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T2 Supracondylar Nailing System

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T2 Supracondylar Nailing System T2 Supracondylar Nailing System Operative Technique Supracondylar Nailing System Contributing Surgeons Prof. Dr. med. Volker Bühren Chief of Surgical Services Medical Director of Murnau Trauma Center Murnau Germany Dean C. Maar, M.D. Methodist Hospital − Indianapolis Indianapolis Indiana USA James Maxey, M.D. Clinical Assistant Professor University of Illinois College of Medicine Peoria, IL USA This publication sets forth detailed recommended procedures for using Stryker Osteosynthesis devices and instruments. It offers guidance that you should heed, but, as with any such technical guide, each surgeon must consider the particular needs of each patient and make appropriate adjustments when and as required. A workshop training is required prior to first surgery. All non-sterile devices must be cleaned and sterilized before use. Follow the instructions provided in our reprocessing guide (L24002000). Multi-component instruments must be disassembled for cleaning. Please refer to the corresponding assembly/ 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: All bone screws referenced in this document here are not approved for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic or lumbar spine. 2 Contents Page 1. Introduction 4 Implant Features 4 Technical Details 5 Instrument Features 6 Target Device Features 6 2. Technical Details 8 Locking Options 8 3. Indications, Precautions & Contraindications 9 Indications 9 Precautions 9 Relative Contraindications 9 4. Pre-operative Plannning 10 5. Operative Technique 11 Patient Positioning 11 Incision 11 Entry Point 12 Reamed Technique 14 Nail Selection 15 Nail Insertion 16 Guided Distal Locking Mode 17 Proximal Locking - Fully Threaded Screw 17 Proximal Locking - Condyle Screw 20 Oblique Locking - Fully Threaded Screw 22 Distal Locking - Fully Threaded or Condyle Screw 24 Freehand Proximal Locking 25 Guided Proximal Locking T2 SCN Short version 26 End Cap Insertion 27 Nail Removal 28 Ordering Information – Implants 29 Ordering Information – Instruments 31 3 Introduction Implant Features Over the past several decades ante- The T2 SCN System is the realization SCN End Cap: grade femoral nailing has become the of superior biomechanical One End Cap for all T2 SCN is treatment of choice for most femoral intramedullary stabilization using available to lock the most distal shaft fractures. Recently, retrograde small caliber, strong and cannulated Locking Screw in order to avoid lateral femoral nailing has increased in implants for internal fixation of the movement of the nail and to prevent popularity, expanding the use of femur. bony ingrowth. intramedullary nails. Complicated This feature creates a fixed angle multiple trauma injuries, ipsilateral According to the fracture type, the between the nail and Locking Screw. femoral neck and shaft fractures, system offers the option of a static associated pelvic and acetabular locking mode with 3 plane fixation. Common 5mm cortical screws fractures, ipsilateral femoral and simplify the surgical procedure tibial shaft fractures, supracondylar The design of the T2 SCN System is and promote a minimally invasive and intercondylar fractures, may be universal for left and right indications. approach. Fully Threaded Screws better managed by utilizing retrograde are available for standard locking femoral nailing techniques. procedures. Two implant versions In addition to the T2 Femoral Nailing are available: Special Condyle Screws with System, Stryker developed the T2 adjustable screw heads for improved Supracondylar Nail (SCN) for the • Short version: fit are designed to fix fragments in the treatment of complex distal femoral Proximal Targeting via Target condyle area. They provide compres- fractures. Device sion of intracondylar fractures and increased stability in distal fracture The T2 Supracondylar Nailing System • Long version: fragment. offers the advantages of a unique Proximal Locking via Freehand locking configuration and targeting Locking All implants of the T2 SCN System are concept, allowing superior fixation made of Type II anodized titanium in the distal femur, using the already Nails: alloy (Ti6Al4V) for enhanced established T2 instrument platform T2 SCN Short version biomechanical and biomedical and locking screws. Length : 170 & 200mm performance. T2 SCN Long version Length: 240−440mm in 20mm increments 4 Introduction Technical Details 0mm Nails 15mm 20mm Diameter 9−14mm Short Version 170 & 200mm Long Version 240−440mm 40mm 5.0mm Fully Threaded Locking Screws L = 25−120mm 5.0mm Condyle Screws L = 40−120mm Note: Screw length is measured from top of head to tip. Condyle Nut 42mm Bend 4° 32mm End Caps 21mm 14mm 6mm 0mm M/L View A/P View M/L View A/P View 5 Introduction Instrument Target Device Features Target Device Features Features (Targeting Arm, SCN) The major advantage of the The Targeting Arm for the T2 SCN instrument system is a breakthrough is designed with one locking hole for in the integration of the instrument all locking screws to be placed in the platform which can be used not only distal femur (Fig. 1). for the complete T2 Nailing System, including the T2 SCN System, but will These are the locking holes in the be the platform for all future Stryker distal femur: nailing systems, reducing complexity and inventory. 1. Proximal Transverse Distal Condylar Locking The instrument platform features 2. Oblique Condylar Locking ergonomically styled targeting devices, 3. Oblique Condylar Locking and provides advanced precision while 4. Distal Transverse Distal Condylar maintaining ease of use. Locking The Targeting Arm can be rotated and Symbol coding on the instruments axially moved along the Nail Adapter. indicates the type of procedure and The Locking Window, together must not be mixed. with the corresponding positions on the Targeting Arm indicates the appropriate locking position. Symbol After the required locking position is = Long instruments reached, the Targeting Arm is locked by tightening the thumb screw. Drills Note: To avoid mis-drilling the Drills feature a color coded ring: Targeting Arm can be locked in the dedicated position only. 4.2mm = Green For Fully Threaded Screws 5.0mm Target Device Features (Targeting Arm Proximal, SCN) 5.0mm = Black For Condyle Screws An additional Target Device for the T2 SCN Short version is available for the proximal locking options: The name of this Target Device is: Targeting Arm Proximal, SCN (Fig. 2). After the required locking position is reached, the Targeting Arm is locked by tightening the thumb screw. The Targeting Arm Proximal, SCN, is designed to provide guided proximal locking for the T2 SCN Short version 170 & 200mm. 6 Introduction Nail Adapter, SCN (1806-3301) Proximal Transverse Distal Condylar Locking 1 Oblique Condylar Locking 2 Oblique Condylar Locking 3 Distal Transverse Distal Condylar Locking 4 Nail Holding Screw, SCN (1806-3307) Targeting Arm, SCN (1806-3302) Target Hole Safety Clip Thumb Screw Targeting Arm Proximal, SCN (1806-3305) Fig. 1 Locking Window Fig. 2 7 Technical Details Locking Options Proximal Locking Options T2 SCN Long version When treating distal fractures, two A/P screws should be used in static position when possible (Fig. 3). Proximal locking may be done in either static or dynamic mode depend- ing on surgeon preference. These holes are targeted freehand. Proximal Locking Options T2 SCN Short version When treating distal fractures, two M/L locking screws should be used when possible (Fig. 4). Both screws can be placed directly through the Fig. 3 Targeting Arm Proximal, SCN. Distal Locking Options T2 SCN Short and Long version The different distal screw positions for both T2 SCN versions are (sequence of recommended insertion, Fig. 5): Fig. 4 Transverse Screw: 1 Condyle Screw or Fully Threaded Screw Oblique Screw: 2 Fully Threaded Locking Screw Oblique Screw: 3 Fully Threaded Locking Screw Transverse Screw: 4 Condyle Screw or Fully Threaded Screw T2 SCN Short Nail T2 SCN Long Nail Fig. 5 8 Indications, Precautions and Contraindications Indications Precautions The T2 SCN System is indicated for: The T2 System has not been evaluated for safety and compatibility in the MR • Open and closed femoral fractures environment. • Pseudoarthrosis and correction The T2 System has not been tested osteotomy for heating or migration in the MR • Pathologic fractures, impending environment. pathologic fractures, and tumor resections • Supracondylar fractures, including those with intra- articular extension • Fractures distal to a Total Hip Prosthesis • Nonunions and malunions Retrograde Fig. 6 Relative Contraindications The physician’s education, training and professional judgement must be relied upon to choose the most appropriate device and treatment. Conditions presenting an increased risk of failure include: • Any active or suspected latent • Patients having inadequate tissue infection or marked local coverage over the operative site. inflammation in or about the • Implant utilization that would affected area. interfere with anatomical • Compromised vascularity that structures or physiological would inhibit adequate blood performance. supply to the fracture or the • Any mental or neuromuscular operative site. disorder which would create an • Bone stock compromised by unacceptable risk of fixation
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