Technique Guide. Flexible Reamers for Intramedullary Nails. To facilitate the insertion of IM nails.

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1 Technique Guide Flexible Reamers for Intramedullary Nails. To facilitate the insertion of IM nails.

2 Table of Contents Introduction Flexible Reamers for Intramedullary Nails 2 Surgical Technique Reduction 6 Confirm Nail Length 8 Medullary Reaming 10 Cleaning the Flexible Shaft 12 Product Information Instruments 13 Set List 16 Image intensifier control Synthes

3 Flexible Reamers for Intramedullary Nails The thin flexible shaft and deeply fluted reamer heads are designed to help reduce intramedullary pressure and increase flow of bone chips and marrow during reaming. 1 Single shaft to drive all reamer heads Reamer heads are coupled to the shaft without hand contact with the reamer head Smooth shaft allows easy cleaning Ball of 2.5 mm reaming rod will fit through the cannulation of all Synthes nail connecting screws 1. C. A. Muller, R. Schavan, R. Frigg, S. M. Perren. Intramedullary pressure increase for different commercial and experimental reaming systems: an experimental investigation. Journal of Orthopedic Trauma. 12 (1998): Synthes Flexible Reamers for Intramedullary Nails

4 5.0 mm Flexible Shaft Available in 470 mm and 620 mm* lengths 5.0 mm shaft is made of Nitinol, a nickel-titanium alloy with superelastic properties Single shaft for all reamer sizes Can be driven forward or reverse Smooth shaft allows easy cleaning Couples with reduction drive Cannulated 2.5 mm Reaming Rod with ball tip Available sterile in 650 mm*, 950 mm*, 1150 mm*, and 950 mm with an extension* Secures connection between the reamer head and the flexible shaft Helps to guide the flexible shaft past the reduced fracture S/ S/ S S * Also available Synthes 3

5 Flexible Reamers for Intramedullary Nails continued 7.0 mm Reduction Heads, straight or angled Attach to flexible shaft Help reduce fractures and aid in passage of reaming rod Must be used with the 2.5 mm reaming rod Holding Forceps Used to insert and maintain placement of reaming rod in the medullary canal Depth Gauge and Depth Gauge Extension Tube Used to determine nail length and estimate canal size Depth gauge used with 650 mm reaming rod Depth gauge and extension tube used with 950 mm and 1150 mm length reaming rod Synthes Flexible Reamers for Intramedullary Nails

6 Hand Reamers, 6.0 mm, 7.0 mm, 8.0 mm In sclerotic medullary canals, the hand reamers may be used prior to insertion of the reaming rod 450 mm length Medullary Reamer Heads Sizes from 8.5 mm to 19.0 mm, in 0.5 mm increments 8.5 mm reamer head is front-cutting, all other sizes are side-cutting Flexible Medullary Reamers* Sizes from 6.0 mm to 8.0 mm, 385 mm length Couple with Jacobs chuck and Synthes large quick couplings ( , ) *Also available Synthes 5

7 Reduction 1 Reduction Instruments Flexible Shaft Handle mm Flexible Shaft, 470 mm mm Reduction Head, straight or mm Reduction Head, angled S S* 2.5 mm Reaming Rod with ball tip, sterile (650 mm, 950 mm, 950 mm with extension, and 1150 mm) *Also available 6 Synthes Flexible Reamers for Intramedullary Nails

8 Assemble one of the reduction heads onto the 5.0 mm flexible shaft (A). A Attach the shaft to the flexible shaft handle (B). Insert the smooth end of a 2.5 mm reaming rod (C) into the tip of the 7.0 mm reduction head until the ball tip touches the reduction head (D). Insert the reduction system into the medullary cavity and reduce the fragments. After reduction has been achieved, remove the reduction assembly and leave the reaming rod in the canal. Advance the reaming rod to the desired depth of implant. B C D Synthes 7

9 Confirm Nail Length 2 Confirm nail length and estimate canal size Instruments Depth Gauge Depth Gauge Extension Tube Assemble the depth gauge extension tube to the depth gauge. Note: To measure the nail length when the 650 mm reaming rod is used, the extension tube is not required. 8 Synthes Flexible Reamers for Intramedullary Nails

10 Place the depth gauge assembly over the 2.5 mm reaming rod. The tip of the extension tube, or the depth gauge, should be positioned at the desired location of the proximal end of the implant. 650 mm and 950 mm reaming rods Read the nail length at the end of the reaming rod on the scale of the depth gauge mm reaming rod Read the nail length at the mark on the reaming rod. Use the depth gauge to estimate the size of the medullary canal. Place the depth gauge across the limb at the level of the isthmus. Move the depth gauge until the tab fills the canal. Synthes 9

11 Medullary Reaming 3 Medullary reaming Instruments Tissue Protector S S* 2.5 mm Reaming Rod with ball tip, sterile (650 mm, 950 mm, 950 mm with extension, 1150 mm) Holding Forceps Removal Tool mm Flexible Shaft, 470 mm or * 5.0 mm Flexible Shaft, 620 mm mm Medullary Reamer Head * Reduction Drive Unit Use the reduction drive unit to attach the flexible shaft to the compact air drive or power drive. To begin reaming, attach the front-cutting, 8.5 mm medullary reamer head to the flexible shaft. To attach the reamer head, insert the tip of the flexible shaft into the cannulation of the reamer head in the tray Notes: The tray holds a complete set of reamer heads and allows the flexible shaft to attach directly onto the reamer head without hand contact. Reaming must always be performed over a 2.5 mm reaming rod. The 2.5 mm reaming rod secures the connection between the reamer head and the flexible shaft. A 3.0 mm reaming rod cannot be used. The tissue protector may be used to protect the soft tissue during reaming. Move the reamer back and forth while reaming to help remove bone chips from the reamer head. *Also available 10 Synthes Flexible Reamers for Intramedullary Nails

12 After reaming, withdraw the reamer shaft from the canal until the reamer head is visible. To prevent loss of reduction, grasp the reaming rod at the canal entry point and hold the reaming rod in place using the holding forceps. The reamer head can be removed from the flexible shaft with the removal tool. Place the reamer head in the slot on the side of the removal tool. Hold the removal tool with one hand while pulling on the flexible shaft with the other. The reamer head will detach from the shaft. Use additional reamer heads for subsequent reaming. Reaming to the desired diameter is typically performed in 0.5 mm increments. Leave the 2.5 mm reaming rod in position for insertion of the cannulated nail. Note: The 2.5 mm ball tip reaming rod can be passed through the cannulation of all Synthes titanium nails and respective instruments. When used with other nailing systems, the cannulation of the nail connecting screw must be larger than 3.5 mm. Synthes 11

13 Cleaning Flexible Shaft 4 Cleaning flexible shaft Instrument mm Cleaning Brush, 680 mm * 3.6 mm Cleaning Brush, 830 mm The 3.6 mm cleaning brush is used to clean the cannulation of the flexible shaft. Note: The cleaning brush cannot be autoclaved. *Also available 12 Synthes Flexible Reamers for Intramedullary Nails

14 Instruments Tissue Protector Flexible Shaft Handle S* S* S* 2.5 mm Reaming Rod with ball tip, sterile 950 mm 1150 mm 650 mm S* 2.5 mm Reaming Rod with ball tip and extension, 950 mm, sterile Depth Gauge Depth Gauge Extension Tube *Also available Synthes 13

15 Instruments continued Holding Forceps Removal Tool mm Hand Reamer mm Hand Reamer mm Hand Reamer mm Flexible Shaft, 470 mm * 5.0 mm Flexible Shaft, 620 mm mm Cleaning Brush, 680 mm * 3.6 mm Cleaning Brush, 830 mm mm Reduction Head, straight mm Reduction Head, angled *Also available 14 Synthes Flexible Reamers for Intramedullary Nails

16 Medullary Reamer Heads, 8.5 mm to mm (0.5 mm increments) Medullary Tube Note: Single sterilization only. Flexible Medullary Reamers, flat wire, 385 mm * 6.0 mm * 6.5 mm * 7.0 mm * 7.5 mm * 8.0 mm Universal Chuck with T-Handle *Also available Synthes 15

17 Flexible Reamer Set for IM Nails ( ) Graphic Case Flexible Reamers for Intramedullary Nails Instrument Set Graphic Case Instruments Tissue Protector Flexible Shaft Handle, quick coupling, cannulated Depth Gauge Depth Gauge Extension Tube Holding Forceps Removal Tool, for use with Medullary Reaming Heads mm Hand Reamer mm Hand Reamer mm Hand Reamer mm Flexible Shaft, 470 mm, 2 ea mm Cleaning Brush, 680 mm mm Reduction Head, straight mm Reduction Head, angled Medullary Tube Universal Chuck with T-Handle Medullary Reamer Heads Length (mm) Length (mm) Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer to or to the below listed inserts, which will be included in the shipping container: Processing Synthes Reusable Medical Devices Instruments, Instrument Trays and Graphic Cases DJ1305 Processing Non-sterile Synthes Implants DJ Synthes Flexible Reamers for Intramedullary Nails

18 Also Available J Flexible Shaft Connector for Jacobs chuck, quick coupling, cannulated S 2.5 mm Reaming Rod with ball tip, 950 mm, sterile S 2.5 mm Reaming Rod with ball tip and extension, 950 mm, sterile S 2.5 mm Reaming Rod with ball tip, 1150 mm, sterile S 2.5 mm Reaming Rod with ball tip, 650 mm, sterile mm Flexible Shaft, 620 mm mm Cleaning Brush, 830 mm Large Quick Coupling Reduction Drive Unit Flexible Medullary Reamers, flat wire, 385 mm mm mm mm mm mm Recommended Additional Sets Power Drive Set Compact Air Drive II Set Synthes

19 Synthes (USA) 1302 Wrights Lane East West Chester, PA Telephone: (610) To order: (800) Fax: (610) Synthes (Canada) Ltd Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) To order: (800) Fax: (905) Synthes, Inc. or its affiliates. All rights reserved. Synthes is a trademark of Synthes, Inc. or its affiliates. Printed in U.S.A. 5/10 J4557-F

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