Expert HAN. Expert Hindfoot Arthrodesis Nail. Technique Guide Expert Nailing System

Image intensifier control Warning This description alone does not provide sufficient background for direct use of the instrument set. Instruction by a surgeon experienced in handling these instruments is highly recommended.

ntroduction Expert Hindfoot Arthrodesis Nail 2 Surgical Technique Preoperative Planning 6 Standard Distal Locking 1 5 Spiral Blade Insertion 19 Implant Removal (optional) 28 Product Information Implant Specifications 30 Expert HAN Technique Guide Synthes 1

Expert HAN. Expert Hindfoot Arthrodesis Nail. Advanced solutions Distal and Talar Locking Options Screw orientation options: – Calcaneus into the cuboid – Talus into the navicular Spiral Blade – Increased surface area optimizes load distribution in the calcaneus – Lengths: 45 mm – 100 mm (5 mm increments) – Cannulated for insertion over a 3.2 mm guide wire – 12.5 mm blade diameter – Front cutting end – Implants common with the Expert Retrograde/Antegrade Femoral Nail System – Titanium alloy * Improved stability End Caps – Securely lock spiral blade or the most distal locking screw – Prevent ingrowth...

Nail Design – The lateral bend allows an entry site in the center of the lateral column of the calcaneus – Permits proper hindfoot alignment and restores 3°–5° valgus positioning for a better gait – Cannulated for use over all Synthes 2.5 mm or 3.0 mm ball-tipped reaming rods. Reaming rods may be removed through the nail and the insertion handle assembly (no exchange tube required) – Titanium alloy* The nail design and aiming arm enable targeted medial-to-lateral or lateral-to-medial proximal locking. Standard Locking Screws – Double-lead threads for ease of insertion – Thread closer to screw...

AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation in general 1, and intramedullary nailing in particular. The Expert Hindfoot Arthrodesis Nail enables an intramedullary approach for the fixation and the fusion of the ankle and of the subtalar joints. The system consists of a series of cannulated nails, cannulated spiral blades, cannulated end caps and locking screws. All the implants are made of titanium alloy. Anatomic reduction Fracture reduction and fixation to restore anatomical relationships. The Expert Hindfoot Arthrodesis...

Indications The Expert Hindfoot Arthodesis Nail is indicated to facilitate tibiotalocalcaneal arthrodesis to treat – Severe foot/ankle deformity – Arthritis – Instability and skeletal defects after tumor resection; these include, but are not limited to neuro-osteoarthropathy (Charcot’s foot) – Avascular necrosis of the talus – Failed joint replacement or failed ankle fusion – Distal tibial fracture nonunions – Osteoarthritis – Rheumatoid arthritis and pseudoarthrosis Expert HAN Technique Guide Synthes 5

Preoperative Planning *Spiral Blades for Expert Retrograde Femoral Nails 04.013.041 – 04.013.052 To estimate nail length, place the template on the AP x-ray of the hindfoot and select the appropriate nail length based on patient anatomy. When selecting nail size, consider canal diameter, indication, patient anatomy and postoperative protocol. 45 60 80 10 20 30 40 30 60 80 100 mm 100 mm *For Distal PA Locking: *6.0 mm Locking Screws (Stardrive T25) 04.005.640 – 04.005.685 *6.0 mm Locking Screws (Stardrive T25) 04.005.690S – 04.005.695S 1.00 Magnification 0 For Expert Hindfoot Arthrodesis Nails,...

3 Determine nail length and diameter Instrument 03.008.001 Radiographic Ruler Measure length Position the C-arm for a lateral view of the distal tibia and subtalar joint. With long forceps, hold the radiographic ruler parallel to the tibia. Adjust the ruler until the distal end is at the desired nail insertion depth. Mark the skin at that site on the lateral side. Move the image intensifier proximally with the ruler positioned on the distal skin mark. An image of the ruler can be used to choose the optimum nail length. Measure diameter Position the C-arm for a lateral view of the tibia with the...

Opening the Hindfoot 1 Perform fibula osteotomy Create an incision laterally over the fibula. Dissection to the bone is directed anteriorly. Using a sagittal saw, create an osteotomy 10 cm from the distal tip of fibula. Resect approximately 1 cm of bone proximal to the first cut, creating a gap. This bone segment can be utilized as bone graft. Incise the anterior soft tissue including anterior tibiofibular, calcaneofibular and talofibular ligaments. Take care to preserve the posterior soft tissue. By maintaining a blood supply to this bone, it can be used later as a live biological plate on the...

Determine entry point 03.010.115 Guide Wire 0 3.2 mm, length 290 mm The entry site is in line with the tibial canal and the lateral O Using a C-arm, identify the center of the tibial canal by placing a 3.2 mm guide wire along the canal. Draw a line. Palpate the center of the lateral column of the calcaneus. The entry point is located at the intersection of these two ines; the incision should be in line with the longitudinal axis Insert guide wire through calcaneus and talus 357.128 Drill Sleeve 13.0/3.2, with trocar tip Thread the drill sleeve into the protection sleeve. Insert this assembly...

03.008.008 Drill Bit 0 5.0 mm, calibrated, length Remove the drill sleeve from the protection sleeve. Place the 13.0 mm cannulated drill bit over the guide wire and through the protection sleeve to the bone. Drill through Remove the 3.2 mm guide wire. 10 Synthes Expert HAN Technique Guide

Invert the hindfoot and insert the 5.0 mm drill bit through the canal created in the calcaneus and talus. Under image intensifier control, center the drill point under the tibial canal in both the AP and lateral planes. Use the drill to create a defect in the subchondral bone to allow passage of the reaming rod. Expert HAN Technique Guide Synthes 11