Вы находитесь на странице: 1из 46

OPERATIVE TECHNIQUE

CONTENTS
Introduction
Features & Benefits
Indications & Contraindications

4
5
6

Hansson Twin Hook & Hip Plate Assembly Technique


Guide Pin Insertion
Femoral Head / Neck Reaming
Hip Plate & Hansson Twin Hook Insertion
Plate Attachment
Hansson Twin Hook Removal

9
11
15
16
18
21

Lag Screw & Hip Plate Assembly Technique


Guide Pin Insertion
Femoral Head / Neck Reaming
Lag Screw Insertion
One-Step Insertion
Plate Attachment
Lag Screw Removal

22
24
28
30
32
33
36

Instrument Assembly Instructions


Combination Reamer Assembly
Hansson Twin Hook Assembly
Lag Screw Assembly

37
37
38
39

Ordering Information
Instruments
Implants

41
41
44

INTRODUCTION

The Omega 2 Compression Hip Screw System is a unique and innovative


system reflecting the long experience of Stryker Trauma
in the treatment of proximal hip fractures.
This modular system offers the surgeon a wide choice of slimlined hip plates
combined with a unique option of cephalic implants,
and state of the art instrumentation.
This system provides a simple and easy-to-use solution for all
surgeons facing hip fractures. All implants are delivered sterile
for traceability and inventory reduction.

FEATURES & BENEFITS

State of the art


instrumentation

Low Prole Hip Plate Range


Available in both Standard Barrel
(38mm) and Short Barrel (25mm)
styles and a full range of sizes
(2 to 14 holes) and angles.

Accurate angle guides:


Radiolucency of the angle guide
body to precisely position the
instrument, and therefore
the guide pin.

Hip Plate barrel accepts


Omega Plus Lag Screws or
Hansson Twin Hook.
Bi-directional hole design from
SPS system

Multiple guide pin holes for accurate


placement of the guide pin without
need to move the instrument.

All sideplate holes accept 6.5mm


cancellous or ASNIS III 6.5mm
cannulated screws for additional
stabilization of a medial fragment.

Variable angle guide with


freehand technique option.

Fully threaded Low Profile


compression screw

Stiffer CoCr guide pin for


reduced deflection.
SPS instruments for bone
screw placement.
Layout of the trays sequenced
according to the surgical technique.

CEPHALIC IMPLANT OPTION:


HANSSON Twin Hook

Omega Plus Lag Screws

Minimized disruption
The smooth profile of the implant allows the
Hansson Twin Hook to slide into place without
turning or hammering, minimizing dislocation.

13mm Standard Lag Screw


Leading edge of the cutting thread
engages quickly, with or without
tapping, and provides tactile control
during final positioning and seating.

Preserved bone integrity


Minimum disruption to cancellous bone.
Full bone / implant surface contact for better stability.
Reduced invasive surgery
The complete procedure can be carried out
through a 5 to 7cm skin incision. This can reduce
bleeding, tissue destruction, operative time,
and may help to limit post-operative pain
and rehabilitation time.
Simpler and atraumatic removal procedure
The Hansson Twin Hook can be removed
through a 10mm skin incision without need
to remove the plate, reducing the trauma
for the patient.

15mm Super Lag Screw


Provide superior resistance to
migration in case of
osteoporotic bone.

INDICATIONS / CONTRAINDICATIONS
Indications
The Omega 2 Compression Hip Screw is indicated for fractures of the Proximal Femur which may include:

Intertrochanteric Fractures

Intracapsular and Basal Neck fractures


NOTE: Due to rotational instability, it is highly
recommended that an Asnis III 6.5mm
Cannulated screw or Hansson Pin
be added to stabilize the fracture.

Contraindications
The physicians 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 infection or marked local inflammation in or about the
affected area.
Compromised vascularity that would inhibit adequate blood supply to the fracture or
the operative site.
Bone stock compromised by disease, infection or prior implantation that can not provide
adequate support and/or fixation 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.
Implant utilization that would interfere with anatomical structures or physiological performance.
Any mental or neuromuscular disorder which would create an unacceptable risk of fixation
failure or complications in postoperative care.
Other medical or surgical conditions which would preclude the potential benefit of surgery.

PREOPERATIVE PLANNING
Review the frontal and lateral X-Rays of the pelvis and
injured femur prior to surgery to assess fracture stability,
bone quality, as well as neck-shaft angle and to estimate
plate length required.
Use templates preoperatively to plan plate angle, plate length,
barrel length, and Hansson Twin Hook / Lag Screw length.
The Hansson Twin Hook / Lag Screw should be centered
in the head within 10 millimeters of subchondral bone,
and the plate should allow for fixation of four bone screws
below the fracture line. Application of the template to an
X-Ray of the uninvolved hip may help simulate reduction
of the fractured hip.

PATIENT POSITIONING
The patient is placed supine on the fracture table.
Satisfactory access to the hip with the C-arm in the frontal and lateral planes are verified.

The fracture is reduced by flexion, longitudinal traction, abduction and internal rotation on a fracture table.
In unstable fractures, guide pins can be placed, in order to stabilize the reduced fragments.

HANSSON TWIN HOOK &


HIP PLATE ASSEMBLY TECHNIQUE

SKIN INCISION
The corresponding landmark is established by placing
a guide pin on the skin under frontal view of the image
intensifier, centrally in relation to the femoral neck and
head. A 5cm longitudinal incision is made distal from
this point through the skin. After closure at the end of
the procedure, the line should be over the holes in the
side plate.

Compared to a standard incision of up to 15cm,


a reduced incision of approximately 5cm is possible
when using the Hansson Twin Hook together with
the Omega 2 Hip Plate. The procedure is performed
without exposing the fracture site and therefore involves
less tissue destruction, less bleeding, and reduced
operative time than conventional techniques.
This minimal access technique may help to reduce
post-operative pain and to shorten rehabilitation time
for the patient.

The incision is continued through the subcutaneous


tissue and tensor fascia lata in line with the skin incision.
Both proximally and distally, this incision is extended
beyond the limits of the skin incision.

The barrel hip plate entry site on the femoral shaft


is situated about 2-3cm below the crest on which the
vastus lateralis originates. This distance is ample for
the insertion of the angle guide, without any need for
detaching the vastus lateralis from its trochanteric origin.
The continuity between the vastus lateralis and the
gluteus medius is preserved. All that needs to be done
is to detach the vastus lateralis from the femoral shaft,
and to reflect it anteriorly. Since the first 2cm of the
vastus are not affected by the procedure, the skin
incision used in the past to expose that part of the
muscle is not required for this procedure.

The posterior part of superficial fascia of the vastus


lateralis is incised longitudinally. However, the vastus
is not detached from its origin at the base of the
greater trochanter.
The vastus is lifted with a Lambotte elevator.
The self-retaining Beckmann retractor is placed
underneath the vastus lateralis anteriorly and
the tensor fascia lata posteriorly.
In this way, the shaft is exposed over a distance
of 6-7cm. The angle guide is positioned against the
femoral shaft.

Optimal
skin
incision
point

Reduced skin incision


Standard skin incision
The optimal point for skin incision is located at a point
where the axis of the femoral neck intersects with the
skin (see picture above).

10

GUIDE PIN INSERTION


ORIENTATION AND PLACEMENT OF THE GUIDE PIN IS ONE OF THE MOST CRITICAL STEPS IN THIS PROCEDURE.
By utilizing one or more of the following visual
landmarks, correct positioning of the guide pin can
be achieved.

There are two types of angle guides for the placement


of the guide pin:
A Fixed Angle Guide which corresponds to the
135 barrel plate angle (angle most commonly indicated).

With the guide pin placed at 135 angle, the pin crosses
the lateral cortex at the level of the lesser trochanter;
at the insertion of the gluteus maximus at the
posterolateral edge of the femur; or two fingerbreadths
(2.5 to 3.5cm) below the crest of the greater trochanter
at the origin of the vastus lateralis.
Correct positioning of the guide pin is achieved
referencing anatomical and visual landmarks,
as shown in the figure below.

A Variable Angle Guide in conjunction with an


Elastosil T-Handle can be used to insert the guide pin
at 130, 135, 140, 145 and 150.

Crest of the Greater


Trochanter

Lesser Trochanter

135

Insertion of gluteus
maximus

For each 5 change in hip plate angle, the guide pin


insertion point will be moved approximately
5mm distally (for increased angle) or proximally
(for decreased angle).

NOTE: The angle guides are radiolucent to help the


correct positioning of the angle guide and
the guide pin under image intensifier
(helpful when a reduced skin incision is
performed and direct visibility of the site
is therefore reduced).

11

GUIDE PIN INSERTION CONTINUED


Using image intensification, the guide pin is advanced
until it reaches the subchondral bone in the center of the
femoral head in both frontal and lateral views.

Freehand technique for guide pin placement:


Place a 2.8mm guide pin anterior to the neck of the femur
and align it in the center of the head against the medial
cortex by using image intensification.

FRONTAL VIEW

LATERAL VIEW

A 3.2mm drill bit can be used to make an opening in the


lateral cortex, allowing for easy insertion of the guide pin.
Using image intensification, the guide pin is advanced until
it reaches the subchondral bone in the femoral head.
After confirming appropriate tip position of the guide pin
on both frontal and lateral views, verify the appropriate
plate angle by using the Variable Angle Guide. To unlock
the mechanism, pull the cylinder of the guide (1) and turn
it by 90 (2).

While holding firmly the appropriate angle guide on


the femoral shaft, the 2.8mm guide pin is inserted in
the central hole of the angle guide and advanced into
the femoral head under image intensification.

(1)

If the guide pin is not positioned correctly, an additional pin


can be inserted 5mm above or below the central position in
the frontal plane, and 5mm anteriorly or posteriorly to the
central position in the lateral plane, without removing
the first guide pin.
NOTE: To insert a second pin near the first one, use a Quick
Coupling Chuck for 2.8mm guide pin (REF. 704027)
together with a 2.8mm guide pin with quick coupling
fitting (REF. 704012S), otherwise there is a risk that
the power drill chuck will touch the first guide pin.

12

(2)

(3)

Slide the Variable Angle Guide over the guide pin and
adjust it down to the lateral aspect of the femur (make sure
that all the spikes are in contact with the bone shaft).
The arrow on the cylinder will indicate at which angle
the guide pin has been inserted (3), and therefore the angle
of the barrel plate to be selected.

GUIDE PIN MEASUREMENT


The direct-reading Lag Screw Depth Gauge is used to determine the proper depth of penetration of the
guide pin. This reading determines the settings for the Combination Reamer and indicates the length of
the Hansson Twin Hook to be used.

To set the reaming depth,


and the Hansson Twin Hook length,
subtract 10mm from the reading.

EXAMPLE:
Direct reading depth gauge measurement: 110mm
Reamer depth setting: 100mm
Hansson Twin Hook length selected: 100mm

13

ANTI-ROTATION GUIDE PIN INSERTION


The Guide Pin Replacement Instrument can be used to
insert a second guide pin parallel to the primary guide pin.
Diam. 2.8mm hole
Diam. 3.2mm hole

This instrument also accommodates a 3.2mm guide wire,


should the surgeon wish to insert a 6.5mm ASNIS III
Cannulated Screw for definitive rotational stability,
like in Basal Neck fractures or Femoral Neck Fractures.

This step is especially useful in providing temporary


stability for femoral neck fractures and basal neck
fractures, where the head could rotate during reaming.
Correct positioning of the anti-rotational wire can be
done by rotating the instrument anteriorly or posteriorly
(see illustration).

14

FEMORAL HEAD / NECK REAMING


Select and assemble the correct Barrel Reamer (according to
the standard or short barrel plate selected).
For assembling instructions see page 37.

NOTE FOR SHORT BARREL PLATES:


For more lateral intertrochanteric fractures or medial
displacement osteotomies, short barrel plates provide
fixation without the barrel crossing the fracture.
Reaming is accomplished using the Short Barrel
Reamer, following the same procedure for standard
barrel reaming.

The Combination Reamer is set and locked at the predetermined


reading (10mm less than the guide pin measurement). Ream over the
guide pin with the Combination Reamer until the stop reaches
the lateral cortex. Remove the Combination Reamer and the guide pin.
NOTE: All guide pins are Single-use products and therefore
must be discarded at the end of the surgical procedure.

15

HIP PLATE & HANSSON TWIN HOOK INSERTION


OMEGA 2 PLATE INSERTION

HANSSON TWIN HOOK INSERTION


Select a Hansson Twin Hook of the appropriate length
and assemble it to the insertion instruments
(See Assembling Instruction Page 38).

The hip plate is slid through the small skin incision


under the vastus lateralis against the femoral shaft.

The Hansson Twin Hook is inserted through the


plate barrel, and the assembly is pushed into the reamed
channel. Use the insertion instruments as a joystick.

The plate is then rotated in order to position the


plate barrel toward the reamed channel.

16

HIP PLATE & HANSSON TWIN HOOK INSERTION

(1)

(2)
When the Hansson Twin Hook is seen to be in position,
the Introducer assembly is inserted through the channel of
the Inner Introducer (1) and rotated clockwise (2) until it
meets resistance, that is, the tip of the Introducer touches
the tip of the inner Twin Hook.

The hooks are activated by turning the Introducer


Assembly clockwise as far as it will go.

Both frontal and lateral image intensification


are utilized to ensure accurate placement.

Impaction of the fracture may be accomplished by using


the Plate Impactor.
The Introducer Assembly is then removed.

NOTE: It is important that the Outer Introducer Handle


is pushed forward when activating the hooks.

17

PLATE ATTACHMENT
Using standard screw insertion technique, fix the Omega 2 Hip Plate to the femoral shaft
beginning at the proximal end of the plate.
NOTE: When using the reduced skin incision technique, supplementary stab incisions can be
performed for distal screws placements.
Use the 3.2mm Drill bit through the
3.2 drill sleeve with the green ring
(Neutral) assembled to the Drill Guide
Handle, to drill the bone screw holes.
NOTE: If necessary it is possible to obtain
compression of a shaft fracture
or osteotomy site when using
the 3.2mm drill sleeve with the
yellow ring (1mm compression).

Determine appropriate cortical screw


length using the Depth Gauge.

Insert the screw using the 3.5mm


Hex Screwdriver with Elastosil Handle
and the Holding Sleeve, or the 3.5mm
Hex Screwdriver with AO fitting attached
directly to a power source.
However, final tightening should always
be done by hand.

Option

A 4.5mm Tap is available, to pre-tap in


extremely hard cortical bone.

18

FRACTURE COMPRESSION / END PROTECTION


When all screws are inserted and tightened, and all traction is released,
fracture compression can be accomplished by means of the compression screw.

Caution should be used when carrying out the compression.


The compression screw exerts a powerful force that must be correlated
with the quality of the bone.
Placement of the compression screw should be considered mandatory when
a short barrel plate is used. The compression screw is designed to hold the
Hansson Twin Hook / Hip plate assembly together.
The compression screw can also be used to protect the inner thread of the
Hansson Twin Hook against soft tissue ingrowth.

19

CLOSING THE WOUND


It is important to ensure that the Hansson Twin Hook is placed
within the femoral head. This is checked by removing traction
and rotating the hip under image intensification.

Closure of the wound is done in layers, closing separately


the fascia of the vastus laterali muscle and the fascia lata.
Carefully reapproximate the subcutaneous tissue and the
skin to facilitate prompt healing of the wound.

20

HANSSON TWIN HOOK REMOVAL


Should the need arise for implant removal, a 10mm skin
incision is made at the level of the Lesser Trochanter
(corresponding to the barrel plate position).

Insert the tip of the Extractor Handle in the channel of the


Outer Extractor and turn it clockwise to engage the threaded
part in the Inner Extractor (4).

If a compression screw has been used, remove the screw


with the 3.5mm hex screwdriver. The end of the Hansson
Twin Hook can be identified manually or using image
intensification.

Continue to turn the Extractor. This withdraws the hooks back


into the outer pin.

The Inner Extractor is placed against the Hansson


Twin Hook and rotated clockwise until it meets resistance (1).
The Outer Extractor is slid over the Inner Extractor (2).
Turn and push gently clockwise or anticlockwise the handle
of the Outer Extractor. When the Outer Extractor meets the
flat sides of the Inner Extractor (and stop the rotation of
the handle), push the Outer Extractor until it is in contact
with the outer pin of the Hansson Twin Hook (3).

NOTE: Check under image intensifier that the hooks are fully
retracted to prior pulling back the implant. This can
be done without removing the plate.
The Hansson Twin Hook can then be extracted by pulling
the extractor assembly laterally (5).
NOTE: Once the Hansson Twin Hook is removed the hooks
cannot be spread again for repositioning and must be
discarded.

(2)

(1)

(3)

(4)

(5)

21

LAG SCREW &


HIP PLATE ASSEMBLY TECHNIQUE

SKIN INCISION
A 10 to 15 centimetre incision is made,
starting at the tip of the greater trochanter
and continuing straight distally.

The incision is continued through the


subcutaneous tissue and tensor fascia lata
in line with the skin incision. The vastus
lateralis is split longitudinally and
reflected upward to allow palpation of the
fracture line and inferior neck anteriorly.

23

GUIDE PIN INSERTION


ORIENTATION AND PLACEMENT OF THE GUIDE PIN IS ONE OF THE MOST CRITICAL STEPS IN THIS PROCEDURE.
By utilising one or more of the following visual
landmarks, correct positioning of the guide pin can
be achieved.

There are two types of angle guides for the placement


of the guide pin:
A Fixed Angle Guide which is corresponding to the
135 barrel plate angle (angle most commonly indicated).

With the guide pin placed at 135 angle, the pin crosses
the lateral cortex at the level of the lesser trochanter;
at the insertion of the gluteus maximus at the
posterolateral edge of the femur; or two fingerbreadths
(2.5 to 3.5cm) below the crest of the greater trochanter
at the origin of the vastus lateralis.
Correct positioning of the guide pin is achieved
referencing anatomical and visual landmarks,
as shown in the figure below.

A Variable Angle Guide in conjunction with


an Elastosil T-Handle can be used to insert the
guide pin at 130, 135, 140, 145 and 150.

Crest of the Greater


Trochanter

Lesser Trochanter

135

Insertion of gluteus
maximus

For each 5 change in hip plate angle,


the guide pin insertion point will be moved
approximately 5mm distally (for increased angle)
or proximally (for decreased angle).

NOTE: The angle guides are radiolucent to help the


correct positioning of the angle guide and
the guide pin under image intensifier
(helpful when a reduced skin incision
is performed and direct visibility of the site
is therefore reduced).

24

GUIDE PIN INSERTION CONTINUED


Using image intensification, the guide pin is advanced until
it reaches the subchondral bone in the center of the femoral
head in both frontal and lateral views.
FRONTAL VIEW

Freehand technique for guide pin placement:


Place a 2.8mm guide pin anterior to the neck of the femur
and align it in the center of the head against the medial
cortex by using image intensification.

LATERAL VIEW

A 3.2mm drill bit can be used to make an opening in the


lateral cortex, allowing for easy insertion of the guide pin.
Using image intensification, the guide pin is advanced until
it reaches the subchondral bone in the femoral head.
After confirming appropriate tip position of the guide pin
on both frontal and lateral views, verify the appropriate
plate angle by using the Variable Angle Guide. To unlock
the mechanism, pull the cylinder of the guide (1) and turn
it by 90 (2).

While holding firmly the appropriate angle guide on


the femoral shaft, the 2.8mm guide pin is inserted in
the central hole of the angle guide and advanced into
the femoral head under image intensification.

(1)

If the guide pin is not positioned correctly, an additional pin


could be inserted 5mm above or below the central position
in the frontal plane, and 5mm anteriorly or posteriorly to
the central position in the lateral plane, without removing
the first guide pin.
NOTE: To insert a second pin near the first one, use a Quick
Coupling Chuck for 2.8mm guide pin (REF. 704027)
together with a 2.8mm guide pin with quick coupling
fitting (REF. 704012S), otherwise there is a risk that
the power drill chuck will touch the first guide pin.

25

(2)

(3)

Slide the Variable Angle Guide over the guide pin and
adjust it down to the lateral aspect of the femur (make sure
that all the spikes are in contact with the bone shaft).
The arrow on the cylinder will indicate at which angle the
guide pin has been inserted (3), and therefore the angle
of the barrel plate to be selected.

GUIDE PIN MEASUREMENT


The direct-reading Lag Screw Depth Gauge is used to determine the proper depth of
penetration of the guide pin. This reading determines the settings for the Combination
Reamer and Tap, and indicates the length of the Lag Screw to be used.

To set the reaming depth,


and the Lag Screw length,
substract 10mm from
the reading.

EXAMPLE:
Direct reading depth gauge measurement: 110mm
Reamer depth Setting: 100mm
Tapping depth (if required): 100mm
Lag Screw Length selected: 100mm

26

ANTI-ROTATION GUIDE PIN INSERTION


The Guide Pin Replacement Instrument can be used to
insert a second guide pin parallel to the primary guide pin.
Diam. 2.8mm hole
Diam. 3.2mm hole

This instrument also accommodates a 3.2mm guide wire,


should the surgeon wish to insert a 6.5mm ASNIS III
Cannulated Screw for definitive rotational stability,
like in Basal Neck fractures or Femoral Neck Fractures.

This step is especially useful in providing temporary


stability for femoral neck fractures and basal neck
fractures, where the head could rotate during reaming
or screw insertion.
Correct positioning of the anti-rotational wire can be
done by rotating the instrument anteriorly or posteriorly
(see illustration).

27

FEMORAL HEAD / NECK REAMING


Select and assemble the correct Barrel Reamer
(according to the standard or short barrel plate selected).
For assembling instructions see page 37.

The Combination Reamer is set and locked at the


predetermined reading (10mm less than the guide pin
measurement).

Should the guide pin be inadvertently withdrawn,


reverse the Guide Pin Replacement Instrument,
insert it into the femur, and reinsert the guide pin.

Ream over the guide pin with the Combination Reamer


until the stop reaches the lateral cortex.

NOTE FOR SHORT BARREL PLATES:


For more lateral intertrochanteric fractures or medial
displacement osteotomies, the short barrel plates provide
fixation without the barrel crossing the fracture.

Remove the Combination Reamer.

Reaming is accomplished using the Short Barrel Reamer,


following the same procedure for standard barrel reaming.

28

FEMORAL HEAD / NECK TAPPING

The Lag Screw Tap should be used when good quality,


dense bone is encountered; the Calibrated Tap Sleeve indicates
the proper depth of the Tap.
The Tap is advanced until the indicator ring on the Tap reaches
the correct depth marking on the Centering Sleeve.
(For assembling instructions see page 39).
EXAMPLE:
Direct reading depth gauge measurement: 110mm
Reamer depth setting: 100mm
Tapping depth: 100mm
Lag Screw length selected: 100mm

29

LAG SCREW INSERTION

Select a Lag Screw of the appropriate


length and assemble it to the
Lag Screw Adapter. Place into
the Lag Screw Inserter Assembly the
Lag Screw Adapter Assembly,
and direct it toward the bone
over the guide pin. (For assembling
instructions see page 39).

The Centering Sleeve on the Inserter


Assembly is advanced into the
pre-reamed hole, and the Lag Screw
is driven into the prepared channel.

The T-Handle of the insertion/extraction


wrench is aligned with the long axis of
the femur in preparation for placement
of the Hip Plate.

Depth of insertion of the Lag Screw


is determined by observing the two
depth indicator rings on the inserter.
(See picture below).

Position the flats of the Lag Screw to


ensure proper alignment with the barrel
of the Hip plate for the keyed system.

DEPTH INDICATOR RINGS

NO COMPRESSION

5mm COMPRESSION

10mm COMPRESSION

Depth indicator rings measure desired compression.


For typical anatomy (135 head/neck angle), advance the Lag Screw Inserter
Assembly until the ring marked 135 reaches the mark on the Inserter.
Center the sleeve corresponding to the amount of compression desired
(see picture above).
For Valgus anatomy (150 head/neck angle), advance the Lag Screw Inserter
Assembly until the ring marked 150 reaches the mark on the inserter.
Center the sleeve corresponding to the amount of compression desired.

30

PLATE INSERTION
Upon completion of Lag Screw
insertion, the Lag Screw Inserter
assembly is removed from the
Lag Screw, leaving the Lag Screw
Adapter in place.

The Plate Impactor should be used to fully seat


the plate. Unscrew the Lag Screw Adapter and
remove it. Then, remove the 2.8mm guide pin.

The selected Hip Plate is now


placed over the Lag Screw
Adapter and advanced to
engage the Lag Screw.

NOTE: All guide pins are Single-use products


and therefore must be discarded at the
end of the surgical procedure.

31

ONE-STEP INSERTION
As an option to the standard technique, the One-Step Insertion Instrument may be used to insert
the plate and the Lag Screw in a one-step procedure.
For Valgus anatomy (150 head/neck angle), advance the
One-Step Insertion Wrench until the ring marked 150
reaches the One-Step Insertion Sleeve.
Other angled plates should be inserted proportionally
between the marks.

Assemble the appropriate Hip Plate and the Lag Screw


onto the One-Step Insertion Wrench (for assembling
instructions see page 39).

At the conclusion of screw insertion, the handle of the


One-Step Insertion Instrument must be perpendicular
to the axis of the femoral shaft to allow proper keying
of the Lag Screw to the plate barrel.

Place the entire assembly over the guide pin and


introduce it into the reamed hole.

Remove the One-Step Insertion Sleeve and advance the


Hip Plate onto the Lag Screw shaft.

Advance the Lag Screw into the proximal femur to the


predetermined depth and verify using image intensification.
Depth of the insertion of the Lag Screw is determined by
observing the two depth indicator rings on the One-Step
Inserter Wrench.

The Plate Impactor should be used to fully seat the plate.


Unscrew the Connecting Bolt and remove the One-Step
Insertion Wrench from the back of the Lag Screw;
then remove the 2.8mm Guide Pin.

Stop inserting the Lag Screw when the


135 ring reaches the One-Step Insertion
Sleeve (when a 135 Hip plate is selected)

For typical anatomy (135 head/neck angle), advance the


One-Step Insertion Wrench until the ring marked 135
reaches the One-Step Insertion Sleeve
(see picture above).

32

PLATE ATTACHMENT
Using standard screw insertion technique, fix the Omega 2 Hip Plate
to the femoral shaft beginning at the proximal end of the plate.

Use the 3.2mm drill bit through the


3.2 drill sleeve with the green ring
(Neutral) assembled to the Drill Guide
Handle, to drill the bone screw holes.
NOTE: If necessary it is possible to obtain
compression of a shaft fracture
or osteotomy site when using
the 3.2mm drill sleeve with the
yellow ring (1mm compression).

Determine appropriate Cortical Screw


length using the Depth Gauge.

Insert the screw using the 3.5mm Hex


Screwdriver with Elastosil handle and
the holding sleeve, or the 3.5mm Hex
Screwdriver with AO fitting attached
directly to a power source.
However, final tightening should always
be done by hand.

Option
A 4.5mm Tap is available, to pre-tap in
extremely hard cortical bone.

33

FRACTURE COMPRESSION
When all screws are inserted and tightened, and all traction is released,
fracture compression can be accomplished by means of the Compression Screw,
or with the Compression Instrument connected to the Large Elastosil T-Handle.

34

CLOSING THE WOUND


Closure of the wound is done in layers, closing separately
the fascia of the vastus lateralis muscle and the facia lata.
Carefully reapproximate the subcutaneous tissue and the
skin to facilitate prompt healing of the wound.

35

REMOVAL
Should the need arise for hardware removal, the Lag Screw is extracted
after removal of the Hip Plate through use of the Large T-Handle
connected to the Lag Screw Inserter and the Connecting Bolt.
(See assembling instructions page 40).

36

INSTRUMENT ASSEMBLY INSTRUCTIONS


COMBINATION REAMER ASSEMBLY:
Step 1 Select the Barrel Reamer Assembly that corresponds
to the selected plate (Standard or Short Barrel).

Barrel Reamer Assembly, Standard

Barrel Reamer Assembly, Short

Combination Reamer Drill

Flat sides

Step 2 Align the flat side of the Barrel Reamer to


the flat side of the Combination Reamer
Drill, and engage the Barrel Reamer over
the coupling end of the Combination
Reamer Drill.

Step 3 Slide the Barrel reamer until the stop has been adjusted to the right

measurement. Lock the Barrel Reamer by turning the Stop Sleeve firmly.

Barrel Reamer Assembly, Standard

37

INSTRUMENT ASSEMBLY INSTRUCTIONS


HANSSON TWIN HOOK ASSEMBLY:
Step 1 Select a Hansson Twin Hook
of the appropriate length.
The Inner Introducer is inserted
into the Outer Introducer.

Hansson Twin Hook

Outer Introducer

Step 2 The Inner Introducer is then


firmly engaged into the base
of the Hansson Twin Hook.

38

Inner Introducer

INSTRUMENT ASSEMBLY INSTRUCTIONS


LAG SCREW TAP ASSEMBLY:
Push the quick coupling sleeve on the Large Elastosil T-Handle and
insert the Lag Screw Tap fitting into the coupling.
Assemble the Lag Screw Tap Sleeve to the Lag Screw Tap by aligning
the flat sides of the Tap to the flat sides in the Tap Sleeve.

Lag Screw Tap

Calibrated Tap Sleeve

Large Elastosil T-Handle

LAG SCREW ADAPTER ASSEMBLY:


The appropriate Lag Screw is prepared by placing the inner part of the Lag Screw Adapter (1)
through the outer part (2), and threading it into the Lag Screw (3).

Lag Screw (3)

Lag Screw Adapter


(Inner Part) (1)

Lag Screw Adapter


(Outer part) (2)

LAG SCREW INSERTER ASSEMBLY:


Push the quick coupling sleeve on the Large Elastosil T-Handle and insert the Lag Screw Inserter into the coupling.
Slide the Lag Screw Inserter Sleeve over the Lag Screw Inserter.

Lag Screw Adapter Assembly

Lag Screw Inserter Sleeve

Lag Screw Inserter

Large Elastosil T-Handle

ONE-STEP INSERTION ASSEMBLY:


STEP ONE:
Assemble the Large Elastosil T-Handle to the One-Step Insertion Wrench as described in instruction below.
Slide the One-Step Insertion Wrench through the barrel of the Hip Plate.
The Connecting Bolt is inserted through the Large Elastosil T-Handle and threaded into the Lag Screw.

Lag Screw

Connecting Bolt

One-Step Insertion Wrench


Omega 2 Hip Plate

Large Elastosil T-Handle

39

INSTRUMENT ASSEMBLY INSTRUCTIONS


ONE-STEP INSERTION ASSEMBLY:
STEP TWO:
Prior to assemble the One-Step Insertion Sleeve to the One-Step Insertion Wrench /Hip plate assembly, ensure that the
One-Step Insertion Sleeve is opened (mark on the inner sleeve lining up with the open mark on the outer sleeve).
Assemble the One-Step Insertion Sleeve to the One-Step Insertion Wrench between the Hip plate and the Lag Screw,
and lock the One-Step Insertion Sleeve.

One-Step Insertion Sleeve

To lock the One-Step Insertion Sleeve,


the inner and outer sleeve are twisted
in opposite directions until the mark
on the inner sleeve lines up with the
close mark on the outer sleeve.
To unlock the sleeve, align the mark
with the "open" mark on the outer sleeve.

LAG SCREW REMOVAL ASSEMBLY:


Assemble the Large Elastosil T-handle to the Lag Screw Inserter as described in instruction above.
The Connecting Bolt is inserted through the Large Elastosil T-handle and threaded in to the Lag Screw.

Lag Screw

Lag Screw Inserter

Connecting Bolt

Large Elastosil T-Handle

40

ORDERING INFORMATION INSTRUMENTS


Standard set configuration (Hansson Twin Hook and Lag Screw)
Reference

Description

Reference

CASES
901721
901723
901725

LOWER TRAY CONFIGURATION


Omega 2 Standard Sterilisation Tray Lid
Omega 2 Standard Upper Sterilisation Tray
Omega 2 Standard Lower Sterilisation Tray

UPPER TRAY CONFIGURATION


704013

Fixed Angle Guide 135

704014

Variable Angle Guide

704020

Description

Large Elastosil T-Handle

702823

Compression Drill sleeve

702824

Neutral Drill Sleeve

702822

Drill Guide Handle

702402

Tissue Protection Sleeve

700358

Drill Bit 3.2mm

700359

Drill Bit 4.5mm

702808

Tap 4.5mm

702809

Tap 6.5mm

702878

Depth Gauge Assembly

702430

Medium Elastosil T-Handle

704010

Lag Screw Depth Gauge

704004

Connecting Bolt

704005

Combination Reamer Assembly, Std

702844

Screwdriver Hex3.5mm

704009

Lag Screw Adapter Assembly

704006-20

Barrel Reamer Assembly, Short

704021

Lag Screw Inserter

702863

Screw Holder Assembly

704007

Lag Screw Tap

704008

Lag Screw Tap Sleeve

704019

Guide Pin Replacement Instrument

901713

Screw Rack

704022

Inserter Sleeve

704026

Cleaning Stylet

704001

Impactor Assembly

704601

Outer Introducer

704602

Inner Introducer

704606

Introducer

704607

Extractor Handle

704608

Outer Extractor

704609

Inner Extractor

41

ORDERING INFORMATION INSTRUMENTS


Lag Screw set conguration
Reference

Description

Reference

CASES
901724
901725
901728

LOWER TRAY CONFIGURATION


Omega 2 Lag Screw Instruments Sterilisation Tray
Omega 2 Standard Lower Sterilisation Tray
Omega 2 Lag Screw Instruments Sterilisation
Tray Lid

UPPER TRAY CONFIGURATION


704013

Fixed Angle Guide 135

704014

Variable Angle Guide

704020

Description

Large Elastosil T-Handle

702823

Compression Drill sleeve

702824

Neutral Drill Sleeve

702822

Drill Guide Handle

702402

Tissue Protection Sleeve

700358

Drill Bit 3.2mm

700359

Drill Bit 4.5mm

702808

Tap 4.5mm

702809

Tap 6.5mm

704010

Lag Screw Depth Gauge

702878

Depth Gauge Assembly

704004

Connecting Bolt

702430

Medium Elastosil T-Handle

704005

Combination Reamer Assembly, Std

702844

Screwdriver Hex 3.5mm

704009

Lag Screw Adapter Assembly

704006-20

Barrel Reamer Assembly, Short

702863

Screw Holder Assembly

704021

Lag Screw Inserter

704007

Lag Screw Tap

704022

Inserter Sleeve

704008

Lag Screw Tap Sleeve

704026

Cleaning Stylet

704019

Guide Pin Replacement Instrument

704001

Impactor Assembly

901713

Screw Rack

42

ORDERING INFORMATION INSTRUMENTS


Hansson Twin Hook conguration
Reference

Optional instruments

Description

Reference

CASES
901722
901726

Description

CASES
Omega 2 Hansson Twin Hook Sterilisation Tray Lid
Omega 2 Hansson Twin Hook Instruments
Sterilisation Tray

901727
901729

Optional Instruments Sterilization Tray


Optional Instruments Sterilization Tray Lid

TRAY CONFIGURATION
TRAY CONFIGURATION
704020

704601
704602

Large Elastosil T-Handle

Outer Introducer
Inner Introducer

704606

Introducer

704607

Extractor Handle

704608

704609

Outer Extractor

704020

Large Elastosil T-Handle

704030

Trial Side Plates 130

704031

Trial Side Plates 135

704032

Trial Side Plates 140

704033

Trial Side Plates 145

704034

Trial Side Plates 150

704023

Screwdriver Hex 3.5mm

704002

One-Step Insertion Wrench

704003

One-Step Insertion Sleeve

704024

Compression Instrument

702634

AO/Hall Coupling

704027

Quick Coupling for Guide Pin 2.8mm

702939

Self-Centering Bone Forceps, Ball Spike, size 3

702946

Self-Centering Bone Forceps, Swivel Head, size 3

981010

X-Ray Template

Inner Extractor

REPLACEMENT PARTS
704001-1

43

Impactor Head

ORDERING INFORMATION IMPLANTS


CEPHALIC IMPLANTS

HANSSON TWIN HOOK

LAG SCREW

Stainless Steel
REF

Length
mm

Stainless Steel
REF

Length
mm

394550S
394555S
394560S
394565S
394570S
394575S
394580S
394585S
394590S
394595S
394600S
394605S
394610S
394615S
394620S
394625S
394630S
394635S
394640S

50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130
135
140

3362-5-050
3362-5-055
3362-5-060
3362-5-065
3362-5-070
3362-5-075
3362-5-080
3362-5-085
3362-5-090
3362-5-095
3362-5-100
3362-5-105
3362-5-110
3362-5-115
3362-5-120
3362-5-125
3362-5-130

50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130

HANSSON TWIN HOOK COMPRESSION SCREW

SUPER LAG SCREW

Stainless Steel
REF

Length
mm

Stainless Steel
REF

Length
mm

394500S

25

3362-8-050
3362-8-055
3362-8-060
3362-8-065
3362-8-070
3362-8-075
3362-8-080
3362-8-085
3362-8-090
3362-8-095
3362-8-100
3362-8-105
3362-8-110
3362-8-115
3362-8-120
3362-8-125
3362-8-130

50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130

OMEGA 2 COMPRESSION SCREW


Stainless Steel
REF

Length
mm

596001S

32.3

GUIDE PIN CoCR THREADED TIP


REF
704011S
704012S

Recommended set item


NOTE: All the implants are sterile packed

44

Length Diameter
mm
mm
230
230

2.8
2.8

Fitting
Jacobs chuck
Quick coupling
chuck

ORDERING INFORMATION IMPLANTS

KEYED HIP-PLATE STANDARD BARREL

KEYED HIP-PLATE SHORT BARREL

Stainless Steel
REF

Holes

Angle

Length
mm

596302S
596303S
596304S
596305S
596306S
596308S
596310S
596312S
596322S
596323S
596324S
596325S
596326S
596328S
596330S
596332S
596342S
596343S
596344S
596345S
596346S
596348S
596350S
596352S
596362S
596363S
596364S
596365S
596366S
596368S
596370S
596372S
596382S
596383S
596384S
596385S
596386S
596388S
596390S
596392S

2
3
4
5
6
8
10
12
2
3
4
5
6
8
10
12
2
3
4
5
6
8
10
12
2
3
4
5
6
8
10
12
2
3
4
5
6
8
10
12

130
130
130
130
130
130
130
130
135
135
135
135
135
135
135
135
140
140
140
140
140
140
140
140
145
145
145
145
145
145
145
145
150
150
150
150
150
150
150
150

46
62
78
94
110
142
174
206
46
62
78
94
110
142
174
206
46
62
78
94
110
142
174
206
46
62
78
94
110
142
174
206
46
62
78
94
110
142
174
206

Recommended set item


NOTE: All the implants are sterile packed

45

Stainless Steel
REF

Holes

Angle

Length
mm

596504S
596505S
596514S
596515S
596524S
596525S
596534S
596535S
596544S
596545S

4
5
4
5
4
5
4
5
4
5

130
130
135
135
140
140
145
145
150
150

78
94
78
94
78
94
78
94
78
94

ORDERING INFORMATION IMPLANTS


BONE SCREWS

CORTICAL SCREWS 4.5mm

CANCELLOUS SCREWS 6.5mm 16mm thread

CANCELLOUS SCREWS 6.5mm Fully threaded

Stainless Steel
REF

Diameter
mm

Length
mm

Stainless Steel
REF

Diameter
mm

Length
mm

Stainless Steel
REF

Diameter
mm

Length
mm

340614
340616
340618
340620
340622
340624
340626
340628
340630
340632
340634
340636
340638
340640
340642
340644
340646
340648
340650
340652
340654
340655
340656
340658
340660
340662
340664
340665
340666
340668
340670
340672
340674
340675
340676
340678
340680
340685
340690
340695
340700
340705
340710

4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5
4.5

14
16
18
20
22
24
26
28
30
32
34
36
38
40
42
44
46
48
50
52
54
55
56
58
60
62
64
65
66
68
70
72
74
75
76
78
80
85
90
95
100
105
110

341030
341035
341040
341045
341050
341055
341060
341065
341070
341075
341080
341085
341090
341095
341100
341105
341110
341115
341120
341125
341130

6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5

30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130

343020
343025
343030
343035
343040
343045
343050
343055
343060
343065
343070
343075
343080
343085
343090
343095
343100
343105
343110
343115
343120
343125
343130

6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5

20
25
30
35
40
45
50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130

CANCELLOUS SCREWS 6.5mm 32mm thread

ASNIS III CANNULATED SCREWS 6.5mm

Stainless Steel
REF

Diameter
mm

Length
mm

Stainless Steel
REF

Total
Length mm

Thread
Length mm

342045
342050
342055
342060
342065
342070
342075
342080
342085
342090
342095
342100
342105
342110
342115
342120
342125
342130

6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5
6.5

45
50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130

326255S
326260S
326265S
326270S
326275S
326280S
326285S
326290S
326295S
326300S
326305S
326310S
326315S
326320S

55
60
65
70
75
80
85
90
95
100
105
110
115
120

40
40
40
40
40
40
40
40
40
40
40
40
40
40

Recommended set item

46

The TGN is the latest development in the continuing evolution of the Gamma
Locking Nail family designed for rapid and secure fixation of intertrochanteric
and pertrochanteric fractures. Combining strength and biomechanical advantages of
the existing Gamma family it is the Golden standard for proximal femoral fractures.

The Long Gamma Nail is a specialised development of the original Gamma


Locking Nail allowing surgeons to extend the benefits of the highly successful
standard implant for trochanteric fractures. It has been designed to treat
subtrochanteric, ipsilateral neck and shaft fractures as well as for prophylactic use.

Based on the long Hansson Pin experience, the Hansson Twin Hook is a unique
alternative to the traditional lag screw, and is used together with the Omega 2
or the Omega Plus Hip plate. The operative procedure includes a minimally
invasive surgical approach. If necessary, cephalic implant revision can be
accomplished without removing the sideplate.

This new generation of Cannulated Screws has been designed to optimise surgical
outcomes while simplifying procedures. The ASNIS III System offers the surgeon
a complete choice of implants, material and packaging combined with a new
user-friendly instrumentation.

This innovative device has been developed for Femoral Neck Fracture and Slipped
Capital Femoral Epiphysis treatments. The Hansson Pin System is a simple and
precise instrumentation combined with a unique implant. This unthreaded pin
with a spreading hook allows a strong and stable fixation through a simple and
short procedure, thus preserving the blood supply and the bone integrity.

www.strykertrauma.com

MANFACTURER:

Stryker Trauma AG
Bohnackerweg 1
2545 Selzach
Switzerland
REF NO: 982270
2003 Stryker Corporation. All rights reserved.