Technique Guide Flexible Reamers for Intramedullary Nails. To facilitate the insertion of IM nails.
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
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): 540 546. 2 Synthes Flexible Reamers for Intramedullary Nails
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 351.706S/ 351.708S/ 351.709S 351.707S * Also available Synthes 3
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 351.717 351.719 4 Synthes Flexible Reamers for Intramedullary Nails
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 (510.161, 511.761) *Also available Synthes 5
Reduction 1 Reduction Instruments 351.15 Flexible Shaft Handle 352.040 5.0 mm Flexible Shaft, 470 mm 352.050 7.0 mm Reduction Head, straight or 352.055 7.0 mm Reduction Head, angled 351.706S 351.709S* 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
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
Confirm Nail Length 2 Confirm nail length and estimate canal size Instruments 351.717 Depth Gauge 351.719 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
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. 1150 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
Medullary Reaming 3 Medullary reaming Instruments 351.05 Tissue Protector 351.706S 351.709S* 2.5 mm Reaming Rod with ball tip, sterile (650 mm, 950 mm, 950 mm with extension, 1150 mm) 351.782 Holding Forceps 351.783 Removal Tool 352.040 5.0 mm Flexible Shaft, 470 mm or 352.044* 5.0 mm Flexible Shaft, 620 mm 352.085 8.5 mm Medullary Reamer Head 511.785* 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. 511.785 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
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
Cleaning Flexible Shaft 4 Cleaning flexible shaft Instrument 352.041 3.6 mm Cleaning Brush, 680 mm 352.045* 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
Instruments 351.05 Tissue Protector 351.15 Flexible Shaft Handle 351.706S* 351.708S* 351.709S* 2.5 mm Reaming Rod with ball tip, sterile 950 mm 1150 mm 650 mm 351.707S* 2.5 mm Reaming Rod with ball tip and extension, 950 mm, sterile 351.717 Depth Gauge 351.719 Depth Gauge Extension Tube *Also available Synthes 13
Instruments continued 351.782 Holding Forceps 351.783 Removal Tool 351.92 6.0 mm Hand Reamer 351.93 7.0 mm Hand Reamer 351.94 8.0 mm Hand Reamer 352.040 5.0 mm Flexible Shaft, 470 mm 352.044* 5.0 mm Flexible Shaft, 620 mm 352.041 3.6 mm Cleaning Brush, 680 mm 352.045* 3.6 mm Cleaning Brush, 830 mm 352.050 7.0 mm Reduction Head, straight 352.055 7.0 mm Reduction Head, angled *Also available 14 Synthes Flexible Reamers for Intramedullary Nails
352.085 Medullary Reamer Heads, 8.5 mm to 352.190 19.0 mm (0.5 mm increments) 355.006 Medullary Tube Note: Single sterilization only. Flexible Medullary Reamers, flat wire, 385 mm 359.106* 6.0 mm 359.107* 6.5 mm 359.108* 7.0 mm 359.109* 7.5 mm 359.110* 8.0 mm 393.10 Universal Chuck with T-Handle *Also available Synthes 15
Flexible Reamer Set for IM Nails (150.060) Graphic Case 690.382 Flexible Reamers for Intramedullary Nails Instrument Set Graphic Case Instruments 351.05 Tissue Protector 351.15 Flexible Shaft Handle, quick coupling, cannulated 351.717 Depth Gauge 351.719 Depth Gauge Extension Tube 351.782 Holding Forceps 351.783 Removal Tool, for use with Medullary Reaming Heads 351.92 6.0 mm Hand Reamer 351.93 7.0 mm Hand Reamer 351.94 8.0 mm Hand Reamer 352.040 5.0 mm Flexible Shaft, 470 mm, 2 ea. 352.041 3.6 mm Cleaning Brush, 680 mm 352.050 7.0 mm Reduction Head, straight 352.055 7.0 mm Reduction Head, angled 355.01 Medullary Tube 393.10 Universal Chuck with T-Handle Medullary Reamer Heads Length (mm) Length (mm) 352.085 8.5 352.140 14.0 352.090 9.0 352.145 14.5 352.095 9.5 352.150 15.0 352.100 10.0 352.155 15.5 352.105 10.5 352.160 16.0 352.110 11.0 352.165 16.5 352.115 11.5 352.170 17.0 352.120 12.0 352.175 17.5 352.125 12.5 352.180 18.0 352.130 13.0 352.185 18.5 352.135 13.5 352.190 19.0 Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer to http://us.synthes.com/medical+community/cleaning+and+sterilization.htm 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 DJ1304 16 Synthes Flexible Reamers for Intramedullary Nails
Also Available 351.16J Flexible Shaft Connector for Jacobs chuck, quick coupling, cannulated 351.706S 2.5 mm Reaming Rod with ball tip, 950 mm, sterile 351.707S 2.5 mm Reaming Rod with ball tip and extension, 950 mm, sterile 351.708S 2.5 mm Reaming Rod with ball tip, 1150 mm, sterile 351.709S 2.5 mm Reaming Rod with ball tip, 650 mm, sterile 352.044 5.0 mm Flexible Shaft, 620 mm 352.045 3.6 mm Cleaning Brush, 830 mm 511.761 Large Quick Coupling 511.785 Reduction Drive Unit Flexible Medullary Reamers, flat wire, 385 mm 359.106 6.0 mm 359.107 6.5 mm 359.108 7.0 mm 359.109 7.5 mm 359.110 8.0 mm Recommended Additional Sets 105.957 Power Drive Set 150.16 Compact Air Drive II Set Synthes
Synthes (USA) 1302 Wrights Lane East West Chester, PA 19380 Telephone: (610) 719-5000 To order: (800) 523-0322 Fax: (610) 251-9056 Synthes (Canada) Ltd. 2566 Meadowpine Boulevard Mississauga, Ontario L5N 6P9 Telephone: (905) 567-0440 To order: (800) 668-1119 Fax: (905) 567-3185 www.synthes.com 2003 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