troch nail trauma fracture system since 1896 INSTRUMENTARIA is a company that manufactures medical implants for traumatology and orthopedics. It was founded in 1896, the year Henry Ford made the first American car to run on petrol, and the year of the first electricity flow between the Niagara Falls and Buffalo. Throughout the years, our products have saved lives and improved the mobility of many patients, while the company collaborated with generations of traumatology and orthopedic surgeons who used our instruments. Nowadays, INSTRUMENTARIA operates in a new factory using stateof-the-art technology for the development, manufacture and control of the products, meeting the international quality standards, ISO 9001:2008, ISO 13485:2003 and Directive 92/42/EEC. Through strategic partnerships, as well as independently collaborating with orthopedic and traumatology surgeons, we manufacture generic and develop new and innovative implants. Furthermore, the technology of our instrument sets is always synchronized with the latest methods and operative techniques around the world. Our accomplishments and quality are valued by local and international clients who entrust us with continuous orders. In five years time, we envision INSTRUMENTARIA as a globally, regionally and locally integrated company with a high level of human resources and technology. By offering surgeons solutions with both our standardized and innovative custom made products, we serve our employees, shareholders and community – local, regional, national and European. Vladimir Kovačević, M.Sc. CEO troch nail rev. 02, date: 2011-09 INDICATION ›› intertrochanteric fractures ›› pertrochanteric fractures ›› high subtrochanteric fractures There are two basic components: the troch nail and the lag screw, effective together in a very wide range of clinical situations and fracture complexity. Insertion is entirely by closed surgical technique, minimizing trauma, blood loss and infection potential. INDIKACIJE ›› intertrohanterni prijelomi ›› pertrohanterni prijelomi ›› visoki subtrohanterni prijelom Postoje dvije osnovne komponente: trohanterni čavao i vijak za vrat kojima se zajedno učinkovito rješava velik broj kliničkih situacija i složenih prijeloma. Postavlja se zatvorenom kirurškom tehnikom, s minimalnim gubitkom krvi i minimalnom mogućnošću infekcije. TN The anatomic design of troch nail is universal for all indicated applications, with a profile specifically designed for trochanteric fractures. Variations in femoral neck anatomy are accomodated by a range of angles available for the lag screw entry - 120°, 125°, 130°, 135°. A single distal locking screw is used to prevent rotation in complex fractures. The lag screw, inserted trought small incision with the aid of radiolucent targeting device, incorporates a special sliding lock to provide dynamic compression with axial stability. Anatomski oblik trohanternog čavla je univerzalan za sve indicirane primjene kod trohanternih prijeloma. Kut ulaza vijka za vrat (120°, 125°, 130°, 135°) je prilagođen anatomskim varijacijama vrata bedrene kosti. Distalni vijak se koristi za spriječavanje rotacije kod složenih prijeloma. Vijak za vrat, postavljen kroz mali rez uz pomoć Rtg propusne vodilice, omogućuje specijalno zaključavanje klizanja koje osigurava dinamičku kompresiju s aksialnom stabilnošću. ordering information informacije za narudžbu troch nail L=180 mm // troch femoralni čavao L=180 mm angle / kut steel / čelik titanium / titan 125 07.800-125 07.800T125 130 07.800-130 07.800T130 135 07.800-135 07.800T135 lag screw // vijak za vrat lenght / dužina (mm) steel / čelik titanium / titan 80 86.001-80 86.001T80 85 86.001-85 86.001T85 90 86.001-90 86.001T90 95 86.001-95 86.001T95 100 86.001-100 86.001T100 105 86.001-105 86.001T105 110 86.001-110 86.001T110 115 86.001-115 86.001T115 120 86.001-120 86.001T120 locking screw // vijak za zaključavanje lenght / dužina (mm) steel / čelik titanium / titan 35 86.002-125 86.002T125 cap screw // vijak kapa steel / čelik titanium / titan 86.003-125 86.003T125 distal screw ø6.28 mm // vijak distalni ø6.28 mm lenght / dužina (mm) steel / čelik titanium / titan 15 - 86.620T15 20 - 86.620T20 25 86.620-25 86.620T25 30 86.620-30 86.620T30 35 86.620-35 86.620T35 40 86.620-40 86.620T40 45 86.620-45 86.620T45 50 86.620-50 86.620T50 55 86.620-55 86.620T55 60 86.620-60 86.620T60 65 86.620-65 86.620T65 70 86.620-70 86.620T70 75 86.620-75 86.620T75 80 86.620-80 86.620T80 85 86.620-85 86.620T85 90 86.620-90 86.620T90 95 86.620-95 86.620T95 instrument set komplet instrumenata 13 15 2 22 12 16 20 19 17 14 21 20 24 3 5 6 4 23 9 7 7 11 Instrument sets design have been perfected in the OR and are produced by the state-of-the-art manufacturing process. They guarantee easy use and help surgeon conform to the parameters fixed during the pre-op planning. Rigorous quality control guarantees full reliability of the products. Kompleti instrumenata usavršeni su u operacionim dvoranama i nastali su najsuvremenijim proizvodnim procesom. Jamče jednostavnu upotrebu kako bi kirurgu omogućili prilagođavanje parametrima postavljenim tijekom preoperativnog planiranja. Rigorozna provjera kvalitete jamči potpunu pouzdanost tih proizvoda. ordering information informacije za narudžbu trohalni čavao komplet instrumenata (63.007-01) troch nail instrument set (63.007-01) no. product code br. naziv proizvoda kataloški br. 1. curved awl 81.007-01 1. zakrivljeno šilo 81.007-01 2. Jacob’s chuck 33.107-02 2. stezna glava Jacobs 33.107-02 3. targeting device 88.007-01 3. vodilica za umetanje čavla 88.007-01 4. nail holding bolt 86.007-01 4. vijak probušeni za držanje čavla 86.007-01 5. socket wrench 74.307-01 5. zglobni ključ 74.307-01 6. screwdriver for nail holding bolt 33.107-01 6. odvijač za probušeni vijak za držanje čavla 33.107-01 7. guide sleeve for lag screw 88.007-05 7. štitnik mekog tkiva 88.007-05 9. lag screw guide sleeve 88.007-06 9. vodilica lag vijka 88.007-06 10. lag screw awl 81.007-02 10. šilo lag vijka 81.007-02 11. K-wire ø3.2 x 450 mm 28.207-01 11. Kirschner igla sa navojem na vrhu ø3.2 x 450 mm 28.207-01 12. lag screw length gauge 50.307-02 12. mjerač duljine lag vijka 50.307-02 13. lag screw step drill 71.307-02 13. svrdlo za lag vijak 71.307-02 14. lag screwdriver 33.107-03 14. odvijač za lag vijak 33.107-03 15. set screwdriver bit 33.107-04 15. odvijač za vijak za zaključavanje 33.107-04 16. distal obturator 51.007-117 16. distalni opturator 51.007-117 17. distal tissue protector 88.007-04 17. distalni štitnik mekog tkiva 88.007-04 18. distal awl 81.007-03 18. šilo distalnog vijka 81.007-03 19. drill guide sleeve for ø5.5 mm distal drill 88.007-03 19. vodilica svrdla ø5.5 mm za distalni vijak 88.007-03 20. drill bit ø5.5 mm for distal screw 71.307-01 20. svrdlo ø5.5 mm za distalni vijak 71.307-01 21. distal screwdriver 33.107-05 21. odvijač za distalni vijak 33.107-05 22. distal screw depth measuring gauge 50.307-01 22. dubinomjer 50.307-01 23. nail extraction rod 74.007-01 23. šipka za izvlačenje čavla 74.007-01 24. final impactor 51.007-116 24. završni nabijač 51.007-116 25. instrument case 44.000-500 25. kutija za instrumentarij 44.000-500 surgical technique kirurška tehnika 1 2 Modular cavity is opened under Rtg image enhancer using canullary curved punch. After placing the punch into medullar cavity guide wire is placed through it into the distal part of medullar cavity of the femoral bone. The entering point must be on the top of the big trochanter, lateral in AP projection and slightly towards back in LL projection to ensure that the degree of the nail curving fits to the curving of the proximal end of the femoral bone. Medularni kanal otvara se pod Rtg pojačivačem slike, koristeći kanulirano zakrivljeno šilo. Točka ulaza mora biti na vrhu velikog trohantera nešto lateralno u AP projekciji i nešto straga u LL projekciji, kako bi stupanj zakrivljenosti čavla odgovarao zakrivljenosti proksimalnog okrajka natkoljenične kosti. A flexible drill of 10 mm is placed along the guide wire and motor bore-machine is used to enlarge the medullar cavity. Drilling is continued by using drills of larger diameter by enlarging gradually by 1 mm. Dimension of distal diameter is obtained by taking away 1 mm of the diameter of the latest introduced drill which showed the resistance while introduced. Trochanter region is enlarged using flexible drills until 17 mm. Po postavljanju šila u medularni kanal, kroz njega se postavlja žica vodilica u distalni dio medularnog kanala natkoljenične kosti. Po žici vodilici postavlja se fleksibilno svrdlo 10 mm, te se uz pomoć motorne bušilice proširuje medularni kanal. Nastavlja se razvratnje povećavajući svrdla za po 1 mm. Mjeru za distalni promjer čavla dobijemo tako da od promjera zadnjeg uvedenog svrdla koje je imalo otpor uvođenju oduzmemo 1 mm. Trohanternu regiju proširuje se fleksibilnim svrdlima do 17 mm. 3 4 Selected trochanter anchored nail is mounted on the guide for introducing nail. Trochanter nail is introduced along guide wire into prepared medullar cavity. Odabrani trohanterni čavao montira se na vodilicu za uvođenje čavla. Trohanterni čavao uvodi se po žici vodilici u pripremljeni medularni kanal. 5 Joined protector of the soft tissue and the guide tube are pushed through the incision and firmly aligned onto the lateral cortex. Spojeni štitnik mekog tkiva i cijev vodilice gurnu se kroz rez i čvrsto prilegnu na lateralni kortikalis. 6 7 Guide of K-wire is placed into the shield of the soft tissue and through it the K-wire guide of the top threaded screw for the neck. Check the correctness of positioning in both projections (AP and LL) using Rtg image enhancer. After appropriate positioning of the guide wire is achieved, required length of the screw for the neck is measured by the screw neck length gauge. Screw neck length measurer is positioned directly under Kirschner needle. U štitnik mekog tkiva pritegnut uz kortikalis umetne se vodilica za Kirschner-žicu, te kroz nju Kirschner-žica vodilica vijka za vrat s navojem na vrhu. Provjeri se ispravnost pozicioniranja u obje projekcije (AP i LL) Rtg pojačivačem slike. Nakon postizanja dobrog položaja žice vodilice, potrebna duljina vijka za vrat mjeri se pomoću mjerača duljine vijka za vrat. Mjerač duljine vijka za vrat postavi se izravno pod Kirschner iglu. 8 9 Adjustable spacer on the drill of the neck screw is placed in the measured cavity on the side towards the top of the drill. The ring is used for locking of the spacer into measured position. The top of the guide wire is partially above the drill. The appropriate length of the neck screw is 5 mm longer than previously measured by neck screw length gauge. Podesivi graničnik na svrdlu vijka za vrat postavi se na izmjerenu dubinu na strani prema vrhu bušilice. Prsten se koristi za zaključavanje graničnika u izmjerenom položaju. Vrh žice vodilice lagano strši iz svrdla. Ispravna dužina vijka za vrat je 5 mm duža nego što je prethodno izmjereno mjeračem dužine vijka za vrat. 10 11 Neck screw of the appropriate length is connected by the screwdriver for the neck screw and placed along guide wire. The locking screw is placed through the opening of the guide for nail inserting and through the hollow screw at the proximal end of the nail and firmed strongly by the screwdriver and angled key and rescrewed for one half of the round to ensure free gliding of neck screw. When the locking screw is in a good position the rotation of the screwdriver is not possible. Vijak za vrat odgovarajuće duljine spoji se odvijačem za vijak za vrat i postavi preko žice vodilice. Vijak za zaključavanje se umetne kroz otvor na vodilici za umetanje čavla i kroz šuplji vijak na proksimalnom kraju čavla i stegne ga se do kraja pomoću odvijača i zglobnog ključa te ga se odvine za jednu polovinu kruga kako bi se osiguralo slobodno klizanje vijka za vrat. Kada je vijak za zaključavanje dobro postavljen nije moguće okretanje odvijača za vijak za vrat. 12 13 Guide of the distal screw is placed into distal protector of the soft tissues and pull through the hole on the guide for placing the nail until lateral cortex. Mark is made on the lateral cortex through the shield of the soft tissue by using distal punch and slight use of the hammer. Guide of drill of 5.5 mm diameter is placed for distal screw. Drill of 5.5 mm is marked of hollow so the needed length of distal screw could be measured immediately. The distal screw length needed is measured by the depth measurer of distal screw. Vodilicu distalnog vijka umetne se u distalni štitnik mekih tkiva, te se provuku kroz rupu na vodilici za umetanje čavla do lateralnog kortikalisa. Distalnim šilom uz blagu upotrebu čekića napravi se oznaka na lateralnom kortikalisu kroz štitnik mekog tkiva. Postavi se vodilica svrdla 5.5 mm promjera za distalni vijak. Svrdlo 5.5 mm ima na sebi oznake dubine pa se tako može odmah izmjeriti i potrebnu duljinu distalnog vijka. Potrebna duljina distalnog vijka mjeri se pomoću dubinomjera distalnog vijka. 14 Distal self cutting screw of appropriate (earlier measured) length is introduced through the distal protector of the soft tissue and firmed by distal screwdriver. The guide for the introduction of the nail is taken off and screw cap is placed to prevent growth over the threads of the nail. Distalni samonarezni vijak odgovarajuće (prethodno izmjerene) duljine se uvodi kroz distalni štitnik mekog tkiva i pritegne pomoću distalnog odvijača. Skida se vodilica za uvođenje čavla i stavlja se vijak kapica da spriječi prerastanje navoja na samom čavlu. INSTRUMENTARIA je tvornica za prozvodnju implantata za traumatologiju i ortopediju osnovana 1896. godine, kada je i Henry Ford konstruirao prvi američki automobil na benzinski pogon, a između dva grada Niagara Fallsa i Buffala dogodio se prvi prijenos električne energije. Tijekom dugogodišnjeg rada, svojim smo proizvodima spasili živote i pokretljivost mnogih pacijenata, dok smo prisutnošću u operacijskim dvoranama s instrumentima koje smo proizvodili rasli zajedno s generacijama traumatologa i ortopeda. Danas INSTRUMENTARIA djeluje u novoj tvornici, koristi najnovija tehnološka dostignuća u razvoju, proizvodnji i kontroli proizvoda, te je u potpunosti svoje poslovanje uskladila sa zahtjevima strogih međunarodnih normi i standarda ISO 9001:2008, ISO 13485:2003 i Directive 92/42/EEC. Kroz strateška partnerstva i samostalno, u suradnji s ortopedima i traumatolozima, proizvodimo generičke, ali razvijamo i nove inovativne implantate, a kroz komplete instrumenata kontinuirano pratimo najnovije globalno priznate metode i operativne tehnike. Naša dostignuća i kvalitetu kroz povjerenje i nove narudžbe vrednuju naši kupci u zemlji, regiji, te na europskim i globalnim tržištima. INSTRUMENTARIA 2015. godine, kompanija je s visokom razinom ljudskih resursa i tehnologijama, globalno, regionalno i lokalno integrirana, koja svojim standardnim i inovativnim „custom made“ proizvodima pruža rješenja za izazove s kojima se suočavaju ortopedi i traumatolozi. Na taj način donosimo korist pacijentima, a isto tako i zaposlenicima, dioničarima, te lokalnoj, regionalnoj, nacionalnoj i europskoj zajednici. mr. sc. Vladimir Kovačević, CEO Rimski put 31, 10360 Sesvete, Croatia, Tel: +38515550555, Fax: +38515550550, E-mail: [email protected] www.instrumentaria.hr
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