Angular Stable Locking System (ASLS) Surgical Technique Table of Contents

For Angular Stable Locking of Intramedullary Nails Angular Stable Locking System (ASLS) Surgical Technique Table of Contents

Introduction Angular Stable Locking System (ASLS) 2

AO Principles 4

Indications 5

Surgical Technique Preparation 6

Targeted Locking 8

Freehand Locking 14

Screw Insertion 21

Implant Removal 27

Product Information Implants 28

ASLS Compatibility With Existing Nails 29

Instruments 30

Set Lists 33

MR Information The Angular Stable Locking System has not been evaluated for safety and compatibility in the MR environment. It has not been tested for heating, migration or image artifact in the MR environment. The safety of the Angular Stable Locking System in the MR environment is unknown. Scanning a patient who has this device may result in patient injury.

Image intensiﬁer control

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 1 Angular Stable Locking System (ASLS)

Angular and axial stability Diameter 1: Diameter 2: – Improved fixation in poor quality bone Provides purchase in Expands sleeve, – Decreased risk of secondary loss reamed near cortex providing angular of reduction stability

Compatibility with existing nails – Compatible with all DePuy Synthes cannulated titanium nails (see page 29 for nail compatibility) – A combination of standard and ASLS screws may be used in the same nail – Intraoperative choice for ASLS

Titanium Angular Stable Locking Screws – Titanium alloy* – Available lengths – 4.0 mm ASLS screw: 26 mm–80 mm – 5.0 mm ASLS screw: 30 mm–100 mm – 6.0 mm ASLS screw: 32 mm–125 mm – Instruments are color coded to screws

4.0 mm ASLS 5.0 mm ASLS 6.0 mm ASLS (brown) (light blue) (dark purple)

*Titanium-6% aluminum-7% niobium alloy

2 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Angular Stable Locking System (ASLS)

Technique overview Diameter 3: Holds unexpanded sleeve for screw insertion, provides purchase in far cortex

1. Drill both cortices

2. Ream near cortex

Resorbable Sleeve – 70:30 poly (L/DL-lactide) – 4.0 mm, 5.0 mm and 6.0 mm sleeves are used with corresponding ASLS screws

3. Insert unexpanded sleeve into nail

4. Expanded sleeve provides angular stability

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 3 AO Principles AO PRINCIPLES

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation.1,2 In 1958, the AO formulated four basic principles, which have become the guidelines for internal ﬁxation1, 2.

4_Priciples_03.pdf 1 05.07.12 12:08

AnatomicAnatomic reductionreduction StableStable fixationfixation FractureFracture reductionreduction and ﬁfixationxation toto FractureFracture fixation ﬁxation providingproviding absoluteabso- restorerestore anatomicalanatomical relationships.relationships. orlute relative or relative stability, stability, as required as by therequired patient, by thethe injury, patient, and the the injury, 1 2 personalityand the personality of the fracture. of the fracture.

Early,Early, activeactive mobilization PreservationPreservation of of bloodblood supplysupply EarlyEarly andand safesafe mobilizationmobilization and 4 3 PreservationPreservation of of the the blood blood supply supply rehabilitationrehabilitation ofof thethe injuredinjured part toto softsoft tissues tissues and and bone bone by by gentle andand thethe patientpatient asas aa whole.whole. reductiongentle reduction techniques techniques and and carefulcareful handling. handling.

1. Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of Internal Fixation. 3rd ed. Berlin, Heidelberg, New York: Springer-Verlag; 1991. 2. Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 1 Müller ME, M Allgöwer, R Schneider, H Willenegger. Manual of Internal 2nd ed. Stuttgart New York: Thieme; 2007. Fixation. 3rd ed. Berlin Heidelberg New York: Springer. 1991. 2 Rüedi TP, RE Buckley, CG Moran. AO Principles of Fracture Management. 2nd ed. Stuttgart, New York: Thieme. 2007. 4 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique

4 DePuy Synthes Expert Lateral Femoral Nail Surgical Technique Indications

The Synthes Angular Stable Locking System (ASLS), when used with Synthes cannulated titanium intramedullary nails, is intended to aid in the alignment and stabilization of tibial, humeral, femoral and ankle fractures.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 5 Preparation

The following pages describe techniques for locking with ASLS. All illustrations use the Tibial Nail-EX, as an example. 1 Preoperative planning Use the appropriate AO preoperative planner template to estimate nail diameter and length.

2 Reduce fracture and insert nail Reduce the fracture and insert the nail. Use a compatible DePuy Synthes titanium cannulated intramedullary nailing system according to the relevant technique guide.

Note: The ASLS is only compatible with cannulated nails. It is necessary for the sleeve to expand within the cannulation of the intramedullary nail to provide sufficient stability.

6 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Preparation

3 Choose appropriate locking screws For each locking hole, preselect the optimal locking implant to stabilize the fracture. If using an ASLS screw, the diameter of the ASLS screw and instruments will match the diameter of the standard screw/bolt for the particular nail.

Note: A combination of standard locking screws/bolts and ASLS screws can be used in the same nail.

Caution: Do not exchange a standard locking screw/bolt for an ASLS screw or vice versa as this may reduce screw-to-bone interface stability.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 7 Targeted Locking

1 Attach aiming arm and insert trocar combination

Instruments

03.010.063† 12.0 mm/8.0 mm Protection Sleeve, 188 mm (for Expert nails)

03.025.040* 11.0 mm/8.0 mm Protection Sleeve, 188 mm, for ASLS

4.0 mm

03.010.064† 8.0 mm/3.2 mm Drill Sleeve

03.010.069† 3.2 mm Trocar

5.0 mm

03.010.065† 8.0 mm/4.2 mm Drill Sleeve

03.010.070† 4.2 mm Trocar

6.0 mm

03.010.066† 8.0 mm/5.0 mm Drill Sleeve

03.010.071† 5.0 mm Trocar

Once the nail is inserted, attach the aiming arm to the insertion handle. Confirm that the nail is tightly connected to the insertion handle.

Insert the appropriate three-part trocar combination (protection sleeve, drill sleeve and trocar) through the desired hole in the aiming arm. Make a skin incision and ensure that the dissection of the fascia is in line with the path of the protection sleeve. Advance the three-part trocar combination to the bone. Remove the trocar.

Note: Ensure that the drill sleeve is pressed firmly to the near cortex.

†Found in the EXPERT NAIL® Instrument Sets. *Also available.

8 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Targeted Locking

2 Drill through both cortices

Instruments

4.0 mm

03.025.104 2.9 mm/3.2 mm Three-Fluted Drill Bit, quick coupling, 331 mm

5.0 mm

03.025.105 3.9 mm/4.2 mm Three-Fluted Drill Bit, quick coupling, 331 mm

6.0 mm

03.025.106 4.9 mm/5.0 mm Three-Fluted Drill Bit, quick coupling, 331 mm

Using the appropriate drill bit, drill through both cortices until the tip of the drill bit penetrates the far cortex.

If necessary, use image intensification to control the position of the drill bit.

Note: Follow all recommended techniques for screw/bolt insertion for the relevant nail system. When inserting a screw monocortically, stop drilling immediately after penetrating the near cortex.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 9 Targeted Locking

3 Determine ASLS screw length Read the measurement from the calibrated drill bit at the back of the drill sleeve. Select the ASLS screw length accordingly. Remove the drill bit and drill sleeve.

Note: Follow all recommended techniques for screw/bolt measurement for the relevant nail system.

Precaution: Do not exchange a standard locking screw/bolt for an ASLS screw or vice versa as this may reduce screw-to-bone interface stability.

11 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Targeted Locking

Alternative technique

Instrument

03.025.052 Depth Gauge, for ASLS screws

Remove the drill bit and the drill sleeve. Disassemble the depth gauge, separating the outer sleeve from the measuring device with hook. Insert the measuring device with hook into the protection sleeve.

Read the measurement from the back of the protection sleeve and select the ASLS screw length accordingly.

Note: Ensure that the hook grasps the far cortex and that the protection sleeve is pressed firmly to the bone.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 11 Targeted Locking

4 Ream near cortex

Instruments

4.0 mm

03.025.030 2.9 mm/5.0 mm Hand Reamer

5.0 mm

03.025.031 3.9 mm/6.0 mm Hand Reamer

6.0 mm

03.025.032 4.9 mm/7.0 mm Hand Reamer

Align the hand reamer with the locking hole axis. Ream the near cortex and clear the passage down to the nail. Remove the hand reamer.

If necessary, use image intensification to control the position of the hand reamer.

Note: To correctly insert the ASLS sleeve, ensure: – the near cortex is completely reamed; – the passage from the near cortex to the nail’s locking hole is cleared; – the drilled/reamed hole aligns with the nail’s locking hole.

11 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Targeted Locking

Alternative technique

Instruments

4.0 mm

03.025.134 2.9 mm/5.0 mm Drill-Reamer, quick coupling, 268 mm

5.0 mm

03.025.135 3.9 mm/6.0 mm Drill-Reamer, quick coupling, 288 mm

6.0 mm

03.025.136 4.9 mm/7.0 mm Drill-Reamer, quick coupling, 288 mm

Use a power-driven drill-reamer to open the near cortex. Align the drill-reamer with the locking hole axis and ream the near cortex. Once the large diameter of the drill-reamer passes through the near cortex, stop reaming immediately. Remove the drill-reamer.

If necessary, clear the passage down to the nail with the hand reamer.

If necessary, use image intensification to control the position of the drill-reamer.

Precaution: Ensure that the drill-reamer does not damage the nail.

Insert screws in targeted locking holes (see Screw Insertion, page 21), before continuing with freehand locking.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 11 Freehand Locking

1 Align image The techniques for distal locking apply. Align the image intensifier with the desired locking hole until a perfect circle is visible in the center of the screen.

Note: Ensure that the image displayed on the image intensifier mirrors the actual image in all axes.

2 Make incision Using image intensification, place a long K-wire or alternative long instrument on the skin over the center of the hole to mark the incision point.

Make a skin incision with a scalpel blade at this location.

Note: Check the reduction, correct alignment of the fragments, and limb length before locking.

11 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Freehand Locking

3 Drill through both cortices

Instruments

511.30* Radiolucent Drive

4.0 mm

03.025.124* 2.9 mm/3.2 mm Three-Fluted Drill Bit, quick coupling, 145 mm, for Radiolucent Drive

5.0 mm

03.025.125* 3.9 mm/4.2 mm Three-Fluted Drill Bit, quick coupling, 145 mm, for Radiolucent Drive

6.0 mm

03.025.126* 4.9 mm/5.0 mm Three-Fluted Drill Bit, quick coupling, 145 mm, for Radiolucent Drive

Attach the appropriate drill bit to the radiolucent drive. Using image intensification, insert the tip of the drill bit through the incision and to the bone.

Incline the drive to center the tip of the drill bit over the locking hole. The drill bit should nearly fill the circle of the locking hole. Hold the drill bit in this position and drill through both cortices. Stop drilling immediately after the tip of the drill penetrates the far cortex. Remove the drill bit.

Precaution: Follow all recommended techniques for screw/bolt insertion for the relevant nail system. When inserting locking screws monocortically, stop drilling immediately after penetrating the near cortex.

*Also available.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 11 Freehand Locking

3 Drill through both cortices continued Alternative technique

Instruments

4.0 mm

03.025.082 2.9 mm/3.2 mm Three-Fluted Drill Bit, quick coupling, 150 mm

5.0 mm

03.025.083 3.9 mm/4.2 mm Three-Fluted Drill Bit, quick coupling, 150 mm

6.0 mm

03.025.084 4.9 mm/5.0 mm Three-Fluted Drill Bit, quick coupling, 150 mm

Standard freehand locking technique can be performed without the radiolucent drive, using the appropriate drill bit.

11 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Freehand Locking

4 Determine ASLS screw length

Instrument

03.025.052 Depth Gauge, for ASLS screws

Insert the depth gauge into the drilled hole. Read the measurement from the outer sleeve of the depth gauge and select the ASLS screw length accordingly.

Note: Follow all recommended techniques for screw/bolt measurement for the relevant nail system. Ensure that the hook grasps the far cortex and that the protection sleeve is pressed firmly to the bone.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 11 Freehand Locking

4 Determine ASLS screw length continued Alternative technique for radiolucent drill bits

Instrument

03.010.106† Direct Measuring Device, for Locking Screws to 100 mm

Stop drilling immediately after the tip of the drill penetrates the far cortex.

Disassemble the drill bit from the radiolucent drive.

Place the direct measuring device onto the drill bit. Read the graduation of the measuring device at the end of the drill bit. This corresponds to the appropriate screw length.

†Found in the EXPERT NAIL Instrument Sets.

11 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Freehand Locking

5 Ream near cortex

Instruments

4.0 mm

03.025.030 2.9 mm/5.0 mm Hand Reamer

5.0 mm

03.025.031 3.9 mm/6.0 mm Hand Reamer

6.0 mm

03.025.032 4.9 mm/7.0 mm Hand Reamer

Align the hand reamer with the locking hole axis. Ream the near cortex and clear the passage down to the nail. Remove the hand reamer.

If necessary, use image intensification to control the position of the hand reamer.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 11 Freehand Locking

5 Ream near cortex continued Alternative technique

Instruments

4.0 mm

03.025.027 2.9 mm/5.0 mm Drill-Reamer, quick coupling, 145 mm

5.0 mm

03.025.028 3.9 mm/6.0 mm Drill-Reamer, quick coupling, 145 mm

6.0 mm

03.025.029 4.9 mm/7.0 mm Drill-Reamer, quick coupling, 145 mm

Use the appropriate drill-reamer to open the near cortex. Align the drill-reamer with the locking hole axis and ream the near cortex. Once the large diameter of the drill-reamer passes through the near cortex, stop reaming immediately. Remove the drill-reamer.

If necessary, clear the passage down to the nail with the hand reamer.

If necessary, use image intensification to control the position of the drill-reamer.

Precaution: Ensure that the drill-reamer does not damage the nail.

22 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Screw Insertion

1 Position sleeve Select the appropriate resorbable sleeve.

Position the sleeve so that the sleeve lip is facing the screwhead. Thread the ASLS sleeve onto the ASLS screw. Sleeve lip Note: The sleeve is positioned correctly when gold is visible on either side of the sleeve and the screw tip protrudes 1 mm–2 mm beyond the sleeve.

Precautions: 1–2 mm Do not use ASLS screws without sleeves.

When attaching the sleeve, stop threading the sleeve once resistance increases. Resistance occurs when the sleeve expands as it moves onto the larger diameter of the screw. An expanded sleeve will prevent screw/sleeve insertion into a locking hole.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 22 Screw Insertion

1 Position sleeve continued Alternative technique

Instruments

4.0 mm/5.0 mm

03.025.067 Sleeve Positioner

6.0 mm

03.025.066 Sleeve Positioner

Place the sleeve into the appropriate side of the sleeve positioner. Rotate the screw into the sleeve until the sleeve is pushed out of the sleeve positioner.

22 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Screw Insertion

2 Insert screw/sleeve assembly into locking hole

Instruments

03.010.063† 12.0 mm/8.0 mm, Protection Sleeve, 188 mm (for Expert nails)

03.010.107† StarDrive Screwdriver, T25, self-retaining

03.025.040* 11.0 mm/8.0 mm, Protection Sleeve, 188 mm, for ASLS

4.0 mm

03.010.064† 8.0 mm/3.2 mm Drill Sleeve

03.010.069† 3.2 mm Trocar

5.0 mm

03.010.065† 8.0 mm/4.2 mm Drill Sleeve

03.010.070† 4.2 mm Trocar

6.0 mm

03.010.066† 8.0 mm/5.0 mm Drill Sleeve

03.010.071† 5.0 mm Trocar

Assemble the appropriate protection sleeve, drill sleeve and trocar and advance the assembly to the bone. Remove the drill sleeve and trocar. Attach the ASLS screw/sleeve assembly to the screwdriver.

†Found in the EXPERT NAIL Instrument Sets. *Also available.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 22 Screw Insertion

2 Insert screw/sleeve assembly into locking hole continued Push the ASLS screw/sleeve assembly through the protection sleeve and near cortex, and into the nail’s locking hole. If necessary, lightly tap the screwdriver to advance the screw/ sleeve into the locking hole.

Precaution: Do not rotate the screwdriver until the sleeve is seated in the locking hole.

Note: If the screw/sleeve assembly cannot be pushed to the nail stop, use the appropriate reamer to completely open the near cortex (see earlier step “Ream near cortex”).

Optional technique

Instrument

399.505 Synthetic Hammer

If necessary, lightly hammer to advance the screw/sleeve assembly into the nail’s locking hole.

22 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Screw Insertion

3 Screw into far cortex Push the screwdriver to get the screw started. Rotate the screwdriver to advance the screw until the screw threads engage the far cortex.

Notes: The larger diameter core expands the sleeve in the nail, providing angular stability.

In the final screw position, the largest diameter screw threads will engage the near cortex and the screw tip will protrude beyond the far cortex.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 22 Screw Insertion

3 Screw into far cortex continued

Note: To prevent overinsertion of the ASLS screw, use a protection sleeve during screw insertion. Ensure that the protection sleeve is pressed to the bone. Advance the screw until the engraved line on the screwdriver shaft meets the edge of the protection sleeve.

After insertion of all screws, use image intensification to ensure that reduction is maintained, that the screwheads contact the bone, and that the screws are not overinserted.

4 Intraoperative screw exchange

Instruments

03.010.107† StarDrive Screwdriver, T25, self-retaining

03.010.112† Holding Sleeve, with Locking Device

Using standard technique, remove the ASLS screw with the screwdriver and, if necessary, by pulling with the holding sleeve.

Note: Since the sleeve remains in the nail, it does not need to be removed and exchanged.

Insert a new ASLS screw.

†Found in the EXPERT NAIL Instrument Sets.

22 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Implant Removal

1 Remove screws

Instruments

03.010.107† StarDrive Screwdriver, T25, self-retaining

03.010.112† Holding Sleeve, with Locking Device

Using standard technique, remove ASLS screws with the screwdriver and, if necessary, the holding sleeve.

2 Remove nail Remove the nail using standard technique for the relevant nail system.

Note: The sleeves remain in the nail if not fully resorbed and can be removed with the nail during nail removal.

†Found in the EXPERT NAIL Instrument Sets.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 22 Implants

Titanium Angular Stable Locking Screws, with T25 StarDriveTM Recess, for intramedullary nails, sterile* – Titanium alloy** D1 – Available lengths – 4.0 mm ASLS screw: 26 mm–80 mm – 5.0 mm ASLS screw: 30 mm–100 mm – 6.0 mm ASLS screw: 32 mm–125 mm D2 – 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 D3 – T25 StarDrive Recess – Sterile packaged

Resorbable Sleeves for Angular Stable Locking Screws, sterile* – 70:30 poly (L/DL-lactide) – Inner thread for secure fit to ASLS screw – Expands in nail’s locking hole to provide angular stability – 4.0 mm, 5.0 mm, and 6.0 mm sleeves used with corresponding ASLS screws – Sterile packaged (2 per package)

*Also available. **Titanium-6% aluminum-7% niobium alloy

22 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique ASLS Compatibility With Existing Nails

The Angular Stable Locking System is compatible with all DePuy Synthes titanium cannulated nailing systems.

Angular Stable Locking Systems Nail 4.0 mm 5.0 mm 6.0 mm Nailing System Diameters (mm) (brown) (light blue) (dark purple)

Humerus Titanium Cannulated Humeral Nail 7, 9, 11 • and Proximal Humeral Nail-EX Femur Titanium Trochanteric Fixation Nail 10, 11, 12, 14 •

Titanium Cannulated Lateral Entry 9–13 • Femoral Nail-EX and Lateral Entry Femoral Recon Nail-EX 14–16 • Titanium Cannulated Retrograde/ 9–13 • Antegrade Femoral Nail-EX 14, 15 • Titanium Femoral Nail (cannulated) 10–15 • Titanium Distal Femoral Nail 10–13 • • (cannulated) Titanium Cannulated Adolescent 8.2, 9, 10 • Lateral Entry Femoral Nail-EX Tibia Titanium Cannulated Tibial Nail-EX 8, 9 • and Tibial Nail-EX with Proximal Bend 10–13 • Titanium Tibial Nail (cannulated) 10–13 • Ankle Titanium Cannulated Hindfoot 10, 12, 13 • • Arthrodesis Nail-EX

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 22 Instruments

General instruments

03.010.063† 12.0 mm/8.0 mm, Protection Sleeve, 188 mm – to be used with Expert nails

03.010.107† StarDrive Screwdriver, T25

03.010.112† Holding Sleeve, with Locking Device

03.025.040* 11.0 mm/8.0 mm, Protection Sleeve, 188 mm, for ASLS – to be used with non-Expert nails

03.025.052 Depth Gauge, for ASLS screws

03.025.066 Sleeve Positioner, for 6.0 mm ASLS sleeves

03.025.067 Sleeve Positioner, for 4.0 mm and 5.0 mm ASLS sleeves

399.505 Synthetic Hammer (100 g)

†Found in the EXPERT NAIL Instrument Sets. *Also available.

33 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Instruments

Instruments for targeted locking

03.010.064† 8.0 mm/3.2 mm Drill Sleeve 03.010.065† 8.0 mm/4.2 mm Drill Sleeve 03.010.066† 8.0 mm/5.0 mm Drill Sleeve

03.010.069† 3.2 mm Trocar 03.010.070† 4.2 mm Trocar 03.010.071† 5.0 mm Trocar

03.025.030 2.9 mm/5.0 mm Hand Reamer, for 4.0 mm ASLS screws 03.025.031 3.9 mm/6.0 mm Hand Reamer, for 5.0 mm ASLS screws 03.025.032 4.9 mm/7.0 mm Hand Reamer, for 6.0 mm ASLS screws

03.025.104 2.9 mm/3.2 mm Three-Fluted Drill Bit, quick coupling, 331 mm, for 4.0 mm ASLS screws 03.025.105 3.9 mm/4.2 mm Three-Fluted Drill Bit, quick coupling, 331 mm, for 5.0 mm ASLS screws 03.025.106 4.9 mm/5.0 mm Three-Fluted Drill Bit, quick coupling, 331 mm, for 6.0 mm ASLS screws

03.025.134 2.9 mm/5.0 mm Drill-Reamer, quick coupling, 268 mm, for 4.0 mm ASLS screws 03.025.135 3.9 mm/6.0 mm Drill-Reamer, quick coupling, 288 mm, for 5.0 mm ASLS screws 03.025.136 4.9 mm/7.0 mm Drill-Reamer, quick coupling, 288 mm, for 6.0 mm ASLS screws

†Found in the EXPERT NAIL Instrument Sets.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 33 Instruments

Instruments for freehand locking

03.025.027 2.9 mm/5.0 mm Drill-Reamer, quick coupling, 145 mm, for 4.0 mm ASLS screws 03.025.028 3.9 mm/6.0 mm Drill-Reamer, quick coupling, 145 mm, for 5.0 mm ASLS screws 03.025.029 4.9 mm/7.0 mm Drill-Reamer, quick coupling, 145 mm, for 6.0 mm ASLS screws

03.025.030 2.9 mm/5.0 mm Hand Reamer, for 4.0 mm ASLS screws 03.025.031 3.9 mm/6.0 mm Hand Reamer, for 5.0 mm ASLS screws 03.025.032 4.9 mm/7.0 mm Hand Reamer, for 6.0 mm ASLS screws

03.025.082 2.9 mm/3.2 mm Three-Fluted Drill Bit, quick coupling, 150 mm, for 4.0 mm ASLS screws 03.025.083 3.9 mm/4.2 mm Three-Fluted Drill Bit, quick coupling, 150 mm, for 5.0 mm ASLS screws 03.025.084 4.9 mm/5.0 mm Three-Fluted Drill Bit, quick coupling, 150 mm, for 6.0 mm ASLS screws

03.025.124* 2.9 mm/3.2 mm Three-Fluted Drill Bit, quick coupling, 145 mm, for 4.0 mm ASLS screws, for Radiolucent Drive 03.025.125* 3.9 mm/4.2 mm Three-Fluted Drill Bit, quick coupling, 145 mm, for 5.0 mm ASLS screws, for Radiolucent Drive 03.025.126* 4.9 mm/5.0 mm Three-Fluted Drill Bit, quick coupling, 145 mm, for 6.0 mm ASLS screws, for Radiolucent Drive

*Also available.

33 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Angular Stable Locking System Instrument Set (01.025.002)

60.025.002 Graphic Case for Angular Stable Locking System, for Cannulated Titanium Intramedullary Nails Instruments 399.505 Synthetic Hammer

Drill-Reamers, quick coupling, 145 mm, 2 ea. 03.025.027 2.9 mm/5.0 mm, for 4.0 mm Angular Stable Locking Screws 03.025.028 3.9 mm/6.0 mm, for 5.0 mm Angular Stable Locking Screws 03.025.029 4.9 mm/7.0 mm, for 6.0 mm Angular Stable Locking Screws

Hand Reamers 03.025.030 2.9 mm/5.0 mm, for 4.0 mm Angular Stable Locking Screws 03.025.031 3.9 mm/6.0 mm, for 5.0 mm Angular Stable Locking Screws 03.025.032 4.9 mm/7.0 mm, for 6.0 mm Angular Stable Locking Screws

03.025.052 Depth Gauge, for Angular Stable Locking System 03.025.066 Sleeve Positioner, for 6.0 mm Angular Stable Locking System Sleeves 03.025.067 Sleeve Positioner, for 4.0 mm and 5.0 mm Angular Stable Locking System Sleeves

Three-Fluted Drill Bits, quick coupling, needle point, 150 mm, 2 ea. Drill-Reamers, quick coupling, 2 ea. 03.025.082 2.9 mm/3.2 mm, for 4.0 mm 03.025.134 2.9 mm/5.0 mm, 268 mm, for 4.0 mm Angular Stable Locking Screws Angular Stable Locking Screws 03.025.083 3.9 mm/4.2 mm, for 5.0 mm 03.025.135 3.9 mm/6.0 mm, 288 mm, for 5.0 mm Angular Stable Locking Screws Angular Stable Locking Screws 03.025.084 4.9 mm/5.0 mm, for 6.0 mm 03.025.136 4.9 mm/7.0 mm, 288 mm, for 6.0 mm Angular Stable Locking Screws Angular Stable Locking Screws

Three-Fluted Drill Bits, quick coupling, needle point, 331 mm, 100 mm calibration, 2 ea. 03.025.104 2.9 mm/3.2 mm, for 4.0 mm Angular Stable Locking Screws 03.025.105 3.9 mm/4.2 mm, for 5.0 mm Note: For additional information, precautions and warnings, please see the Angular Stable Locking Screws package insert. 03.025.106 4.9 mm/5.0 mm, for 6.0 mm For detailed cleaning and sterilization Angular Stable Locking Screws instructions, please refer to www.synthes.com/hcp/cleaning-sterilization or sterilization instructions, if provided.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 33 Implant Sets

ASLS Screws 01.025.008 4.0 mm Angular Stable Locking System 01.025.009 5.0 mm Angular Stable Locking System Screw Set Screw Set 4.0 mm Titanium Angular Stable Locking Screws, with T25 5.0 mm Titanium Angular Stable Locking Screws, with T25 StarDrive Recess, for intramedullary nails, sterile, 2 ea. StarDrive Recess, for intramedullary nails, sterile, 2 ea. Length Length Length Length (mm) (mm) (mm) (mm) 04.025.416S 26 04.025.444S 54 04.025.520S 30 04.025.550S 60 04.025.418S 28 04.025.446S 56 04.025.522S 32 04.025.552S 62 04.025.420S 30 04.025.448S 58 04.025.524S 34 04.025.554S 64 04.025.422S 32 04.025.450S 60 04.025.526S 36 04.025.556S 66 04.025.424S 34 04.025.452S 62 04.025.528S 38 04.025.558S 68 04.025.426S 36 04.025.454S 64 04.025.530S 40 04.025.560S 70 04.025.428S 38 04.025.456S 66 04.025.532S 42 04.025.562S 72 04.025.430S 40 04.025.458S 68 04.025.534S 44 04.025.564S 74 04.025.432S 42 04.025.460S 70 04.025.536S 46 04.025.566S 76 04.025.434S 44 04.025.462S 72 04.025.538S 48 04.025.568S 78 04.025.436S 46 04.025.464S 74 04.025.540S 50 04.025.570S 80 04.025.438S 48 04.025.466S 76 04.025.542S 52 04.025.575S 85 04.025.440S 50 04.025.468S 78 04.025.544S 54 04.025.580S 90 04.025.442S 52 04.025.470S 80 04.025.546S 56 04.025.585S 95 04.025.548S 58 04.025.590S 100

33 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Implant Sets

01.025.010 6.0 mm Angular Stable Locking System Alternative Set Configurations Screw Set 01.025.001 Angular Stable Locking System Screw Set 6.0 mm Titanium Angular Stable Locking Screws, with T25 Consists of: StarDrive Recess, for intramedullary nails, sterile, 2 ea. 4.0 mm ASLS Screw Set (01.025.008) and Length Length 5.0 mm ASLS Screw Set (01.025.009) (mm) (mm) 04.025.622S 32 04.025.656S 66 04.025.624S 34 04.025.658S 68 04.025.626S 36 04.025.660S 70 04.025.628S 38 04.025.662S 72 04.025.630S 40 04.025.664S 74 04.025.632S 42 04.025.666S 76 04.025.634S 44 04.025.668S 78 04.025.636S 46 04.025.670S 80 04.025.638S 48 04.025.675S 85 04.025.640S 50 04.025.680S 90 04.025.642S 52 04.025.685S 95 04.025.644S 54 04.025.690S 100 04.025.646S 56 04.025.695S 105 04.025.648S 58 04.025.700S 110 04.025.650S 60 04.025.705S 115 04.025.652S 62 04.025.710S 120 04.025.654S 64 04.025.715S 125

ASLS Sleeves* Resorbable Sleeve for Angular Stable Locking Screws, sterile, 2/pkg. 08.025.032S for 4.0 mm ASLS Screws 08.025.044S for 5.0 mm ASLS Screws 08.025.057S for 6.0 mm ASLS Screws

*Must be ordered separately.

Angular Stable Locking System (ASLS) Surgical Technique DePuy Synthes 33 Also Available

Instruments Power Equipment Drill-Reamers, quick coupling, 145 mm, 105.955 Small Battery Drive Set for Radiolucent Drive 150.119 Battery Power Line Set 03.025.037 2.9 mm/5.0 mm, for 4.0 mm Angular Stable 511.30 Radiolucent Drive Locking Screws 530.605 Battery Reamer/Drill 03.025.038 3.9 mm/6.0 mm, for 5.0 mm Angular Stable 530.620 Battery, for Battery Power Line Locking Screws 530.680 Battery Casing, for Battery Power Line 03.025.039 4.9 mm/7.0 mm, for 6.0 mm Angular Stable 530.741 Adaptor for Radiolucent Drive, for Battery Locking Screws Power Line 03.025.040 11.0 mm/8.0 mm Protection Sleeve, 188 mm, 530.750 Quick Coupling for Drill Bits, for Battery for Angular Stable Locking System Power Line 532.010 Small Battery Drive Three-Fluted Drill Bits, quick coupling, 532.013 Quick Coupling for Drill Bits needle point, 145 mm, for Radiolucent Drive 532.031 Adaptor for Radiolucent Drive 03.025.124 2.9 mm / 3.2 mm, for 4.0 mm Angular Stable 532.032 Small Battery Drive Battery Casing, Locking Screws for 14.4 V Battery 03.025.125 3.9 mm/4.2 mm, for 5.0 mm Angular Stable 532.033 Small Battery Drive 14.4 V Battery Locking Screws 03.025.126 4.9 mm/5.0 mm, for 6.0 mm Angular Stable Locking Screws

Expert Nail Instruments† 03.010.063 12.0 mm/8.0 mm Protection Sleeve, 188 mm

Drill Sleeves 03.010.064 8.0 mm/3.2 mm, 200 mm 03.010.065 8.0 mm/4.2 mm, 200 mm 03.010.066 8.0 mm/5.0 mm, 200 mm

Trocars 03.010.069 3.2 mm, 210 mm 03.010.070 4.2 mm, 210 mm 03.010.071 5.0 mm, 210 mm

03.010.106 Direct Measuring Device, for Locking Screws to 100 mm, for IM Nails 03.010.107 StarDrive Screwdriver, T25, self-retaining 03.010.112 Holding Sleeve, with Locking Device 03.010.150 Star/HexDrive Screwdriver, T25, 3.5 mm hex, self-retaining

†Found in the EXPERT NAIL Instrument Sets.

33 DePuy Synthes Angular Stable Locking System (ASLS) Surgical Technique Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed. Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information. CAUTION: Federal Law restricts these devices to sale by or on the order of a physician. Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada. Not all products may currently be available in all markets.

Manufactured or distributed by: Synthes USA Products, LLC Synthes USA, LLC 1302 Wrights Lane East 1101 Synthes Avenue West Chester, PA 19380 Monument, CO 80132

To order (USA): 800-523-0322 To order (Canada): 855-946-8999

Note: For recognized manufacturer, refer to the product label. www.depuysynthes.com