T2™ Tibial Nailing System

1 T2 . Tibial Nailing System Operative Technique Tibial Nailing System Contributing Surgeons : Prof. Dr. med. Volker B hren Chief of Surgical Services Medical Director of Murnau Trauma Center Murnau, Germany Kyle F. Dickson, M. D. Director of Surgery & Chief of Orthopaedics Charity Hospital Associate Professor & Director of Orthopaedic Trauma Tulane University Assistant Clinical Professor Louisiana State University New Orleans, Louisiana USA. Paul Tornetta, III , M. D. Director of Orthopaedic Trauma, Boston Medical Center Professor and Vice Chairman Department of Orthopaedic Surgery Boston University School of Medicine Boston, Massachusetts USA. This publication sets forth detailed recommended procedures for using Stryker Trauma devices and instruments.

2 It 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. A workshop training is required prior to first surgery. 2. Contents 1. Introduction 4. Implant Features 4. Instrument Features 6. References 6. 2. Indications 7. 3. Pre-operative Planning 7. 4. Operative Technique 8. Patient Positioning Options and Reduction 8. Incision 8. Entry Point 8. Unreamed Technique 9. Reamed Technique 9. Nail Selection 10. Nail Insertion 10. Guided Locking Mode (via Target Device) 13. Static Locking Mode 14. Freehand Distal Locking 16.

3 End Cap Insertion 17. Dynamic Locking Mode 18. Apposition /Compression Locking Mode 18. Advanced Locking Mode 20. Nail Removal 21. Blocking Screw Technique (optional) 22. Ordering Information Implants 24. Ordering Information Instruments 28. 3. Introduction 1. Introduction In some indications, a controlled dynamization and apposition/. apposition/compression of bone compression. Compared to the Stand- The T2 Tibial Nailing System fragments can be applied by ard Nail, the oblong hole is 7mm represents the latest and most com- introducing a Compression Screw further distal, ending just above the prehensive development of the original from the top of the nail.

4 To further Herzog 10 bend. The Distal Tibial intramedullary principles presented by increase rotational stability, the nail Nail has 2 distal locking holes at 5mm Prof. Gerhard K ntscher in 1940. can be locked statically after using and 13mm centered from the distal Stryker Trauma has created a new the controlled dynamization and tip. generation locking nail System , apposition/compression option. bringing together all the capabilities The T2 Proximal Tibial Nail and benefits of separate Nailing The Compression Screw is pushed may also be used for very proximal systems to create a single, integrated against the proximal Partially and very distal fractures.

5 The Proxi- surgical resource for fixation of long Threaded Locking Screw that has mal Tibial Nail does not feature an bone fractures. been placed in the oblong hole, oblong hole for optional controlled drawing the distal segment towards dynamization and apposition/com- The T2 Tibial Nailing System offers the fracture site. In stable fractures, pression. The location of the 3 distal the competitive advantages of: this has the biomechanical advantage locking holes is the same as the of creating active circumferential Standard Nail. Not limiting the approach to a compression to the fracture site, certain Nailing technique. transferring axial load to the bone, Note: Accommodating reamed or and reducing the function of the nail All three nail designs feature the unreamed procedures.

6 As a load bearing device (1). distal most hole centered at 5mm Providing locking options for all from the distal tip to better address types of fractures, plus the This ability to transfer load back hard to reach distal fractures. Advanced Locking Mode for to the bone can reduce the incidence increased rotational stability. of implant failure secondary to fatigue. Common 5mm cortical screws Typical statically locked nails function simplify the surgical procedure and Through the development of a com- as load bearing devices and failure promote a minimally invasive mon, streamlined and intuitive rates in excess of 20 % have been approach. Fully Threaded Locking surgical approach, both in principle reported (2).

7 Screws are available for regular and in detail, the T2 Tibial Nailing locking procedures. Partially Thread- System offers significantly increased The beneficial effect of apposition/ ed Locking Screws (Shaft Screws) are speed and functionality for the compression in treating long bone designed for use if apposition/. treatment of fractures as well as sim- fractures in cases involving transverse compression is applied. plifying the training requirements for and short oblique fractures that are all personnel involved. axially stable is well documented Note: (3, 4). The 8mm T2 Tibial Nail can In addition to the T2 Standard only be locked distally with 4mm Implant Features Tibial Nail that features options to Fully Threaded screws.

8 As with address very proximal and very distal all diameters of T2 Tibial Nails, the The T2 Tibial Nailing System is fractures as well as the advanced proximal screws are 5mm. the realization of superior biome- compression feature, there are two chanical intramedullary stabilization additional Tibial Nail designs avail- One common Compression Screw to using small caliber, strong cannulated able on a special order basis that close the fracture site, and End Caps implants for internal fixation address specific surgical indications: in eight sizes are available to provide a of long bones. best fit for every indication. The T2 Distal Tibial Nail, avail- According to the fracture type, the able in 10mm diameter only, may be All implants in the T2 Tibial Nail- System offers the option of different used for very distal fractures *.

9 As ing System are gun-drilled and locking modes. In addition to static with the Standard Nail, an oblong made of Type II anodized titanium locking, a controlled dynamization hole is located in the proximal third alloy (Ti6AL4V) for enhanced with rotational stability is optional. of the nail for optional controlled biomechanical and biomedical per- formance. * The Distal Tibial Nail is not cleared for primary ankle arthrodesis in the U. S. 4. Technical Details 0mm Nails Diameters 8* 15mm 10 A / P slope Sizes 240 420mm 17. 24. Note: 34 S. L Compression Range**. Screw Length is measured from top of O. 41 T. head to tip. Herzog Bend, 10 . (All Three Nails). Fully Threaded Locking Screws L = 25 120mm Fully Threaded Locking Screws for 8mm Nails (Distal Holes Only).

10 L = 20 60mm Partially Threaded Locking Screws(Shaft Screws). L = 25 120mm 0mm 0mm 17 17. 24 24. Compression Tibia Advanced 41 Range**. 48. Compression Screw End Caps Distal Bend, 4 . (All Three Nails). Standard +5mm +10mm +15mm 60mm 25. 15. 25. 5 15. 5 13. +20mm +25mm +30mm +35mm 0mm 0mm 5. 0mm Standard + Proximal + Distal ** Compression Range Total Length of Slot 12mm * 8mm nails require 4mm Fully Threaded Screws Less Screw Diameter (-) 5mm for Distal Locking + Proximal and Distal Nails are available as Maximum Movement of Screw 7mm special order implants 5. Features Instrument Features Step Color Number The major advantage of the instru- Opening Red 1. ment System is a breakthrough in the Reduction Brown 2.