REAMER / IRRIGATOR / ASPIRATOR (RIA)

1 REAMER / IRRIGATOR / ASPIRATOR (RIA)For Intramedullary Reaming and Bone HarvestingSURGICAL TECHNIQUEI nstruments and implants approved by the AO publication is not intended for distribution in the intensifier controlWar ningThis description alone does not provide sufficient background for direct use of DePuy Synthes products. Instruction by a surgeon experienced in handling these products is highly , Reprocessing, Care and MaintenanceFor general guidelines, function control and dismantling of multi-part instruments, as well as processing guidelines for implants, please contact your local sales representative or refer to: general information about reprocessing, care and maintenance of Synthes reusable devices, instrument trays and cases, as well as processing of Synthes non-sterile implants, please consult the Important Information leaflet (SE_023827) or refer to.

2 OF CONTENTSINTRODUCTION Overview 2 Indications 4 SURGICAL TECHNIQUE Preparation 5 Assembly 9 Reaming 18 Bone Harvesting 20 Disassembly 22 PRODUCT INFORMATION Single-Patient-Use Instruments 23 Other Material 25 General Instruments 26 Optional Instruments 28 Power Equipment 30 Cleaning Instruments 31 RIA-Instruments Set ( ) 31 BIBLIOGRAPHY 32 REAMER / IRRIGATOR / ASPIRATOR (RIA) Surgical Technique DePuy Synthes 1 Designed for.

3 Lower intramedullary pressure1, 4, 5 Lower fat embolisation2, 3, 14 Lower heat generated11 Removal of infected tissue6, 7, 8, 13, 14 REAMING WITH LOWERED RISK OF SYSTEMIC COMPLICATIONFAST, EFFICIENT REAMINGDeep flutes to prevent cloggingSharp edges for efficient cutting Removal of marrow and bone through aspiration holes creates negative intramedullary pressureConstant cooling with irrigation fluid, also emulsifies reamings for evacuation Time saving one-step procedure10 Sharp REAMER heads for facilitated cuttingTube assemblyReamer headFlow of irrigating fluidBone marrow, morselized bone OVERVIEWAUTOGRAFT HARVESTING Low morbidity7, 18 Possible range: 30 to 80 cc per procedure Well-known technique Osteoinductive and osteogenic12, 16, 172 DePuy Synthes REAMER / IRRIGATOR / ASPIRATOR (RIA) Surgical TechniqueReamer / IRRIGATOR / ASPIRATOR (RIA) Surgical Technique DePuy Synthes 3 Locking clipDrive shaftAspiration of bone marrow and finely morselized bone Mesh sized to capture morselized bone and bone marrowAspiration tube connected to vacuum sourceGravity fed irrigation into cannulation of drive shaftDrive shaft sealGraft filter 100 cc capacity4 DePuy Synthes REAMER / IRRIGATOR / ASPIRATOR (RIA)

4 Surgical TechniqueINDICATIONSI ntended use To clear the medullary canal of bone marrow and reaming debris To clear the medullary canal of infected bone tissue To effectively size the medullary canal for the acceptance of an intramedullary implant or prosthesis To harvest finely morselized autogenous bone and bone marrow for any surgical procedures that require bone graft in order to facilitate fusion and/or fill bone defects. These procedures include spinal fusion, joint arthrodesis, total joint replacement, fracture repair, nonunion, maxillofacial reconstruction, and tumor removal Note: When deciding on bone harvesting, the patient s history, bone quality, physiological condition and compliance must be taken into account. REAMER / IRRIGATOR / ASPIRATOR (RIA) Surgical Technique DePuy Synthes 51 Select appropriate length of tube RIA Tube Assembly, for RIA Drive Shaft mini-mum length 360 mm, for No.

5 , RIA Tube Assembly, for RIA Drive Shaft mini-mum length 520 mm, for No. , sterilePREPARATION Select the appropriate length of the RIA tube assembly based on the length of the canal. Length of the canal Tube assemblyLess than 350 mm 360 mmGreater than 350 mm 520 mm 6 DePuy Synthes REAMER / IRRIGATOR / ASPIRATOR (RIA) Surgical TechniquePreparation2 Confirm reaming Depth Gauge for Medullary NailsTo estimate the canal diameter, position image intensifier for an AP view of the limb at the level of the isthmus. Hold the radiographic depth gauge perpendicular to the limb and overlay the diameter tabs over the isthmus. Read the diameter on the tab that fills the canal. Repeat with a LM view. a For reaming only, choose the implant diameter. Select a REAMER head mm to mm larger than the chosen implant For bone harvesting only, select a REAMER head mm to mm larger than the canal diameter at the : Measure both in AP and LM : The distance of the depth gauge from the bone and the position of the receiver affect the diameter measurement.

6 Always place the depth gauge on the side of the limb closest to the receiver. Estimate the real width as follows:Distance between depth gauge and bone 25 mm = 1 mm larger reading 50 mm = 2 mm larger reading 100 mm = 3 mm larger readingReamer / IRRIGATOR / ASPIRATOR (RIA) Surgical Technique DePuy Synthes 73 Access canal and place reaming rodInstruments Universal Chuck with SynReam Reaming Rod B mm, short, length 950 mm Gain access to the intramedullary canal using standard opening procedures and instrumentation for the chosen implant or entry point. Reduce the fracture, if the universal chuck with T-handle to the reaming rod. Insert the reaming rod into the canal to the physeal scar. Verify its position with the image intensifier. Note: Ensure the reaming rod is centered in the canal in both AP and LM DePuy Synthes REAMER / IRRIGATOR / ASPIRATOR (RIA) Surgical TechniquePreparation 4 Confirm nail length (for reaming only) Depth Gauge for Medullary Elongation Tube for Reaming Rods, for Depth Gauge for Medullary Nails, for Nos.

7 And Assemble the extension tube to the depth the length of the canal. Choose the length of the implant : Consider dynamization when choosing the length of the the depth gauge assembly over the reaming : The tip of the depth gauge assembly should be located at the entry : Use the depth gauge only with the 950 mm reaming / IRRIGATOR / ASPIRATOR (RIA) Surgical Technique DePuy Synthes 91 Attach REAMER RIA Medullary REAMER Heads mm mm, RIA Medullary REAMER Heads mm mm, RIA Tube Assembly, for RIA Drive Shaft minimum length 360 mm, for No. , RIA Tube Assembly, for RIA Drive Shaft minimum length 520 mm, for No. , sterileSelect the appropriate REAMER head. Insert it into the tube : The REAMER head is attached correctly when it can spin freely and is retained by the tube : REAMER heads are sharp.

8 Use care when attaching the REAMER head to the tube DePuy Synthes REAMER / IRRIGATOR / ASPIRATOR (RIA) Surgical Technique2 Attach drive shaft to tube assembly and REAMER RIA Drive Shaft, length 360 RIA Drive Shaft, length 520 mmSelect the respective length of the drive shaft. Guide the tip of the drive shaft through the RIA tube the hexagonal end of the RIA drive shaft with the hexagonal recess in the REAMER : Visually check mating through the aspiration : Improper assembly can result in product breakage, which may lead to surgical delay, bone damage, and/or adverse tissue grooveReamer / IRRIGATOR / ASPIRATOR (RIA) Surgical Technique DePuy Synthes 11 Note: The drive shaft is properly attached when the hex flats are not visible.

9 The helix is also visible when properly : Improper assembly can result in product breakage, which may lead to surgical delay, bone damage, and/or adverse tissue : The drive shaft hex is properly engaged in the REAMER head when the retaining groove is : Improper assembly can result in product breakage, which may lead to surgical delay, bone damage, and/or adverse tissue DePuy Synthes REAMER / IRRIGATOR / ASPIRATOR (RIA) Surgical TechniquePush the outer sleeve of the RIA drive shaft forward to engage the body of the RIA tube : Improper assembly can result in product breakage, which may lead to surgical delay, bone damage, and/or adverse tissue : The drive shaft is properly attached when the tan/gray plastic coupling shaft is no longer : Improper assembly can result in product breakage, which may lead to surgical delay, bone damage, and/or adverse tissue / IRRIGATOR / ASPIRATOR (RIA) Surgical Technique DePuy Synthes 133 Attach locking Locking Clip for RIA, sterileSlide the locking clip onto the assembled RIA drive shaft and tube assembly.

10 Note: The small ridge on the inner surface of the locking clip matches the groove between the drive shaft and the tube the locking clip until the circular notches on the locking clip align with the corresponding buttons on the tube on tube assembly14 DePuy Synthes REAMER / IRRIGATOR / ASPIRATOR (RIA) Surgical Technique4 Attach drive shaft Seal for RIA Drive Shaft, sterile, pack of 2 unitsAttach the drive shaft seal to the proximal end of the drive : The drive shaft seal is important to retain irrigation within the cannulation of the drive drive unit with large quick Battery Quick Coupling for DHS/DCS Triple Reamers, for Battery Power LineSelect a cannulated drive unit that will deliver to Nm of torque and 700 to 900 rpm (standard drill speed).