The technique description herein is made available to the healthcare professional .. to surgeon preference and/or fracture pattern. IMHS CP Nail Extractor. Surgical Technique. International Version. Page 2. Page 3. Nota Bene. The technique description herein is made available to the healthcare professional to illustrate the . enhanced sliding and compression of the IMHS™ IMHS™ CP Nail. Patient positioned with operative extremity adducted for intramedullary nailing. Distal interlocking of these longer nails requires a freehand technique. models of each of these devices have been introduced—Gamma III and IMHS CP.
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In the final analysis, the preferred treatment is that which addresses the needs of the specific patient. The long nails expand indications to include comminuted neck sudgical shaft fractures, and prophylactic nailings of impending pathological fractures. Introduced in with its design, the IMHS system provided a more minimally invasive technique than the traditional Compression Hip Screw.
By featuring a Centering Sleeve to enhance Lag Screw sliding and medializing the implant to reduce the moment arm, this design improved implant biomechanics for the treatment of hip fractures. IMHS CP retains the clinically proven features of the original design while adding new features to simplify the procedure and provide more options for the surgeon to treat the indication that presents.
Proven tecbnique increase stability and early weight bearing in unstable fractures from sliding compression and surfical an intramedullary trochanteric buttress. Available with Standard Lag Screw and Sleeve.
The new Subtrochanteric Lag Techjique provides more clinical options. The Set Screw is preloaded and cannulated to allow nail insertion over a ball tip guide rod, removing steps from the technique. Additional steps are removed by using the 3 in 1 Lag Screw Inserter that places the Lag Screw and Sleeve and compresses the Lag Screw all in one instrument. Other new features A more anatomical 2.
Short nails now have left and right components. The proximal end of the nail has been reduced by 5mm in length to avoid prominence at the greater trochanter. All nails can be dynamically or statically locked. Patient positioning Patient is techniaue supine on a fracture table with unaffected limb extended below the affected limb and trunk.
The affected limb is adducted. Flex the affected hip Apply traction through a skeletal traction pin or with the fracture table foot holder. Adjust the affected limb for length and rotation by comparison with the unaffected limb.
Check rotation by rotating the C-arm in line with the femoral neck anteversion and then making the appropriate correction, usually 0 15 of external rotation. This is best checked by visualizing the femoral anteversion proximally and matching it with correct rotation at the knee. Another common position is to flex the hip and knee of the unaffected extremity and place it in a leg holder.
Abduction and internal rotation of the hip allows unimpeded flouroscopic imaging. Make a 1 to 3cm incision that is approximately 3 to 6cm proximal to the greater trochanter. Angle this incision posteriorly at its proximal end. Carry the incision through the fascia.
Entry portal location and guide pin insertion Option 1 Insert the Tissue Protector with the Guide Pin Centering Sleeve such that it rests on the medial apex of the greater trochanter.
No mm Guide Pin Cat. Remove the Trocar and replace with the 3. Entry portal location and proximal reaming With the 3. Ream until the proximal femur is prepared to accept the proximal portion of the implant. Reaming depth should be sufficient when the indicator on the reamer is level with the top of the tissue protector. Check depth on AP X-Ray to ensure that the widest part of the reamer has reached the level of the lesser trochanter and has sufficiently opened the canal.
If not satisfied with depth, continue reaming and confirm depth with X-Ray. No Cannulated Awl Cat. No Proximal Reamer Cat. This will help ensure tecnique reaming of the canal. If a long nail is being implanted, it will be necessary to measure for nail length. To measure the length of the implant needed, ensure that the distal tip of the Ball-Tip Guide Rod is located at the desired position of the distal tip of the nail.
Slide the Ruler over the proximal end of the Ball-Tip Guide Rod and advance the open end of the Ruler to where the proximal portion of the implant will be seated, just below the tip of the greater trochanter.
Survical the nail length from the calibrations exposed at the other end of the Ruler. Canal preparation long nail Proceed to sequentially ream over the Ball-Tip Guide Rod through the Tissue Protector using the reamers contained in the set.
Begin reaming with the 9.
IMHS CP Clinically Proven Intramedullary Hip Screw Surgical Technique – PDF
Implant trials have left and right components. If an implant has not been previously selected, determine the following: Select the Drill Guide based on the neck angle of the nail being used. To help ensure the accuracy of the drill guide, it is helpful to tighten the Guide Bolt with the Tissue Protector and Lag Screw Reamer in place.
No Guide Bolt Iimhs. Noand Guide Bolt Wrench Cat. The nail should techniqe enter easily. If the nail fails to advance adequately, use biplanar imaging of the nail tip and the fracture zone to identify the source of the impingement. Additional reaming may be required, or, in some instances, a smaller implant diameter may be selected. Remove the Ball-Tip Surgial Rod, if used. The nail is properly placed in the AP plane when the Guide Pin is seen on the X-Ray to be parallel to the neck and center in the femoral head.
No This illustration depicts an older design where the side plates have now been removed, as well as the mating holes for the Anteversion Locking Guide.
Reconfirm the final placement of the pin with a lateral C-Arm image. It is inserted into the Telescoping Reamer Sleeve until it abuts the end of the sleeve. Take the Lag Screw measurement by lining up the end of the 3. Lag Screw Length Gauge Cat.
Adjust the appropriate reamer for the length shown on the Lag Screw Length Gauge. Visualize reaming with X-Ray to confirm that the Guide Pin is not being forced forward. Ream until the positive stop on the reamer abuts the Telescoping Reamer Sleeve that is locked into the Drill Guide.
Note Always use imaging in addition to guides to confirm reamer depth and positioning. Use the Obturator to prevent the Guide Pin from backing out as the reamer is removed. Tap over the Guide Pin as necessary, using imaging to determine the proper depth. Tip If the Combination Reamer is difficult to pass through the nail, it is likely the teeth of the Reamer Sleeve are obstructed with bone.
It is recommended to pass the Subtrochanteric Reamer techniqhe the nail to clear the bone, remove it, then complete reaming with the Combination Reamer to the correct depth. This indicator is found at the end of the threads located on the shaft of the Lag Screw Insertion Wrench. At final seating, the T-Handle should be positioned perpendicular to the Drill Guide to properly orient the Lag Screw.
Use the Torque Wrench to achieve two clicks to confirm proper tightening. HN Compression Dial Cat. No Centering Sleeve Inserter Cat.
No Set Screw Driver Cat. No Torque Wrench Cat. Connect this assembly to the Subtrochanteric Lag Screw. Note If the fracture is not going to be compressed, a longer Lag Screw at least 5mm longer than the measurement must be selected, to ensure proper lag screw length. The Compression Dial on the Insertion Wrench must also be set for added length.
Example If the measured length was 95mm and a mm screw was selected, the Compression Dial on the Insertion Wrench must be set to 5. The Subtrochanteric Lag Screw can be oriented in a manner that allows up to 15mm of limited sliding or unlimited sliding. For limited sliding, orient the T-Handle parallel to the Drill Guide. For more sliding, orient the T-Handle perpendicular to the Drill Guide. To help prevent sliding, tighten the Set Screw to two clicks with the T-Handle in the parallel position.
Compression can be achieved by turning the gold knob on the Compression Dial clockwise. The calibration marks on the shaft of the Lag Screw Insertion Wrench indicate the amount of compression. Parallel T-Handle position limited sliding Perpendicular T-Handle position more sliding This illustration depicts an older design where the side plates have now been removed, as well as the mating holes for the Anteversion Locking Guide.
Make a stab incision and seat the Drill Sleeve assembly to bone. The screw length measurement can be taken from the Drill Bit calibrations measured against the Black 3. Screw length may also be determined using the Screw Depth Gauge. Attach the appropriate length 4. Attach the T-Handle to the Hex Driver and insert the screw. Both static proximal and dynamic distal locking options are available through the Drill Guide.
Lateral cortex over drilling optional When distally locking especially in diaphyseal bone it may be desirable to over drill the lateral cortex with the optional 4. This is achieved by inserting the 4. While this is a stopped drill, care should be taken to ensure only the lateral cortex is over drilled.
No Screw Depth Gauge Cat. Once perfect circles are established, make a stab incision and using the Short 3. Take the screw length measurement from the calibrations on the Drill Bit as it relates to the end of the Screw Length Half Sleeve.
IMHS CP Clinically Proven Intramedullary Hip Screw Surgical Technique
Attach the appropriate length screw to the Short Hexdriver, connect the T-Handle and insert the screw until it is seated. Screw Length Half Sleeve Cat. No Short Hexdriver Cat.