Femoral Neck System Locking Screw and Antirotation-Screw Insertion

Locking Screw and Antirotation-Screw Insertion Irrigate and apply suction for removal of debris potentially generated during antirotation-screw and locking screw insertion. 1. Attach Protection Sleeve for Locking Screw Insertion* 1 Instrument 03.168.013 Protection Sleeve, for Insertion Instruments E Note: Ensure that the central guide wire is removed. E Attach the protection sleeve to the insertion handle. (1) Notes: • In obese patients, the use of a second incision to insert the protection sleeve should be considered. • Check that the protection sleeve is inserted in the correct position (1-hole plate or 2-hole plate) of the insertion handle. • Insert the proximal locking screw first if using a 2-hole plate. Check that the protection sleeve is fully inserted. (2) * Alternative for standard insertion only: The system allows to insert the antirotation-screw before inserting the locking screw(s). Perform steps 5 to 8 first before completing steps 1 to 4. 18 2 2. Drill for Locking Screw 1 Instruments 03.168.011 Drill Bit B 4.3 mm, length 413 mm 03.168.017 Depth Gauge, measuring range up to 100 mm (optional) F Precautions: • Confirm that the insertion handle and plate are aligned with the femoral shaft axis. • Push on the insertion handle to ensure that the plate is down to the bone. F Drill the hole for the bi-cortical locking screw through the protection sleeve. (1) 2 Read the screw length directly off the etching on the drill bit. (2) Option: Use the depth gauge through the protection sleeve to determine the depth of the drilled hole. (3) Note: The screw length should be chosen at least 4 mm longer than the determined depth of the hole. 3 19 Locking Screw and Antirotation-Screw Insertion 3. Insert Locking Screw 1 Instruments 03.168.014 or 03.168.016 Screwdriver Shaft Stardrive, T25, length 241 mm Screwdriver Shaft hexagonal, 3.5 mm, length 241 mm 511.774 Torque Limiter, 4 Nm, for AO/ASIF Quick Coupling for Reamers 03.140.027 Handle, large, cannulated, with Quick Coupling, Hex 12 mm Precautions: • Confirm that the insertion handle and plate are still aligned with the femoral shaft. • Push on the insertion handle to ensure that the plate is still down to the bone. F 2 F Insert the locking screw with the determined length, as read from the drill bit or depth gauge. (1) The locking screw may be inserted using power equipment. Final tightening must be done slowly and by hand using the screwdriver shaft, together with the 4 Nm Torque Limiter and the appropriate handle. (2) Note: Monitor locking screw insertion and confirm screw position as well as length using the image intensifier prior to final tightening. Option: If using a 2-hole plate, repeat steps 1 to 3 to insert the distal screw. (3) 21 3 4. Remove Protection Sleeve 1 Remove the protection sleeve by pressing together the head of the sleeve while pulling. (1) 21 Locking Screw and Antirotation-Screw Insertion 5. Check Insertion Instruments 1 Ensure that the insert tip is in contact with the bolt by carefully turning the black screw clockwise. (1) If needed, this will close the gap between insert tip and bolt. (2) Note: If the implant is inserted pre-collapsed (see page 12), the black screw can have a distance from the handle of as much as 5 mm, even after tightening. Standard Insertion Precautions: • Use image intensification to reconfirm that the insert tip is in contact with the bolt. (2) • Use image intensification to reconfirm the insertion depth of the bolt. (2) Pre-collapsed Insertion 2   2 22 6. Drill for Antirotation-Screw 1 Instruments Precautions: • Monitor depth during drilling using the image intensifier. Drilling too deep could lead to bone damage. • Confirm that the insertion handle and plate are aligned with the femoral shaft, if using the alternative of inserting the antirotation-screw before inserting the locking screw. 3 Wi re Note: The length of the bolt and the antirotationscrew are pre-defined based on the calculated construct size. 2 on Pass the fixation sleeve over the back end of the drill bit and check the fixation sleeve for wear per the instructions on page 28. (1) Adjust the setting to the same construct size as the bolt (95 mm in the example before, respectively 75 mm with pre-collapsed insertion as shown in table on page 29). (2) tati Fixation Sleeve, length 60 mm tiro Drill Bit B 4.3 mm, length 413 mm 03.168.012 An 03.168.011 4 D D Use the guide of the insert to drill the hole for the antirotation-screw. (3) Drill until the fixation sleeve stops on the guide of the insert. (4) Remove the drill bit. 23 Locking Screw and Antirotation-Screw Insertion 7. Insert Antirotation-Screw 1 D Insert the antirotation-screw with the same construct size as the bolt (95 mm in the example before, respectively 75 mm with pre-collapsed insertion as shown in table on page 29). (1) Insertion as well as final tightening should be done slowly and by hand using the screwdriver shaft, together with the 4 Nm Torque Limiter and the appropriate handle. (2) If dense bone is preventing antirotationscrew insertion, then carefully use the handle without Torque Limiter for insertion. Precaution: Monitor antirotation-screw insertion and confirm screw position using the image intensifier prior to final tightening. Remove any antirotation wires. i on tat 2 Wi re Precautions: • Confirm that the femoral head is temporarily fixated with an antirotation wire and hold the position of the handle during final tightening to prevent any inadvertent rotation. • Confirm that the insertion handle and plate are still aligned with the femoral shaft, if using the alternative of inserting the antirotation-screw before inserting the locking screw. 24 tiro Handle, large, cannulated, with Quick Coupling, Hex 12 mm An 03.140.027 i on Torque Limiter, 4 Nm, for AO/ASIF Quick Coupling for Reamers tat 511.774 tiro Screwdriver Shaft Stardrive, T25, length 241 mm An 03.168.014 Wi re Instruments D 8. Check Antirotation-Screw c Precaution: After final tightening, use the image intensifier to check that the antirotation-screw is fully inserted. (3) If not, then loosen and reinsert the antirotation-screw. Use the 4Nm torque limiter and the appropriate handle for final tightening. 3 c a b a The head of the antirotation-screw should not appear outside of the bolt. b The tip of the antirotation-screw should be in a similar insertion depth when compared to the tip of the bolt.  For Standard Insertion only (not applicable for Pre-Collapsed Insertion): c The notch of the antirotation-screw should be at the same level as the notch of the plate barrel. c 3 c b  a 25