Expert Adolescent Lateral Femoral Nail. - Synthes

Technique Guide 

Expert Adolescent Lateral Femoral 

Nail. 

EXPERT 

Nailing System

Image intensifier 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 and dismantling of multi-part instruments, 

please refer to: www.synthes.com/reprocessing

Table of Contents 

Introduction 

Surgical Technique 

Product Information 

Expert Adolescent Lateral Femoral Nail System 2 

AO Principles 4 

Indications 5 

Clinical Cases 6 

Preoperative Planning 10 

Opening the Femur 13 

Inserting the Nail 21 

Locking Options 26 

Proximal Locking – Standard 28 

Proximal Locking – Recon 32 

Distal Locking 37 

End Cap Insertion 42 

Implant Removal 44 

Implants 46 

Instruments 50 

Set Lists 56 

Expert Adolescent Lateral Femoral Nail Technique Guide Synthes 1


Nail System 

Nail features 

– Design accommodates a lateral entry site through the 

greater trochanter 

– Anatomic nail design based on a femoral canal study 1 

– Titanium cannulated nail for reamed or unreamed techniques 

– Lengths from 240 mm to 400 mm, in 20 mm increments 

– Designed for use in patients where Titanium Elastic Nails 

are not large enough and the Expert Lateral Femoral Nail 

for adults is too large 

– 8.2 mm, 9 mm, and 10 mm diameter nails with 11 mm 

diameter proximal ends 

End caps 

– Prevent ingrowth of tissue and facilitate nail extraction 

– Self-retaining, T40 Stardrive recess for easy pickup and 

insertion of the end cap 

– Cannulated for insertion over a guide wire 

– 0 mm end cap sits flush with the nail 

– 5 mm, 10 mm, and 15 mm end caps extend nail height 

if the nail is overinserted 

1 Ehmke L, Polzin B, Roth C, Bottlang M (2006) Femoral Nailing Through the 

Trochanter: The Reamer Pathway Indicates A Helical Shape. Journal of 

Orthopedic Trauma Vol. 20 (Number 10): 668 – 674 

2 Synthes Expert Adolescent Lateral Femoral Nail Technique Guide 

Improved instrumentation 

– Easy-to-use instrumentation facilitates the surgical 

procedure 

– Ball-tip reaming rod can be removed through the nail and 

the insertion instruments, eliminating the need for an 

exchange tube 

– Tailored to the needs of clinic (available as upgrade set for 

adolescents to Expert Lateral Femoral System for adults 

or Standard Instrument Set for Expert Adolescent Lateral 

Femoral Nail)

Standard locking screws 

– Double-lead thread for ease of insertion 

– Thread closer to screw head provides better bone 

purchase in the near cortex and improved stability 

– Titanium alloy* for improved mechanical and fatigue 

properties 

– Self-tapping blunt tip 

– Self-retaining T25 Stardrive recess allows improved torque 

transmission, increased resistance to stripping relative to 

a hex recess, and secure locking screw pickup 

– 4.0 mm diameter 

5.0 mm hip screws 

– Lengths from 50 mm to 125 mm in 5 mm increments 

– Self-retaining T25 Stardrive recess 

– Titanium alloy* 

*Titanium-6% aluminum-7% niobium alloy 


AO Principles 

In 1958, the AO formulated four basic principles, which have 

become the guidelines for internal fixation in general, and 

intramedullary nailing in particular. 2 

Anatomic reduction 

The Expert Adolescent Lateral Femoral Nail in titanium is 

cannulated as well as designed to fit anatomically in the 

medullary canal and allows indirect reduction. 

Stable fixation 

The intramedullary nail acts as an internal splint that controls 

but does not prevent micromovements of the fragments. It 

provides relative stability that leads to an indirect healing 

through callus formation. 

Preservation of blood supply 

The instruments and implants in the Expert Adolescent 

Lateral Femoral System permit a minimally invasive technique 

and less tissue stripping than other treatment methods. 

An intramedullary approach results in decreased blood loss 

compared to plate fixation. 

Early, active mobilization 

The titanium cannulated Expert Adolescent Lateral Expert 

Femoral Nail provides secure fixation which permits 

controlled, early, active rehabilitation conducive to optimal 

recovery. 

2 Müller ME, Allgöwer M, Schneider R, Willenegger H (1991) AO Manual of 

Internal Fixation, 3rd Edition. Berlin: Springer-Verlag 

4 Synthes Expert Adolescent Lateral Femoral Nail Technique Guide

Indications 

The Expert Adolescent Lateral Femoral Nail is indicated for 

use in adolescent and small-stature adult patients to stabilize: 

– Fractures of the femoral shaft 

– Subtrochanteric fractures 

– Ipsilateral neck / shaft fractures 

– Impending pathologic fractures 

– Nonunions and malunions 

Note: ASLS, the Angular Stable Locking System, is indicated 

in cases where increased stability is needed in fractures closer 

to the metaphyseal area or in poor quality bone. For more 

details regarding the intramedullary fixator principle, please 

consult the ASLS technique guide (036.000.708) and concept 

flyer (036.001.017). 


Clinical Cases 

Case 1 – standard transverse locking 

– 16-year-old female, 45 kg 

– Isolated transverse femoral shaft fracture 

Case 2 – antegrade locking 

– 15-year-old male, 55 kg 

– Oblique midshaft femoral shaft fracture 


Preoperative 

Preoperative

Intraoperative 

Postoperative 

Follow-up (6 weeks after surgery) 

Follow-up (4 months after surgery) 


Clinical Cases 

Case 3 – recon locking 


– Pathologic proximal femoral shaft fracture 

Case 4 – distal locking 


– Oblique distal third femoral shaft fracture 


Preoperative 

Preoperative

Postoperative 

Postoperative 

Follow-up (3 weeks after surgery) 

Follow-up (1 month after surgery) 


Preoperative Planning 

Use the AO preoperative planner templates for the Expert 

Adolescent Lateral Femoral Nail (034.000.600/605) to estimate 

nail length and medullary canal diameter. 

To estimate medullary canal diameter, place the template on 

the AP or lateral x-ray of the femur and measure the dia - 

meter of the medullary canal at the narrowest part that will 

contain the nail. 

To estimate nail length, place the template on the AP x-ray of 

the uninjured femur and select the appropriate nail length 

based on patient anatomy. When selecting nail size, consider 

canal diameter, fracture pattern, patient anatomy and postoperative 

protocol. 

Note: Templates are available in two sizes: actual size and 

115% magnification in which the image is enlarged 15% to 

correspond to typical radiographic magnification; however, 

variations in magnification levels are common. 

1 

Position patient 

Position the patient in the lateral decubitus or supine position 

on a fracture table or radiolucent operating table. 

Position the C-arm to allow visualization of the proximal 

femur in both the AP and lateral planes. 

To facilitate access to the medullary canal, abduct the upper 

part of the body approximately 10°–15° to the contralateral 

side and adduct the affected limb by 10°–15°. 


Expert Adolescent Lateral Entry Femoral Nail for Right Femur 

8.2 mm, 9 mm and 10 mm diameter 240 mm to 400 mm lengths 

15 mm 

10 mm 

5 mm 

0 mm 

15 mm 

End Caps 

10 mm 

5 mm 

0 mm 

A-P View 

Lateral View 

Locking Screw Stardrive 4.0 mm, TAN [04.005.408 – 04.005.470] 

Hip Screw Stardrive 5.0 mm, TAN [04.031.020 – 04.031.035] 

1.0 Magnification 

0 10 20 30 40 50 60 70 80 90 100mm 

For use only with the Original AO System of 

Instruments and Implants 

Affected leg 

10º–15º adduction 

8.2 mm 

9 mm 

10 mm 

Synthes GmbH 

Eimattstrasse 3 

CH-4436 Oberdorf 

www.synthes.com 

8.2 mm 

9 mm 

10 mm 

240 mm 

240 mm 

260 mm 

260 mm 

280 mm 

280 mm 

300 mm 

300 mm 

320 mm 

320 mm 

340 mm 

340 mm 

360 mm 

360 mm 

380 mm 

380 mm 

Expert Adolescent 

Lateral Entry Femoral Nail 

for Right Femur 

400 mm 

400 mm

2 

Reduce fracture 

Instrument 

394.350 Large Distractor* 

Perform closed reduction manually by axial traction under 

image intensifier control. The use of the large distractor may 

be appropriate in certain circumstances. 

3 

Confirm nail length 

Instrument 

03.010.020 Radiographic Ruler for Expert Femoral Nails 

The required nail length must be determined after reduction 

of the femoral fracture. 

Position the C-arm for an AP view of the proximal femur. 

With long forceps, hold the ruler alongside the lateral thigh, 

parallel to and at the same level as the femur. Adjust the 

ruler until the proximal end is at the desired nail insertion 

depth. Mark the skin at the proximal end of the ruler. 

*Additional available 


Preoperative Planning 

Move the C-arm to the distal femur. Verify fracture reduction. 

Align the proximal end of the radiographic ruler to the skin 

mark, and take an AP image of the distal femur. 

Read nail length directly from the ruler image, selecting the 

measurement proximal to the epiphysis, or at the chosen 

insertion depth. 

Note: It is recommended to treat the fracture with the 

longest nail possible without crossing the physis, taking into 

account patient anatomy or a previous implant. The distal 

end of the nail should be 15 mm from the physis. 

Back-hammering or dynamization to close a fracture gap 

must be taken into account when determining the nail 

length. A shorter nail should be chosen when back-hammering 

or dynamization is planned. The dynamic slot allows 

7 mm of movement. 

4 

Confirm canal diameter 

Instrument 

03.010.023 Radiographic Ruler for Nail Diameters for 

Expert Femoral Nails 

Position the C-arm for an AP or lateral view of the femur at 

the level of the isthmus. Hold the radiographic canal width 

estimator over the femur with the diameter gauge centered 

over the narrowest part of the medullary canal. Read the 

estimated diameter measurement on the circular indicator 

that fills the canal. 

Note: If the reamed technique is used, the diameter of the 

largest medullary reamer must be at least 1.0 mm greater 

than the nail diameter. 


Opening the Femur 

1 

Approach 

Palpate the posterior edge of the greater trochanter. 

Make a 3 cm incision in line with the central axis of the 

intramedullary canal in the lateral view, and depending on 

the anatomy of the patient, 2– 5 cm proximal to the tip 

of the greater trochanter. 

2 

Determine entry point 

The insertion point is 12° lateral to the greater trochanter, as 

measured from a point 20 mm distal to the lesser trochanter. 

The entry point can also be described as lateral to the greater 

trochanter at the same level as the superior aspect of the 

base of the femoral neck (just above the piriformis fossa). 

This point can be found by extending a line horizontally from 

the base of the femoral neck to the lateral side of the femur. 

12° 

20 mm 



3 

Insert guide wire 

Instruments 

03.010.031 Drill Sleeve 13.0/3.2 for antegrade 

approach 

03.010.229 Protection Sleeve 15.5 mm/13.7 mm, 

length 122.5 mm 

357.393 Trocar 3.2 mm, length 172 mm, for 

No. 357.392 

357.399 Guide Wire 3.2 mm, length 400 mm 

Insert the protection sleeve, wire guide and trocar assembly 

into the incision site and to the bone. 

Remove the trocar. Insert the guide wire through the wire 

guide. 

The guide wire must be inserted laterally at an angle of 12° 

to the center of the medullary canal. The tip of the guide 

wire should be centered in the medullary canal 20 mm distal 

to the lesser trochanter. 

Verify that the guide wire position allows adequate clearance 

on the lateral side of the femur for the opening drill bit. 

The guide wire is inserted with it centered in the lateral view. 


4 

Open proximal femur to medullary canal 

Required set 

189.060 SynReam Intramedullary Reaming System 

in Vario Case 

Instruments 

03.010.229 Protection Sleeve 15.5 mm/13.7 mm, 


351.270 Drill Bit 13.0 mm, cannulated, 

length 290 mm, 3-flute, for 

Quick Coupling No. 511.760 

351.706S Reaming Rod 2.5 mm, length 950 mm, 

with Olive, sterile 


with Olive and extension, sterile 

or 

352.032 SynReam Reaming Rod 2.5 mm. short, 

length 950 mm 

352.033 SynReam Reaming Rod 2.5 mm, long, 

length 1150 mm 

Drill to open cortex 

Drill through the protection sleeve. Drill the cortex until the 

drill bit stops in the sleeve. 

Remove the guide wire, drill bit and protection sleeve. 

Note: Dispose of the guide wire. Do not reuse. 

If reaming the medullary canal, proceed to page 17. 

Ream to open proximal femur 

Insert the 2.5 mm reaming rod. Using the flexible reamers, 

open the proximal femur to a depth of approximately 

75 mm, starting with an 8.5 mm reamer and ending with 

a 13.0 mm reamer. 

75 mm 



Alternative technique (with awl) 

Alternative instruments 

03.010.041 Awl 14.0/3.2 mm, cannulated 


Place the cannulated awl over the guide wire and open the 

medullary canal. Use a twisting motion to advance the awl to 

a depth of approximately 75 mm. 

Remove the guide wire and awl. 

Note: After opening the proximal femur, dispose of the 

guide wire. Do not reuse. 


5 

Ream medullary canal (optional) 

Required set 

189.060 SynReam Intramedullary Reaming System 

in Vario Case 

Instruments 

03.010.093 Rod Pusher for Reaming Rod with 

Hexagonal Screwdriver 8.0 mm 


with Olive, sterile 


with Olive and extension, sterile 

or 

352.032 SynReam Reaming Rod 2.5 mm. short, 

length 950 mm 

352.033 SynReam Reaming Rod 2.5 mm, long, 

length 1150 mm 

351.782 Holding Forceps for SynReam Reaming Rod 

2.5 mm 

03.010.369 Reduction Instrument for 

Medullary Nails 

393.105 Universal Chuck, small, with T-Handle 

If necessary, enlarge the femoral canal with the medullary 

reamer. The largest medullary reamer must be at least 

1.0 mm greater than the nail diameter. 

Check fracture reduction under image intensifier. Use the reduction 

instrument for medullary nails to facilitate reduction. 



Insert reaming rod 

Using the T-handle chuck or holding device, insert the reaming 

rod with ball tip into the medullary canal to the desired 

depth. 


Beginning with the 8.5 mm diameter reaming head, ream to 

a diameter of at least 1.0 mm greater than the nail diameter. 

Ream in 0.5 mm increments and advance the reamer with 

steady, moderate pressure. Do not force the reamer. Partially 

retract the reamer often to clear debris from the medullary 

canal. 

The holding forceps can be used to control the rotation of 

the reaming rod. 

Note: The reaming rod with ball tip can be removed through 

the cannulated adolescent lateral femoral nails. Reaming rod 

exchange is not required. 



Option 

Use the reaming rod push rod to help retain the reaming rod 

during reamer extraction. 


Inserting the Nail 

1 

Assemble insertion instruments 

Instruments 

03.010.044 Connecting Screw, cannulated, for Expert 

Tibial and Femoral Nails, for 

No. 03.010.045 

03.010.093 Rod Pusher for Reaming Rod with 

Hexagonal Screwdriver 8.0 mm 

03.010.226 Insertion Handle for Expert Adolescent 

Lateral Femoral Nail 

03.010.092 Screwdriver, hexagonal with spherical head 

8.0 mm 

Match the tangs on the handle to the notches in the Expert 

Adolescent Lateral Femoral Nail. 

Place the connecting screw into the insertion handle and 

thread it into the proximal nail end, using the 8 mm 

hexa gonal screwdriver with spherical head. 

The Expert Adolescent Lateral Femoral Nails are labeled left 

or right on the proximal nail end. 



Slide the connecting screw onto the reaming rod push rod. 

Slide the assembly through the insertion handle and match 

the tangs on the handle to the nail. Tighten using the hex on 

the reaming rod push rod. 

Secure the assembly using the 8 mm hexagonal screwdriver 

with spherical head. 


2 

Insert nail 

Instruments 

03.010.047 Connector, for Insertion Handle 

03.010.056 Combined Hammer 700 g, can be 

mounted, for No. 357.220 


8.0 mm 

321.170 Pin Wrench 4.5 mm, length 120 mm 

321.160 Combination Wrench 11.0 mm 

357.220 Hammer Guide, for No. 357.250 

357.398 Shaft, hexagonal, 8.0 mm, cannulated, 

short, length 125 mm 

Slide the connector into the groove on the insertion handle 

and secure it using the 11 mm ratchet wrench. If patient 

anatomy allows, attach the driving cap in the medial position. 

Orient the insertion handle in an anterior position. Use the 

C-arm to verify fracture reduction. Insert the nail as far as 

possible. 

The nail rotates approximately 90° during insertion. The insertion 

handle rotates from an anterior to a lateral position 

during insertion of the last one-third of the nail length. If the 

nail does not rotate to the lateral position, remove the nail 

and reinsert it with the handle slightly lateral to the sagittal 

plane. 

Monitor nail passage across the fracture, and control in two 

planes to avoid malalignment. 



If desired, insert the nail using light hammer blows. 

Lock the head of the hammer in place by tightening the nut 

onto the threads located below the hammer head. Use the 

pin wrench if necessary. Strike the driving cap directly. 

Optionally, the hammer guide can be threaded onto the driving 

cap and the hammer can be used as a slide hammer. 

Loosen the nut from the threads located below the hammer 

head and secure the nut onto the threads located above 

the handle. 

Note: Do not mount the aiming arm until the nail has been 

completely inserted. 


3 

Check proximal nail position 

Insert the nail until it is at or below the femoral opening. 

Check final nail position under image intensification in AP 

and lateral views. 

If primary compression or secondary dynamization is planned, 

it is recommended to overinsert the nail by more than 7 mm, 

which corresponds to the maximum distance between the 

positions in static and dynamic modes. 

Note: The distance between the markings on the insertion 

handle is 5 mm and corresponds to the extensions of the 

end caps. This feature can be used for overinsertion of the 

nail. 

4 

Check distal nail location 

Use image intensification to ensure the nail is centered in 

both AP and lateral views. Verify fracture alignment. 

Remove the reaming rod. 


Locking Options 

130° 

CCD 


120° 

Proximal locking with recon locking Proximal locking with 120° locking screw

Proximal locking with dynamization Proximal locking with static transverse locking screw 


Proximal Locking – Standard 

1 

Choose locking option 

For standard locking, three targeted proximal locking options 

are possible: 

1 120° antegrade locking 

2 Dynamic locking (LM) 

3 Static locking (LM) 

For immediate dynamization, insert one proximal locking 

screw through the dynamic slot. If dynamization may be 

required in the future, use the dynamic locking option with 

the 120° antegrade locking hole. 

2 

Mount aiming arm 

Instruments 


8.0 mm 

03.010.227 Aiming Arm for Expert Adolescent Lateral 

Femoral Nail 

Confirm that the nail is securely connected to the insertion 

handle using the 8 mm ball hex screwdriver. Mount the aiming 

arm to the insertion handle. 


1 

2 

3

3 

Insert trocar assembly 

Instruments 

03.010.063 Protection Sleeve 12.0/8.0, length 188 mm 

03.010.064 Drill Sleeve 8.0/3.2, for No. 03.010.063 

03.010.069 Trocar 3.2 mm, for No. 03.010.064 

Insert the three-part trocar assembly (protection sleeve, drill 

sleeve and trocar) through the desired hole in the aiming arm, 

make a stab incision and insert the trocar to the bone. Remove 

the trocar. 

If using the 120° antegrade locking option, insert the trocar 

assembly through the hole labeled 120° on the insertion 

handle. 

Note: Do not exert forces on the aiming arm, protection 

sleeve, drill sleeves or drill bits. Such force may prevent accurate 

targeting through the proximal locking holes and damage 

the drill bits. 


Proximal Locking – Standard 

4 

Drill and determine locking screw length 

Instrument 

03.010.060 Drill Bit 3.2 mm, calibrated, 

length 340 mm, 3-flute, for Quick 

Coupling, for No. 03.010.064 

Ensure that the drill sleeve is pressed firmly to the lateral 

cortex. Drill through both cortices until the tip of the drill bit 

just penetrates the far cortex. 

Confirm drill bit position. 

Ensure that the drill sleeve is pressed firmly to the lateral 

cortex and read the measurement from the calibrated drill bit 

at the back of the drill sleeve. This measurement corresponds 

to the appropriate length locking screw. Remove the drill bit 

and drill sleeve. 

Alternative instrument 

03.010.072 Depth Gauge for Locking Screws, 

measuring range up to 110 mm, 

for No. 03.010.063 

After drilling both cortices, remove the drill bit and drill 

sleeve. 

Disassemble the depth gauge into two parts: the outer 

sleeve and the measuring device with hook. Insert the measuring 

device into the protection sleeve. Make sure that the 

hook grasps the far cortex. 

Ensure that the protection sleeve is firmly pressed against the 

lateral cortex. 

Read the measurement from the back of the protection 

sleeve, which indicates the appropriate length locking screw. 


Option: Locking with ASLS 

ASLS, the Angular Stable Locking System, can be used as an 

alternative to standard locking screws in any round hole of a 

Synthes cannulated titanium nail. For more details regarding 

the intramedullary fixator principle please consult the ASLS 

surgical technique (036.000.708) and concept flyer 

(036.001.017). Please note that for the use of ASLS special 

instruments are required. 

5 

Insert locking screw 

Instrument 

03.010.107 Screwdriver Stardrive, T25, length 330 mm 

Insert the appropriate length locking screw through the protection 

sleeve using the Stardrive screwdriver. Verify locking 

screw length under image intensification. 

The tip of the locking screw should not project more than 

2 mm to 4 mm beyond the far cortex. 

Note: A groove on the screwdriver provides a rough indication 

that the locking screw is fully inserted through the 

sleeve. 

Repeat for a second proximal locking screw if desired. 


Proximal Locking – Recon 

1 

Confirm nail position 

In the AP view, adjust the nail insertion depth to ensure that 

the two hip screws can be placed into the femoral head. 

Adjust nail position for correct anteversion. 

2 

Mount aiming arm 

Instruments 


8.0 mm 



Confirm that the nail is securely connected to the insertion 

handle using the screwdriver, hexagonal with spherical head 

8.0 mm. Mount the aiming arm to the insertion handle. 


3 

Insert guide wires for hip screws 

Instruments 

03.010.075 Protection Sleeve 11.5/8.5, for LFN 

Reconstruction Locking 




Insert both three-part trocar combinations (protection sleeve, 

drill sleeve, and trocar) through the aiming arm. Make a stab 

incision and insert the trocars to the bone. 

Following the arrows on the aiming arm, rotate the cams so 

that the protection sleeves are locked in the aiming arm. This 

will ensure proper measurement for the hip screws. 

Remove the inferior trocar. 



In case of an arrested or closed physis, insert a guide wire 

into the femoral head, stopping approximately 5 mm from 

the subchondral bone. 

If the physis in the femoral head is not fully arrested, stop 

the wire short of the physis. Check the guide wire placement 

radiographically in both planes. 

Remove the superior trocar and repeat steps for second 

guide wire. 

Note: Do not exert force on the aiming arm, protection 

sleeves, or drill sleeves. Such force may prevent accurate 

targeting through the locking holes. 


4 

Determine length and drill for inferior hip screw 

Instruments 

03.010.079 Fixation Sleeve, for No. 03.010.078 

03.010.085 Direct Measuring Device for Guide Wires 

3.2 mm, length 400 mm 

03.010.228 Drill Bit 3.2 mm, calibrated, length 

474 mm, 3-flute, for Mini Quick Coupling, 

for Hip Screw Stardrive 5.0 mm 

Measure for the inferior screw. 

Ensure the protection sleeve is pressed firmly to the lateral 

cortex. Remove the wire guide and insert the specialty measuring 

device over the guide wire, into the protection sleeve, 

and to the bone. Read the length of the required hip screw 

directly on the measuring device. 

Remove the measuring device and the inferior guide wire. 

Attach the fixation sleeve to the stepped drill bit for the 

appropriate length screw. 

Guide the stepped drill bit through the protection sleeve to 

the bone. Drill to the stop. 



5 

Insert inferior hip screw 

Instrument 


Insert the appropriate hip screw through the protection 

sleeve into the femoral neck using the long T25 Stardrive 

screwdriver. Verify the position of the locking screw under 

image intensification in both planes. 

A groove on the screwdriver indicates when the locking 

screw is fully inserted. 

6 

Insert superior hip screw 

Repeat steps 3 through 5 for the superior hip screw. 


Distal Locking 

1 

Distal locking 

There are two transverse distal locking holes. 

2 

Align image 

Check the reduction and correct alignment of the fragments 

and leg length before locking the nail. 

Align the C-arm with the hole in the nail closest to the fracture 

until a perfect circle is visible in the center of the screen. 

3 

Determine incision point 

Place a Kirschner wire on the skin over the center of the hole 

to mark the incision point and make a stab incision. 



4 

Drill 

Standard locking with locking screws 

Instrument 


145 mm, 3-flute, for Quick Coupling 

If using the standard freehand technique, insert the tip of the 

drill bit through the incision and down to the bone. 

Incline the drive so that the tip of the drill bit is centered over 

the locking hole. Hold the drill bit in this position and drill 

through both cortices. 

Technique tip: For greater drill bit control, discontinue drill 

power after perforating the near cortex. Manually guide the 

drill bit through the nail before resuming power to drill the 

far cortex. 




145 mm, 3-flute, with Coupling for RDL 

Using the radiolucent drive under image intensification, insert 

the tip of the drill bit through the incision and down to 

the bone. 

Incline the drive so that the tip of the drill bit is centered over 

the locking hole. The drill bit should almost completely fill 

the circle of the locking hole. Hold the drill bit in this position 

and drill through both cortices. 

Option: Locking with ASLS 

ASLS, the Angular Stable Locking System, can be used as an 

alternative to standard locking screws in any round hole of a 

Synthes cannulated titanium nail. For more details regarding 

the intramedullary fixator principle please consult the ASLS 

surgical technique (036.000.708) and concept flyer 

(036.001.017). Please note that for the use of ASLS special 

instruments are required. 



5 

Determine locking screw length 

Instruments 


145 mm, 3-flute, with Coupling for RDL 


145 mm, 3-flute, for Quick Coupling 

03.010.106 Direct Measuring Device for Drill Bits of 

length 145 mm, for Nos. 03.010.100 to 

03.010.105 

Stop drilling immediately after penetrating the far cortex. 

Disassemble the power drive or radiolucent drive from the 

drill bit. 

Ensure the correct position of the drill bit in regard to the far 

cortex of the femur. 

Place the direct measuring device onto the drill bit. Read the 

graduation on the measuring device at the end of the drill bit. 

This corresponds to the appropriate locking screw length. 

Note: Drill bit location with respect to the far cortex is critical 

for measuring the appropriate locking screw length. 



measuring range up to 110 mm, for 

No. 03.010.063 

Measure the locking screw length using the depth gauge for 

locking screws. Ensure the outer sleeve is in contact with the 

bone and the hook grasps the far cortex. 

Read the locking screw length directly from the depth gauge 

at the back of the outer sleeve. 


6 

Insert locking screw 

Instruments 


03.010.112 Holding Sleeve, with Locking Device 

Insert the locking screw using the screwdriver, and the 

holding sleeve with locking device; if desired. 

Verify locking screw length under image intensification. The 

screw tip should be about 2 mm beyond the far cortex. If 

needed, a second locking screw may be inserted using the 

same technique. 

Use the holding sleeve as described below: Insert the holding 

sleeve onto the shaft of the screwdriver and place the tip of 

the screwdriver in the recess of the locking screw (Figure 1). 

Push the holding sleeve in the direction of the locking screw. 

The sleeve now holds the locking screw. 

Lock the holding sleeve by tightening it counterclockwise 

(Figure 2). After insertion of the locking screw, release the 

holding sleeve by loosening it clockwise and pulling it back 

(Figure 3). 

Figure 1 

Figure 2 

Figure 3 


End Cap Insertion 

1 

Insert end cap 

Instruments 

03.010.110 Screwdriver Stardrive, T40, cannulated 

length 300 mm 


Choose an end cap with the appropriate extension; 0 mm if 

the nail is not overinserted, 5 mm, 10 mm or 15 mm if the 

nail is overinserted. 

The end caps are cannulated for use over a guide wire, if 

necessary. 

Remove the nail insertion instruments. 

Optionally, for insertion of the 0 mm end cap, remove the 

connecting screw only. The insertion handle can remain to 

help align the end cap to the top of the nail. The 0 mm end 

cap fits through the barrel of the insertion handle. 

Insert the guide wire into the proximal end of the nail. 

Engage the end cap with the cannulated screwdriver by exerting 

axial pressure. To prevent cross-threading, align the 

end cap with the nail axis and turn the end cap counterclockwise, 

until the thread of the end cap aligns with that of 

the nail. 

Turn the end cap clockwise to thread the end cap into the 

nail. 

Remove the guide wire and screwdriver. 


Alternative instruments 

03.010.111 Screwdriver Stardrive, T40, cannulated, 

length 190 mm, with Lever Arm 


The cannulated Stardrive, screwdriver, T40, with lever handle, 

may be used with the 11 mm combination wrench to insert 

the end cap. 


Implant Removal 

1 

Remove end cap and locking screws 

Instruments 



length 300 mm 



Implant removal is an optional procedure. 

Clear the Stardrive recess of the end cap and the locking 

implants of any ingrown tissue. Insert the guide wire for easy 

alignment of the screwdriver in the cannulated end cap. 

Remove the end cap using the T40 screwdriver. 

Remove all locking screws except one proximal locking screw. 

2 

Attach extraction screw and hammer guide 

Instruments 


357.133 Extraction Screw for AFN/DFN 


Before removing the final locking screw, screw the extraction 

screw into the nail and tighten it. The locking screw will 

prevent nail rotation as the extraction screw is tightened. 

Attach the hammer guide to the extraction screw. 

Remove the remaining locking screw with the screwdriver. 


3 

Remove nail 

Instrument 

03.010.056 Combined Hammer 700 g, 

can be mounted, for No. 357.220 

Extract the nail by applying gentle blows with the hammer. 

Note: The nail will rotate about 90°, similar to the movement 

during the insertion. 


Implants 

Expert Adolescent Lateral Femoral Nail 

– Available for left or right femur 

– Anatomic nail design based on a femoral canal tracing 

study 3 

Material 

– Titanium-6% aluminum-7% niobium alloy 

Diameters 

– 8.2 mm, cannulated 



Lengths 

– 240 mm through 400 mm in 20 mm increments 

Cross Section 

– Helical fluted 

Proximal locking 

– Dynamization slot (LM) 

– Static transverse locking hole (LM) 

– 120° antegrade locking 

– Two recon locking holes 

Distal locking 

– Two transverse locking holes (LM) 

3 L. Ehmke, et al. 


120° antegrade 

Recon locking 

Dynamic transverse 

Static transverse 

LM 

LM 

20.6 mm 

36.25 mm 

50 mm 

12.5 mm 

12 mm 

7 mm 

42 mm

Expert Adolescent Lateral Femoral Nail, sterile 

Length (mm) mm Right Left 

240 8.2 04.031.924S 04.031.925S 

260 8.2 04.031.926S 04.031.927S 

280 8.2 04.031.928S 04.031.929S 

300 8.2 04.031.930S 04.031.931S 

320 8.2 04.031.932S 04.031.933S 

340 8.2 04.031.934S 04.031.935S 

360 8.2 04.031.936S 04.031.937S 

380 8.2 04.031.938S 04.031.939S 

400 8.2 04.031.940S 04.031.941S 


240 9 04.031.944S 04.031.945S 

260 9 04.031.946S 04.031.947S 

280 9 04.031.948S 04.031.949S 

300 9 04.031.950S 04.031.951S 

320 9 04.031.952S 04.031.953S 

340 9 04.031.954S 04.031.955S 

360 9 04.031.956S 04.031.957S 

380 9 04.031.958S 04.031.959S 

400 9 04.031.960S 04.031.961S 


240 10 04.031.964S 04.031.965S 

260 10 04.031.966S 04.031.967S 

280 10 04.031.968S 04.031.969S 

300 10 04.031.970S 04.031.971S 

320 10 04.031.972S 04.031.973S 

340 10 04.031.974S 04.031.975S 

360 10 04.031.976S 04.031.977S 

380 10 04.031.978S 04.031.979S 

400 10 04.031.980S 04.031.981S 


Implants 

Expert End Cap for Adolescent Lateral Femoral Nail 

8.2 mm, Titanium Alloy (TAN), (dark purple)* 

– Titanium alloy** 

– Protect nail threads from tissue ingrowth 

– Cannulated to allow insertion over a guide wire 

– T40 Stardrive recess 

0 mm: Sits flush with end of nail 

5 mm, 10 mm and 15 mm extensions: Extend nail height 

if nail is overinserted 

Extension (mm) 

04.031.000 0 

04.031.001 5 

04.031.002 10 

04.031.003 15 

Hip Screw Stardrive 5.0 mm, self-tapping, Titanium 

Alloy (TAN), (dark purple)* 


– Lengths: 50 mm – 125 mm (5 mm increments) 

– 3.2 mm core diameter 

– Partially threaded 

– Self-tapping, blunt tip 

– T25 Stardrive recess for improved torque transmission 

and self-retention on screwdriver 

04.031.020 50 

04.031.021 55 

04.031.022 60 

04.031.023 65 

04.031.024 70 

04.031.025 75 

04.031.026 80 

04.031.027 85 

Length (mm) 

04.031.028 90 

04.031.029 95 

04.031.030 100 

04.031.031 105 

04.031.032 110 

04.031.033 115 

04.031.034 120 

04.031.035 125 

**Available nonsterile or sterile-packed. Add “S” to catalog number 

to order sterile product. 

**Titanium-6% aluminum-7% niobium alloy 

Length (mm) 


Locking Screw Stardrive 4.0 mm, for Medullary Nails, 

Titanium Alloy (TAN), (dark blue)* 


– Lengths: 18 mm – 80 mm (2 mm increments) 

– 3.3 mm core diameter 

– Fully threaded 

– Self-tapping, blunt tip 

– T25 Stardrive recess for improved torque transmission 

and self-retention on screwdriver 

04.005.408 18 

04.005.410 20 

04.005.412 22 

04.005.414 24 

04.005.416 26 

04.005.418 28 

04.005.420 30 

04.005.422 32 

04.005.424 34 

04.005.426 36 

04.005.428 38 

04.005.430 40 

04.005.432 42 

04.005.434 44 

04.005.436 46 

04.005.438 48 

Length (mm) 

04.005.440 50 

04.005.442 52 

04.005.444 54 

04.005.446 56 

04.005.448 58 

04.005.450 60 

04.005.452 62 

04.005.454 64 

04.005.456 66 

04.005.458 68 

04.005.460 70 

04.005.462 72 

04.005.464 74 

04.005.466 76 

04.005.468 78 

04.005.470 80 

**Available nonsterile or sterile-packed. Add “S” to catalog number 


**Titanium-6% aluminum-7% niobium alloy 

Length (mm) 


Instruments 

03.010.020 Radiographic Ruler for Expert Femoral Nails, 

length 475 mm 

03.010.023 Radiographic Ruler for Nail Diameters 

for Expert Femoral Nails, length 365 mm 

03.010.031 Drill Sleeve 13.0/3.2 for antegrade 

approach, for No. 03.010.030 

03.010.044 Connecting Screw, cannulated, 

for Expert Tibial and Femoral Nails, 

for No. 03.010.045 

03.010.047 Connector, for Insertion Handle 

03.010.056 Combined Hammer 700 g, 

can be mounted, for No. 357.220 


03.010.060* Drill Bit 3.2 mm, calibrated, 

length 340 mm, 3-flute, 

for Quick Coupling, for No. 03.010.064 

03.010.063 Protection Sleeve 12.0/8.0, length 188 mm 




measuring range up to 110 mm, 

for No. 03.010.063 

03.010.075 Protection Sleeve 11.5/8.5, 

for LFN Reconstruction Locking 


* Available nonsterile or sterile-packed. Add «S» to catalog number to order sterile 

product. 


Instruments 


03.010.079 Fixation Sleeve, for No. 03.010.078 

03.010.085 Direct Measuring Device for Guide Wires 

3.2 mm, length 400 mm 


8.0 mm 

03.010.093 Rod Pusher for Reaming Rod 

with Hexagonal Screwdriver 8.0 mm 

03.010.100 Drill Bit 3.2 mm, calibrated, 


with Coupling for RDL 

03.010.103* Drill Bit 3.2 mm, calibrated, 


for Quick Coupling 

* Available nonsterile or sterile-packed. Add «S» to catalog number to order sterile 

product. 


03.010.106 Direct Measuring Device for Drill Bits 

of length 145 mm, for Nos. 03.010.100 

to 03.010.105 


03.010.108 Screwdriver Stardrive, T25, length 

330 mm, long 


length 300 mm 


length 190 mm, with Lever Arm 


03.010.226 Insertion Handle for Expert Adolescent 

Lateral Femoral Nail 




Instruments 


474 mm, 3-flute, for Mini Quick Coupling, 

for Hip Screw Stardrive 5.0 mm 

03.010.229 Protection Sleeve 15.5 mm / 13.7 mm, 


319.970 Screw Forceps, self-holding, length 85 mm 


321.170 Pin Wrench 4.5 mm, length 120 mm 

351.270 Drill Bit 13.0 mm, cannulated, 


for Quick Coupling No. 511.760 


357.133 Extraction Screw for AFN/DFN 


357.393 Trocar 3.2 mm, length 172 mm, 

for No. 357.392 


393.105 Universal Chuck, small, with T-Handle 

Optional Instruments 

351.050 Tissue Protector 




Nail Instrument Set 

01.031.004 Expert Adolescent Lateral Femoral Nail Instrument Set 

in Vario Case 

68.031.004 Vario Case for Standard Instrument Set for Expert Adolescent 

Lateral Femoral Nail, without Lid, without Contents 

351.270 Drill Bit 13.0 mm, cannulated, length 290 mm, 3-flute, 

for Quick Coupling No. 511.760 1 

321.160 Combination Wrench 11.0 mm 1 

321.170 Pin Wrench 4.5 mm, length 120 mm 1 

357.133 Extraction Screw for AFN/DFN 1 

357.220 Hammer Guide, for No. 357.250 1 

357.393 Trocar 3.2 mm, length 172 mm, for No. 357.392 1 

357.399 Guide Wire 3.2 mm, length 400 mm 10 

393.105 Universal Chuck, small, with T-Handle 1 

03.010.020 Radiographic Ruler for Expert Femoral Nails, length 475 mm 1 

03.010.023 Radiographic Ruler for Nail Diameters for Expert Femoral Nails, 

length 365 mm 1 

03.010.031 Drill Sleeve 13.0/3.2, for antegrade approach 1 

03.010.044 Connecting Screw, cannulated, for Expert Tibial and Femoral Nails, 

for No. 03.010.045 2 

03.010.047 Connector, for Insertion Handle 1 

03.010.056 Combined Hammer 700 g, can be mounted, for No. 357.220 1 

03.010.060* Drill Bit 3.2 mm, calibrated, length 340 mm, 3-flute, for Quick 

Coupling, for No. 03.010.064 2 

03.010.063 Protection Sleeve 12.0/8.0, lenght 188 mm 1 

03.010.064 Drill Sleeve 8.0/3.2, for No. 03.010.063 1 

03.010.069 Trocar 3.2 mm, for No. 03.010.064 1 

03.010.072 Depth Gauge for Locking Screws, measuring range up to 110 mm, 

for No. 03.010.063 1 

03.010.075 Protection Sleeve 11.5/8.5, for LFN Reconstruction Locking 2 



03.010.079 Fixation Sleeve, for No. 03.010.078 1 

03.010.085 Direct Measuring Device for Guide Wires 3.2 mm, 

length 400 mm 1 

03.010.092 Screwdriver, hexagonal with spherical head 8.0 mm 1 

03.010.093 Rod Pusher for Reaming Rod with Hexagonal Screwdriver 

8.0 mm 1 

03.010.100 Drill Bit 3.2 mm, calibrated, length 145 mm, 3-flute, 

with Coupling for RDL 1 

03.010.103* Drill Bit 3.2 mm, calibrated, length 145 mm, 3-flute, 

for Quick Coupling 1 

03.010.106 Direct Measuring Device for Drill Bits of length 145 mm, 

for Nos. 03.010.100 to 03.010.105 1 

03.010.107 Screwdriver Stardrive, T25, length 330 mm 1 

03.010.108 Screwdriver Stardrive, T25, length 330 mm, long 1 

03.010.110 Screwdriver Stardrive, T40, cannulated, length 300 mm 1 

03.010.111 Screwdriver Stardrive, T40, cannulated, length 190 mm, 

with Lever Arm 1 

03.010.112 Holding Sleeve, with Locking Device 1 

03.010.226 Insertion Handle for Expert Adolescent Lateral Femoral Nail 1 

03.010.227 Aiming Arm for Expert Adolescent Lateral Femoral Nail 1 


for Quick Coupling, for Hip Screw Stardrive 5.0 mm 1 

03.010.229 Protection Sleeve 15.5 mm/ 13.7 mm, length 122.5 mm 1 


*Available nonsterile or sterile-packed. Add «S» to catalog number 


Note: For additional information, please refer to package insert.


Nail Instrument Set 

01.031.005 Expert Adolescent Lateral Femoral Nail Upgrade 

for LFN Instrument Set 

68.031.005 Vario Case for Expert Adolescent Lateral Femoral Nail, Upgrade 

Instruments to Expert LFN, without Lid, without Content 1 

351.270 Drill Bit 13.0 mm, cannulated, length 290 mm, 3-flute, 

for Quick Coupling No. 511.760 1 

357.133 Extraction Screw for AFN/DFN 1 

357.393 Trocar 3.2 mm, length 172 mm, for No. 357.410 1 

03.010.031 Drill Sleeve 13.0/3.2 for antegrade approach 1 


for Quick Coupling, for No. 03.010.064 2 

03.010.063 Protection Sleeve 12.0//8.0, length 188 mm 1 



03.010.093 Rod Pusher for Reaming Rod with Hexagonal Screwdriver 

8.0 mm 1 


with Coupling for RDL 2 

03.010.103 145 mm, 3-flute, with Coupling for RDL 1 

03.010.111 Screwdriver Stardrive, T40, cannulated, length 190 mm, 

with Lever Arm 1 

03.010.226 Insertion Handle for Expert Adolescent Lateral Femoral Nail 1 

03.010.227 Aiming Arm for Expert Adolescent Lateral Femoral Nail 1 


for Quick Coupling, for Hip Screw Stardrive 5.0 mm 1 

03.010.229 Protection Sleeve 15.5 mm/ 13.7 mm, length 122.5 mm 1 

01.031.004 Expert Adolescent Lateral Femoral Nail Instrument Set 

in Vario Case 

01.031.005 Expert Adolescent Lateral Femoral Nail Upgrade for 

LFN Instrument Set 

Optionally available 

351.050 Soft Tissue Protector 


Additionally available 

321.200 Ratchet Wrench 11.0 mm 

351.707S Reaming Rod 2.5 mm, length 950 mm, with Olive & extension, 

sterile 

351.706S Reaming Rod 2.5 mm, length 950 mm, with Olive, sterile 

03.010.124 Combined Hammer 500 g, can be mounted, for No. 357.117 

393.100 Universal Chuck with T-Handle 

03.010.369 Reduction Instrument for Medullary Nails 

357.398 Shaft, hexagonal, 8.0 mm, cannulated, short, length 125 mm 

357.117 Hammer Guide for DFN, for no. 357.026 

352.033 SynReam Reaming Rod 2.5 mm, long, length 1150 mm 

352.032 SynReam Reaming Rod 2.5 mm, short, length 950 mm 

189.060 SynReam Intramedullary Reaming System in Vario Case 

394.350 Large Distractor 


Option: Modular Aiming Device ModAD 

Option for C-arm independent distal locking 

of nails for femur, tibia and humerus 

When using the ModAD for the interlocking of intra - 

medullary nails, no image intensifier control is required. The 

system is especially suitable when no C-arm is available. 

01.101.309 ModAD for Expert LFN und HN 

68.010.035 Sliding Carriage for Expert Tibial Nails, 

for Calibration Block No. 312.952 

The ModAD for Expert LFN has to be used with the Sliding 

Carriage for Expert Tibial Nails. Distal locking is performed 

using the sliding carriage. 



Nail Implant Set 

01.031.003 Implant Set for Expert Adolescent Lateral Femoral Nail 

68.031.002 Screw Rack, 1/4, for Locking Screw Stardrive 4.0 mm and Hip 

Screw Stardrive 5.0 mm, including Module and Lid, 

without content 

Instrument 

319.970 Screw Forceps 

Implants 

Locking Screw Stardrive 4.0 mm, for Medullary Nails, Titanium Alloy (TAN), 

dark blue, 2 each* 

04.005.416 26 

04.005.418 28 

04.005.420 30 

04.005.422 32 

04.005.424 34 

04.005.426 36 

04.005.428 38 

04.005.430 40 

04.005.432 42 

04.005.434 44 

04.005.436 46 

04.005.438 48 

04.005.440 50 

04.005.442 52 

04.005.440 50 

Hip Screw Stardrive 5.0 mm, self-tapping, Titanium Alloy (TAN), 

dark purple, for Expert Adolescent Lateral Femoral Nail, 4 each 

5.0 mm Titanium Recon Screws*, with T25 StarDrive recess, for IM Nails, 4 ea. 

04.031.022 60 

04.031.023 65 

04.031.024 70 

04.031.025 75 

04.031.026 80 

04.031.027 85 

04.031.028 90 

Length (mm) 

Length (mm) 

Expert End Cap for Adolescent Lateral Femoral Nail 8.2 mm,Titanium 

Alloy (TAN), dark purple* 

Extension (mm) 

04.031.000 0 2 each 

04.031.001 5 1 

04.031.002 10 1 

04.031.003 15 1 

04.005.442 52 

04.005.444 54 

04.005.446 56 

04.005.448 58 

04.005.450 60 

04.005.452 62 

04.005.454 64 

04.005.456 66 

04.005.458 68 

04.005.460 70 

04.005.462 72 

04.005.464 74 

04.005.466 76 

04.005.468 78 

04.005.470 80 

04.031.029 95 

04.031.030 100 

04.031.031 105 

04.031.032 110 

04.031.033 115 

04.031.034 120 

Length (mm) 

Length (mm) 

Optionally available 

Hip Screws 

04.031.020 Hip Screw Stardrive 5.0 mm, self-tapping, length 50 mm, 

Titanium Alloy (TAN), dark purple, for 








Locking Screws 

04.005.408 Locking Screw Stardrive 4.0 mm, for Medullary Nails, 

Titanium Alloy (TAN), length 18 mm, dark blue 







*Available nonsterile or sterile-packed. Add “S” to catalog number 


Note: For additional information, please refer to package insert. 


Optional: Angular Stable Locking System (ASLS) 

What is ASLS? 

The Angular Stable Locking System (ASLS) provides the ability 

to create a fixed-angle construct to an intrame dullary nail. 

Therefore, it combines the advantages of angular stability 

and a minimally invasive approach. ASLS together with an 

intra medullary nail form the principle of the Intramedullary 

Fixator. 

How does ASLS work? 

The system consists of a screw with three outer diameters 

and a resorbable sleeve. 

The resorbable sleeve is placed on the screw tip which has 

the smallest screw diameter and is pushed into the locking 

hole of the nail. 

During screw advancement, the resorbable sleeve is expanded 

by the larger middle diameter. Radial expansion of 

the sleeve and its fixation in the nail creates the angular 

stability. 


ASLS screws 

– Titanium alloy* 

– Screws ASLS4: Length 26 mm – 80 mm, are compatible 

with Expert Adolescent Lateral Femoral Nails 

– Fully threaded shaft with 3 diameters 

– D1: Provides purchase in reamed near cortex 

– D2: Expands sleeve, providing angular stability 

– D3: Holds unexpanded sleeve for screw insertion, 

provides purchase in far cortex 

– T25 Stardrive recess 

– Sterile packaged 

ASLS sleeves 

– 70:30 poly (L-lactide-co-D,L-lactide) 

– Bioresorbable, provides 80% decreased 

fracture site motion during first 12 weeks of healing 

– Gradually degrades within 2 years (resorption rate varies 

per patient and implant site) 

– Inner thread for secure fit to screw 

– Expands in nail locking hole 

– Available in diameters of 4.0 mm (ASLS4), 5.0 mm 

(ASLS5) and 6.0 mm (ASLS6) 

– Sterile-packed 

Note: For more details regarding the intramedullary fixator 

principle please consult the ASLS surgical technique 

(036.000.708) and concept flyer (036.001.017). 

*Titanium-6% aluminum-7% niobium alloy 

D1 

D2 

D3 


All technique guides are available as PDF files at 

www.synthes.com/lit 

Ö036.000.648öAC‚ä 

© Synthes, Inc. or its affiliates Subject to modifications Synthes, Expert, Stardrive and Vario Case are trademarks of Synthes, Inc. or its affiliates 

0123 036.000.648 version AC 02/2012 30101140

Expert Adolescent Lateral Femoral Nail. - Synthes

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