To Facilitate the Insertion of IM Nails
Flexible Reamers for Intramedullary NailsSurgical Technique
Intramedullary Nails
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Flexible Reamers for Intramedullary Nails Surgical Technique DePuy Synthes 1
Table of Contents
Introduction
Surgical Technique
Product Information
Flexible Reamers for Intramedullary Nails 2
Reduction 7
Confirm Nail Length 9
Medullary Reaming 11
Cleaning Flexible Shaft 14
Instruments 15
Set List 18
Intended UseThe Monobloc or Modular Intramedullary Flexible Reamers are intended to ream an intramedullary bone canal in preparation for insertion of implants (e.g. intramedullary nails or stems).
1 DePuy Synthes Flexible Reamers for Intramedullary Nails Surgical Technique
Flexible Reamers for Intramedullary Nails
Modular Intramedullary Flexible Reaming SystemThe thin fl exible shaft and deeply fl uted reamer heads are designed to help reduce intramedullary pressure and increase fl ow of bone chips and marrow during reaming.1
• Single shaft to drive all reamer heads• Reamer heads are coupled to the shaft without
hand contact with the reamer head• Ball of 2.5 mm reaming rod will fi t through the
cannulation of all DePuy Synthes nail connecting screws
1. C. A. Muller, R. Schavan, R. Frigg, S. M. Perren. “Intramedullary pressure increase for different commercial and experimental reaming systems: an experimental investigation.” Journal of Orthopedic Trauma. 12 (1998): 540–546.
*Also available.
5.0 mm Flexible ShaftAvailable in 470 mm and 620 mm* lengths• 5.0 mm shaft is made of Nitinol, a nickel-titanium alloy
with superelastic properties• Single shaft for all reamer sizes• Can be driven forward or reverse• Couples with reduction drive• Cannulated
Flexible Reamers for Intramedullary Nails Surgical Technique DePuy Synthes 3
Flexible Reamers for Intramedullary Nails
2.5 mm Reaming Rod with ball tipAvailable sterile in 650 mm,* 950 mm,* 1150 mm,* and 950 mm and 1150 mm with an extension*• Secures connection between the reamer head and the
fl exible shaft• Helps to guide the fl exible shaft past the reduced fracture
Precaution: Never ream without using a reaming rod, as it secures the connection between the reamer head and the fl exible shaft.
351.706S/351.708S/351.709S
351.707S/351.704S
*Also available.
Medullary Reamer Heads• Sizes from 8.5 mm to 19.0 mm, in 0.5 mm increments• The 8.5 mm reamer head is front-cutting, all others are
side-cutting• The 8.5 mm reamer head should only be used in a
medullary canal with an isthmus 8.0 mm or larger. Ifnecessary, use the hand reamers or Monobloc Flexible Reamers to open the canal to 8.0 mm fi rst
• To reduce the likelihood of the reamer head jamming intraoperatively, do not skip reamer head sizes
Notes: • Inspect the reamer heads for damages, as blunt
reamer heads can increase intramedullary pressure and tempera ture signifi cantly.2–3
• For technical reasons (cutting geometry), the reamer heads cannot be resharpened. Damaged reamer heads have to be replaced.
Precaution: Never ream without using a reaming rod, as it secures the connection between the reamer head and the fl exible shaft.
Good Reaming Practices• Inspect reamer heads for dullness before every
surgery that requires reaming• Ream with a ball tipped reaming rod• Widen canals narrower than 8.0 mm with the
hand reamers or Monobloc Flexible Reamers• Ream in 0.5 mm increments; do not skip reamer
head sizes
2. Mü ller C.A., Mc Iff T., Rahn B.A., Pfi ster U., Weller S.: Intramedullary pressure, strain on the diaphysis and increase in cortical temperature when reaming the femoral medullary cavity–A comparison of blunt and sharp reamers. Injury 24, Suppl. 3: 22–30
3. Mü ller C.A., Rahn B.A., Pfi ster U., Weller S.: Extent of bluntness and damage to reamers from hospitals. Injury 24, Suppl. 3, 31–35
4 DePuy Synthes Flexible Reamers for Intramedullary Nails Surgical Technique
Hand Reamers, 6.0 mm, 7.0 mm, 8.0 mm• For use in medullary canals with an isthmus smaller
than 8.0 mm • Use hand reamers incrementally to widen the medullary
canal to 8.0 mm, before using the front-cutting 8.5 mm medullary reamer head under power
• In sclerotic medullary canals, the hand reamers may be used before insertion of the reaming rod
• 450 mm length
Flexible Reamers for Intramedullary Nails
*Also available.
Monobloc Flexible Reamers*• From sizes 6.0 mm to 10.5 mm in 0.5 mm increments• 385 mm length• Flexible laser pattern, one piece, front-cutting reamers• Couples with Modified Trinkle drill couplings or Jacobs
Chuck drill couplings
Flexible Reamers for Intramedullary Nails Surgical Technique DePuy Synthes 1
Flexible Reamers for Intramedullary Nails
Depth Gauge and Depth Gauge Extension Tube• Used to determine nail length and estimate canal size• The depth gauge is used with the 650 mm reaming rod• The depth gauge and extension tube are used with the
950 mm and 1150 mm length reaming rods
351.717
351.719
Holding Forceps• Used to insert and maintain placement of the reaming
rod in the medullary canal
7.0 mm Reduction Heads, straight or angled• Attach to the fl exible shaft• Help reduce fractures and aid in passage of the
reaming rod• Must be used with the 2.5 mm reaming rod
1 DePuy Synthes Flexible Reamers for Intramedullary Nails Surgical Technique
Flexible Reamers for Intramedullary Nails
1. Insertion
Handling Technique for Reaming Rod and Medullary Reamers
2. HoldingDuring reaming, grasp the end of the reaming rod to prevent its withdrawal. After the reamer head is removed from the canal, grasp the reaming rod between the reamer head and the canal entry point.
3. Emergency applicationIf a reamer head jams, use the holding forceps for reaming rods to grasp the back end of the reaming rod, and remove the jammed reamer with light hammer blows on the holding forceps.
Flexible Reamers for Intramedullary Nails Surgical Technique DePuy Synthes 7
Reduction
1. Reduce fracture
Instruments
351.15 Flexible Shaft Handle
352.040 5.0 mm Flexible Shaft, 470 mm
7.0 mm Reduction Heads 352.050 straight 352.055 angled
2.5 mm Reaming Rods with ball tip, sterile* 351.709S 650 mm, with extension 351.706S 950 mm 351.707S 950 mm, with extension 351.708S 1150 mm 351.704S 1150 mm, with extension
*Also available.
1 DePuy Synthes Flexible Reamers for Intramedullary Nails Surgical Technique
Reduction
A
C
Assemble one of the reduction heads onto the 5.0 mm fl exible shaft (A).
Attach the shaft to the fl exible shaft handle (B).
Insert the smooth end of a 2.5 mm reaming rod (C) into the tip of the 7.0 mm reduction head until the ball tip touches the reduction head (D).
Insert the reduction system into the medullary cavity and reduce the fragments under imaging.
Precaution: A secure fi xation of the reduction head is not guaranteed if the reduction system is used without the reaming rod. The reduction head may be lost in the medul lary canal.
After reduction has been achieved, remove the reduction assembly and leave the reaming rod in the canal. Advance the reaming rod to the desired depth of implant.
Precaution: As each manipulation in the fat-fi lled medullary cavity causes an intramedullary pressure increase, reduction with the reduction system also increases the pressure. Ma nipulations should therefore be minimized. As an alternative, reduction can also be carried out using the reaming rod only.
D
B
Flexible Reamers for Intramedullary Nails Surgical Technique DePuy Synthes 9
Confirm Nail Length
2. Confirm nail length and estimate canal size
Instruments
351.717 Depth Gauge
351.719 Depth Gauge Extension Tube
Assemble the depth gauge extension tube to the depth gauge.
Note: To measure the nail length when the 650 mm reaming rod is used, the extension tube is not required.
show reaming rod continuing down canal new image to come
10 DePuy Synthes Flexible Reamers for Intramedullary Nails Surgical Technique
Confi rm Nail Length
Place the depth gauge assembly over the 2.5 mm reaming rod. The tip of the extension tube, or the depth gauge, should be positioned at the desired location of the proximal end of the implant.
650 mm and 950 mm reaming rodsRead the nail length at the end of the reaming rod on the scale of the depth gauge.
1150 mm reaming rodRead the nail length at the mark on the reaming rod.
Use the depth gauge to estimate the size of the medullary canal. Place the depth gauge across the limb at the level of the isthmus. Move the depth gauge until the tab fi lls the canal.
Precaution: The distance of the depth gauge from the bone and the position of the receiver affect the diameter measurement.
Always place the depth gauge on the side of the limb closest to the receiver. Estimate the width as follows:
Distance between depth gauge and bonea. 25 mm = 1 mm larger readingb. 50 mm = 2 mm larger readingc. 100 mm = 3 mm larger reading
Flexible Reamers for Intramedullary Nails Surgical Technique DePuy Synthes 11
Medullary Reaming
511.785
3. Ream medullary canal
Instruments
351.05 Tissue Protector
2.5 mm Reaming Rods with ball tip, sterile*351.709S 650 mm351.706S 950 mm351.707S 950 mm, with extension351.708S 1150 mm351.704S 1150 mm, with extension
351.782 Holding Forceps
351.783 Removal Instrument
Hand Reamers351.92 6.0 mm Hand Reamer351.93 7.0 mm Hand Reamer351.94 8.0 mm Hand Reamer
5.0 mm Flexible Shafts352.040 470 mm352.044* 620 mm
352.085 8.5 mm Medullary Reamer Heads
Monobloc Flexible Reamers03.028.060* 6.0 mm03.028.065* 6.5 mm03.028.070* 7.0 mm03.028.075* 7.5 mm03.028.080* 8.0 mm
511.785** Reduction Drive Unit
511.701** ComPact Air Drive II
05.001.210** AO Reaming Attachment
05.001.201** Trauma Recon System Handpiece
*Also available.**Not available in Flexible Reamers for Intramedullary Nailing Instrument set.
11 DePuy Synthes Flexible Reamers for Intramedullary Nails Surgical Technique
Medullary Reaming
In medullary canals with an isthmus narrower than 8.0 mm, or in sclerotic medullary canals, use the hand reamer(s) or the Monobloc Flexible Reamers over the 2.5 mm reaming rod to widen the canal to 8.0 mm before using the power driven, front-cutting 8.5 mm reamer head.
Precaution: Monobloc Flexible Reamers must be used with drill power configurations only. DO NOT use reaming power configurations as it will cause reamer breakage in the event that the reamer is incarcerated.
Clip the shaft onto the reamer head in the tray. If necessary, rotate the shaft slightly until the connection fits.
For the initial reaming, the flexible shaft is usually equipped with the 8.5 mm reamer head. Clip the shaft onto the reamer head in the Tray for Reaming Heads. If the click-on connection does not fit, turn the shaft slightly until the hexagon matches.
Precaution: This is only a primary connection. Always ream over the reaming rod to ensure a secure connection.
Use the ComPact Air Drive II with the reduction drive unit or the Trauma Recon System with the AO reaming attachment (as the driving unit). Guide the reaming system over the reaming rod.
Do not rotate the reamer head when inserting it into the medullary canal. The tissue protector protects the soft tissues. Use the highest speed and slight but uniform force to advance the reamer head in the medullary canal. Move the reaming shaft back and forth to remove bone chips from the reamer head, and prevent jamming of the reamer head.
After reaming, withdraw the reaming shaft until the entire reamer head is visible. To prevent a loss of reduction, grasp the reaming rod at the canal entry point and hold the rod in place using the holding forceps.
Flexible Reamers for Intramedullary Nails Surgical Technique DePuy Synthes 13
Medullary Reaming
If a reamer jams while reaming, disconnect the reduction drive unit. Use the holding forceps to grasp the reaming rod (in the countersinking). Use light hammer blows on the holding forceps to withdraw the jammed reamer head from the medullary canal. As an alternative, release the reamer head by rotating the shaft in reverse.
The reamer head can be removed from the fl exible shaft with the removal tool. Place the reamer head in the slot on the side of the removal tool. Hold the removal tool with one hand while pulling on the fl exible shaft with the other. The reamer head will detach from the shaft.
Use the sideways cutting reamer heads for the subsequent reaming steps. Reaming should always be performed in 0.5 mm increments.
Leave the 2.5 mm reaming rod in position for insertion of the cannulated nail.
Note: The 2.5 mm ball tip reaming rod can be passed through the cannulation of all DePuy Synthes titanium nails and their respective instruments. When used with other nailing systems, the cannulation of the nail connecting screw must be larger than 3.5 mm.
Precaution: The reamer head can only be disengaged from the shaft if the reaming rod has been removed.
14 DePuy Synthes Flexible Reamers for Intramedullary Nails Surgical Technique
Cleaning Flexible Shaft
Cleaning flexible shaft
Instrument
3.6 mm Cleaning Brush 352.041** 680 mm 352.045* 830 mm
Use cleaning brush to clean the cannulation of the flexible shaft. In case of an obstructed cannulation, use the reaming rod to push through it. The cleaning brush cannot be autoclaved.
Precaution: The Cleaning Brush is intended for cleaning purposes only and may not be brought into the sterile field in the operating theater.
Note: The Monobloc Flexible Reamers follow different cleaning guidelines than the standard DePuy Synthes cleaning guidelines. For cleaning instructions for the Monobloc Flexible Reamers part numbers 03.028.060–03.028.105, refer to www.avalign.com/ifu; packaging insert # RD_IFU-0001.
*Also available.**Not included in set.
Flexible Reamers for Intramedullary Nails Surgical Technique DePuy Synthes 11
351.05 Tissue Protector
351.15 Flexible Shaft Handle
351.717 Depth Gauge
2.5 mm Reaming Rods with ball tip, sterile* 351.709S 650 mm 351.706S 950 mm 351.708S 1150 mm
351.719 Depth Gauge Extension Tube
Instruments
*Also available.
2.5 mm Reaming Rods with ball tip and extension, sterile* 351.707S 950 mm 351.704S 1150 mm
11 DePuy Synthes Flexible Reamers for Intramedullary Nails Surgical Technique
Instruments
351.782 Holding Forceps
352.055 7.0 mm Reduction Head, angled
352.040 5.0 mm Flexible Shaft, 470 mm 352.044* 5.0 mm Flexible Shaft, 620 mm
352.050 7.0 mm Reduction Head, straight
351.92 6.0 mm Hand Reamer 351.93 7.0 mm Hand Reamer 351.94 8.0 mm Hand Reamer
351.783 Removal Tool
352.041* 3.6 mm Cleaning Brush, 680 mm 352.045* 3.6 mm Cleaning Brush, 830 mm
*Also available.
Flexible Reamers for Intramedullary Nails Surgical Technique DePuy Synthes 17
393.10 Universal Chuck with T-Handle
Monobloc Flexible Reamers, 385 mm03.028.060* 6.0 mm 03.028.065* 6.5 mm 03.028.070* 7.0 mm 03.028.075* 7.5 mm 03.028.080* 8.0 mm 03.028.085* 8.5 mm 03.028.090* 9.0 mm03.028.095* 9.5 mm03.028.100* 10.0 mm03.028.105* 10.5 mm
Instruments
*Also available.
355.006 Medullary Tube
Note: Single sterilization only. Do not use with 3.0 mm Reaming Rod with offset ball tip (351.71)
352.085– Medullary Reamer Heads, 8.5 mm to 352.190 19.0 mm (0.5 mm increments)
11 DePuy Synthes Flexible Reamers for Intramedullary Nails Surgical Technique
Flexible Reamer Set for IM Nails (150.060)
Graphic Case690.382 Flexible Reamers for Intramedullary Nails Instrument Set Graphic Case
Instruments351.05 Tissue Protector351.15 Flexible Shaft Handle, quick coupling,
cannulated351.717 Depth Gauge351.719 Depth Gauge Extension Tube351.782 Holding Forceps351.783 Removal Tool, for use with Medullary
Reaming Heads351.92 6.0 mm Hand Reamer351.93 7.0 mm Hand Reamer351.94 8.0 mm Hand Reamer352.040 5.0 mm Flexible Shaft, 470 mm, 2 ea.352.050 7.0 mm Reduction Head, straight352.055 7.0 mm Reduction Head, angled393.10 Universal Chuck with T-Handle
Monobloc Flexible Reamers, 385 mm03.028.060 6.0 mm 03.028.065 6.5 mm 03.028.070 7.0 mm 03.028.075 7.5 mm 03.028.080 8.0 mm
Medullary Reamer Heads Dia. (mm) Dia. (mm)
352.085 8.5 352.140 14.0
352.090 9.0 352.145 14.5
352.095 9.5 352.150 15.0
352.100 10.0 352.155 15.5
352.105 10.5 352.160 16.0
352.110 11.0 352.165 16.5
352.115 11.5 352.170 17.0
352.120 12.0 352.175 17.5
352.125 12.5 352.180 18.0
352.130 13.0 352.185 18.5
352.135 13.5 352.190 19.0
Note: For additional information, please refer to package insert.
For detailed cleaning and sterilizationinstructions, please refer towww.depuysynthes.com/hcp/cleaning-sterilization or sterilization instructions, if provided.
Note: The Monobloc Flexible Reamers follow different cleaning guidelines than the standard DePuy Synthes cleaning guidelines. For cleaning instructions for the Monobloc Flexible Reamers part numbers 03.028.060–03.028.105, refer to www.avalign.com/ifu; packaging insert # RD_IFU-0001.
Flexible Reamers for Intramedullary Nails Surgical Technique DePuy Synthes 19
Flexible Reamer Set, Long (01.004.306)
Graphic Case60.004.306 Flexible Reamer Set Graphic Case, long
Instruments351.05 Tissue Protector351.15 Flexible Shaft Handle, quick coupling,
cannulated351.717 Depth Gauge351.719 Depth Gauge Extension Tube351.782 Holding Forceps351.783 Removal Tool, for use with Medullary
Reaming Heads352.044 5.0 mm Flexible Shaft, 620 mm, 2 ea.352.050 7.0 mm Reduction Head, straight352.055 7.0 mm Reduction Head, angled393.105 Small Universal Chuck with T-Handle
Medullary Reamer Heads Dia. (mm) Dia. (mm)
352.085 8.5 352.140 14.0
352.090 9.0 352.145 14.5
352.095 9.5 352.150 15.0
352.100 10.0 352.155 15.5
352.105 10.5 352.160 16.0
352.110 11.0 352.165 16.5
352.115 11.5 352.170 17.0
352.120 12.0 352.175 17.5
352.125 12.5 352.180 18.0
352.130 13.0 352.185 18.5
352.135 13.5 352.190 19.0
10 DePuy Synthes Flexible Reamers for Intramedullary Nails Surgical Technique
Also Available
Instruments 351.16J Flexible Shaft Connector for Jacobs
chuck, quick coupling, cannulated
351.704S 2.5 mm Reaming Rod with ball tip and extension, 1150 mm, sterile
351.706S 2.5 mm Reaming Rod with ball tip, 950 mm, sterile
351.707S 2.5 mm Reaming Rod with ball tip and extension, 950 mm, sterile
351.708S 2.5 mm Reaming Rod with ball tip, 1150 mm, sterile
351.709S 2.5 mm Reaming Rod with ball tip, 650 mm, sterile
352.041 3.6 mm Cleaning Brush, 680 mm352.044 5.0 mm Flexible Shaft, 620 mm
352.045 3.6 mm Cleaning Brush, 830 mm
355.006 Medullary Tube
511.761 Large Quick Coupling
511.785 Reduction Drive Unit
Monobloc Flexible Reamers, 385 mm
03.028.060 6.0 mm
03.028.065 6.5 mm
03.028.070 7.0 mm
03.028.075 7.5 mm
03.028.080 8.0 mm
03.028.085 8.5 mm
03.028.090 9.0 mm
03.028.095 9.5 mm
03.028.100 10.0 mm
03.028.105 10.5 mm
60.028.000 Base–Monobloc Flexible Reamer Case
60.028.001 Lid–Monobloc Flexible Reamer Case
Recommended Additional SystemsComPact Air Drive II System
Trauma Recon System
Also Available for the Flexible Reamer Set, Long, for IM Nails (01.004.306)351.16J Flexible Shaft Connector for use with Ja-
cobs Chuck
352.040 5.0 mm Flexible Shaft, 470 mm
360.240 IM Nail Reduction Tool, 7.5 mm shaft with curved tip
360.243 Handle for 12.0 mm Tapered Intramedullary Reduction Tool
03.010.093 Reaming Rod Push Rod with Ball Handle
03.010.427 Curved Awl 8 mm Intramedullary Reduction Tool
© DePuy Synthes 2017. All rights reserved.DSUS/TRM/0417/1431 8/17 DV
Synthes USA, LLC 1101 Synthes AvenueMonument, CO 80132
Distributed by:Synthes USA Products, LLC 1302 Wrights Lane EastWest Chester, PA 19380
To order (USA): 800-523-0322 To order (Canada): 855-946-8999
Note: For recognized manufacturer, refer to the product label.
www.depuysynthes.com
Limited Warranty and Disclaimer: DePuy Synthes products are sold with a limited warranty to the original purchaser against defects in workmanship and materials. Any other express or implied warranties, including warranties of merchantability or fitness, are hereby disclaimed.
Please also refer to the package insert(s) or other labeling associated with the devices identified in this surgical technique for additional information.
CAUTION: Federal Law restricts these devices to sale by or on the order of a physician.
Some devices listed in this surgical technique may not have been licensed in accordance with Canadian law and may not be for sale in Canada. Please contact your sales consultant for items approved for sale in Canada.
Not all products may currently be available in all markets.
Manufactured by: Avalign Technologies8727 Clinton Park DriveFort Wayne, IN, 46825www.avalign.com