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Expert Adolescent Lateral Femoral Nail. - Synthes

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Technique Guide<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong><br />

<strong>Nail</strong>.<br />

EXPERT<br />

<strong>Nail</strong>ing System


Image intensifier control<br />

Warning<br />

This description alone does not provide sufficient background for direct use of<br />

the product. Instruction by a surgeon experienced in handling this product is<br />

highly recommended.<br />

Reprocessing, Care and Maintenance of<br />

<strong>Synthes</strong> Instruments<br />

For general guidelines, function control and dismantling of multi-part instruments,<br />

please refer to: www.synthes.com/reprocessing


Table of Contents<br />

Introduction<br />

Surgical Technique<br />

Product Information<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> System 2<br />

AO Principles 4<br />

Indications 5<br />

Clinical Cases 6<br />

Preoperative Planning 10<br />

Opening the Femur 13<br />

Inserting the <strong>Nail</strong> 21<br />

Locking Options 26<br />

Proximal Locking – Standard 28<br />

Proximal Locking – Recon 32<br />

Distal Locking 37<br />

End Cap Insertion 42<br />

Implant Removal 44<br />

Implants 46<br />

Instruments 50<br />

Set Lists 56<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 1


<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong><br />

<strong>Nail</strong> System<br />

<strong>Nail</strong> features<br />

– Design accommodates a lateral entry site through the<br />

greater trochanter<br />

– Anatomic nail design based on a femoral canal study 1<br />

– Titanium cannulated nail for reamed or unreamed techniques<br />

– Lengths from 240 mm to 400 mm, in 20 mm increments<br />

– Designed for use in patients where Titanium Elastic <strong>Nail</strong>s<br />

are not large enough and the <strong>Expert</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong><br />

for adults is too large<br />

– 8.2 mm, 9 mm, and 10 mm diameter nails with 11 mm<br />

diameter proximal ends<br />

End caps<br />

– Prevent ingrowth of tissue and facilitate nail extraction<br />

– Self-retaining, T40 Stardrive recess for easy pickup and<br />

insertion of the end cap<br />

– Cannulated for insertion over a guide wire<br />

– 0 mm end cap sits flush with the nail<br />

– 5 mm, 10 mm, and 15 mm end caps extend nail height<br />

if the nail is overinserted<br />

1 Ehmke L, Polzin B, Roth C, Bottlang M (2006) <strong>Femoral</strong> <strong>Nail</strong>ing Through the<br />

Trochanter: The Reamer Pathway Indicates A Helical Shape. Journal of<br />

Orthopedic Trauma Vol. 20 (Number 10): 668 – 674<br />

2 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide<br />

Improved instrumentation<br />

– Easy-to-use instrumentation facilitates the surgical<br />

procedure<br />

– Ball-tip reaming rod can be removed through the nail and<br />

the insertion instruments, eliminating the need for an<br />

exchange tube<br />

– Tailored to the needs of clinic (available as upgrade set for<br />

adolescents to <strong>Expert</strong> <strong>Lateral</strong> <strong>Femoral</strong> System for adults<br />

or Standard Instrument Set for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong><br />

<strong>Femoral</strong> <strong>Nail</strong>)


Standard locking screws<br />

– Double-lead thread for ease of insertion<br />

– Thread closer to screw head provides better bone<br />

purchase in the near cortex and improved stability<br />

– Titanium alloy* for improved mechanical and fatigue<br />

properties<br />

– Self-tapping blunt tip<br />

– Self-retaining T25 Stardrive recess allows improved torque<br />

transmission, increased resistance to stripping relative to<br />

a hex recess, and secure locking screw pickup<br />

– 4.0 mm diameter<br />

5.0 mm hip screws<br />

– Lengths from 50 mm to 125 mm in 5 mm increments<br />

– Self-retaining T25 Stardrive recess<br />

– Titanium alloy*<br />

*Titanium-6% aluminum-7% niobium alloy<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 3


AO Principles<br />

In 1958, the AO formulated four basic principles, which have<br />

become the guidelines for internal fixation in general, and<br />

intramedullary nailing in particular. 2<br />

Anatomic reduction<br />

The <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> in titanium is<br />

cannulated as well as designed to fit anatomically in the<br />

medullary canal and allows indirect reduction.<br />

Stable fixation<br />

The intramedullary nail acts as an internal splint that controls<br />

but does not prevent micromovements of the fragments. It<br />

provides relative stability that leads to an indirect healing<br />

through callus formation.<br />

Preservation of blood supply<br />

The instruments and implants in the <strong>Expert</strong> <strong>Adolescent</strong><br />

<strong>Lateral</strong> <strong>Femoral</strong> System permit a minimally invasive technique<br />

and less tissue stripping than other treatment methods.<br />

An intramedullary approach results in decreased blood loss<br />

compared to plate fixation.<br />

Early, active mobilization<br />

The titanium cannulated <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Expert</strong><br />

<strong>Femoral</strong> <strong>Nail</strong> provides secure fixation which permits<br />

controlled, early, active rehabilitation conducive to optimal<br />

recovery.<br />

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

Internal Fixation, 3rd Edition. Berlin: Springer-Verlag<br />

4 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


Indications<br />

The <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> is indicated for<br />

use in adolescent and small-stature adult patients to stabilize:<br />

– Fractures of the femoral shaft<br />

– Subtrochanteric fractures<br />

– Ipsilateral neck / shaft fractures<br />

– Impending pathologic fractures<br />

– Nonunions and malunions<br />

Note: ASLS, the Angular Stable Locking System, is indicated<br />

in cases where increased stability is needed in fractures closer<br />

to the metaphyseal area or in poor quality bone. For more<br />

details regarding the intramedullary fixator principle, please<br />

consult the ASLS technique guide (036.000.708) and concept<br />

flyer (036.001.017).<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 5


Clinical Cases<br />

Case 1 – standard transverse locking<br />

– 16-year-old female, 45 kg<br />

– Isolated transverse femoral shaft fracture<br />

Case 2 – antegrade locking<br />

– 15-year-old male, 55 kg<br />

– Oblique midshaft femoral shaft fracture<br />

6 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide<br />

Preoperative<br />

Preoperative


Intraoperative<br />

Postoperative<br />

Follow-up (6 weeks after surgery)<br />

Follow-up (4 months after surgery)<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 7


Clinical Cases<br />

Case 3 – recon locking<br />

– 12-year-old male, 43 kg<br />

– Pathologic proximal femoral shaft fracture<br />

Case 4 – distal locking<br />

– 12-year-old male, 30 kg<br />

– Oblique distal third femoral shaft fracture<br />

8 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide<br />

Preoperative<br />

Preoperative


Postoperative<br />

Postoperative<br />

Follow-up (3 weeks after surgery)<br />

Follow-up (1 month after surgery)<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 9


Preoperative Planning<br />

Use the AO preoperative planner templates for the <strong>Expert</strong><br />

<strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> (034.000.600/605) to estimate<br />

nail length and medullary canal diameter.<br />

To estimate medullary canal diameter, place the template on<br />

the AP or lateral x-ray of the femur and measure the dia -<br />

meter of the medullary canal at the narrowest part that will<br />

contain the nail.<br />

To estimate nail length, place the template on the AP x-ray of<br />

the uninjured femur and select the appropriate nail length<br />

based on patient anatomy. When selecting nail size, consider<br />

canal diameter, fracture pattern, patient anatomy and postoperative<br />

protocol.<br />

Note: Templates are available in two sizes: actual size and<br />

115% magnification in which the image is enlarged 15% to<br />

correspond to typical radiographic magnification; however,<br />

variations in magnification levels are common.<br />

1<br />

Position patient<br />

Position the patient in the lateral decubitus or supine position<br />

on a fracture table or radiolucent operating table.<br />

Position the C-arm to allow visualization of the proximal<br />

femur in both the AP and lateral planes.<br />

To facilitate access to the medullary canal, abduct the upper<br />

part of the body approximately 10°–15° to the contralateral<br />

side and adduct the affected limb by 10°–15°.<br />

10 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> Entry <strong>Femoral</strong> <strong>Nail</strong> for Right Femur<br />

8.2 mm, 9 mm and 10 mm diameter 240 mm to 400 mm lengths<br />

15 mm<br />

10 mm<br />

5 mm<br />

0 mm<br />

15 mm<br />

End Caps<br />

10 mm<br />

5 mm<br />

0 mm<br />

A-P View<br />

<strong>Lateral</strong> View<br />

Locking Screw Stardrive 4.0 mm, TAN [04.005.408 – 04.005.470]<br />

Hip Screw Stardrive 5.0 mm, TAN [04.031.020 – 04.031.035]<br />

1.0 Magnification<br />

0 10 20 30 40 50 60 70 80 90 100mm<br />

For use only with the Original AO System of<br />

Instruments and Implants<br />

Affected leg<br />

10º–15º adduction<br />

8.2 mm<br />

9 mm<br />

10 mm<br />

<strong>Synthes</strong> GmbH<br />

Eimattstrasse 3<br />

CH-4436 Oberdorf<br />

www.synthes.com<br />

8.2 mm<br />

9 mm<br />

10 mm<br />

240 mm<br />

240 mm<br />

260 mm<br />

260 mm<br />

280 mm<br />

280 mm<br />

300 mm<br />

300 mm<br />

320 mm<br />

320 mm<br />

340 mm<br />

340 mm<br />

360 mm<br />

360 mm<br />

380 mm<br />

380 mm<br />

<strong>Expert</strong> <strong>Adolescent</strong><br />

<strong>Lateral</strong> Entry <strong>Femoral</strong> <strong>Nail</strong><br />

for Right Femur<br />

400 mm<br />

400 mm


2<br />

Reduce fracture<br />

Instrument<br />

394.350 Large Distractor*<br />

Perform closed reduction manually by axial traction under<br />

image intensifier control. The use of the large distractor may<br />

be appropriate in certain circumstances.<br />

3<br />

Confirm nail length<br />

Instrument<br />

03.010.020 Radiographic Ruler for <strong>Expert</strong> <strong>Femoral</strong> <strong>Nail</strong>s<br />

The required nail length must be determined after reduction<br />

of the femoral fracture.<br />

Position the C-arm for an AP view of the proximal femur.<br />

With long forceps, hold the ruler alongside the lateral thigh,<br />

parallel to and at the same level as the femur. Adjust the<br />

ruler until the proximal end is at the desired nail insertion<br />

depth. Mark the skin at the proximal end of the ruler.<br />

*Additional available<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 11


Preoperative Planning<br />

Move the C-arm to the distal femur. Verify fracture reduction.<br />

Align the proximal end of the radiographic ruler to the skin<br />

mark, and take an AP image of the distal femur.<br />

Read nail length directly from the ruler image, selecting the<br />

measurement proximal to the epiphysis, or at the chosen<br />

insertion depth.<br />

Note: It is recommended to treat the fracture with the<br />

longest nail possible without crossing the physis, taking into<br />

account patient anatomy or a previous implant. The distal<br />

end of the nail should be 15 mm from the physis.<br />

Back-hammering or dynamization to close a fracture gap<br />

must be taken into account when determining the nail<br />

length. A shorter nail should be chosen when back-hammering<br />

or dynamization is planned. The dynamic slot allows<br />

7 mm of movement.<br />

4<br />

Confirm canal diameter<br />

Instrument<br />

03.010.023 Radiographic Ruler for <strong>Nail</strong> Diameters for<br />

<strong>Expert</strong> <strong>Femoral</strong> <strong>Nail</strong>s<br />

Position the C-arm for an AP or lateral view of the femur at<br />

the level of the isthmus. Hold the radiographic canal width<br />

estimator over the femur with the diameter gauge centered<br />

over the narrowest part of the medullary canal. Read the<br />

estimated diameter measurement on the circular indicator<br />

that fills the canal.<br />

Note: If the reamed technique is used, the diameter of the<br />

largest medullary reamer must be at least 1.0 mm greater<br />

than the nail diameter.<br />

12 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


Opening the Femur<br />

1<br />

Approach<br />

Palpate the posterior edge of the greater trochanter.<br />

Make a 3 cm incision in line with the central axis of the<br />

intramedullary canal in the lateral view, and depending on<br />

the anatomy of the patient, 2– 5 cm proximal to the tip<br />

of the greater trochanter.<br />

2<br />

Determine entry point<br />

The insertion point is 12° lateral to the greater trochanter, as<br />

measured from a point 20 mm distal to the lesser trochanter.<br />

The entry point can also be described as lateral to the greater<br />

trochanter at the same level as the superior aspect of the<br />

base of the femoral neck (just above the piriformis fossa).<br />

This point can be found by extending a line horizontally from<br />

the base of the femoral neck to the lateral side of the femur.<br />

12°<br />

20 mm<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 13


Opening the Femur<br />

3<br />

Insert guide wire<br />

Instruments<br />

03.010.031 Drill Sleeve 13.0/3.2 for antegrade<br />

approach<br />

03.010.229 Protection Sleeve 15.5 mm/13.7 mm,<br />

length 122.5 mm<br />

357.393 Trocar 3.2 mm, length 172 mm, for<br />

No. 357.392<br />

357.399 Guide Wire 3.2 mm, length 400 mm<br />

Insert the protection sleeve, wire guide and trocar assembly<br />

into the incision site and to the bone.<br />

Remove the trocar. Insert the guide wire through the wire<br />

guide.<br />

The guide wire must be inserted laterally at an angle of 12°<br />

to the center of the medullary canal. The tip of the guide<br />

wire should be centered in the medullary canal 20 mm distal<br />

to the lesser trochanter.<br />

Verify that the guide wire position allows adequate clearance<br />

on the lateral side of the femur for the opening drill bit.<br />

The guide wire is inserted with it centered in the lateral view.<br />

14 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


4<br />

Open proximal femur to medullary canal<br />

Required set<br />

189.060 SynReam Intramedullary Reaming System<br />

in Vario Case<br />

Instruments<br />

03.010.229 Protection Sleeve 15.5 mm/13.7 mm,<br />

length 122.5 mm<br />

351.270 Drill Bit 13.0 mm, cannulated,<br />

length 290 mm, 3-flute, for<br />

Quick Coupling No. 511.760<br />

351.706S Reaming Rod 2.5 mm, length 950 mm,<br />

with Olive, sterile<br />

351.707S Reaming Rod 2.5 mm, length 950 mm,<br />

with Olive and extension, sterile<br />

or<br />

352.032 SynReam Reaming Rod 2.5 mm. short,<br />

length 950 mm<br />

352.033 SynReam Reaming Rod 2.5 mm, long,<br />

length 1150 mm<br />

Drill to open cortex<br />

Drill through the protection sleeve. Drill the cortex until the<br />

drill bit stops in the sleeve.<br />

Remove the guide wire, drill bit and protection sleeve.<br />

Note: Dispose of the guide wire. Do not reuse.<br />

If reaming the medullary canal, proceed to page 17.<br />

Ream to open proximal femur<br />

Insert the 2.5 mm reaming rod. Using the flexible reamers,<br />

open the proximal femur to a depth of approximately<br />

75 mm, starting with an 8.5 mm reamer and ending with<br />

a 13.0 mm reamer.<br />

75 mm<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 15


Opening the Femur<br />

Alternative technique (with awl)<br />

Alternative instruments<br />

03.010.041 Awl 14.0/3.2 mm, cannulated<br />

357.399 Guide Wire 3.2 mm, length 400 mm<br />

Place the cannulated awl over the guide wire and open the<br />

medullary canal. Use a twisting motion to advance the awl to<br />

a depth of approximately 75 mm.<br />

Remove the guide wire and awl.<br />

Note: After opening the proximal femur, dispose of the<br />

guide wire. Do not reuse.<br />

16 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


5<br />

Ream medullary canal (optional)<br />

Required set<br />

189.060 SynReam Intramedullary Reaming System<br />

in Vario Case<br />

Instruments<br />

03.010.093 Rod Pusher for Reaming Rod with<br />

Hexagonal Screwdriver 8.0 mm<br />

351.706S Reaming Rod 2.5 mm, length 950 mm,<br />

with Olive, sterile<br />

351.707S Reaming Rod 2.5 mm, length 950 mm,<br />

with Olive and extension, sterile<br />

or<br />

352.032 SynReam Reaming Rod 2.5 mm. short,<br />

length 950 mm<br />

352.033 SynReam Reaming Rod 2.5 mm, long,<br />

length 1150 mm<br />

351.782 Holding Forceps for SynReam Reaming Rod<br />

2.5 mm<br />

03.010.369 Reduction Instrument for<br />

Medullary <strong>Nail</strong>s<br />

393.105 Universal Chuck, small, with T-Handle<br />

If necessary, enlarge the femoral canal with the medullary<br />

reamer. The largest medullary reamer must be at least<br />

1.0 mm greater than the nail diameter.<br />

Check fracture reduction under image intensifier. Use the reduction<br />

instrument for medullary nails to facilitate reduction.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 17


Opening the Femur<br />

Insert reaming rod<br />

Using the T-handle chuck or holding device, insert the reaming<br />

rod with ball tip into the medullary canal to the desired<br />

depth.<br />

18 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


Beginning with the 8.5 mm diameter reaming head, ream to<br />

a diameter of at least 1.0 mm greater than the nail diameter.<br />

Ream in 0.5 mm increments and advance the reamer with<br />

steady, moderate pressure. Do not force the reamer. Partially<br />

retract the reamer often to clear debris from the medullary<br />

canal.<br />

The holding forceps can be used to control the rotation of<br />

the reaming rod.<br />

Note: The reaming rod with ball tip can be removed through<br />

the cannulated adolescent lateral femoral nails. Reaming rod<br />

exchange is not required.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 19


Opening the Femur<br />

Option<br />

Use the reaming rod push rod to help retain the reaming rod<br />

during reamer extraction.<br />

20 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


Inserting the <strong>Nail</strong><br />

1<br />

Assemble insertion instruments<br />

Instruments<br />

03.010.044 Connecting Screw, cannulated, for <strong>Expert</strong><br />

Tibial and <strong>Femoral</strong> <strong>Nail</strong>s, for<br />

No. 03.010.045<br />

03.010.093 Rod Pusher for Reaming Rod with<br />

Hexagonal Screwdriver 8.0 mm<br />

03.010.226 Insertion Handle for <strong>Expert</strong> <strong>Adolescent</strong><br />

<strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong><br />

03.010.092 Screwdriver, hexagonal with spherical head<br />

8.0 mm<br />

Match the tangs on the handle to the notches in the <strong>Expert</strong><br />

<strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong>.<br />

Place the connecting screw into the insertion handle and<br />

thread it into the proximal nail end, using the 8 mm<br />

hexa gonal screwdriver with spherical head.<br />

The <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong>s are labeled left<br />

or right on the proximal nail end.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 21


Inserting the <strong>Nail</strong><br />

Slide the connecting screw onto the reaming rod push rod.<br />

Slide the assembly through the insertion handle and match<br />

the tangs on the handle to the nail. Tighten using the hex on<br />

the reaming rod push rod.<br />

Secure the assembly using the 8 mm hexagonal screwdriver<br />

with spherical head.<br />

22 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


2<br />

Insert nail<br />

Instruments<br />

03.010.047 Connector, for Insertion Handle<br />

03.010.056 Combined Hammer 700 g, can be<br />

mounted, for No. 357.220<br />

03.010.092 Screwdriver, hexagonal with spherical head<br />

8.0 mm<br />

321.170 Pin Wrench 4.5 mm, length 120 mm<br />

321.160 Combination Wrench 11.0 mm<br />

357.220 Hammer Guide, for No. 357.250<br />

357.398 Shaft, hexagonal, 8.0 mm, cannulated,<br />

short, length 125 mm<br />

Slide the connector into the groove on the insertion handle<br />

and secure it using the 11 mm ratchet wrench. If patient<br />

anatomy allows, attach the driving cap in the medial position.<br />

Orient the insertion handle in an anterior position. Use the<br />

C-arm to verify fracture reduction. Insert the nail as far as<br />

possible.<br />

The nail rotates approximately 90° during insertion. The insertion<br />

handle rotates from an anterior to a lateral position<br />

during insertion of the last one-third of the nail length. If the<br />

nail does not rotate to the lateral position, remove the nail<br />

and reinsert it with the handle slightly lateral to the sagittal<br />

plane.<br />

Monitor nail passage across the fracture, and control in two<br />

planes to avoid malalignment.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 23


Inserting the <strong>Nail</strong><br />

If desired, insert the nail using light hammer blows.<br />

Lock the head of the hammer in place by tightening the nut<br />

onto the threads located below the hammer head. Use the<br />

pin wrench if necessary. Strike the driving cap directly.<br />

Optionally, the hammer guide can be threaded onto the driving<br />

cap and the hammer can be used as a slide hammer.<br />

Loosen the nut from the threads located below the hammer<br />

head and secure the nut onto the threads located above<br />

the handle.<br />

Note: Do not mount the aiming arm until the nail has been<br />

completely inserted.<br />

24 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


3<br />

Check proximal nail position<br />

Insert the nail until it is at or below the femoral opening.<br />

Check final nail position under image intensification in AP<br />

and lateral views.<br />

If primary compression or secondary dynamization is planned,<br />

it is recommended to overinsert the nail by more than 7 mm,<br />

which corresponds to the maximum distance between the<br />

positions in static and dynamic modes.<br />

Note: The distance between the markings on the insertion<br />

handle is 5 mm and corresponds to the extensions of the<br />

end caps. This feature can be used for overinsertion of the<br />

nail.<br />

4<br />

Check distal nail location<br />

Use image intensification to ensure the nail is centered in<br />

both AP and lateral views. Verify fracture alignment.<br />

Remove the reaming rod.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 25


Locking Options<br />

130°<br />

CCD<br />

26 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide<br />

120°<br />

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


Proximal locking with dynamization Proximal locking with static transverse locking screw<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 27


Proximal Locking – Standard<br />

1<br />

Choose locking option<br />

For standard locking, three targeted proximal locking options<br />

are possible:<br />

1 120° antegrade locking<br />

2 Dynamic locking (LM)<br />

3 Static locking (LM)<br />

For immediate dynamization, insert one proximal locking<br />

screw through the dynamic slot. If dynamization may be<br />

required in the future, use the dynamic locking option with<br />

the 120° antegrade locking hole.<br />

2<br />

Mount aiming arm<br />

Instruments<br />

03.010.092 Screwdriver, hexagonal with spherical head<br />

8.0 mm<br />

03.010.227 Aiming Arm for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong><br />

<strong>Femoral</strong> <strong>Nail</strong><br />

Confirm that the nail is securely connected to the insertion<br />

handle using the 8 mm ball hex screwdriver. Mount the aiming<br />

arm to the insertion handle.<br />

28 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide<br />

1<br />

2<br />

3


3<br />

Insert trocar assembly<br />

Instruments<br />

03.010.063 Protection Sleeve 12.0/8.0, length 188 mm<br />

03.010.064 Drill Sleeve 8.0/3.2, for No. 03.010.063<br />

03.010.069 Trocar 3.2 mm, for No. 03.010.064<br />

Insert the three-part trocar assembly (protection sleeve, drill<br />

sleeve and trocar) through the desired hole in the aiming arm,<br />

make a stab incision and insert the trocar to the bone. Remove<br />

the trocar.<br />

If using the 120° antegrade locking option, insert the trocar<br />

assembly through the hole labeled 120° on the insertion<br />

handle.<br />

Note: Do not exert forces on the aiming arm, protection<br />

sleeve, drill sleeves or drill bits. Such force may prevent accurate<br />

targeting through the proximal locking holes and damage<br />

the drill bits.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 29


Proximal Locking – Standard<br />

4<br />

Drill and determine locking screw length<br />

Instrument<br />

03.010.060 Drill Bit 3.2 mm, calibrated,<br />

length 340 mm, 3-flute, for Quick<br />

Coupling, for No. 03.010.064<br />

Ensure that the drill sleeve is pressed firmly to the lateral<br />

cortex. Drill through both cortices until the tip of the drill bit<br />

just penetrates the far cortex.<br />

Confirm drill bit position.<br />

Ensure that the drill sleeve is pressed firmly to the lateral<br />

cortex and read the measurement from the calibrated drill bit<br />

at the back of the drill sleeve. This measurement corresponds<br />

to the appropriate length locking screw. Remove the drill bit<br />

and drill sleeve.<br />

Alternative instrument<br />

03.010.072 Depth Gauge for Locking Screws,<br />

measuring range up to 110 mm,<br />

for No. 03.010.063<br />

After drilling both cortices, remove the drill bit and drill<br />

sleeve.<br />

Disassemble the depth gauge into two parts: the outer<br />

sleeve and the measuring device with hook. Insert the measuring<br />

device into the protection sleeve. Make sure that the<br />

hook grasps the far cortex.<br />

Ensure that the protection sleeve is firmly pressed against the<br />

lateral cortex.<br />

Read the measurement from the back of the protection<br />

sleeve, which indicates the appropriate length locking screw.<br />

30 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


Option: Locking with ASLS<br />

ASLS, the Angular Stable Locking System, can be used as an<br />

alternative to standard locking screws in any round hole of a<br />

<strong>Synthes</strong> cannulated titanium nail. For more details regarding<br />

the intramedullary fixator principle please consult the ASLS<br />

surgical technique (036.000.708) and concept flyer<br />

(036.001.017). Please note that for the use of ASLS special<br />

instruments are required.<br />

5<br />

Insert locking screw<br />

Instrument<br />

03.010.107 Screwdriver Stardrive, T25, length 330 mm<br />

Insert the appropriate length locking screw through the protection<br />

sleeve using the Stardrive screwdriver. Verify locking<br />

screw length under image intensification.<br />

The tip of the locking screw should not project more than<br />

2 mm to 4 mm beyond the far cortex.<br />

Note: A groove on the screwdriver provides a rough indication<br />

that the locking screw is fully inserted through the<br />

sleeve.<br />

Repeat for a second proximal locking screw if desired.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 31


Proximal Locking – Recon<br />

1<br />

Confirm nail position<br />

In the AP view, adjust the nail insertion depth to ensure that<br />

the two hip screws can be placed into the femoral head.<br />

Adjust nail position for correct anteversion.<br />

2<br />

Mount aiming arm<br />

Instruments<br />

03.010.092 Screwdriver, hexagonal with spherical head<br />

8.0 mm<br />

03.010.227 Aiming Arm for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong><br />

<strong>Femoral</strong> <strong>Nail</strong><br />

Confirm that the nail is securely connected to the insertion<br />

handle using the screwdriver, hexagonal with spherical head<br />

8.0 mm. Mount the aiming arm to the insertion handle.<br />

32 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


3<br />

Insert guide wires for hip screws<br />

Instruments<br />

03.010.075 Protection Sleeve 11.5/8.5, for LFN<br />

Reconstruction Locking<br />

03.010.076 Drill Sleeve 8.5/3.2, for No. 03.010.075<br />

03.010.077 Trocar 3.2 mm, for No. 03.010.076<br />

357.399 Guide Wire 3.2 mm, length 400 mm<br />

Insert both three-part trocar combinations (protection sleeve,<br />

drill sleeve, and trocar) through the aiming arm. Make a stab<br />

incision and insert the trocars to the bone.<br />

Following the arrows on the aiming arm, rotate the cams so<br />

that the protection sleeves are locked in the aiming arm. This<br />

will ensure proper measurement for the hip screws.<br />

Remove the inferior trocar.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 33


Proximal Locking – Recon<br />

In case of an arrested or closed physis, insert a guide wire<br />

into the femoral head, stopping approximately 5 mm from<br />

the subchondral bone.<br />

If the physis in the femoral head is not fully arrested, stop<br />

the wire short of the physis. Check the guide wire placement<br />

radiographically in both planes.<br />

Remove the superior trocar and repeat steps for second<br />

guide wire.<br />

Note: Do not exert force on the aiming arm, protection<br />

sleeves, or drill sleeves. Such force may prevent accurate<br />

targeting through the locking holes.<br />

34 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


4<br />

Determine length and drill for inferior hip screw<br />

Instruments<br />

03.010.079 Fixation Sleeve, for No. 03.010.078<br />

03.010.085 Direct Measuring Device for Guide Wires<br />

3.2 mm, length 400 mm<br />

03.010.228 Drill Bit 3.2 mm, calibrated, length<br />

474 mm, 3-flute, for Mini Quick Coupling,<br />

for Hip Screw Stardrive 5.0 mm<br />

Measure for the inferior screw.<br />

Ensure the protection sleeve is pressed firmly to the lateral<br />

cortex. Remove the wire guide and insert the specialty measuring<br />

device over the guide wire, into the protection sleeve,<br />

and to the bone. Read the length of the required hip screw<br />

directly on the measuring device.<br />

Remove the measuring device and the inferior guide wire.<br />

Attach the fixation sleeve to the stepped drill bit for the<br />

appropriate length screw.<br />

Guide the stepped drill bit through the protection sleeve to<br />

the bone. Drill to the stop.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 35


Proximal Locking – Recon<br />

5<br />

Insert inferior hip screw<br />

Instrument<br />

03.010.108 Screwdriver Stardrive, T25, length 330 mm<br />

Insert the appropriate hip screw through the protection<br />

sleeve into the femoral neck using the long T25 Stardrive<br />

screwdriver. Verify the position of the locking screw under<br />

image intensification in both planes.<br />

A groove on the screwdriver indicates when the locking<br />

screw is fully inserted.<br />

6<br />

Insert superior hip screw<br />

Repeat steps 3 through 5 for the superior hip screw.<br />

36 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


Distal Locking<br />

1<br />

Distal locking<br />

There are two transverse distal locking holes.<br />

2<br />

Align image<br />

Check the reduction and correct alignment of the fragments<br />

and leg length before locking the nail.<br />

Align the C-arm with the hole in the nail closest to the fracture<br />

until a perfect circle is visible in the center of the screen.<br />

3<br />

Determine incision point<br />

Place a Kirschner wire on the skin over the center of the hole<br />

to mark the incision point and make a stab incision.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 37


Distal Locking<br />

4<br />

Drill<br />

Standard locking with locking screws<br />

Instrument<br />

03.010.103 Drill Bit 3.2 mm, calibrated, length<br />

145 mm, 3-flute, for Quick Coupling<br />

If using the standard freehand technique, insert the tip of the<br />

drill bit through the incision and down to the bone.<br />

Incline the drive so that the tip of the drill bit is centered over<br />

the locking hole. Hold the drill bit in this position and drill<br />

through both cortices.<br />

Technique tip: For greater drill bit control, discontinue drill<br />

power after perforating the near cortex. Manually guide the<br />

drill bit through the nail before resuming power to drill the<br />

far cortex.<br />

38 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


Alternative instrument<br />

03.010.100 Drill Bit 3.2 mm, calibrated, length<br />

145 mm, 3-flute, with Coupling for RDL<br />

Using the radiolucent drive under image intensification, insert<br />

the tip of the drill bit through the incision and down to<br />

the bone.<br />

Incline the drive so that the tip of the drill bit is centered over<br />

the locking hole. The drill bit should almost completely fill<br />

the circle of the locking hole. Hold the drill bit in this position<br />

and drill through both cortices.<br />

Option: Locking with ASLS<br />

ASLS, the Angular Stable Locking System, can be used as an<br />

alternative to standard locking screws in any round hole of a<br />

<strong>Synthes</strong> cannulated titanium nail. For more details regarding<br />

the intramedullary fixator principle please consult the ASLS<br />

surgical technique (036.000.708) and concept flyer<br />

(036.001.017). Please note that for the use of ASLS special<br />

instruments are required.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 39


Distal Locking<br />

5<br />

Determine locking screw length<br />

Instruments<br />

03.010.100 Drill Bit 3.2 mm, calibrated, length<br />

145 mm, 3-flute, with Coupling for RDL<br />

03.010.103 Drill Bit 3.2 mm, calibrated, length<br />

145 mm, 3-flute, for Quick Coupling<br />

03.010.106 Direct Measuring Device for Drill Bits of<br />

length 145 mm, for Nos. 03.010.100 to<br />

03.010.105<br />

Stop drilling immediately after penetrating the far cortex.<br />

Disassemble the power drive or radiolucent drive from the<br />

drill bit.<br />

Ensure the correct position of the drill bit in regard to the far<br />

cortex of the femur.<br />

Place the direct measuring device onto the drill bit. Read the<br />

graduation on the measuring device at the end of the drill bit.<br />

This corresponds to the appropriate locking screw length.<br />

Note: Drill bit location with respect to the far cortex is critical<br />

for measuring the appropriate locking screw length.<br />

Alternative instrument<br />

03.010.072 Depth Gauge for Locking Screws,<br />

measuring range up to 110 mm, for<br />

No. 03.010.063<br />

Measure the locking screw length using the depth gauge for<br />

locking screws. Ensure the outer sleeve is in contact with the<br />

bone and the hook grasps the far cortex.<br />

Read the locking screw length directly from the depth gauge<br />

at the back of the outer sleeve.<br />

40 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


6<br />

Insert locking screw<br />

Instruments<br />

03.010.107 Screwdriver Stardrive, T25, length 330 mm<br />

03.010.112 Holding Sleeve, with Locking Device<br />

Insert the locking screw using the screwdriver, and the<br />

holding sleeve with locking device; if desired.<br />

Verify locking screw length under image intensification. The<br />

screw tip should be about 2 mm beyond the far cortex. If<br />

needed, a second locking screw may be inserted using the<br />

same technique.<br />

Use the holding sleeve as described below: Insert the holding<br />

sleeve onto the shaft of the screwdriver and place the tip of<br />

the screwdriver in the recess of the locking screw (Figure 1).<br />

Push the holding sleeve in the direction of the locking screw.<br />

The sleeve now holds the locking screw.<br />

Lock the holding sleeve by tightening it counterclockwise<br />

(Figure 2). After insertion of the locking screw, release the<br />

holding sleeve by loosening it clockwise and pulling it back<br />

(Figure 3).<br />

Figure 1<br />

Figure 2<br />

Figure 3<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 41


End Cap Insertion<br />

1<br />

Insert end cap<br />

Instruments<br />

03.010.110 Screwdriver Stardrive, T40, cannulated<br />

length 300 mm<br />

357.399 Guide Wire 3.2 mm, length 400 mm<br />

Choose an end cap with the appropriate extension; 0 mm if<br />

the nail is not overinserted, 5 mm, 10 mm or 15 mm if the<br />

nail is overinserted.<br />

The end caps are cannulated for use over a guide wire, if<br />

necessary.<br />

Remove the nail insertion instruments.<br />

Optionally, for insertion of the 0 mm end cap, remove the<br />

connecting screw only. The insertion handle can remain to<br />

help align the end cap to the top of the nail. The 0 mm end<br />

cap fits through the barrel of the insertion handle.<br />

Insert the guide wire into the proximal end of the nail.<br />

Engage the end cap with the cannulated screwdriver by exerting<br />

axial pressure. To prevent cross-threading, align the<br />

end cap with the nail axis and turn the end cap counterclockwise,<br />

until the thread of the end cap aligns with that of<br />

the nail.<br />

Turn the end cap clockwise to thread the end cap into the<br />

nail.<br />

Remove the guide wire and screwdriver.<br />

42 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


Alternative instruments<br />

03.010.111 Screwdriver Stardrive, T40, cannulated,<br />

length 190 mm, with Lever Arm<br />

321.160 Combination Wrench 11.0 mm<br />

The cannulated Stardrive, screwdriver, T40, with lever handle,<br />

may be used with the 11 mm combination wrench to insert<br />

the end cap.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 43


Implant Removal<br />

1<br />

Remove end cap and locking screws<br />

Instruments<br />

03.010.107 Screwdriver Stardrive, T25, length 330 mm<br />

03.010.110 Screwdriver Stardrive, T40, cannulated,<br />

length 300 mm<br />

03.010.112 Holding Sleeve, with Locking Device<br />

357.399 Guide Wire 3.2 mm, length 400 mm<br />

Implant removal is an optional procedure.<br />

Clear the Stardrive recess of the end cap and the locking<br />

implants of any ingrown tissue. Insert the guide wire for easy<br />

alignment of the screwdriver in the cannulated end cap.<br />

Remove the end cap using the T40 screwdriver.<br />

Remove all locking screws except one proximal locking screw.<br />

2<br />

Attach extraction screw and hammer guide<br />

Instruments<br />

03.010.107 Screwdriver Stardrive, T25, length 330 mm<br />

357.133 Extraction Screw for AFN/DFN<br />

357.220 Hammer Guide, for No. 359.250<br />

Before removing the final locking screw, screw the extraction<br />

screw into the nail and tighten it. The locking screw will<br />

prevent nail rotation as the extraction screw is tightened.<br />

Attach the hammer guide to the extraction screw.<br />

Remove the remaining locking screw with the screwdriver.<br />

44 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


3<br />

Remove nail<br />

Instrument<br />

03.010.056 Combined Hammer 700 g,<br />

can be mounted, for No. 357.220<br />

Extract the nail by applying gentle blows with the hammer.<br />

Note: The nail will rotate about 90°, similar to the movement<br />

during the insertion.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 45


Implants<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong><br />

– Available for left or right femur<br />

– Anatomic nail design based on a femoral canal tracing<br />

study 3<br />

Material<br />

– Titanium-6% aluminum-7% niobium alloy<br />

Diameters<br />

– 8.2 mm, cannulated<br />

– 9.0 mm, cannulated<br />

– 10.0 mm, cannulated<br />

Lengths<br />

– 240 mm through 400 mm in 20 mm increments<br />

Cross Section<br />

– Helical fluted<br />

Proximal locking<br />

– Dynamization slot (LM)<br />

– Static transverse locking hole (LM)<br />

– 120° antegrade locking<br />

– Two recon locking holes<br />

Distal locking<br />

– Two transverse locking holes (LM)<br />

3 L. Ehmke, et al.<br />

46 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide<br />

120° antegrade<br />

Recon locking<br />

Dynamic transverse<br />

Static transverse<br />

LM<br />

LM<br />

20.6 mm<br />

36.25 mm<br />

50 mm<br />

12.5 mm<br />

12 mm<br />

7 mm<br />

42 mm


<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong>, sterile<br />

Length (mm) mm Right Left<br />

240 8.2 04.031.924S 04.031.925S<br />

260 8.2 04.031.926S 04.031.927S<br />

280 8.2 04.031.928S 04.031.929S<br />

300 8.2 04.031.930S 04.031.931S<br />

320 8.2 04.031.932S 04.031.933S<br />

340 8.2 04.031.934S 04.031.935S<br />

360 8.2 04.031.936S 04.031.937S<br />

380 8.2 04.031.938S 04.031.939S<br />

400 8.2 04.031.940S 04.031.941S<br />

Length (mm) mm Right Left<br />

240 9 04.031.944S 04.031.945S<br />

260 9 04.031.946S 04.031.947S<br />

280 9 04.031.948S 04.031.949S<br />

300 9 04.031.950S 04.031.951S<br />

320 9 04.031.952S 04.031.953S<br />

340 9 04.031.954S 04.031.955S<br />

360 9 04.031.956S 04.031.957S<br />

380 9 04.031.958S 04.031.959S<br />

400 9 04.031.960S 04.031.961S<br />

Length (mm) mm Right Left<br />

240 10 04.031.964S 04.031.965S<br />

260 10 04.031.966S 04.031.967S<br />

280 10 04.031.968S 04.031.969S<br />

300 10 04.031.970S 04.031.971S<br />

320 10 04.031.972S 04.031.973S<br />

340 10 04.031.974S 04.031.975S<br />

360 10 04.031.976S 04.031.977S<br />

380 10 04.031.978S 04.031.979S<br />

400 10 04.031.980S 04.031.981S<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 47


Implants<br />

<strong>Expert</strong> End Cap for <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong><br />

8.2 mm, Titanium Alloy (TAN), (dark purple)*<br />

– Titanium alloy**<br />

– Protect nail threads from tissue ingrowth<br />

– Cannulated to allow insertion over a guide wire<br />

– T40 Stardrive recess<br />

0 mm: Sits flush with end of nail<br />

5 mm, 10 mm and 15 mm extensions: Extend nail height<br />

if nail is overinserted<br />

Extension (mm)<br />

04.031.000 0<br />

04.031.001 5<br />

04.031.002 10<br />

04.031.003 15<br />

Hip Screw Stardrive 5.0 mm, self-tapping, Titanium<br />

Alloy (TAN), (dark purple)*<br />

– Titanium alloy**<br />

– Lengths: 50 mm – 125 mm (5 mm increments)<br />

– 3.2 mm core diameter<br />

– Partially threaded<br />

– Self-tapping, blunt tip<br />

– T25 Stardrive recess for improved torque transmission<br />

and self-retention on screwdriver<br />

04.031.020 50<br />

04.031.021 55<br />

04.031.022 60<br />

04.031.023 65<br />

04.031.024 70<br />

04.031.025 75<br />

04.031.026 80<br />

04.031.027 85<br />

Length (mm)<br />

04.031.028 90<br />

04.031.029 95<br />

04.031.030 100<br />

04.031.031 105<br />

04.031.032 110<br />

04.031.033 115<br />

04.031.034 120<br />

04.031.035 125<br />

**Available nonsterile or sterile-packed. Add “S” to catalog number<br />

to order sterile product.<br />

**Titanium-6% aluminum-7% niobium alloy<br />

Length (mm)<br />

48 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


Locking Screw Stardrive 4.0 mm, for Medullary <strong>Nail</strong>s,<br />

Titanium Alloy (TAN), (dark blue)*<br />

– Titanium alloy**<br />

– Lengths: 18 mm – 80 mm (2 mm increments)<br />

– 3.3 mm core diameter<br />

– Fully threaded<br />

– Self-tapping, blunt tip<br />

– T25 Stardrive recess for improved torque transmission<br />

and self-retention on screwdriver<br />

04.005.408 18<br />

04.005.410 20<br />

04.005.412 22<br />

04.005.414 24<br />

04.005.416 26<br />

04.005.418 28<br />

04.005.420 30<br />

04.005.422 32<br />

04.005.424 34<br />

04.005.426 36<br />

04.005.428 38<br />

04.005.430 40<br />

04.005.432 42<br />

04.005.434 44<br />

04.005.436 46<br />

04.005.438 48<br />

Length (mm)<br />

04.005.440 50<br />

04.005.442 52<br />

04.005.444 54<br />

04.005.446 56<br />

04.005.448 58<br />

04.005.450 60<br />

04.005.452 62<br />

04.005.454 64<br />

04.005.456 66<br />

04.005.458 68<br />

04.005.460 70<br />

04.005.462 72<br />

04.005.464 74<br />

04.005.466 76<br />

04.005.468 78<br />

04.005.470 80<br />

**Available nonsterile or sterile-packed. Add “S” to catalog number<br />

to order sterile product.<br />

**Titanium-6% aluminum-7% niobium alloy<br />

Length (mm)<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 49


Instruments<br />

03.010.020 Radiographic Ruler for <strong>Expert</strong> <strong>Femoral</strong> <strong>Nail</strong>s,<br />

length 475 mm<br />

03.010.023 Radiographic Ruler for <strong>Nail</strong> Diameters<br />

for <strong>Expert</strong> <strong>Femoral</strong> <strong>Nail</strong>s, length 365 mm<br />

03.010.031 Drill Sleeve 13.0/3.2 for antegrade<br />

approach, for No. 03.010.030<br />

03.010.044 Connecting Screw, cannulated,<br />

for <strong>Expert</strong> Tibial and <strong>Femoral</strong> <strong>Nail</strong>s,<br />

for No. 03.010.045<br />

03.010.047 Connector, for Insertion Handle<br />

03.010.056 Combined Hammer 700 g,<br />

can be mounted, for No. 357.220<br />

50 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


03.010.060* Drill Bit 3.2 mm, calibrated,<br />

length 340 mm, 3-flute,<br />

for Quick Coupling, for No. 03.010.064<br />

03.010.063 Protection Sleeve 12.0/8.0, length 188 mm<br />

03.010.064 Drill Sleeve 8.0/3.2, for No. 03.010.063<br />

03.010.069 Trocar 3.2 mm, for No. 03.010.064<br />

03.010.072 Depth Gauge for Locking Screws,<br />

measuring range up to 110 mm,<br />

for No. 03.010.063<br />

03.010.075 Protection Sleeve 11.5/8.5,<br />

for LFN Reconstruction Locking<br />

03.010.076 Drill Sleeve 8.5/3.2, for No. 03.010.075<br />

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

product.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 51


Instruments<br />

03.010.077 Trocar 3.2 mm, for No. 03.010.076<br />

03.010.079 Fixation Sleeve, for No. 03.010.078<br />

03.010.085 Direct Measuring Device for Guide Wires<br />

3.2 mm, length 400 mm<br />

03.010.092 Screwdriver, hexagonal with spherical head<br />

8.0 mm<br />

03.010.093 Rod Pusher for Reaming Rod<br />

with Hexagonal Screwdriver 8.0 mm<br />

03.010.100 Drill Bit 3.2 mm, calibrated,<br />

length 145 mm, 3-flute,<br />

with Coupling for RDL<br />

03.010.103* Drill Bit 3.2 mm, calibrated,<br />

length 145 mm, 3-flute,<br />

for Quick Coupling<br />

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

product.<br />

52 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


03.010.106 Direct Measuring Device for Drill Bits<br />

of length 145 mm, for Nos. 03.010.100<br />

to 03.010.105<br />

03.010.107 Screwdriver Stardrive, T25, length 330 mm<br />

03.010.108 Screwdriver Stardrive, T25, length<br />

330 mm, long<br />

03.010.110 Screwdriver Stardrive, T40, cannulated,<br />

length 300 mm<br />

03.010.111 Screwdriver Stardrive, T40, cannulated,<br />

length 190 mm, with Lever Arm<br />

03.010.112 Holding Sleeve, with Locking Device<br />

03.010.226 Insertion Handle for <strong>Expert</strong> <strong>Adolescent</strong><br />

<strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong><br />

03.010.227 Aiming Arm for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong><br />

<strong>Femoral</strong> <strong>Nail</strong><br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 53


Instruments<br />

03.010.228 Drill Bit 3.2 mm, calibrated, length<br />

474 mm, 3-flute, for Mini Quick Coupling,<br />

for Hip Screw Stardrive 5.0 mm<br />

03.010.229 Protection Sleeve 15.5 mm / 13.7 mm,<br />

length 122.5 mm<br />

319.970 Screw Forceps, self-holding, length 85 mm<br />

321.160 Combination Wrench 11.0 mm<br />

321.170 Pin Wrench 4.5 mm, length 120 mm<br />

351.270 Drill Bit 13.0 mm, cannulated,<br />

length 290 mm, 3-flute,<br />

for Quick Coupling No. 511.760<br />

54 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


357.133 Extraction Screw for AFN/DFN<br />

357.220 Hammer Guide, for No. 357.250<br />

357.393 Trocar 3.2 mm, length 172 mm,<br />

for No. 357.392<br />

357.399 Guide Wire 3.2 mm, length 400 mm<br />

393.105 Universal Chuck, small, with T-Handle<br />

Optional Instruments<br />

351.050 Tissue Protector<br />

03.010.041 Awl 14.0/3.2 mm, cannulated<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 55


<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong><br />

<strong>Nail</strong> Instrument Set<br />

01.031.004 <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Instrument Set<br />

in Vario Case<br />

68.031.004 Vario Case for Standard Instrument Set for <strong>Expert</strong> <strong>Adolescent</strong><br />

<strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong>, without Lid, without Contents<br />

351.270 Drill Bit 13.0 mm, cannulated, length 290 mm, 3-flute,<br />

for Quick Coupling No. 511.760 1<br />

321.160 Combination Wrench 11.0 mm 1<br />

321.170 Pin Wrench 4.5 mm, length 120 mm 1<br />

357.133 Extraction Screw for AFN/DFN 1<br />

357.220 Hammer Guide, for No. 357.250 1<br />

357.393 Trocar 3.2 mm, length 172 mm, for No. 357.392 1<br />

357.399 Guide Wire 3.2 mm, length 400 mm 10<br />

393.105 Universal Chuck, small, with T-Handle 1<br />

03.010.020 Radiographic Ruler for <strong>Expert</strong> <strong>Femoral</strong> <strong>Nail</strong>s, length 475 mm 1<br />

03.010.023 Radiographic Ruler for <strong>Nail</strong> Diameters for <strong>Expert</strong> <strong>Femoral</strong> <strong>Nail</strong>s,<br />

length 365 mm 1<br />

03.010.031 Drill Sleeve 13.0/3.2, for antegrade approach 1<br />

03.010.044 Connecting Screw, cannulated, for <strong>Expert</strong> Tibial and <strong>Femoral</strong> <strong>Nail</strong>s,<br />

for No. 03.010.045 2<br />

03.010.047 Connector, for Insertion Handle 1<br />

03.010.056 Combined Hammer 700 g, can be mounted, for No. 357.220 1<br />

03.010.060* Drill Bit 3.2 mm, calibrated, length 340 mm, 3-flute, for Quick<br />

Coupling, for No. 03.010.064 2<br />

03.010.063 Protection Sleeve 12.0/8.0, lenght 188 mm 1<br />

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

03.010.069 Trocar 3.2 mm, for No. 03.010.064 1<br />

03.010.072 Depth Gauge for Locking Screws, measuring range up to 110 mm,<br />

for No. 03.010.063 1<br />

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

03.010.076 Drill Sleeve 8.5/3.2, for No. 03.010.075 2<br />

03.010.077 Trocar 3.2 mm, for No. 03.010.076 2<br />

03.010.079 Fixation Sleeve, for No. 03.010.078 1<br />

03.010.085 Direct Measuring Device for Guide Wires 3.2 mm,<br />

length 400 mm 1<br />

03.010.092 Screwdriver, hexagonal with spherical head 8.0 mm 1<br />

03.010.093 Rod Pusher for Reaming Rod with Hexagonal Screwdriver<br />

8.0 mm 1<br />

03.010.100 Drill Bit 3.2 mm, calibrated, length 145 mm, 3-flute,<br />

with Coupling for RDL 1<br />

03.010.103* Drill Bit 3.2 mm, calibrated, length 145 mm, 3-flute,<br />

for Quick Coupling 1<br />

03.010.106 Direct Measuring Device for Drill Bits of length 145 mm,<br />

for Nos. 03.010.100 to 03.010.105 1<br />

03.010.107 Screwdriver Stardrive, T25, length 330 mm 1<br />

03.010.108 Screwdriver Stardrive, T25, length 330 mm, long 1<br />

03.010.110 Screwdriver Stardrive, T40, cannulated, length 300 mm 1<br />

03.010.111 Screwdriver Stardrive, T40, cannulated, length 190 mm,<br />

with Lever Arm 1<br />

03.010.112 Holding Sleeve, with Locking Device 1<br />

03.010.226 Insertion Handle for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> 1<br />

03.010.227 Aiming Arm for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> 1<br />

03.010.228 Drill Bit 3.2 mm, calibrated, length 474 mm, 3-flute,<br />

for Quick Coupling, for Hip Screw Stardrive 5.0 mm 1<br />

03.010.229 Protection Sleeve 15.5 mm/ 13.7 mm, length 122.5 mm 1<br />

56 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide<br />

*Available nonsterile or sterile-packed. Add «S» to catalog number<br />

to order sterile product.<br />

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


<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong><br />

<strong>Nail</strong> Instrument Set<br />

01.031.005 <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Upgrade<br />

for LFN Instrument Set<br />

68.031.005 Vario Case for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong>, Upgrade<br />

Instruments to <strong>Expert</strong> LFN, without Lid, without Content 1<br />

351.270 Drill Bit 13.0 mm, cannulated, length 290 mm, 3-flute,<br />

for Quick Coupling No. 511.760 1<br />

357.133 Extraction Screw for AFN/DFN 1<br />

357.393 Trocar 3.2 mm, length 172 mm, for No. 357.410 1<br />

03.010.031 Drill Sleeve 13.0/3.2 for antegrade approach 1<br />

03.010.060 Drill Bit 3.2 mm, calibrated, length 340 mm, 3-flute,<br />

for Quick Coupling, for No. 03.010.064 2<br />

03.010.063 Protection Sleeve 12.0//8.0, length 188 mm 1<br />

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

03.010.069 Trocar 3.2 mm, for No. 03.010.064 1<br />

03.010.093 Rod Pusher for Reaming Rod with Hexagonal Screwdriver<br />

8.0 mm 1<br />

03.010.100 Drill Bit 3.2 mm, calibrated, length 145 mm, 3-flute,<br />

with Coupling for RDL 2<br />

03.010.103 145 mm, 3-flute, with Coupling for RDL 1<br />

03.010.111 Screwdriver Stardrive, T40, cannulated, length 190 mm,<br />

with Lever Arm 1<br />

03.010.226 Insertion Handle for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> 1<br />

03.010.227 Aiming Arm for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> 1<br />

03.010.228 Drill Bit 3.2 mm, calibrated, length 474 mm, 3-flute,<br />

for Quick Coupling, for Hip Screw Stardrive 5.0 mm 1<br />

03.010.229 Protection Sleeve 15.5 mm/ 13.7 mm, length 122.5 mm 1<br />

01.031.004 <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Instrument Set<br />

in Vario Case<br />

01.031.005 <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Upgrade for<br />

LFN Instrument Set<br />

Optionally available<br />

351.050 Soft Tissue Protector<br />

03.010.041 Awl 14.0/3.2 mm, cannulated<br />

Additionally available<br />

321.200 Ratchet Wrench 11.0 mm<br />

351.707S Reaming Rod 2.5 mm, length 950 mm, with Olive & extension,<br />

sterile<br />

351.706S Reaming Rod 2.5 mm, length 950 mm, with Olive, sterile<br />

03.010.124 Combined Hammer 500 g, can be mounted, for No. 357.117<br />

393.100 Universal Chuck with T-Handle<br />

03.010.369 Reduction Instrument for Medullary <strong>Nail</strong>s<br />

357.398 Shaft, hexagonal, 8.0 mm, cannulated, short, length 125 mm<br />

357.117 Hammer Guide for DFN, for no. 357.026<br />

352.033 SynReam Reaming Rod 2.5 mm, long, length 1150 mm<br />

352.032 SynReam Reaming Rod 2.5 mm, short, length 950 mm<br />

189.060 SynReam Intramedullary Reaming System in Vario Case<br />

394.350 Large Distractor<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 57


Option: Modular Aiming Device ModAD<br />

Option for C-arm independent distal locking<br />

of nails for femur, tibia and humerus<br />

When using the ModAD for the interlocking of intra -<br />

medullary nails, no image intensifier control is required. The<br />

system is especially suitable when no C-arm is available.<br />

01.101.309 ModAD for <strong>Expert</strong> LFN und HN<br />

68.010.035 Sliding Carriage for <strong>Expert</strong> Tibial <strong>Nail</strong>s,<br />

for Calibration Block No. 312.952<br />

The ModAD for <strong>Expert</strong> LFN has to be used with the Sliding<br />

Carriage for <strong>Expert</strong> Tibial <strong>Nail</strong>s. Distal locking is performed<br />

using the sliding carriage.<br />

58 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong><br />

<strong>Nail</strong> Implant Set<br />

01.031.003 Implant Set for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong><br />

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

Screw Stardrive 5.0 mm, including Module and Lid,<br />

without content<br />

Instrument<br />

319.970 Screw Forceps<br />

Implants<br />

Locking Screw Stardrive 4.0 mm, for Medullary <strong>Nail</strong>s, Titanium Alloy (TAN),<br />

dark blue, 2 each*<br />

04.005.416 26<br />

04.005.418 28<br />

04.005.420 30<br />

04.005.422 32<br />

04.005.424 34<br />

04.005.426 36<br />

04.005.428 38<br />

04.005.430 40<br />

04.005.432 42<br />

04.005.434 44<br />

04.005.436 46<br />

04.005.438 48<br />

04.005.440 50<br />

04.005.442 52<br />

04.005.440 50<br />

Hip Screw Stardrive 5.0 mm, self-tapping, Titanium Alloy (TAN),<br />

dark purple, for <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong>, 4 each<br />

5.0 mm Titanium Recon Screws*, with T25 StarDrive recess, for IM <strong>Nail</strong>s, 4 ea.<br />

04.031.022 60<br />

04.031.023 65<br />

04.031.024 70<br />

04.031.025 75<br />

04.031.026 80<br />

04.031.027 85<br />

04.031.028 90<br />

Length (mm)<br />

Length (mm)<br />

<strong>Expert</strong> End Cap for <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> 8.2 mm,Titanium<br />

Alloy (TAN), dark purple*<br />

Extension (mm)<br />

04.031.000 0 2 each<br />

04.031.001 5 1<br />

04.031.002 10 1<br />

04.031.003 15 1<br />

04.005.442 52<br />

04.005.444 54<br />

04.005.446 56<br />

04.005.448 58<br />

04.005.450 60<br />

04.005.452 62<br />

04.005.454 64<br />

04.005.456 66<br />

04.005.458 68<br />

04.005.460 70<br />

04.005.462 72<br />

04.005.464 74<br />

04.005.466 76<br />

04.005.468 78<br />

04.005.470 80<br />

04.031.029 95<br />

04.031.030 100<br />

04.031.031 105<br />

04.031.032 110<br />

04.031.033 115<br />

04.031.034 120<br />

Length (mm)<br />

Length (mm)<br />

Optionally available<br />

Hip Screws<br />

04.031.020 Hip Screw Stardrive 5.0 mm, self-tapping, length 50 mm,<br />

Titanium Alloy (TAN), dark purple, for<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong><br />

04.031.021 Hip Screw Stardrive 5.0 mm, self-tapping, length 55 mm,<br />

Titanium Alloy (TAN), dark purple, for<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong><br />

04.031.035 Hip Screw Stardrive 5.0 mm, self-tapping, length 125 mm,<br />

Titanium Alloy (TAN), dark purple, for<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong><br />

Locking Screws<br />

04.005.408 Locking Screw Stardrive 4.0 mm, for Medullary <strong>Nail</strong>s,<br />

Titanium Alloy (TAN), length 18 mm, dark blue<br />

04.005.410 Locking Screw Stardrive 4.0 mm, for Medullary <strong>Nail</strong>s,<br />

Titanium Alloy (TAN), length 20 mm, dark blue<br />

04.005.412 Locking Screw Stardrive 4.0 mm, for Medullary <strong>Nail</strong>s,<br />

Titanium Alloy (TAN), length 22 mm, dark blue<br />

04.005.414 Locking Screw Stardrive 4.0 mm, for Medullary <strong>Nail</strong>s,<br />

Titanium Alloy (TAN), length 24 mm, dark blue<br />

*Available nonsterile or sterile-packed. Add “S” to catalog number<br />

to order sterile product.<br />

Note: For additional information, please refer to package insert.<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 59


Optional: Angular Stable Locking System (ASLS)<br />

What is ASLS?<br />

The Angular Stable Locking System (ASLS) provides the ability<br />

to create a fixed-angle construct to an intrame dullary nail.<br />

Therefore, it combines the advantages of angular stability<br />

and a minimally invasive approach. ASLS together with an<br />

intra medullary nail form the principle of the Intramedullary<br />

Fixator.<br />

How does ASLS work?<br />

The system consists of a screw with three outer diameters<br />

and a resorbable sleeve.<br />

The resorbable sleeve is placed on the screw tip which has<br />

the smallest screw diameter and is pushed into the locking<br />

hole of the nail.<br />

During screw advancement, the resorbable sleeve is expanded<br />

by the larger middle diameter. Radial expansion of<br />

the sleeve and its fixation in the nail creates the angular<br />

stability.<br />

60 <strong>Synthes</strong> <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide


ASLS screws<br />

– Titanium alloy*<br />

– Screws ASLS4: Length 26 mm – 80 mm, are compatible<br />

with <strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong>s<br />

– Fully threaded shaft with 3 diameters<br />

– D1: Provides purchase in reamed near cortex<br />

– D2: Expands sleeve, providing angular stability<br />

– D3: Holds unexpanded sleeve for screw insertion,<br />

provides purchase in far cortex<br />

– T25 Stardrive recess<br />

– Sterile packaged<br />

ASLS sleeves<br />

– 70:30 poly (L-lactide-co-D,L-lactide)<br />

– Bioresorbable, provides 80% decreased<br />

fracture site motion during first 12 weeks of healing<br />

– Gradually degrades within 2 years (resorption rate varies<br />

per patient and implant site)<br />

– Inner thread for secure fit to screw<br />

– Expands in nail locking hole<br />

– Available in diameters of 4.0 mm (ASLS4), 5.0 mm<br />

(ASLS5) and 6.0 mm (ASLS6)<br />

– Sterile-packed<br />

Note: For more details regarding the intramedullary fixator<br />

principle please consult the ASLS surgical technique<br />

(036.000.708) and concept flyer (036.001.017).<br />

*Titanium-6% aluminum-7% niobium alloy<br />

D1<br />

D2<br />

D3<br />

<strong>Expert</strong> <strong>Adolescent</strong> <strong>Lateral</strong> <strong>Femoral</strong> <strong>Nail</strong> Technique Guide <strong>Synthes</strong> 61


All technique guides are available as PDF files at<br />

www.synthes.com/lit<br />

Ö036.000.648öAC‚ä<br />

© <strong>Synthes</strong>, Inc. or its affiliates Subject to modifications <strong>Synthes</strong>, <strong>Expert</strong>, Stardrive and Vario Case are trademarks of <strong>Synthes</strong>, Inc. or its affiliates<br />

0123 036.000.648 version AC 02/2012 30101140

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