Hip Fractures - Stryker MedEd

1 Hip FracturesHipLong Nail and p e r a t i v e Te c h n i q u eGamma3 Contributing Surgeons:Prof. Kwok Sui Leung, M. of Department of Orthopaedics and TraumatologyThe Chinese University of Hong KongPrince of Wales HospitalHong KongDr. Gilbert TaglangHead of the Trauma DepartmentCenter for Traumatology, StrasbourgFranceProf. Dr. med. Volker B hrenChief of Surgical ServicesMedical Director of Murnau Trauma Center, MurnauGermanyKatsumi Sato , Chief SurgeonTohoku University Graduate School of MedicineTohoku Rosai Hospital, SendaiJapanChristopher T.

2 Born of Orthopaedic SurgeryBrown University, Providence, RIUSAR obert Probe, of Orthopaedic SurgeryScott & White Memorial Hospital, Temple, TxUSAProf. Dr. med. Vilmos V cseiChief of Traumatology DepartmentUniversity of Vienna, ViennaAustriaJames Maxey, Assistant ProfessorUniversity of Illinois College of Medicine Peoria, ILUSAThis publication sets forth detailed recommended procedures for using Stryker Osteosynthesis devices and 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.

3 A workshop training is recommended prior to first 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 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 r n i ng : 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 Nail and Page1.

4 Introduction 42. Design of the Gamma3 System 5 Lag screw and Set screw Function 6 Distal Locking Screws 7 Gamma3 System Benefits 83. Indications, Precautions & Contraindications 9 Indications 9 Contraindications 9 Precautions 94. Operative Technique 10 Pre-operative Planning 10 Implant selection 10 Patient Positioning 11 Fracture Reduction 12 Special Techniques for Fracture Reduction 13 Incision 14 Entry Point 16 Opening the Cortex 16 Preparation of Medullary Canal 17 Assembly of Targeting Device 23 Nail Insertion 26 Lag screw Positioning using One Shot Device 28 Lag screw Insertion 29 Pre- drilling the lateral cortex 30 Lag screw Fixation 34 Distal

5 screw Locking 38 Free-hand Technique 40 End Cap Insertion 42 Nail Extension End Caps 43 Post-operative Care and Rehabilitation 43 Extraction of the Gamma3 Implants 44 Dealing with Special Cases 46 Packaging 47 References 49 Contents3 The Gamma3 Locking Nail System is based on more than 20 years of Gamma Nail experience. This is the third generation of intramedullary short and long Gamma fixation nails.

6 The Evolution of the successful Trochanteric and Long Gamma Nails as well as the small stature versions followed strictly a step by step improvement based on the clinical experience and outcome from surgeons all over the world. Our thanks are due to the many surgeons who supported the develop-ment of the new Gamma3 System, with their feedback and ideas, during worldwide panel meetings and helped the Gamma3 System to be what it is :Introduction4 Gamma3 Set ScrewGamma3 Long NailGamma3 Lag Screw120 125 130 Gamma3 End CapDistal Locking ScrewsFig.

7 2 Dynamic LockingRemove this screw to allow for dynamizationFig. 3 Secondary DynamizationFig. 4 Static LockingFig. 1* Each nail is supplied sterile packaged together with a Set screw in one Locking Nails come in 3 neck-shaft angles of 120, 125 and 130 . In the following, these Gamma3 Nails are called: Long NailAll nails* use the same Lag Screws, Set screw , distal Locking Screws and End Caps (see Fig. 1).Gamma3 Nail LongThis nail incorporates several important mechanical design features.

8 The nail is unslotted and cannulated for Guide-Wire-controlled insertion. To facilitate conformity with the human anatomy, the Long Nail is supplied in a left and right three neck-shaft angles accommodate variations in femoral neck anatomy. The Long Nail offers the opportunity to use two distal Locking Screws that are inserted through the distal nail end to control rotation and telescoping. As shown below, the nail offers the possibility for either static, dynamic or secondary dynamic distal locking, depending on the fracture pattern.

9 Material: Titanium alloy with anodized type II surface treatment. Nail length: 260mm to 480mm, in 20mm incre-ments, shorter or longer nails are available on request Nail diameter: proximal: , distal: : 10mm, 11mm, 13mm, : 11mm, 13mm, 15mm Proximal Nail angle range: 120 , 125 , 130 M-L bend for valgus curvature: 4 degrees Proximal anterversion of 10 End Caps 0mm, +5mm and +10mm Antecurvature radius and of the shaft Distal locking holes (round and oblong) for 5mm screws.

10 Up to 5mm dynamization is possibleLong Nail Distal Locking Options Locking in the distal part of the oblong hole creates a dynamic locking mechanism requires only one screw (see Fig. 2). One screw placed in the distal part of the oblong hole and the other in the round hole. If dynamization is required after a period of time, the screw , placed in the round hole, has to be removed requires two screws (see Fig. 3). One screw placed in the round hole and the other is placed in the proximal part of the oblong hole requires two screws (see Fig.)