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Gamma3 Trochanteric Nail 170 &180 Operative Technique Operative Trochanteric Nail 170 & 180

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Gamma3 Trochanteric Nail 170 &180 Operative Technique Operative Trochanteric Nail 170 & 180 Hip Gamma3 Trochanteric Nail 170 & 180 Operative Technique Hip Fractures Trochanteric Nail 170 & 180 Contributing Surgeons Prof. Kwok Sui Leung, M. D. Chairman of Department of Orthopaedics and Traumatology The Chinese University of Hong Kong Prince of Wales Hospital Hong Kong Assist. Prof. Gilbert Taglang, M. D. Department of Traumatology University Hospital, Strasbourg France Prof. Dr. med. Volker Bühren Chief of Surgical Services Medical Director of Murnau Trauma Center, Murnau Germany Katsumi Sato M. D. Ph. D. This publication sets forth detailed Vice-Director, Chief Surgeon recommended procedures for using Tohoku University Graduate School of Medicine Stryker Osteosynthesis devices and Tohoku Rosai Hospital, Sendai instruments. Japan It offers guidance that you should Christopher T. Born, M. D. heed, but, as with any such technical Professor of Orthopaedic Surgery guide, each surgeon must consider the Department of Orthopaedic Trauma particular needs of each patient and Brown University School of Medicine make appropriate adjustments when Providence, Rhode Island and as required. A workshop training is USA recommended prior to first surgery. Robert Probe, M. D. All non-sterile devices must be Chairman - Department of Orthopaedic Surgery cleaned and sterilized before use. Scott & White Memorial Hospital, Temple, TX Follow the instructions provided in USA our reprocessing guide (L24002000). Prof. Dr. med. Vilmos Vécsei Multi-component instruments must Chief of Traumatology Department be disassembled for cleaning. Please University of Vienna, Vienna refer to the corresponding assembly/ Austria disassembly instructions. See package insert (L22000007) for a complete list of potential adverse effects, contraindications, warnings and precautions. The surgeon must discuss all relevant risks, including the finite lifetime of the device, with the patient, when necessary. Warning: Fixation Screws: Stryker Osteosynthesis bone screws are not approved or intended for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic or lumbar spine. 2 Contents Page 1. Introduction 4 2. Design of the Gamma3 System 5 Lag Screw and Set Screw Function 6 Distal Locking Screws 6 3. Indications, Precautions & Contraindications 7 Indications 7 Contraindications 7 Precautions 7 4. Operative Technique 8 Pre-operative Planning 8 Implant Selection 8 Patient Positioning 9 Fracture Reduction 9 Incision 10 Entry Point 12 Opening the Cortex 12 Preparation of Medullary Canal 13 Assembly of Targeting Device 19 Nail Insertion 22 Lag Screw Positioning using One Shot Device 24 Lag Screw Insertion 25 Pre-Drilling the lateral cortex 26 Lag Screw Insertion 27 Lag Screw Fixation 30 Distal Screw Locking 34 End Cap Insertion 36 Nail Extension End Caps 37 Post-operative Care and Rehabilitation 37 Extraction of the Gamma3 Implants 38 Dealing with Special Cases 40 Packaging 41 Implants 42 Instruments 44 References 47 3 Introduction Introduction The Gamma3 Locking Nail System The Gamma3 Locking Nail System The thread design also offers exceptional was developed based on more than was developed based on more than grip in the cancellous bone of the 20 years of Gamma Nail experience. 15 years of Gamma Nail experience. femoral head and strong resistance This is the third generation of Gamma This is the third generation of Gamma against cut-out. intramedullary short and long fixation intramedullary short and long fixation The 5mm distal locking screws are also nails. nails. used in the T2 intramedullary nailing The evolution of the successful The evolution of the successful system. Trochanteric and Long Gamma Nails Trochanteric and Long Gamma Nails A major advantage of the system is the as well as the Asia Pacific and Japanese as well as the Asia Pacific and Japanese state-of-the-art instrument platform. versions followed strictly a step-by-step versions followed strictly a step-by-step The instruments are downsized to enhancement based on the clinical enhancement based on the clinical facilitate a minimally invasive approach experience and outcome from surgeons experience of the clinical outcome from for a minimally invasive surgical all over the world. surgeons all over the world. technique. The instruments are easy to The newest generation nail, Gamma3, use, and share the same platform as the Acknowledgements: is designed to facilitate minimally Stryker intramedullary T2 and S2 nails. invasive surgery and to help reduce Our thanks are due to the many sur- Acknowledgements: geons who supported the develop ment the OR time to a mini mum with the of the Gamma3 System, with their aid of using the state-of-the-art Our thanks are due to the many feedback and ideas during worldwide instrumentation and an optimized surgeons who supported the develop- panel meetings. They have helped the surgical technique. ment of the Gamma3 System, with their Gamma3 System to be what it is today. The nails have a proximal diameter of feedback and ideas during worldwide 15.5mm to help minimize the incision panel meetings. They have helped the length required for minimally invasive Gamma3 System to be what it is today. surgery. Nevertheless, they offer the Special thanks to the Asian Pacific same biomechanical strength and cut- Technical Committee, who supported out resistance as the well established very early the idea of smaller implants Trochanteric and Long Gamma Nails. for the treatment of proximal femur The Lag Screw shape has been fractures. improved, especially in the area of the thread and the cutting flutes at the tip of the screw. This design offers exceptional cutting behavior during Lag Screw insertion, providing very low insertion torque. 4 4 Design The Gamma3 System Gamma3 Locking Nails come in 3 neck- Technical Specifications: shaft angles of 120, 125 and 130°. • Material: Gamma3 End Cap All nails* use the same Lag Screws, Set Titanium alloy with anodized type II Screw, distal Locking Screws and End surface treatment. Caps (see Fig. 1). • Nail length: Gamma3 Set Screw 170mm, 180mm Gamma3 Nail 170 and 180 • Nail diameter: The anatomical shape of the nail is 180mm: universal for all indications involving proximal 15.5mm, distal: 11mm the treatment of trochanteric fractures. 170mm: The nail is cannulated for Guide-Wire- proximal 15.5mm, distal:10mm controlled insertion. • Proximal Nail angle range: A range of three different neck-shaft 120°, 125°, 130° angles are available for Lag Screw entry to accommodate variations in femoral • M-L bend for valgus curvature: neck anatomy. 4 degrees Gamma3 Lag Screw 120° A single distal Locking Screw is • End Caps in lengths of 125° provided to stabilize the nail in the 0mm, +5mm and +10mm 130° medullary canal and to help to prevent • Distal oblong hole for rotation in complex fractures. 5mm screws; up to 5mm The oblong hole allows static or dynamization is possible dynamic locking. Gamma3 Nail 170 & 180 Distal Locking Options • Locking in the distal part of the Distal Locking Screw oblong hole creates a dynamic locking mechanism (see Fig. 2). • Locking in the proximal part of the Fig. 1 oblong hole allows static locking of the nail (see Fig. 3). Dynamic Locking Static Locking Fig. 2 Fig. 3 * Each nail is supplied sterile packaged together with a Set Screw in one box. 5 Design Lag Screw and Set Screw Function Technical Specifications • Lag Screw diameter: 10.5mm • Lag Screw lengths: 70−130mm in 5mm increments • Lag Screw design for high load absorption and easy insertion • Asymmetrical depth profile to allow the Lag Screw to slide in the lateral direction only (see orange arrow on Fig. 4). • Self retaining Set Screw to protect the Lag Screw against rotation and simultaneously allowing sliding of the Lag Screw laterally. Fig. 4 Distal Locking Screws Lag Screw Stabilization System Length Definition of the Distal Locking Screw The distal Locking Screw is measured from head to tip (Fig. 5). Technical Specifications • Distal Locking Screw Diameter: 5mm. • Distal Locking Screw lengths ranging from 25−50mm, in 2.5 and 5mm increments. Longer screws up to 120mm are available on request. Length Definition • Fully threaded screw design. Partially treaded screws are available on request. 5mm Fig. 5 6 Indications, Precautions & Contraindications Indications Precautions The indications for the Gamma3 Stryker Osteosynthesis systems have not Nail 170 and 180 are the same of those been evaluated for safety and use in MR for the Gamma Trochanteric Locking environment and have not been tested Nail (Fig. 7). for heating or migration in the MR • Intertrochanteric fractures environment, unless specified otherwise • Pertrochanteric fractures in the product labeling or respective • Nonunion and malunion operative technique. Contraindications Contraindications are medial neck fractures and sub-trochanteric fractures. Caution: The Gamma Nail is designed for temporary implantation until the bone consolidation occurs. Therefore, if no bone consolidation occurs or if consolidation is not sufficient, the system may break. The aim of post-operative care must be to ensure the promotion of bone consolidation. The Gamma Nail is not intended for full weight bearing in patients with complex unstable fractures until sufficient bone consolidation is confirmed in Fig. 7 the follow up X-rays. This operative technique has been devised in consultation with leading surgeons in many countries to be a basic guide, particularly for less experienced users of the Gamma3 System. It is acknowledged that several alternative approaches to certain elements of the procedure are available, and may have advantages for particular situations or surgeons. 7 Operative Technique Pre-operative Planning The Gamma3 Nail with a 125° nail angle may be used in the majority of patients. Where such variations in femoral anatomy require an alternative, the following chapter describes how to select the optimum implant size. Implant Selection X-Ray templates are very helpful during pre-operative planning. Use the X-Ray Templates for short and long nails to select the correct implant and the optimal nail angle. These templates show the true implant size at a magnification of 15 % in Fig. 9 anterior-posterior view.
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