flexible reamers for intramedullary nails tgsynthes.vo.llnwd.net/o16/llnwmb8/us mobile/synthes north...

Flexible Reamers for IntramedullaryNails. To facilitate the insertion of IM nails.

Technique Guide

Instruments and implants approved by the AO Foundation

Introduction

Surgical Technique

Product Information

Table of Contents

Flexible Reamers for Intramedullary Nails 2

8

Confirm Nail Length 10

Medullary Reaming 12

Cleaning the Flexible Shaft 15

Instruments 16

Set List 19

Image intensifier control

Synthes

Reduction

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

2 Synthes Flexible Reamers for Intramedullary Nails Technique Guide

1. C. A. Muller, R. Schavan, R. Frigg, S. M. Perren. “Intramedullarypressure increase for different commercial and experimental reamingsystems: an experimental investigation.” Journal of OrthopedicTrauma. 12 (1998): 540–546.

2.5 mm Reaming Rod with ball tipAvailable sterile in 650 mm,* 950 mm,*1150 mm,* and 950 mm and 1150 mmwith an extension*– Secures connection between the

reamer head and the flexible shaft

– Helps to guide the flexible shaft past the reduced fracture

Important: Always use a reaming rodwhen reaming, to secure the reamerhead to the flexible shaft connection.

5.0 mm Flexible ShaftAvailable 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

Synthes 3

351.706S/351.708S/351.709S

351.707S/351.704S

* Also available

Flexible Reamers for Intramedullary Nails continued

Hand Reamers, 6.0 mm, 7.0 mm, 8.0 mm– For use in medullary canals with an isthmus smaller than

8.0 mm

– Use hand reamers incrementally to widen the medullarycanal to 8.0 mm, before using the front-cutting 8.5 mmmedullary reamer head under power

– In sclerotic medullary canals, the hand reamers may beused before insertion of the reaming rod

– 450 mm length


Synthes 5

Medullary Reamer Heads– Sizes from 8.5 mm to 19.0 mm, in 0.5 mm increments

– The 8.5 mm reamer head is front-cutting, all others areside-cutting

– The 8.5 mm reamer head should only be used in amedullary canal with an isthmus 8.0 mm or larger. Ifnecessary, use the hand reamers to open the canal to 8.0 mm first

– To reduce the likelihood of the reamer head jamming intraoperatively, do not skip reamer head sizes

Note: Inspect reamer heads for damage before use, as ablunt or damaged reamer head can increase medullarypressure and temperature. Reamer heads cannot be resharp-ened. Damaged reamer heads must be replaced.2,3

– Inspect reamer heads for dullness before every surgerythat requires reaming

– Ream with a ball tipped reaming rod

– Widen canals narrower than 8.0 mm with the hand reamers

– Ream in 0.5 mm increments; do not skip reamer headsizes

2.Muller C.A., Mc Iff T., Rahn B.A., Pfister U., Weller S.: Intramedullary pressure,strain on the diaphysis and increase in cortical temperature when reaming thefemoral medullary cavity – A comparison of blunt and sharp reamers. Injury 24,Suppl. 3: 22 – 30

3.Muller C.A., Rahn B.A., Pfister U., Weller S.: Extent of bluntness and damage toreamers from hospitals. Injury 24, Suppl. 3, 31 – 35

Good reaming practices

Flexible Reamers for Intramedullary Nails continued


Depth Gauge and Depth Gauge ExtensionTube– Used to determine nail length and estimate

canal size

– The depth gauge is used with the 650 mmreaming rod

– The depth gauge and extension tube are usedwith the 950 mm and 1150 mm length reamingrods

351.717

351.719

Flexible Medullary Reamers*– Sizes from 6.0 mm to 8.0 mm, 385 mm length

– Couple with Jacobs chuck and Synthes large quick couplings (511.761, 05.001.213)

*Also available

Holding Forceps– Used to insert and maintain placement

of the reaming rod in the medullary canal

7.0 mm Reduction Heads, straight or angled– Attach to the flexible shaft

– Help reduce fractures and aid in passage of the reaming rod

– Must be used with the 2.5 mm reaming rod

Synthes 7

1Insertion

Handling technique for reaming rod and medullary reamers

2Holding

During reaming, grasp the end of the reaming rod to preventits withdrawal. After the reamer head is removed from thecanal, grasp the reaming rod between the reamer head andthe canal entry point.

3Emergency application

If a reamer head jams, use the holding forceps for reamingrods to grasp the back end of the reaming rod, and removethe jammed reamer with light hammer blows on the holdingforceps.


Reduction

1Reduce fracture

Instruments

351.15 Flexible Shaft Handle

352.040 5.0 mm Flexible Shaft, 470 mm

7.0 mm Reduction Heads 352.050 straight352.055 angled

2.5 mm Reaming Rods with ball tip, sterile*351.709S 650 mm, with extension351.706S 950 mm351.707S 950 mm, with extension351.708S 1150 mm351.704S 1150 mm, with extension

*Also available

Synthes 9

A

C

Assemble one of the reduction headsonto the 5.0 mm flexible shaft (A).

Attach the shaft to the flexible shafthandle (B).

Insert the smooth end of a 2.5 mmreaming rod (C) into the tip of the 7.0 mm reduction head until the balltip touches the reduction head (D).

Insert the reduction system into themedullary cavity and reduce the frag-ments under imaging.

Important: The reaming rod must beheld in place to secure the reductionhead during reaming, and to ensure itdoes not miss a displaced fragment orbecome lost in the medullary canal.

After reduction has been achieved, re-move the reduction assembly and leavethe reaming rod in the canal. Advancethe reaming rod to the desired depthof implant.

Note: All manipulations in themedullary cavity, including reductionwith the reduction system, cause an intramedullary pressure increase andshould be minimized. As an alternative,reduction can be carried out using thereaming rod alone.

D

B


2Confirm 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 reamingrod is used, the extension tube is not required.

Confirm Nail Length

Synthes 11

Place the depth gauge assembly over the 2.5 mm reamingrod. The tip of the extension tube, or the depth gauge, shouldbe positioned at the desired location of the proximal end ofthe implant.

650 mm and 950 mm reaming rodsRead the nail length at the end of the reaming rod on thescale of the depth gauge.

1150 mm reaming rodRead the nail length at the mark on the reaming rod.

Use the depth gauge to estimate the size of the medullarycanal. Place the depth gauge across the limb at the level of the isthmus. Move the depth gauge until the tab fills the canal.


Medullary Reaming

511.785

3Ream medullary canal

Instruments

351.05 Tissue Protector

2.5 mm Reaming Rods with ball tip, sterile*351.709S 650 mm351.706S 950 mm351.707S 950 mm, with extension351.708S 1150 mm351.704S 1150 mm, with extension

351.782 Holding Forceps

351.783 Removal Instrument

Hand Reamers351.92 6.0 mm Hand Reamer351.93 7.0 mm Hand Reamer351.94 8.0 mm Hand Reamer

5.0 mm Flexible Shafts352.040 470 mm352.044* 620 mm

352.085 8.5 mm Medullary Reamer Head

511.785* Reduction Drive Unit

511.701 ComPact Air Drive II

05.001.210 AO Reaming Attachment

05.001.201 Trauma Recon System Handpiece

In medullary canals with an isthmus narrower than 8.0 mm,or in sclerotic medullary canals, use the hand reamer(s) towiden the canal to 8.0 mm before using the power driven,front-cutting 8.5 mm reamer head.

Clip the shaft onto the reamer head in the tray. If necessary,rotate the shaft slightly until the connection fits.

*Also available

Synthes 13

For the initial reaming, the flexible shaft is usually equippedwith the 8.5 mm reamer head. Clip the shaft onto thereamer head in the Tray for Reaming Heads. If the click-onconnection does not fit, turn the shaft slightly until the hexagon matches.

Important: This is only a primary connection. Always reamover a 2.5 mm reaming rod to ensure a secure connection.

Use the ComPact Air Drive II with the reduction drive unit orthe Trauma Recon System with the AO reaming attachment(as the driving unit). Guide the reaming system over thereaming rod.

Do not rotate the reamer head when inserting it into themedullary canal. The tissue protector protects the soft tis-sues. Use the highest speed and slight but uniform force toadvance the reamer head in the medullary canal. Move the reaming shaft back and forth to remove bonechips from the reamer head, and prevent jamming of thereamer head.

After reaming, withdraw the reaming shaft until the entirereamer head is visible. To prevent a loss of reduction, graspthe reaming rod at the canal entry point and hold the rod inplace using the holding forceps.

Important: If a reamer jams while reaming, disconnect thereduction drive unit. Use the holding forceps to grasp thereaming rod (in the countersinking). Use light hammer blowson the holding forceps to withdraw the jammed reamerhead from the medullary canal. As an alternative, release thereamer head by rotating the shaft in reverse.

Medullary Reaming continued

The reamer head can be removed from the flexible shaft withthe removal tool. Place the reamer head in the slot on theside of the removal tool. Hold the removal tool with one handwhile pulling on the flexible shaft with the other. The reamerhead will detach from the shaft.

Use the sideways cutting reamer heads for the subsequentreaming steps. Reaming should always be 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 throughthe cannulation of all Synthes titanium nails and their respec-tive instruments. When used with other nailing systems, the cannulation of the nail connecting screw must be larger than 3.5 mm.

Important: Remove the reaming rod before locking the intramedullary nail.


Cleaning Flexible Shaft

Synthes 15

Cleaning flexible shaft

Instrument

3.6 mm Cleaning Brush352.041 680 mm352.045* 830 mm

The 3.6 mm cleaning brush is used to clean the cannulationof the flexible shaft.

Note: The cleaning brush cannot be autoclaved.

*Also available


351.05 Tissue Protector

351.15 Flexible Shaft Handle

351.717 Depth Gauge

2.5 mm Reaming Rods with ball tip, sterile*351.709S 650 mm351.706S 950 mm351.708S 1150 mm

2.5 mm Reaming Rods with ball tipand extension, sterile*

351.707S 950 mm351.704S 1150 mm

351.719 Depth Gauge Extension Tube

Instruments

*Also available

Synthes 17

351.782 Holding Forceps

352.055 7.0 mm Reduction Head, angled

352.040 5.0 mm Flexible Shaft, 470 mm352.044* 5.0 mm Flexible Shaft, 620 mm

352.050 7.0 mm Reduction Head, straight

351.92 6.0 mm Hand Reamer351.93 7.0 mm Hand Reamer351.94 8.0 mm Hand Reamer

351.783 Removal Tool

352.041 3.6 mm Cleaning Brush, 680 mm352.045* 3.6 mm Cleaning Brush, 830 mm

*Also available


393.10 Universal Chuck with T-Handle

Flexible Medullary Reamers, flat wire, 385 mm359.106* 6.0 mm359.107* 6.5 mm359.108* 7.0 mm359.109* 7.5 mm359.110* 8.0 mm

Instruments continued

*Also available

355.006 Medullary TubeNote: Single sterilization only.Do not use with 3.0 mm Reaming Rod withoffset ball tip (351.71)

352.085– Medullary Reamer Heads, 8.5 mm to 352.190 19.0 mm (0.5 mm increments)

Synthes 19

Flexible Reamer Set for IM Nails (150.060)

Graphic Case690.382 Flexible Reamers for Intramedullary Nails

Instrument Set Graphic Case

Instruments351.05 Tissue Protector351.15 Flexible Shaft Handle, quick coupling,

cannulated351.717 Depth Gauge351.719 Depth Gauge Extension Tube351.782 Holding Forceps351.783 Removal Tool, for use with Medullary

Reaming Heads351.92 6.0 mm Hand Reamer351.93 7.0 mm Hand Reamer351.94 8.0 mm Hand Reamer352.040 5.0 mm Flexible Shaft, 470 mm, 2 ea.352.041 3.6 mm Cleaning Brush, 680 mm352.050 7.0 mm Reduction Head, straight352.055 7.0 mm Reduction Head, angled393.10 Universal Chuck with T-Handle

Medullary Reamer HeadsDia. (mm) Dia. (mm)

352.085 8.5 352.140 14.0352.090 9.0 352.145 14.5352.095 9.5 352.150 15.0352.100 10.0 352.155 15.5352.105 10.5 352.160 16.0352.110 11.0 352.165 16.5352.115 11.5 352.170 17.0352.120 12.0 352.175 17.5352.125 12.5 352.180 18.0352.130 13.0 352.185 18.5352.135 13.5 352.190 19.0

Note: For additional information, please refer to package insert.

For detailed cleaning and sterilization instructions, please refer towww.synthes.com/cleaning-sterilization In Canada, the cleaning and sterilization instructions will be provided with the Loaner shipments.

Flexible Reamer Set, Long (01.004.306)


Graphic Case60.004.306 Flexible Reamer Set Graphic Case, long

Instruments351.05 Tissue Protector351.15 Flexible Shaft Handle, quick coupling,

cannulated351.717 Depth Gauge351.719 Depth Gauge Extension Tube351.782 Holding Forceps351.783 Removal Tool, for use with Medullary

Reaming Heads352.044 5.0 mm Flexible Shaft, 620 mm, 2 ea.352.050 7.0 mm Reduction Head, straight352.055 7.0 mm Reduction Head, angled393.105 Small Universal Chuck with T-Handle

Medullary Reamer HeadsDia. (mm) Dia. (mm)

352.085 8.5 352.140 14.0352.090 9.0 352.145 14.5352.095 9.5 352.150 15.0352.100 10.0 352.155 15.5352.105 10.5 352.160 16.0352.110 11.0 352.165 16.5352.115 11.5 352.170 17.0352.120 12.0 352.175 17.5352.125 12.5 352.180 18.0352.130 13.0 352.185 18.5352.135 13.5 352.190 19.0

Synthes

Instruments 351.16J Flexible Shaft Connector for Jacobs chuck,

quick coupling, cannulated351.704S 2.5 mm Reaming Rod with ball tip

and extension, 1150 mm, sterile351.706S 2.5 mm Reaming Rod with ball tip,

950 mm, sterile351.707S 2.5 mm Reaming Rod with ball tip

and extension, 950 mm, sterile351.708S 2.5 mm Reaming Rod with ball tip,

1150 mm, sterile351.709S 2.5 mm Reaming Rod with ball tip,

650 mm, sterile352.044 5.0 mm Flexible Shaft, 620 mm352.045 3.6 mm Cleaning Brush, 830 mm355.006 Medullary Tube511.761 Large Quick Coupling511.785 Reduction Drive Unit

Flexible Medullary Reamers, flat wire, 385 mm359.106 6.0 mm359.107 6.5 mm359.108 7.0 mm359.109 7.5 mm359.110 8.0 mm

Recommended Additional SystemsComPact Air Drive II SystemTrauma Recon System

Also Available for the Flexible Reamer Set, Long, for IM Nails (01.004.306)351.16J Flexible Shaft Connector for use with Jacobs

Chuck352.040 5.0 mm Flexible Shaft, 470 mm360.240 IM Nail Reduction Tool, 7.5 mm shaft with

curved tip360.243 Handle for 12.0 mm Tapered Intramedullary

Reduction Tool03.010.093 Reaming Rod Push Rod with Ball Handle03.010.427 Curved Awl 8 mm Intramedullary Reduction Tool

Also Available

Synthes (USA)1302 Wrights Lane EastWest Chester, PA 19380Telephone: (610) 719-5000To order: (800) 523-0322Fax: (610) 251-9056

Synthes (Canada) Ltd.2566 Meadowpine BoulevardMississauga, Ontario L5N 6P9Telephone: (905) 567-0440To order: (800) 668-1119Fax: (905) 567-3185

© 2003 Synthes, Inc. or its affiliates. All rights reserved. Synthes is a trademark of Synthes, Inc. or its affiliates. Printed in U.S.A. 5/13 J4557-I

www.synthes.com

flexible reamers for intramedullary nails tgsynthes.vo.llnwd.net/o16/llnwmb8/us mobile/synthes north...

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