Königsee Implantate und Instrumente zur Osteosynthese GmbH
PROXIMAL FEMORAL NAIL
Technical instructions
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
Proximal femoral nail – OP – implantation steps
Introduction:
The patient is usually positioned on an extension table. The image converter is placed on the
healthy side to guarantee no interference with a.p. and axial radiographs. The leg to be operated is
slightly adducted. The standard incisions for nail introduction are made starting ca. 4 cm proximal to
the palpable upper edge of the greater trochanter. The incisions for the supporting, anti-rotation and
interlocking screws are made following marking with the guide sleeves. The nail diameter is
determined using the radiograph. Important: note increased antecurvation and medullary cavity
width in the subtrochanteric region. It is better to select a smaller nail diameter in order to avoid
strains with potential incorrect interlocking.
Guide frame system
Guide frame with locking screw (Art. no. 10.264.50/3)
Guide frame cap, distal
Guide frame cap, 130°
Guide frame cap, 125°
10.264.50
10.264.51
10.264.52
10.264.55
Mounting the nail on the basic frame through a tension screw with a hexagonal screwdriver wrench
width 8 (Art. no. 10.264.29).
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
Important notes on the guide frame system
The integrated locking bolts guarantee an optimal use of the guide device. They lock the respective
sleeves for tissue protection (Article numbers 10.261.011; 10.264.05; 10.264.12) while using the cap
for the guide frame system.
Description of use:
~ Example of use of the guide frame with the proximal cap.
A locking bolt is supplied with each cap for the guide frame.
The locking bolt can be inserted and removed by pressing on its plunger. Removing and changing it
is possible only if the drill guide was removed beforehand.
The locking bolt must be attached before the drill guide is pushed in.
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
The drill guide can be pushed in when the arrow on the locking
bolt points to the arrow on the attachment.
Arrows point to each other –
sleeves can be pushed in
The drill guides are fixed by rotating the locking bolt (see
illustrations).
Arrows point in different
directions – sleeves lock
When the guide frame is used with the distal cap, the locking bolt works the same way.
Arrows point away from each other
– sleeve is locked in the guide frame
It is possible to use both locking bolts at the same time.
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
Example: guide frame with proximal
cap and both locking bolts used at
the same time
Opening the medullary cavity
Tissue protection drill sleeve
Sleeve for intramedullary reamer
Trocar for intramedullary reamer sleeve
10.264.20
10.264.21
10.264.22
Remove trocar and place guide wire Ø3.0mm (Art. no. 2.984.30/400).
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
Remove drill guide for guide wire and open the femur with the intramedullary reamer (Art. no. 10.264.19)
through the tissue protection sleeve.
Insert the premounted nail with guide frame:
Impaction adapter
10.264.11A
Insertion of supporting screw and anti-rotation screw
Select the cap for the guide frame for supporting and anti-rotation screw according to the selected
nail (125° or 130°) and fix to the guide frame.
Use instruments with yellow marking for supporting screw!
Sleeve for supporting screw
Drill sleeve for supporting screw
Trocar for supporting screw sleeve
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10.264.05 (Ø16/Ø14x200)
10.264.06 (Ø14/Ø2,7x211)
10.264.07
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
Insert all sleeves (bone contact), then remove the
trocar and insert the guide wire Ø2.5mm (Art. no.
2.984.25/400).
Attach the gauge f. supporting screw 10.264.04
through the guide wire as far as the drill sleeve –
subtract 5-10mm if the guide wire was predrilled as
far as the calotte.
Remove the gauge and drill guide for the guide wire and drill through the in situ guide wire with the
step drill-set for supporting screw (Art. no. 10.264.08).
Mount the selected supporting screw on the T-handle.
T-handle with quick coupling for KFN, cannulated (screwdriver for insertion)
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10.264.27
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
screwdriver for insertion
- both joined together through the coupling
Fixing rod for screwdriver for insertion
- insert and screw to the implant (supporting screw + sleeve).
10.264.01
10.264.02
Insert the supporting screw in the guide frame cap through the sleeve.
Place the compression screw (if required):
Hexagonal screwdriver for inserting and removing the compression screw
10.264.03
For safe insertion, the compression screw is fixed by means of a holding sleeve.
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
Insert the compression screws in the guide frame cap through the sleeve.
Use instruments with green marking for anti-rotation screw!
Sleeve for anti-rotation screw
Drill sleeve for anti-rotation screw
Trocar for anti-rotation screw sleeve
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10.264.12 (Ø8,8/Ø6,7x198)
10.264.14 (Ø6,5/Ø2,2x205)
10.264.15
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
Insert all sleeves (bone contact), remove the trocar and insert the guide wire Ø2.0mm
(Art. no. 2.984.20/400).
Attach the gauge
10.264.04
over the guide wire as far as the drill sleeve – subtract 5-10mm if the guide wire was predrilled as far
as the calotte.
After removing the drill sleeve for the guide wire, drill the bone through the in situ guide wire with the
cannulated spiral drill
10.264.16.
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
Insert the anti-rotation screw in the guide attachment over the guide wire through the sleeve using
the cannulated screwdriver (Art. no. 10.264.17).
After insertion of the supporting and anti-rotation screw the cap is removed from the guide frame.
Distal interlocking
Fix the attachment for distal interlocking to the basic frame.
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
Use instruments with silver marking for distal interlocking!
Drill guide as tissue protection sleeve
Drill guide for spiral drill
Trocar for distal interlocking
10.261.011
10.261.031
10.264.26
Insert 3-part sleeves in the guide frame cap (dynamic interlocking, distal) and fix.
Drill the bone for the interlocking screw using the spiral drill Ø4.8mm
10.261.15.
Remove the drill sleeve and determine the required length of the interlocking screw with the gauge
(Art. no. 10.261.16).
Alternatively: read the length on the scaled drill.
Screw length = measured reading + 10mm
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
Insert the selected interlocking screw with the hexagonal screwdriver with T-handle
through the tissue protection sleeve in the guide attachment.
2.930.35
If necessary, implant the second distal interlocking screw (static, proximal) in the same way.
After complete interlocking, the guide frame is removed from the nail with the hexagonal screwdriver
with T-handle
10.264.29.
Finally, the sealing screw is inserted. Sealing is usually carried out without fixed bolts in order to
ensure dynamics. In exceptional cases, fixed interlocking can be carried out (Art. no. 7.311.30).
Explantation of proximal femoral nails
Explantation can be performed optionally either freely or with the aid of the guide attachments.
1. Removal of the distal interlocking screws after a stab incision
Hexagonal screwdriver
10.264.17
(or 2.930.35)
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
2. Removal of the anti-rotation screw after a stab incision with
hexagonal screwdriver
10.264.17
with unscrewable sleeve
10.264.18
3. Removal of the compression screw after a stab incision
Screwdriver
10.264.03
4. Removal of the sleeve with supporting screw
Screwdriver for extraction with T-handle
10.264.09
with fixing rod for extraction
10.264.10
Insert the fixing rod into the supporting screw until the inner surface of the wrench meets the sleeve
and unscrew the supporting screw with sleeve using light traction.
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Königsee Implantate und Instrumente zur Osteosynthese GmbH
5. Removal of the sealing screw
Screwdriver
10.264.17
6. Removal of the nail
Nail extractor
Open-end wrench
locking screw
10.263.01
10.263.05
10.264.30/3
(2.930.35)
Fix the nail extractor to the nail through the tension screw (Caution! Do not mistake the tension screw
for the adapter or tension screw for guide frame system).
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