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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. THE MOST RESPONSIVE COMPANY IN ORTHOPEDICS SM P.O. Box 587, Warsaw, IN 46581-0587 • 574.267.6639 • ©2001, 2003 Biomet Orthopedics, Inc. All Rights Reserved web site: www.biomet.com • eMail: [email protected] Form No. Y-BMT-704R/041503/K