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Stryker T2 Operative Technique

Stryker T2 Operative Technique

Recon nailing system r2.0
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T2
Hip
KnifeLight
Recon Nailing System R2.0
Carpal Tunnel Ligament Release
Operative Technique
Femur
Operative Technique

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Summary of Contents for Stryker T2

  • Page 1 KnifeLight Recon Nailing System R2.0 Carpal Tunnel Ligament Release Operative Technique Femur Operative Technique...
  • Page 2 T2 Recon Nailing System Contributing Surgeons We greatly acknowledge and appreciate the contributions to this operative technique made by: Kevin W. Luke, M.D. Parkview Orthopaedic Group Assistant Clinical Professor Department of Orthopaedic Surgery University of Illinois Illinois, Chicago Anthony T. Sorkin, M.D.
  • Page 3 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.

  • Page 4: Table Of Contents

    Contents Page Introduction & Features Implant Features Technical Specifications Instrument Features Indications, Precautions & Contraindications Pre-operative Planning Locking Options Operative Technique Patient Positioning and Fracture Reduction Incision Entry Point Reaming Nail Selection Assembly of the Targeting Device and the Nail Nail Insertion Final Seating with Impactor Guided Locking for the Recon Mode...

  • Page 5: Introduction & Features

    Mode) and options to address fracture variability. - Antegrade Set Screw: Tightens the The T2 Recon nail is one of the first oblique 5mm Fully Threaded Screw femoral nailing systems to offer a As with all other T2 Nails, the T2 (Femoral Antegrade Mode).

  • Page 6: Technical Specifications

    Introduction Technical Specifi cations Recon Set Screw Antegrade Set Screw Nail Diameter 9, 11, 13 and 15mm (Left and Right) Sizes 280−480mm, in 20mm increments Note: • Proximal diameter is 13mm for 26mm 70° the 9 and 11mm Nails and 15mm for the 13 and 15mm Nails.

  • Page 7: Instrument Features

    Instrument Features A major advantage of the T2 instrument platform is the integration of core instruments that can be used not only for the complete T2 Nailing System, but for future Stryker Osteosynthesis nailing systems, thereby, reducing complexity and inventory.

  • Page 8: Indications, Precautions & Contraindications

    Indications, Precautions & Contraindications Indications Precautions The T2 Recon Nail is indicated for: Stryker Osteosynthesis systems have not been evaluated for safety and use • Subtrochanteric fractures in MR environment and have not been • Intertrochanteric fractures tested for heating or migration in the •...

  • Page 9: Pre-Operative Planning

    Evaluation of the femoral neck angle on the pre-operative X-Rays is mandatory as the T2 Recon Nail has a fixed 125° neck angle for the two Lag Screws. Proper placement of both Lag Screws in the femoral head is essential.

  • Page 10: Locking Options

    Locking Options Recon Mode The T2 Recon Nail can be locked proximally with two 6.5mm Lag Screws (Recon Mode, Fig. 1) or with one 5mm Fully Threaded Screw (Antegrade Femoral Mode, Fig. 2). For both Recon and Antegrade Femoral applications, depending on fracture pattern, either static or dynamic distal locking can be used.

  • Page 11: Operative Technique

    This will also allow easier access to entry point. Fig. 3 Incision The design of the T2 Recon Nail, with a 4° medial lateral bend, will only allow for insertion through the tip of the greater trochanter. With experience, the tip of the greater trochanter can be identifi ed by palpation (Fig.

  • Page 12: Entry Point

    Operative Technique Entry Point • The Tip of the greater Trochanter The entry point is located at the junction of the anterior third and posterior two-thirds of the greater trochanter on the medial edge of the tip itself (Fig. 6). Note: Before opening the tip of greater trochanter, image intensifi er...
  • Page 13 Operative Technique • Entry point with One Step Conical Reamer Alternatively, the 13mm diameter K-Wire One Step Conical Reamer for the 9 and 11mm nails or the 15mm diameter Reamer for the 13 and 15mm nails may be used for opening the medullary canal and reaming of the trochanteric region.

  • Page 14: Reaming

    Operative Technique Reaming The Ø 3 × 1000mm Ball Tip Guide Wire is inserted with the Guide Wire Handle through the fracture site to the level of the epiphyseal scar. The Ø 9mm Universal Rod with Reduction Spoon may be used as a fracture reduction tool to facilitate Guide Wire insertion through the fracture site (Fig.
  • Page 15 Guide Wire Pusher will keep the Guide Wire in place. Fig. 15 Guide Wire Pusher (1806-0271) Note: The T2 Recon Nail may be inser- Reaming of the trochanteric region is ted without reaming of the needed (Fig. 13) as the proximal nail subtrochanteric and diaphyseal...

  • Page 16: Nail Selection

    Guide Wire Ruler (Fig. 16a, b). Upon completion of reaming, the appropriate size nail is ready for insertion. A unique design feature of the T2 Recon Nail is that the Ø3 × 1000mm Ball Tip Guide Wire does not need to be exchanged. Fig. 16b Fig.

  • Page 17: Assembly Of The Targeting Device And The Nail

    Operative Technique Assembly of Targeting Device First, assemble the Knob to the Target- ing Device by aligning the arrow on the Knob with the white line on the Target Sleeve, (Fig. 18a) then push hard to click it. By turning the Knob clockwise to the position labeled (A), the sleeve inserted in target (A) position, which is the distal Recon Mode targeting hole, can...

  • Page 18: Nail Insertion

    Operative Technique Nail Insertion The nail is advanced through the entry point passing the fracture site to the appropriate level. If dense bone is encountered, fi rst re-evaluate that suffi cient reaming has been achieved, then, if necessary, the Strike Plate can be attached to the Targeting Arm and the Slotted Hammer may be used to further insert the nail (Fig.

  • Page 19: Guided Locking For The Recon Mode

    Operative Technique Guided Locking for the Recon Mode Nail / Lag Screws Positioning Drive the T2 Recon Nail to the depth that correctly aligns the proxi mal screw holes parallel with the femoral head and neck under fluoroscopic control (Fig. 20).
  • Page 20 Operative Technique Now attach the Recon Paddle Trocar to the T-Handle, AO Medium Coupling (Fig. 21). Then, advance them together with the Recon Tissue Protection Sleeve to the skin through the hole on the Target Device labeled (A). Make a small skin incision and push the assembly through until it is in contact with the lateral cortex.
  • Page 21 Operative Technique Note: With the image intensifier, verify if the K-Wire is placed along the calcar region in the A/P view and central on the lateral view (correct anteversion) (Fig. 24). If the K-Wire is incorrectly positioned, the first step is to remove it and then to correct the nail position.
  • Page 22 Note: Fig. 26 The use of the One Shot Device should not replace any steps in the T2 Recon Operative Technique. While pressing the attachment grip, the device is positioned between the anterior aspect of the patient’s hip and the fluoroscope screen positioned for an A/P view of the hip (Fig.
  • Page 23 To identify the accurate position, the dashed wire of the target must appear between the two solid wires at the desired position. If the position is incorrect the T2 Recon Nail position may be corrected by ei ther pulling backwards or pushing forwards (Fig. 28).
  • Page 24 Operative Technique Solid Stepdrill Technique For the insertion of proximal screws in Recon Mode, the Solid Stepdrill Technique, which is mentioned in this chapter, is the recommended method to optimize the proximal targeting accuracy. Attach the Recon Paddle Trocar to the T-Handle, AO Medium Coupling as demonstrated in Fig.
  • Page 25 Operative Technique Using the Recon Screwdriver the correct Lag Screw is inserted through the Tissue Protection Sleeve and threaded up to the subcondral part of the femoral head. The screw is near its proper seating position when the groove around the shaft of the screwdriver is approaching the end of the Tissue Protection Sleeve (Fig.
  • Page 26 Operative Technique Alternatively, the K-Wire can be used prior to drilling with the Solid Drill. Place a second Recon K-Wire into the K-Wire Inserter and attach it to the T-Handle or power tool. The K-Wire is then advanced through the K-Wire Sleeve until it reaches the subchondral bone of the femoral head.
  • Page 27 Operative Technique Cannulated Stepdrill Technique As the Cannulated Stepdrill technique was also discussed in a previous version of the operative technique, the insertion of the proximal screws in Recon Mode using this method will also be mentioned as a potential option.
  • Page 28 Operative Technique Caution: Before proceeding with drilling for the selected Lag Screw, check the A/P fluoroscopic views to see if the two Recon K-Wires are parallel. The distal K-Wire Sleeve is removed while the Tissue Protection Sleeve remains in position (Fig. 36a). The cannulated Ø6.5mm Recon Stepdrill for Lag Screw (REF 1806-3025) is forwarded through the Tissue...

  • Page 29: Guided Locking For Antegrade Femoral Mode

    Operative Technique Guided Locking for Antegrade Femoral Mode Guided Locking for Antegrade Femoral Mode Now attach the Paddle Trocar, Now attach the Paddle Trocar, Antegrade and the AO T-Handle Antegrade and the AO T-Handle Medium Coupling (Fig. 39). Then, Medium Coupling (Fig. 39). Then, advance them together with the Long advance them together with the Long Tissue Protection Sleeve through...
  • Page 30 Operative Technique Pre-drilling the lateral cortex Pre-drilling opens the lateral cortex for the drill entry. Pre-drilling helps to prevent a possible slipping of the drill on the cortex and may avoid deflection within the cancellous bone. The Paddle Trocar Assembly is then removed and the Drill Sleeve is inserted through the Long Tissue Protection Sleeve (Fig.
  • Page 31 Operative Technique Therefore, if the end of the Drill is 3mm beyond the far cortex, the end of the screw will also be 3mm beyond (Fig. 46). Check the position of the end of the Drill with image intensification before measuring the screw length.

  • Page 32: Freehand Distal Locking

    Operative Technique Freehand Distal Locking The freehand technique is used to insert Fully Threaded Locking Screws into both distal transverse holes in the nail. Rotational alignment must be checked prior to locking the nail. This is performed by checking a lateral view at the hip and a lateral view at the knee.
  • Page 33 5mm Fully Threaded Locking Screw into the oblong hole in a static position (Fig. 52). The T2 Recon Nail may be used in the dynamic locking mode. When the fracture pattern permits, dynamic lock ing may be utilized for transverse, rotationally stable fractures.

  • Page 34: Set Screw Or End Cap Insertion

    Operative Technique Set Screw or End Cap Insertion After removal of the Target Device, Set Screw, Set Screw, End Caps Recon Antegrade a Set Screw or End Cap can be used. Two different Set Srews are available (Fig. 53a): - a Recon Set Screw to tighten down on the Proximal Lag Screw for the Recon Mode Standard...

  • Page 35: Ordering Information - Implants

    Ordering Information – Implants T2 Recon Nail, Left T2 Recon Nail, Right Titanium Diameter Length Titanium Diameter Length 1846-0928S 1847-0928S 1846-0930S 1847-0930S 1846-0932S 1847-0932S 1846-0934S 1847-0934S 1846-0936S 1847-0936S 1846-0938S 1847-0938S 1846-0940S 1847-0940S 1846-0942S 1847-0942S 1846-0944S 1847-0944S 1846-0946S 1847-0946S 1846-0948S 1847-0948S 1846-1128S 11.0...
  • Page 36 Ordering Information – Implants 6.5mm Lag Screws 5mm Fully Threaded Locking Screws Titanium Diameter Length Titanium Diameter Length 1896-5025S 25.0 1897-6065S 1896-5030S 30.0 1897-6070S 1896-5035S 35.0 1897-6075S 1896-5040S 40.0 1897-6080S 1896-5045S 45.0 1897-6085S 1896-5050S 50.0 1897-6090S 1896-5055S 55.0 1897-6095S 1896-5060S 60.0 1897-6100S 1896-5065S...

  • Page 37: Ordering Information - Instruments

    Elastosil handles be used only for their intended use. DO NOT HIT them. *** items are part of T2 Basic Long Instrument set (1806-9901); however, not used for T2 Recon Nailing surgery...
  • Page 38 Ordering Information – Instruments Description T2 Recon Instruments 1806-3100 Target Device 1806-3101 Knob for Target Device 1806-3005 Nail Holding Screw, Recon 1806-3010 One Step Conical Reamer Ø13, Recon 1806-3015 One Step Conical Reamer Ø15, Recon 1806-3026S Solid Stepdrill for Lag Screw*...
  • Page 39 1806-9993 T2 Recon Instrument Tray Insert **Caution: 1806-9992 T2 Recon Silicone Mat Free Space The coupling of Elastosil handles contains a mechanism with one or multiple ball bearings. In case of applied axial stress on 1806-9995 T2 Recon Drill Rack...
  • Page 40 Ordering Information – Instruments Bixcut Complete range of modular and fixed-head reamers to match surgeon preference and optimize O. R. efficiency, presented in fully sterilizable cases. Large clearance rate resulting from reduced number of reamer blades coupled with reduced length of reamer head to allow for effective relief of pressure and effi cient removal of material Cutting fl ute geometry optimized to lower pressure...
  • Page 41 AO Fitting (REF No: 0227-xxxx) * Use with 2.2mm × 800mm Smooth Tip and 2.5mm × 800mm Ball Tip Guide Wires only. ** Use with Stryker power equipment. 1. Non-Sterile shafts supplied without Grommet. Use new Grommet for each surgery. See shaft accessories.
  • Page 42 Notes...
  • Page 43 Notes...
  • Page 44 Stryker does not dispense medical advice and recommends that surgeon‘s be trained in the use of any particular product before using it in surgery. The information presented in this brochure is intended to demonstrate a Stryker product.

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