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Instrument Assembly
The driver bolt is passed through the driver arm and attaches
to the nail. The two tangs on the underside of the driver must
engage with the two slots on the upper end of the nail. Firmly
tighten the driver bolt onto the nail using the 3/8" hex socket
T-wrench (Figure 1). The driver handle is inserted into the top
of the driver arm (Figure 2).
Figure 1
Nail Insertion
The slide hammer is inserted into the driver handle. The nail
is placed over the nail-driving guide and driven down the
medullary canal. The nail must be inserted in flexion. The
3.2mm nail-driving guide exits through the proximal posterior
slot in the nail (Figure 3). The fracture should be adequately
reduced and out to length during insertion of the nail and
should be monitored with the image intensifier. The nail-driving
guide is removed after the nail passes the fracture site. Drive
the nail until the anterior bevel of the nail is flush with the bone.
Figure 2
Figure 3
Proximal Screw Insertion
Proximal locking screws can be inserted with the leg in
extension. This position allows assessment of rotational
alignment prior to locking. Remove the driver handle from
the driver arm before extending the leg.
The proximal target is attached to the driver arm with the
target handle (Figure 4). The proximal target engages the
driver arm with the target placed medial to the nail. Firmly
tighten the target handle onto the driver arm. The drill
bushing is placed into the guide tube and the assembly is
inserted through the hole in the proximal target (Figure 5).
For static locking, use the most distal locking hole or both
oval and distal holes. For immediate dynamization, use the
proximal oval hole only for locking (Figure 6).
Figure 4
Figure 5
Static locking
Figure 6
Dynamic locking
Proximal Screw Insertion (cont’d)
After making a small stab incision, under fluoroscopic control,
the 4.3mm drill is used to perforate the medial cortex, pass
through the nail and perforate the lateral cortex. With the
drill guide bushing assembly held firmly against the medial
cortex, the appropriate screw length is read on the calibrated
drill bit (Figure 7). Alternatively, a depth gauge may be used
to determine the length of the locking screw (Figure 8). The
drill bushing is removed and the appropriate 5.0mm diameter
screw is inserted through the guide tube using the hex drive
wrench (Figure 9). The screw head is seated when the ring
on the T-wrench reaches the guide tube. For static locking,
use most distal locking hole or both oval and distal holes.
Figure 7
All screw placements (proximal and distal) should be verified
before removing the driving assembly from the nail, to prevent
the need to reattach.
Refer to standard technique for distal screw placement.
End Cap Placement
Following proximal screw insertion, the driver bolt is removed
using the 3/8" hex socket T-wrench. Insert the end cap with
the T-wrench into the proximal end of the nail (Figure 10).
Ordering Information
Figure 8
Flexion Extension Driver Arm
471660
Flexion Extension Driver Bolt
471662
Flexion Extension Proximal Target
Figure 9
471664
Flexion Extension Target Handle
471666
Flexion Extension Driver Handle
471668
Figure 10
Note: Standard Tibia Instruments
required also.
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SM
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web site: www.biomet.com • eMail: [email protected]
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