Implant Extraction Guide Module One & Two

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1 Implant Extraction Set Implant Extraction Guide Module One & Two 1

2 Contents Page 1. Introduction 3 Introduction 3 Features and Benefits 3 Contraindications 3 2. Product Description 4 3. Technical Details 6 Screws 6 Condyle Screws 6 Cannulated Screws 7 Damaged Screw Head 7 Broken Screws 8 Plates 9 Broken Cannulated Screws 10 Lag Screw 11 IM Nails 13 Broken IM Nails Additional Information 15 HydroSet 15 References 15 This publication sets forth detailed recommended procedures for using Stryker Osteosynthesis devices and instruments. Ordering Information Instruments 16 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. See package insert (L ) 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 necessary. Warning: All bone screws referenced in this document here are not approved for screw attachment or fixation to the posterior elements (pedicles) of the cervical, thoracic or lumbar spine. 2

3 Introduction Introduction Hardware removal occurs for four reasons: 1. Elective removal. 2. Removal secondary to symptoms. 3. Removal for infection. 4. During revision procedures. The most challenging are typically points 3 and 4 as the hardware maybe broken and / or tissue planes distorted. In addition, there is frequently no bail out because the hardware must be removed in order to revise the fixation for a non-union or to address infection. Although considered easy and straightforward by patients, hardware removal is almost always more challenging than the insertion of the implants ¹. Specialty instruments can significantly facilitate hardware removal while minimizing damage to the surrounding bone/soft-tissue. Stryker has developed a comprehensive set of instruments / techniques to assist the surgeon with these challenging issues, regardless of the indication or timing. Additionally, stripped screws and stripped IM Nails proximal threads (used for removal) may rise surgical difficulty and should be treated together. It has evolved from our extensive clinical experience with trauma devices, as well as from the collaboration with experienced surgeons worldwide. Module One includes instrumentation for the removal of internal fixation systems and associated screws. Conical and Spreading Tip Screwdrivers are provided in varying sizes for the safe removal of torx, hex, and cannulated screws. Nail and Lag Screw removal is facilitated through the availability of different sized Adaptors and Conical Extraction Rods that are easily assembled. Module Two contains extraction instruments for the removal of stripped and / or broken screws and implants. Stryker Extraction System is a single instrument platform that can be used for various extraction methods according to each individual case, in a minimally invasive operating procedure, allowing for the removal of almost any Stryker Trauma implants. It may also be compatible with non- Stryker implants*. Features and Benefits Versatility: Removal of standard, broken and / or stripped nails, plates and screws Multiple extraction methods Universal Instruments Compatible for use with other manufactures implants* Single Instrument Platform Simplified surgical technique Contraindications Cold welded screws require cutting tools for metal to remove the screws. The extraction set does not feature carbide drills or other cutting tools to remove cold welded screws. Nails Lag Screw Screws Stryker Extraction System is a set of instrumentation developed to meet the surgeons need for implant extraction. The System consist of two modules for the removal of almost any Stryker Trauma implant, as well as many non- Stryker plates, nails, and screws*. Since broken hardware can often be identified on preoperative radiographs, but may also be encountered unexpectedly during an operation, Stryker recommends having both modules present in the operating room to facilitate surgical procedures and to reduce operative time. HydroSet * Stryker can only recommend use of the extractor instruments with its own products. Application of the instruments to competitive products or to Stryker products that have been altered may be possible but has not been validated. Where competitive products are mentioned in this document this is solely to indicate where application of the extractor instruments appears possible due to similar design or dimensions, and Stryker does not guarantee that the extractor instruments demonstrated herein will work in any cases where competitive products are used, or in cases where Stryker products have been altered. As a precaution, make sure to have other standard instruments available in case the tolerances of the implants do not match the tolerances of the extractor tool. Instruments 1. J Am Acad Orthop Surg 2006;14: Hardware Removal: Indications and Expectations Matthew L. Busam, MD, Robert J. Esther, MD, MSc, William T. Obremskey, MD, 3

4 Product Description Article Stryker Systems Teardrop handle, AO-medium For AO medium bits: - Screwdriver bits - Crowndrills (Trephines) - Conical extractors male/female Screwdriver Bit 2.5 (conical) For 2.5mm Hex Screws: T2 Hum Compression; Asnis III 4.0; Numelock 4.5; ISO 2.7; ISO 3.5; ISO 4.0 Screwdriver Bit 3.5 (conical) For 3.5mm Hex Screws: 4 and 5mm Locking Screws (T2, S2, Gamma3, IC etc.); T2/S2 End Caps; T2/S2 Fem/Tib Compr. Screws; TLN all Screws; T2 Recon Set Screws 3.7 and 4.6mm Locking Screws G&K; Asnis III 5.0; Numelock 6.5; ISO 4.5; ISO 6.5 Screwdriver Bit 4 (conical) Set Screws for Gamma, Gamma3, Gamma Ti, Dyax-A, AP, AP-J; Proximal Plugs for Gamma, Gamma Ti, Dyax, Dyax-A, AP, AP-J Screwdriver Bit 5 For 5mm Hex Screws: 6.28mm Locking Screws; Asnis III 6.5 and 8.0 and T2/S2 Recon Lag Screws Screwdriver Bit 6.3 For 6.3mm Hex Screws: T2/S2 Condyle Screws Screwdriver Bit 8 G&K SCN Condyle Screws; Gamma3 End Caps Screwdriver Bit T 8 (Torx) AxSOS 3.0 Screwdriver Bit T 15 (Torx) AxSOS 4.0 Screwdriver Bit T 20 (Torx) ALTA 3.7mm Locking Screws; AxSOS 5.0 Screwdriver Bit T 25 (Torx) ALTA 5mm Locking Screws, Lag Screws and Caps Conical Extractor, male, left hand, small Asnis III 4.0 (left hand driving) for diameter range 1 2.5mm Conical Extractor, male, left hand, 2.5 (left hand driving, for damaged hex 2.5mm and diameter range 2.3 4mm) Conical Extractor, male, left hand, 3.5 (left hand driving, for damaged hex 3.5mm and diameter range 3.3 4mm) Conical Extractor, male, left hand, 4 (left hand driving, for damaged hex 4mm and diameter range mm) Conical Extractor, male, left hand, 5 (left hand driving, for damaged hex 5mm and diameter range mm) Crowndrill 3 (bonedrill for broken Screws with diameter range =< 3mm) Crowndrill 4 (bonedrill for broken Screws with diameter range =< 4mm) Crowndrill 5 (bonedrill for broken Screws with diameter range =< 5mm) Crowndrill 6.5 (bonedrill for broken Screws with diameter range =< 6.5mm) Crowndrill 8 (bonedrill for broken Screws with diameter range =< 8mm) Crowndrill 10 (bonedrill for broken Screws with diameter range =< 10mm) Crowndrill 12 (bonedrill for broken Screws with diameter range =< 12mm) Conical Extractor, female, left hand, 3 (left hand driving, for broken Screws with diameter range =<3mm) Conical Extractor, female, left hand, 4 (left hand driving, for broken Screws with diameter range =<4mm) Conical Extractor, female, left hand, 5 (left hand driving, for broken Screws with diameter range =<5mm) Conical Extractor, female, left hand, 6.3 (left hand driving, for broken Screws with diameter range =<6.3mm) Screws: T2 Hum Compression; Asnis III 4.0; ISO 2.7; ISO 3.5; ISO 4.0 Screws: 4 and 5mm Locking Screws (T2, S2, Gamma3, IC etc.); T2/S2 End Caps; T2/S2 Fem/Tib Compr. Screws; TLN all Screws; T2 Recon Set Screw 3.7 and 4.6mm Locking Screws G&K; Asnis III 5.0; ISO 4.5; ISO 6.5 Set Screws for Gamma, Gamma3, Gamma Ti, Dyax-A, AP, AP-J; Proximal Plugs for Gamma, Gamma Ti, Dyax, Dyax-A, AP, AP-J 6.28mm Locking Screws; Asnis III 6.5 and 8.0 and T2/S2 Recon Lag Screws n/a n/a n/a n/a n/a n/a n/a ISO 2.7 Screws, Ulna Locking Screws T2/S2 4mm Locking Screws, G&K 3.7mm Locking Screws, ISO Screws 3.5 and 4.0, ALTA 3.7mm Locking Screws 5mm Locking Screws (T2, S2, Gamma3, IC, ALTA etc.); ISO Srews mm Locking Screws 4

5 Product Description Article Stryker Systems Teardrop handle, AO-medium, cannulated (including Rotation Rod) for AO medium bits: Spreading Screwdriver Spreading Screwdriver Bit mm Locking Screws; Asnis III 6.5 and 8.0 and T2/S2 Recon Lag Screws Spreading Screwdriver Bit 6.3 T2/S2 Condyle Screws Spreading Screwdriver Bit 8 G&K SCN Condyle Screws; Gamma3 End Caps Punches 2.7 for broken Screws with diameter range =<3mm Punches 3.7 for broken Screws with diameter range from 3 4mm Punches 5 for broken Screws with diameter range >4mm Forceps, small for damaged Screws, broken Screws with diameter <9mm Forceps, large for damaged Screws, broken Screws with diameter >9mm Conical Extraction Rod 6 Extraction of nails using proximal Nail End: T2 Humeral Conical Extraction Rod 8 Extraction of nails using proximal Nail End: Humerus Seidel, T2 Proximal Humeral, T2 Humeral, Alta Humeral, TLN (M7),SCN (M8), Alta Femoral & Tibial, Zickel, IC Femoral & Tibial, T2/S2 Tibial & Femoral Antegrade/Retrograde Conical Extraction Rod 10 Extraction of nails for the proxmal Nail End: Gamma3, Dyax-A, all G&K Nails (Fem, Tib, SFN, STN, SCN) Conical Extraction Rod 13 Extraction of nails using proximal Nail End: Gamma, Gamma Ti, Dyax, AP, AP-J Extraction Hook, small Extraction of cannulated nails with inner diameter mm: G&K, Gamma3 (Ti), Seidel, IC, SCN, TLN, T2/S2 Extraction Hook, large Extraction of cannulated nails with inner diameter =>5.6mm: Gamma, Gamma3 (StSt), Dyax, Dyax-A, AP, AP-J, G&K, IC, SCN, Kuentscher Nails Extraction Instrument Lag Screw Consisting of Handle and Extraction Rod. To be used with the threaded rod and nut for the Lag screw extraction Nut Fastens the Extraction Rod to the threaded rods and Connectors Threaded Rod M7 Threaded into Lag screw (Gamma/Dyax-A), fastens connection between Extraction Rod and Connectors Threaded Rod M5 Threaded into Lag screw (Omega), fastens connection between Extraction Rod and Connectors Threaded Rod M4 Threaded into Lag screw (OHS/OCS), fastens connection between Extraction Rod and Connectors Spanner SW17 Serves for larger torque transmission of the Extraction Instrument Lag Screw Connector, Gamma Connector, Gamma U-Blade Connector, Gamma3 U-Blade Connector, Dyax-A Connector, Gamma3 Connector, Omega and Omega plus Connector, OHS/OCS Sharp Hook (Optional) Osteotome (Optional) Outer Introducer (Optional) Inner Introducer (Optional) Extractor (Optional) Emergency Inner Extractor (Optional) Extractor Handle (Optional) Outer Extractor (Optional) Inner Extractor (Optional) Fits onto the specific Lag Screws, over the threaded Rod, and connects with the Extraction Instrument Lag Screw Removes from bone material Removes from bone material Hansson Pin Hansson Pin Hansson Pin Hansson Pin Hansson Twin Hook Hansson Twin Hook Hansson Twin Hook T-Handle, AO-medium (Optional) for AO medium bits: Screwdriver Screw removal, conical - Crowndrill - Screw extraction, conical Screwdriver 2.5 Seidel Humerus Spreading Screw (Standard Seidel instrument) Caution: Implants can be subject to change. This can impact the compatibility of extraction instruments. It is therefore required to start the implant extraction with a complete Extraction Set in order to have access to alternative instruments. 5

6 Technical Details Screws Screws After identifying screw type and diameter, extract the screws with the appropriate screwdriver bit by turning the screwdriver counterclockwise. To avoid damaging the screw, make sure the screwdriver is in line with the screw axis and fully inserted. Screwdriver Bits (hex) Screwdriver Bits (torx) Partially threaded screw removal (e.g. Asnis III screws, T2 Recon Lag Screws) is facilitated by using the spreading screwdriver bits and cannulated handle. For spreading screwdriver instructions see Condyle Screw removal below. Solid Teardrop Handle Stryker offers a wide variety of hex (standard, conical, spreading) and torx screwdrivers. Check the available type and size on the Ordering Information page. Condyle Screws For T2/S2 Condyle Screw removal, assemble the necessary screwdrivers: The 6.3hex Screwdriver Bit with the Solid Teardrop Handle (for the nut) and the 6.3hex Spreading Screwdriver bit with the Cannulated Teardrop Handle (in combination with the Rotation Rod) as shown in the illustration. Screwdriver Bit Solid Teardrop Handle Spreading Screwdriver Bit Teardrop Handle (cannulated) Rotation Rod Make sure to tighten the Rotation Rod until the tip of the screwdriver spreads firmly and fully into the screw head. A screwdriver needs to be inserted from each side of the Condyle Screw using one to stabilize the Nut and the Spreading Screwdriver to loosen and extract the Condyle Screw. If necessary, use the Spreading Screwdriver to remove the Nut in a second step. The Condyle Screw is extracted by turning the Screwdriver in a counterclockwise direction. 6

7 Technical Details Cannulated Screws Never use a worn or damaged screwdriver to remove Asnis screws. Reverse cutting flutes are present for this reason. It is recommended that the Solid Screwdriver be used for Screw removal. The Solid Screwdriver applies greater torque and will reduce the potential for damaging the hexagonal tip on the Screwdriver. Strong bone formation around the implant has been seen in the pediatric cases using partially threaded screws. Spreading Screwdriver Bit Solid Teardrop Handle Screwdriver Bits (hex) Teardrop Handle (cannulated) Rotation Rod This may lead to difficult implant removal with an increased risk of screw head breakage or stripping of screw hexagonal head. If the oblique direction of the screw (approximately 135 to the shaft) is not changed, then the reverse flutes are not in an opportune position to cut the cortex. If the screw head is placed under traction and the angle of the screw is brought to a perpendicular position relative to the bone, cutting the cortex will progress and facilitate screw removal. Caution: Be sure to use the Solid Screwdriver in combination with the appropriate sized screwdriver bits or the cannulated screwdriver with the Spreading Screwdriver Bits. Proceed as described above. Screws Damaged Screw Head Screw stripping is commonly caused by slippage of a screwdriver that is not correctly aligned with the screw axis and/or fully seated. This can occur either during insertion or, more commonly, during attempted screw removal. The appropriate sized Conical Extractor (based on the size of the Conical Extractor (male) Solid Teardrop Handle Forceps for Screw Removal Slotted Hammer screw head hex / torx) is inserted firmly into the screw head. Lightly tapping the Conical Extractor with a Slotted Hammer may be tried if purchase is not initially obtained with manual pressure. It is at the surgeons discretion if and how hard to use the hammer. Assemble the selected Conical Extractor (male) with the Teardop- Handle and turn it counter-clockwise while applying pressure in line with the screw axis, extracting the screw at the same time. If the screw does not come completely out, the Foreceps can be used to complete the extraction. 7

8 Technical Details Broken Screws Screws In case of a Broken Screw Shaft: Step 1: Remove the screw head portion in order to gain access to the remaining part of the screw shaft. The screw head can be removed with the appropriate screwdriver as described on page 6. Step 2: Use the Drift Punch to extract the remaining part of the screw. If difficulties are encountered with the above process, overdrill the remaining part of the screw with a Crowndrill before proceeding with the Drift Punch. In case of a Torn off Screw Head: Step 1: Overdrill the remaining part of the screw with a Crowndrill. Use another Crowndrill, one size larger, in order to create space for the female Conical Extractor/Drift Punch. It may be necessary to start with light pressure on the crowndrill in order to avoid the drill walking on the cortex surface before applying additional pressure to penetrate the bone. Light tapping with the Slotted Hammer may be required. It remains at the surgeons` own discretion if and how hard to use the Slotted Hammer. Alternatively, the optional Countersink (6 or 8mm) can be used to create a path for the Crowndrill. Step 2: Remove the remaining part of the screw with the Conical Extractor, (female) if the screw is broken close to the first cortex or with the help of a Drift Punch if the screw is broken close to the second cortex. This procedures can also be applied to broken IM locking screws. Screwdriver Bit Drift Punches Slotted Hammer Crowndrill (Trephine) Forceps for Screw Removal Conical Extractor (female) Solid Teardrop Handle Broken screw shaft - Step 1 Broke screw shaft - Step 2 Torn-off screw head - Step 1 Torn-off screw head - Step 2 8

9 Technical Details Plates To remove any plate, first extract all screws by using the appropriate size Screwdriver Bits. Remove the plate by using a regular forceps. Screws The development of locking plate technology has lead to cold welding of screws to the plates. In this case, cutting tools for metal have to be used for the removal of the screws. In order to protect the soft tissue from excessive heat and metal debris accumulation, irrigation and suction should be used in combination with cutting tools. Warning: If screws are cold welded to the plate, carbide drills may be required. The extraction set does not feature carbide drills or any other instruments to remove cold welded screws. Solid Teardrop Handle Crowndrill (Trephine) Screwdriver Bit Solid Teardrop Handle Forceps 9

10 Technical Details Screws Broken Cannulated Screws To remove the torn-off head: Step 1: Select the appropriate Spreading Screwdriver Bit. Attach Cannulated Teardrop Handle. Insert Rotation Rod through the top of the Teardrop Handle. Insert tip into the screw head and turn Rotation Rod to engage and remove screw head. To remove remaining screw body (parts): Step 2: Insert the Conical Extractor (male) and extract the remaining screw body turning the Conical Extractor in a counter-clockwise fashion. Spreading Screwdriver Bit Conical Extractor (male) Teardrop Handle (cannulated) Crowndrill (Trephine) Conical Extractor (female) Rotation Rod If Steps 1 and 2 are unsuccessfully for screw removal: Step 3: Overdrill the shaft using the Crowndrill. Step 4: Use a Conical Extractor (female) for screw removal. If the attempt for screw removal is not successful, follow the standard procedure for broken screw removal describes on page 8. Cannulated Screw Removal - Method A - Step 1 Cannulated Screw Removal - Method A - Step 2 Cannulated Screw Removal - Method B - Step 1 Cannulated Screw Removal - Method B - Step 2 10

11 Technical Details Lag Screw An incision is made over the proximal end of the nail. The End Cap, if used, is removed using the appropriate Screwdriver Bit followed by removal of the Set Screw using the 4.0mm Screwdriver as shown in the image below 1. Screwdriver Bit 4.0mm Threaded Rod Solid Teardrop Handle Make a small incision through the old scar distal to the greater trochanter to expose the end of the Lag Screw. The Threaded Rod is then threaded and tightened into the end of the Lag Screw 2. For Gamma Implants: At first, position the K-Wire through the Lag Screw. Then, the Threaded Rod is inserted over the K-Wire (when used for Gamma) and tightened into the end of the Lag Screw. Remove the K-Wire, if used. Lag Screw

12 Technical Details Lag Screw (continued) Connector Threaded Rod Extraction Rod and Nut Check that ingrowth does not obstruct secure engagement of the Extraction Device, otherwise the implant or the instrument may be damaged and extraction will be more difficult. Slide the appropriate Connector over the Threaded Rod before adding the Extraction Rod & Nut as shown in the picture 3. Lag Screw 3 4 Wrench 8/10mm, standard Note: In this Technical Guide the Gamma3 Lag Screw is selected as an example to demonstrate Lag Screw removal. However, different Connectors are available for other implants including a Lag Screw. See details on the ordering information page. Finish assembly of the Lag Screw Extraction Device by tightening the Nut 4 and attaching the T-Handle 5 in a final step as shown in the picture. Handle The Lag Screw is extracted by turning counterclockwise direction 6. Spanner 17mm standard Use the 17mm Spanner if higher forces are required for the removal of the Lag Screw

13 Technical Details IM Nails When removing an IM nail, it is helpful to identify the nail brand and its diameter in order to choose the correct instrumentation. Conical Extraction Rod Universal Rod Strike Plate Sliding Hammer Slotted Hammer Caution: Special care must be taken to check if the nail moves offcenter from the entry point when screws are removed. Any attempt to remove a nail that is off-center may result in fractures of the distal condylar region. The End Cap, if used, is removed using a Screwdriver. If bone ingrowth obstructs access to the nail, use of either a Crowndrill, pick (not supplied), or currette (not supplied) may provide access. Universal Rod Sliding Hammer or use the Slotted Hammer Remove the distal/proximal screw with the appropriate Screwdriver Bit. Do not take out the screws of the driving end until the Conical Extraction Rod is attached to the top of the nail in order to avoid rotation. Insert the Conical Extraction Rod into the driving end of the nail. Lightly hammer the Conical Extractor in order to fully engage the cutting flutes. Nails Strike Plate Conical Extraction Rod Connect the Strike Plate and the Universal Rod either adding the Sliding or Slotted Hammer as shown in the picture. Remove now the remaining locking screws before using either Hammer to remove the nail. Step 1 Step 2 13

14 Technical Details Broken IM Nails Removal of broken IM nails is particularly challenging. Stryker developed a system that can be used for the removal of many cannulated IM nails. Remove the distal screw with the appropriate Screwdriver Bit. Do not take out the proximal screws until you have attached the Conical Extraction Rod to the top of the nail in order to avoid rotation. Conical Extraction Rod Universal Rod Sliding Hammer Strike Plate Extraction Hook An incision is made over the proximal end of the nail. The End Cap, if used, is removed using a Screwdriver. If bone ingrowth obstructs the access to the nail, the use of either a Chisel / Pick (not provided) or a Crowndrill will facilitate removal. Connect the Universal Rod and the Strike Plate to the Extraction Rod (center of page) either adding the Sliding or the Slotted Hammer. Universal Rod Step 1: Insert the nail Extraction Device into the proximal end of the nail, tightening it as firm as possible. Remove the proximal screws before using either Hammer to remove the nail end. Nails Sliding Hammer Strike Plate Step 2: After removal of the proximal nail end, exchange the Conical Extraction Rod for the Extraction Hook (as shown to the left). Insert Extraction Hook into the cannulation of the nail fragment. Step 3: Under fluoroscopy, verify that the Hook has passed through the nail end. Make sure that the Hook takes a hold at the end of the nail before pulling to remove it. Extraction Hook Step 4: Use the Sliding or the Slotted Hammer to pull out the remaining part of the nail. Broken IM Nails - Step 1 Broken IM Nails - Step 2 Broken IM Nails - Step 3 Broken IM Nails - Step 4 14

15 Additional Information HydroSet HydroSet is an injectible self-setting calcium phosphate cement indicated to fill bony voids or gaps of the skeletal system (i.e. extremities, craniofacial, spine, and pelvis). These defects may be surgically created or osseous defects created from traumatic injury to the bone. HydroSet is indicated only for bony voids or gaps that are not intrinsic to the stability of the bony structure. HydroSet cured in situ provides an open void/gap filler that can augment provisional hardware (e.g. K-Wires, Plates, Screws) to help support bone fragments during the surgical procedure. The cured cement acts only as a temporary support media and is not intended to provide structural support during the healing process. Carefully read the IFU, the specific indications and the contraindications. REF Description HydroSet 3cc HydroSet 5cc HydroSet 10cc HydroSet 15cc References J Am Acad Orthop Surg 2006; 14: Hardware Removal: Indications and Expectations Matthew L. Busam, MD, Robert J. Esther, MD, MSc, William T. Obremskey, MD HydroSet 15

16 Ordering Information - Instruments REF Description Tray Module 1 (Generic Sterilization and Storage Tray) Module 1 Fully loaded Universal Screw Extraction Devices Screwdriver Bits conical, hex. 2.5mm Screwdriver Bits conical, hex. 3.5mm Screwdriver Bits conical, hex. 4.0mm Screwdriver Bits, hex. 5.0mm Screwdriver Bits, hex. 6.3mm Screwdriver Bits, hex. 8.0mm Screwdriver Bits, Torx T Screwdriver Bits, Torx T Screwdriver Bits, Torx T Screwdriver Bits, Torx T Spreading Screwdriver Bit, hex. 5.0mm Spreading Screwdriver Bit, hex. 6.3mm Spreading Screwdriver Bit, hex. 8.0mm Teardrop Handle, solid Cannulated Teardrop Handle Rotation Rod used with Cannulated Teardrop Handle Universal Nail Extraction Device Conical Extraction Rod, standard 6mm Conical Extraction Rod, standard 7/8mm Conical Extraction Rod, 10mm Conical Extraction Rod, male, 13mm Wrench 8 /10mm, standard Strike Plate, standard Sliding Hammer Universal Rod Slotted Hammer, standard Universal Lag Screw Extraction Device Connector Gamma Connector Gamma U-Blade Connector Gamma3 U-Blade Connector Gamma Connector Dyax-Asiatic Connector Omega Connector OHS /OCS Threaded Rod Gamma etc Threaded Rod Omega Threaded Rod OHS /OCS Spanner 17mm standard Instruments Extraction Instrument Lag Screw Nut 16

17 Ordering Information - Instruments REF Description Universal Emergency Screw Extraction Devices Tray Module 2 (Generic Sterilization and Storage Tray) Module 2 Fully Loaded Conical Extractor, male, small Conical Extractor, male, 2.5mm Conical Extractor, male, 3.5mm Conical Extractor, male, 4.0mm Conical Extractor, male, 5.0mm Crowndrill (Trephine), 3.0mm Crowndrill (Trephine), 4.0mm Crowndrill (Trephine), 5.0mm Crowndrill (Trephine), 6.5mm Crowndrill (Trephine), 8.0mm Crowndrill (Trephine), 10.0mm Crowndrill (Trephine), 12.0mm Conical Extractor, female, 3.0mm Conical Extractor, female, 4.0mm Conical Extractor, female, 5.0mm Conical Extractor, female, 6.3mm Drift Punch, 2.7mm Drift Punch, 3.7mm Drift Punch, 5.0mm Teardrop Handle, solid Extraction Hook (can also be stored in Module 1), small Extraction Hook (can also be stored in Module 1), large Forceps for Screw Removal, small Forceps for Screw Removal, large Optional Instruments Module 1 & Sharp Hook, Removal from bone material Osteotome, Removal from bone material Countersink 6mm, Preparing the cortex Countersink 8mm, Preparing the cortex Outer Introducer, Hansson Pin Inner Introducer, Hansson Pin Extractor, Hansson Pin Emergency Inner Extractor, Hansson Pin Extractor Handle, Hansson Twin Hook Outer Extractor, Hansson Twin Hook Inner Extractor, Hansson Twin Hook T-Handle, AO-medium, for AO medium bits: screwdriver - screw removal, conical - crowndrill - screw extraction, conical Screwdriver 2.5, Seidel Humerus Spreading Screw Gamma3 U-Blade Extractor Instruments * Please ask your Stryker sales representative for further information. 17

18 Notes 18

19 Notes 19

20 Stryker Trauma GmbH Prof.-Küntscher-Strasse 1 5 D Schönkirchen Germany This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product before using it in surgery. The information presented in this brochure is intended to demonstrate a Stryker product. Always refer to the package insert, product label and/or user instructions including the instructions for Cleaning and Sterilization (if applicable) before using any Stryker products. Products may not be available in all markets. Product availability is subject to the regulatory or medical practices that govern individual markets. Please contact your Stryker representative if you have questions about the availability of Stryker products in your area. Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trademarks or service marks: Stryker, Alta, Asnis, AxSOS, G&K, Gamma, IC Nails, Küntscher Nails, Numelock, OHS&OCS, S2, SCN, Seidel, T2, TLN, Zickel. All other trademarks are trademarks of their respective owners or holders. The products listed above are CE marked. Swemac Orthopaedics AB owns the following trademark: Hansson. Wacker-Chemie GmbH owns the following trademark: Elastosil. Literature Number : B LOT D4809 Copyright 2009 Stryker

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