TGN OP Anleitung engl - Stryker

1 1 HIP FRACTURE SYSTEMSOPERATIVE TECHNIQUETROCHANTERIC GAMMA LOCKING NAILCONTENTSA cknowledgements:The Gamma Locking Nail Operating Technique was compiled from thekind contributions of leading surgeons in many countries; the principalauthors and commentators were:-Dr. G. Taglang, Dr. A. Grosse, Strasbourg, FranceDr. 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 TROCHANTERIC GAMMA LOCKING NAIL4 INDICATIONS AND DESIGN FEATURES6 COMPLETE OPERATING GUIDE 8 Pre-operative Planning9 Patient Positioning, Fracture Reduction10 Anteversion Guide11 Incision & Entry Point12 Preparation of Medullary Cavity13 Reaming Technique13 Nail Insertion14 Nail/Lag Screw Positioning14 Lag Screw Targeting15 Lag Screw Drilling17 Lag Screw Selection and Insertion18 Set Screw Insertion19 Distal Locking20 Final Checking22 Extraction23 Problem Solving24 Implants and Instrumentation29 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 Trochanteric Gamma Locking Nail is the latestdevelopment in the continuing evolution of the Gamma Locking Nail family. Like the original Gamma and LongGamma Locking Nails, the Trochanteric Gamma LockingNail has been designed by surgeons. The requirement,based on the Gamma experience of over three hundredthousand implants world-wide, was to develop an implantspecifically for fractures in the trochanteric region, but withall the benefits of the existing Gamma Locking Nail new Trochanteric Gamma Locking Nail is shorterand simpler than the standard Gamma Locking Nail, andhas:- only one distal locking screw only one distal diameter 180 mm overall length profile designed for rapid and secure fixation offractures around the trochanter The Trochanteric Gamma Locking Nail uses the sameaward-winning instrumentation* as the standard and LongGamma Locking Nails, with the addition of new targetingsleeves.

3 It combines the strength and biomechanicaladvantages of the existing Gamma family with a smallinventory and simplified technique. And, as the latestdevelopment of one of the world s leading locking nails, thedesign of the Trochanteric Gamma Locking Nail benefitsfrom an unrivalled pedigree of clinical experience. * Design-Innovation 95, awarded for high design quality; Design Centre, Nordrhein clinical studies for the Gamma Locking Nailfamily are among the most extensive for any surgicalimplant currently available. 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-bearing1,2,3,4,5,6,7 through superiorstrength and stability Reduced trauma3,4through closed operatingtechnique3,4 Low blood loss5,6, low level of wound problems5and low risk of infection5 More secure fracture fixation through betterbiomechanics7 The clinical objective of the Trochanteric Gamma Locking Nail, as with the original and Long Gamma Locking Nails, is.

4 - Rapid mobilization, with fewer complications, forbetter patient rehabilitation7 The operating technique for the Trochanteric Gamma Locking Nail is essentially the same as for the standardGamma Locking Nail, the main variation being in thesimpler distal locking process. Instrumentation for theTrochanteric Gamma Nail is also the same as for the rest ofthe Gamma family, obviating the need for further inventoryand training for both the surgeon and the theatre aim of this surgical technique booklet is to provideyou with a simple step-by-step operating guide to aidsuccessful adoption of the Trochanteric Gamma LockingNail into your standard trauma the technique has been learned, you should findthe operative procedures simple to implement.

5 In fact, manyof the basic principles for the Trochanteric Gamma technique are those employed for all intramedullary closedlocking you are in any doubt as to any part of the operatingprocedure, please contact your local Stryker Traumarepresentative or the office shown on the back TROCHANTERIC GAMMA LOCKING NAIL4 REFERENCES: 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, 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 et al, (Prince of Wales Hospital, Hong Kong), J Bone JointSurg [Br] 1992; 74B, 3:345-51.

6 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. : Paper presented atAdvanced Course in Intramedullary Locking Nailing, Courchevel, France,February , Cohen , Pittsburgh Orthopaedic Journal, 1990,Volume 1, pages 20 - 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 trochanteric fractures Article in fracturesPertrochanteric fracturesHigh sub-trochanteric fracturesAnatomical efficiencyThe Trochanteric Gamma Locking Nail is designed foroptimum efficiency both in operating technique andsubsequent are two basic components, universal inapplication to left or right hip fractures, and effectivetogether in a very wide range of clinical situations andfracture is entirely by closed surgical technique,minimizing trauma, blood loss and infection NailThe intramedullary nail itself integrates several importantmechanical features.

7 The anatomic design is universal for allindicated applications, with a profile specifically designedfor trochanteric fractures, and is 18 centimetres long in femoral neck anatomy are accommodatedby a range of angles available for the lag screw entry(125 , 130 , 135 ).A single distal locking screw is used to prevent rotationin complex fractures. Cannulated for guide wire controlledinsertion, and with a conical tip, the nail is available in asingle distal diameter, 11 Lag ScrewThe lag screw, inserted through a small incision with the aid of a radiolucent targeting device, incorporates a special sliding lock to provide dynamic compression withaxial insertion, a set screw inserted through the proximalhead of the nail engages in one of four grooves in the lagscrew.

8 As these are of asymmetrical depth profile, theyallow the lag screw to slide in one direction, producingdynamic osteosynthesis by compression during early lag screw incorporates a rounded nose profile andself-tapping thread designed for easy insertion andresistance to AND DESIGN FEATURES6 The Gamma advantage strength and stabilityThe Trochanteric Gamma Locking Nail offers significantlygreater strength and stability in clinical use through theinherent biomechanical advantage of the biomechanical advantageAs the load-bearing axis of the Trochanteric Gamma Locking Nail is closer to the hip joint fulcrum, the effectivelever on the implant and femur is significantly less than withan external plate, reduced by a factor equivalent to d/D inthe diagram (approximately 25%*).

9 The resultant force is transmitted directly down the centreof the femur rather than through the many bone-weakeningscrews used in the side-plate system, increasing both thestrength and reliability of the mechanical rehabilitation advantageThe extra strength effectively gained by the biomechanicaladvantage of the Trochanteric Gamma Locking Nail,combined with improved control of axial telescoping androtational instability, allows early weight-bearing even incomplex or unstable proximal mobilization, combined with dynamiccompression 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 lockingscrewDistal diameter 11 mmProximal diameter 17 mmLength180 mmAngles:125 , 130 & 135 D>ddDINDICATIONS & DESIGN FEATURESThis surgical technique has been devised in consultationwith leading surgeons in many countries to be a basicguide, particularly for less experienced users of theTrochanteric Gamma Locking is acknowledged that several alternative approachesto certain elements of the procedure are practised, and mayhave advantages for particular situations or surgeons.

10 Partsof this guide may seem simplistic or redundant forexperienced readers, but are included for the guidance ofmore junior chart of the complete operating instrumentation isfolded into the back of this Operating Guide, and can befolded out for easy reference in conjunction with the text thatfollows. For easy identification, each instrument referred toin the guide is keyed to the chart by a reference number,and contains pictures of the Instrumentation and Implantcases, shown on page 30 and 31 complete with thecatalogue numbers of each OPERATING GUIDE8In the majority of patients the standard 130 neck anglecan be used without difficulty. The 125 neck angle may beneeded in osteoarthritic coxa vara, and the 135 in coxavalga.