Flexible Reamers for Intramedullary
Nails. To facilitate the insertion of IM nails.
Technique Guide
Instruments and implants
approved by the AO Foundation
Table of Contents
Introduction
Flexible Reamers for Intramedullary Nails
2
Surgical Technique
Reduction
8
Product Information
Confirm Nail Length
10
Medullary Reaming
12
Cleaning the Flexible Shaft
15
Instruments
16
Set List
19
Image intensifier control
Synthes
Flexible Reamers for Intramedullary Nails
The thin flexible shaft and deeply fluted reamer heads
are designed to help reduce intramedullary pressure and
increase flow of bone chips and marrow during reaming.1
– Single shaft to drive all reamer heads
– Reamer heads are coupled to the shaft without
hand contact with the reamer head
– Smooth shaft allows easy cleaning
– Ball of 2.5 mm reaming rod will fit through the
cannulation of all Synthes nail connecting screws
1. C. A. Muller, R. Schavan, R. Frigg, S. M. Perren. “Intramedullary
pressure increase for different commercial and experimental reaming
systems: an experimental investigation.” Journal of Orthopedic
Trauma. 12 (1998): 540 – 546.
2
Synthes Flexible Reamers for Intramedullary Nails Technique Guide
5.0 mm Flexible Shaft
Available in 470 mm and 620 mm*
lengths
– 5.0 mm shaft is made of Nitinol,
a nickel-titanium alloy with
superelastic properties
– Single shaft for all reamer sizes
– Can be driven forward or reverse
– Smooth shaft allows easy cleaning
– Couples with reduction drive
– Cannulated
2.5 mm Reaming Rod with ball tip
Available sterile in 650 mm,* 950 mm,*
1150 mm,* and 950 mm and 1150 mm
with an extension*
– Secures connection between the
reamer head and the flexible shaft
– Helps to guide the flexible shaft
past the reduced fracture
351.706S / 351.708S / 351.709S
351.707S/351.704S
Important: Always use a reaming rod
when reaming, to secure the reamer
head to the flexible shaft connection.
* Also available
Synthes
3
Flexible Reamers for Intramedullary Nails continued
Hand Reamers, 6.0 mm, 7.0 mm, 8.0 mm
– For use in medullary canals with an isthmus smaller than
8.0 mm
– Use hand reamers incrementally to widen the medullary
canal to 8.0 mm, before using the front-cutting 8.5 mm
medullary reamer head under power
– In sclerotic medullary canals, the hand reamers may be
used before insertion of the reaming rod
– 450 mm length
4
Synthes Flexible Reamers for Intramedullary Nails Technique Guide
Medullary Reamer Heads
– Sizes from 8.5 mm to 19.0 mm, in 0.5 mm increments
– The 8.5 mm reamer head is front-cutting, all others are
side-cutting
– The 8.5 mm reamer head should only be used in a
medullary canal with an isthmus 8.0 mm or larger. If
necessary, use the hand reamers to open the canal to
8.0 mm first
– To reduce the likelihood of the reamer head jamming
intraoperatively, do not skip reamer head sizes
Note: Inspect reamer heads for damage before use, as a
blunt or damaged reamer head can increase medullary
pressure and temperature. Reamer heads cannot be resharpened. Damaged reamer heads must be replaced.2,3
Good reaming practices
– Inspect reamer heads for dullness before every surgery
that requires reaming
– Ream with a ball tipped reaming rod
– Widen canals narrower than 8.0 mm with the hand
reamers
– Ream in 0.5 mm increments; do not skip reamer head
sizes
2.Muller C.A., Mc Iff T., Rahn B.A., Pfister U., Weller S.: Intramedullary pressure,
strain on the diaphysis and increase in cortical temperature when reaming the
femoral medullary cavity – A comparison of blunt and sharp reamers. Injury 24,
Suppl. 3: 22 – 30
3.Muller C.A., Rahn B.A., Pfister U., Weller S.: Extent of bluntness and damage to
reamers from hospitals. Injury 24, Suppl. 3, 31 – 35
Synthes
5
Flexible Reamers for Intramedullary Nails continued
7.0 mm Reduction Heads, straight or angled
– Attach to the flexible shaft
– Help reduce fractures and aid in passage
of the reaming rod
– Must be used with the 2.5 mm reaming rod
Holding Forceps
– Used to insert and maintain placement
of the reaming rod in the medullary canal
Depth Gauge and Depth Gauge Extension
Tube
– Used to determine nail length and estimate
canal size
– The depth gauge is used with the 650 mm
reaming rod
– The depth gauge and extension tube are used
with the 950 mm and 1150 mm length reaming
rods
351.717
351.719
Flexible Medullary Reamers*
– Sizes from 6.0 mm to 8.0 mm, 385 mm length
– Couple with Jacobs chuck and Synthes large
quick couplings (511.761, 05.001.213)
*Also available
6
Synthes Flexible Reamers for Intramedullary Nails Technique Guide
Handling technique for reaming rod and medullary reamers
1
Insertion
2
Holding
During reaming, grasp the end of the reaming rod to prevent
its withdrawal. After the reamer head is removed from the
canal, grasp the reaming rod between the reamer head and
the canal entry point.
3
Emergency application
If a reamer head jams, use the holding forceps for reaming
rods to grasp the back end of the reaming rod, and remove
the jammed reamer with light hammer blows on the holding
forceps.
Synthes
7
Reduction
1
Reduce fracture
Instruments
351.15
Flexible Shaft Handle
352.040
5.0 mm Flexible Shaft, 470 mm
352.050
352.055
7.0 mm Reduction Heads
straight
angled
351.709S
351.706S
351.707S
351.708S
351.704S
2.5 mm Reaming Rods with ball tip, sterile*
650 mm, with extension
950 mm
950 mm, with extension
1150 mm
1150 mm, with extension
*Also available
8
Synthes Flexible Reamers for Intramedullary Nails Technique Guide
Assemble one of the reduction heads
onto the 5.0 mm flexible shaft (A).
A
B
Attach the shaft to the flexible shaft
handle (B).
Insert the smooth end of a 2.5 mm
reaming rod (C) into the tip of the
7.0 mm reduction head until the ball
tip touches the reduction head (D).
Insert the reduction system into the
medullary cavity and reduce the fragments under imaging.
C
D
Important: The reaming rod must be
held in place to secure the reduction
head during reaming, and to ensure it
does not miss a displaced fragment or
become lost in the medullary canal.
After reduction has been achieved, remove the reduction assembly and leave
the reaming rod in the canal. Advance
the reaming rod to the desired depth
of implant.
Note: All manipulations in the
medullary cavity, including reduction
with the reduction system, cause an
intramedullary pressure increase and
should be minimized. As an alternative,
reduction can be carried out using the
reaming rod alone.
Synthes
9
Confirm Nail Length
2
Confirm nail length and estimate canal size
Instruments
351.717
Depth Gauge
351.719
Depth Gauge Extension Tube
Assemble the depth gauge extension tube to the depth gauge.
Note: To measure the nail length when the 650 mm reaming
rod is used, the extension tube is not required.
10
Synthes Flexible Reamers for Intramedullary Nails Technique Guide
Place the depth gauge assembly over the 2.5 mm reaming
rod. The tip of the extension tube, or the depth gauge, should
be positioned at the desired location of the proximal end of
the implant.
650 mm and 950 mm reaming rods
Read the nail length at the end of the reaming rod on the
scale of the depth gauge.
1150 mm reaming rod
Read the nail length at the mark on the reaming rod.
Use the depth gauge to estimate the size of the medullary
canal. Place the depth gauge across the limb at the level
of the isthmus. Move the depth gauge until the tab fills
the canal.
Synthes
11
Medullary Reaming
3
Ream medullary canal
Instruments
351.05
Tissue Protector
351.709S
351.706S
351.707S
351.708S
351.704S
2.5 mm Reaming Rods with ball tip, sterile*
650 mm
950 mm
950 mm, with extension
1150 mm
1150 mm, with extension
351.782
Holding Forceps
351.783
Removal Instrument
351.92
351.93
351.94
Hand Reamers
6.0 mm Hand Reamer
7.0 mm Hand Reamer
8.0 mm Hand Reamer
352.040
352.044*
5.0 mm Flexible Shafts
470 mm
620 mm
352.085
8.5 mm Medullary Reamer Head
511.785*
Reduction Drive Unit
511.701
ComPact Air Drive II
05.001.210
AO Reaming Attachment
05.001.201
Trauma Recon System Handpiece
In medullary canals with an isthmus narrower than 8.0 mm,
or in sclerotic medullary canals, use the hand reamer(s) to
widen the canal to 8.0 mm before using the power driven,
front-cutting 8.5 mm reamer head.
Clip the shaft onto the reamer head in the tray. If necessary,
rotate the shaft slightly until the connection fits.
*Also available
12
Synthes Flexible Reamers for Intramedullary Nails Technique Guide
511.785
For the initial reaming, the flexible shaft is usually equipped
with the 8.5 mm reamer head. Clip the shaft onto the
reamer head in the Tray for Reaming Heads. If the click-on
connection does not fit, turn the shaft slightly until the
hexagon matches.
Important: This is only a primary connection. Always ream
over a 2.5 mm reaming rod to ensure a secure connection.
Use the ComPact Air Drive II with the reduction drive unit or
the Trauma Recon System with the AO reaming attachment
(as the driving unit). Guide the reaming system over the
reaming rod.
Do not rotate the reamer head when inserting it into the
medullary canal. The tissue protector protects the soft tissues. Use the highest speed and slight but uniform force to
advance the reamer head in the medullary canal.
Move the reaming shaft back and forth to remove bone
chips from the reamer head, and prevent jamming of the
reamer head.
After reaming, withdraw the reaming shaft until the entire
reamer head is visible. To prevent a loss of reduction, grasp
the reaming rod at the canal entry point and hold the rod in
place using the holding forceps.
Important: If a reamer jams while reaming, disconnect the
reduction drive unit. Use the holding forceps to grasp the
reaming rod (in the countersinking). Use light hammer blows
on the holding forceps to withdraw the jammed reamer
head from the medullary canal. As an alternative, release the
reamer head by rotating the shaft in reverse.
Synthes
13
Medullary Reaming continued
The reamer head can be removed from the flexible shaft with
the removal tool. Place the reamer head in the slot on the
side of the removal tool. Hold the removal tool with one hand
while pulling on the flexible shaft with the other. The reamer
head will detach from the shaft.
Use the sideways cutting reamer heads for the subsequent
reaming steps. Reaming should always be performed in
0.5 mm increments.
Leave the 2.5 mm reaming rod in position for insertion
of the cannulated nail.
Note: The 2.5 mm ball tip reaming rod can be passed through
the cannulation of all Synthes titanium nails and their respective instruments. When used with other nailing systems, the
cannulation of the nail connecting screw must be larger
than 3.5 mm.
Important: Remove the reaming rod before locking the
intramedullary nail.
14
Synthes Flexible Reamers for Intramedullary Nails Technique Guide
Cleaning Flexible Shaft
Cleaning flexible shaft
Instrument
352.041
352.045*
3.6 mm Cleaning Brush
680 mm
830 mm
The 3.6 mm cleaning brush is used to clean the cannulation
of the flexible shaft.
Note: The cleaning brush cannot be autoclaved.
*Also available
Synthes
15
Instruments
351.05
Tissue Protector
351.15
Flexible Shaft Handle
351.709S
351.706S
351.708S
2.5 mm Reaming Rods with ball tip, sterile*
650 mm
950 mm
1150 mm
351.707S
351.704S
2.5 mm Reaming Rods with ball tip
and extension, sterile*
950 mm
1150 mm
351.717
Depth Gauge
351.719
Depth Gauge Extension Tube
*Also available
16
Synthes Flexible Reamers for Intramedullary Nails Technique Guide
351.782
Holding Forceps
351.783
Removal Tool
351.92
351.93
351.94
6.0 mm Hand Reamer
7.0 mm Hand Reamer
8.0 mm Hand Reamer
352.040
352.044*
5.0 mm Flexible Shaft, 470 mm
5.0 mm Flexible Shaft, 620 mm
352.041
352.045*
3.6 mm Cleaning Brush, 680 mm
3.6 mm Cleaning Brush, 830 mm
352.050
7.0 mm Reduction Head, straight
352.055
7.0 mm Reduction Head, angled
*Also available
Synthes
17
Instruments continued
352.085–
352.190
Medullary Reamer Heads, 8.5 mm to
19.0 mm (0.5 mm increments)
355.006
Medullary Tube
Note: Single sterilization only.
Do not use with 3.0 mm Reaming Rod with
offset ball tip (351.71)
359.106*
359.107*
359.108*
359.109*
359.110*
Flexible Medullary Reamers, flat wire, 385 mm
6.0 mm
6.5 mm
7.0 mm
7.5 mm
8.0 mm
393.10
Universal Chuck with T-Handle
*Also available
18
Synthes Flexible Reamers for Intramedullary Nails Technique Guide
Flexible Reamer Set for IM Nails (150.060)
Graphic Case
690.382
Flexible Reamers for Intramedullary Nails
Instrument Set Graphic Case
Instruments
351.05
351.15
351.717
351.719
351.782
351.783
351.92
351.93
351.94
352.040
352.041
352.050
352.055
393.10
Tissue Protector
Flexible Shaft Handle, quick coupling,
cannulated
Depth Gauge
Depth Gauge Extension Tube
Holding Forceps
Removal Tool, for use with Medullary
Reaming Heads
6.0 mm Hand Reamer
7.0 mm Hand Reamer
8.0 mm Hand Reamer
5.0 mm Flexible Shaft, 470 mm, 2 ea.
3.6 mm Cleaning Brush, 680 mm
7.0 mm Reduction Head, straight
7.0 mm Reduction Head, angled
Universal Chuck with T-Handle
Medullary Reamer Heads
Dia. (mm)
352.085
8.5
352.090
9.0
352.095
9.5
352.100
10.0
352.105
10.5
352.110
11.0
352.115
11.5
352.120
12.0
352.125
12.5
352.130
13.0
352.135
13.5
352.140
352.145
352.150
352.155
352.160
352.165
352.170
352.175
352.180
352.185
352.190
Dia. (mm)
14.0
14.5
15.0
15.5
16.0
16.5
17.0
17.5
18.0
18.5
19.0
Note: For additional information, please refer to package insert.
For detailed cleaning and sterilization instructions, please refer to
www.synthes.com/cleaning-sterilization
In Canada, the cleaning and sterilization instructions will be provided with the
Loaner shipments.
Synthes
19
Flexible Reamer Set, Long (01.004.306)
Graphic Case
60.004.306 Flexible Reamer Set Graphic Case, long
Instruments
351.05
351.15
351.717
351.719
351.782
351.783
352.044
352.050
352.055
393.105
Tissue Protector
Flexible Shaft Handle, quick coupling,
cannulated
Depth Gauge
Depth Gauge Extension Tube
Holding Forceps
Removal Tool, for use with Medullary
Reaming Heads
5.0 mm Flexible Shaft, 620 mm, 2 ea.
7.0 mm Reduction Head, straight
7.0 mm Reduction Head, angled
Small Universal Chuck with T-Handle
Medullary Reamer Heads
Dia. (mm)
352.085
8.5
352.090
9.0
352.095
9.5
352.100
10.0
352.105
10.5
352.110
11.0
352.115
11.5
352.120
12.0
352.125
12.5
352.130
13.0
352.135
13.5
20
352.140
352.145
352.150
352.155
352.160
352.165
352.170
352.175
352.180
352.185
352.190
Dia. (mm)
14.0
14.5
15.0
15.5
16.0
16.5
17.0
17.5
18.0
18.5
19.0
Synthes Flexible Reamers for Intramedullary Nails Technique Guide
Also Available
Instruments
351.16J
352.044
352.045
355.006
511.761
511.785
Flexible Shaft Connector for Jacobs chuck,
quick coupling, cannulated
2.5 mm Reaming Rod with ball tip
and extension, 1150 mm, sterile
2.5 mm Reaming Rod with ball tip,
950 mm, sterile
2.5 mm Reaming Rod with ball tip
and extension, 950 mm, sterile
2.5 mm Reaming Rod with ball tip,
1150 mm, sterile
2.5 mm Reaming Rod with ball tip,
650 mm, sterile
5.0 mm Flexible Shaft, 620 mm
3.6 mm Cleaning Brush, 830 mm
Medullary Tube
Large Quick Coupling
Reduction Drive Unit
359.106
359.107
359.108
359.109
359.110
Flexible Medullary Reamers, flat wire, 385 mm
6.0 mm
6.5 mm
7.0 mm
7.5 mm
8.0 mm
351.704S
351.706S
351.707S
351.708S
351.709S
Recommended Additional Systems
ComPact Air Drive II System
Trauma Recon System
Also Available for the Flexible Reamer Set, Long,
for IM Nails (01.004.306)
351.16J
Flexible Shaft Connector for use with Jacobs
Chuck
352.040
5.0 mm Flexible Shaft, 470 mm
360.240
IM Nail Reduction Tool, 7.5 mm shaft with
curved tip
360.243
Handle for 12.0 mm Tapered Intramedullary
Reduction Tool
03.010.093
Reaming Rod Push Rod with Ball Handle
03.010.427
Curved Awl 8 mm Intramedullary Reduction Tool
Synthes
Synthes (USA)
1302 Wrights Lane East
West Chester, PA 19380
Telephone: (610) 719-5000
To order: (800) 523-0322
Fax: (610) 251-9056
© 2003 Synthes, Inc. or its affiliates. All rights reserved.
Synthes (Canada) Ltd.
2566 Meadowpine Boulevard
Mississauga, Ontario L5N 6P9
Telephone: (905) 567-0440
To order: (800) 668-1119
Fax: (905) 567-3185
Synthes is a trademark of Synthes, Inc. or its affiliates.
www.synthes.com
Printed in U.S.A.
5/13
J4557-I