TRIGEN META-NAIL Semi-extended Instrument Set
Contents
1. I Ez EE en erh T o l ha SU S Es o ny ars SM 8 LP Ak en IE O TIT w Reamed technique L va amava ABE Use radiographic templating to determine Figure 22 TRIGEN META NAIL Tibial Nail nail size Radiographic Template Cat No 7118 0810 Use the 9 0mm Front Cutting Reamer Head 7111 8231 and Flexible Reamer Shaft 7111 8200 to ream the intramedullary canal sequentially in half millimeter increments to a size 1 0 1 5mm larger than the selected nail size Figure 23 To ensure Guide Rod placement during reaming insert the Obturator 7167 4078 into the back of the Reamer unit during retraction Continue to confirm Guide Rod placement in the distal tibia throughout reaming Note Periodically move the reamer back and forth in the canal to clear debris trom the cutting flutes Figure 23 NO Use the Semi extended Guide Bolt 7165 4525 Attach the META NAIL Anterior Drop Nail assembly to attach the META NAIL Semi extended Drill Guide Bolt Guide 7165 4524 to the nail Tighten with the Guide Bolt Wrench 7163 1140 and T handle The nail is correctly aligned when s META Nail E TY Semi extended The vertical black line on the posterior side of the insertion barrel aligns with the line on the posterior side of the nail Drill Guide The A on the anterior side of the nail aligns with the A on the anterior side of the in2. Figure 37 Note If there are screws in the other proximal holes the fracture cannot be compressed Note Use fluoroscopy to check dynamic screw position when compressing the fracture compressed lock the nail with up to three additional proximal static screws while the Anterior Drop is still attached to the drill guide Note If the Compression Driver is progressed after the fracture is fully compressed the locking screw will begin to bend In extreme gt cases where excess force is applied the screw may break upon removal Figure 37 u Nail Cap Set Screw method Lock the nail distally then fully insert the dynamic locking screw as previously described Remove the Drill Guide Anterior Drop assembly Insert the Nail Cap Set Screw 7165 6000 into the top of the nail and advance with the Medium Hexdriver T handle assembly until the fracture is compressed and the Nail Cap Set Screw has fully engaged the locking screw Figures 38a and 38b Note If there are screws in the other proximal holes the fracture cannot be compressed Note Use fluoroscopy to check dynamic screw position when compressing the fracture Figure 38a Figure 38b Note For information on the use of Blocking Screws refer to the TRIGEN META NAIL Tibial Nail Surgical Technique 7118 1610 Nail extraction optional Standard technique If implanted remove the Nail Cap or Nail Cap Set Screw by using the Medium Hexdri
3. Lid for Outer Case TRIGEN Base Tray Medium Hexdriver Short Hexdriver 12 5mm Entry Reamer Guide Bolt Wrench 9 0mm Drill Sleeve Multipurpose Driver Mini Connector Screw Depth Gauge Cannulated Awl Entry Portal Tube 3 2mm T handle Trocar Honeycomb T handle Reducer Reducer Connector Qty EF E E E d E NN ES ES d E E Cat Item 7167 4078 7167 4079 7167 4080 7167 4081 7167 4082 7167 4083 7167 4084 7167 4085 7167 4092 7167 1212 7111 8200 7163 1130 7164 1123 7163 1121 7167 1123 7167 4130 7163 1070 7175 1153 7163 1187 Description Obturator Ruler Gripper Impactor Slotted Hammer 4 0mm Drill Sleeve Screwdriver Release Handle Screw Length Sleeve Entry Portal Handle TRIGEN Reamer Set Optional SCULPTOR Flexible Reamer Optional Flexible Reamer Extender Optional TRIGEN 4 0 Diaphyseal Drill 4 0mm Long AO Pilot Drill 333mm Disposable 4 0mm Short AO Pilot Drill 161mm Disposable 3 2mm x 343mm Brad Point Tip Guide Pin Disposable Long Hexdriver Optional AO Mini Connector Optional Trinkle to Mini Connector Optional Qty 2 2 222 Do gt gt gt gt d Instrument Set Set No 7165 4002 Cat Item 7165 4501 7165 4502 7165 4503 7165 4505 7165 4506 7165 4520 7165 4554 7163 1025 Description META NAIL Anterior Drop META NAIL Drill Guide META NAIL Extension Drill Guide Extension Guide Bolt 23mm Guide Bolt Long 51mm Long Screw Length Sleeve Cannul
4. close attention to rotation length alignment distraction and or shortening of the affected limb Check the final nail position in both the AP and lateral views to confirm correct alignment Note To obtain provisional fixation of the proximal tibial fragments reattach the Anterior Drop and insert the gold 9 0mm Drill Sleeve 7163 1152 and silver 4 0mm Drill Sleeve 7167 4083 into one of the two Blocking Screw holes in the Drop then pass a 4 0mm Long Pilot Drill 7163 1110 through the drill sleeves The 4 0mm Long Pilot Drill 7163 1110 is interchangeable with 4 0mm AO Long Drill 7163 1121 Figure 27 Check nail depth Check the proximal nail depth In the lateral view confirm nail position by observing the nail drill guide junction Figure 28 Note If compression or dynamic locking is desired countersink the nail approximately 10mm in order to avoid implant prominence Check the distal nail depth In the AP and lateral views confirm that the nail has been inserted to the desired depth Figure 28 Figure 29 Note Optimal insertion depth which will allow room for screw insertion below the fracture is essential Distal third tibial fractures require at least two locking screws to maintain stability Remove the Guide Rod once the nail is fully seated Reattach the Anterior Drop Following nail insertion confirm that the nail and drill guide are securely connected Hammering can loosen t
5. tibial nailing approach outlined in the article below Tornetta P 3rd Collins E Semiextended position of intramedullary nailing of the proximal tibia Clin Orthop Relat Res 1996 Number 328 pp 185 189 Introduction The following technique is for informational and educational purposes only It is not intended to serve as medical advice It is the responsibility of treating physicians to determine and utilize the appropriate products and techniques according to their own clinical judgement for each of their patients For more information on the TRIGEN META NAIL Tibial Nail System including its indications for use contraindications and product safety information please refer to the product s label the Instructions for Use REF 81068703 packaged with the product and if using the TRIGEN SURESHOT Distal Targeting System the TRIGEN SURESHOT Distal Targeting System User Manual REF 7118 1540 The TRIGEN META NAIL Tibial Nail System is designed specifically to repair fractures of the proximal and distal thirds of the tibia including the shaft stable and unstable fractures nonunions malunions and for the prophylactic nailing of impending pathological fractures The META NAIL System can be used with or without the SURESHOT Distal Targeting System If using the SURESHOT Distal Targeting System be sure to read and understand the TRIGEN SURESHOT Distal Targeting System User Manual REF 7118 1540 Only trained operat
6. 341 41cm 7165 5342 42cm 7165 5343 43cm 7165 5344 44cm 7165 5346 46cm 7165 5348 48cm 7165 5350 50cm Contained in the standard implant set 24 Notes Notes Notes Caution U S Federal law restricts these devices to sale by or on the order of a physician Smith amp Nephew Inc www smith nephew com 1450 Brooks Road Telephone 1 901 396 2121 Memphis TN 38116 Information 1 800 821 5700 USA Orders Inquiries 1 800 238 7538 2015 Smith amp Nephew Trademark of Smith amp Nephew Certain marks Reg US Pat amp TM Off 01361 V3 71181612 REVC 05 15
7. 7163 1185 into the back of the Disposable Nail Extractor 7163 1320 Thread the assembly into the top of the nail Ln ON 7 Remove the remaining proximal locking screw CO Extract the nail with a back slapping motion Figure 41 An alternative method for extraction Guide rod jamming technique 1 Advance the end of a 3 0mm Ball Tip Guide Cuide rode Rod through the end of the nail Cat No Description 2 Insert the smooth end of a 2 0mm Ball Tip 7163 1626 3 0mm x 1000mm Ball Tip Guide Rod Guide Rod 7175 1146 in the same manner 7175 1146 2 0mm x 600mm Ball Tip Guide Rod 3 With both guide rods in place attach the Gripper to the end of the 3 0mm Ball Tip Ao alar Guide Rod Cat No Description 4 Pull the Gripper back so that it wedges the ball 115074 Large Extractor Hook tip against the 2 0mm Guide Rod 115073 Small Extractor Hook Ln Backslap against the Gripper with the Slotted Hammer to extract the nail Available sterile packed For nail removal only do not use for nail insertion Located in RUSSELL TAYLOR Extraction Kit Set 7508 available through Loaners Catalog intormation TRIGEN Base Instrument Set Set No 7167 4012 Cat Item 7112 9401 7112 9402 7167 4021 7163 1066 7163 1068 7163 1116 7163 1140 7163 1152 7163 1161 7163 1186 7163 1189 7167 4000 7167 4060 7167 4074 7167 4075 7167 4076 or 7167 4576 7167 4077 7167 4077 20 Description Small Outer Case
8. 7165 5026 26cm 7165 5036 36cm 7165 5028 28cm 7165 5037 37cm 7165 5029 29cm 7165 5038 38cm 7165 5030 30cm 7165 5039 39cm 7165 5031 31cm 7165 5040 40cm 7165 5032 32cm 7165 5041 41cm 7165 5033 33cm 7165 5042 42cm 7165 5034 34cm Contained in the standard implant set 23 TRIGEN META NAIL 10mm Tibial TRIGEN META NAIL 11 5mm Tibial Set No 7165 3000 Set No 7165 3001 Cat Item Length Cat Item Length 7165 5124 24cm 7165 5224 24cm 7165 5126 26cm 7165 5226 26cm 7165 5128 28cm 7165 5228 28cm 7165 5129 29cm 7165 5229 29cm 7165 5130 30cm 7165 5230 30cm 7165 5131 31cm 7165 5231 31cm 7165 5132 32cm 7165 5232 32cm 7165 5133 33cm 7165 5233 33cm 7165 5134 34cm 7165 5234 34cm 7165 5135 35cm 7165 5235 35cm 7165 5136 36cm 7165 5236 36cm 7165 5137 37cm 7165 5237 37cm 7165 5138 38cm 7165 5238 38cm 7165 5139 39cm 7165 5239 39cm 7165 5140 40cm 7165 5240 40cm 7165 5141 41cm 7165 5241 41cm 7165 5142 42cm 7165 5242 42cm TRIGEN META NAIL 13mm Tibial Nail Cap Set Screw hei Cat Item Length Cat Item 7165 6000 7165 5318 18cm 7165 5320 20cm 7165 5322 22cm 7165 5324 24cm 7165 5326 26cm IM l j id H H p 7165 5328 28cm i Hi 7165 5329 29cm 7165 5330 30cm 7165 5331 31cm TRIGEN Nail Caps 7165 5332 32cm Cat Item Length 7165 5333 33cm 7163 4000 Omm 7165 5334 34cm ae 7165 5335 35cm 7165 5336 36cm 7163 4010 10mm 7165 5337 37cm 7163 4015 15mm 7165 5338 38cm 7163 4020 20mm 7165 5339 39cm 7165 5340 40cm 7165 5
9. TRIGEN META NAIL Semi extended Instrument Set Table of contents T ee Re T 3 TRIGEN META NAIL Tibial Nail Specifications 4 Surgical Technique esse esse an eee serene eenn 5 Patient positioning ee een 5 Prepare the Entry TUDO iii 5 Incision and entry point Lateral subluxation of the patella 6 Entry portal acquisitiON oooconoccnoconoconinonaconanonanonanionarnos 7 Enty DOMAL sie i ea e 7 Alternative technique Entry Gora 8 Reduce the Trachure ss ennenzenzznnennnnenznnnnnnnnen nn nn zna 9 Determine the implant length 00 ss ss ee 10 Unreamed technique o ocooccocococccoccnoconcccnncconanonoronononononananoninonos 11 Reamed techniaue ss sseneenennznnnnznznnnzz nanna rna r ratata 11 Nal ass etorri 12 Nail insertion ooooonooniccnccnnccnononcccononaconnnononononanonoconnnnnornnonncinnos 13 CHECR SS 14 Lock INE We ee nee 15 PrOXIM AL oe ia een 16 Proximal locking Compression eee ee 17 Nail extraction phong 18 An alternative method for extraction o on 19 Catalog information oonnncnnnccnonoconccnonanonnnonccnonanonanonos 20 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 The technique is based on the
10. ail Extractor 7163 1278 located in the original TRIGEN Instrument Set 7163 1326 and the HFN Instrument Set 7170 0001 22 Implants TRIGEN Internal Captured Screws 4 5mm and 5 0mm Set No 71642005 Cat Item 7164 5420 7164 5422 7164 2125 7164 2127 7164 2130 7164 5432 7164 2135 7164 5437 7164 2140 7164 5442 7164 2145 7164 5447 7164 2150 7164 5452 7164 5455 7164 5457 7164 5460 7164 5462 7164 5465 Length 4 5mm x 20mm 4 5mm x 22 5mm 4 5mm x 25mm 4 5mm x 27 5mm 4 5mm x 30mm 4 5mm x 32 5mm 4 5mm x 35mm 4 5mm x 37 5mm 4 5mm x 40mm 4 5mm x 42 5mm 4 5mm x 45mm 4 5mm x 47 5mm 4 5mm x 50mm 4 5mm x 52 5mm 4 5mm x 55mm 4 5mm x 57 5mm 4 5mm x 60mm 4 5mm x 62 5mm 4 5mm x 65mm Set No 7164 2000 Cat Item 7164 5020 7164 5022 7164 5025 7164 5027 7164 5030 7164 5032 7164 5035 7164 5037 7164 5040 7164 5042 7164 5045 7164 5047 7164 5050 7164 5052 7164 5055 7164 5057 7164 5060 7164 5062 7164 5065 7164 5067 7164 5070 7164 5072 7164 5075 TRIGEN META NAIL 8 5mm Tibial Set No 7165 3002 Length 5 0mm x 20mm 5 0mm x 22 5mm 5 0mm x 25mm 5 0mm x 27 5mm 5 0mm x 30mm 5 0mm x 32 5mm 5 0mm x 35mm 5 0mm x 37 5mm 5 0mm x 40mm 5 0mm x 42 5mm 5 0mm x 45mm 5 0mm x 47 5mm 5 0mm x 50mm 5 0mm x 52 5mm 5 0mm x 55mm 5 0mm x 57 5mm 5 0mm x 60mm 5 0mm x 62 5mm 5 0mm x 65mm 5 0mm x 67 5mm 5 0mm x 70mm 5 0mm x 72 5mm 5 0mm x 75mm Cat Item Length Cat Item Length 7165 5024 24cm 7165 5035 35cm
11. ated Impactor Short Large Nail Extractor Qty Blocking Screw Instrument Set Optional Set No 7165 4001 Cat Item 7165 4515 7165 4509 7165 4522 7165 4511 7165 4513 7165 4514 7165 4523 7163 4508 Description Blocking Screw Device Tibial Blocking Screw Attachment 11 0mm T handle Awl 8 5mm 10mm Blocking Screw Cartridge 11 5mm 13mm Blocking Screw Cartridge Offset Blocking Screw Cartridge Blocking Screw Alignment Pin Retrograde Femoral Blocking Screw Attachment Qty 21 TRIGEN META NAIL META NAIL Disposables Semi extended Instrument Set Ne 7165 4003 Set No 7165 4004 Cat Item Description Qty Cat ltem Description 7165 4524 Semi extended Drill Guide 7163 1110 4 0mm Long Pilot Drill 7165 4525 Semi extended Guide Bolt 7163 1117 4 0mm Short Drill 7165 4527 Semi extended Guide Pin Sleeve 7163 1626 3 0mm x 1000mm Ball Tip Guide Rod 7165 4533 Semi extended Honeycomb 7167 4130 7165 4526 Semi extended Entry Tube or 3 2mm Brad Point Guide Pin 7163 1436 7165 4554 Cannulated Impactor Short 7167 4092 Entry Portal Handle 7165 4528 Universal Compression Driver 7163 1320 Disposable Nail Extractor 2 2222 SPO The 4 0mm Long Pilot Drill 7163 1110 is interchangeable with 4 0mm AO Long Drill 7163 1121 The 4 0mm Short Drill 7163 1117 is interchangeable with 4 0mm AO Short Drill 7163 1123 The Disposable Nail Extractor 7163 1320 is interchangeable with the Large N
12. eeve Figure 9 Figure 7 Note If the guide pin insertion is suboptimal insert the Semi extended Honeycomb 7165 4533 and rotate the Honeycomb within the Entry Tube to the desired location Insert another 3 2mm Brad Point Guide Pin Avoid over insertion of the guide pin as this can establish a false trajectory and subsequently cause fracture malalignment AP Lateral Figure 8 Figure 9 Entry portal Pin Sleeve and carefully slide the Entry Tube down and onto the tibial plateau Figure 10 to a power drill Advance the reamer over the guide pin and through the Entry Tube into the tibia to a depth of 4 6cm Maintain alignment to avoid penetration of the posterior cortex radiographic imaging and then remove the Entry Reamer and Guide Pin Figure 10 Alternative technique Entry portal With the Entry Tube Figure 11 and Entry Portal Handle Figure 12 still in the joint space attach the T handle 7167 4076 or 7167 4576 Figure 13 to the Cannulated Awl Figure 14 Entry Tube Cat No 7165 4526 Note Introduce the 3 2mm T handle Trocar Figure 1 7167 4074 Figure 15 into the back of the assembly prior to insertion in order to prevent awl slippage and the accumulation of cortical bone within the cannulation Entry Portal Handle Cat No 7167 4092 Insert the awl into the proximal tibia to a depth of 4 6cm Figure 12 T handle Cat No 7167 4076 or 7167 4576 Figure 13 Cannula
13. eve Figure 3 Entry Portal Handle NO Q Incision and entrv point Lateral subluxation ot the patella Make a midline skin incision approximatelv 1 5 inches in length from the upper pole of the patella to the middle of the patella Figure 4 Make a second deep incision medial to the patella cutting the superior two thirds of the medial retinaculum but leaving the cuff intact Extend the incision 1 2cm into the quadriceps tendon Figure 5 This incision is through the medial one third of the quadriceps tendon as outlined in the image Sublux the patella laterally and pass the fully assembled entry tube through the skin incision until it is sitting on the tibial plateau Figure 6 Figure 4 Figure 5 Figure 6 gt oo NO Q Use the femoral condyles as guides for proper Attach the 3 2mm Brad Point Guide Pin After guide pin placement remove the Guide Attach the 12 5mm Entry Reamer 7163 1116 Check position of the entry reamer via Entry portal acquisition tube placement making sure that the Guide Pin Sleeve sits at the appropriate entry point Figure 7 Locate the entry point just medial to the lateral tibial eminence in the AP view and in line with the anterior cortex and intramedullary canal in the lateral view Figure 8 7167 4130 or 7163 1436 to the drill via the Mini Connector 7163 1186 and insert the guide pin into the Guide Pin Sl
14. he Guide Bolt Figure 29 Lock the screw Determine the length of the locking screw There are three options available to determine the locking screw lengths Gold 9 0mm Drill Sleeve silver 4 0mm Drill Sleeve and 4 0mm Long Pilot Drill Figure 30A Screw Depth Gauge 7163 1189 Figure 30B Screw Length Sleeve 7167 4085 and 4 0mm Short Drill 7163 1117 Figure 30C Note For information regarding Drill Depth Measurement Software DDM using the TRIGEN SURESHOT Targeting System refer to the TRIGEN SURESHOT Targeting System User Manual 7118 1540 The DDM software can be used for distal locking only Figure 30 Insert the Locking Screws Proximal locking options include three Statically locked threaded holes and one slot that allows for both fracture compression and or dynamization These are targeted through the orange and blue color coded holes on the Anterior Drop Distal locking options include three statically locked holes two ML mediolateral and one AP The most distal ML hole is threaded for additional stability Gold 5 0mm locking screws are compatible with 10mm 11 5mm and 13mm diameter nails Grey 4 5mm locking screws are compatible with 8 5mm diameter nails Note Do not use the 4 0mm Short Step Drill 7164 1123 when drilling for a grey 4 5mm locking screw Its diameter transitions from 4 0mm to 4 7mm and will drill too large a hole in the near cortex which may compromise locking sc
15. ithin the distal tibia Slide the Ruler 7167 4079 over the guide rod until the metal tip contacts the proximal tibia Figure 20 Confirm the guide rod position in the window at the opposite end of the Ruler as shown in order to ensure accurate implant measurement Figure 21 Push down on the top of the Ruler until it contacts the 3 0mm Ball Tip Guide Rod Note Ensure that the ruler is in contact with the Ball Tip Guide Rod Read the implant length from the exposed calibrations at the end of the Ruler Confirm fracture reduction to ensure that the implant length is not underestimated Reference the fibula for accurate fracture distraction or compression Figure 20 Window a aa Thumb wheel Figure 21 Unreamed technique Use radiographic templating to determine nail size Figure 22 Note The appropriate diameter implant provides translational fill within the isthmus of the intramedullary canal To help avoid implant incarceration during ji insertion select a nail approximatelv 1 0 1 5mm less than the narrowest canal measurement on the lateral radiograph Note The 8 2mm diameter of the Reducer provides an initial determination of the canal width in small diameter tibias N B bel an wo o s 3537 2 3 3 2 a g aa GE u T o m CEECECEEE ME 3 g amp D 3 S 39 3 8 3 3333333353 8 8 3 8 83 3 o
16. mm AP 5mm ML Threaded 5mm ML Threaded Static Lock Locations Orientations Static Locking Hole E 4 mm 5 3mm Dimensions Note These views are not to scale and should Set does not include all sizes be used as a pictorial representation only Most distal hole threaded 4 NO Q B Surgical Technique Patient positioning Position the patient supine on a radiolucent table with the unaffected limb extended away from the affected limb For the semi extended technique the operative limb should be in 10 20 of flexion Caution If using the TRIGEN SURESHOT Distal Targeting System verify that there are no metal objects in the immediate targeting area Metal interference will cause the SURESHOT System to be inaccurate Prepare the Entry Tube Inspect the Entry Tube to ensure that it is not damaged bent or chipped Any flaws in the tube can lead to damage of the surrounding tendons and tissues Assemble the Entry Tube 7165 4526 to the Entry Portal Handle 7167 4092 by pulling back the black trigger of the Entry Portal Handle and inserting the Entry Tube into the handle ring Turn the tube until it clicks into a locked position Place the Guide Pin Sleeve 7165 4527 through the tube until it locks into both the end of the sleeve and Entry Portal Handle ring Optional Suction can be applied to the Entry Portal Handle Figure 2 Entry Tube w Guide Pin Sle
17. or Drop down to bone Figures 33 and 34 Drill both cortices with the 4 0mm Long Figure 33 Pilot Drill Use the techniques described in the Lock the Screw section to measure and insert the screw Note Use the TIBIA and ALL NAILS holes marked on the META NAIL Anterior Drop Note If the screw is left in the dynamic mode a nail cap cannot be used as it will push against the locking screw Figure 34 The 4 0mm Long Pilot Drill 7163 1110 is interchangeable with 4 0mm AO Long Drill 7163 1121 16 NO Ln ON CO Countersink the nail a minimum of 10mm Lock the nail distally Reduce the fracture as much as possible Insert a screw through the proximal side of Remove the gold 9 0mm Drill Sleeve Turn the Compression Driver clockwise to Once the fracture gap is adequately Proximal locking Compression There are two methods that can be used to compress the fracture Compression Driver method Figure 35 to maximize the advantage of the compression driver dynamic slot as described in the Dynamic locking section and Medium Hexdriver Figure 35 Attach the Universal Compression Driver 7165 4528 to the T handle and thread it through the guide bolt into the top of the nail until it contacts the most proximal 5 0mm locking screw Figure 36 advance the driver and drive the locking screw distally which will compress the fracture up to 7mm
18. ors are allowed to use the TRIGEN SURESHOT Distal Targeting System TRIGEN META NAIL Tibial Nail Specifications S TRIGEN META NAIL Tibia Pr Specifications 8 5mm TRIGEN META NAIL Tibia Lengths 16 50cm 16 50cm Proximal Diameter 12mm 10 11 5 diameter driving end 13mm 13 diameter Feu 8 10 11 5 and 13mm non driving end 1 D 3 Smallest Through 5 0mm gt co 3 3 Distal end of nail all knee and distal tibial Diameter mm 2 3mm 10 Wall Thickness mm 3 0mm 11 5 2 3mm 13 Guide Bolt Thread 5 16 24 UNF 5 16 24 UNF Minor Diameter core 4 3mm Screw Lengths 25 65mm 25 110mm RT Femoral amp Recon S 9 Q 2 4 lt RT Femoral amp Recon f l 7 0mm Cannulated Screw Alternative Hexdrivers 7 0mm Cannulated Screw i PERI LOC 4 7mm Hexdriver PERI LOC Locking Screw PROFIX 4 7mm Hexdriver Proximal Locking Driving End 17mm 45 Screw Locked w META NAIL Cap Top view of nail Static Lock 23mm 45 Threaded w bushing Locations Orientations 30mm 25 Threaded A 40mm 25 Threaded Threaded 4 3mm Threaded 4 5mm Static Locking Hole minor diameter minor diameter 60mm Dimensions Threaded 4 7mm Threaded 5 3mm major diameter major diameter E Compression Dynamic om one Slot Location 90 Compression Dynamic AImm 7mm an Slot Diameter Length ML view Degree of Proximal Bend m Non driving end of nail Herzog Distal Locking Non Driving End 25mm ML 25mm ML 15mm AP 15
19. rew purchase Figure 31 META NAIL Tibial Nail with Note If using the SURESHOT Distal Targeting all four proximal screws inserted System be sure to remove the probe prior to proximal locking The 4 0mm Long Pilot Drill 7163 1110 is interchangeable with 4 0mm AO Long Drill 7163 1121 The 4 0mm Short Drill 7163 1117 is interchangeable with 4 0mm AO Short Drill 7163 1123 KO A Q B Ln ON N NO Da Make a small incision at the site of screw entry Insert the gold 9 0mm Drill Sleeve and silver Drill both cortices with the 4 0mm Long Use power to insert the screw through the gold With the nail countersunk approximately 10mm Proximal locking Static locking 4 0mm Drill Sleeve through the static slot STAT on the Anterior Drop Figure 32 down to bone Pilot Drill Measure for screw length using either the calibrations on the 4 0mm Long Pilot Drill or by Figure 32 removing the 4 0mm Drill Sleeve and using the Screw Depth Gauge Attach the appropriate length screw to the end of the Medium Hexdriver 7163 1066 9 0mm Drill Sleeve until the laser etched ring on the Hexdriver reaches the back of the Drill Sleeve Attach the T handle to the Hexdriver and tighten the screw by hand Dynamic locking make a small incision at the site of screw entry and insert the gold 9 0mm Drill Sleeve and silver 4 0mm Drill Sleeve through the dynamic slot DYN on the Anteri
20. sertion barrel Figure 24 The apex of the nail s proximal Herzog Bend faces posteriorly and the drill guide be ad TRIGEN META NAIL is oriented anteriorly Figure 25 Note The bevel on the front of the nail marks Figure 24 the connection to the drill guide and can be seen in the lateral view as a means to determine proximal insertion depth 7165 4501 to the drill guide To verity the accuracy of the target insert a gold 9 0mm Drill Sleeve 7163 1152 and silver 4 0mm Drill Sleeve 7167 4083 into the drop Figure 26 and then pass a 4 0mm Long Pilot Drill 7163 1110 through the assembly Note An incorrectly attached nail will not target Note If using the SURESHOT Distal Targeting System refer to the TRIGEN SURESHOT Distal Targeting System s User Manual REF 7118 1540 for the field accuracy check instructions Figure 25 META NAIL Anterior Drop 9 0mm Drill Sleeve Figure 26 Nail insertion Remove the Entry Tube and Handle Remove the Anterior Drop and attach the Cannulated Impactor Medium 7167 5081 to the drill guide Orient the drill guide assembly in the AP anteroposterior position Use light blows with the Slotted Hammer 7167 4082 to advance the nail over the guide rod Note If excessive force is required to insert the nail additional reaming of the intramedullary canal may be required Verify fracture reduction as the nail crosses the fracture site by paying
21. ted Awl Cat No 7167 4000 Figure 14 3 2mm T handle Trocar Cat No 7167 4074 Figure 15 1 2 A a NO Reduce the Fracture Open the Gripper 7167 4080 Insert the smooth back end of the 3 0mm Ball Tip Guide 7163 1626 into the front of the Gripper and gently close the trigger grip Figure 16 Connect the Reducer and Reducer Connector 7167 4077 so that the words Slot Orientation are in line with the opening at the Reducer s tip Figure 17 Connect the assembly to the T handle Advance the Reducer through the Entry Tube into the intramedullary canal and use the curved tip to direct the 3 0mm Ball Tip Guide Rod past the fracture into the region of the distal epiphyseal scar Figure 18 Note The guide rod should be center center in the AP and lateral views Reduce removal Once the guide rod reaches the desired depth detach the Gripper and remove the Reducer from the tibial canal To maintain guide rod position within the canal slide the Obturator 7167 4078 into the back of the T handle during extraction Figure 19 Figure 16 Reducer Reducer Connector Figure 17 Figure 18 Figure 19 Trigger grip Determine the implant length Confirm that the Ruler opens easily If it does not adjust the thumb wheel connection at the end to ensure free movement After the Reducer has been removed reconfirm the guide rod placement w
22. ver T Handle assembly Remove all the distal locking screws and all but one of the proximal locking screws Thread the Cannulated Impactor Medium 7167 5081 or Cannulated Impactor Long 7163 1185 into the back of the Disposable Nail Extractor 7163 1320 Thread the assembly into the top of the nail Remove the remaining proximal locking screw Use the Slotted Hammer with a back slapping motion to extract the nail Figure 39 Figure 39 The Cannulated Impactor Long is located in the original TRIGEN Instrument Set 7163 1326 The Disposable Nail Extractor 7163 1320 is interchangeable with the Large Nail Extractor located in the original TRIGEN Instrument Set 7163 1326 and the HFN Instrument Set 7170 0001 18 Percutaneous technique In the absence of a Nail Cap or Nail Cap Set Screw 1 Use the Medium Hexdriver T handle assembly to remove all distal locking screws and all but one of the proximal locking screws NO Under fluoroscopy insert a 3 2mm Brad Point Tip Guide Pin 7167 4130 or 7163 1436 into the top of the nail either using power or by hand Figure 40 Make a 2cm incision around the pin oo 4 Advance the 12 5mm Entry Reamer over the pin and into the top of the nail to remove any bony ingrowth Figure 41 Note The flared portion of the Entry Reamer l enters the top of the nail Figure 40 Thread the Cannulated Impactor Medium or Cannulated Impactor Long
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