GAMMA LOCKING NAIL INSTRUMENTS OPERATIVE TECHNIQUE

GAMMA LOCKING NAIL INSTRUMENTS OPERATIVE TECHNIQUE

FEATURES AND BENEFITS The One Shot Device is a new component of the Gamma Locking Nail instrumentation system determining the correct position of the Gamma lag screw. It can be used to place a K-wire very easily and exactly in a desired location within the femoral head by attaching it onto the lag screw target sleeve. Without the One Shot Device, the final placement of the lag screw can be determined only after the lateral cortex is opened and the K-wire is inserted. In cases were the K-wire is inserted too proximal, correct placement of the lag screw is often difficult. By penetrating the cortex slightly more distally the tip of the awl automatically slipped into the first opening. In order to ensure good lag screw and thus Gamma Locking Nail positioning it is crucial to correctly position the K-wire. Using the One Shot Device during surgery this step can be performed exactly, with one drilling only. The goals of the One Shot Device are to: determine correct K-wire, lag screw and Gamma Locking Nail placement decrease OR time decrease X-ray exposure Metal indicators The One Shot Device is made of carbon fibre and works by providing a target that indicates the potential position of the K-wire on the fluoroscope screen. The target consists of three wires a dashed inner wire and two solid outer wires. These wires work like a gun sight to indicate the potential position of the K-wire. The One Shot Device is attached by slightly pressing the grip and releasing it when positioned onto the lag screw sleeve. If the device is moved on the sleeve the grip always has to be pressed slightly. Instructions Attachment grip

OPERATING TECHNIQUE The use of the One Shot Device should not interfere with or replace any steps in the Gamma Locking Nail Op-technique. To use the device, follow the Gamma Locking Nail technique until the lag screw target sleeve has been inserted (Fig. 1). Fig. 1 Note: The tip of the K-wire must be placed in the inferior half of the femoral head in the frontal plane, and on the midline in the lateral plane. The objective is to place the lag screw below the centre of the femoral head on the A/P view and centrally on the lateral view. Pressing the attachment grip slightly the device is positioned between the anterior aspect of the patient s hip and the fluoroscope screen (Fig. 2 + Fig. 3). It is important to drape the patient such that the One Shot Device does not interfere with any drapes anterior to the patient s hip. Fig. 2 Fig. 3 If positioned correctly, the target will appear in the fluoroscopic image. If it does not, the fluoroscope screen can be repositioned or the One Shot Device can be moved towards or away from the patient by pressing the grip slightly until the target is within the view of the fluoroscope.

OPERATING TECHNIQUE Once the target is correctly aligned, the Gamma Locking Nail can be moved superiorly or inferiorly until the dashed wire appears in the desired location for the K-wire within the femoral head (Fig. 4). To predict the location of the K-wire accurately, the dashed wire of the target must appear between the two solid wires at the desired position. If it does not, the device must be rotated about the lag screw sleeve until the dashed wire is in the centre (Fig. 5). If the position is incorrect the Gamma Locking Nail must be either pulled backwards (Fig. 6) or pushed forward (Fig. 7). Fig. 5 Fig. 6 Fig. 7 Fig. 4 The K-wire can then either be placed into the femur or the targeting arm is held in place until the K-wire s position in the lateral view has been determined. Fig. 9 Fig. 10 Fig. 8 Rotate the device to the Adjust the lateral view (Fig. 9). Position the fluoroscope lateral view by pressing The device must not have the screen to 45, 50 of the the grip slightly (Fig. 8). same plane like the Target Device. femoral axis (Fig. 10).

OPERATING TECHNIQUE Fig. 11 Check alignment by means of image intensifier (Fig. 11). If the dashed wire of the target appears between the two solid wires insert the K-wire and follow the Gamma Locking Nail Op-technique (Fig. 12). If it does not, the device must be rotated up (Fig. 13) or down (Fig. 14). Fig. 12 Fig. 13 Fig. 14 One Shot Device Catalogue number 1213-3010 Acknowledgements: The One Shot Device was designed with the contribution of: Dr. Asche, Freudenstadt/Germany Dr. Tokunaga, Fukuoka/Japan 2000 Stryker Corporation. All rights reserved. Printed in Germany. Stryker and Gamma logos are registered trademarks of the Stryker Corporation. To ensure the best quality of its products and their improvements Stryker reserves the right to modify all or part of their products. Caution: Federal law (U.S.A.) restricts this device to sale by or on the order of a licensed physician.

The Trochanteric Gamma Locking Nail and the original Long Gamma Locking Nail are made of Orthinox and have been designed by surgeons. Combining the strength and biomechanical advantages of the existing Gamma family they are the Golden standard for proximal femoral fractures with more than 500.000 treatments worldwide. I.C.NAIL The IC-Nail system is the realization of superior biomechanical intramedullary stabilization using small caliber, high tensile strength implants for internal fixation of long bones. Femoral and tibial implants offers three types of locking including active controlled intersegmentary compression in cases that are axially stable. More than 1.000.000 Grosse & Kempf locking nails have been implanted since its introduction in 1974. A development of the original intramedullary principles presented by Prof. Gerhard Küntscher, the femoral and tibial system provides the established advantages of closed operating technique and undisturbed callus formation using a sophisticated instrument system. For retrograde femoral nailing the Supracondylar Nail is the specialised implant. It is made of Orthinox and features a superior biomechanical stability. Unique to the short SCN is the locking of all screws via the target device. The design of the condyle screws allow for interfragmentary compression. METAIZEAU Since more than 10 years children from all over the world have been treated successfully using the Metaizeau paediatric nailing system. The main advantages of the system are: Simple and fast technique, closed reduction discharge from hospital at day 4 6 and minimal disturbance of bone growth. The nail can be adapted to the patient and guarantees a best fit for every case. I.M. SAW The I.M. Saw is suitable for closed osteotomies of the femur and tibia in all cases which allow the use of intramedullary nails for fragment fixation. Closed osteotomies with subsequent fragment fixation are indicated for correction of rotational deformities, angular deformities along the axis and lengthening and shortening procedures. MANUFACTURER: Stryker Trauma GmbH Prof.-Küntscher-Straße 1 5 D-24232 Schönkirchen Germany stryker.europe@ emea.strykercorp.com REF NO: B0300001 2000 Stryker Corporation. All rights reserved.