Orthopaedics
S2
Nailing System
Orthopaedics
S2
Tibial Nailing System
Orthopaedics
Indications
• Open or closed shaft fractures
(with a very proximal and/or very distal extent in
which locking screw fixation can be obtained)
• Multi-fragment fractures
• Segmental fractures
• Pathologic and impending
pathologic fractures
• Tumor resections
• Corrective osteotomies/Mal-unions
• Non-unions
• Comminuted fractures with or without bone loss
S2 Tibial Nail
Orthopaedics
3 very proximal locking holes
- 17mm (Oblique)
- 24mm (Oblique)
- 41mm (ML)
10° Herzog bend
(at 50mm from top)
Sizes:
8-14mm Diameter
240-420mm Lengths
(15mm increments)
6° Distal bend
(at 60mm
from tip)
3 very distal locking holes
- 5mm (ML)
- 15mm (AP)
- 25mm (ML)
Orthopaedics
S2 Locking Screws & End Caps
Fully Threaded for routine locking
(all 5mm for diam. 9-14mm Nails)*
*Only the 8mm Tibial Nails require 4mm screws for distal locking
End Caps in various sizes
(standard, +5, +10mm, +15mm)
Helps adjust nail height
Prevent bony ingrowth
Locks down on the first screw at the driving end avoiding lateral sliding
Orthopaedics
Radiolucent S2 Target Device
with
Patented Friction Locking Mechanism
Press to
insert the
sleeve
Orthopaedics
S2 Instruments are the same for Tibial or
Femoral Nailing
Instruments are grouped and colour coded on trays
1.
2.
3.
4.
5.
Opening
Reduction
Nail Insertion
Guided Locking
Freehand Locking
Red
Brown
Green
Light Blue
Dark Blue
Orthopaedics
Opening - Reduction
Orthopaedics
Nail Insertion - Guided Locking
Orthopaedics
Guided Locking - Freehand Locking
Orthopaedics
All in ONE Instrument box!
Orthopaedics
Operative Technique
Orthopaedics
Distal 1/3 Tibial Fx: Preoperative XRays
Orthopaedics
X_ray Template to be used for preoperative
planning
Upper third
lower third
wedge fractures
segmental fractures
open fractures: nailing without reaming
Orthopaedics
Patient positioning
Traction table
Trans-calcaneal traction
Counter support below the
knee
Opposite limb in abd. &
flexion
Orthopaedics
Incision & Entry Point
Incision :
medial to the patellar
tendon
Entry Point :
curved awl to open the
medullary canal
proximal to the tibial
tuberosity in the midline
Orthopaedics
Incision
Orthopaedics
Opening with the cannulated awl
Orthopaedics
Guide Wire inserted & Nail Length measured
on the Guide Wire Ruler
Insertion of a guide rod
measure nail ‘s length
Orthopaedics
Reduction help
Used for introducing the guide wire, the reaming and the nail
introduction
Orthopaedics
Reaming
Reaming 1,5 mm above the
diameter of the nail
No replacement of the guide
wire
Same is used to insert the
nail
Orthopaedics
Nail insertion after correct assembly with
the Target Device
Orthopaedics
Depth of Nail insertion
Three circumferencial
grooves
Located on the insertion
post
Indicates depth of insertion
Orthopaedics
First: distal locking@.freehand
@.OR@@@@.
Orthopaedics
First: distal locking@. guided by DTD
Orthopaedics
Proximal Locking
Remove the Guide-Wire
before Drilling!
Orthopaedics
Final result
Orthopaedics
S2 Femoral Nail
trauma
University
Theory
and
Practice
Orthopaedics
Indications
• Open and closed shaft fractures
• Ipsilateral shaft fractures
• Segmental fractures
• Comminuted fractures with or without bone loss
• Fractures distal to a hip prosthesis
• Fractures proximal to a total knee arthroplasty
• Pathologic and impending pathologic fractures
• Tumor resections
• Corrective osteotomies/Mal-unions
• Non-unions
• Supracondylar fractures including those with intra-articular
extension
Orthopaedics
Antegrade
S2 Femoral Nail A/R
Same Nail
•For Left or Right
•For Ante or Retrograde
application
R3000
Antecurvature
Sizes:
9-14mm Diameter
260-480mm Lengths
(20mm increments)
Retrograde
Orthopaedics
S2 Femoral Nail A/R - ANTEGRADE
31
35
19
Same Nail
For Left or Right
Proximal: 1 oblique screw
Distal: 2 ML
Most distal at 10mm
Orthopaedics
S2 Femoral Nail A/R - RETROGRADE
Same Nail
for antegrade or
Retrograde
Proximal: 1 AP screw
35
19
Most distal at 19mm
31
Distal: 2 ML
Orthopaedics
Condyle Screws - for retrograde approach
• Cannulated – insertion over K-Wire
• Adaptable washers – optimal fit
Orthopaedics
S2 Locking Screws & End Caps
Fully Threaded for routine locking
(all 5mm for proximal &distal )
End Caps
Various sizes (standard, +5, +10mm, +15mm)
−
Help adjust nail height
−
Prevent bony ingrowth
−
Lock down on the first screw at driving & avoid lateral sliding
Orthopaedics
Set Screw, Proximal
Provides axial stability (tightens
down on the oblique screw) in
case of very proximal, oblique
fracture patterns
Prevents bony ingrowth
An End Cap can no longer be used!!
Orthopaedics
Radiolucent S2 Target Device
with
Patented Friction Locking Mechanism
Press to
insert the
sleeve
Orthopaedics
S2 Instruments are the same for Tibial or
Femoral Nailing
Instruments are grouped and colour coded on trays
1.
2.
3.
4.
5.
Opening
Reduction
Nail Insertion
Guided Locking
Freehand Locking
Red
Brown
Green
Light Blue
Dark Blue
Orthopaedics
Opening - Reduction
Orthopaedics
Nail Insertion - Guided Locking
Orthopaedics
Guided Locking - Freehand Locking
Orthopaedics
All in ONE Instrument box!
Orthopaedics
Operative Technique
Orthopaedics
Distal 1/3 Femoral Fx: preoperative XRays
Fracture table and traction for
fracture reduction is
recommended
Orthopaedics
Orthopaedics
X_ray Template to be used for preoperative
planning
Orthopaedics
Patient positioning
Traction table
Opposite limb in abd. &
flexion
C-arm in good position
Orthopaedics
Incision & Entry Point
The design of the implant allows for
insertion either through the Tip of
the Greater Trochanter (A) or the
Piriformis Fossa (B) .
Orthopaedics
Incision:
Greater Trochanter can be located by palpation
Orthopaedics
Opening with the cannulated awl
Orthopaedics
Guide Wire inserted & Nail Length measured
on the Guide Wire Ruler
Insertion of a guide rod
measure nail ‘s length
Orthopaedics
Reaming
Reaming 1,5 mm above the
diameter of the nail
No replacement of the guide
wire
Same is used to insert the
nail
Orthopaedics
Nail insertion after correct assembly with
the Target Device
Orthopaedics
Depth of Nail insertion
Three circumferencial
grooves
Located on the insertion
post
Indicates depth of insertion
Orthopaedics
First: distal locking@.freehand
@.OR@@@@.
Orthopaedics
First: distal locking@. guided by DTD
Orthopaedics
Proximal Locking
Remove the Guide-Wire
before Drilling!
Orthopaedics
Final result
Orthopaedics
Synthes IM Nails
Orthopaedics
Synthes Expert Tibial Nailing System
trauma
University
Theory
and
Practice
Orthopaedics
Expert Tibial Nailing System
Summary:
The Expert Tibial Nail is the new standard for tibial nailing. The versatile
nail design allows to cover more proximal and distal indications. The
Expert Tibial Nail is part of the new generation of Synthes nails, the
Expert Nailing System.
Indications:
The Expert Tibial Nail is indicated for fractures in the tibial shaft as well as for
metaphyseal and certain intraarticular fractures of the tibial head and the pilon
tibiale:
41-A2/A3
All diaphyseal fractures
43-A1/A2/A3
Combinations of these fractures
Orthopaedics
Expert Tibial Nailing System
Features & Benefits
Numerous multiplanar locking
options for expanded proximal and
distal indications
New anatomic bend for facilitated
nail insertion and extraction
Cannulated nails (Ø 8 mm to Ø 13
mm) for reamed or unreamed
techniques, enabling nail insertion
over guide wire
Orthopaedics
Expert Tibial Nailing System
Features & Benefits
Solid nails (Ø 8 mm to Ø 10 mm)
for unreamed technique (not
available in the US and Canada)
Available in a wide variety of
diameters and lengths (255 – 465
mm)
Orthopaedics
ROUND 5 - T2 Tibia Nail WINS AGAINST
Synthes EXpert Tibia Nail
Tale of the Tape@
Stryker T2*
Synthes EXpert*
1
2
Screw Sizes
1 (5mm)
2 (4.0,5.0 & Dual Core)
Drill Sleeves
1
3
Drill Bits
1
2
Herzog/4 deg.
Low Transitional Radius (Std)
Insertion Handles
Prox./Distal Bends
Complex &
Confusing
Herzog/4 deg. (Prox. Bend)
AP Proximal Screw
No
Yes
Internal Screw
External instruments
Maintains soft tissue sleeve
positioning
Yes – Friction Lock
No
Radiolucent Targeting Arm
Fully
Limited
Compression
* Source: Stryker, Smith & Nephew, and / or Synthes Operative Technique Guides
Where’s that
going???
Compression!
Orthopaedics
Synthes Expert Lateral Femoral Nail
trauma
University
Theory
and
Practice
Orthopaedics
Expert Lateral Femoral Nail
Summary:
The Expert Lateral Femoral Nail is the new generation antegrade
femoral nail, an important component of the new Synthes Expert Nailing
System.
The new anatomical nail design allows a more lateral entry point –
slightly lateral of the tip of the greater trochanter – which is easy to find
surgically and minimizes the damage to the gluteus muscle attachment.
Indications:
Standard locking indications:
Femoral shaft fractures (except subtrochanteric fractures
Recon locking indications:
Femoral subtrochanteric fractures
Ipsilateral femoral shaft and neck fractures
Orthopaedics
Expert Lateral Femoral Nail
Features & Benefits
Optimal lateral entry point: easier
and safer access to entry site, less
soft tissue damage, lower risk of
avascular necrosis
Anatomical nail design: easier
insertion and extraction
Recon and standard locking
options: expanded indications,
increased stability in
subtrochanteric fractures
Orthopaedics
Expert Lateral Femoral Nail
Features & Benefits
Multiplanar distal locking:
increased stability in more distal
fractures
Part of the Expert Nailing System:
shorter learning curve, easier
surgical procedure due to
streamlined instrumentation, costefficient owing to common implants
and instruments
Orthopaedics
ROUND 7 - T2 Recon Nail DEFEATS Synthes
EXpert LEFN!
Tale of the Tape@
T2 Recon*
Synthes LEFN*
No (4 degrees)
Yes (10 degrees)
Screw Sizes
2 (5.0mm 6.5mm)
3 (5.0,6.0 & 6.5mm)
Drill Sleeves
2
3
Drill Bits
2
3
Proximal Lock Set Screws
Yes
No
Retains Soft-Tissue Sleeve Position
Yes
No
Extreme Lateral Entry Required
Friction Lock
Targeting Arm Radiolucency
Fully
Limited
* Source: Stryker, Smith & Nephew, and / or Synthes Operative Technique Guides
Extreme!
Complex &
Confusing
Orthopaedics
Synthes
Expert Retrograde/Antegrade Femoral Nail
trauma
University
Theory
and
Practice
Orthopaedics
Expert Retrograde/Antegrade Femoral Nail
Summary:
The Expert Retrograde/Antegrade Femoral Nail (R/AFN) is the new
femoral nail for retrograde and antegrade approach. The versatile nail
design is based on a combination of the known DFN and UFN/CFN
systems. The Expert R/AFN is part of the new generation of Synthes
nails, the Expert Nailing System.
Indications:
In retrograde approach, the Expert R/AFN is indicated for fractures in
the distal femur and fractures in the femoral shaft (subtrochanteric
fractures)).
In antegrade approach, the Expert R/AFN is indicated for fractures in
the femoral shaft (subtrochanteric fractures)).
Orthopaedics
Expert Retrograde/Antegrade Femoral Nail
Features & Benefits
Part of Expert Nailing System with
streamlined instrumentation and
shared locking implants resulting in
faster learning curves, simpler surgical
techniques and reduced inventory and
costs.
A retrograde and antegrade nail with
spiral blade, standard and dynamic
locking for all fractures in femoral shaft
and distal femur represents a femoral
nail system with great versatility.
Spiral blade with angular stable
locking for better purchase and higher
stability especially in osteoporotic bone.
Orthopaedics
Synthes EXpert RAFN
Tale of the Tape@
Stryker T2*
Synthes RAFN*
Aiming Arms
1
2
Screw Sizes
1 (5.0mm)
2 (5.0,6.0, 12.5mm blade)
1
3
1.5 & 3.0
1.5
No
Yes
Defect in Lateral Cortex
4.2mm
12.5mm
Diameters
8 Sizes
7 Sizes
10mm Internal & Dynamic Slot
Dynamic Slot only
Yes – Friction Lock
No
Fully
Limited
Drill Sleeves/Bits
Radius of Curvature
Metaphyseal Hammering
Compression
Maintains soft-tissue sleeve positioning
Radiolucent Targeting Arm
* Source: Stryker, Smith & Nephew, and / or Synthes Operative Technique Guides
Complex
& Confusing
Hammer what
in where???
Compression,
Compression,
Compression!
Orthopaedics
Synthes Expert Humeral Nailing System
Humeral Nail (HN)
Proximal Humeral Nail (PHN)
trauma
University
Theory
and
Practice
Orthopaedics
Expert Humeral Nailing System
Summary:
The Expert Humeral Nail System consists of the Expert Humeral
Nail (Expert HN) and Expert Proximal Humeral Nail (Expert PHN)
It is part of the new generation of Synthes nails, the Expert Nailing
System.
The Expert HN/PHN completes the features and benefits of the
current UHN/PHN humeral nailing system by a cannulation of all
nails, an extended product range and new locking options.
Depending on the indication and preference, the surgeon has the
choice to ream, to insert the nail guided over a guide wire by
antegrade or retrograde approach and to lock either with the spiral
blade or with locking screws (including the possibility of a
controlled compression).
Orthopaedics
Expert Humeral Nailing System
Indications:
The indications for the Expert Proximal Humeral Nail with spiral blade
locking include humeral fractures in adults in the subcapital area
(AO/ASIF classification: A2, A3), or with concurrent avulsion of the
greater tuberosity (AO/ASIF classification: extra-articular bifocal
fractures B1, B2, B3).
The indications for the Expert Humeral Nail with standard locking (in
either antegrade or retrograde approach) include humeral shaft
fractures down to approximately 5 cm proximal to the olecranon fossa
with closed epiphyseal lines (AO/ASIF classification: A - C). With spiral
blade locking, the Expert HN is also indicated for combinations of
humeral head (mentioned above for the Expert PHN) and shaft
fractures.
Orthopaedics
Expert Humeral Nailing System
Features & Benefits
Part of Expert Nailing System with
streamlined instrumentation and
shared locking implants resulting
in faster learning curves, simpler
surgical techniques and reduced
inventory and costs.
A retrograde and antegrade nail
with spiral blade, standard,
dynamic and compression
locking for most common humeral
fractures represents a humeral nail
system with great versatility.
Orthopaedics
Expert Humeral Nailing System
Features & Benefits
Spiral blade with angular stable
locking for better purchase and
higher stability especially in
osteoporotic bone, and suture
anchoring for small osseous
fragments.
Improved distal locking (1 x AP
and 2 x oblique) for reduced risk of
damaging median nerve.