Zimmer ITST Intertrochanteric/ Subtrochanteric Fixation System. Abbreviated Surgical Technique

Transcription

1 Zimmer ITST Intertrochanteric/ Subtrochanteric Fixation System Abbreviated Surgical Technique

2 ITST System Abbreviated Surgical Technique Indications The ITST Intramedullary Nail is indicated for use in a variety of femoral fractures, such as: Subtrochanteric Fractures Intertrochanteric Fractures Comminuted Fractures Segmental Fractures Fractures with Bone Loss Proximal and Distal Fractures Nonunions 1 Creating the Entry Portal Place the cannulated awl at the selected starting point and confirm its position in both the A/P and lateral planes on C-arm. Advance the cannulated awl through the greater trochanter to the lesser trochanter location. WARNING: The surgeon should be aware that use in osteoporotic bone or improper placement of the nail-screw construct could increase the risk of failure or cut out of the implant. 2 Guide Wire Placement Attach the 3.0mm Bulb-tipped Guide Wire to the Wire Grip T-Handle. Insert the guide wire through the cannulated awl past the fracture site. Pass the wire to the distal epiphyseal scar. 7 Lag Screw Positioning Superior Anti-rotation Screw Position Inferior Position 8 Reamer Head Preparation Gold to Gold Reamer Stop Assembly Bushing Stop Assembly is flush against the Bushing The projected path of the into the Femoral Head should be assessed using the C-arm. This may be verified using the Screw Position Outrigger (A/P) and the 3.2mm Threaded Guide Pin (Lateral) as illustrated. Insert Pin Bushing and Bushing together into the inferior screw hole in the Targeting Guide. Drill the Guide Pin to the level of the subchondral bone of the femoral head. Measurement designates the correct length of the to be implanted. Under power, advance the reamer until the Stop Assembly stops against the Bushing. Monitor progress of the reamer using the C-arm.

3 3 Measure (For Long Nails Only) Connect the 2 piece Nail Length Gauge. Slide the gauge over the Guide Wire and measure. 4 Reaming For long Nails, ream the medullary canal to 1mm greater than the diameter of the chosen Nail size. Ream trochanteric region to 17mm in diameter to accommodate the implant using the Trochanteric Reamer. Ream to the level of the lesser trochanter. NOTE: If the GUIDE WIRE becomes lodged within the reamer, use the WIRE GRIP T-Handle to push the GUIDE WIRE back into the IM canal. Trochanteric Reamer 9 Lag Screw Insertion with ITST Compression Device Compressor Compression Device T-Handle Thread the appropriate securely to the Compression Device T-Handle. Insert Lag Screw to within 5mm of the subchondral bone, monitoring the advancement with the C-arm. Rotate the Lag Screw Compression Device T-Handle such that one of the four etched lines is in line with the etched line on the Proximal Targeting Guide. If intra operative compression of the fracture is desired, begin advancing the Compressor clockwise against the Lag Screw Bushing. Compression Retainer Proximal Targeting Guide Indicator Line 10a Distal Screw Fixation 180mm / Short Nails Assemble appropriate Bushings into the ITST Targeting Guide. Drill, measure and insert appropriate sized screws. ITST Global Nails 180mm Diameter Distal Screw Drill Size 10mm Nail 4.5mm Screw 3.7mm Drill 11mm Nail 5.5mm Screw 5.0mm Drill 12mm Nail 5.5mm Screw 5.0mm Drill 13mm Nail 5.5mm Screw 5.0mm Drill 14mm Nail 5.5mm Screw 5.0mm Drill 15mm Nail 5.5mm Screw 5.0mm Drill

4 5 Nail Assembly Locking Bolt 6 Nail Insertion Proximal Targeting Guide Guide Pin Wrench/ Driver Bushing Correct Alignment: arrow to arrow Select the appropriate size ITST Femoral Nail. Slide the ITST Locking Bolt through the barrel in the ITST Proximal Targeting Guide and secure. Check lag and distal screw holes for correct instrument assembly. Nail may be inserted by hand. 10b Distal Screw Fixation Long Nails Freehand Technique 11Completion Incorrect Correct Insert the appropriate Nail Cap: Neutral Nail Cap, Sliding Nail Cap, or Locking Nail Cap with the Nail Cap Inserter. Tighten until fully seated. Neutral Cap* (5mm Shown) * All Nail Caps are available in 0, 5, 10, 15, and 20mm head heights. Sliding Cap* (0mm Shown) ITST Global Nails 300mm-500mm 10mm Nail 4.5mm Screw 3.7mm Drill 11mm Nail 5.5mm Screw 5.0mm Drill 12mm Nail 5.5mm Screw 5.0mm Drill 13mm Nail 5.5mm Screw 5.0mm Drill 14mm Nail 5.5mm Screw 5.0mm Drill Locking Cap* (15mm Shown)

5 Zimmer ITST Intertrochanteric/Subtrochanteric Fixation System ITST Implant Ordering Information Prod. No. Description Size ITST Asia Set Univ L/R Fem IM Nail 10mmDX18cm Univ L/R Fem IM Nail 11mmDX18cm Univ L/R Fem IM Nail 12mmDX18cm Univ L/R Fem IM Nail 13mmDX18cm Univ L/R Fem IM Nail 14mmDX18cm Univ L/R Fem IM Nail 15mmDX18cm ITST Global Short Set Univ L/R Fem IM Nail 10mmDX18cm Univ L/R Fem IM Nail 11mmDX18cm Univ L/R Fem IM Nail 12mmDX18cm Univ L/R Fem IM Nail 13mmDX18cm Univ L/R Fem IM Nail 14mmDX18cm Univ L/R Fem IM Nail 15mmDX18cm ITST Global Long Set Left Fem IM Nail 10mmDX30cm Left Fem IM Nail 11mmDX30cm Left Fem IM Nail 12mmDX30cm Left Fem IM Nail 13mmDX30cm Left Fem IM Nail 14mmDX30cm Right Fem IM Nail 10mmDX30cm Right Fem IM Nail 11mmDX30cm Right Fem IM Nail 12mmDX30cm Right Fem IM Nail 13mmDX30cm Right Fem IM Nail 14mmDX30cm Left Fem IM Nail 10mmDX32cm Left Fem IM Nail 11mmDX32cm Left Fem IM Nail 12mmDX32cm Left Fem IM Nail 13mmDX32cm Left Fem IM Nail 14mmDX32cm Right Fem IM Nail 10mmDX32cm Right Fem IM Nail 11mmDX32cm Right Fem IM Nail 12mmDX32cm Right Fem IM Nail 13mmDX32cm Right Fem IM Nail 14mmDX32cm Left Fem IM Nail 10mmDX34cm Left Fem IM Nail 11mmDX34cm Left Fem IM Nail 12mmDX34cm Left Fem IM Nail 13mmDX34cm Left Fem IM Nail 14mmDX34cm Right Fem IM Nail 10mmDX34cm Right Fem IM Nail 11mmDX34cm Right Fem IM Nail 12mmDX34cm Right Fem IM Nail 13mmDX34cm Right Fem IM Nail 14mmDX34cm Left Fem IM Nail 10mmDX36cm Left Fem IM Nail 11mmDX36cm Left Fem IM Nail 12mmDX36cm Left Fem IM Nail 13mmDX36cm Left Fem IM Nail 14mmDX36cm Right Fem IM Nail 10mmDX36cm Right Fem IM Nail 11mmDX36cm Right Fem IM Nail 12mmDX36cm Right Fem IM Nail 13mmDX36cm Right Fem IM Nail 14mmDX36cm Left Fem IM Nail 10mmDX38cm Left Fem IM Nail 11mmDX38cm Left Fem IM Nail 12mmDX38cm Left Fem IM Nail 13mmDX38cm Left Fem IM Nail 14mmDX38cm Right Fem IM Nail 10mmDX38cm Right Fem IM Nail 11mmDX38cm Right Fem IM Nail 12mmDX38cm Right Fem IM Nail 13mmDX38cm Right Fem IM Nail 14mmDX38cm Left Fem IM Nail 10mmDX40cm Left Fem IM Nail 11mmDX40cm Left Fem IM Nail 12mmDX40cm Left Fem IM Nail 13mmDX40cm Left Fem IM Nail 14mmDX40cm Right Fem IM Nail 10mmDX40cm Right Fem IM Nail 11mmDX40cm Right Fem IM Nail 12mmDX40cm Right Fem IM Nail 13mmDX40cm Right Fem IM Nail 14mmDX40cm Left Fem IM Nail 10mmDX42cm Left Fem IM Nail 11mmDX42cm Left Fem IM Nail 12mmDX42cm Left Fem IM Nail 13mmDX42cm Left Fem IM Nail 14mmDX42cm Right Fem IM Nail 0mmDX42cm Right Fem IM Nail 11mmDX42cm Right Fem IM Nail 12mmDX42cm Right Fem IM Nail 13mmDX42cm Right Fem IM Nail 14mmDX42cm Left Fem IM Nail 10mmDX44cm Left Fem IM Nail 11mmDX44cm Left Fem IM Nail 12mmDX44cm Prod. No. Description Size Left Fem IM Nail 13mmDX44cm Left Fem IM Nail 14mmDX44cm Right Fem IM Nail 10mmDX44cm Right Fem IM Nail 11mmDX44cm Right Fem IM Nail 12mmDX44cm Right Fem IM Nail 13mmDX44cm Right Fem IM Nail 14mmDX44cm Left Fem IM Nail 10mmDX46cm Left Fem IM Nail 11mmDX46cm Left Fem IM Nail 12mmDX46cm Left Fem IM Nail 13mmDX46cm Left Fem IM Nail 14mmDX46cm Right Fem IM Nail 10mmDX46cm Right Fem IM Nail 11mmDX46cm Right Fem IM Nail 12mmDX46cm Right Fem IM Nail 13mmDX46cm Right Fem IM Nail 14mmDX46cm Left Fem IM Nail 10mmDX48cm Left Fem IM Nail 11mmDX48cm Left Fem IM Nail 12mmDX48cm Left Fem IM Nail 13mmDX48cm Left Fem IM Nail 14mmDX48cm Right Fem IM Nail 10mmDX48cm Right Fem IM Nail 11mmDX48cm Right Fem IM Nail 12mmDX48cm Right Fem IM Nail 13mmDX48cm Right Fem IM Nail 14mmDX48cm Left Fem IM Nail 10mmDX50cm Left Fem IM Nail 11mmDX50cm Left Fem IM Nail 12mmDX50cm Left Fem IM Nail 13mmDX50cm Left Fem IM Nail 14mmDX50cm Right Fem IM Nail 10mmDX50cm Right Fem IM Nail 11mmDX50cm Right Fem IM Nail 12mmDX50cm Right Fem IM Nail 13mmDX50cm Right Fem IM Nail 14mmDX50cm Nail Caps ITST 1-Piece Slide Nail Cap 0mm ITST 1-Piece Slide Nail Cap 5mm ITST 1-Piece Slide Nail Cap 10mm ITST 1-Piece Slide Nail Cap 15mm ITST 1-Piece Slide Nail Cap 20mm ITST 1-Piece Lock Nail Cap 0mm ITST 1-Piece Lock Nail Cap 5mm ITST 1-Piece Lock Nail Cap 10mm ITST 1-Piece Lock Nail Cap 15mm ITST 1-Piece Lock Nail Cap 20mm ITST One-Piece NTRL Nail Cap 0mm ITST One-Piece NTRL Nail Cap 5mm ITST One-Piece NTRL Nail Cap 10mm ITST One-Piece NTRL Nail Cap 15mm ITST One-Piece NTRL Nail Cap 20mm Anti-Rotation Screws ITST Anti-Rotate Screw 6.5mmDX60mm ITST Anti-Rotate Screw 6.5mmDX65mm ITST Anti-Rotate Screw 6.5mmDX70mm ITST Anti-Rotate Screw 6.5mmDX75mm ITST Anti-Rotate Screw 6.5mmDX80mm ITST Anti-Rotate Screw 6.5mmDX85mm ITST Anti-Rotate Screw 6.5mmDX90mm ITST Anti-Rotate Screw 6.5mmDX95mm ITST Anti-Rotate Screw 6.5mmDX100mm ITST Anti-Rotate Screw 6.5mmDX105mm ITST Anti-Rotate Screw 6.5mmDX110mm ITST Asia s Asia 1-Piece 11mm X 70mm Asia 1-Piece 11mm X 75mm Asia 1-Piece 11mm X 80mm Asia 1-Piece 11mm X 85mm Asia 1-Piece 11mm X 90mm Asia 1-Piece 11mm X 95mm Asia 1-Piece 11mm X 100mm Asia 1-Piece 11mm X 105mm Asia 1-Piece 11mm X 110mm Asia 1-Piece 11mm X 115mm Asia 1-Piece 11mm X 120mm ITST STD s Piece 11mm X 70mm Piece 11mm X 75mm Piece 11mm X 80mm Piece 11mm X 85mm Piece 11mm X 90mm Piece 11mm X 95mm Piece 11mm X 100mm Piece 11mm X 105mm Piece 11mm X 110mm Piece 11mm X 115mm Piece 11mm X 120mm Prod. No. Description ITST Short Nail Instrument Set (includes all of the following listed below) ITST Short Nail Instrument Case Wire Grip T-Handle Long Cannulated Awl Pin Wrench (1 only) T-Handle Perc Trochanteric Reamer ITST Taper Reamer Locking Bolt Extractor Locking Bolt Inserter (Lag) Screw Position Outrigger mm Threaded Guide Pin (Qty: 3) ITST Cannula ITST Centering Bushing Linked Nail Cap Inserter U-Joint Sleeve Screw Inserter Adapter T-Handle HxHD Screwdriver (3.5mm) Locking Bolts (Qty: 2) ITST Targeting Guide Threaded Guide Pin Bushing ITST Bushing Cannulated Depth Gauge Reamer Tap Stop Assembly (Qty: 2) ITST 3.2 Bushing ITST 5.0mm Drill Bushing ITST 8.0mm Screw Bushing (Qty: 2) ITST 5.0mm Femoral Drill ITST Compression Device ITST Accessory Instrument Set (includes all of the following listed below) ITST Accessory Instrument Case mm T-Handle Screwdriver Long Threaded Driver Nail Length Gauge Wand Insert Wand Set Screw Wand Handle Distal Screw Depth Gauge (short) mm Distal Trocar Drill (Qty: 2) mm Distal Trocar Drill (Qty: 2) Reduction Finger ITST 3.7mm Drill Bushing ITST 3.7mm Drill ITST 4.5mm Screw Tap ITST Screw Depth Gauge (long) Driver Extension Driver Extension Bolt (Qty: 1) Optional ITST Instrumentation Straight Ball Spike Pusher Medium Bone Hook (Shoulder Hook) ITST One-Piece Nail Cap Inserter ITST Linked Nail Cap Inserter ITST Compression Assembly (Note: includes: Compression Device T-Handle, Compressor, Compression Retainer.) Compression Retainer (Replacement Part) ITST Asia Instrument Set* (set includes all instruments and case) ITST Asia Taper Reamer ITST Asia Targeting Guide

6 Cortical Screws Prod. No. Description Cortical Screw 4.5mmDX20mm Cortical Screw 4.5mmDX22.5mm Cortical Screw 4.5mmDX25mm Cortical Screw 4.5mmDX27.5mm Cortical Screw 4.5mmDX30mm Cortical Screw 4.5mmDX32.5mm Cortical Screw 4.5mmDX35mm Cortical Screw 4.5mmDX37.5mm Cortical Screw 4.5mmDX40mm Cortical Screw 4.5mmDX42.5mm Cortical Screw 4.5mmDX45mm Cortical Screw 4.5mmDX47.5mm Cortical Screw 4.5mmDX50mm Cortical Screw 4.5mmDX52.5mm Cortical Screw 4.5mmDX55mm Cortical Screw 4.5mmDX57.5mm Cortical Screw 4.5mmDX60mm Cortical Screw 4.5mmDX62.5mm Cortical Screw 4.5mmDX65mm Cortical Screw 4.5mmDX67.5mm Cortical Screw 4.5mmDX70mm Cortical Screw 4.5mmDX72.5mm Cortical Screw 4.5mmDX75mm Cortical Screw 4.5mmDX77.5mm Cortical Screw 4.5mmDX80mm Cortical Screw 4.5mmDX82.5mm Cortical Screw 4.5mmDX85mm Cortical Screw 4.5mmDX87.5mm Cortical Screw 4.5mmDX90mm Cortical Screw 5.5mmDX20mm Cortical Screw 5.5mmDX22.5mm Cortical Screw 5.5mmDX25mm Cortical Screw 5.5mmDX27.5mm Cortical Screw 5.5mmDX30mm Cortical Screw 5.5mmDX32.5mm Cortical Screw 5.5mmDX35mm Prod. No. Description Cortical Screw 5.5mmDX37.5mm Cortical Screw 5.5mmDX40mm Cortical Screw 5.5mmDX42.5mm Cortical Screw 5.5mmDX45mm Cortical Screw 5.5mmDX47.5mm Cortical Screw 5.5mmDX50mm Cortical Screw 5.5mmDX52.5mm Cortical Screw 5.5mmDX55mm Cortical Screw 5.5mmDX57.5mm Cortical Screw 5.5mmDX60mm Cortical Screw 5.5mmDX62.5mm Cortical Screw 5.5mmDX65mm Cortical Screw 5.5mmDX67.5mm Cortical Screw 5.5mmDX70mm Cortical Screw 5.5mmDX72.5mm Cortical Screw 5.5mmDX75mm Cortical Screw 5.5mmDX77.5mm Cortical Screw 5.5mmDX80mm Cortical Screw 5.5mmDX82.5mm Cortical Screw 5.5mmDX85mm Cortical Screw 5.5mmDX87.5mm Cortical Screw 5.5mmDX90mm Cortical Screw 5.5mmDX92.5mm Cortical Screw 5.5mmDX95mm Cortical Screw 5.5mmDX97.5mm Cortical Screw 5.5mmDX1000m DISCLAIMER: This documentation is intended exclusively for physicians and is not intended for laypersons. Information on the products and procedures contained in this document is of a general nature and does not represent and does not constitute medical advice or recommendations. Because this information does not purport to constitute any diagnostic or therapeutic statement with regard to any individual medical case, each patient must be examined and advised individually, and this document does not replace the need for such examination and/or advise in whole or in part. Please refer to the package inserts for important product information, including, but not limited to, indications, contraindications, warnings, precautions, and adverse effects. Contact your Zimmer representative or visit us at The CE mark is valid only if it is also printed on the product label Rev Printed in USA 2015 Zimmer, Inc.