Trauma Lower Extremities

Product

The Femoral Nail System is used for intramedullary fixation for fractures of the femur. The system contains unique screw configurations for both antegrade and retrograde nailing. This combination of versatility and diversity offers surgeons comprehensive solutions for managing femoral fractures.
Antegrade Nail Features:
<ul>
 <li>Use for trochanteric entry, it can target up to 3 proximal screw holes at the same time</li>
 <li>Threaded proximal screw holes helps prevent screw backout</li>
 <li>Provides up to 8 mm of compression at the level of the oblong hole1</li>
</ul>
Retrograde Nail Features:
<ul>
 <li>Four threaded distal screw holes helps prevent screw backout</li>
 <li>Provides up to 7 mm of compression at the level of the oblong hole1</li>
 <li>Screws targeted into the posterior condyles provide additional fixation</li>
 <li>Threaded nut and washer system provides compression across an intra-articular break</li>
</ul>
Reference:
1. Test report T303. In vitro testing of AOS antegrade femoral nail. Advanced Orthopaedic Solutions; April 2013.

The Arthrex Femoral Nail System is targeted for use in intramedullary fixation of fractures of the femur. Consisting of antegrade and retrograde femoral options, each nail offers unique screw configurations that provide both versatility and diversity.

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Retrograde Femoral Nail System Surgical Technique

Determine the entry point for the nail located in line with the femoral canal in an AP view. And just anterior to where a bloomin sports line intersects the anterior intercondylar notch on a lateral view. Insert the 3.2mm guide. Pin through the soft tissue Protector assembly directed down the central shaft of the femur. Remove the black pin, guide and ream over the guide. Pin with the 13.5mm cannulated entry. Reamer until the groove on the entry reamer is in line with the top of the soft tissue. Protector. The grooves represent how many millimeters the nail will be. Countersunk. The first line represents five millimeters. The 3.2mm guide pin is removed, and the 3.0mm ball nose guide wire is introduced down the shaft of the femur. Using the guide wire gripper, remove the soft tissue Protector and measure the length of the ball nose guidewire with the guidewire depth gauge to determine the nail length. Measurement is taken at the black edge line. The eight millimeter end cutting reamer is used to ream out the central path for the nail, sequentially ream. Until cortical chatter is achieved, it's recommended to ream 1 to 1.5 millimeters over the desired nail diameter. Attach the nail to the retrograde Radiolucent targeting guide. Introduce the nail over the ball nose guidewire. Complete the insertion with gentle mallet strikes on the targeting guide impactor pad. Remove the impactor pad and the ball nose guidewire. When the desired orientation of the targeting guide is achieved, insert the screw sheath, drill guide and obturator assembly through the distal lateral hole until it contacts with the lateral cortex. Optionally, the outer sheath can be locked into place for added stability. Remove the obturator and obturator and drill bicortical with a calibrated 5.5mm drill, using the calibration marks on the drill to determine depth. Do not remove the drill. Assemble the chondola nut, hex driver and condyle locking collet. A washer must be added to the chondola nut on the inside of the targeting guide. Drive the chondola nut through the femoral cortex and over the drill bit until the condyle locking collar is snug in the targeting guide. Remove the obturator drill by cortically with a 5.5mm. Drill and remove the drill guide sleeve. Insert the 6.5mm cancellous, or cortical screw through the distal lateral hole with a washer on the inside of the targeting guide. It is recommended to subtract 5 to 10mm from screw length when using chondola nut to achieve desired chondola compression. The medial t-handle assembly, lateral hex driver, and screw sleeve are removed. Insert the screw sheath, drill guide and obturator assembly through the proximal lateral hole until it contacts with the lateral cortex. Remove the inner trocar and drill bicortical with a 5.5mm drill using the calibration marks on the drill to determine depth. Insert the 6.5mm cortical or cancellous screw using the 5.0mm hex driver. Using the laser mark on the driver to determine depth and remove the screw sleeve. Repeat the screw insertion process through the anteromedial hole in the targeting guide. This process is repeated with the screw sheath, drill guide and obturator assembly through the anterolateral hole on the guide. Remove the obturator drill bicortical with the 5.5mm. Drill and remove the drill guide sleeve. Insert another 6.5mm screw using the 5.0mm hex driver. Using the laser mark for insertion depth and remove the screw sleeve once complete. For a proximal fixation, use the drill sleeve to drill bicortical using a perfect circle technique. Screw length is measured using a measuring sled. Reading off the green stripe, a standard depth gauge may also be used. Insert a 5.0mm screw using the short hex driver. Repeat the process twice to insert another two adjacent 5.0mm cortical screws. Uncouple the targeting guide from the nail with the ball hex driver and remove it to complete the nail implantation.

This animation demonstrates the surgical technique for the Antegrade Femoral Nail System.

Antegrade Femoral Nail System Surgical Technique

Determine the entry point for the nail at the tip of the greater trochanter. This point may vary slightly depending on the patient anatomy and fracture pattern. Insert the 3.2mm guide. Pin through the soft tissue Protector by aiming towards the central axis of the femoral shaft. Remove the black pin guide and remove the guide pin with a 13.5mm cannulated entry reamer. The depth is determined by the first indentation of the reamer lining up with the top of the soft tissue. Protector. The 3.2mm guide pin is removed, as well as the soft tissue Protector, and the 3.0mm ball nose guide wire is introduced down the shaft of the femur. Using the guide wire gripper, measure the length of the ball nose guide wire with the guide wire depth gauge from the laser etch line to determine the nail length. The eight millimeter n cutting reamer is used to remount the central path for the nail. Progressively ream in diameter until cortical chatter is achieved. Ream 1 to 1.5 millimeter over desired nail diameter. Introduce the nail into the femur over the ball. Nose. Guidewire. Complete the insertion with gentle mallet strikes on the targeting guide. Impactor pad. Remove the ball nose guidewire and slide the screw sheath. Four millimeter drill guide and four millimeter obturator assembly through the appropriate transverse hole in the in the targeting guide until it contacts with the lateral cortex of the bone. Remove the obturator and drill the bone using the four millimeter calibrated drill. Measure the screw length from the end of the drill guide using the calibration marks on the drill. Remove the drill guide sleeve and insert the five millimeter cortical screw assembled on the captured hex driver until the black laser line is flush with the end of the sheath. The sheath is removed and the reassembled screw sheath, pin, guide, and obturator assembly is slid through the distal hole on the targeting guide. Remove the obturator and insert the 3.2mm guide. Pin through the guide and into the femoral head. Use the laser marking on the guide pin by sliding the guide pin depth gauge over the guide pin and reading the required screw length. Remove the pin guide and drill using the 5.5mm. Calibrated cannulated. Drill over the guide pin to the appropriate depth by using the calibration marks on the drill. Remove the guide pin and insert the 6.5mm fully threaded cancellous screw assembled on the captured hex driver until the black laser line on the driver is flush with the end of the sheath. Once the screw is fully inserted, remove the screw sheath. Slide the screw sheath purple, yellow, blue 5.5mm. Drill and obturator assembly through the proximal hole in the targeting guide. Drill to the appropriate depth using the calibration marks on the drill. Insert the 6.5mm fully threaded cortical locking screw assembled with the captured hex driver through the screw sleeve until the laser mark is flush with the end of the sleeve. Remove the screw sleeve. Finally, use the ball hex driver to uncouple and remove the targeting arm from the nail. Using a perfect circle technique. Drill bicortical through the distal femur with the short four millimeter drill bit. Measure the screw length using the green line on the drill bit referenced off the distal depth gauge. Insert a distal five millimeter cortical screw using the hex driver to complete the nail fixation.

Femoral Nail System

Child (D)

The FibuLock fibular nail is a cutting-edge, biologically friendly treatment for ankle fractures. It is inserted into the fibula through a small incision and acts like an internal splint to stabilize the fracture during healing. This minimally invasive technique may reduce wound complications often associated with standard open reduction internal fixation (ORIF) plating techniques.1 The proximal talons allow for stable fixation to restore length, alignment, and rotation. The FibuLock nail is the only system on the market with this capability.
 
Reference:
1. Walton DM, Adams SB, Parekh SG. Intramedullary fixation for fractures of the distal fibula. Foot Ankle Int. 2016;37(1):115-123. doi:10.1177/1071100715622392

FibuLock® Fibular Nail

The Arthrex Tibial Nail System is designed to provide intramedullary fixation for various types of fractures, malunions, and nonunions of the tibia. A single instrumentation tray provides the tools for a parapatellar or suprapatellar approach. The distal screw configuration is the most distal, locked cluster of screws available on the market today. It maximizes the working length of the nail, allowing surgeons to treat extremely proximal or distal fracture patterns.
The Tibial Nail System features the following:
<ul>
 <li>Most distal, locked screw cluster on the market: Three distal screws at 5 mm, 13 mm, and 21 mm from the end of the nail</li>
 <li>Three proximal screw options, including a dynamic slot for compression or static positioning</li>
 <li>Threaded screw holes to maintain screw position in the 2 proximal static holes and the distal AP hole</li>
 <li>Up to 8 mm intraoperative or postoperative compression</li>
 <li>Flexible suprapatellar sheath to minimize pressure on the patella</li>
 <li>Diameters: 8 mm to 13 mm (in 1 mm increments)</li>
 <li>Lengths: 27 cm to 39 cm (in 1.5 cm increments)</li>
 <li>10° proximal Herzog bend and 3° distal bend to facilitate implantation</li>
</ul>

The Arthrex Tibial Nail System features the most distal cluster of screws on the market and a simple, intuitive surgical technique that allows for intraoperative compression.

Tibial Nail System—Standard Surgical Technique

Orient the entry tube and pin guide in the desired position. Insert the 3.2mm guide pin into the proximal tibia so that it reaches the center of the intramedullary canal. Remove the inner pin sleeve and use the 12.0mm reamer to open the canal. Remove the 3.2mm guide pin. After accessing the tibial canal, insert the 3.0mm ball nose guide wire down the shaft of the tibia and pass the fracture using the guide wire gripper with the tip of the guide wire at the desired depth. Measure the length of the nail by sliding the guide wire depth gauge over the guide wire and reading the measurement based on the etched line. Using the cannulated reamers sequentially ream the canal until cortical chatter is obtained, it is recommended to ream 1 to 1.5 millimeters over the desired diameter of nail. Remove the entry tube and insert the nail over the ball nose guide wire and into the canal. Lightly strike the impactor pad with a mallet to complete the nail insertion. Remove the ball nose guidewire. Thread the green locking collar into the locking hole on the targeting module. When compression is desired, be sure to use the hole marked dynamic. Insert the assembled drill sheath, drill guide and obturator into the targeting guide until it rests on the outer cortex of the tibia. Using the calibrated 4.0mm drill, drill through the drill guide and sheath to the desired depth and measure using the calibrations on the drill bit. Next, remove the drill guide. Insert the desired 5.0mm cortical screw through the sheath. Using the captured screwdriver, unscrew the capturing rod on the back of the t handle and remove the screw driver. Remove the sheath and locking collet nut. If using the compression mechanism, fixate the nail distally. Next, for distal fixation, the screws are targeted using fluoroscopy. Drill bicortical through the bone. Using the 4.0mm freehand drill, measure the screw length using the distal depth gauge and the depth mark at the 4.0mm freehand drill. Advance the desired screw to the captured driver until it's secured in the bone. Repeat the steps to place the additional distal screws. For intraoperative fracture compression. Insert the reduction bolt through the locking bolt at the top of the nail using the ball hex driver. Rotate the reduction bolt clockwise until the desired compression is achieved or significant resistance is felt on the screw. Insert the remaining proximal screws by threading in the collet, nut and drill guide sleeve. Drilling to the desired depth and inserting the appropriately sized captured screw. Complete the remaining proximal screw insertion to fully lock the nail in place and maintain compression. Unthread and remove the compression bolt using the hex driver. Finally, unthread the locking bolt using the ball hex driver and remove the targeting arm assembly to complete the procedure.

Benjamin J . Maxson, DO (Tampa, FL), demonstrates the suprapatellar approach to tibial nailing featuring the Arthrex Tibial Nail System.

Suprapatellar Approach to a Tibial Nailing

Today we're going to be discussing technique for suprapatellar nailing of the tibia. When we look at where our incision is going to be for a suprapatellar nailing, we're going to look at the patella itself with the patient in the right position. The patella superior pole is here. We're going to mark out the lateral and medial and the distal pole. Our incision is going to be skin central above the superior pole of the patella. And this needs to be somewhere between 3 and 5cm. And that needs to be able to be extended distally. In the event that there is not enough patellar excursion for the skin incision longitudinal I prefer in the midline. It can be cheated medially if you prefer. We're going to go down through skin and subcutaneous tissue. At this point we don't need to go beyond the superior pole of the patella. We can place a self-retaining retractor And we're going to dissect down to the quadriceps tendon. Once we have our tendon exposed. We then make our longitudinal incision along the fibers of the tendon. The next step is to take our suprapatellar guide. This is the cannula through which all of our instrumentation will be taken during the procedure. Finding the start point, entering our opening reamer, reaming, and even passing our nail. The cannula has a blunt tip with smooth edges to prevent damage to the articular surface of the patellofemoral joint. The handle has holes for pinning the guide to the femur to prevent back out of the cannula, and the handle itself is cannulated. It has a central hole for the initial wire, and four additional holes as a honeycomb, to allow for fine tune adjustments of position of your guide wire in the In the proximal tibia. The cannula is then taken into the patellofemoral joint, utilizing the arthrotomy we've made in the tendon, and slid gently across the joint. And this is the appropriate appearance of the guide. Sitting across the patellofemoral joint, you can see appropriate alignment of the handle and cannula to the shaft of the tibia. In order to obtain an appropriate start position for the guidewire and for the opening reamer for suprapatellar nailing. Appropriate AP and lateral images should be obtained before placing the guidewire. This will allow you to come back to a good AP and lateral view, to ensure that you are not misinterpreting what the X-ray is showing you about your start point. Here we have an appropriate start position for the AP view, with the wire entering longitudinally straight down the tibia and the wire start position being just medial to the lateral tibial spine. Once I have my start position that I like on the AP view, I will advance the wire with the wire driver just into bone to hold it stable until I come to my lateral view and confirm position on the lateral view. Here is a good lateral view showing an appropriate start point at the superior anterior aspect of the tibia, well proximal to the tibial tubercle. Once we have an appropriate start position on both our AP and lateral, we can remove the honeycomb handle that comes out by unscrewing. The handle can come out. And at this point, if your preference is to pin the sheath to the femur, that can be done at this point. The next step will be to open ream the tibia across our guidewire. This is our 12 millimeter reamer for open reaming of the proximal tibia. This is cannulated and slides over our wire. I like to take a lateral image to ensure that everything still looks appropriate. We are going to advance our opening reamer until all of the flutes are buried in bone, and that indicates that we have reamed distal enough into the proximal segment. And here is our AP view showing the reamer into the proximal tibia with all the flutes into bone with appropriate trajectory. We can remove the opening reamer as well as the guidewire. And the next step is to advance our long guide rod down the tibial shaft. Here we have the handle that can be used to hold the guide wire if needed. The guide wire can be advanced free, otherwise if that's your preference. Once we have the guide wire in, we're going to take an AP of the ankle to look and see where our wire is. Make sure that we are centered in the distal tibia. And then we'll get a lateral. Make sure we're centered there. Once we have an appropriate position of our wire distally, we're going to come back to a lateral at the knee and use our measuring device and determine what length nail this patient needs. Here we have an AP view of the distal tibia and ankle, showing a nice centered position of the guidewire all the way down to the physeal scar of the distal tibia. This is an appropriate depth to measure for our nail length. Here we have a good lateral of the ankle, showing the wire in a central position in the distal shaft coming down to the tibial plafond. We're going to take our nail measuring guide, slide it over the cannulation of the guide over the wire, and use our lateral x ray at the knee to determine what length nail we're going to use for this particular patient. Here we have the cannula down on bone our guide for our nail length down on bone. And we can see our measurement here. We're between a 36 and a 34.5 length nail. Now that we've determined what length nail we are going to use, we can start reaming. We will ream over our guidewire and through our cannula to protect our patellofemoral joint. Our first reamer should be our end cutter. This is an eight millimeter solid end cutter. This is not a removable head. Once we move past the eight millimeter to the nine millimeter and beyond, we'll be using an interchangeable head with a flexible shaft with the sheath held in place so that we're protecting our patellofemoral joint. My recommendation would be to push past our initial entry into the tibia. And that is because we want to prevent reaming out the proximal tibia anteriorly. The reamer heads will preferentially remount the anterior bone of our proximal tibia if we're not pushing past. So we want to push into proximal tibia and then start reaming. Going all the way down. And all the way back out. And again, once we get to the proximal tibia, we're going to pull past so we don't remount the proximal tibia. We're going to hold our wire. Make sure we don't lose our wire. Now we can sequentially ream up to appropriate diameter for our nail. My preference is about 1.5mm over the diameter of the nail. For this patient we're going to use a ten millimeter nail. This is our nine millimeter reamer. We are going to sequentially ream up to 11.5mm. The sheath will accommodate up to a 12.5mm reamer for an 11 millimeter nail. The nail attaches to the handle with this guide. And the targeting guide then attaches to the handle with this screw. And here we have our direct medial lateral screw and our two oblique screws for a total of three interlocking screws. The one on this side can be used either as a static or a dynamic interlock. The nail goes over the wire. Through our cannula. Once we have the nail well past our fracture site, the guidewire can be removed. At this point, we'll finish advancing our nail, and then we'll need to come to a lateral view at the knee to confirm the depth of insertion of the nail proximally. Here we have a good lateral view of the knee showing that we are almost buried. And here we have a lateral view. After advancing the nail just a bit more, showing that the nail is completely buried in the bone and in a safe position. If the fracture requires compression utilizing the dynamic slot in the nail. I would recommend advancing the nail a bit further to allow for some room for proximal migration of the nail in bone with the compression device, so that your nail doesn't end up prominent out of bone. We are going to decide whether or not to lock proximal or distal first. If you want to use any compression through the nail, then locking distally first is the appropriate choice, followed by the dynamic screw to allow for compression, and then it can be locked statically with the other two proximal screws. For this particular patient we're going to be locking distally first. We have on our x ray perfect circles down at the ankle. So we can put our distal interlocks from medial to lateral. We use our x ray to localize our incision site. Perfect circle technique is percutaneous Cutaneous small skin incision and then blunt dissection down to the bone with a hemostat. The saphenous vein is right here often gets cut. The more blunt dissection you do, the less likely you are to cut it. Here's our drill for the interlocks. This is a four millimeter drill for a five millimeter screw. This is an x ray showing the drill bicortical and through the nail. Now, with the drill all the way across bicortical, through the tibia and through the nail, we have an x ray showing that the position of the drill is good. And we can take out the drill and use the depth gauge. Or if we want to flip to the AP view, we could use the sled to measure for the screw length as well. Here we are measuring for our interlocking screw length. And here we have our final AP after screw insertion showing appropriate position of our distal interlocking screw. Note how distill it is in the nail adjacent to the physeal scar. From here, if more fixation distally is required, there's one more medial to lateral screw and one anterior to posterior screw. Those can be inserted with the same perfect circle technique. Of note, the anterior to posterior screw is the threaded screw for static fixation of the screw to the nail. Once we have our distal fixation completed, we can move on to proximal fixation through our interlocking guide. We're going to use the compression device. So we're going to have this nut inserted into the guide into the dynamic hole. And we can insert our first screw here. And this is the screw we'll use to push against to compress our fracture in the shaft. Here's our drill guide for our drill bit and then screw insertion. This cannula insert comes out for the drill to go in and then for the screw to go in. We release this tab and this comes out of our cannula. And again here just a small percutaneous incision marked by where our guide is going to need to go with blunt dissection. Once we have dissection to allow for the cannula the cannula is inserted down to bone and then it can be locked in place. The first insert comes out and we have a drill with markings to allow us to tell what depth or length screw we need based on the top of the cannula. And again up here at the proximal tibia, as we do down at the distal tibia, we have a capture device to hold the screw in place for insertion. That's connected up top here with this wire and screw, which attaches on top of our insertion handle. There is also a power driver option for this. As we get close to completion of screw insertion, we see two lines on the handle. This first line indicates that the screw is just starting to engage bone. The second line would indicate that the screw head has been completely inserted into bone and is flush or deep to bone, and that is based on this cannula being up against the cortex of the bone here. And here we have our compression bolt which is going to be inserted through the guide. This will contact our screw. The dynamic screw that we already put in. And as we engage this, this will engage the screw and pull our nail back to apply compression distally because we already have the distal tibia. Secured with our distal interlocking fixation, we use the ball hex and advance. You can feel when it starts to engage the nail because you'll start to get some resistance. And then we can progressively take X-rays to demonstrate that the nail is in fact being. Pulled proximal and compressing our fracture. Once we've compressed the fracture. Utilizing the compression bolt and the dynamic screw we've already placed. The next step is to lock the nail in its static position at this point, with one of our other. Interlocking screws and same technique for inserting the other interlocking screws. And here we have an image showing that we've now locked in the compression that we obtained with our dynamic screw with the secondary static screw. Now that we have the intramedullary rod locked both distally as well as proximally. And we've locked our compression screw with our additional static screw. We can remove our compression bolt first, again using that same ball hex driver. And finally we're going to remove our guide from our nail. Again using the same ball hex driver our sheath can now come out. And as a note make sure that you irrigate the knee joint very well before closure. Our next step after removal of our insertion guide is to get our final AP and lateral X-rays of the proximal and distal tibia. We discussed indications followed by the techniques for suprapatellar nailing with the Arthrex tibial nailing system.

application/pdf

Tibial Nail System

The Arthrex trochanteric nail is a next-generation hip nail that addresses the remaining shortcomings of current systems and consists of three nail types—short nail, long nail, and the innovative ES nail.
Telescoping Lag Screw—Self-contained collapse within the lag screw prevents lateral lag screw irritation.
ES Nail Option—Combines the mechanical advantages of a long nail with the ease of a short nail. It extends through the isthmus of the bone, which can reduce distal tip stress risers, potential “pendulum” effects, and risks of peri-prosthetic fractures associated with short nails.1 The ES hole is easily targeted through the nail jig.
Biological Augmentation—Allows for the delivery of orthobiologics (BoneSync™ cement, autologous blood products, AlloSync Pure™, etc) through the lag screw instrumentation, prior to final screw seating.
Advanced Instrumentation—Designed to reduce surgical pain points and facilitate surgical work flow.
<ul>
 <li>Lag screw locking through the inserter (no set screw required)</li>
 <li>Captured distal 5.0 mm screws</li>
 <li>Calibrated drill bits</li>
 <li>Jig removal through the more lateral impactor attachment hole</li>
</ul>
Reference:
1. Wright RC, Yacoubian SV, Salzman GA, Raven RB 3rd, Falkinstein Y, Yacoubian SV. The extended-short nail system, a novel concept in the management of proximal femur fractures. Am J Orthop (Belle Mead NJ). 2011;40(12):630-635.

The Arthrex trochanteric nail is a next-generation hip nail that addresses the remaining shortcomings of current systems such as lateral lag screw irritation, lag screw cut out, workflow inefficiencies, and loss of rotational reduction. The system consists of three nail types—short nails, long nails, and the innovative ES nail.

Trochanteric Nail System With Telescoping Lag Screw

The entry point for the nail is typically at the tip of the greater trochanter on the AP x ray, and at the junction of the anterior and middle third of the greater trochanter on the lateral x ray. This point may vary slightly depending on the patient anatomy and fracture pattern. Insert the 3.2mm guide, pin through the soft tissue Protector and aim towards the central axis of the femoral shaft. Advance at least to the level of the lesser trochanter. The pin trajectory is verified through fluoroscopy. Remove the black pin guide and remove the guide pin with the 16.5mm cannulated entry reamer. The entry reamer has grooves which are read from the top of the soft tissue. Protector. The grooves indicate the reaming depth needed to insert the nail flush 5mm or 10mm deep into the femur. The 3.2mm guide pin is removed, and the 3.0mm ball nose guide wire is introduced down the shaft of the femur using the guidewire gripper. The length for the trochanteric nail and long trochanteric nail is determined by sliding the guidewire depth gauge over the guidewire to the greater trochanter, and reading the measurement from the laser mark on the guidewire. Begin reaming with the eight millimeter end cutting reamer over the ball. Nose. Guidewire. Sequentially. Ream larger with the side cutting reamers until cortical chatter is achieved. It is recommended to ream at least 1.0 to 1.5 millimeter over the desired nail diameter. Introduce the nail into the proximal femur over the guidewire using the radiolucent targeting arm to control nail rotation. Complete the insertion with gentle mallet strikes on the impactor pad. Once the desired nail depth has been achieved, insert the lag screw triple sleeve assembly through the targeting arm by pressing the black button. Slide in the assembly until it contacts the lateral cortex of the femur. Remove the obturator and place the 3.2mm lag screw guide pin through the pin guide. Verify the pin depth and trajectory using fluoroscopy. Place the guide pin depth gauge with the flat end against the pin guide under the 3.2mm lag. Screw guide pin and read the measurement. The guide pin is measured to the tip, so at least 5 to 10mm should be subtracted from the measurement when determining drilling depth and lag. Screw length selection. Other factors such as fracture reduction, nail position, and anticipated fracture compression should be accounted for. Remove the 3.2mm pin guide. Set the adjustable stop on the 10.3mm cannulated lag. Screw drill at at least 5 to 10mm less than the measurement, so the tip of the drill does not pass beyond the guide pin. Insert the 10.3mm cannulated lag screw. Drill over the guide pin and drill into the femoral head until the depth stop contacts the sleeve. Slide the lag screw inserter assembly over the guide pin and through the lag screw sheath. Rotate the assembly clockwise with the blue handle. When the black laser marking on the inserter reaches the sheath. The lag screw has exited the other end of the sheath. It is recommended to insert the lag screw further if intraoperative compression is planned. The 10.5mm telescoping lag screw features many innovative internal features and mechanisms, and is locked into the nail via expansion of the circumferential locking ring. The design allows up to ten millimeters of postoperative compression within the lag screw to prevent lateral thigh pain. For initial compression of the fracture. Push the compression sleeve towards the targeting arm and rotate clockwise until the desired compression is achieved. Pull back on the gold knob and turn counterclockwise to disengage the blue handle and engage the black handle. The black line will now be showing to lock the telescoping lag screw. Hold the blue handle stationary and turn the black handle clockwise until the torque limiter clicks. Remove the lag screw capturing rod nut by hand or with the ball hex driver. Pull out the lag screw inserter assembly and unscrew the lag screw capturing rod by hand or with the removal tool. The lag screw guide pin is also removed to allow post-operative compression in the telescoping lag screw. Remove the activation sleeve by inserting the activation tool through the sheath into the lag screw and turning counterclockwise. The activation sleeve will retain the tip of the activation tool. Once disengaged from the lag screw, remove the lag screw sheath to complete the lag screw insertion. For the ES trochanteric nail and short trochanteric nail, distal locking is performed through the targeting module. Place the distal screw triple sleeve assembly through the appropriate distal hole in the targeting module and mark the skin. Make the incision and advance the distal screw. Triple sleeve assembly to the lateral cortex of the bone. Remove the distal drill guide. Obturator drill bicortical using the 4.0mm calibrated drill bit. Determine the screw length using the calibrations on the drill bit. Remove the distal drill guide and insert the 5.0mm captured screw with the 5.0mm hex driver. When the first laser mark reaches the sheath, the bottom of the screw head has reached the other end of the sheath. Unscrew the capturing rod in the hex driver and remove the driver assembly. To remove the targeting arm, unscrew the locking bolt from the jig through either the top hole or impactor pad. Attachment hole. As the fracture begins to heal. The telescoping lag screw is able to compress up to ten millimeters without any lateral protrusion into the surrounding tissue. The Arthrex trochanteric nail system is available in three nail types. The short nail. Long nail. And innovative S nail.

Trochanteric Nail System

The Arthrex Trochanteric Nail System offers the left-threaded telescoping lag screw to help maintain reduction during insertion for left-sided intertrochanteric and basicervical fractures.

Arthrex Trochanteric Nail System—Left-Threaded Telescoping Lag Screw

Orthobiologics

Procedure

The Arthrex Trochanteric Nail Augmentation System allows for precise delivery of bone graft to poor-quality bone surrounding the lag screw within the trochanteric nail. The kit configuration offers flexibility in bone graft selection, with allograft or synthetic bone void fillers available for augmentation. The system components are designed to efficiently integrate into the lag screw insertion workflow, augmenting poor-quality bone in the femoral head.

Trochanteric Nail Biologic Augmentation

The 7.0 Cannulated Screw System is intended for fixation of fractures in the pelvis, distal femur, proximal femur, proximal tibia, foot and ankle, and calcaneus. The screw offerings feature a self-drilling/tapping design for efficient cutting, alongside a low-profile screw head to minimize soft-tissue irritation. The 7.0 mm screws are cannulated and cancellous, and they are available in 20 mm partially threaded, 36 mm partially threaded, and fully threaded configurations.

Nails

Femoral Nail System

FibuLock^® Fibular Nail

Tibial Nail System

Trochanteric Nail System

Trochanteric Nail Biologic Augmentation

7.0 Cannulated Screw System