TRIGEN TAN and FAN with SURESHOT
Contents
1. Retrograde IMSC Revision Standard Femoral Recon Locking Proximal Locking Screw Diameter Major Diameter Minor Diameter Shank Hex Size Alternative Hexdrivers Screw Color Screw Lengths Anteversion Location Proximal Dynamization Slot Proximal Screw Hole Dimensions Degree of Proximal Bend Location of Proximal Bend Standard 5 0mm Recon 6 4mm Standard 5 0mm Recon 6 4mm Standard 4 3mm Recon 4 7mm Standard N A Recon 6 3mm 4 7mm RT Femoral amp Recon 7 0mm Cannulated Screw PERI LOC Locking Screw Guide Standard Lock Gold Recon Lock Blue Standard 25 110mm Recon 65 125mm Recon Lock 12 Degrees 21 33 amp 47mm No Standard 5 3mm Recon 6 4mm N A N A Distal Locking Screw Diameter Major Diameter Minor Diameter core Screw Color Screw Lengths Location Orientation Dynamization Slot Distal Screw Hole Dimensions AP Bow Location of Distal Bend Dynamization Slot Location 5 0mm 5 0mm 4 3mm Gold 25 110mm 15 20 amp 40mm L M Yes 5 3mm Hybrid Bow Proximal 1 5 meters Distal 2 5 meters 100mm Distal Surgical Technique Patient positioning Place the patient in the supine or lateral decubitus position on a fracture table The foot of the affected limb is placed in a foot holder or a pin is inserted through the calcaneus for traction purposes The unaffected limb is extended below and away from the affected2. Attach the Percutaneous Drill Guide 7163 1021 to the nail with the Percutaneous Guide Bolt 7163 1024 and tighten with the Guide Bolt Wrench 7163 1140 and T handle 7167 4076 The nail is correctly aligned when 1 The apex of the nail s AP bow points anterior 2 The three proximal locking holes on the lateral side of the nail mirror the image depicted on the underside of the drill guide Example For a left 130 TAN orient the drop on the drill guide so that the two lime colored arrows indicating 130 TAN on its surface point towards the nail The Smith amp Nephew mark on the drop will face laterally Refer to SURESHOT User Manual for the Field Accuracy check instructions 22 Surgical procedure after IM Nail Assembly to the Drill Guide Probe connection Probe selection and ass embly Connect the probe to either of the probe sensor ports on the Trauma Interface Assemble the appropriate probe and set the stop for the TRIGEN IM Nail and Drill Guide that will be used CAUTION Proper orientation of the probe to the set stop as shown is required Failure to do so may result in inaccurate targeting TRIGEN SURESHOT Percutaneous TAN FAN Drill Guide Probe a elie SURESHOT Probe i TAN FAN Probe connected Confirm that the tool connection has been verified Green probe Note When oriented as shown the connector a A should assemble easily Do not force the Ao ad connector into the port Simpl
3. Location Proximal Dynamization Slot Proximal Screw Hole Dimensions Degree of Proximal Bend Location of Proximal Bend Standard 5 0mm Recon 6 4mm Standard 5 0mm Recon 6 4mm Standard 4 3mm Recon 4 7mm N A Recon 6 3mm 4 7mm RT Femoral amp Recon 7 0mm Cannulated Screw PERI LOC Locking Screw Guide Standard Lock Gold Recon Lock Blue Standard 25 110mm Recon 65 125mm Recon Lock 12 21 33 amp 47mm No Standard 5 3mm Recon 6 4mm 5 lateral 65mm AP bend Distal Locking Screw Diameter Major Diameter Minor Diameter core Screw Color Screw Lengths Location Orientation Dynamization Slot Distal Screw Hole Dimensions AP Bow Location of Distal Bend Dynamization Slot Location 5 0mm 5 0mm 4 3mm Gold 25 110mm 15 20 amp 40mm L M Yes 5 3mm Proximal 1 5 meters Distal 2 5 meters 100mm Distal Design features FAN 130 Femoral and Recon gt screw angles 12 of built in femoral neck anteversion for optimal proximal screw position Hybrid proximal distal AP gt Bow transition 1 5m 2 5m lt Straight proximal profile for ease Unique five hole of insertion proximal locking through the configuration allows piriformis fossa femoral or recon locking modes in one nail Color coded Lime left Rose right lt Cannulated round geometry for ease of insertion u
4. down to bone Perfect circles Align the tip of the drill sleeve over the desired hole in the nail This will be represented on the screen when the green circle is centered in the hole as shown Push serrated tip firmly against bone to keep the green circle static on the screen Note The orientation of the view is determined based on the orientation of the Targeter relative to the implant For example if the desired hole to target is an AP hole direct the Targeter generally on the Anterior side of the leg For more options please see section Trauma Interface Screen Operation Adjust the trajectory represented by red line between two circles of the red circle until both circles are concentric and centered with the desired hole on the screen Then start drilling Critical Verify there are no other metal objects including metal triangles in the field Metal interference will cause the system to be inaccurate i TANTAN La hae Hie ET oon n a ee hip ee p bm a wen TamTam Let i heen Note The green ring must be fully within the hole of the IM nail displayed on the Trauma Interface screen to ensure accurate drilling 31 32 Drilling distal hole Drill through near cortex and the nail using the TRIGEN SURESHOT 4 0mm Drill Bit 7169 2810 or 7169 2811 Before drilling through far cortex obtain the screw measurement Note Important if standard 4 0mm drill from TRIGEN set
5. in the lower left corner of the navigation screen Surgical procedure after IM Nail Assembly to the Drill Guide Drill sleeve attachment Tightly secure the selected drill sleeve to the Targeter Note The short long and long combo drill sleeves 7169 2805 7169 2804 and 7169 1166 can be loosened from the Targeter using the slot in the TRIGEN Hammer 7167 4082 25 1 Femoral locking mode 2 Recon locking mode 26 Verifying targeting accuracy Attach the Radiolucent Drop 7163 1022 to the drill guide to verify targeting accuracy The drop is etched with color coded markings to allow for accurate nail drill guide assembly Insert a 9 0mm Drill Sleeve 7163 1152 and 4 0mm Trocar Drill Sleeve 7163 1026 into the Percutaneous Drill Guide Pass a 4 0mm Long Pilot Drill 7163 1110 through the drill sleeves and nail Insert a 9 0mm Drill Sleeve into the appropriately color coded locking hole on the Radiolucent Drop Pass a 6 4mm Step Drill 7163 1160 through the drill sleeve and nail An incorrectly attached nail will not target With targeting accuracy confirmed remove the drop and any drill sleeves Nail insertion Note Detach set stop before attaching Impactor and inserting nail Orient the drill guide assembly in the AP plane and manually insert the nail into the intramedullary canal as far as possible If necessary attach the Cannulated Impactor Medium 7167 5081 to the drill guide and advanc
6. is below the level of the lesser trochanter Remove the 3 2mm Trocar and pass a 3 0mm Ball Tip Guide Rod 7163 1626 into the back of the T handle Remove the awl from the proximal femur The region of the proximal femur extending to the lesser trochanter must be enlarged to 14mm in order to accommodate the proximal geometry of a 10mm 11 5mm or 13mm TAN FAN nail If inserting a 14 5mm or 16mm FAN the proximal femur must be reamed to 17 5mm Note Intramedullary reamers should be used to prepare the proximal femur if the 144mm Channel Reamer is not used The entry point for the Cannulated Awl will differ depending on whether a TAN or FAN is being implanted The largest Reamer Head that the TRIGEN Base Instrument Tray can hold is 16mm Larger sizes are available in the SculptOR Reamer System 7111 8330 Instruments for tracture reduction and intramedullary reaming Entry Portal Tube Cat No 7167 4060 Entry Portal Handle Cat No 7167 4092 Ruler a eo 14mm Channel Reamer Gripper Cat No 7163 1039 Cat No 7167 4080 Obturator Cat No 7167 4078 GW T handle Reamer Heads Cat No 7167 4076 Cat No 7111 8231 to 7111 8256 Reamer Shaft Cat No 7111 8200 Reducer Cat No 7167 4077 TT 3 0mm x 1000mm Ball Tip Guide Rod Cat No 7163 1626 The largest Reamer Head that the TRIGEN Base Instrument Tray can hold is 16 0mm Larger sizes are available in the SculptOR Reamer Set 7111 8330 Fra
7. is used magnetic metal can adversely affect accuracy causing the drill to miss Verify there is no other magnetic metal object in area other than the items shown The standard 4 0mm drill cannot be used with the TRIGEN SURESHOT system A note will appear on screen warning of compromised targeting field if magnetic metal is close If it is in the field image disappears Drill depth measurement Refer to User Manual Page 16 and 17 for drill depth measurements screw insertion Using the TRIGEN SURESHOT Hexdriver 7169 2809 the screw may be inserted using the Targeter WARNING The standard TRIGEN Hexdrivers are made trom magnetic stainless steel that will cause interference with the system and cannot be used Using the Combo Drill Sleeve TRIGEN SURESHOT Inner Drill Sleeve Long Cat No 7169 1165 TRIGEN SURESHOT Outer Screw Sleeve Long Cat No 7169 1166 Mi While holding the Targeter to bone remove the SURESHOT Inner Drill Sleeve Long 7169 1165 from the SURESHOT Outer Screw Sleeve Long 7169 1166 Use the TRIGEN SURESHOT Hexdriver 7169 2809 to insert the appropriate length screw through the SURESHOT Outer Screw Sleeve Long When screw insertion is complete remove the probe from the IM nail NO CD 33 34 Instruments for proximal locking 4 0mm Trocar Drill Sleeve Cat No 7163 1026 4 0mm Trocar Cat No 7163 1191 Percutaneous Drill
8. limb or flexed and placed in a leg holder Check the affected limb for length and rotation by comparison to the unaffected limb Abduct the torso 10 15 to allow clear access to the intramedullary canal Rotate the C Arm to ensure optimal AP and lateral visualization of the entire femur Note If using a radiolucent table a distraction device may be helpful in reducing the fracture Warnings and cautions for TRIGEN SURESHOT Refer to the SURESHOT User Manual 7118 1540 for all warnings cautions maintenance cleaning and sterilization instructions Devices for system set up o Trauma Interface Cat No 7169 2802 Power Cord Cat No 6680 0193 TRIGEN SURESHOT Targeter Cat No 7169 2801 Note The Targeter will be operated within the Sterile field and may have contact with the skin of the patient The drill sleeve inserts will be used in the incision and have direct bone contact Note Verify that the Targeter housing is not damaged holes tears cracks If the housing or the connector is damaged the Targeter is no longer safe to use Note If the Targeter is not recognized after connection to the system the Targeter is defective and must be exchanged See also instrument connection Note Broken or damaged instruments must be exchanged immediately and sent back to Smith amp Nephew Inc Note This device is provided non sterile and must be cleaned and sterilized per Cleaning and St
9. 130 130 130 130 130 130 130 130 130 13mm Diameter Nails 30cm 50cm Left Lime 7164 7430 7164 7432 7164 7434 7164 7436 7164 7438 7164 7440 7164 7442 7164 7444 7164 7446 7164 7448 7164 7450 Right Rose 7164 8430 7164 843 2 7164 8434 7164 8436 7164 8438 7164 8440 7164 8442 7164 8444 7164 8446 7164 8448 7164 8450 Length 30 32 34 36 38 40 42 44 46 48 50 Contained in the standard implant set Neck Angle 130 130 130 130 130 130 130 130 130 130 130 Catalog information TRIGEN TAN and FAN Implants TRIGEN TAN Femoral Antegrade Nails Set No 7163 1337 10mm Diameter Nails 30cm 50cm Left Lime 7163 4230 7163 4232 7163 4234 7163 4236 7163 4238 7163 4240 Right Rose 7163 5230 7163 5232 7163 5234 7163 5236 7163 5238 7163 5240 Length Neck Angle 30 130 32 130 34 130 36 130 38 130 40 130 11 5mm Diameter Nails 30cm 50cm Left Lime 7163 4330 7163 4332 7163 4334 7163 4336 7163 4338 7163 4340 13mm Diameter Nails Left Lime 7163 4430 7163 4432 7163 4434 7163 4436 7163 4438 7163 4440 Right Rose 7163 5330 7163 5332 7163 5334 7163 5336 7163 5338 7163 5340 Right Rose 7163 5430 7163 5432 7163 5434 7163 5436 7163 5438 7163 5440 Length Neck Angle 30 130 32 130 34 130 36 130 38 130 40 130 30cm 50cm Len
10. 67 4075 Entry Portal Handle 7167 4092 and Entry Portal Tube sei 7167 4060 The pieces will lock in place securely at either 0 or 180 A longitudinal incision is made proximal to the greater trochanter Carry the incision through to the fascia and palpate the tip of the greater trochanter The optimal entry point for the Trochanteric i Antegrade Nail TAN is located lateral to the tip LA of the greater trochanter approximately 5 from s the anatomical axis in the AP and in line with the intramedullary canal in the lateral view rA i _ its a i KA Ld a i aa i Li 1 A ee demnm mm o A The entry point for the FAN is in line with the center of the intramedullary canal in both the AP b and the lateral views The entry point is slightly pe posterior in the top view shown although this varies with patient anatomy This surgical technique is written from the Trochanteric Antegrade Nail TAN perspective The Femoral Antegrade Nail FAN technique changes with respect to nail entry point and insertion technique Entry portal acquisition Insert the Entry Portal Instrumentation through the incision down to bone Attach a 3 2mm x 343mm Brad Point Drill Tip Threaded Guide Pin 7167 4130 to power via the Mini Connector 7163 1186 and insert 2 3cm into the trochanteric region Avoid over insertion of the guide pin as this can establish a false trajectory and lead to
11. 7163 1066 Medium Hexdriver 7163 1068 Short Hexdriver 7163 1116 12 5mm Entry Reamer 7163 1140 Guide Bolt Wrench 7163 1152 9 0mm Drill Sleeve 7163 1161 Multipurpose Driver 7163 1186 Mini Connector 7163 1189 Screw Depth Gauge 7167 4000 Cannulated Awl 7167 4060 Entry Portal Tube 7167 4074 3 2mm T handle Trocar 7167 4075 Honeycomb Instrument Set pictured with additional instruments Tray Qty lea lea lea lea 2 ea lea lea lea lea lea lea lea Cat No 7167 4076 7167 4077 7167 4078 7167 4079 7167 4080 7167 4082 7167 4083 7167 4084 7167 4085 7167 4092 7167 5081 A ey Ol Description T handle Reducer Obturator Ruler Gripper Slotted Hammer 4 0mm Drill Sleeve Screwdriver Release Handle Screw Length Sleeve Entry Portal Handle Cannulated Impactor Medium Tray Qty lea lea lea lea lea lea 2 ea lea lea lea lea Catalog information TRIGEN TAN and FAN Instruments TRIGEN Percutaneous TAN and FAN Instrument Set Set No 7163 2351 Instrument Case Cat No Description 7163 1027 Percutaneous Instrument Tray 7163 1028 Percutaneous Instrument Lid Instruments Cat No Description 7163 1021 Percutaneous Drill Guide 7163 1022 Radiolucent Drop 7163 1039 14mm Channel Reamer 7163 1024 Percutaneous Guide Bolt 7163 1036 Sterile 6 4mm Tap Disposables Set No 7163 1000 Cat No 7163 1035 7163 1320 7163 1121 Description Sterile 6 4mm Drill TRIGEN Disposable Nail Ex
12. Guide Cat No 7163 1021 9 0mm Drill Sleeve Cat No 7163 1152 j Screw Depth Gauge Cat No 7163 1189 Radiolucent Drop Cat No 163 1022 T handle Cat No 7167 4076 i EE Screwdriver Release Medium Hexdriver Cat No 7167 4084 Cat No 7163 1066 it iene Long Hexdriver ae Cat No 7163 1070 A Cat No 7163 1186 4 0mm Long Pilot Drill Cat No 7163 1110 6 4mm Tap Cat No 7163 1036 Not included in the TRIGEN Base Instrument Set 7167 4012 4 0mm AO Long Drill 7163 1121 is interchangeable with 4 0mm Long Pilot Drill 7163 1110 Note Make sure to remove probe before proximal locking Proximal locking Standard femoral locking Slide the 4 0mm Trocar 7163 1191 into the 4 0mm Drill Sleeve Trocar 7163 1026 and insert into a 9 0mm Drill Sleeve 7163 1152 Make a small incision at the site of screw entry and insert the trocar sleeve assembly through the hole on the drill guide and down to bone Attach the 4 0mm Long Pilot Drill 7163 1110 to power via the Mini Connector 7163 1186 remove the trocar from the drill sleeve assembly and drill both cortices Measure for screw length using either the calibrations on the 4 0mm Long Pilot Drill or by removing the Drill Sleeve Trocar and using the Screw Depth Gauge 7163 1189 Note The 4 0mm Drill Sleeve Trocar must be against the lateral cortex for accurate locking screw length measurement Attach the appr
13. Instrument Tray Lid Other TRIGEN SURESHOT Instruments Cat No Description Qty 7169 1165 Inner Drill Sleeve Long 1 7169 1166 Outer Screw Sleeve Long 1 TRIGEN SURESHOT Targeting Disposables Set Set No 7165 7002 Cat No Description Qty 7169 2810 AO Drill Bit Short 2 7169 2811 AO Drill Bit Long 1 Additional Disposable Description Percutaneous TAN FAN Drill Guide Probe used with TRIGEN Percutaneous TAN FAN Instrument Set 7163 2351 47 48 TRIGEN SURESHOT Country Kit North America Cat No 7165 7003 Cat No Description Qty 6680 0193 Power Cord 125 Volt 10 Amp North 1 America Hospital Grade 7118 1927 User Manual English 1 Additional Country Kits TRIGEN SURESHOT Country Kit Australia Cat No 7165 7004 Cat No Description Qty 6680 0303 Power Cord 250 Volt 10 Amp 1 Australia NZ 7118 1927 User Manual English 1 TRIGEN SURESHOT Country Kit Continental Europe Cat No 7165 7005 Cat No Description Qty 6680 0291 Power Cord 250 Volt 10 Amp 1 Continental Europe 7118 1927 User Manual English 1 TRIGEN SURESHOT Country Kit Germany Cat No 7165 7006 Cat No Description Qty 6680 0291 Power Cord 250 Volt 10 Amp 1 Continental Europe 7118 1538 User Manual German 1 TRIGEN SURESHOT Country Kit Spain Cat No 7165 7007 Cat No Description Qty 6680 0291 Power Cord 250 Volt 10 Amp 1 Continental Europe 7118 1539 User Manual Spanis
14. TRIGEN TAN FAN Trochanteric and Femoral Antegrade Intramedullary Nails Including TRIGEN SURESHOT Distal Targeting System Indications rr r LL 2 TRIGEN TAN and FAN case examples 4 Design features AN sree cscs ccuecets ccucecesedseederesedtorinarscusestedeotcaonesseavestdeneoens 5 Implant specifications TAN cccccccccscccccescesccsecsseeseesecsssssecseesssesseseeseees 6 DSS OS SAN spctecronieinaceccacceepantenteddectouy vente idda 7 Implant specifications FAN 8 Surgical Technique eee ccceeccceeeeceteeecseeeeceeseeeeseseeeeseaeeeeseeeeeateeee 9 Patient ST RIR xgaitipa st ina ska a unnu 9 Konana E O a N 14 Entry portal acquisition 0 et rr 15 Alternative technique Entry portal 16 eae ORS TO Osaka gn a a HR as 18 Reducer removal DANIR RUN 18 Implant measurement 19 Preparing CAN ell ote rectciaacticmnct stageyaseeabs nanna ng ba 19 Unreamed technique ccccccccccccscesccsssesccsccsessssesecsscsssssessesssseessesseeaees 20 NASN aos ctcccctssecas oct recttescener sccteabi cesses nan a aan au i 22 INGA SaS AT ER RE santas 26 GIS CI FAN E S ia E EEEE 27 Nail anteversion ne na 28 Proximal IOCKINE cenaa EE NE 35 Standard femoral locking 2 0 0 cece ccecceeseesceecseeseescesceeseeseeecseeseeseeeeseeseees 35 RECOM OCIS css arses E E EN EEOAE E AE EEEE 36 BIREN aa AAA i E A T 38 Nail cap insertion Optional 0 0 ccc c
15. al Captured Screw Gold For 10mm 11 5mm 13mm 14 5mm and 16mm Implants Cat No Length Cat No Length 7164 2225 25mm 7164 2270 70mm 7164 2230 30mm 7164 2275 75mm 7164 2235 35mm 7164 2280 80mm 7164 2240 40mm 7164 2285 85mm 7164 2245 45mm 7164 2290 90mm 7164 2250 50mm 7164 2295 95mm 7164 2255 55mm 7164 2200 100mm 7164 2260 60mm 7164 2205 105mm 7164 2265 65mm 7164 2210 110mm 6 4mm Captured Recon Screw Blue Set No 7163 1341 Cat No Length Cat No Length 7164 2365 65mm 7164 2300 100mm 7164 2370 70mm 7164 2305 105mm 7164 2375 75mm 7164 2310 110mm 7164 2380 80mm 7164 2315 115mm 7164 2385 85mm 7164 2320 120mm 7164 2390 90mm 7164 2325 125mm 7164 2395 95mm TRIGEN Nail Caps Cat No Length Cat No Length 7163 4000 Omm 7163 4015 15mm 7163 4005 smm 7163 4020 20mm 7163 4010 10mm Contained in the standard implant set Cat No 7169 2815 Catalog information TRIGEN SURESHOT Instruments TRIGEN SURESHOT Targeting Interface Cat No 7165 7000 Cat No Device Case Qty 7169 2802 Trauma Interface 1 TRIGEN SURESHOT Targeting Instrument Set Set No 7165 7001 Cat No Description Tray Qty 7169 2801 Targeter 7169 2804 Drill Sleeve Long 7169 2805 Drill Sleeve Short 7169 2806 META Set Stop 7169 2807 TAN Set Stop 7169 2808 Field Accuracy Gauge 7169 2809 Hexdriver Es 7169 2816 TAN Anteversion Locking Guide zE 7169 2830 Targeting Instrument Tray e ee 7169 2831 Targeting
16. cture reduction Insert the back end of the 3 0mm Ball Tip Guide Rod 7163 1626 into the front end of the Gripper 7167 4080 and gently close the trigger grip Connect the Reducer and Reducer Connector 7167 4077 so that the words Slot Orientation are in line with the opening at the tip Complete the Reducer assembly by connecting it to the T handle 7167 4076 Introduce the Reducer into the intramedullary canal through the channel reamer and Entry Portal Instrumentation Care should be taken to maintain fracture reduction Pass the ball tip guide rod through the back of the T handle and insert to the desired depth using the Reducer s curved tip to avoid any areas of comminution The guide rod should be center center in the AP and lateral views Reducer removal Once the guide rod is in position detach the Gripper and remove the Reducer from the intramedullary canal Slide the Obturator 7167 4078 into the back of the T handle during extraction in order to maintain guide rod position within the canal Implant measurement After Reducer removal reconfirm guide rod position in the distal femur Advance the Ruler 7167 4079 over the guide rod through the Channel Reamer 7163 1039 and Entry Portal Instrumentation to the desired depth The bottom of the Ruler s metal tip denotes the driving end of the nail Note Fractures should be treated with the longest nail possible in order to reduce the likelihood of
17. e the nail over the guide rod using light blows from the Slotted Hammer 7167 4082 As the distal tip of the nail reaches the isthmus of the canal rotate the drill guide to the lateral position Insert the nail to the desired depth Verify fracture reduction as the nail crosses the fracture site paying close attention to rotation length alignment distraction and shortening After nail insertion confirm that the nail and drill guide are securely connected as hammering can loosen the guide bolt Note If excessive force is required to implant the nail it may be necessary to ream the intramedullary canal additionally 4 Omm AO Long Drill 7163 1121 is interchangeable with 4 0mm Long Pilot Drill 7163 1110 Orient the drill guide assembly in the lateral plane for FAN nail insertion Check nail depth Proximal Insert the nail until its driving end is at or below the top of the greater trochanter Each gauge on the insertion barrel represents a 10mm depth interval Femoral locking mode Attach the AP Alignment Tower 7163 1025 to the drill guide and slide the back end of the AP Alignment Arm 7163 1015 into the tower Under fluoroscopy the center portion of the alignment arm indicates the path of the 5 0mm locking screw through the trochanteric region 27 28 Recon locking mode Attach the alignment tower to the drop and Slide the back end of the alignment arm into the tower Under fluoroscopy the parallel s
18. ece ccc cesccseceeecectsecnesesteseeseenes 38 Implant 519 5 URI RV NR 40 Guide rod jamming technique 000e0eerenrenrrererrrrerr 41 Catalog information 2 0 cece cee eceeeeseeeeeeseeeeseeeeseesteeeaeeeeseeeeaees 42 Nota Bene The technique description herein is made available to the healthcare professional to illustrate the authors suggested treatment for the uncomplicated procedure In the final analysis the preferred treatment is that which addresses the needs of the patient Indications The TRIGEN TAN and FAN intramedullary nails are indicated for fractures of the femur including intertrochanteric basi transcervical femoral neck fractures and subtrochanteric fractures ipsilateral femoral neck shaft fractures stable and unstable shaft fractures segmental fractures nonunions and malunions polytrauma reconstructions following tumor resection and bone lengthening and shortening TRIGEN SURESHOT indications Legend Important warnings appear in orange Tips tricks and important information appear in blue Indications contraindications intended use and training The Smith amp Nephew TRIGEN SURESHOT Distal Targeting System is intended to be an intraoperative image guided localization system It is a computer assisted orthopaedic surgery tool to aid the surgeon with drill positioning for screws during intramedullary nail implantation It provides information to the surgeon that is used
19. eparation The SURESHOT Targeter will change color to orange upon successful connection to the Trauma Interface CAUTION The Targeter body may have contact with the patient and must remain in the sterile field at all times Only the cable and connector may be removed from the sterile field CAUTION Connect the Targeter at least 10 minutes prior to targeting in order to ensure proper accuracy Note When oriented as shown the connector should assemble easily Do not force the connector into the port Note If the Targeter is properly connected to the system and the application remains in this screen for more than 30 seconds the Targeter may have been damaged during cleaning sterilization In this case another Targeter has to be used Note It is possible at any time to disconnect and reconnect tools when the application is running The display will show a screen reporting the missing instrument Instruments for opening the proximal femur 3 2mm x 343mm Brad Point Drill Tip Threaded Guide Pin Cat No 7167 4130 a Honeycomb Entry Portal Tube Cat No 7167 4075 Cat No 7167 4060 12 5mm Entry Reamer Cat No 7163 1116 3 2mm T handle Trocar Toana Cat No 7167 4074 Cat No 7167 4076 Cannulated Awl Cat No 7167 4000 Mini Connector Cat No 7163 1186 Entry Portal Handle Cat No 7167 4092 14mm Channel Reamer Cat No 7163 1039 Incision and entry point Assemble the Honeycomb 71
20. erilization Smith amp Nephew document 7138 1339 prior to use Note Verify version 2 0 2 or higher is installed before using Sureshot with TAN FAN Nails To find the software version select MENU gt About WARNING The maximum temperature of the Targeter body can reach 47 Celsius at ambient room temperatures above 30 C The Targeter body should not remain in constant contact with a patient s exposed skin for more than one minute Surgical procedure OR preparation Trauma Interface setup Atter the sterile areas have been established place the Trauma Interface 7169 2802 in the desired non sterile location and turn on the power switch CAUTION No other electrical devices should be placed near the Trauma Interface See the Guidance and Manufacturer s Declaration Separation Distances table at the end of this document Note If the Trauma Interface does not power on make sure the switch is in the on position Note The means for mains disconnection of power to the Trauma Interface is the appliance inlet located below the power switch The Trauma Interface should not be positioned such that it is difficult to reach this location TRIGEN SURESHOT Targeter connection When the display prompts for tool connections connect the TRIGEN SURESHOT Targeter 7169 2801 to the Targeter port on the Trauma Interface SURESHOT Probe SURESHOT Tarpeter nel found mot found Surgical procedure OR pr
21. fracture malalignment Confirm guide pin placement in the AP and lateral planes Note In the instance of suboptimal guide pin placement rotate the Honeycomb within the Entry Portal Tube to the desired location and insert another 3 2mm guide pin Following guide pin placement remove the Honeycomb from the Entry Portal Tube along with any additionally inserted guide pins Insert the 12 5mm Entry Reamer 7163 1116 into the 14mm Channel Reamer 7163 1039 until it clicks and attach to power Advance the assembly through the Entry Portal Instrumentation 2 3cm into the trochanteric region Evaluate reamer position before proceeding Adjust the trajectory of the reamer assembly if desired and advance to the positive stop on the Entry Portal Tube The channel reamer will stop just below the level of the lesser trochanter If the Entry Portal Instrumentation is not used the channel reamer must still be advanced to the same point Confirm the reamer assembly s final position in both the AP and lateral planes Detach and remove the 12 5mm Entry Reamer from the 14mm Channel Reamer Note The channel reamer and Entry Portal Instrumentation will serve as a soft tissue protector Alternative technique Entry portal Attach the T handle 7167 4076 to the Cannulated Awl 7167 4000 and insert the 3 2mm T handle Trocar 7167 4074 into the back of the assembly Introduce the awl into the proximal femur at the designated entry point until it
22. gth Neck Angle 30 130 32 130 34 130 36 130 38 130 40 130 14 5mm Diameter Nails 36cm 44cm Left Lime 7164 4536 7164 4538 7164 4540 Right Rose 7164 5536 7164 5538 7164 5540 Length Neck Angle 36 130 38 130 40 130 16mm Diameter Nails 36cm 44cm Left Lime 7164 4636 7164 4638 7164 4640 Right Rose 7164 5636 7164 5638 7164 5640 Length Neck Angle 36 130 38 130 40 130 Contained in the standard implant set Left Lime 7163 4242 7163 4244 7163 4246 7163 4248 7163 4250 Left Lime 7163 4342 7163 4344 7163 4346 7163 4348 7163 4350 Left Lime 7163 4442 7163 4444 7163 4446 7163 4448 7163 4450 Left Lime 7164 4542 7164 4544 Left Lime 7164 4642 7164 4644 Right Rose 7163 5242 7163 5244 7163 5246 7163 5248 7163 5250 Right Rose 7163 5342 7163 5344 7163 5346 7163 5348 7163 5350 Right Rose 7163 5442 7163 5444 7163 5446 7163 5448 7163 5450 Right Rose 7164 5542 7164 5544 Right Rose 7164 5642 7164 5644 Length 42 44 46 48 50 Length 42 44 46 48 50 Length 42 44 46 48 50 Length 42 44 Length 42 44 Neck Angle 130 130 130 130 130 Neck Angle 130 130 130 130 130 Neck Angle 130 130 130 130 130 Neck Angle 130 130 Neck Angle 130 130 45 TRIGEN TAN Trochanteric Antegrade Nails Set No 7163 1236 5 0mm Intern
23. h 1 Catalog information TRIGEN SURESHOT Instruments TRIGEN SURESHOT Country Kit Italy Cat No 7165 7009 Cat No Description Qty 6680 0291 Power Cord 250 Volt 10 Amp 1 Continental Europe 7118 1536 User Manual Italian 1 TRIGEN SURESHOT Country Kit United Kingdom Cat No 7165 7011 Cat No Description Qty 6680 0213 Power Cord 250 Volt 10 Amp UK 1 7118 1927 User Manual English 1 TRIGEN SURESHOT Country Kit South Africa India Cat No 7165 7012 Cat No Description Qty 6680 0302 Power Cord 250 Volt 10 Amp 1 So Africa India 7118 1927 User Manual English 1 49 50 Notes 91 Smith amp Nephew Inc 7135 Goodlett Farms Parkway www smith nephew com Cordova TN 38016 USA Telephone 1 901 396 2121 Information 1 800 821 5700 Orders Inquiries 1 800 238 7538 2014 Smith amp Nephew Inc All rights reserved Trademark of Smith amp Nephew Certain marks Reg US Pat amp TM Off 01360 V1 71181611 REVB 01 14
24. king is performed in the lateral plane using a free hand technique Reconfirm fracture reduction and align the C Arm over the desired locking hole Obtain a perfect circle image of the locking hole and use a blunt object to approximate the location of the locking hole by dimpling the skin Make a stab incision at the site of screw entry insert the 4 0mm Short Drill 7163 1117 down to bone and drill both cortices Measure for screw length using the Screw Depth Gauge 7163 1189 Alternatively leave the 4 0mm Short Drill in place insert the Screw Length Sleeve 7167 4085 down to bone and read the exposed calibrations off the drill Insert the appropriate length 5 0mm locking screw using either the Medium or Short Hexdriver 7163 1068 and T handle Nail cap insertion Optional Remove the Percutaneous Drill Guide and Radiolucent Drop Attach the selected nail cap to the Medium Hexdriver and T handle and insert into the top of the nail until tight Note If cross threading occurs rotate the nail cap counterclockwise until its threads line up with those of the nail Proceed with insertion until tight 4 0mm AO Short Drill 7163 1123 is interchangeable with 4 0mm Short Drill 7163 1117 38 Instruments for implant removal IS Medium Hexdriver Mini Connector Cat No 7163 1066 Cat No 7163 1186 12 5mm Entry Reamer Cat No 7163 1116 Disposable Nail Extractor Cat No 7163 1320 Cannulated Impac
25. lots and threaded screw tips of the alignment arm indicate the position of both 6 4mm recon locking screws in the femoral neck and head Distal Verify center center placement of the nail in the distal femoral metaphysis in both the AP and lateral planes Note Remove the 3 0mm Ball Tip Guide Rod Nail anteversion With the C Arm in the lateral position rotate the drill guide until it transects the nail and is center center in the femoral neck and head When using the TRIGEN SURESHOT system to distally lock TAN FAN nails the Anteversion Locking Guide 7169 2816 is used to provisional lock the proximal fragment to the nail Attach TAN Anteversion Locking Guide 7169 2816 to the Percutaneous Drill Guide 7163 1021 Insert 4 0mm Long Drill 7163 1121 and drill deep enough into bone to hold anteversion position Note Anteversion Locking Guide places the drill in the bone just anteriorly to the nail Devices to lock distally oe e 8 Trauma Interface Cat No 7169 2802 Power Cord Cat No 6680 0193 Inner Drill Sleeve Long Cat No 7169 1165 Outer Screw Sleeve Long Cat No 7169 1166 Drill Sleeve Long Cat No 7169 2804 un Drill Sleeve Short Cat No 7169 2805 Percutaneous TAN FAN Drill Guide Probe Cat No 7169 2815 Note When the Targeter is out of the preferred range or there is metal or electrical interference the green and red Targeter circles on the Trauma I
26. m Drill Sleeve Attach the 6 4mm Step Drill 7163 1035 to power and drill to the depth measured for the 6 4mm recon locking screw The calibration on the drill will be flush with the back of the drill sleeve Leave the step drill in place and repeat the process for the superior locking screw Note It is recommended to monitor all drilling under fluoroscopy to avoid penetration of the acetabulum Attach the appropriate length 6 4mm recon locking screw to the Medium Hexdriver and T handle Remove the inferior 6 4mm Step Drill and insert the locking screw through the 9 0mm Drill Sleeve Do not tighten definitively Repeat the process for the superior Recon locking screw using the Long Hexdriver 7163 1070 and T handle Release any traction and tighten both locking screws definitively Not included in the TRIGEN Base Instrument Set 7167 4012 Instruments for distal locking without the use of the TRIGEN SURESHOT system Screw Depth Gauge Cat No 7163 1189 SPER BSE PRB 4 0mm Short Drill Cat No 7163 1117 T handle Cat No 7167 4076 Medium Hexdriver Cat No 7163 1066 Screwdriver Release Cat No 7167 4084 Short Hexdriver Cat No 7163 1068 Mini Connector Cat No 7163 1186 Screw Length Sleeve Cat No 7167 4085 4 0mm AO Short Drill 7163 1123 is interchangeable with 4 0mm Short Drill 7163 1117 37 Distal locking without the TRIGEN SURESHOT system Distal loc
27. nal Hex Captured Locking Screws TRIGEN Trochanteric Antegrade Nail TAN specifications ma From 130 bone shaft centerline Standard Femoral Lock 130 135 TAN From bone shaft centerline Recon Lock 12 Anteversion 130 135 TAN 10 11 5 amp 13mm 130 135 TAN Distal Lock M L view Proper Screw Measurement All TRIGEN locking screw measuring devices measure from bottom of head to the last complete thread of screw This is the working length of the screw Thus the screw itself is longer than the measurement and adding length is not necessary Note These views are not to scale and should be used as a pictorial representation only Specifications TRIGEN TAN Nail Material Diameter Lengths Nail Color Left Nail Color Right Cross Section Neck Angle Proximal Diameter driving end Distal Diameter non driving end Smallest Thru Diameter Wall Thickness Guide Bolt Thread Alternative Guide Bolts Removal only Alternative Modes TI6AL4V 10 11 5 amp 13mm 30 50cm Lime Rose Round 130 135 13mm 10 11 5 amp 13mm diameter of the nail 5 4mm 2 3mm 10 diameter 3 0mm 11 5 diameter 2 3mm 13 diameter 5 16 24 RT Tibial Retrograde IMSC Revision Standard Femoral Recon Locking Proximal Locking Screw Diameter Major Diameter Minor Diameter Shank Hex Size Alternative Hexdrivers Screw Color Screw Lengths Anteversion
28. nterface screen may become unstable and or a warning message will be displayed If the interference is excessive the IM nail image on the Trauma Interface screen will disappear If interference cannot be avoided a standard X Ray technique must be used Note All tool cables should be uncoiled completely and any excess cables should be kept out of the Targeter measurement volume TRIGEN SURESHOT Targeter Cat No 7169 2801 AO Drill Bit Short Cat No 7169 2810 AO Drill Bit Long Cat No 7169 2811 Hexdriver Cat No 7169 2809 TAN Set Stop Cat No 7169 2807 29 30 Detach Cannulated Impactor Medium 7167 5081 from drill guide Reattach TAN Set Stop 7169 2807 and insert Percutaneous TAN FAN Drill Guide Probe 7169 2815 in the nail Adjust probe to nail length Skin incision Use serrated tip of Drill Sleeve to identify where to make incision The tip is at the right position when the green circle is aligned with the desired hole on screen Make incision and place tip of the drill sleeve down to bone where the green circle is aligned directly over the hole on screen Note No X Rays necessary Frk Casa TANIFAN Lol 5 mm Br shot Targeting the locking hole With the appropriate length TRIGEN SURESHOT 4 0mm Drill Bit 7169 2810 or 7169 2811 inserted into the Targeter insert the tip of the drill sleeve represented by the green circle through the incision and
29. opriate length 5 0mm locking screw to the end of the Medium Hexdriver 7163 1066 and insert through the 9 0mm Drill Sleeve on power until the laser etched ring on the hexdriver reaches the back of the drill sleeve Attach the T handle 7167 4076 to the hexdriver and tighten the locking screw by hand 4 0mm AO Long Drill 7163 1121 is interchangeable with 4 0mm Long Pilot Drill 7163 1110 36 Recon locking After confirming nail insertion depth and femoral neck anteversion make two small incisions at the site of screw entry Insert a 9 0mm Drill Sleeve 4 0mm Drill Sleeve Trocar and 4 0mm Trocar into the inferior most recon locking hole on the Radiolucent Drop 7163 1022 and down to bone Repeat the process for the superior locking hole Remove the 4 0mm Trocar from the inferior trocar sleeve assembly Attach the 4 0mm Long Pilot Drill to power via the Mini Connector and drill to the desired depth in the femoral neck and head Leave the 4 0mm drill in place and repeat the process for the superior trocar sleeve assembly Measure for screw length using the calibrations on the 4 0mm Long Pilot Drill Note The 4 0mm Drill Sleeve Trocar must be against the lateral cortex for accurate locking screw measurement Note As the 9 0mm Drill Sleeve is inserted through the Radiolucent Drop rotating the Sleeve back and forth will allow for easier insertion Remove the 4 0mm drill and drill sleeve trocar from the inferior 9 0m
30. proper use or more rarely technical failure To reduce the risks involved with such technical malfunction the operation can be completed using manually controlled instruments providing the malfunction is detected without delay It is therefore important to check the plausibility of the steps as indicated by the system and to carry out verification of the software targeting particularly when using the system for the first time Should there be any doubt regarding correct functioning the targeting should be verified or a switch made to a traditional X Ray technique Refer to the SURESHOT User Manual 7118 1540 for details about the SURESHOT Distal Targeting System TRIGEN TAN and FAN Nail case examples Case 1 Preoperative Postoperative Case 2 Preoperative Postoperative Design features TAN 130 Femoral and 130 gt _ 135 Recon screw angles 5 lateral offset for minimally pe Unique five hole invasive 12 of built in femoral proximal locking trochanteric neck anteversion for configuration allows entry optimal proximal screw femoral or recon position locking modes in one nail Hybrid proximal distal AP gt Color coded Bow transition 1 5m 2 5m Lime left Rose right lt Cannulated round geometry for ease of insertion using reamed or unreamed technique lt Static and dynamic gt distal locking configuration using 5 0mm TRIGEN Inter
31. sing reamed or unreamed technique lt Static and dynamic distal locking configuration using 5 0mm TRIGEN Internal Hex Captured Locking Screws TRIGEN Femoral Antegrade Nail FAN specifications From bone shaft centerline Standard Femoral Lock 130 standard FAN Exchange Recon Lock 12 Anteversion 130 standard FAN Exchange Distal Lock 130 standard FAN Exchange Proper Screw Measurement All TRIGEN locking screw measuring devices measure from bottom of head to the last complete thread of screw This is the working length of the screw Thus the screw itself is longer than the measurement and adding length is not necessary Note These views are not to scale and should be used as a pictorial representation only Specifications TRIGEN FAN Nail Material Diameter Lengths Nail Color Left Nail Color Right Cross Section Neck Angle Proximal Diameter driving end Distal Diameter non driving end Smallest Thru Diameter Wall Thickness Guide Bolt Thread Alternative Guide Bolts Removal only Alternative Modes TI6AL4V 10 11 5 13 14 5 amp 16mm 30 50cm 36 44cm Lime Rose Round 130 13mm 10 11 5 amp 13 diameter 14 5mm 14 5 diameter 16mm 16 diameter 10 11 5 13 14 5 amp 16mm diameter of the nail 5 4mm 2 3mm 10 diameter 3 0mm 11 5 diameter 2 3mm 13 diameter 2 3mm 14 5 diameter 2 4mm 16 diameter 5 16 24 RT Tibial
32. stress risers Confirm guide rod position in the window at the proximal end of the Ruler as shown in order to ensure accurate implant measurement Push down on the top of the Ruler until contact is made with the guide rod Implant length is read from the exposed calibrations near the thumbwheel on the Ruler Note Confirm fracture reduction so as not to underestimate correct implant length Reference the fibula for accurate fracture distraction or compression Note Confirm that the Ruler opens easily Adjust the thumb wheel connection at the end to allow for free movement Preparing the canal Beginning with the 9 0mm End Cutting Reamer Head 7111 8231 and Flexible Reamer Shaft 7111 8200 ream the intramedullary canal sequentially in half millimeter increments to a size 1 1 5mm larger than the selected nail diameter Ensure guide rod position during reaming by inserting the Obturator into the back of the reamer unit during retraction Continue to contirm guide rod position throughout reaming Periodically move the reamer back and forth in the canal to clear debris from the cutting flutes Note The channel reamers will not accommodate reamer heads larger than 12 5mm The largest Reamer Head that the TRIGEN Base Instrument Tray can hold is 16 0mm Larger sizes are available in the SculptOR Reamer Set 7111 8330 20 Unreamed technique Radiographic templating is used to determine nail size The appropria
33. te diameter implant will provide translational fill within the isthmus of the intramedullary canal Generally selection of a nail approximately 1 1 5mm less than the narrowest canal measurement on the lateral radiograph assists in avoiding implant incarceration during insertion TRIGEN TAN TRIGEN FAN Preoperative Template Preoperative Template Cat No 7118 0884 Cat No 7118 0497 Instruments for nail assembly and insertion AP Alignment Arm Cat No 7163 1015 B AP Alignment Tower Cat No 7163 1025 e Percutaneous Guide Bolt Cat No 7163 1024 Percutaneous Drill Guide Cat No 7163 1021 T handle Cat No 7167 4076 Slotted Hammer Cat No 7167 4082 Guide Bolt Wrench Cannulated Impactor Medium Cat No 7163 1140 Cat No 7167 5081 9 0mm Drill Sleeve 4 0mm Trocar Drill Sleeve Cat No 7163 1152 Cat No 7163 1026 6 4mm Step Drill Radiolucent Drop Cat No 7163 1160 Cat No 7163 1022 a 4 0mm Long Pilot Drill Cat No 7163 1110 AO Drill Bit Long TAN Anteversion Locking Guide Cat No 7169 2811 pictured with drill Cat No 7169 2816 Percutaneous TAN FAN Drill Guide Probe Cat No 7169 2815 TAN Set Stop Cat No 7169 2807 The Cannulted Impactor Medium 7167 5081 is interchangeable with the Cannulated Impactor Long 7163 1185 4 0mm AO Long Drill 7163 1121 is interchangeable with 4 0mm Long Pilot Drill 7163 1110 21 Nail assembly
34. to place surgical instruments during surgery utilizing intraoperatively obtained electromagnetic tracking data The Smith amp Nephew TRIGEN SURESHOT Targeting System is indicated for long bone fractures treated with intramedullary nails in which the use of stereotactic surgery may be appropriate An example of a surgical procedure includes but is not limited to locating and drilling the distal holes in an intramedullary nail Contraindications The screw targeting software application for this system is contraindicated for all IM nails other than Smith amp Nephew TRIGEN META NAIL TAN FAN Humeral Pediatric and Adolescent nails Do not operate the TRIGEN SURESHOT Targeter within 200mm of an installed pacemaker The magnetic field produced by the Targeter may interfere with the operation of the pacemaker Intended use The TRIGEN SURESHOT Distal Targeting System is only designed for use with the indicated implants and instruments Implants and instruments must be used in accordance with the instructions as described in this manual and or in the non navigated surgical procedure Training Only trained operators are allowed to use the TRIGEN SURESHOT Distal Targeting System The various operating instructions must be fully read and understood as part of the training If any part of the instructions is unclear please contact your local representative Plausibility check As with all technical equipment malfunctions may occur due to im
35. tor Medium Cat No 7167 5081 Cannulated Impactor Long Cat No 7163 1185 Slotted Hammer Cat No 7167 4082 T handle Cat No 7167 4076 A TT 3 0mm x 1000mm Ball Tip Guide Rod Cat No 7163 1626 Brad Point Drill Tip Threaded Guide Pin Cat No 7167 4130 The Cannulated Impactor Long is found in the original TRIGEN Instrument Set 7163 1326 39 40 Implant removal Optional Open nail extraction technique Remove the nail cap if implanted and all but one of the locking screws using the Medium Hexdriver 7163 1066 and T handle Thread the Disposable Nail Extractor 7163 1320 into the Cannulated Impactor Medium or Cannulated Impactor Long 7163 1185 and introduce the extraction assembly into the top of the nail Remove the final locking screw s and extract the nail with a back slapping motion using the Slotted Hammer Percutaneous nail extraction technique This technique assumes the absence of a nail cap Attach a 3 2mm x 343mm Brad Point Drill Tip Threaded Guide Pin to power via the Mini Connector and insert into the top of the nail under fluoroscopy This may also be performed manually Attach the 12 5mm Entry Reamer 7163 1116 to power Make a one inch incision around the guide pin and advance the entry reamer over the guide pin and into the top of the nail to remove bony in growth Nail extraction follows the previously described technique Note The tip of the entry reamer is s
36. tractor 4 0mm Long AO Pilot Drill Tray Qty 1 ea 1 ea 1 ea 2 ea 1 ea Tray Qty 1 ea 1 ea 2ea Cat No 7163 1026 7163 1191 7163 1025 7163 1015 Cat No 7163 1123 7163 1626 7167 4130 Description 4 0mm Trocar Drill Sleeve 4 0mm Trocar AP Alignment Tower AP Alignment Arm Description 4 0mm Short AO Pilot Drill 3 0mm X 1000mm Ball Tip Guide Rod 3 2mm X 343mm Tip Threaded Guide Pin Tray Qty 2 ea lea 1 ea lea Tray Qty 2 ea 2 ea 3 ea 43 44 Catalog information TRIGEN TAN and FAN Implants TRIGEN TAN Trochanteric Antegrade Nails Set No 7163 1236 10mm Diameter Nails 30cm 50cm Left Lime 7164 7230 7164 7232 7164 7234 7164 7236 7164 7238 7164 7240 7164 7242 7164 7244 7164 7246 7164 7248 7164 7250 Right Rose 7164 8230 7164 8232 7164 8234 7164 8236 7164 8238 7164 8240 7164 8242 7164 8244 7164 8246 7164 8248 7164 8250 Length 30 32 34 36 38 40 42 44 46 48 50 Neck Angle 130 130 130 130 130 130 130 130 130 130 130 11 5mm Diameter Nails 30cm 50cm Left Lime 7164 7330 7164 7332 7164 7334 7164 7336 7164 7338 7164 7340 7164 7342 7164 7344 7164 7346 7164 7348 7164 7350 Right Rose 7164 8330 7164 8332 7164 8334 7164 8336 7164 8338 7164 8340 7164 8342 7164 8344 7164 8346 7164 8348 7164 8350 Length 30 32 34 36 38 40 42 44 46 48 50 Neck Angle 130 130
37. traight for approximately one inch before flaring out It is this portion of the entry reamer that enters the top of the nail The Cannulated Impactor Long is found in the original TRIGEN Instrument Set 7163 1326 Guide rod jamming technique Advance the end of a 3 0mm Ball Tip Guide Rod through the end of the nail Insert a 2 0mm Smooth Guide Rod 7111 8280 in the same manner With both guide rods in place attach the Gripper to the end of the 3 0mm Ball Tip Guide Rod and pull it back so that it wedges the ball tip against the 2 0mm Smooth Guide Rod Backslap against the Gripper with the Slotted Hammer to extract the nail Guide rods Cat No Description 7111 8280 2 0mm x 900mm Smooth RUSSELL TAYLOR System 7111 8202 3 0mm x 900mm Ball Tip RUSSELL TAYLOR System 7163 1626 3 0mm x 1000mm Ball Tip TRIGEN System Additional removal items Cat No Description 115074 Large Extractor Hook 115073 Small Extractor Hook 914658 Large Easy Out 914659 Small Easy Out Available sterile packed For nail removal only do not use for nail insertion Located in RUSSELL TAYLOR Extraction Kit Set 7508 available through Loaners 4 Catalog information TRIGEN TAN and FAN Instruments TRIGEN Base Instrument Set Set No 7167 4012 Instrument Case Cat No Description 7112 9401 Small Outer Case 7112 9402 Lid for Outer Case 7167 4021 TRIGEN Base Tray Instruments Cat No Description
38. y try rotating the 7163 1021 connector until the keys are oriented in the 12 o clock position Set the probe to the length of the TRIGEN IM Nail Note If the probe is properly connected to the system and the application reports Probe not found for more than 10 seconds the probe may be damaged or defective In this case the probe has to be exchanged Note It is possible at any time to disconnect and reconnect tools when the application is running The display will show a screen reporting the missing instrument For TAN FAN notches should face medially 23 24 Surgical procedure atter IM Nail Assembly to the Drill Guide Drill sleeve selection Implant selection screen Select the length of the drill sleeve 7169 2804 Select the TRIGEN IM Nail and size that will be 7169 2805 or 7169 1165 and 7169 1166 that will used be used TAN FAN F hiss T his Drill Sleeve Selection Implant Selection Lorg Combo Long TEMAM A different sleeve can be selected at any time Tian during the procedure by choosing the drill sleeve Implant Selection option from the drop down menu OR by pressing Sn the drill sleeve tab located in the lower right corner of the navigation screen TANSFAN Loft Implant Selection TAN Agolomcond Note A different TRIGEN IM Nail and or size can be selected at any time during the procedure by choosing the Implant option from the drop down menu OR by pressing the implant tab located
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