titanium distal femoral nail system. for retrograde insertion.synthes.vo.llnwd.net/o16/llnwmb8/us...

Titanium Distal Femoral Nail System.For retrograde insertion.

Technique Guide

Introduction

Surgical Technique

Product Information

Table of Contents

Titanium Distal Femoral Nail System 2

AO Principles 4

Indications 5

Clinical Cases 6

Preoperative Planning 8

Opening the Distal Femur 9

Inserting the Nail 14

Locking Distally 16

Locking Proximally 20

Inserting the End Cap 22

Implant Removal 23

Implant Specifications 27

Implants 28

Instruments 32

Set List 35

Image intensifier control

Synthes

Titanium Distal Femoral Nail System. For retrograde insertion.

2 Synthes Titanium Distal Femoral Nail System Technique Guide

Advanced solutionsNail Features– Universal design for the right and

left femur

– 1.5 m radius of curvature foranatomic fit

– Titanium–6% aluminum–7% niobium alloy

– 9 mm solid nails

– 10 mm–13 mm cannulated nails

– 9 mm and 10 mm diameters, round cross-section

– 11 mm, 12 mm, and 13 mm diameters, fluted cross-section

– Lengths: 160 mm–460 mm (20 mm increments)

4.9 mm Titanium Locking Bolts (green)– Lengths: 26 mm–100 mm

– 4.3 mm core diameter

– Fully threaded

– Self-cutting trocar tip

– 3.5 mm hex drive

5.0 mm Titanium Locking Screws (green)– Lengths: 26 mm–100 mm


– Fully threaded



Synthes 3

Titanium End Cap (aqua)– 8 mm diameter

– Locks distal most 6.0 mm titanium locking screw in place

– Protects nail threads from tissue ingrowth

– Sits flush with the distal end of the nail

6.0 mm Titanium Locking Screws (aqua)– Lengths: 30 mm–100 mm


– Fully threaded

– Self-tapping


Proximal Locking– Proximal locking holes accept 4.9 mm

locking bolts or 5.0 mm locking screws

– Dynamic slot accepts 4.9 mm lockingbolt or 5.0 mm locking screw

– Permits up to 5 mm controlled axial dynamization

Distal Locking– Distal locking holes accept

6.0 mm titanium locking screws

– 30 mm from end of nail

– 15 mm from end of nail

AO Principles

In 1958, the AO formulated four basic principles, which have become the guidelines for internal fixation in general,and intramedullary nailing in particular.1

Anatomic reductionThe Titanium Distal Femoral Nail is designed to fit anatomicallyin the medullary canal, allowing indirect reduction.

Stable fixationThe intramedullary nail acts as an internal splint that controlsbut does not prevent micromovements of the fragments. Itprovides relative stability that leads to an indirect healingthrough callus formation.

Preservation of blood supplyThe instruments and implants in the Titanium Distal Femoral Nailsystem permit a percutaneous technique and less tissue strippingthan other treatment methods. An intramedullary approachresults in decreased blood loss compared to plate fixation.

Early, active mobilizationThe Titanium Distal Femoral Nail provides secure fixation which permits controlled, early, active rehabilitation conducive to optimal recovery.


1. M.E. Müller, M. Allgöwer, R. Schneider, and H. Willenegger:Manual of Internal Fixation, 3rd Edition. Berlin: Springer-Verlag. 1991.

Indications

Synthes 5

The Titanium Distal Femoral Nail is indicated for the stabilizationof fractures of the distal femur and/or diaphyseal fractures in which a retrograde approach is indicated. These include:– supracondylar fractures, including those

with intra-articular extension

– ipsilateral hip /shaft fractures

– ipsilateral femur / tibia fractures

– femoral fractures in the multiply-injured patient

– fractures proximal to a total knee arthroplasty

– fractures distal to a hip implant

– fractures in the morbidly obese patient

– pathologic fractures including those in osteoporotic bone

– malunions

– nonunions

The Titanium Distal Femoral Nail may be used in eitherreamed or nonreamed applications.

Clinical Cases

Case 1


Preoperative Preoperative

Postoperative Postoperative

Case 2

Synthes 7

Preoperative Postoperative

Postoperative

Preoperative Planning

Recommended Set

105.954 Small Battery Drive Set, with 14.4 V Battery

Use the AO preoperative planner ruler for the Titanium DistalFemoral Nail to determine nail length and nail diameter.

Note: There are two templates available for use: actual sizeand 115%, with template image magnified 15% to accountfor average radiograph magnification. However, variations inmagnification levels are common.

When selecting nail size, consider canal diameter, fracturepattern, and postoperative protocol.


460 mm

440 mm

420 mm

400 mm

380 mm

360 mm

340 mm

320 mm

300 mm

280 mm

240 mm

200 mm

160 mm

9 mm

10 mm

220 mm

180 mm

260 mm

11 mm

12 mm

13 mm

13 mm

12 mm

11 mm

10 mm

9 mm

AO

A–P View Lateral View

A–P View Lateral View

Titanium D

istal Femoral N

ail RulerFor 9 m

m, 10 m

m, 11 m

m, 12 m

m, and 13 m

m Nails

For use only with the AO System

of instruments and im

plants.

For Titanium Distal Femoral Nails [450.XXX]

For proximal locking, use the 4.9 mmTitanium Locking Bolts [459.30–459.60] or 5.0 mmTitanium Locking Screws [458.926–458.960]

For distal locking, use the 6.0 mmTitanium Locking Screws [450.86–450.872]

J5653C GP0801F Rev. 10/07J5653C GP0801F Rev. 10/07

0% M

agnificationDFN 9-13 m

m

Opening the Distal Femur

1Position patientPosition the patient supine on a radiolucent table. The kneeof the injured leg should be flexed 30°–40°. A leg roll maybe used to allow for proper reduction and stabilization of thefracture. Ensure that x-ray visualization of the entire femur is possible in both the AP and lateral views.

2Reduce fractureIntra-articular fractures should be stabilized with interfrag-mentary screw fixation prior to insertion of the nail. Thescrews should be positioned so as not to interfere with thepath of the nail.

Optional instrument

394.35* Large Distractor

A large distractor may also be used.

Synthes 9

*Also available


3Confirm nail length

Instrument

357.111 Radiographic Ruler

Position the image intensifier for an AP view of the distal femur. With a long forceps, hold the radiographic ruler along the lateral aspect of the leg, parallel to and at the samelevel as the femur. Adjust the ruler until the distal end is atthe desired nail insertion depth. Mark the skin at that site.

Move the image intensifier to the proximal femur, replacethe distal end of the ruler at the skin mark, and take an AP image of the proximal femur. Verify fracture reduction.Read nail length directly from the ruler image, selecting themeasurement that places the proximal end of the nail at the level of the lesser trochanter.

Note: All fractures should be treated with the longest nail possible, taking into account patient anatomy or previous implant.


4Identify nail entry point

Instruments

292.69 3.2 mm Calibrated Guide Wire

357.127 13.0 mm Protection Sleeve

357.128 13.0 mm/3.2 mm Trocar

Make a medial parapatellar incision. Retract the patellar tendon laterally.

The entry point for the nail is in the intercondylar notch, just anterior and lateral to the femoral attachment of the posterior cruciate ligament. The location of the entrypoint in relation to the intercondylar notch varies with patient anatomy.

Thread the 13.0 mm/3.2 mm trocar into the 13.0 mm protection sleeve. Insert the assembly through the incision to the bone. Hold the protection sleeve firmly and pass the 3.2 mm calibrated guide wire through the trocar. Insert theguide wire using a power drill. The guide wire should be inserted in line with the anatomic axis of the femur which is7°–9° lateral to a line perpendicular to the articular surface.

Synthes 11

AP view Lateral view


5Open canal

Instrument

351.27 13.0 mm Cannulated Drill Bit

Place the 13.0 mm cannulated drill bit into a cannulated drill.Pass the drill bit over the guide wire and through the protectionsleeve. Advance the drill bit to the bone and drill to a depthof 50 mm.

Optional instrument

351.11 Large Reverse Awl

The surgeon may also use the large reverse awl to open the canal.


Optional technique: reaming

Instruments

355.006 Medullary TubeNote: Single Sterilization only. Do not use with3.0 mm Reaming Rod with offset ball tip(351.71).

355.041* 3.0 mm Guide Rod, with smooth tip

Under image intensification, reduce the fracture and insertthe appropriate reaming rod into the canal to the desired nail insertion depth.

Ream in 0.5 mm increments and advance the reamer withsteady, moderate pressure.

Note: Do not force the reamer.

Partially retract the reamer often to clear debris from themedullary canal.

Ream to a diameter 0.5 mm to 1.0 mm greater than nail diameter.

After reaming, remove the reaming assembly. Pass themedullary tube down the reamed canal over the reaming rod.

Remove the reaming rod and insert a 3.0 mm guide rod,with smooth tip, through the medullary tube.

Remove the medullary tube leaving the guide rod in positionfor insertion of the cannulated nail.

Synthes 13

*Also available

Inserting the Nail

1Assemble insertion instruments

Instruments

321.25 Spanner Wrench

357.095 Connecting Screw

357.112 Insertion Handle

357.22 Hammer Guide

357.25 Slide Hammer

Orient the insertion handle laterally and match the flats onthe handle and nail. The anterior bow of the implant mustbe aligned with the anterior bow of the femur.

Place the connecting screw into the insertion handle andthread it into the distal end of the nail. Tighten the connectingscrew with the spanner wrench.

Note: Do not overtighten.

Slide the hammer guide through the slide hammer and attach the hammer guide to the connecting screw. Finger-tighten the assembly.

Alternative technique

Instrument

399.43 Hammer, 700 grams

A hammer may also be used to insert the nail. The distal end of the connecting screw is the direct striking surface for the hammer.


2Insert nailInsert the nail as far as possible by hand using a twisting motion. When using a guide wire, pass the cannulated nail(10 mm–13 mm nails) over the guide wire and into thefemoral opening. Monitor nail passage across the fractureunder image intensification. The insertion assembly may be used to manipulate the nail across the fracture.

Use light blows of the slide hammer on the connecting screwuntil the distal end of the nail is inserted 5 mm–10 mm beyondthe articular cartilage. Insertion depth is indicated by thegrooves on the barrel of the insertion handle.

Note: Do not attach the aiming arm to the insertion handleuntil the nail is fully inserted. The aiming arm may loosenduring nail insertion.

Synthes 15

5 mm

10 mm

Locking Distally

1Assemble instruments

Instruments

357.096 Aiming Arm, for 6.0 mm Titanium Locking Screws

357.097 8.0 mm/5.0 mm Drill Sleeve

357.098 5.0 mm Trocar

357.76 11.0 mm/8.0 mm Protection Sleeve

Distal locking is performed using the 6.0 mm titanium locking screws.

Attach the aiming arm to the insertion handle. Insert thetriple trocar assembly (11.0 mm/8.0 mm protection sleeve,8.0 mm/5.0 mm drill sleeve and 5.0 mm trocar) into the aiming arm and through a stab incision to the bone.Remove the trocar.


2Drill

Instrument

357.099 5.0 mm Three-Fluted Drill Bit

Drill through both cortices using the 5.0 mm three-fluted drill bit, stopping the drill immediately after penetrating the far cortex.

Confirm drill bit position radiographically. Ensure the drillsleeve is pressed firmly to the cortex and read locking screwlength directly from the drill bit at the back of the drill sleeve.The drill bit provides a direct measurement.

Note: Since drill bit position directly represents locking screwposition in bone, the locking screw will be too long if thedrill bit is overinserted, or if the drill sleeve is not presseddown to the cortex.

Synthes 17

Locking Distally

2. Drill continued


Instruments


357.113 Locking Bolt Measuring Device


The locking bolt measuring device may be used through the 11.0 mm/8.0 mm protection sleeve to determine locking screw length.

Remove the 8.0 mm/5.0 mm drill sleeve and pass the measuring hook through the 11.0 mm/8.0 mm protectionsleeve. Read locking screw length directly from the measuring device at the back of the protection sleeve.


3Insert locking screws

Instrument

314.75 Hexagonal Screwdriver

Insert the locking screw through the protection sleeve using the hexagonal screwdriver.

Repeat the procedure for a second distal locking screw.

Synthes 19

Locking Proximally

1Reconfirm reduction

Instrument

511.30* Radiolucent Drive

Confirm reduction/alignment of the fracture.

2Align imageAlign the image intensifier with the hole in the nail closest to the fracture until a perfect circle is visible in the center of the screen.

3Determine incision pointPlace a scalpel blade on the skin to determine the incisionpoint and make a stab incision.

4Center drill bit in locking hole

Instrument

511.417* 4.0 mm Three-Fluted Drill Bit

Under image intensification, insert the tip of the 4.0 mm drillbit for the radiolucent drive through the incision and place itonto the bone. Keep the drill bit oblique to the x-ray beamuntil the tip is centered in the locking hole.


Oblique (incorrect) Round (correct)

*Also available

Synthes 21

5DrillTilt the drive until the drill bit is in line with the beam andappears centered in the outer ring. The drill bit will nearly fillthe locking hole image. Hold the drill firmly in this positionand drill through both cortices.

6Measure

Instrument


Measure for locking bolt or locking screw length using thelocking bolt measuring device. Locking bolt or locking screwlength is read directly from the device.

7Insert locking bolt or locking screw

Instrument


Insert the appropriate length 4.9 mm titanium locking bolt or 5.0 mm titanium locking screw, using the hexagonal screwdriver.


Instrument

315.40 4.0 mm Three-Fluted Drill Bit

Use the 4.0 mm three-fluted drill bit to perform freehandproximal locking.

Inserting the End Cap

Insert end cap

Instrument


The end cap locks the most distal 6.0 mm titanium lockingscrew in place, thereby creating a fixed angle construct.

Remove the insertion instrumentation. Using the hexagonalscrewdriver, align the end cap with the nail axis to preventcross-threading. Thread the end cap into the nail until it engages the locking screw.

Technique tip: To minimize the chance of cross-threading,turn the end cap counterclockwise until the threads of theend cap align with the threads of the nail. Insert the end capby turning clockwise until it is fully seated.


Implant Removal

1Remove locking implants and end cap

Instrument


Clear tissue ingrowth from the hex of the end cap and lockingimplants and remove using the hexagonal screwdriver.

2Remove nail

Instruments


357.22 Hammer Guide

357.25 Slide Hammer

Thread the connecting screw into the distal end of the nail. Slide the hammer guide through the slide hammer and attach it to the connecting screw. Finger-tighten the assembly.

Remove the final locking screw and remove the nail.

Note: Before removing the last locking screw, thread theconnecting screw into the distal end of the nail. This will prevent the nail from rotating in the medullary canal.

Synthes 23


Alternative Technique–Extraction Hook

The extraction hook is for use with cannulated nails only.

For removal of broken nail

Instruments

355.399◊ Extraction Hook, for Titanium Cannulated Nails

393.10 Universal Chuck with T-Handleor393.105 Small Universal Chuck with T-Handle

1Clear tissue from the end of the nail and remove the end cap.

2Remove the locking bolts and/or screws with the appropriatescrewdriver.

3Insert the extraction hook into the universal chuck with T-handle.The hook should be parallel with the T-handle. This facilitatesvisualization of the hook position in the bone.

◊ Available nonsterile or sterile-packed. Add “S” to catalog number to order sterile product.

Implant Removal

Synthes 25

4Attach the appropriate extraction bolt or connecting screwto the nail. Remove the near nail fragment using the extractionthe bolt or connecting screw.

Note: The extraction hook can be used as an alternative to extraction instrumentation.

5Ream the medullary canal 1 mm larger than the diameter to clear a path for the distant nail fragment.

6Insert the extraction hook and explanted, near nail fragmentinto the medullary canal. The near nail fragment aligns the ex-traction hook with the cannulation of the distant nail fragment.

7Pass the extraction hook through the cannula of the distantnail fragment.

Note: Under image intensification, verify that the hook haspassed through and engaged the distant end of the nail.

8Extract both nail fragments.

Note: Keep the patient’s limb restrained to increase the efficiency of the extraction force.


For removal of an intact nail

Instruments

355.399◊ Extraction Hook, for Titanium Cannulated Nails

393.10 Universal Chuck with T-Handleor393.105 Small Universal Chuck with T-Handle

1Clear tissue from the end of the nail and remove the end cap.

2Remove the locking bolts and/or screws with the appropriatescrewdriver.

3Insert the extraction hook into the universal chuck with T-handle. The hook should be parallel with the T-handle. This facilitates visualization of the hook position in the bone.

4Insert the extraction hook through the nail cannula.

Note: Under image intensification, verify that the hook haspassed through and engaged the distant end of the nail.

5Extract the nail.

Note: Keep the patient’s limb restrained to increase the efficiency of the extraction force.

◊ Available nonsterile or sterile-packed. Add “S” to catalog number to order sterile product.

Implant Removal

Synthes 27

Implant Specifications

Titanium Distal Femoral Nails– Universal design for the right and

left femur

– 1.5 m radius of curvature foranatomic fit

Material– Titanium–6% aluminum–

7% niobium alloy

Diameters– 9 mm solid nails

– 10 mm–13 mm cannulated nails

– 9 mm–12 mm nails are 12 mm in diameter at the distal end

– 13 mm nails are 13 mm in diameter throughout

Color– Aqua

Lengths– 160 mm–460 mm (20 mm increments)

Cross Section– 9 mm and 10 mm diameters,

round cross-section

– 11 mm, 12 mm, and 13 mm diameters, fluted cross-section

Proximal Locking– Proximal locking holes accept 4.9 mm

locking bolts or 5.0 mm locking screws

– Dynamic slot accepts 4.9 mm lockingbolt or 5.0 mm locking screw

– Permits up to 5 mm controlled axial dynamization

Distal Locking– Distal locking holes accept

6.0 mm titanium locking screws

30 mm from end of nail

15 mm from end of nail

52 mm

17 mm

22 mm

37 mm

0 mm

••

•

Dynamic

Static

Static

Static

Proximal locking hole orientation:two anterior-to-posterior holes;one lateral-to-medial hole

Implants

Length (mm)

450.701 160450.714 180 450.702 200450.715 220 450.703 240450.716 260450.704 280450.705 300


Titanium Solid Distal Femoral Nails (9 mm diameter)

Length (mm)

450.706 320450.707 340450.708 360450.709 380450.710 400450.711 420450.712 440450.713 460

10 mm dia.Length (mm)

450.781 160450.794 180450.782 200450.795 220450.783 240450.796 260450.784 280450.785 300450.786 320450.787 340450.788 360450.789 380450.790 400450.791 420450.792 440450.793 460


450.801 160450.814 180450.802 200450.815 220450.803 240405.816 260450.804 280450.805 300450.806 320450.807 340450.808 360450.809 380450.810 400450.811 420450.812 440450.813 460

Titanium Cannulated Distal Femoral Nails (10 mm–13 mm diameters)


450.821 160450.834 180450.822 200450.835 220450.823 240450.836 260450.824 280450.825 300450.826 320450.827 340450.828 360450.829 380450.830 400450.831 420450.832 440450.833 460


450.841 160450.854 180450.842 200450.855 220450.843 240450.856 260450.844 280450.845 300450.846 320450.847 340450.848 360450.849 380450.850 400450.851 420450.852 440450.853 460

Synthes 29

4.9 mm Titanium Locking Bolts (green)– Titanium alloy*

– Lengths: 26 mm–100 mm


– Fully threaded



Length (mm)

459.54 54459.56 56459.58 58459.60 60459.64 64459.68 68459.72 72459.76 76459.80 80459.85 85459.90 90459.95 95459.100 100

Length (mm)

459.26 26459.28 28459.30 30459.32 32459.34 34459.36 36459.38 38459.40 40459.42 42459.44 44459.46 46459.48 48459.50 50459.52 52

* Titanium-6% aluminum-7% niobium alloy

Implants


5.0 mm Titanium Locking Screws (green)– Titanium alloy*



– Fully threaded



Length (mm)

458.926 26458.928 28458.930 30458.932 32458.934 34458.936 36458.938 38458.940 40458.942 42458.944 44458.946 46458.948 48458.950 50458.952 52

Length (mm)

458.954 54458.956 56458.958 58458.960 60458.964 64458.968 68458.972 72458.976 76458.980 80458.985 85458.990 90458.995 95458.999 100


Synthes 31

Length (mm)

450.873 30450.874 35450.875 40 450.861 45450.862 50450.863 55450.864 60450.865 65

Length (mm)

450.866 70450.867 75450.868 80 450.869 85450.870 90450.871 95450.872 100

Titanium End Cap (aqua)– Titanium alloy*

– 8 mm diameter

– Locks distal most 6.0 mm titanium locking screw in place

– Protects nail threads from tissue ingrowth

– Sits flush with the distal end of the nail

450.896 Titanium End Cap, for Titanium DistalFemoral Nail

6.0 mm Titanium Locking Screws (aqua)– Titanium alloy*



– Fully threaded

– Self-tapping



Instruments

292.69 3.2 mm Calibrated Guide Wire, 300 mm


315.40 4.0 mm Three-Fluted Drill Bit, 195 mm, quick coupling



351.27 13.0 mm Cannulated Drill Bit, 300 mm



Synthes 33



357.098 5.0 mm Trocar

357.099 5.0 mm Three-Fluted Drill Bit, 330 mm, 100 mm calibration, quick coupling





357.128 13.0 mm/3.2 Trocar

357.22 Hammer Guide, for use with Slide Hammer (357.25)

357.25 Slide Hammer, for use with Hammer Guide (357.22)


Instruments


Synthes 35

Titanium Distal Femoral Nail Insertion and Locking Set With locking bolts (105.521)With locking screws (105.523)

Graphic Case and Labels304.545 Titanium Distal Femoral Nail Insertion and

Locking Set Graphic Case

305.580 Graphic Case Labels, for 4.0 mm/5.0 mmTitanium Locking Screws (in set 105.523)

Instruments (in both sets)292.69 3.2 mm Calibrated Guide Wire, 300 mm, 5 ea.


315.40 4.0 mm Three-Fluted Drill Bit, 195 mm, quick coupling, 2 ea.



351.27 13.0 mm Cannulated Drill Bit, 300 mm




357.098 5.0 mm Trocar

357.099 5.0 mm Three-Fluted Drill Bit, 330 mm, 100 mm calibration, quick coupling, 2 ea.





357.128 13.0 mm/3.2 mm Trocar

357.22 Hammer Guide

357.25 Slide Hammer


◊ Available nonsterile or sterile-packed. Add ”S” to catalog number to order sterile product.

Note: For additional information, please refer to package insert. For detailed cleaning and sterilization instructions, please refer to http://www.synthes.com/sites/NA/MedicalCommunity/Pages/Cleaning_and_Sterilization.aspxor to the below listed inserts, which will be included in the shipping container: – Processing Synthes Reusable Medical Devices - Instruments, Instrument Trays

and Graphic Cases—DJ1305 – Processing Non-sterile Synthes Implants—DJ1304

Implants (in set 105.521)4.9 mm Titanium Locking Bolts, 2 ea.◊

Implants (in set 105.523)5.0 mm Titanium Locking Screws, 2 ea.◊

Also Available Sets105.954 Small Battery Drive Set, with 14.4 V Battery

150.060 Flexible Reamer Set, for IM Nails

Also Available Instruments314.11 Holding Sleeve for Hexagonal

Screwdriver (314.75)

351.71S 3.0 mm Reaming Rod, with offset ball tip, 950 mm, sterile

351.76S 3.0 mm Reaming Rod, with straight ball tip,950 mm, sterile

355.006 Medullary Tube

355.041◊ 3.0 mm Guide Rod, with smooth tip, 950 mm, sterile

393.10 Universal Chuck with T-Handle

394.35 Large Distractor

399.43 Hammer, 700 grams

511.30 Radiolucent Drive

511.417 4.0 mm Three-Fluted Drill Bit, brad point, 150 mm, for use with radiolucent drive

Also Available Implants450.701– 9 mm Titanium Solid Distal Femoral Nails,450.716◊ 160 mm–460 mm (20 mm increments)

450.781– 10 mm Titanium Solid Distal Femoral Nails,450.796◊ 160 mm–460 mm (20 mm increments)




458.964– 5.0 mm Titanium Locking Screws,458.999◊ 64 mm–80 mm (4 mm increments),

85 mm–100 mm (5 mm increments)

459.64– 4.9 mm Titanium Locking Bolts,459.100◊ 64 mm–80 mm (4 mm increments),

85 mm–100 mm (5 mm increments)


◊ Available nonsterile or sterile-packed. Add ”S” to catalog number to order sterile product.

Length (mm)

459.44 44459.46 46459.48 48459.50 50459.52 52459.54 54459.56 56459.58 58459.60 60

Length (mm)

459.26 26459.28 28459.30 30459.32 32459.34 34459.36 36459.38 38459.40 40459.42 42

Length (mm)

458.944 44458.946 46458.948 48458.950 50458.952 52458.954 54458.956 56458.958 58458.960 60

Length (mm)

458.926 26458.928 28458.930 30458.932 32458.934 34458.936 36458.938 38458.940 40458.942 42

Titanium Distal Femoral Nail Insertion and Locking Set With locking bolts (105.521)With locking screws (105.523)

Length (mm)

450.866 70450.867 75450.868 80450.869 85450.870 90450.871 95450.872 100

Length (mm)

450.873 30450.874 35450.875 40450.861 45450.862 50450.863 55450.864 60450.865 65

450.896 Titanium End Cap, 2 ea.◊

Implants (in both sets)6.0 mm Titanium Locking Screws, 2 ea.◊

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

© 1997 Synthes, Inc. or its affiliates. All rights reserved. Synthes is a trademark of Synthes, Inc. or its affiliates. Printed in U.S.A. 11/11 J2983-G

www.synthes.com

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