T2-Femoral Nailing s685

T2
Femoral Nailing System

Operative Technique
Femoral Nailing System
Contributing Surgeons
Prof. Dr. med. Volker Bühren
Chief of Surgical Services
Medical Director of Murnau Trauma Center
Murnau
Germany
Joseph D. DiCicco III, D. O.

Director Orthopaedic Trauma Service
Good Samaritan Hospital
Dayton, Ohio
Associate Clinical Professor of Orthopeadic Surgery
Ohio University and Wright State University
USA
Thomas G. DiPasquale, D. O.

Medical Director, Orthopedic Trauma Services
Director, Orthopedic Trauma Fellowship and This publication sets forth detailed
Orthopedic Residency Programs recommended procedures for using
York Hospital Stryker Osteosynthesis devices and
York instruments.
USA
It offers guidance that you should
heed, but, as with any such technical
guide, each surgeon must consider
the particular needs of each patient
and make appropriate adjustments
when and as required.
A workshop training is required prior

to first surgery.
All non-sterile devices must be

cleaned and sterilized before use.
Follow the instructions provided in
our reprocessing guide (L24002000).
Multi-component instruments must
be disassembled for cleaning. Please
refer to the corresponding assembly/
disassembly instructions.
See package insert (L22000007) for

a complete list of potential adverse
effects, contraindications, warnings
and precautions. The surgeon must
discuss all relevant risks, including
the finite lifetime of the device, with
the patient, when necessary.
Warning:
Fixation Screws:
Stryker Ostreosynthesis bone
screws are not approved or
intended for screw attachment or
fixation to the posterior elements
(pedicles) of the cervical,
thoracic or lumbar spine.
2
Contents
Page
1. Introduction 4
Implant Features 4
Instrument Features 6
References 6
2. Indications, Precautions and Contraindications 7
Indications 7
Precautions 7
Relative Contraindications 7
3. Additional Information 8
Locking Options 8
4. Pre-operative Planning 10
5. Operative Technique – Retrograde Technique 11
Patient Positioning 11
Incision 11
Entry Point 12
Unreamed Technique 13
Reamed Technique 13
Nail Selection 15
Nail Insertion 16
Guided Locking Mode (via Target Device) 18
Static Locking Mode 19
Freehand Proximal Locking 23
End Cap Insertion 25
Dynamic Locking Mode 26
Apposition /Compression Locking Mode 26
Advanced Locking Mode 28
External Compression Device 30
Nail Removal 32
6. Operative Technique – Antegrade Technique 33
Patient Positioning and Fracture Reduction 33
Incision 33
Entry Point 34
Unreamed Technique 35
Reamed Technique 35
Nail Selection 37
Nail Insertion 38
Guided Locking Mode (via Target Device) 40
Static Locking Mode 41
Freehand Distal Locking 43
End Cap Insertion 44
Dynamic Locking Mode 45
Apposition /Compression Locking Mode 46
Advanced Locking Mode 48
External Compression Device 48
Nail Removal 50
Ordering Information – Implants 51

Ordering Information – Instruments 54
3
Introduction
Implant Features
Over the past several decades ante The T2 Femoral Nailing System is Besides the T2 Femoral nail with a
grade femoral nailing has become the realization of excellent biome 3m radius of curvature, Stryker offers
the treatment of choice for most chanical intramedullary stabilization also a 1.5m radius T2 Femoral Nail
femoral shaft fractures. Retrograde using small caliber, strong, cannu to complete the product offering for
femoral nailing has expanded the lated implants for internal fixation those patients with a higher anterior
use of intramedullary nails (1, 2). of long bones. According to the femoral curvature.
Complicated multiple trauma injuries, fracture type, the system offers the
associated pelvic and acetabular option of different locking modes. In Common 5mm cortical screws*
fractures, ipsilateral femoral shaft addition to static locking, a control simplify the surgical procedure
fractures, supracondylar and inter led dynamization with rotational and promote a minimally invasive
condylar fractures, may be better stability is an option. approach. Fully Threaded Locking
managed by utilizing retrograde Screws are available for regular
femoral nailing techniques In some indications, a controlled locking procedures. Partially
(3, 4, 5, 6, 7). apposition/compression of bone Threaded Locking Screws (Shaft
fragments can be applied by intro Screws) are designed if appo-
The T2 Femoral Nailing System ducing a Compression Screw from sition/compression is applied. Special
is one of the first femoral nailing the top of the nail. To further help Condyle Screws with adjustable
systems to offer an option for either increase rotational stability, the nail washers for improved fit are designed
an antegrade or a retrograde approach can be locked statically after using to fix fragments in the condyle area.
to repair fractures of the femur. the controlled dynamization and They also allow controlled “lag effect”
apposition/compression option. with intercondylar split type fractures.
One Implant,
Two Approaches The Compression Screw is pushed Compression Screws to close the
against the Partially Threaded fracture site and End Caps are
Stryker has created a next generation Locking Screw (Shaft Screw) that available in various sizes to allow an
locking nail system, bringing together has been placed in the oblong improved fit.
all the capabilities and benefits of hole, drawing either the distal or
separate antegrade and retrograde the proximal segment towards the All implants of the T2 Femoral
nailing systems to create a single, fracture site. In stable fractures, this Nailing System are made of Type II
integrated surgical resource for offers the biomechanical advantage anodized titanium alloy (Ti6AL4V)
fixation of long-bone fractures. of creating active circumferential for enhanced biomechanical and
compression to the fracture site, biomedical performance**.
Furthermore, the development of transferring axial load to the bone,
the T2 Femoral Nailing System offers and reducing the function of the nail See the detailed chart on the next page
the competitive advantages of: as a load bearing device (8). for the design specifications and size
offerings.
• Not limiting the approach to This ability to transfer load back to
a certain nailing technique the bone may reduce the incidence
• Accommodating reamed or of implant failure secondary to
unreamed procedures fatigue. Typical statically locked nails
• Providing locking options for function as load bearing devices, and * Special order 8mm T2 Femoral Nails can only be
locked with 4mm Fully Threaded screws at the non-
all types of fractures, plus the failure rates in excess of 20 % have driving end. As with all diameters of T2 Femoral
Advanced Locking Mode for been reported (9). Nails, the screws for driving end locking are 5mm.
increased rotational stability
** A xel Baumann, Nils Zander
The beneficial effect of apposition/ Ti6Ai4V with Anodization Type II: Biological and
Through the development of a com compression in treating long-bone Biomechanical Effects, White Paper, March 2005
mon, streamlined and intuitive fractures in cases involving transverse
surgical approach, both in principle and short oblique fractures that are
and in detail, the T2 Femoral Nailing axially stable is well documented
System offers the potential for (10, 11).
increased speed and functionality for
the treatment of fractures as well as Anthropological (13) and forensic
simplifying the training requirements (14) literature reveals that differences
for all personnel involved. in the anterior femoral curvature
between racial and ethnic groups have
long been recognized.
4
Introduction
Antegrade 0mm
15
Nails
25
Diameter 9−15mm (special order 8mm)*
Sizes 140−480mm 35 32.5
40 42.5
50
Note:
45mm
Screw length is measured from top
of head to tip.
5.0mm Partially Threaded Locking

Screws (Shaft Screws)
L = 25−120mm
5.0mm Fully Threaded

Locking Screws
L = 25−120mm
5.0mm Condyle Screws

L = 40−120mm
Condyle Nut
Compression
Screws
Femur Advanced 60
Compression 47.5
Compression 45
Screw Range*
50 35
Advanced 32.5
Compression
Screw
15
25
0mm
0mm Retrograde
Standard +5mm +10mm +15mm
End Caps
* 8mm nails (special order) require 4mm
Fully Threaded Screws for Distal Locking
* Compression Range
Total Length of Slot 15mm

Less Screw Diameter (-) 5mm
Maximum Movement of Screw 10mm
Standard +5mm +10mm +15mm +20mm +25mm +30mm +35mm

5
Introduction
Instrument Features
A major advantage of the instru- Symbol Drills
ment system is a breakthrough in the
integration of the instrument platform Square = Long instruments Drills feature color coded rings :
which can be used for the complete T2 4.2mm = Green
Nailing System, thereby to help reduce
complexity and inventory. Triangular = Short instruments For 5.0mm Fully Threaded Locking
Screws and for the second cortex
The instrument platform offers when using 5.0mm Partially Threaded
advanced precision and usability, and Locking Screws (Shaft Screws).
features ergonomically styled targeting
devices. 5.0mm = Black
Symbol coding on the instruments For the first cortex when using 5.0mm
indicates the type of procedure, and Partially Threaded Locking Screws
must not be mixed. (Shaft Screws) and for both corticies
when using Condyle Screws.
References
1. Janzing HMJ et al.: The Retrograde 6. Ostrum F. D., Joseph DiCicco, 10. M.E. Müller, et al., Manual of
Intramedullary Nail: Prospective Retrograde Intramedullary Nailing Internal Fixation, Springer-Verlag,
Experience in Patients Older than of Femoral Diaphyseal Fractures, Berlin, 1991
Sixty-five Years. Journal of Ortho- Journal of orthopaedic Trauma,
paedic Trauma 12 (5) 330-333, 1998 Vol. 12, N° 7, pp. 464-468, 1998 11. O. Gonschorek, G. O. Hofmann,
V. Bühren, Interlocking
2. Koval KJ et al.: Distal Femoral 7. Lucas SE et al.: Intramedullary Compression Nailing: a
Non-union: Treatment with Supracondylar Nailing of Femoral Report on 402 Applications.
a Retrograde Inserted Locked Fractures. A Preliminary Report Arch. Orthop. Trauma Surg (1998),
Intramedullary Nail, Journal of of the GSH Supracondylar Nail. 117: 430-437
Orthopaedic Trauma, Vol. 9 N°4, pp. Clinical Orthopaedics and Related
285-291, 1995 Research 296 200-206, 1993 12. Mehdi Mousavi, et al., Pressure
Changes During Reaming with
3. Herscovici D Jr. and Whiteman 8. T. E. Richardson, M. Voor, Different Parameters and Reamer
KW: Retrograde Nailing of the D. Seligson, Fracture Site Designs, Clinical Orthopaedics
Femur Using an Intercondylar Compression and Motion with and Related Research, Number
Approach. Clinical Orthopaedics Three Types of Intramedullary 373, pp. 295-303, 2000
and related Research, 332, 98-104, Fixation of the Femur,
1996 Osteosynthese International (1998), 13. Gilbert BM. Anterior femoral
6: 261-264 curvature: its propabable basis
4. Roy Sanders, Kenneth J. Koval et and utility as a criterion of a racial
al.: Retrograde Reamed Femoral 9. Hutson et al., Mechanical assessment. Am J Phys Anthropol.
Nailing. Journal of Orthopaedic Failures of Intramedullary Tibial 1976;45:601-604.5
Trauma 1993; Vol. 7, No. 4: 293-302 Nails Applied without Reaming,
Clin. Orthop. (1995), 315: 129-137 14. Ballard ME, Trudell MB. Anterior
5. Ostrum F. D., et al., A Prospective femoral curvature revisited: race
Comparison of Antegrade and assessment from the femur. J
Retrograde Intramedullary Nailing, Forensic Sci. 1999;44:700-707.
Friday, October 9, 1998 Session V,
11:31 a. m. OTA Vancouver
6
Indications, Precautions and Contraindications
Indications Precautions
• Open and closed femoral Stryker Osteosynthesis systems have
fractures not been evaluated for safety and use
• Pseudarthrosis and Correction in MR environment and have not been
Osteotomy tested for heating or migration in the
• Pathologic fractures, impending MR environment, unless specified
pathologic fractures and tumor otherwise in the product labeling or
resections respective operative technique.
• Supracondylar fractures,
Antegrade
including those with
intraarticular extension
• Ipsilateral femur fractures
• Fractures proximal to a total knee
arthroplasty
• Fractures distal to a hip joint
• Nonunions and malunions.
Retrograde
Relative Contraindications
The physician’s education, training
and professional judgement must
be relied upon to choose the most
appropriate device and treatment.
Conditions presenting an increased
risk of failure include:
• Any active or suspected latent • Implant utilization that would
infection or marked local interfere with anatomical
inflammation in or about the structures or physiological
affected area. performance.
• Compromised vascularity that • Any mental or neuromuscular
would inhibit adequate blood disorder which would create
supply to the fracture or the an unacceptable risk of fixation
operative site. failure or complications in
• Bone stock compromised by postoperative care.
disease, infection or prior • Other medical or surgical
implantation that can not provide conditions which would preclude
adequate support and/or fixation the potential benefit of surgery.
of the devices.
• Material sensitivity, documented
or suspected.
• Obesity. An overweight or obese
patient can produce loads on the
implant that can lead to failure
of the fixation of the device or to
failure of the device itself.
• Patients having inadequate tissue
coverage over the operative site.
7
Additional Information
Locking Options
Antegrade
Static Mode
Retrograde
8
Additional Information
Dynamic Mode Apposition / Compression Mode Advanced Locking Mode
9
Pre-operative Planning
An X-Ray Template 1806-0005 is

available for pre-operative planning.
Thorough evaluation of pre-operative

radiographs of the affected extremity
is critical. Careful radiographic
examination of the trochanteric region
and intercondylar regions may prevent
certain intra-operative complications.
The proper nail length when inserted

antegrade should extend from the
Tip of the Greater Trochanter to the
Epiphyseal Scar.
The retrograde nail length is deter

mined by measuring the distance
between a point 5mm–15mm proxi
mal to the Intercondylar Notch to
a point at/or proximal to the Lesser
Trochanter.
In either approach this allows the

surgeon to consider the apposition/
compression feature of the T2 Femo
ral Nail, knowing that up to 10mm
of active apposition/compression is
possible, prior to determining the final
length of the implant. If apposition/
compression is planned, the nail
should be 10mm to 15mm shorter.
Note:
Check with local representative
regarding availability of nail sizes.
10
Operative Technique – Retrograde Technique
Incision
A 3cm midline skin incision is made
extending from the inferior pole of the
Patella to the Tibial Tubercle, followed
by a medial parapatellar capsular
incision. This should be sufficient to
5mm
expose the Intercondylar Notch for
retrograde nail insertion. Occasionally,
a larger incision may be needed, espe
cially if the fracture has intra-articular
extension and fixation of the condyles
Patient Positioning is necessary.
Retrograde nail insertion is per Distal femoral fractures are often

formed with the patient supine on a complicated by intra-articular fracture
radiolucent table. The affected lower line extension. These fractures should
extremity and hip region are freely be anatomically reduced and secured
draped, and the knee is placed over with the aid of titanium Asnis III
a sterile bolster. This will allow for 6.5mm/8.0mm Large Cannulated
30-45 degrees of knee flexion. Manual Screws in the anterior and posterior
traction through a flexed knee or a aspect of the femoral condyles. This
distraction device may be used to will allow for adequate space when
facilitate reduction for most acute inserting the nail retrograde. Cannu
femoral shaft fractures. lated Screws are advantageous,
allowing the surgeon to use intra-
operative radiographs to check
Guide Wire placement prior to screw
insertion. An alternative is to reduce
and maintain reduction of the femoral
condyles with a pointed reduction
forceps during the insertion of the
retrograde nail and place cannulated
screws after the nail is inserted.
11
Entry Point
The 3 × 285mm K-Wire (1806-
0050S)* can easily be fixed to the
Guide Wire Handle (1806-1095
and 1806-1096) (Fig. 1). With the
condyles secured, the entry point
for retrograde nail insertion is made
by centering the 3 × 285mm K-Wire
through the Retrograde Protection
Sleeve (703165) and positioning within
the Intercondylar Notch anterior
to Blumensaat´s line on the M/L
radiograph using the Slotted Hammer
(1806-0170) (Fig. 2).
Note:
This point is found by palpating a Fig. 1
During opening the entry portal
distinct ridge just anterior to the
with the Awl, dense cortex may
Posterior Cruciate Ligament (Fig. 2).
block the tip of the Awl. An
Awl Plug (1806-0032) can be
The K-Wire is advanced manually or
inserted through the Awl to avoid
with the Slotted Hammer approxi
penetration of bone debris into
mately 10cm confirming its placement
the cannulation of the Awl shaft.
within the center of the distal femur
on an A/P and Lateral radiograph.
The Retrograde Protection Sleeve
is contoured to fit the profile of the
Intercondylar Notch.
It is designed to help reduce the Fig. 2
potential for damage during reaming,
and also provide an avenue for the
reamer debris to exit the knee joint

(Fig. 3).
When the inner Retrograde K-Wire

Guide is removed, the Ø12mm Rigid
Reamer (1806-2014) is inserted over
the 3 × 285mm K-Wire and through
the Retrograde Protection Sleeve.
The distal most 8cm of the femur is
reamed (Fig. 4).
The Ø12mm Rigid Reamer is used for

nails 9mm−11mm in diameter. Larger Fig. 3
nail diameters may be reamed with a
flexible reamer 1mm larger than the
nail.
Caution:
Prior to advancing the K-Wire
within the distal femur, check
the correct guidance through the
Ø12mm Rigid Reamer. Do not use
bent K-Wires.
* Outside of the U. S., product with an “S” may be

Fig. 4
ordered Non-Sterile without the “S” at the end of
the corresponding REF Number.
12
Unreamed Technique
If an unreamed technique is preferred, The Guide Wire is advanced until the
the 3 × 1000mm Ball Tip Guide Wire tip rests at/or just above the Lesser
(1806-0085S) is passed through the Trochanter. The Guide Wire should
fracture site using the Guide Wire lie in the center of the metaphysis in
Handle. the A/P and M/L views to avoid offset
positioning of the nail. The Guide
The Universal Rod (1806-0110) with Wire Handle is removed, leaving the Fig. 5
Reduction Spoon (1806-0125) may be Guide Wire in place.
used as a fracture reduction tool to
facilitate Guide Wire insertion (Fig. 5).
Internal rotation during insertion will
aid in passing the Guide Wire down
the femoral shaft.
Reamed Technique
For reamed techniques, the
3 × 1000mm Ball Tip Guide Wire is
inserted through the fracture site
and does not require a Guide Wire
exchange. The Universal Rod with
Reduction Spoon may be used as a
fracture reduction tool to facilitate
Guide Wire insertion through the
fracture site (see Fig. 5).
Note:
The Ball Tip at the end of the
Guide Wire will stop the reamer
head.
Reaming (Fig. 6)is commenced in

0.5mm increments until cortical
contact is appreciated. Final reaming
should be 1mm-1.5mm larger than the Fig. 6
diameter of the nail to be used.
13
The Guide Wire Pusher can be used to

help keep the Guide Wire in position
during reamer shaft extraction. The
metal cavity at the end of the handle
pushed on the end of the power tool
facilitates to hold the Guide Wire in
place when starting to pull the power
tool (Fig. 7). When close to the Guide
Wire end place the Guide Wire Pusher
with its funnel tip to the end of the
power tool cannulation (Fig. 8). While
removing the power tool the Guide
Wire Pusher will keep the Guide Wire
in place.
Caution:
The diameter of the driving end
of the 9mm–11mm (and special
Fig. 7 oder 8mm nails) diameter nails is
11.5mm. Additional metaphyseal
reaming may be required to
facilitate nail insertion. Nail
sizes 12–15mm have a constant
diameter.
Thoroughly irrigate the knee joint
to remove any debris.
Note:
• 8mm Femoral Nails cannot be
inserted over the 3 × 1000mm
Ball Tip Guide Wire (1806-
0085S). The Ball Tip Guide
Wire must be exchanged for the
3 × 800mm Smooth Tip Guide
Wire (1806-0090S) prior to nail
insertion.
• Use the Teflon Tube (1806-0073S)
for the 8mm Nail Guide Wire
exchange only.
Fig. 8
14
Nail Selection
Diameter
3 1 2 1
The diameter of the selected nail
should be 1mm smaller than that of
the last reamer used. Alternatively,
the nail diameter may be determined Length Scale Diameter Scale
using the Femur X-Ray Ruler (1806- Fig. 9.1
0015) (Fig. 9.1 and 9.2).
Fig. 9.1 Hole Positions (nondriving

end) Antegrade or Retrograde* Length Hole Positions
(driving end)
1. Static Locking – both M/L holes
2. Oblong hole – depending on 1 2 1
Antegrade or Retrograde;
static or dynamic modes – A/P
3. Static Locking – A/P
330 mm
Fig. 9.2 Hole Positions (driving end)
Antegrade or Retrograde*
1. Static Locking – both M/L holes
2. Oblong hole – depending on Length Static and Dynamic
Calibration Slot Locking Options Fig. 9.2
Antegrade or Retrograde; static,
dynamic, apposition/compression,
advanced locking modes – M/L
Length
Nail length may be determined by
measuring the remaining length of the
Guide Wire. The Guide Wire Ruler
(1806-0022) may be used by placing it
on the Guide Wire reading the correct
nail length at the end of the Guide
Wire on the Guide Wire Ruler
(Fig. 10 and Fig. 11).
End of Guide Wire Ruler
is the measurement reference.
Alternatively, the X-Ray Ruler (1806-
0015) may be used to determine nail Fig. 10
diameter and length (Fig. 9.1, 9.2).
Additionally, the X-Ray Ruler can
be used as a guide for locking screw
positions.
Note:
X-Ray Ruler and Guide Wire
Ruler can be used for nail length
determination beginning from
240mm. Shorter nail length can
be determined via the template.
Fig. 11
Caution:
If the fracture is suitable for appo
sition/compression, the implant
selected should be 10–15mm
shorter than measured, to help
avoid migration of the nail
beyond the insertion site.
The Guide Wire Ruler can be easily
* see pages 8-9 for detailed illustrations of Antegrade
and Retrograde Locking Options.
folded and unfolded.
15
Nail Holding Screw Nail Insertion

Strike Plate The selected nail is assembled onto the
Femoral Target Device (1806-1005)
with the Femoral Nail Holding Screw
(1806-0165) (Fig. 12). Tighten the Nail
Fixation Screw Holding Screw with the Universal
Clamp Joint Socket Wrench (1806-0400)
securely so that it does not loosen
during nail insertion.
Fixation
Screw Alternatively, the Fixation Screw
Clamp (1806-0273) can be used to fix
the Targeting Arm to the Nail Handle.
After clamping it on the Targeting
Arm the knob will tighten the sleeve
Nail
Handle to the Targeting Arm.
Targeting
Arm Caution:
Prior to nail insertion please
check correct alignment by
inserting a drill bit through the
K-Wire Hole assembled Tissue Protection- and
Drill Sleeve placed in the required
holes of the targeting device
(Fig. 12.1).
Upon completion of reaming, the

appropriate size nail is ready for
insertion. Unique to the T2 Femoral
Fig. 12
Nail, the 3 × 1000mm Ball Tip Guide
Wire does not need to be exchanged.
The Strike Plate (1806-0150) may be
threaded into the hole next to the
Nail Holding Screw and the nail is
advanced through the entry point past
the fracture site to the appropriate
Fig. 12.2 level.
Additionally, the 3 × 285mm K-Wire

may be inserted through the Targeting
Device which identifies the junction
of the nail and insertion post which
helps determine nail depth through a
mini incision using X-Ray
(see Fig. 12.2).
Insertion of the 3 × 285mm K-Wire

into the lateral cortex may also help
to lock the targeting device to the
distal femur and prevent rotation of
the nail in cases where the Apposition/
Compression Locking Mode is
utilized.
Caution:
Curvature of the nail must match
the curvature of the femur.
Fig. 12.1
16
Note:
DO NOT hit the Target Device.
Only hit on the Strike Plate.
The Slotted Hammer can be used on

the Insertion Wrench that is placed
onto the Nail Holding Screw to insert
the nail over a Guide Wire (Fig. 13).
A chamfer is located on the driving

end of the nail to denote the end
under X-Ray. Three circumferential
grooves are located on the insertion
post at 2mm, 10mm, and 15mm from
the driving end of the nail. Depth of
insertion may be visualized with the
aid of fluoroscopy.
If the nail has been inserted to far, it Fig. 13

has to be repositioned. Repositioning
should be carried out either by hand
or by using the Strike Plate attached
to the Target Device. The Universal
Rod and Slotted Hammer may then
be attached to the Strike Plate to
carefully and smoothly extract the
assembly (Fig. 14).
When locking the retrograde nail

in the Static Mode, the nail is
countersunk a minimum of 5mm
to the chondral surface. When the
implant is inserted in the Dynamic
Mode, without active apposition/
compression, the recommended
insertion depth is 10mm. When
the implant is inserted with active
apposition/compression or in
the Advanced Locking Mode, the
recommended depth of insertion is
15mm (Fig. 15). Fig. 14
Note:
Remove the Guide Wire prior
to drilling and inserting the
Locking Screws.
5mm
2mm Static
10mm Dynamic
15mm Apposition/Compression
Fig. 15
17
Guided Locking Mode (via Target Device)

Before locking the nail distally, the
Nail Holding Screw must be firmly
tightened using the Universal Joint
Socket Wrench to ensure that the nail
is correctly aligned with the Target
Device.
The Target Device is designed to

provide four options for distal locking
(Fig. 16.1–16.3).
3
2
In Static Locking Mode, all three 1
indicated holes may be used
(Fig. 16.1).
Fig. 16.1
1. Static
2. Static
3. Static
In controlled Dynamic Mode, and/or

controlled Apposition/Compression
Mode, the dynamic hole is required.
This hole is also used for compression
(Fig. 16.2).
4
4. Dynamic
In Advanced Locking Mode, the

dynamic hole is required. After Fig. 16.2
utilizing compression with the
Advanced Compression Screw, either
or both static holes are used
(Fig. 16.3).
4. Dynamic
1. Static
3. Static
3
4
1
The Long Tissue Protection Sleeve
(1806-0185) together with the Long
Drill Sleeve (1806-0215) and the Long
Trocar (1806-0315) is inserted into the Fig. 16.3
Target Device by pressing the safety
clip (Fig. 17). The mechanism will
help keep the sleeve in place and help
prevent it from falling out.
It will also help prevent the
sleeve from sliding during screw
measurement.
released locked
To release the Tissue Protection Sleeve,
the safety clip must be pressed again.
Fig. 17
18
Static Locking Mode

When treating supracondylar fractures,
three screws should be used whenever
possible. The screw placed within the
oblong hole should be in the static
position. Always start with the most
proximal screw.
If secondary dynamization is planned,

it is recommended to dynamize at
the proximal portion of the nail.
This is achieved by putting a Fully
Threaded Locking Screw at the proxi
mal location of the A/P oblong hole
at the top of the nail. This allows
dynamization of the fracture in case
of delayed union after removal of the
most proximal screw.
Fig. 18
together with the Long Drill Sleeve
and Long Trocar, are positioned
through the static locking hole on the
Target Device. A small skin incision
is made, and the assembly is pushed
through until it is in contact with the
lateral cortex of the femur (Fig. 18).
The Trocar is removed, with the

Tissue Protection Sleeve and the Drill
Sleeve remaining in position.
Alternatively, the Trocar (1806-0311)

can be advanced together with the
Tissue Protection Sleeve. Push the
assembly down to the bone. The
paddle tip design may help to pass
the soft tissue and prepare the way for
Fig. 19
drilling. Remove the Trocar to insert
the Drill Sleeve (Fig. 19).
19
To ensure accurate drilling and easy

determination of screw length, use the
center tipped, Ø4.2 × 340 calibrated
Drill (1806-4260S). The centered Drill
is forwarded through the Drill Sleeve 50mm
and pushed onto the cortex.
After drilling both cortices, the screw

length may be read directly off of the
calibrated Drill at the end of the Drill
Sleeve. If measurement with the Screw
Gauge, Long is preferred, first remove
the Drill Sleeve, Long and read the
screw length directly at the end of the
Tissue Protection Sleeve, Long (Fig. 20
and Fig. 21).
Fig. 20
Caution:
Make sure the Tissue Protection
Sleeve/Drill Sleeve Assembly is
seated on bone prior to selecting
final screw length.
50mm
Note:
The position of the end of the
Drill as it relates to the far cortex
is equal to where the end of the
screw will be. Therefore, if the
end of the Drill is 3mm beyond
the far cortex, the end of the Fig. 21
screw will also be 3mm beyond.
Alternatively, the Screw Gauge can be Alternatively, the 3.5mm Hex Self-
used to measure the screw length. Holding Screwdriver Long (1806-0233)
can be used for the screw insertion.
The Screw Gauge, Long is calibrated
so that with the bend at the end pulled Caution:
back flush with the far cortex, the The coupling of Elastosil handles
Fig. 22
screw tip will end 3mm beyond the far contains a mechanism with
cortex (Fig. 21). one or multiple ball bearings.
In case of applied axial stress
When the Drill Sleeve is removed, the on the Elastosil handle, those
correct Locking Screw is inserted components are pressed into the
through the Tissue Protection Sleeve surrounding cylinder resulting in
using the Long Screwdriver Shaft a complete blockage of the device
(1806-0227) with Teardrop Handle and possible bending.
(702429). The screw is advanced
through both cortices. To help avoid intra-operative
The screw is near its’ proper seating complications and promote long-
position when the groove around the term functionality, we mandate
shaft of the screwdriver is approaching that Elastosil handles be used only
the end of the Tissue Protection Sleeve for their intended use.
(Fig. 22). DO NOT HIT on any Elastosil
Repeat the locking procedure for handles.
the other statically positioned Cross
Locking Screws.
20
Condyle Screw Locking

If a Condyle Screw is to be inserted,
both cortices are drilled with the
Ø5 × 340mm Drill (1806-5020S)
(Fig. 23). After drilling both cortices,
the screw length may be read directly
off of the calibrated Drill at the end of
the Drill Sleeve. The Condyle Screw
K-Wire (0152-0218S) is inserted from
the lateral side through the Tissue
Protection Sleeve to the medial side.
At the medial point of the perforation
a skin incision is made for the
Condyle Screw.
From the medial side, the Condyle

Screw is now brought forward over
the Condyle Screw K-Wire and
inserted using the Condyle Screw
Fig. 23
Screwdriver (1806-0255).
If necessary, contour the bone

geometry with the Countersink for
Condyle Screw prior to inserting the
Condyle Screw and Nut to optimize
the seating of the washer (Fig. 24).
The lateral cortex can be contoured
through the Tissue Protection Sleeve,
the medial cortex in a freehand
technique, guided by the 1.8mm
K-Wire.
Fig. 24
21
To insert the Condyle Nut, the Tissue

Protection Sleeve and the Drill Sleeve
are removed, and the K-Wire is
withdrawn to the medial side. This
allows for the nut to be positioned
between the Target Device and the
level of the skin and onto the Condyle
Screw K-Wire (Fig. 25).
Alternatively, if the patient anatomy
allows, the Condyle Screw may be
introduced from Lateral to Medial in
a similar manner as described above
(Fig. 25a).
Condyle Screw- Using both Condyle Screw Screw

introduced M-L
drivers, the Condyle Nut and the
Condyle Screw are tightened. Once
tightened, the K-Wire is removed.
Fig. 25 The adjustable screw washer of the
Condyle Screw and the Condyle
Nut adapt to the surface of the bone
eliminating the need to countersink
both.
The geometry of the implant allows

three Condyle Screws to be used.
At least two of the three distal holes
should be engaged with either Locking
Screws and/or Condyle Screws
(Fig. 26). Always lock the most
proximal hole.
Condyle Screw-
introduced L-M
Fig. 25a
Fig. 26
22
Freehand Proximal Locking

The freehand technique is used to
insert Locking Screws into both the
A/P oblong hole and A/P round hole
in the nail. In Static, Apposition/
Compression and Advanced Locking
Mode, the Locking Screw placed in
the oblong hole should be positioned
in the distal position. Rotational
alignment must be checked prior to
locking the nail statically.
Caution:
Only one Locking Screw is
inserted in the Dynamic Locking
Mode. The Locking Screw is
placed in the proximal position
of the A/P oblong hole in order Fig. 27
to optimize dynamization at the
proximal end of the nail.
The M/L holes may also be used

alternatively or in addition to A/P
Locking Screws by adjusting the
C-Arm and leg position to locate the
holes.
Multiple locking techniques and

radiolucent drill devices are available
for freehand locking. The critical step
with any freehand locking technique,
proximal or distal, is to visualize
a perfectly round locking hole, or
perfectly oblong locking hole with the
C-Arm. Fig. 28
The center-tipped Ø4.2 × 230mm

Drill (1806-4290S) is held at an
oblique angle to the center of the
locking hole (Fig. 27 and 28). Upon
X-Ray verification, the Drill is placed
perpendicular to the nail and drilled Green Ring
through the anterior and posterior
cortex. Confirm that the Drill passes
through the hole in the nail in both
the A/P and M/L planes by X-Ray.
After drilling both cortices the screw

calibrated Screw Scale, Long (1806-
0365) at the green ring on the center-
tipped Drill (Fig. 29).
As with proximal locking (Fig. 20,
p. 20), the position of the end of the Fig. 29
drill is equal to the end of the screw as
they relate to the far cortex.
23
Routine Locking Screw insertion is

employed with the assembled Long
Screwdriver Shaft and the Teardrop
Handle (Fig. 30).
40mm Alternatively, the Screw Gauge can be

used to determine the screw length.
Alternatively, the 3.5mm Hex Self-

Holding Screwdriver Extra-short
(1806-0203) can be used for the screw
insertion.
Caution:
Special order 8mm T2 Femoral
Nails can only be locked with
4mm Fully Threaded screws at
the non-driving end. Use the
Ø3.5 × 180mm Drill (1806-3570S)
for freehand locking.
Fig. 30
24
End Cap Insertion

After removal of the Target Device, an
End Cap is used. Eight different sizes
of End Caps* are available to adjust
nail length and to reduce the potential
for bony ingrowth into the proximal
thread of the nail (Fig. 31).
Standard +5mm +10mm +15mm +20mm +25mm +30mm +35mm
Note:
Fig. 31
All End Caps are designed to
tighten down onto the locking
screw at the working end of the
nail. This will help prevent the
nail from M/L sliding.
The End Cap is inserted with the

Long Screwdriver Shaft and Teardrop
Handle after intra-operative radio
graphs show satisfactory reduction
and hardware implantation (Fig. 32).
Fully seat the End Cap to minimize
the potential for loosening.
Caution:
Final verification of implants
should be confirmed by X-Ray at Fig. 32
this time.
Thoroughly irrigate the wound to

prevent debris from remaining within
the knee joint. Close the wound using
standard technique.
Fig. 32a

Holding Screwdriver Long (1806-0233)
can be used for the End Cap insertion.
* Optional 8mm diameter End Caps are available in

+5, +10 and +15mm length to facilitate insertion
through the Nail Adapter (Fig. 32a & 32b).
Fig. 32b
25
Dynamic Locking Mode

When the fracture profile permits,
controlled dynamic locking may be
utilized for transverse or axially stable
fractures. While dynamic locking can
be performed at either end of the nail,
routine retrograde dynamic locking
should utilize the oblong hole at the
proximal end of the nail. The potential
for nail migration into the joint is
thereby reduced.
Retrograde dynamization is
performed by statically locking the
nail distally via the Target Device.
The freehand Locking Screw is then

placed in the dynamic position of the
oblong hole. This allows the nail to
move and the fracture to settle while
torsional stability is maintained
Fig. 33
(Fig. 33).
Apposition/Compression Locking Mode

In transverse or axially stable This will allow for a maximum of Wire (if used) is withdrawn.
fracture patterns, active apposition/ 10mm of active, controlled apposition/ With the driving end of the nail
compression may increase fracture compression. In order to insert the still not fully seated and extending
stability, may enhance fracture Shaft Screw, drill both cortices with out of the bone, the Nail Holding
healing, and allow for early weight the Ø4.2 × 340 Drill (1806-4260S). Screw is removed and the Advanced
bearing. The T2 Femoral Nail Next, drill the near cortex, ONLY, Compression Screw is inserted.
provides the option to treat a femur with the Ø5 × 230mm Drill (1806-
fracture with active mechanical 5000S). Caution:
apposition/compression prior to Care should be taken that
leaving the operating room. After the opposite cortex is drilled the shaft of the Advanced
with the Ø4.2 × 340mm Drill, the Compression Screw does not
Caution: correct screw length can be read extend into the area of the oblong
Proximal freehand static directly off of the calibrated Drill at hole.
locking with at least two Fully the end of the Drill Sleeve. ONLY the Advanced Compression
Threaded Locking Screws must Screw allows reattachment of
be performed prior to applying The 3.5mm Hex Self-Holding the Targeting Device without
active, controlled apposition/ Screwdriver Long (1806-0233) can be extending in the area of the
compression to the fracture site. use for screw insertion. oblong hole.
If active apposition/compression is It may be easier to insert the Advanced

required, a Partially Threaded Locking Compression Screw prior to fully
Screw (Shaft Screw) is inserted via the seating the nail. Once the nail tip has
Target Device in the dynamic position cleared the fracture site, the Guide
of the oblong hole.
26
Caution:
In order to prevent damage
during drilling and insertion
of the most proximal locking
screw, the Advanced Compression
Screw has to be placed between
the oblong hole and the most
proximal locking hole.
After the Shaft Screw is inserted, the

Nail Holding Screw securing the
nail to the insertion post is removed,
leaving the insertion post intact with
the nail (Fig. 34). This will act as a
guide for t he Compression Screw.
The Compression Screw is inserted
with the Compression Screwdriver Fig. 34
Shaft (1806-0268) assembled on
the Teardrop Handle through the
insertion post. When the ring marked
with an “F” on the Compression
Screwdriver Shaft is close to the Target
Device, it indicates the engagement of
the apposition/compression feature of
the nail. This applies only when the
Advanced Compression Screw is used.
Note:
The ring marked with a “T” is for
the Tibial Compression Screw.
The Long Tissue Protection Sleeve is

removed and the Compression Screw
is gently tightened utilizing the two-
finger technique. As the Compression
Screw is advanced against the
5.0mm Partially Threaded Locking
Fig. 35
Screw (Shaft Screw), it draws the
proximal fracture segment towards
the fracture site, employing active
apposition/compression (Fig. 35).
Image intensification will enable the
surgeon to visualize active apposition/
compression (Fig. 36). Some bending
of the transverse Shaft Screw may be
seen.
Caution:
• Apposition/compression must
be carried out under X-Ray
control. Over compression
may cause the nail or the Fig. 36
Shaft Screw to fail.
27
• When compressing the nail, Compression Screws are available in

the implant must be inserted different lengths. A short Advanced
a safe distance from the entry Compression Screw to enable the
point to accommodate for the Advanced Locking Mode and longer
10mm of active compression. Compression Screws from Standard to
The three grooves on the +15mm offer an improved fit. An End
insertion post help attain Cap can only be inserted when using
accurate insertion depth of the Advanced Compression Screw or
the implant. when not using compression.
Advanced Locking Mode

In order to achieve additional fixation
and to reduce the load on the Partially
Threaded Locking Screw (Shaft Screw),
the design of the T2 Femoral Nail
provides the opportunity to insert an
additional Fully Threaded Locking
Screw into the hole nearest t he driving
end of the nail after apposition/com
pression is utilized. An additional
Fully Threaded Locking Screw should
be inserted in either the more proxi
mal or more distal of the static holes
depending on the fracture stability.
Affix the Compression Screw on

the self-retaining Compression
Screwdriver Shaft. Remove the Nail Fig. 37
Holding Screw leaving the Target
Device in place (Fig. 37). Advance
the Compression Screw through the
Target Device until the ring marked
with an “F” on the Compression
Screwdriver Shaft is close to the Target
Device (Fig. 38). This applies only
when the Advanced Compression
Screw is used.
Fig. 38
28
To insert the most distal Screw, follow

the locking procedure for static
locking (Fig. 39−41).
To insert the Advanced Compression
Screw, follow the OP-Technique under
Apposition/Compression Locking
Mode section (p. 26) on the previous
page.
It may be easier to insert the

Compression Screw prior to fully
seating the nail.
To reattach the Target Device to the

nail, detach the Teardrop Handle from
the Compression Screwdriver Shaft
and screw the Nail Holding Screw over
the Compression Screwdriver Shaft Fig. 39
into its required position.
Prior to guided locking via the Target

Device, the Nail Holding Screw must
be tightened using the Universal Joint
Socket Wrench.
Fig. 40
Fig. 41
29
External Compression Device

Alternatively, the External Com-
pression Device (1806-0272) can be
used. After the Shaft Screw is inserted,
the External Compression Device
is threaded into the Nail Holding
Screw (Fig. 42 & 42a). The 8mm Hex
“click” Screwdriver bit, ball tip (1806-0065)
is attached to the Handle and placed
on top of the External Compression
Device to carefully apply compression
(Fig.43, 43a, 44 & 44a).
Fig. 42a
Fig. 42
Fig. 43a
Fig. 43
30
After successful compression a second

Locking Screw is inserted in the round
hole below the oblong hole
(Fig. 45). This will keep the com-
pression. After screw insertion, the
External Compression Device can be
detached.
Fig. 44a
Note:
The round hole above the oblong
hole is engaged by the External
Compression Device and can not
be used, while being attached.
For cleaning the External Com-

pression Device parts have to be disas-
sembled. Fig. 44
Fig. 45
31
Nail Removal
Nail removal is an elective procedure.
If needed, the End Cap and Compres
sion Screw (if Advanced Locking
Mode was utilized after the most
distal screw is extracted) are removed
with the Long Screwdriver Shaft and
Teardrop Handle (Fig. 46).
The Self-holding Screwdriver Long

(1806-0233) or Extra-short (1806-
0203) can be used for Screw removal.
As an alternative to removing the

Advanced Compression Screw (if
Fig. 46 used), it can be just disengaged from
the Partially Threaded Locking
Screw (Shaft Screw) by turning the
Compression Screwdriver one full
turn in a counter-clockwise direction.
There is no need to remove it from the
nail.
The Universal Rod is inserted into

the driving end of the nail. All
Locking Screws are removed with the
Handle (Fig. 47).
The Slotted Hammer is used to

extract the nail in a controlled
Fig. 47 manner (Fig. 48). A captured Sliding
Hammer (1806-0175) is available as an
“optional” instrument.
Note:
• Stryker offers also a Universal
Extraction Set for the removal
of internal fixation systems and
associated screws. For more
information, please refer to the
Literature Number B1000057.
• Check with local representative
regarding the availability of the
Universal Extraction Set.
Fig. 48
32
Operative Technique – Antegrade Technique
Patient Positioning and Fracture Reduction

Patient positioning for antegrade
femoral nail insertion is surgeon
dependent. The patient may be
positioned supine or lateral on a
fracture table, or simply supine on a
radiolucent table.
Incision
The design of the implant allows
for insertion either through the
Piriformis Fossa or the Tip of the
Greater Trochanter.
Piriformis Fossa
A skin incision is made beginning at
the level of the Greater Trochanter
extending proximal and slightly
posterior, in line with the Gluteus
Muscle, exposing the Piriformis Fossa
for antegrade femoral nail insertion.
Tip of the Greater Trochanter

With experience, the Tip of the
Greater Trochanter can be located
by palpation, and a horizontal skin
incision is made from the Greater
Trochanter to the Iliac Crest.
33
Entry Point
The Tip (Medial Edge) of
the Greater Trochanter (A)
The medullary canal is opened with
the Curved Awl (1806-0040) at the
junction of the anterior third and
posterior two-thirds of the Greater
Trochanter, on the medial edge of the
tip itself (Fig. 49). Image intensifica
tion (A/P and Lateral) is used for
confirmation.
Piriformis Fossa (B)

Alternatively, the implant may be
introduced in the Piriformis Fossa,
with a starting point just medial to
the Greater Trochanter and slightly
posterior to the central axis of the
Fig. 49
femoral neck.
Once the Tip of the Greater

Trochanter or the Piriformis Fossa
(Fig. 50) has been penetrated, the
3 × 1000mm Ball Tip Guide Wire
(1806-0085S) may be advanced
through the cannulation of the
Curved Awl with the Guide Wire
Handle (1806-1095 and 1806-1096)
(Fig. 51).
Note:
During opening the entry portal
Fig. 50
with the Awl, dense cortex may
block the tip of the Awl. An
Awl Plug (1806-0032) can be in-
serted through the Awl to avoid
penetration of bone debris into
the cannulation of the Awl shaft.
Fig. 51
34
Unreamed Technique
If an unreamed technique is preferred,
the 3 × 1000mm Ball Tip Guide Wire
(1806-0085S) is passed through the
fracture site using the Guide Wire
Handle.
The Universal Rod (1806-0110) with

Reduction Spoon (1806-0125) may
be used as a fracture reduction tool
to facilitate Guide Wire insertion
(Fig. 52). Internal rotation during
insertion will aid in passing the
Guide Wire down the femoral shaft.
The Guide Wire is advanced until
Fig. 52
the tip rests at/or to the level of the
Epiphyseal Scar or the mid-pole of
the Patella. The Guide Wire should
lie in the center of the metaphysis in
the A/P and M/L views to avoid offset
positioning of the nail. The Guide
Wire Handle is removed, leaving the
Guide Wire in place.
Reamed Technique
If the procedure will be performed
using a reamed technique, the
3 × 1000mm Ball Tip Guide Wire is
inserted with the Guide Wire Handle
through the fracture site to the level of
the Epiphyseal Scar or the mid-pole of
the Patella and does not need a Guide
Wire exchange. The Ø9mm Universal
Rod (1806-0110) with Reduction
Spoon (1806-0125) may be used as
a fracture reduction tool to facilitate
Guide Wire insertion through the
fracture site (Fig. 52), and in an
unreamed technique, may be used
as a “sound” to help determine the
diameter of the medullary canal.
Note:
The Ball Tip at the end of the Fig. 53
Guide Wire will stop the reamer
head.
Reaming is commenced in 0.5mm

increments until cortical contact is
appreciated (Fig. 53). Final reaming
should be 1mm-1.5mm larger than the
diameter of the nail to be used.
35
The Guide Wire Pusher can be used to

help keep the Guide Wire in position
during reamer shaft extraction. The
metal cavity at the end of the handle
pushed on the end of the power tool
facilitates to hold the Guide Wire in
place when starting to pull the power
tool (Fig. 54). When close to the
Guide Wire end place the Guide Wire
Pusher with its funnel tip to the end
of the power tool cannulation (Fig. 55).
While removing the power tool the
Guide Wire Pusher will keep the
Guide Wire in place.
Note:
• The proximal diameter
(driving end) of the 9mm–
Fig. 54 11mm diameter nails is
11.5mm. Nail sizes 12–15mm
have a constant diameter.
Additional metaphyseal
reaming may be required to
facilitate nail insertion.
• 8mm Femoral Nails cannot
be inserted over the 3 ×
1000mm Ball Tip Guide
Wire (1806-0085S). The Ball
Tip Guide Wire must be
exchanged for the 3 × 800mm
Smooth Tip Guide Wire
(1806-0090S) prior to nail
insertion.
• Use the Teflon Tube (1806-
0073S) for the 8mm Nail
Guide Wire exchange only.
Fig. 55
36
Nail Selection
Diameter
The diameter of the selected nail
should be 1mm smaller than that of
the last reamer used. Alternatively, the
diameter may be determined using the
Femur X-Ray Ruler (1806-0015) with
the different diameters matching with
the radiographs (see Fig. 9.1 on
page 15).
Length
Nail length may be determined with
the X-Ray Ruler or may be deter-
mined by measuring the remaining End of Guide Wire Ruler
length of the Guide Wire. The Guide is the measurement reference
Wire Ruler (1806-0022) may be used
Fig. 56
by placing it on the Guide Wire
reading the correct nail length at the
end of the Guide Wire on the Guide
Wire Ruler (Fig. 56 and 57).
Note:
X-Ray Ruler and Guide Wire
Ruler can be used for nail length
determination beginning from
240mm. Shorter nail length can
be determined via the template.
Caution:
If the fracture is suitable for Fig. 57
apposition/compression, the
implant selected should be
10–15mm shorter than measured,
to help avoid migration of the nail
beyond the insertion site.
The Guide Wire Ruler can be easily

folded and unfolded.
37
Nail Insertion
The selected nail is assembled onto the
Target Device with the Nail Holding
Screw (Fig. 58). Tighten the Nail
Holding Screw with the Universal
Joint Socket Wrench (1806-0400) K-Wire
securely so that it does not loosen Fig. 58.1
during nail insertion.
Alternatively, the Fixation Screw

Clamp (1806-0273) can be used to fix
the Targeting Arm to the Nail Handle.
After clamping it on the Targeting
Arm the knob will tighten the sleeve
to the Targeting Arm.
Caution:
Prior to nail insertion please
check correct alignment by
inserting a drill bit through the
assembled Tissue Protection and
Drill Sleeve placed in the required
holes of the targeting device Fig. 58
(Fig. 58.2).
Upon completion of reaming, the

appropriate size nail is ready for
insertion. Unique to the T2 Femoral
Nail the 3 × 1000mm Ball Tip Guide Fig. 58.2
Wire does not need to be exchanged.
The Strike Plate (1806-0150) is
threaded into the Target Device and
the nail is advanced through the entry
point past the fracture site to the
appropriate level.
Additionally, the 3 × 285mm K-Wire

may be inserted through the Target
Device which indicates the junction
of the nail and insertion post (see
Fig. 58.2).
Insertion of the 3 × 285mm K-Wire

into the lateral cortex may also help to
lock the Target Device to the proximal Fig. 59.1
femur and prevent rotation of the nail
in cases where the Apposition/Com-
pression Locking Mode is utilized.
Caution:
Curvature of the nail must match
the curvature of the femur.
The Slotted Hammer can be used on

the Strike Plate (Fig. 59.1), or if dense
bone is encountered, the Universal
Rod may be attached to the Nail
Holding Screw and used in conjunc
tion with the Slotted Hammer to
insert the nail (Fig. 59.2). Fig. 59.2
38
Note:
DO NOT hit the Target Device.
Only hit on the Strike Plate.
A chamfer is located on the working 5mm

Static
end of the nail to denote the end 2mm
under X-Ray. Three circumferential 10mm Dynamic
grooves are located on the insertion 15mm Apposition/Compression
post at 2mm, 10mm, and 15mm from
the driving end of the nail (Fig. 60). Fig. 60
Depth of insertion may be visualized
with the aid of fluoroscopy.
If the nail has been inserted to far, it

has to be respositioned. Repositioning
should be carried out either by hand
or by using the Strike Plate on the top
of the Target Device. The Universal
Rod and Slotted Hammer may then be Fig. 61
attached to the Strike Plate to carefully
and smoothly extract the assembly.
When locking the antegrade nail in

the static mode, the nail is counter
sunk a minimum of 5mm (Fig. 61).
When the implant is inserted in

the dynamic mode, without active
apposition/compression, or when Fig. 62
the implant is inserted with active
apposition/compression, the recom-
mended depth of insertion is 15mm
(Fig. 62).
Note:
Remove the Guide Wire prior
to drilling and inserting the
Locking Screws.
39
Guided Locking Mode (via Target Device)

Prior to guided locking via the Target
Device, the Nail Holding Screw
must be firmly tightened using the
Universal Joint Socket Wrench, to
help ensure that the nail is in correct
alignment with the Target Device
(Fig. 63).
The Target Device is designed with

four locking holes. According to the
selected locking mode, the appropriate
holes are used (see Fig. 16.1.–16.3 on
p. 18).

(1806-0185) together with the Long
Drill Sleeve (1806-0215) and the Long
Trocar (1806-0315) is inserted into
the Target Device by pressing the
safety clip (see Fig. 17 on p. 18). The
mechanism will help keep the sleeve
in place and help prevent it from
falling out. It will also help prevent
the sleeve from sliding during screw
measurement. To release the Tissue
Protection Sleeve, the safety clip must
be pressed again.
Fig. 63
40
Static Locking Mode

The Long Tissue Protection Sleeve to-
gether with the Long Drill Sleeve
and the Long Trocar are positioned
through the static locking hole on the
Target Device. A small skin incision
is made, and the assembly is pushed
through until it is in contact with the
lateral cortex of the femur (Fig. 64).
The Trocar is removed while the
Tissue Protection Sleeve and the Drill
Sleeve remain in position.
Alternatively, the Trocar (1806-0311)

can be advanced together with the
Tissue Protection Sleeve. Push the
assembly down to the bone (Fig. 65).
The paddle tip design may help to pass
the soft tissue and prepare the way
for drilling. Remove the the Trocar to
Fig. 64
insert the Drill Sleeve.
To help ensure accurate drilling, and

easy determination of screw length,
use the center tipped, calibrated
Ø4.2 × 340 Drill (1806-4260S). The
centered Drill is forwarded through
the Drill Sleeve and pushed onto the
cortex.

calibrated Drill at the end of the Drill
Sleeve (Fig. 66 and see Fig. 20 and 21
on p. 20).
Fig. 65
Fig. 66
41
When the Drill Sleeve is removed, the

correct Locking Screw is inserted
through the Tissue Protection Sleeve
using the Long Screwdriver Shaft
(1806-0227) with Teardrop Handle
(702429) (Fig. 67).

Holding Screwdriver Long (1806-
0233) can be used for screw insertion.
The screw is advanced through both
cortices. The screw is near its proper
seating position when the groove
around the shaft of the screwdriver
is ap-proaching the end of the Tissue
Protection Sleeve (see Fig. 22 on p. 20).
Repeat the locking procedure for the
other statically positioned Locking
Screws (Fig. 68). The most proximal
Fig. 67 M/L hole (nearest the driving end of
the nail) is not generally utilized in
the antegrade mode.
Caution:
In unstable fracture patterns,
static locking should always be
performed with at least two distal
Locking Screws and two proximal
Locking Screws.
Fig. 68
42
Freehand Distal Locking

The freehand technique is used to
insert Fully Threaded Locking Screws
into both distal M/L holes in the nail.
Rotational alignment must be checked
prior to locking the nail statically.
Multiple locking techniques and

radiolucent drill devices are available
for freehand locking. The critical
step with any freehand locking
technique, proximal or distal, is to
visualize a perfectly round locking
hole or perfectly oblong locking hole
with the C-Arm. Fig. 69
The center-tipped Ø4.2 × 180mm Drill

(1806-4270S) is held at an oblique
angle to the center of the locking
hole (Fig. 69 and 70). Upon X-Ray
verification, the Drill is placed per
pendicular to the nail and drilled
through the lateral and medial cortex.
Confirm in both the A/P and M/L
planes by X-Ray that the Drill passes
through the hole in the nail.
Caution:
Special order 8mm T2 Femoral
Nails can only be locked with Fig.70
4mm Fully Threaded screws at
the non-driving end. Use the
Ø3.5 × 180mm Drill (1806-3570S)
for freehand locking.

Long Screw Scale (1806-0365) at the
green ring on the center tipped Drill
(see Fig. 29 on p. 23). Alternatively,
the optional Depth Gauge, Standard
Style for Freehand Locking (1806-
0390), may be used after drilling to
determine the length of screw needed.
Routine Locking Screw insertion Fig. 71

is employed with the assembled Long
Screwdriver Shaft and Teardrop
Handle (Fig. 71).

Holding Screwdriver Long (1806-0233)
or Extra-short (1806-0203) can be
used for screw insertion.
43
End Cap Insertion

After removal of the Target Device, an
End Cap is used. Eight different sizes
of End Caps* are available to adjust
nail length and to reduce the potential
for bony ingrowth into the proximal
thread of the nail. (see Fig. 31 on p. 25)
Note:
All End Caps are designed to
tighten down onto the Locking or
Fig. 72 Condyle Screw at the driving end
of the nail. This will help prevent
the nail from M/L sliding.
The End Cap is inserted with the Long

Screwdriver Shaft and Teardrop
Hand le after intra-operative radio-
graphs show satisfactory reduction
and hardware implantation (Fig. 72).
Fully seat the End Cap to minimize
the potential for loosening.
The 3.5mm Hex Self-Holding

Screwdriver Long (1806-0233) or
Extra-short (1806-0203)can be used
for end cap insertion.
Fig. 72a
Caution:
Final verification of implants
should be confirmed by X-Ray at
this time.
Thoroughly irrigate the wound to

prevent debris from remaining.
Close the wound using the standard
technique.
Fig. 73b
* Optional 8mm diameter End Caps are available in

+5, +10 and +15mm length to facilitate insertion
through the Nail Adapter (Fig. 61a & 61b).
44
Dynamic Locking Mode

When the fracture profile permits,
dynamic locking may be utilized for
transverse, axially stable fractures.
While dynamic locking can be per
formed at either end of the nail,
routine antegrade dynamic locking
should utilize the M/L oblong hole at
the Target Device.
The Partially Threaded Locking

Screw is placed in the dynamic posi
tion of the oblong hole via the Target
Device. This allows the nail to move
and the fracture to settle while
providing torsional stability (Fig. 74).
Antegrade dynamization is performed

by statically locking the nail distally
with two M/L Fully Threaded Locking
Screws in a freehand technique.
Fig. 74
45
Apposition / Compression Locking Mode

In transverse, axially stable fracture Caution: This will act as a guide for the Com-
patterns, active apposition/compres • Care should be taken that pression Screw. The Compression
sion increases fracture stability, may the shaft of the Advanced Screw is inserted with the Com-
enhance fracture healing, and allow Compression Screw does not pression Screwdriver Shaft (1806-
for early weight bearing. The T2 extend into the area of the oblong 0268) and Teardrop Handle through
Femoral Nail gives the option to treat hole. the insertion post (Fig. 76). When
a femur fracture with active mechani ONLY the Advanced Compression the ring marked with an “F” on the
cal apposition/compression prior to Screw allows reattachment of Compression Screwdriver Shaft is
leaving the operating room. the Targeting Device without close to the Target Device, it indicates
extending in the area of the the engagement of the apposition/
Caution: oblong hole. compression feature of the nail.
Distal freehand static locking • In order to prevent damage This applies only when the Advanced
with at least two Fully Threaded during drilling and insertion Compression Screw is used.
Locking Screws must be per of the most proximal locking
formed prior to applying screw, the Advanced Compression Note:
active, controlled apposition/ Screw has to be placed between The ring marked with a “T” is for
compression to the fracture site. the oblong hole and the most the Tibial Compression Screw.
proximal locking hole.
If active apposition/compression is
required, a Partially Threaded Locking After the Shaft Screw is inserted, the
Screw (Shaft Screw) is inserted via the Nail Holding Screw securing the
Target Device in the dynamic position nail to the insertion post is removed,
of the oblong hole. leaving the insertion post intact with
This will allow for a maximum of the nail (Fig. 75).
10mm of active, controlled apposition/
compression. In order to insert the
Shaft Screw, drill both cortices with
the Ø4.2 × 340mm Drill (1806-4260S).
Next, drill the near cortex, ONLY,
with the Ø5 × 230mm Drill (1806-
5000S).
After the opposite cortex is drilled

with the Ø4.2 × 340mm Drill, the
correct screw length can be read
directly off of the calibrated Drill at
the end of the Drill Sleeve.
The 3.5mm Hex Self-Holding

Screwdriver Long (1806-0233) can be
use for screw insertion.
It may be easier to insert the Advanced

Compression Screw prior to fully
seating the nail. Once the nail tip has Fig. 75
cleared the fracture site, the Guide
Wire (if used) is withdrawn.
With the driving end of the nail
still not fully seated and extending
out of the bone, the Nail Holding
Screw is removed and the Advanced
Compression Screw is inserted.
46
The Long Tissue Protection Screw

is removed and the Compression
Screw is gently tightened utilizing
the two-finger technique. As the
Compression Screw is advanced
against the 5.0mm Partially Threaded
Locking Screw (Shaft Screw), it draws
the distal fracture segment towards
the fracture site, employing active
apposition/compression (Fig. 77).
Image intensification will enable the
surgeon to visualize active apposition/
compression. Some bending of the
transverse Shaft Screw may be seen.
Caution:
• Apposition/compression must be
carried out under X-Ray control.
Over compression may cause the Fig. 76
nail or the Shaft Screw to fail.
• When compressing the nail, the
implant must be inserted a safe
distance from the entry point to
accommodate for the 10mm of
active compression. The three
grooves on the insertion post help
attain accurate insertion depth of
the implant.
Compression Screws are available in

different lengths. A short Advanced
Compression Screw to enable the
Advanced Locking Mode and longer
Compression Screws from Standard
to +15mm provide an improved for
every indication. An End Cap can only
be inserted when using the Advanced
Compression Screw or when not using
compression.
Fig. 77
47
Advanced Locking Mode

In order to achieve additional Warning:
fixation and to reduce the load on the Using the most proximal locking
Partially Threaded Locking Screw hole to reduce the load on the
(Shaft Screw), an additional Locking Partially Threaded Locking Screw
Screw should also be inserted in the requires appropriate positioning
more distal or more proximal of the of the nail. Ensure secure screw
proximal locking holes depending on placement below the calcar region.
the fracture stability. End Caps in eight different
lengths allow for intra-operative
length adjustment.
External Compression Device

Alternatively, the External Com-
pression Device (1806-0272) can be
used. After the Shaft Screw is inserted,
the External Compression Device is
“click”
threaded into the Nail Holding Screw
(Fig. 78). The 8mm Hex Screwdriver
bit, ball tip (1806-0065) is attached
to the Handle and placed on top of
the External Compression Device to
carefully apply compression (Fig. 79 &
80). The Ball Tip design may help to
reduce collusion with the ilium and/or
soft tissue.
Fig. 78
Fig. 79
48
After successful compression a second

Locking Screw is inserted in the round
hole below the oblong hole (Fig. 81).
This will keep the compression.
After screw insertion, the External
Compression Device can be detached.
Note:
The round hole above the oblong
hole is engaged by the External
Compression Device and can not
be used, while it is being attached.
For cleaning the External Com-

pression Device parts have to be disas-
sembled.
Fig. 80
Fig. 81
49
Nail Removal
Nail removal is an elective procedure.
If needed, the End Cap and Compres
sion Screw (if Advanced Locking
Mode was utilized after the most
distal screw is extracted) are removed
with the Long Screwdriver Shaft and
Teardrop Handle (Fig. 82).
The Self-holding Screwdriver Long

(1806-0233) or Extra-short (1806-
0203) can be used for Screw removal.
As an alternative to removing the

Advanced Compression Screw (if
used), it can be just disengaged from
the Partially Threaded Locking
Screw (Shaft Screw) by turning the
Compression Screwdriver one full
turn in a counter-clockwise direction.
Fig. 82 There is no need to remove it from the
nail.
The Universal Rod is inserted into

the driving end of the nail. All
Locking Screws are removed with the
Handle.
The Slotted Hammer is used to

extract the nail in a controlled
manner (Fig. 83). A captured Sliding
Hammer (1806-0175) is available as an
“optional” instrument.
Note:
• Stryker offers also a Universal
Extraction Set for the removal
of internal fixation systems and
associated screws. For more
information, please refer to the
Literature Number B1000057.
• Check with local representative
regarding the availability of the
Universal Extraction Set.
Fig. 83
50
Ordering Information – Implants
T2 Femoral Locking Nail
REF Diameter Length REF Diameter Length

mm mm mm mm
1 825-0814S 8.0 140 1825-1214S 12.0 140

1825-0816S 8.0 160 1825-1216S 12.0 160
1825-0818S 8.0 180 1825-1218S 12.0 180
1825-0820S 8.0 200 1825-1220S 12.0 200
1825-0822S 8.0 220 1825-1222S 12.0 220
1825-0824S 8.0 240 1825-1224S 12.0 240
1825-0826S 8.0 260 1825-1226S 12.0 260
1825-0828S 8.0 280 1825-1228S 12.0 280
1825-0830S 8.0 300 1825-1230S 12.0 300
1825-0832S 8.0 320 1825-1232S 12.0 320
1825-0834S 8.0 340 1825-1234S 12.0 340
1825-0836S 8.0 360 1825-1236S 12.0 360
1825-0838S 8.0 380 1825-1238S 12.0 380
1825-0840S 8.0 400 1825-1240S 12.0 400
1825-0842S 8.0 420 1825-1242S 12.0 420
1825-0844S 8.0 440 1825-1244S 12.0 440
1825-0846S 8.0 460 1825-1246S 12.0 460
1825-0848S 8.0 480 1825-1248S 12.0 480
1 825-0914S 9.0 140 1825-1314S 13.0 140

1825-0916S 9.0 160 1825-1316S 13.0 160
1825-0918S 9.0 180 1825-1318S 13.0 180
1825-0920S 9.0 200 1825-1320S 13.0 200
1825-0922S 9.0 220 1825-1322S 13.0 220
1825-0924S 9.0 240 1825-1324S 13.0 240
1825-0926S 9.0 260 1825-1326S 13.0 260
1825-0928S 9.0 280 1825-1328S 13.0 280
1825-0930S 9.0 300 1825-1330S 13.0 300
1825-0932S 9.0 320 1825-1332S 13.0 320
1825-0934S 9.0 340 1825-1334S 13.0 340
1825-0936S 9.0 360 1825-1336S 13.0 360
1825-0938S 9.0 380 1825-1338S 13.0 380
1825-0940S 9.0 400 1825-1340S 13.0 400
1825-0942S 9.0 420 1825-1342S 13.0 420
1825-0944S 9.0 440 1825-1344S 13.0 440
1825-0946S 9.0 460 1825-1346S 13.0 460
1825-0948S 9.0 480 1825-1348S 13.0 480
1825-1014S 10.0 140 1825-1414S 14.0 140

1825-1016S 10.0 160 1825-1416S 14.0 160
1825-1018S 10.0 180 1825-1418S 14.0 180
1825-1020S 10.0 200 1825-1420S 14.0 200
1825-1022S 10.0 220 1825-1422S 14.0 220
1825-1024S 10.0 240 1825-1424S 14.0 240
1825-1026S 10.0 260 1825-1426S 14.0 260
1825-1028S 10.0 280 1825-1428S 14.0 280
1825-1030S 10.0 300 1825-1430S 14.0 300
1825-1032S 10.0 320 1825-1432S 14.0 320
1825-1034S 10.0 340 1825-1434S 14.0 340
1825-1036S 10.0 360 1825-1436S 14.0 360
1825-1038S 10.0 380 1825-1438S 14.0 380
1825-1040S 10.0 400 1825-1440S 14.0 400
1825-1042S 10.0 420 1825-1442S 14.0 420
1825-1044S 10.0 440 1825-1444S 14.0 440
1825-1046S 10.0 460 1825-1446S 14.0 460
1825-1048S 10.0 480 1825-1448S 14.0 480
1825-1114S 11.0 140 1825-1514S 15.0 140

1825-1116S 11.0 160 1825-1516S 15.0 160
1825-1118S 11.0 180 1825-1518S 15.0 180
1825-1120S 11.0 200 1825-1520S 15.0 200
1825-1122S 11.0 220 Special Order 1825-1522S 15.0 220
1825-1124S 11.0 240 1825-1524S 15.0 240
1825-1126S 11.0 260 Implants in sterile 1825-1526S 15.0 260
1825-1128S 11.0 280 packaging. 1825-1528S 15.0 280
1825-1130S 11.0 300 1825-1530S 15.0 300
1825-1132S 11.0 320 Note : 1825-1532S 15.0 320
1825-1134S 11.0 340 1825-1534S 15.0 340
1825-1136S 11.0 360
Check with 1825-1536S 15.0 360
1825-1138S 11.0 380 local repre- 1825-1538S 15.0 380
1825-1140S 11.0 400 sentative 1825-1540S 15.0 400
1825-1142S 11.0 420 1825-1542S 15.0 420
1825-1144S 11.0 440
regarding 1825-1544S 15.0 440
1825-1146S 11.0 460 availability 1825-1546S 15.0 460
1825-1148S 11.0 480 of nail sizes. 1825-1548S 15.0 480
51
5mm Fully Threaded Locking Screws 5mm Partially Threaded Locking Screws

mm mm mm mm
1896-5025S 5.0 25.0 1891-5025S 5.0 25

1896-5027S 5.0 27.5 1891-5030S 5.0 30
1896-5030S 5.0 30.0 1891-5035S 5.0 35
1896-5032S 5.0 32.5 1891-5040S 5.0 40
1896-5035S 5.0 35.0 1891-5045S 5.0 45
1896-5037S 5.0 37.5 1891-5050S 5.0 50
1896-5040S 5.0 40.0 1891-5055S 5.0 55
1896-5042S 5.0 42.5 1891-5060S 5.0 60
1896-5045S 5.0 45.0 1891-5065S 5.0 65
1896-5047S 5.0 47.5 1891-5070S 5.0 70
1896-5050S 5.0 50.0 1891-5075S 5.0 75
1896-5052S 5.0 52.5 1891-5080S 5.0 80
1896-5055S 5.0 55.0 1891-5085S 5.0 85
1896-5057S 5.0 57.5 1891-5090S 5.0 90
1896-5060S 5.0 60.0 1891-5095S 5.0 95
1896-5065S 5.0 65.0 (Shaft Screws) 1891-5100S 5.0 100
1896-5070S 5.0 70.0 1891-5105S 5.0 105
1896-5075S 5.0 75.0 1891-5110S 5.0 110
1896-5080S 5.0 80.0 1891-5115S 5.0 115
1896-5085S 5.0 85.0 1891-5120S 5.0 120
1896-5090S 5.0 90.0
1896-5095S 5.0 95.0
1896-5100S 5.0 100.0
1896-5105S 5.0 105.0
1896-5110S 5.0 110.0
1896-5115S 5.0 115.0
1896-5120S 5.0 120.0
4mm Fully Threaded Locking Screws Condyle Screws

mm mm mm mm
1896-4020S 4.0 20 1895-5040S 5.0 40

1896-4025S 4.0 25 1895-5045S 5.0 45
1896-4030S 4.0 30 1895-5050S 5.0 50
1896-4035S 4.0 35 1895-5055S 5.0 55
1896-4040S 4.0 40 1895-5060S 5.0 60
1896-4045S 4.0 45 1895-5065S 5.0 65
1896-4050S 4.0 50 1895-5070S 5.0 70
1896-4055S 4.0 55 1895-5075S 5.0 75
1896-4060S 4.0 60 1895-5080S 5.0 80
1895-5085S 5.0 85
1895-5090S 5.0 90
1895-5095S 5.0 95
1895-5100S 5.0 100
1895-5105S 5.0 105
1895-5110S 5.0 110
1895-5115S 5.0 115
1895-5120S 5.0 120
Nut for Condyle Screws
REF Diameter Length

mm mm
1895-5001S 5.0
52
End Caps Advanced Compression Screw, Femur
REF Diameter Length REF Diameter

mm mm mm
Standard +5mm +10mm 1822-0003S 8.0 Standard 1825-0001S 8.0
1822-0005S 11.5 + 5mm
1822-0010S 11.5 +10mm
1822-0015S 11.5 +15mm
1822-0020S 11.5 +20mm
1822-0025S 11.5 +25mm
+15mm +20mm +25mm 1822-0030S 11.5 +30mm
1822-0035S 11.5 +35mm
Compression Screws
REF Diameter Length

mm mm
+30mm +35mm
1825-0000S 8.0
1825-0005S 8.0 5
1825-0010S 8.0 10
1825-0015S 8.0 15
Note:
Outside of the U. S., Locking Screws
and other specific products may be
ordered Non-Sterile without the “S”
at the end of the corresponding REF
Number.
53
Ordering Information – Instruments
REF Description REF Description Quantity
T2 Basic Long T2 Femur
702429 Teardrop Handle, AO 702427 T-Handle, AO Coupling

Coupling
0152-0218* K-Wire 1,8x310mm 2
703165 Protection Sleeve,
Retrograde 1806-0015 X-Ray Ruler, Femur
1806-0022 Guide Wire Ruler 1806-0050 K-Wire 3x285mm 2
1806-0065 8mm Hex Screwdriver bit,

ball tip
1806-0032 Awl Plug 1806-0165 Nail Holding Screw, 2

Femur
1806-0041 Awl, Curved, 9mm
1806-0255 Screwdriver, Condyle 2
1806-0110 Universal Rod, 9mm Screw
1806-0125 Reduction Spoon, 9mm 1806-0257 Revision Screwdriver Bit,

6.3mm
1806-0130 Wrench 8mm/10mm
1806-0272 External Compression
1806-0135 Insertion Wrench, 10mm Device
1806-0273 Fixation Screw Clamp

1806-0150 Strike Plate
1806-0311 Trocar, Paddle
1806-0170 Slotted Hammer
1806-0400 Socket Wrench,
1806-0185 Tissue Protection Sleeve, Universal Joint 10mm
Long, 9mm
1806-1005 Target Device, Femur
1806-0203 Screwdriver, Self-Holding, (2 components)
Extra Short (3.5mm)
1806-0215 Drill Sleeve, Long, 5mm

1806-2016 Countersink for Condyle
1806-0227 Screwdriver Shaft AO, Screws
Long, 3.5mm
1806-4260* Drill Ø4.2 × 340mm, AO
1806-0233 Screwdriver, Self-Holding,
Long (3.5) 1806-4270* Drill Ø4.2 × 180mm, AO
1806-0268 Screwdriver Shaft, 1806-4290* Drill Ø4.2 × 230mm, AO

Compression (hex3.5)
1806-5000* Drill Ø5.0 × 230mm, AO
1806-0271 Guide Wire Pusher
1806-5020* Drill Ø5.0 × 340mm, AO
1806-0315 Trocar, Long
1806-9920 T2 Femur Instrument Tray
1806-0325 Screw Gauge, Long
1806-0331 Screw Gauge (20-120mm)
1806-0350 Extraction Rod,

Conical (Ø8mm)
T2 8mm Femur Nail Instruments
1806-0365 Screw Scale, Long
1 806-0073S Teflon Tube (for 8mm Nail
Guide Wire exchange ONLY)
1806-1095 Guide Wire Handle
1806-0090 Guide Wire, Smooth Tip 3×800 mm
1806-1096 Guide Wire Handle
(outside of U. S.)*
Chuck, 2-3.5mm
1 806-0090S Guide Wire, Smooth Tip 3×800 mm,
1806-2014 Rigid Reamer Ø12mm
sterile (U. S.)
1806-9900 T2 Basic Long
1 806-3570S Drill Ø3.5×180mm AO, sterile
Instrument Tray
(U. S.)
Caution:
8mm Nails require 4mm Fully
Threaded Screws for locking at the
non-driving end.
* Instruments designated “Outside of the U. S.” may not
be ordered for the U. S. market.
54
REF Description REF Description
Optional Optional
1806-0005 X-Ray Template, Femur 702427 T-Handle, AO Coupling
0140-0002 Reaming Protector , 161mm
1806-0045 Awl, Straight, Ø10mm 1806-0047 Awl, Straight Ø11.5mm
1806-0085 Guide Wire, Ball Tip, 3 × 1000mm 1806-0202 Screwdriver, Extra Short, 3.5mm
(outside of U. S.)*
1806-0450 Long Freehand Tissue
1806-0085S Guide Wire, Ball Tip, 3 × 1000mm, Protection Sleeve
sterile (U. S.)
1806-0460 Long Drill Sleeve Ø 4.2mm
1806-0175 Sliding Hammer
1806-1007 Target Device Locking Nut, Spare
1806-0232 Screwdriver, Long, 3.5mm
1806-0237 Screwdriver, Short, 3.5mm

Spare Parts
1806-0240 Screw Capture Sleeve, Long,
1806-1097 Handle
1806-0270 Ratchet T-Handle AO
1806-0098 Cage
1806-0300 Screw Driver Shaft, Ball Tip, 3.5mm
1806-0099 Clamping Sleeve
1806-0480 Long Screw Gauge (20mm–80mm)
1 806-4260S Drill Ø4.2 × 340mm,

AO, sterile (U. S.)
1 806-4270S Drill Ø4.2 × 180mm,

AO, sterile (U. S.)
1 806-4290S Drill Ø4.2 × 230mm,

AO, sterile (U. S.)
1 806-5000S Drill Ø5.0 × 230mm,

AO, sterile (U. S.)
1 806-5020S Drill Ø5.0 × 340mm,

AO, sterile (U. S.)
1806-9010 Screw Tray
1806-9971 T2 Femur Drill Rack
1806-9982 T2 Silicon Mat
* Instruments designated “Outside of the U. S.” may not

be ordered for the U. S. market.
55
Bixcut Complete range of modular and

fixed-head reamers to match
surgeon preference and optimize
O. R. efficiency, presented in fully
sterilizable cases.
Large clearance rate resulting from reduced number

of reamer blades coupled with reduced length of
reamer head to allow for effective relief of pressure
and efficient removal of material 3.
Cutting flute geometry optimized to lower pressure

generation3.
Forward- and side-cutting face combination produces

efficient material removal and rapid clearance3.
Double-wound shaft transmits torque effectively and

with high reliability. Low-friction surface finish aids
rapid debris clearance3.
Smaller, 6 and 8mm shaft diameters are designed to

reduce IM pressure.
Typical Standard Bixcut
Reamer Ø14mm Reamer Ø14mm
Studies1 have demonstrated that

the pressures developed within
the medullary cavity through the
introduction of unreamed IMnails can
Clearance area : Clearance area :
be far greater than those developed
32% of cross section 59% of cross section during reaming − but this depends
very much upon the design of the
reamer.
After a three year development study2

involving several universities, the
factors that determine the pressures
and temperatures developed during
reaming were clearly established.
These factors were applied to the de-
velopment of advanced reamers that
demonstrate significantly better per-
formance than the best of previous
designs 3 .
1
Jan Paul M. Frolke, et al. ;
Intramedullary Pressure in Reamed Femoral
Bixcut
Nailing with Two Different Reamer Designs.,
Eur. J. of Trauma, 2001 #5
2
Medhi Moussavi, et al.;
Pressure Changes During Reaming with Different
Parameters and Reamer Designs,
Clinical Orthopaedics and Related Research
Number 373, pp. 295-303, 2000
3 Andreas Speitling;
Intramedullary Reamers, commented slides of
internal test report, Sep 1999
56
Bixcut Modular Head Bixcut Fixed Head − AO Fitting**
REF Description Diameter REF Diameter Length

mm mm mm
0226-3090 Bixcut Head 9.0 0225-5060 6.0* 400

0226-3095 Bixcut Head 9.5 0225-5065 6.5* 400
0226-3100 Bixcut Head 10.0 0225-5070 7.0* 400
0226-3105 Bixcut Head 10.5 0225-6075 7.5 480
0226-3110 Bixcut Head 11.0 0225-6080 8.0 480
0226-3115 Bixcut Head 11.5 0225-6085 8.5 480
0226-3120 Bixcut Head 12.0 0225-6090 9.0 480
0226-3125 Bixcut Head 12.5 0225-6095 9.5 480
0226-3130 Bixcut Head 13.0 0225-6100 10.0 480
0226-3135 Bixcut Head 13.5 0225-6105 10.5 480
0226-3140 Bixcut Head 14.0 0225-6110 11.0 480
0226-3145 Bixcut Head 14.5 0225-8115 11.5 480
0226-3150 Bixcut Head 15.0 0225-8120 12.0 480
0226-3155 Bixcut Head 15.5 0225-8125 12.5 480
0226-3160 Bixcut Head 16.0 0225-8130 13.0 480
0226-3165 Bixcut Head 16.5 0225-8135 13.5 480
0226-3170 Bixcut Head 17.0 0225-8140 14.0 480
0226-3175 Bixcut Head 17.5 0225-8145 14.5 480
0226-3180 Bixcut Head 18.0 0225-8150 15.0 480
0226-4185 Bixcut Head 18.5 0225-8155 15.5 480
0226-4190 Bixcut Head 19.0 0225-8160 16.0 480
0226-4195 Bixcut Head 19.5 0225-8165 16.5 480
0226-4200 Bixcut Head 20.0 0225-8170 17.0 480
0226-4205 Bixcut Head 20.5 0225-8175 17.5 480
0226-4210 Bixcut Head 21.0 0225-8180 18.0 480
0226-4215 Bixcut Head 21.5
0226-4220 Bixcut Head 22.0
0226-4225 Bixcut Head 22.5 Optional Instruments
0226-4230 Bixcut Head 23.0
0226-4235 Bixcut Head 23.5 REF Description
0226-4240 Bixcut Head 24.0
0226-4245 Bixcut Head 24.5 0227-0060 Hand Reamer 6 mm
0226-4250 Bixcut Head 25.0 w/Mod Trinkle connection
1806-6520 Curved Reduction Rod 8.5 mm
w/Mod Trinkle connection
Bixcut Shafts (Sterile)1,2,3, 4 1806-6500 T-Handle w/Mod Trinkle connection
REF Description Length

mm
0227-8240S Mod. Trinkle 284

0227-3000S Mod. Trinkle 448
0227-8510S Mod. Trinkle 510 Bixcut Trays empty
0227-8885S Mod. Trinkle 885 REF Description
0226-8240S AO 284
0226-3000S AO 448 0225-6000 Tray, Modular Head
(up to size 22.0mm)
Shaft Accessories 0225-6001 Tray, Modular Head
(up to size 28.0mm)
0225-8000 Tray, Fixed Head
REF Description
(up to size 18.0mm)
3212-0-210 Grommet (pack of 25) 0225-6040 Mini Trauma Tray
3212-0-220 Grommet inserter/extractor (for modular heads 9-18)
0225-6010 Grommet Case 0225-6050 Mini Revision Tray
(for modular heads 9-28)
Note:
Bixcut Fixed Head − Modified Trinkle fitting available in same diameters and length as the
AO Fitting (REF No: 0227-xxxx)
* Use with 2.2mm × 800mm Smooth Tip and 2.5mm × 800mm Ball Tip Guide Wires only.
** Use with Stryker Power Equipment.
1. Non-Sterile shafts supplied without grommet. Use new grommet for each surgery. See Shaft
Accessories.
2. Sterile shafts supplied with grommet pre-assembled.
3. For Non-Sterile leave “S” off the REF Number when ordering (510 and 885mm available only sterile
Modified Trinkle Fitting).
4. Non-Sterile, AO Fitting Shafts in 510 and 885mm are available as build to order items:
• CM810921 AO Fitting Shaft, length 510mm
• CM810923 AO Fitting Shaft, length 885mm.
57
Notes
58
Notes
59
Stryker Trauma GmbH
Prof.-Küntscher-Straße 1–5
D - 24232 Schönkirchen
Germany
www.osteosynthesis.stryker.com
This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or her own
professional clinical judgment when deciding whether to use a particular product when treating a particular patient.
Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any particular product
before using it in surgery. The information presented in this brochure is intended to demonstrate a Stryker product.
Always refer to the package insert, product label and/or user instructions including the instructions for Cleaning and
Sterilization (if applicable) before using any Stryker products. Products may not be available in all markets. Product
availability is subject to the regulatory or medical practices that govern individual markets. Please contact your Stryker
representative if you have questions about the availability of Stryker products in your area.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following trade-
marks or service marks: Stryker, T2 and BixCut.
All other trademarks are trademarks of their respective owners or holders.

The products listed above are CE marked.
Literature Number : B1000004

LOT G4909
Copyright © 2010 Stryker

T2-Femoral Nailing s685

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T2-Femoral Nailing s685

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T2

Femoral Nailing System

Joseph D. DiCicco III, D. O.

Thomas G. DiPasquale, D. O.

A workshop training is required prior

All non-sterile devices must be

See package insert (L22000007) for

Ordering Information – Implants 51

5.0mm Partially Threaded Locking

5.0mm Fully Threaded

5.0mm Condyle Screws

Total Length of Slot 15mm

Standard +5mm +10mm +15mm +20mm +25mm +30mm +35mm

Dynamic Mode Apposition / Compression Mode Advanced Locking Mode

An X-Ray Template 1806-0005 is

Thorough evaluation of pre-operative

The proper nail length when inserted

The retrograde nail length is deter­

In either approach this allows the

Retrograde nail insertion is per­ Distal femoral fractures are often

When the inner Retrograde K-Wire

The Ø12mm Rigid Reamer is used for

* Outside of the U. S., product with an “S” may be

Reaming (Fig. 6)is commenced in

The Guide Wire Pusher can be used to

Fig. 9.1 Hole Positions (nondriving

Nail Holding Screw Nail Insertion

Upon completion of reaming, the

Additionally, the 3 × 285mm K-Wire

Insertion of the 3 × 285mm K-Wire

The Slotted Hammer can be used on

A chamfer is located on the driving

If the nail has been inserted to far, it Fig. 13

When locking the retrograde nail

Guided Locking Mode (via Target Device)

The Target Device is designed to

In controlled Dynamic Mode, and/or

In Advanced Locking Mode, the

Static Locking Mode

If secondary dynamization is planned,

The Trocar is removed, with the

Alternatively, the Trocar (1806-0311)

To ensure accurate drilling and easy

After drilling both cortices, the screw

Condyle Screw Locking

From the medial side, the Condyle

If necessary, contour the bone

To insert the Condyle Nut, the Tissue

Condyle Screw- Using both Condyle Screw Screw­

The geometry of the implant allows

Freehand Proximal Locking

The M/L holes may also be used

Multiple locking techniques and

The center-tipped Ø4.2 × 230mm

After drilling both cortices the screw

Routine Locking Screw insertion is

40mm Alternatively, the Screw Gauge can be

Alternatively, the 3.5mm Hex Self-

End Cap Insertion

The End Cap is inserted with the

Thoroughly irrigate the wound to

Alternatively, the 3.5mm Hex Self-

* Optional 8mm diameter End Caps are available in

The retrograde nail length is deter

Retrograde nail insertion is per Distal femoral fractures are often

Condyle Screw- Using both Condyle Screw Screw