Locking Nail - Stryker

1 LONGGAMMA Locking nail LONG GAMMA Locking NAILCONTENTSA cknowledgements:The Gamma Locking nail Operating Technique was compiled from the kindcontributions of leading surgeons in many countries; the principal authors andcommentators were:- Dr. G. Taglang, Dr. A. Grosse, Strasbourg, France Dr. Halder, Halifax, UK Dr Leung, Hong Kong Dr. S. Boriani, Bologna, ItalyOur thanks are due to the many surgeons whose work has helped to confirmthe utility of the technique to present and future users of the Gamma LockingNail : Bone screws referenced in this material are not approved for screwattachment or fixation to the posterior elements (pedicles) of the cervical,thoracic or lumbar AND DESIGN FEATURES6 COMPLETE OPERATING GUIDE 8 Pre-operative Planning8 Patient Positioning, Fracture Reduction9 Anteversion Guide10 Incision & Entry Point11 Preparation of Medullary Cavity12 Reaming Technique12 nail Insertion13 Lag Screw Targeting14 Lag Screw Drilling16 Lag Screw Selection and Insertion17 Set Screw Insertion18 Distal Locking19 Final Checking22 Extraction23 Problem Solving24 Implants and Instrumentation28 Instrument Guide323 This publication sets forth detailed recommended procedures for usingStryker Trauma devices and instruments.

2 It offers guidance that you shouldheed, but, as with any such technical guide, each surgeon must consider theparticular needs of each patient and make appropriate adjustments whenand as DEVELOPMENT OF THE LONG GAMMA Locking NAIL4 The Long Gamma Locking nail is a specializeddevelopment of the original Gamma Locking Trauma introduced the Long variant entirely inresponse to demand from experienced surgeons worldwidewho wished to extend the benefits of the highly successfulstandard Gamma nail to even more long nailsFollowing the world-wide introduction of the Gamma Locking nail , experienced surgeons regularly requestedcustom-made long variants from Stryker Trauma to deal withcertain specific clinical challenges. Versions with extendeddistal stems were requested for such indications as:- Spiralling subtrochanteric fractures Ipsilateral neck and shaft fractures Prophylactic use to avoid pathologicfractures in osteoporotic bones in bothtrochanteric and diaphyseal areasFor such applications, the advantages of using anintramedullary Locking nail in proximal fractures were nowextended for more distal fractures, increased security offixation, optimum biomechanical advantage, closedoperating technique and flexibility of Locking options toprovide control of fracture fragments and allowdynamization.

3 The same benefits of early weight-bearing andrapid rehabilitation, even in complex fractures, led more andmore surgeons to request these custom-made implants. Long Gamma nail introductionAfter more than five years experience with custom-madeimplants, Stryker Trauma introduced the Long Gamma Locking nail in 1993 as a standard implant to satisfy thecontinuing demand for this specialized variant. Intended foruse by experienced surgeons already familiar with theoperating technique for the standard Gamma Locking nail ,the Long Gamma Locking nail was introduced in a rangeof four lengths and three angles, handed left and right. Thesuccess of the Long Gamma Locking nail has completelyjustified its introduction, with tens of thousands of implantssupplied worldwide since pedigreePublished clinical studies for the Gamma Locking Nailfamily are among the most extensive for any surgical implantcurrently available.

4 They consistently illustrate howsuccessfully this evolving range of implants has achieved theoriginal design goals: to improve both the procedure andprognosis for all grades of femoral fracture by extending theapplication of the established intramedullary principle to seta new standard for treatment:- Early weight-bearing1,2,3,4,5,6,7throughsuperi or strength and stability Reduced trauma3,4through closed operatingtechnique3,4 Low blood loss5,6, low level of woundproblems5and low risk of infection5 More secure fracture fixation through betterbiomechanics7 The clinical objective of the Long Gamma Locking nail ,as with the original Gamma Locking nail and the recently-introduced Trochanteric Gamma Locking nail , is:- Rapid mobilization, with fewercomplications, for better patient rehabilitation7 The operating technique for the Long Gamma LockingNail is essentially the same as for the standard Gamma Locking nail , the main variation being in the distal lockingprocess.

5 The Long Gamma nail uses the same award-winning Instrumentation* as for the rest of the Gamma family, obviating the need for further inventory and trainingfor both the surgeon and the theatre team. The Long Gamma Operating Technique is designedspecifically for the use of surgeons already familiar with thestandard Gamma Locking nail Operating Technique, asthis is an essential precondition for the use of the implantitself. While the Long Gamma nail is indicated in relativelyinfrequent clinical situations, Stryker Trauma believe that thevalue of this implant as a surgical option is significant inrespect of the potential patient benefits; reduced surgicaltrauma and early weight-bearing are both importantcontributors to rapid mobilization and successful recoveryfrom you have any difficulties with the technique, orquestions about the Long Gamma Locking nail , pleasecontact your local Stryker Trauma representative or the officeshown on the back cover.

6 * Design-Innovation 95, awarded for high design quality; Design Centre, Nordrhein A., Favreul E., Taglang G., The Gamma nail ; The results at theCTO Strasbourg Paper presented at the International Symposium RecentAdvances in Locking Nails , Hong Kong, 1992. G., Favreul E., Results from the Centre de Traumatologie etd Orthop die, Strasbourg : Paper presented at the Advanced Course inIntramedullary Locking Nailing, Courchevel, France, February 1991. et al, (Prince of Wales Hospital, Hong Kong), J Bone Joint Surg[Br] 1992; 74B, 3:345-51. S. et al., results of Multicentric Italian Experience on the Gamma nail . A report on 648 cases, Orthopedics 1991;14,12: 1307-1314. , (University Hospital Queen s Medical Centre, Nottingham,England): Comparison of results of the Gamma nail and Dynamic HipScrew in Extracapsular fractures of the Proximal Femur.

7 : Paper presented atAdvanced Course in Intramedullary Locking Nailing, Courchevel, France,February 1991. , Cohen , Pittsburgh Orthopaedic Journal, 1990,Volume 1, pages 20 - 23. Groote W., Van Hoye M. et al, (St Jan General Hospital,Bruge/Middelheim General Hospital, Antwerp, Belgium): The Gamma Locking nail in the treatment of Long fractures Article in AND DESIGN FEATURES6 IndicationsSpiralling subtrochanteric fracturesPertrochanteric fractures associated with shaft fracturesPathologic fractures in osteoporotic bone (includingprophylactic use) in both trochanteric and diaphyseal areasProximal or distal non-unions and malunions, revision proceduresX-ray illustrations of a range of Long Gamma Locking Nailuses are shown on the inside back cover of this guideAnatomical efficiencyThe Long Gamma Locking nail is designed for optimumefficiency both in operating technique and subsequentrehabilitation.

8 There are two basic components, effectivetogether in a very wide range of clinical situations and fracturecomplexity. Insertion is entirely by closed surgical technique,minimizing trauma, blood loss and infection NailThe nail itself incorporates several important mechanical designfeatures. The nail itself is unslotted and cannulated for guidewire controlled insertion. It has a 17 mm proximal diametertapering to 11 mm distally and is available in Left and Rightforms in lengths from 340 mm to 440 mm in 20 mm in femoral neck anatomy are accommodated by arange of neck angles available for the lag screw entry (125 ,130 , 135 ). The nail incorporates proximal anteversion of 10 .Two distal Locking screws are inserted through the distal end ofthe nail to control rotation and Lag ScrewThe lag screw, inserted through a small incision with the aid ofa radiolucent targeting device, incorporates a special slidinglock to provide dynamic compression with axial stability.

9 Afterinsertion, a set screw inserted through the proximal head of thenail engages in one of four grooves in the lag screw. As theseare of asymmetrical depth profile, they allow the lag screw toslide in one direction, producing dynamic osteosynthesis bycompression during early weight-bearing. The lag screwincorporates a rounded nose profile and self-tapping threaddesigned for easy insertion and resistance to for the standard Gamma Locking nail , except that distaltargeting is accomplished using a free-hand technique or animage-intensifier-mounted targeting Gamma advantage strength and stabilityThe Long Gamma Locking nail offers significantly greaterstrength and stability in clinical use through the inherentbiomechanical advantage of the intramedullary biomechanical advantageAs the load-bearing axis of the Long Gamma Locking nail iscloser to the hip joint fulcrum, the effective lever on the implantand femur is significantly less than with an external plate,reduced by a factor equivalent to d/D in the diagram(approximately 25%*).

10 The resultant force is transmitted directlydown the centre of the femur rather than through the manybone-weakening screws used in the side-plate system,increasing both the strength and reliability of the rehabilitation advantageThe extra strength effectively gained by the biomechanicaladvantage of the Long Gamma Locking nail , combined withimproved control of axial telescoping and rotational instability,allows early weight-bearing even in complex or unstableproximal fractures. Earlier mobilization, combined withdynamic compression and less traumatic operative technique,increases the chance of successful patient recovery andreliable repair.* Leung , The Chinese University of Hong Kong: Gamma AP Anthropometric Study of Proximal Femur, Jan 1991; Data on file, Stryker plugLag ScrewNailSet screwDistal lockingscrewsDistal diameter 11 mmProximal diameter 17 mmLengths340 mm360 mm380 mm400 mm420 mm440 mmAngles:125 , 130 & 135 INDICATIONS & DESIGN FEATURESCOMPLETE OPERATING GUIDE8 This surgical technique has been devised in consultationwith leading surgeons in many countries to be a basicguide, particularly for less experienced users of the LongGamma Locking nail .