Surgical technique. End Cap for TEN. For axial stabilization and simultaneous protection of soft tissue.

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1 Surgical technique End Cap for TEN. For axial stabilization and simultaneous protection of soft tissue.

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3 Table of contents Indications and contraindications 3 Implants 4 Instruments 4 Preoperative planning 5 Surgical technique 6 Bibliography 8 Image intensifier Warning This description is not sufficient for immediate application of the instrumentation. Instruction by a surgeon experienced in handling this instrumentation is highly recommended. Synthes End Cap for TEN 1

4 End Cap for TEN. For axial stabilization and simultaneous protection of soft tissue. Description The end cap prevents the TEN from sliding back. The rounded end parts also optimally protect soft tissue. Features / Design The diameter of the cannulation of the end cap is 4.4 mm. The large area, self-tapping spongiosa thread is 11.0 mm long and provides firm anchoring in the metaphysis. The back-cutting flutes enable the end cap to be easily removed. Benefits The end cap ensures that the TEN does not slide back through the insertion site. The repositioning and length of the bone are thereby retained until healing is complete, and leg shortening is prevented. The end cap also provides protection against painful soft-tissue irritation. The end cap can be introduced in a minimally invasive manner without additional enlargement of the incision or drilling. Using the end cap makes it easier to extract the nail. 2 Synthes End Cap for TEN

5 Indications and contraindications Indication Unstable shaft fractures in the femur and tibia. a The end cap is designed for a nail diameter of 3.0 to 4.0 mm. Relative contraindications Combined with a nail diameter smaller than 3.0 mm. Cases Long spiral fracture of the proximal femur diaphysis (a) accident picture, postoperative, before removing the metal (x-rays by Dr. Th. Slongo, Pediatrics Clinic, Inselspital Bern) accident postoperative before metal removal before metal removal Long oblique fracture at the transition from the middle to distal third of the femur diaphysis (b). Accident picture, intraoperative, postoperative, before metal removal. b (x-rays by Dr. Th. Slongo, Pediatrics Clinic, Inselspital Bern) accident accident intraoperative intraoperative postoperative postoperative before metal removal before metal removal 3

6 Implants and instruments Implants The end cap for TEN comes in one size. It is designed for use with nails 3.0 to 4.0 mm in diameter. The end cap is made of TAN End Cap for TEN mm Instruments In addition to the TEN instrument set, an additional special instrument is necessary for inserting the end cap Screwdriver Shaft for End Cap TEN. Used in combination with the TEN inserter to insert the end cap Inserter for TEN. Included in the TEN instrument set. 4 Synthes End Cap for TEN

7 Preoperative planning 1 Opening the bone Required instruments Awl for TEN When opening the cortical bone with the awl, make sure that the diameter of the nail insertion site corresponds to the outer diameter of the insertion section of the end cap. Note: Rotate the awl by at least 180 to provide an adequate hole for the nail and the end cap. >180 The titanium elastic nail is then implanted following the TEN surgical technique ( ). 2 Preparing the instruments and implant Required instruments Inserter for TEN Screwdriver Shaft for End Cap TEN Insert the screwdriver shaft into the inserter and tighten it. Then mount the end cap. 5

8 Surgical technique 1 Positioning the titanium elastic nail Required instruments Impactor for TEN, bevelled Hammer, 500 g After the nail has been inserted and its length adapted, it is placed in its final position with the impactor. The bevelled portion of the impactor faces the bone. The end of the nail extends 10 mm out of the bone. The nail is not bent. Both of these facts enable the end cap to be optimally positioned and fixed, and the nail can be easily removed after healing. Note: If the nail end extends out of the bone by more than 10 mm, the end cap cannot be sufficiently fixed. In this case, the nail must be shortened. 6 Synthes End Cap for TEN

9 2 Implanting the end cap Required instruments Inserter for TEN Screwdriver Shaft for End Cap TEN The end cap is guided over the end of the nail up to the bone and then screwed in. Note: The part of the threads close to the bone must be completely introduced into the bone. Radiological monitoring with the image intensifier 3 Remove the metal Required instruments Inserter for TEN Screwdriver Shaft for End Cap TEN Extraction Pliers, for TEN Optional instruments Awl for TEN Hammer 500 g Guide Rod for TEN Slide Hammer 400 g, can be mounted When removing the nail, first remove the end cap using the screwdriver shaft. If a great deal of scar tissue has grown over the end cap, remove the scar tissue with the awl or rasp, and invert the screwdriver shaft over it (with light hammer blows if necessary). Then remove the nail with the extraction pliers. 7

10 Bibliography Schmittenbecher Peter P, Dietz Hans Georg, Linhart Wolfgang E, Slongo Theddy; Complications and Problems in Intramedullary Nailing of Children s Fractures; European Journal of Trauma 2000, No. 6 Jubel A, Andermahr J, Isenberg J, Schiffer G, Prokop A, Rehm K. E.; Experience with elastic stable intramedullary nailing (ESIN) of shaft fractures in children (article in German); Der Orthopäde 2004; 33: Synthes End Cap for TEN

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12 Presented by: Ö öAA-ä SE_ AA Synthes 2006 Printed in Switzerland Subject to modifications.