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Summary of Contents for Synthes DFN
- Page 1 DFN Distal Femoral Nail Surgical Technique Standard Locking Spiral Blade Locking Original Instruments and Implants of the Association for the Study of Internal Fixation – AO/ASIF...
- Page 2 117.500 Reaming Instrument Set for Medullary Nails (not illustrated) 399.430 Hammer 700 g 399.505 Hammer, synthetic 314.280 Holding Sleeve, large 357.360 Extraction Screw for Spiral Blade 357.133 Extraction Screw for AFN/DFN 357.117 Hammer Guide for DFN 357.026 Slotted Hammer 400 g, can be mounted...
- Page 3 357.530 Protection Sleeve 17.0/15.0 357.531 Drill Sleeve 15.0/3.2 357.129 Guide Wire 3.2 mm 351.270 Drill Bit 13.0 mm 357.112 Insertion Handle for DFN 451.701–831 Distal Femoral Nail 357.135 Connecting Screw 357.122 Radiographic Ruler for DFN 321.170 Pin Wrench 450.862–872 Locking Screws 357.098 Trocar...
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Page 4: Table Of Contents
Indications/contraindications Implants Standard locking Spiral blade locking Implant removal Cleaning of instruments Image intensifier control Warning This description is not sufficient for immediate application of the instrumentation. Instruction by a surgeon experienced in handling this instrumentation is highly recommended. Synthes... -
Page 5: Indications/Contraindications
Distal Femoral Nail Indications/contraindications The Distal Femoral Nail DFN is indicated for the stabilization of fractures of the distal femur. It can also be used for diaphyseal fractures in which a retrograde approach is indicated (e.g. ipsilateral tibia and/or patella fractures, proximal or distal endoprosthesis, adipositas permagna). -
Page 6: Implants
For better purchase in osteoporotic bone and for all complex supracondylar fracture morphologies. Locking Screws 6.0 mm, self-tapping (450.862–872) (turquoise) Lengths: 50 to 100 mm Spiral Blades for DFN (450.882–892) (pink) Lengths: 50 to 100 mm Synthes End Cap for Spiral Blade (451.895) (pink) -
Page 7: Standard Locking
Distal Femoral Nail Standard locking Careful preoperative planning with clear classification of the fracture and correct choice of implants are mandatory for a successful surgical result. Position patient Position the patient supine on the operating table. The knee of the injured leg should be flexed 70°–90°. A leg roll may be used or the lower leg be flexed by lowering part of the table to allow proper reduction and stabilization of the reduced fracture. - Page 8 Guide Wire 3.2 mm (357.129) to a depth of 10 to 15 cm, taking into consideration the 7° to 9° valgus angle of the anatomic axis of the femur. AP and lateral image inten- sifier control is mandatory. Synthes...
- Page 9 Open medullary canal Place the cannulated Drill Bit 13.0 mm (351.270) into a cannulated power drill. Guide the drill bit through the protection sleeve and over the guide wire to the bone. Drill to a depth of approximately 30 mm. Remove the protection sleeve, the drill sleeve and the guide wire.
- Page 10 1 Assemble reduction system Assemble the reduction system of the SynReam Intra- medullary Reaming System (189.060): Attach the T-Handle (351.150) at the rear of the SynReam Flexible Shaft (352.040) and a Reduction Head (352.050 or 352.055) at the front. Synthes...
- Page 11 2 Reduce fracture To secure the reduction head, insert the SynReam Reaming 2.5 mm (352.032, length 950 mm or 352.033, length 1150 mm) in a retrograde direction up to the olive. The olive must be located in the reduction head throughout reduction. Insert the assembled reduction system with the SynReam reaming rod into the medullary cavity and reduce the distal fragments under image intensifier control.
- Page 12 (352.090–190). The reaming depth should be identical to the chosen nail length. 5 Insert reaming system Insert the assembled reaming system, without rotating it, over the SynReam reaming rod into the medullary canal. Use the Tissue Protector (351.050) to spare the soft tissues. Synthes...
- Page 13 6 Ream medullary canal Ream the medullary canal according to the standard proce- dure. Advance the reamer slowly and steadily at maximum drill speed. Secure the SynReam reaming rod with the Holding Forceps for SynReam Reaming Rod (351.782) to prevent it from rotating during reaming.
- Page 14 Note the inscription ANTERIOR on the nail. Slide the Connecting Screw (357.135) through the insertion handle and screw it into the nail. Tighten the connecting screw with the Pin Wrench (321.170) without stripping it. Synthes...
- Page 15 Insert nail If hammering with the Slotted Hammer (357.026) is necessary for insertion, attach the Hammer Guide (357.117) to the connecting screw and tighten the assembly. Insert the nail by hand as far as possible twisting gently. When using a guide rod, slide the Cannulated Nail 12.0 mm over the guide rod into the femoral canal.
- Page 16 Remove the Drill Sleeve 8.0/4.9 and insert the measuring hook through the Protection Sleeve 11.0/8.0. Determine the length of the locking screw by adding 2 mm to the reading on the depth gauge. Synthes...
- Page 17 Insert first locking screw Insert the locking screw through the Protection Sleeve 11.0/8.0 using the Hexagonal Screwdriver (314.750) and make sure the screw head is in contact with the medial cortex. The locking screw should surpass the medial cortex by at least 2 mm, but not more than 4 mm.
- Page 18 Alternative Centre drill bit Drill If there is no radiolucent drive available and locking is performed with the standard freehand technique use the three-flute Drill Bit 4.0 mm (315.400). Synthes...
- Page 19 Measure length for locking bolt and insert locking bolt Measure the length for the locking bolt with the Depth Gauge for Locking Bolts (357.791). The length of the locking bolt is determined by adding at least 2, but not more than 4 mm to the length read from the depth gauge.
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Page 20: Spiral Blade Locking
13 and 14. Insert double-sleeve combination Insert the pink double-sleeve combination (Protection Sleeve 15.0/13.0 (357.123) and Drill Sleeve 13.0/3.2 (357.124)) through the caudal hole on the aiming arm. Make a stab incision and advance the combination to the lateral cortex. Synthes... - Page 21 Insert guide wire and measure length for spiral blade Insert the calibrated Guide Wire 3.2 mm (357.129) into the condyles until its tip is flush with the medial cortex. Confirm wire position radiographically. Make sure the drill sleeve is in contact with the bone and read the length for the spiral blade from the guide wire.
- Page 22 The last turns will offer some resistance caused by a groove in the thread which prevents the screw from loosening. Tighten the end cap firmly. Alternative The end cap can also be inserted after step 16. Synthes...
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Page 23: Implant Removal
Distal Femoral Nail Implant removal Remove end cap Remove the ingrown tissue from the hexagonal recess of the end cap and the locking implants. Unscrew the end cap using the Hexagonal Screwdriver (314.750). Remove the most distal locking implant Remove the most distal locking implant (locking screw 6 mm or spiral blade). - Page 24 Mount hammer guide Before removing the last locking implant, screw the Extraction Screw for DFN (357.133) into the distal end of the nail and tighten with the Pin Wrench (321.170). The last locking implant prevents the nail from rotating or sliding away.
- Page 25 Distal Femoral Nail Implant removal Remove last locking implant Unscrew the last locking implant using the Hexagonal Screw- driver (314.750) and, if necessary, the Holding Sleeve (314.280). Remove nail Knock the nail out with gentle blows of the slide hammer.
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Page 26: Cleaning Of Instruments
Distal Femoral Nail Cleaning of instruments Cleaning of instruments Proper functioning of the instruments can be maintained by careful cleaning. Synthes... - Page 27 DFN Distal Femoral Nail Surgical Technique Europe Czech Republic Hungary Slovakia Stratec Medical spol. s r. o. Stratec Medical Kft. Intes Poprad s.r.o. CZ-162 00 Praha 6 H-1021 Budapest SK-05899 Poprad Tel. +420 2 2051 50 06 Tel. +36 1 391 45 60 Tel.
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