Navy A/R Femoral Nail Surgical Technique Navy Surgical Technique

Special thanks to Contributing Surgeons, Yalkın ÇAMURCU, MD, Department of Orthopedics and Traumatology Medical Faculty of Erzincan University Erzincan, Turkey Mehmet Cenk Cankuş, MD, FEBOT Department of Orthopedics and Traumatology Medical Faculty of Sanko University Gaziantep, Turkey

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Navy A/R Femoral Nail Specifications Navy A/R Femoral Nail Indications TABLE OF CONTENTS Navy A/R Femoral Nail RETROGRADE APPROACH

Claw Technology Dunitech leads innovational systems and aims to supply options for the surgeons to excel at their expertise. Claws are a novelty solution on distal locking systems designed to support the orthopedic trauma community. Six retractable Claws are designed to penetrate the cortex and provide exceptional axial and rotational stability. Claws are titanium pins that act as anchors to provide a stable fixation, as well as other superior operative parameters. Claws are made from titanium, and mechanically deploy from within the nail. Claws penetrate through the cancellous bone, and anchor...

Navy A/R Femoral Nail Specifications reliably retractable! All Claws were successfully retracted after every test. Nail length: 280 mm to 460 mm in 20 mm increment Conventional systems are subjected to screw breakage, screw head wear and drill bit breakage that may prevent the nail to be removed. Dunitech Claws are deployed within the nails from precise holes in a tight fit, preventing empty spaces for bone ingrowth. Distal Diameter: 10 mm to 13 mm in 1 mm increment Distal Claw Maximum Span: 38 mm (11-12-13 mm) 26 mm (10 mm) Cumulative Rotation(deg) Rotational Stability In unstable subtrochanteric...

Navy A/R Femoral Nail Indications INDICATIONS ● Femoral Shaft Fractures Ipsilateral hip / shaft fractures Ipsilateral femur / tibia fractures (floating knee) Supracondylar fractures including those with intraarticular extension Fractures proximal to a knee implant Osteoporotic fractures Pathologic / impending pathologic fractures Malunions / nonunions PRECAUTIONS Navy A/R Femoral nails and accessories were not evaluated for safety and compatibility in magnetic resonance (MR) environment and no tests for heating or migration were conducted for this product in MR environment. CONTRAINDICATIONS...

Surgical Technique

1. Patient Positioning and Fracture Reduction INSTRUMENTS FOR ACCESSING THE CANAL AND PROXIMAL REAMING Place the patient in the supine or lateral decubitus position according to surgeon preference on a fracture or other radiolucent table. Navy Entry Reamer (N03-0030) Apply traction to the affected leg and place it in slight adduction to ease access to the piriformis fossa and intramedullary canal. Alternatively, the torso can be abducted 10-15° towards the unaffected leg. The unaffected leg should be placed in a leg holder or extended away from the affected leg (Fig-1 and Fig-2). Position the...

4. Proximal Reaming INSTRUMENTS: Option 1: Trocar Tip Guide Wire Tissue Protector (N01-0150) Navy Entry Reamer (N03-0030) Ball Tip Guide Wire 2 mm x 900 mm (N01-0290), for Navy 10 mm Trocar Tip Guide Wire 3 mm x 600 mm (N01-0250) 2 mm Guide Wire Sheath (N01-0300), for Navy 10 mm ● Advance the 3 mm Trocar Tip Guide Wire through the entry point and into the proximal femur with the help of a powered driver. Ball Tip Guide Wire 3 mm x 900 mm (N01-0270), for Navy 11 mm to 13 mm 3 mm Guide Wire Sheath (N01-0280), for Navy 11 mm to 13 mm ● The wire should be centered in the canal on the AP and lateral...

INSTRUMENTS FOR DETERMINING NAIL LENGTH AND DISTAL REAMING 5. Determining the Nail Length INSTRUMENTS: Navy Radiographic Claw Template - 10 mm (N03-0080), for Navy 10 mm Navy Radiographic Claw Template - 11-13 mm (N03-0090), for Navy 11-13 mm Navy Radiographic Claw Template - 10 mm (N03-0080), for Navy 10 mm Confirm that the fracture is well reduced and place the appropriate Navy Radiographic Claw Template over the thigh (Fig-9). Use N03-0080 for nails with distal diameter of 10 mm and N03-0090 for nails with distal diameters between 11 to 13 mm. The template shows approximately the full opening...

INSTRUMENTS FOR ATTACHING THE NAIL INSTRUMENTS: Dunitech Intramedullary Reamer Set (INST-01-002) Guide Wire Pusher (N01-0060) ● Navy Guide Handle (N03-0060) Confirm that the fracture is well reduced. Starting from 8.5 mm Reamer Cutter Head, ream until the desired depth with a steady pressure. By each pass, increase the diameter of the Reamer Cutter Head in 0.5 mm increments. Use the Guide Wire Navy Handle-Nail Connector Screw (N03-0070) Pusher to keep the guide wire in place. If the sheath comes out with the reamer, insert it back before starting the next pass. ● The canal should be reamed to...

INSTRUMENTS FOR CHECKING ALIGNMENT AND INSERTING THE NAIL INSTRUMENTS: Navy Handle-Nail Connector Screw (N03-0070) 7 mm Hex Driver (N01-0030) Navy Guide Handle (N03-0060) ● The marks on the Guide Handle have the following meaning: Handle-Arm Connector Screw (N01-0140) 3 LA/RR for Left femur and Antegrade approach (LA) or Right femur and Retrograde approach (RR). 3 RA/LR for Right femur and Antegrade approach (RA) or Left femur and Retrograde approach (LR). ● For Antegrade approach, align the mark on the nail to the LA/RR mark on the Guide Handle for the Left leg or RA/LR Navy Guide Arm (N03-0050)...

Handle - Arm Connector Screw (N01-0140) Screw Sleeve (N01-0130) 4 If the Guide Wire Sheath has not been removed, it has to be removed in before the insertion of the nail (Fig-11). The Sheath will not pass through the nail. Before inserting the nail check the nail’s holes are correctly aligned to the holes of the Guide Arm. 4 If a traditional ball tip guide wire was used, it must be exchanged for a smooth guide wire. Its tip won’t pass through the nail. Mate the Navy Guide Arm with the Navy Guide Handle and secure them with the Handle-Arm Connector Screw. Insert the Drill Sleeve into the Screw...