Distal Targeting System Gamma3 Long Nail R1.5 / T2 Recon Nail R1.5 Operative Technique

Distal Targeting Device Contributing Surgeons Prof. Gilbert Taglang, M.D. Department of Traumatology University Hospital, Strasbourg France Florian Krug, Ph.D. Head of Trauma Department Klinikum Eilbek, Schoen Kliniken, Hamburg Germany This publication sets forth detailed recommended procedures for using Stryker Osteosynthesis devices and instruments. Clinical Assistant Professor Department of Orthopaedic Surgery University of Illinois, Chicago USA Robert Probe, M.D. Chairman − Department of Orthopaedic Surgery Scott & White Memorial Hospital, Temple, Tx USA It offers guidance that you should...

Distal Targeting System 4 Distal Targeting System Components 5 Distal Targeting Device Calibration 6 Prior to the Distal Locking Procedure 11 Distal Drilling and Locking 17

Introduction Distal Targeting System for Gamma3 Long Nails and T2 Recon Nails In response to the request of surgeons around the world, Stryker Osteosynthesis has created a dedicated Distal Targeting System. Without using the Distal Targeting System, the placement of the distal locking screws is done primarily by a variety of freehand techniques, using conventional or radiolucent drilling devices. These methods may result in repeated drilling, repeated X-Ray adjustment, which may require longer exposure as well as higher potential for mis-drilling2. Compatibility Using the Distal Targeting System...

Introduction Distal Targeting System Components The major components of the device are made of carbon fiber material, providing radiolucency under the C-Arm imaging and stiffness for the distal locking procedure. Distal Targeting System with T2 Recon Targeting Device Fixation Bolt Storage Pocket Adjusting Device Adjusting Screw Sleeve Fixation Button Adjusting Device Lever Positioning Pins Targeting Holes

Operative Technique Distal Targeting Device Calibration This operative technique does not describe the entire surgical procedure. For full Gamma3 Long Nail R1.5 and for full T2 Recon Nail R1.5 surgical procedures, please refer to the dedicated operative techniques. It is important to perform Distal Targeting Device calibration prior to the nail insertion. Then, follow the operative technique until “Distal Screw Locking”. The following description of the surgical technique is using a Gamma3 Long Nail R1.5 / LEFT and will describe distal locking in a static locking configuration. Calibration Calibration...

Operative Technique Distal Targeting Device Calibration Assembly and Length Adjustment Slide the Distal Targeting Arm R1.5 (REF 1320-5315) onto the Gamma3 Targeting Arm until a click is felt (Fig. 4). The white line must be seen through the Alignment Indicator Window for correct assembly (Fig. 4a). Insert the Fixation Bolt completely (Fig. 5 1 ) from the lateral opening until a click is felt. The Fixation Lever must then be securely locked (Fig. 5 2 ). Alignment Indicator Window Fixation Lever Fixation Bolt Note: Be sure that the Distal Targeting Arm is positioned anteriorly to the chosen nail...

Operative Technique Distal Targeting Device Calibration The length of the chosen nail determines where the Adjusting Device should be attached. The selected Adjusting Device (in this case we chose a left Gamma3 Long Nail R1.5 - 360mm to be locked in a static/static configuration) is placed into the Pin Positioning Holes that match the length of the selected nail. The corresponding nail lengths are marked on the Distal Targeting Arm (Fig. 12). Positioning Pins Insert the Positioning Pins into the Pin Positioning Holes, then lock the Adjusting Device Lever by turning it in a clockwise direction...

Operative Technique Distal Targeting Device Calibration A/P Adjustment The Instrument Tray has a dedicated Calibration Stand. Place the assembled device onto this by placing it onto the metal pin as shown (Fig. 16a). Then, look through the Tissue Protection Sleeve and adjust the targeting position by turning the Adjusting Screw until the holes of the sleeve and the nail appear coaxial. Now make final adjustments with the drill, passing it through the most proximal hole in the nail as shown. The drill must go through the nail hole smoothly and easily. If not, turn the Adjusting Screw until passage...

Operative Technique — Distal Guided Locking After the calibration steps have been completed, remove the Sleeve Assembly (Fig. 17 2 ) by pressing the Sleeve Fixation Button (Fig. 17 1 ) of the Adjusting Device. Release the Fixation Lever (Fig. 18a 1 ), then remove the Fixation Bolt (Fig. 18a 2 ) and place it into the Fixation Bolt Storage Pocket (Fig. 18b 3 ). Detach the Distal Target Arm assembly and store it back onto the Tray (Fig. 19). Warning: Keep the Adjusting Device in its position as calibrated. Do NOT remove the Adjusting Device from the Distal Targeting Arm at this point.

Operative Technique — Distal Guided Locking Prior to the Distal Locking Procedure Reattach the proximal Gamma3 Targeting Sleeve Assembly to the Gamma3 Targeting Arm according the Gamma3 Long Nail R 1.5 operative technique and select the chosen CCD angle on the device. Follow the Gamma3 Operative Technique, Long Nail R1.5, up to that part of the chapter entitled “Distal Screw Locking”. When this chapter is completed, the Set Screw has been properly positioned in a groove of the Lag Screw (Fig. 20) and a check has been done with the Lag Screwdriver T-handle to make sure that the Lag Screw can not...

Operative Technique — Distal Guided Locking Reassembly of the Calibrated Distal Targeting Arm The calibrated Distal Targeting Arm is slid over the Gamma3 Targeting Arm (Fig. 22 1 ). The white line must be visible in the Alignment Indicator Window (Fig. 22a). The Fixation Bolt is removed from the Fixation Bolt Storage Pocket and reinserted into the hole (Fig. 23 2 ), going completely through the Targeting Arm until a click is felt. Then, the Fixation Lever must be locked to ensure proper fixation. This is required to secure the arm to the targeter and stabilize the system. (Fig. 23 3 ). Alignment...