruments
357.113
Locking Bolt Measuring Device
357.127
13.0 mm Protection Sleeve
357.128
13.0 mm / 3.2 Trocar
357.22
Hammer Guide, for use with
Slide Hammer (357.25)
357.25
Slide Hammer, for use with
Hammer Guide (357.22)
357.76
11.0 mm / 8.0 mm Protection Sleeve
34
Synthes Titanium Distal Femoral Nail System Technique Guide
Titanium Distal Femoral Nail Insertion and Locking Set
With locking bolts (105.521)
With locking screws (105.523)
Graphic Case and Labels
304.545
Titanium Distal Femoral Nail Insertion and
Locking Set Graphic Case
305.580
Graphic Case Labels, for 4.0 mm/5.0 mm
Titanium Locking Screws (in set 105.523)
Instruments (in both sets)
292.69
3.2 mm Calibrated Guide Wire, 300 mm, 5 ea.
314.75
Hexagonal Screwdriver
315.40
4.0 mm Three-Fluted Drill Bit, 195 mm,
quick coupling, 2 ea.
321.25
Spanner Wrench
351.11
Large Reverse Awl
351.27
13.0 mm Cannulated Drill Bit, 300 mm
357.095
Connecting Screw
357.096
Aiming Arm, for 6.0 mm Titanium
Locking Screws
357.097
8.0 mm / 5.0 mm Drill Sleeve
357.098
5.0 mm Trocar
357.099
5.0 mm Three-Fluted Drill Bit, 330 mm,
100 mm calibration, quick coupling, 2 ea.
357.111
Radiographic Ruler
357.112
Insertion Handle
357.113
Locking Bolt Measuring Device
357.127
13.0 mm Protection Sleeve
357.128
13.0 mm / 3.2 mm Trocar
357.22
Hammer Guide
357.25
Slide Hammer
357.76
11.0 mm / 8.0 mm Protection Sleeve
Note: For additional information, please refer to package insert.
For detailed cleaning and sterilization instructions, please refer to
http://www.synthes.com/sites/NA/MedicalCommunity/Pages/Cleaning_and_Sterilization.aspx
or to the below listed inserts, which will be included in the shipping container:
– Processing Synthes Reusable Medical Devices - Instruments, Instrument Trays
and Graphic Cases — DJ1305
– Processing Non-sterile Synthes Implants — DJ1304
◊ Available nonsterile or sterile-packed.
Add ”S” to catalog number to order sterile product.
Synthes
35
Titanium Distal Femoral Nail Insertion and Locking Set
With locking bolts (105.521)
With locking screws (105.523)
Implants (in both sets)
6.0 mm Titanium Locking Screws, 2 ea.◊
Length (mm)
450.873
30
450.866
450.874
35
450.867
450.875
40
450.868
450.861
45
450.869
450.862
50
450.870
450.863
55
450.871
450.864
60
450.872
450.865
65
450.896
Length (mm)
70
75
80
85
90
95
100
Titanium End Cap, 2 ea.◊
Implants (in set 105.521)
4.9 mm Titanium Locking Bolts, 2 ea.◊
Length (mm)
459.26
26
459.44
459.28
28
459.46
459.30
30
459.48
459.32
32
459.50
459.34
34
459.52
459.36
36
459.54
459.38
38
459.56
459.40
40
459.58
459.42
42
459.60
Length (mm)
44
46
48
50
52
54
56
58
60
Implants (in set 105.523)
5.0 mm Titanium Locking Screws, 2 ea.◊
458.926
458.928
458.930
458.932
458.934
458.936
458.938
458.940
458.942
Length (mm)
26
28
30
32
34
36
38
40
42
458.944
458.946
458.948
458.950
458.952
458.954
458.956
458.958
458.960
Length (mm)
44
46
48
50
52
54
56
58
60
◊ Available nonsterile or sterile-packed.
Add ”S” to catalog number to order sterile product.
36
Synthes Titanium Distal Femoral Nail System Technique Guide
Also Available Sets
Small Battery Drive Set, with 14.4 V Battery
105.954
Flexible Reamer Set, for IM Nails
150.060
Also Available Instruments
Holding Sleeve for Hexagonal
314.11
Screwdriver (314.75)
3.0 mm Reaming Rod, with offset ball tip,
351.71S
950 mm, sterile
3.0 mm Reaming Rod, with straight ball tip,
351.76S
950 mm, sterile
Medullary Tube
355.006
◊
3.0 mm Guide Rod, with smooth tip,
355.041
950 mm, sterile
Universal Chuck with T-Handle
393.10
Large Distractor
394.35
Hammer, 700 grams
399.43
Radiolucent Drive
511.30
4.0 mm Three-Fluted Drill Bit, brad point,
511.417
150 mm, for use with radiolucent drive
Also Available Implants
9 mm Titanium Solid Distal Femoral Nails,
450.701–
◊
160 mm – 460 mm (20 mm increments)
450.716
10 mm Titanium Solid Distal Femoral Nails,
450.781–
160 mm – 460 mm (20 mm increments)
450.796◊
11 mm Titanium Solid Distal Femoral Nails,
450.801–
160 mm – 460 mm (20 mm increments)
450.816◊
12 mm Titanium Solid Distal Femoral Nails,
450.821–
160 mm – 460 mm (20 mm increments)
450.836◊
13 mm Titanium Solid Distal Femoral Nails,
450.841–
160 mm – 460 mm (20 mm increments)
450.856◊
5.0 mm Titanium Locking Screws,
458.964 –
◊
64 mm – 80 mm (4 mm increments),
458.999
85 mm – 100 mm (5 mm increments)
4.9 mm Titanium Locking Bolts,
459.64 –
64 mm – 80 mm (4 mm increments),
459.100◊
85 mm – 100 mm (5 mm increments)
Synthes (USA)
1302 Wrights Lane East
West Chester, PA 19380
Telephone: (610) 719-5000
To order: (800) 523-0322
Fax: (610) 251-9056
© 1997 Synthes, Inc. or its affiliates. All rights reserved.
Synthes (Canada) Ltd.
2566 Meadowpine Boulevard
Mississauga, Ontario L5N 6P9
Telephone: (905) 567-0440
To order: (800) 668-1119
Fax: (905) 567-3185
Synthes is a trademark of Synthes, Inc. or its affiliates.
www.synthes.com
Printed in U.S.A. 11/11 J2983-G