GAMMA LOCKING NAIL INSTRUMENTS

OPERATIVE TECHNIQUE

FEATURES AND BENEFITS

The One Shot Device is a new component of the Gamma Locking Nail
instrumentation system determining the correct position of the Gamma lag
screw. It can be used to place a K-wire very easily and exactly in a desired
location within the femoral head by attaching it onto the lag screw target sleeve.
Without the One Shot Device, the final placement of the lag screw can be
determined only after the lateral cortex is opened and the K-wire is inserted.
In cases were the K-wire is inserted too proximal, correct placement of the lag
screw is often difficult. By penetrating the cortex slightly more distally the tip of
the awl automatically slipped into the first opening.
In order to ensure good lag screw and thus Gamma Locking Nail positioning it
is crucial to correctly position the K-wire. Using the One Shot Device during
surgery this step can be performed exactly, with one drilling only.
The goals of the One Shot Device are to:
determine correct K-wire, lag screw and Gamma Locking Nail placement

Metal indicators

decrease OR time

decrease X-ray exposure

The One Shot Device is made of carbon fibre and works by providing a target
that indicates the potential position of the K-wire on the fluoroscope screen.
The target consists of three wires a dashed inner wire and two solid outer
wires. These wires work like a gun sight to indicate the potential position of the K-wire. The One Shot Device is attached by slightly pressing the grip and releasing it when positioned
onto the lag screw sleeve. If the device is moved
on the sleeve the grip always has to be
pressed slightly.
Instructions

Attachment grip

OPERATING TECHNIQUE
The use of the One Shot Device should not interfere with
or replace any steps in the Gamma Locking Nail Op-technique. To use the device, follow the Gamma Locking Nail technique until the lag screw target sleeve has been
inserted (Fig. 1).

Fig. 1

Note:
The tip of the K-wire must be placed in the inferior half of
the femoral head in the frontal plane, and on the midline in the
lateral plane. The objective is to place the lag screw below the
centre of the femoral head on the A/P view and centrally
on the lateral view.

Pressing the attachment grip slightly the device is positioned between the
anterior aspect of the patients hip and the fluoroscope screen (Fig. 2 + Fig. 3).
It is important to drape the patient such that the One Shot Device does not
interfere with any drapes anterior to the patients hip.

Fig. 2

Fig. 3

If positioned correctly, the target will appear in the

fluoroscopic image. If it does not, the fluoroscope screen can
be repositioned or the One Shot Device can be moved
towards or away from the patient by pressing the grip slightly
until the target is within the view of the fluoroscope.

OPERATING TECHNIQUE
Once the target is correctly aligned, the Gamma Locking Nail can be moved
superiorly or inferiorly until the dashed wire appears in the desired location for
the K-wire within the femoral head (Fig. 4).
To predict the location of the K-wire accurately, the dashed wire of the target must
appear between the two solid wires at the desired position. If it does not, the
device must be rotated about the lag screw sleeve until the dashed wire is in the
centre (Fig. 5). If the position is incorrect the Gamma Locking Nail must be either
pulled backwards (Fig. 6) or pushed forward (Fig. 7).
Fig. 5

Fig. 6

Fig. 7

Fig. 4

The K-wire can then either be placed into the femur or the targeting arm is held
in place until the K-wires position in the lateral view has been determined.

Fig. 9
Fig. 10

Fig. 8

Rotate the device to the

lateral view by pressing
the grip slightly (Fig. 8).

Adjust the lateral view (Fig. 9).

The device must not have the
same plane like the Target Device.

Position the fluoroscope

screen to 45, 50 of the
femoral axis (Fig. 10).

OPERATING TECHNIQUE

Fig. 11

Check alignment by means of image

intensifier (Fig. 11).

If the dashed wire of the target appears between

the two solid wires insert the K-wire and
follow the Gamma Locking Nail Op-technique
(Fig. 12). If it does not, the device must be rotated up (Fig. 13) or down (Fig. 14).

Fig. 12

Fig. 13

One Shot Device

Catalogue number 1213-3010
Acknowledgements:
The One Shot Device was designed with the contribution of:
Dr. Asche, Freudenstadt/Germany
Dr. Tokunaga, Fukuoka/Japan
2000 Stryker Corporation. All rights reserved. Printed in Germany.
Stryker and Gamma logos are registered trademarks of the Stryker Corporation.
To ensure the best quality of its products and their improvements
Stryker reserves the right to modify all or part of their products.
Caution: Federal law (U.S.A.) restricts this device
to sale by or on the order of a licensed physician.

Fig. 14

The Trochanteric Gamma Locking Nail and the original Long Gamma Locking Nail are made of Orthinox and have been designed by
surgeons. Combining the strength and biomechanical advantages of
the existing Gamma family they are the Golden standard for proximal femoral fractures with more than 500.000 treatments worldwide.

I.C.NAIL
The IC-Nail system is the realization of superior biomechanical
intramedullary stabilization using small caliber, high tensile strength
implants for internal fixation of long bones. Femoral and tibial
implants offers three types of locking including active controlled
intersegmentary compression in cases that are axially stable.

More than 1.000.000 Grosse & Kempf locking nails have been
implanted since its introduction in 1974. A development of the
original intramedullary principles presented by Prof. Gerhard
Kntscher, the femoral and tibial system provides the established
advantages of closed operating technique and undisturbed callus
formation using a sophisticated instrument system.
For retrograde femoral nailing the Supracondylar Nail is the specialised implant. It is made of Orthinox and features a superior biomechanical stability. Unique to the short SCN is the locking of all
screws via the target device. The design of the condyle screws allow
for interfragmentary compression.

METAIZEAU

Since more than 10 years children from all over the world have
been treated successfully using the Metaizeau paediatric nailing
system. The main advantages of the system are: Simple and fast
technique, closed reduction discharge from hospital at day 46
and minimal disturbance of bone growth. The nail can be adapted to the patient and guarantees a best fit for every case.

I.M. SAW

The I.M. Saw is suitable for closed osteotomies of the femur and
tibia in all cases which allow the use of intramedullary nails for
fragment fixation. Closed osteotomies with subsequent fragment
fixation are indicated for correction of rotational deformities,
angular deformities along the axis and lengthening and shortening
procedures.

MANUFACTURER:

Stryker Trauma GmbH

Prof.-Kntscher-Strae 1 5
D-24232 Schnkirchen
Germany

stryker.europe@
emea.strykercorp.com
REF NO: B0300001
2000 Stryker Corporation. All rights reserved.