Olecranon Osteotomy Nail. For simple fractures and osteotomies of the olecranon. Technique Guide

Table of Contents Introduction 2 AO Principles 4 Indications 5 Patient Positioning 6 Preparation 7 Implantation Surgical Technique Olecranon Osteotomy Nail 9 Implant Removal Implant Removal: Alternative Technique 21 Implant Specifications 22 Instruments 23 Set Lists Product Information 19 26 Image intensier control Warning This description alone does not provide sufficient background for direct use of the product. Instruction by a surgeon experienced in handling this product is highly recommended. Reprocessing, Care and Maintenance of Synthes Instruments For general guidelines, function control...

Olecranon Osteotomy Nail. For simple fractures and osteotomies of the olecranon. Olecranon Osteotomy End Cap – Countersunk end cap for reduced soft tissue irritation and reoperations – Easy reattachment of olecranon – Single size: Diameter 6 mm, length 40 mm 2 Synthes Olecranon Osteotomy Nail Technique Guide

Olecranon Osteotomy Nail – Pre-osteotomy fixation ensures anatomic reduction and quick realignment – Easy instrumentation for simple fixation – Universal right and left design – Single size: Diameter 6 mm, length 63 mm Threaded Stepped Screws – Countersunk screw head for reduced soft tissue irritation and less reoperations – Targeted, angled locking to prevent nail from moving – Fully threaded stepped screws, diameter 2.7 mm Synthes 3

AO Principles In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1, 2 Those principles, as applied to the Olecranon Osteotomy Nail, are: Anatomic reduction The Olecranon Osteotomy Nail allows anatomic alignment of the olecranon fragment. Stable fixation The oblique locking screws prevent the nail from moving within the medullary canal, stabilizing the construct. The end cap inserted through the olecranon fragment and secured to the nail stabilizes the fragment for postoperative healing. Preservation of blood supply Targeted locking of the...

Indications The Olecranon Osteotomy Nail is indicated to treat simple olecranon fractures and osteotomies of the olecranon. Synthes 5

Patient Positioning Place the patient in the lateral decubitus position to accommodate distal humerus surgery. The prone position can also be selected according to the surgeon’s preference and the severity of the patient’s injury. Rest the arm on a padded bar, allowing elbow flexion of 120°. 6 Synthes Olecranon Osteotomy Nail Technique Guide

Preparation 1 Approach Beginning level with the junction of the middle and distal thirds of, and centered on, the humeral shaft, make a straight or curved incision around the olecranon to the radial side. The incision ends over the ulnar diaphysis. An ulnarbased subcutaneous flap is developed. Determine the site of the osteotomy by incising either the medial capsule, after retracting the ulnar nerve, or the lateral capsule, after elevating part of the anconeus muscle and finding the center of the trochlear notch. Split the triceps tendon longitudinally for nail insertion. Triceps Anconeus Ulnar...

Preparation 2 Assemble insertion instruments Instruments Nail inserter 03.007.008 Nail Inserter 03.007.011 Alignment Tool 03.007.009 Aiming Arm 03.007.010 Pinch Screw for Aiming Arm 03.007.015 Screwdriver, hexagonal Nail Alignment tool Attach the nail Thread the proximal end of the nail into the nail inserter. Align the recess in the alignment tool with the flats at the tip of the nail and secure the assembly by tightening the nail in the nail inserter. Attach the aiming arm Insert the inserter/nail assembly through the aiming arm. Verify the construct alignment by inserting the alignment tool...

Implantation 1 Open proximal ulna and ream canal Instruments 03.007.020 Guide Wire л 2.8 mm, length 180 mm, with thread 03.007.007 Opening Drill Sleeve 03.007.006 Stepped Opening Drill Bit л 6.0 mm 5 mm Note: If using the nail for a simple fracture of the olecranon, reduce the fracture first and then proceed. Insert the guide wire into the olecranon process, targeting the center of the proximal third of the ulnar medullary canal. Verify that the guide wire is centered in the canal in both AP and lateral views. Ensure that the guide wire is positioned at least 5 mm from the humeroulnar joint,...

Implantation 2 Insert nail Insert the nail into the medullary canal. Ensure that the aiming arm is oriented posterior to the forearm. Insert the nail until the hexagonal proximal end of the inserter makes contact with the olecranon process. Verify appropriate insertion depth radiographically. Place a scalpel blade (or similar) on the desired location of the osteotomy. A groove on the inserter shows the proximal end of the nail and can be seen radiographically. Ensure that the top of the nail is distal to the desired osteotomy location. 3 Insert stabilization guide wire Instrument 03.007.020 Guide...

4 Drill and measure for screw length Instruments 03.007.013 Protection Sleeve 5.5/2.4 03.007.012 Protection Sleeve 8.0/5.5 03.007.024 Drill Bit л 2.4 mm, length 180 mm Measure to back end of drill bit Assemble the drill sleeve into the protection sleeve. Insert the assembly through the distal oblique hole in the aiming arm. Make a stab incision. Then make sure that the protection sleeve sits flush with the bone. Insert the 2.4 mm drill bit through the drill sleeve. Ensure that the drill is running before the drill bit contacts the bone. Stop drilling immediately after penetrating the far cortex....

Implantation Option B: Measure for screw length with depth gauge for 2.7 mm screws Instrument 03.007.025 Depth Gauge for 2.7 mm Screws Remove the drill bit and drill sleeve. Measure the screw length using the depth gauge. Ensure that the outer sleeve of the depth gauge is in contact with the aiming arm. Verify position radiographically. Read the measurement at the back of the outer sleeve. 12 Synthes Olecranon Osteotomy Nail Technique Guide